Iron deficiency anemia: causes, symptoms, diagnosis

Anemia

or
“anemia”
- a decrease in the concentration of hemoglobin in the blood below established standards, most often, with a simultaneous decrease in the total volume of red blood cells (red blood cells that carry oxygen). Anemia, as a secondary symptom, can accompany various diseases, causing the development of oxygen starvation of tissues. The patient experiences chronic fatigue and weakness, constant drowsiness and loss of strength, dizziness and shortness of breath.

Anemia in men and women

Anemia is one of the most common diseases among the adult population of the Earth today. Risk groups for developing anemia include:

• lovers of vegetarian cuisine.
• patients suffering from large blood losses due to the physiological characteristics of the body or a number of chronic diseases.
• pregnant women.
• professional athletes.

Anemia in men is diagnosed in the presence of malignant neoplasms or hidden bleeding of the gastrointestinal tract, peptic ulcer, hemorrhoids and other pathologies. A decrease in the level of hemoglobin in a woman’s blood can be associated with heavy menstruation, pregnancy and lactation, and a period of hormonal changes during menopause. Varying degrees of anemia also appear in children due to lack of adequate nutrition, impaired absorption of iron in the gastrointestinal tract, gastritis or parasitic diseases, limited exposure to fresh air and physical inactivity.

Features and diagnostic methods

Diagnosis of anemia includes not only determining the fact of a decrease in hemoglobin levels. The doctor must understand the causes, assess the general state of health, and exclude severe pathologies that occur in a latent form, if they were not detected earlier. For this purpose, laboratory tests may be involved: a detailed clinical blood test is required. It will help assess the size, structural and other characteristics of blood cells.

The content of hemoglobin, erythrocytes, platelets, leukocytes, and several calculated erythrocyte indices are assessed. These indicators allow you to obtain data on the size, hemoglobin saturation, and uniformity of red blood cells. Determination of reticulocytes (young red blood cells) helps to understand the nature of anemia, as well as assess the reactivity of the hematopoietic system to the pathological condition. This is also important for monitoring treatment - the doctor can evaluate the response to the course of therapy.

Determination of erythrocyte parameters includes assessment of the following indicators:

• red blood cell count;
• hemoglobin concentration;
• average erythrocyte volume;
• hematocrit;
• width of distribution of red blood cells by volume;
• normoblasts.

The average volume and diameter of red blood cells are also assessed. An increase in these parameters may indicate a vitamin B12 deficiency. A decrease indicates a lack of iron.

Reticulocytosis or quantitative indicators of immature red blood cells may indicate certain features of bone marrow activity. In aplastic anemia associated with bone marrow suppression, the indicator may drop to zero. Reticulocytosis increases with blood loss and hemolytic anemia.

The doctor will also pay attention to those blood parameters that are not directly related to red blood cells. For example, an increase in platelet levels may be a consequence of IDA due to chronic blood loss. If leukocytes and platelets are reduced, we can talk about aplastic anemia. Detection of blast cells requires special attention; there is a high probability of acute leukemia.

Although laboratory diagnosis is critical, it is important to resort to other research methods. An examination is mandatory - the doctor evaluates the color of the skin and mucous membranes. Palpation helps to suspect possible disorders of internal organs and tumors. A thorough survey allows you to identify lifestyle features, probable causes, and the duration of symptoms.

If you have symptoms of anemia, it is important to consult a general practitioner or hematologist. He will order the necessary tests and make suggestions as to the reasons. To clarify them, it is sometimes necessary to resort to additional diagnostic tools:

• fibrogastroduodenoscopy. Assessing the condition of the mucous membranes of the esophagus and stomach will help in identifying gastric bleeding;
• Ultrasound of the liver and kidneys;
• examination of the pelvic organs in women;
• CT or MRI if indicated;
• colonoscopy;
• X-ray of the lungs, etc.

A complete list of diagnostic methods is not required: a specialist will find out the possible causes and refer you to certain studies according to indications. If necessary, he can refer you to another doctor. So, if the cause of anemia is heavy and prolonged menstruation or a short cycle, an examination by a gynecologist will be required. Detection of gum problems (bleeding) and symptoms of periodontal disease will require a visit to a periodontist. Frequent nosebleeds are a reason to consult an otolaryngologist, assess blood pressure parameters, etc.

Principles of classification of anemia

There are several types of classifications of anemia, based on a number of signs - the cause of the disease, the mechanism of its development, stages, symptoms and other parameters. The following groups are distinguished:

Sign up for an anemia screening

Make an appointment

Reasons for development

Thus, we can distinguish 4 main reasons for the development of IDA:

• insufficient intake of iron into the body from food;
• increasing the body's need for iron;
• violation of its absorption;
• disruption of iron transport throughout the body.

Insufficient intake of iron into the body

Food is the main source of iron for the human body. And an unbalanced diet is one of the most common causes of iron deficiency anemia in both children and adults.

In most cases this is due to:

• prolonged fasting;
• vegetarian or vegan diet;
• consumption of monotonous foods with insufficient amounts of heme and non-heme iron;
• anorexia.

For infants, especially during the first six months of life, the only source of iron is mother's milk. Provided that a nursing woman does not have IDA, the child receives it in the required amount. At the same time, transferring a baby to artificial feeding or early introduction of complementary foods often becomes the reason for the development of iron deficiency anemia.

Nan-O-Fer (Switzerland)

Nan-O-Fer (Switzerland) – capsules for oral use, created taking into account the peculiarities of iron absorption in the body. It is Nanofer that today is one of the priority drugs for the treatment of IDA, since it contains liposomal iron in the form of pyrophosphate, and in order to improve the quality of its absorption, vitamins B12, B6 and folic acid are added to the drug.

Eslotin

Check availability

If a nursing mother has a severe form of iron deficiency anemia, this can lead to congenital iron deficiency in the child. This can also occur in premature babies, as well as those born from multiple pregnancies. In such situations, they speak of congenital iron deficiency, and its symptoms appear from the first weeks of the child’s life.

Increasing the body's need for iron

An increased need for iron is usually characteristic of women during pregnancy and breastfeeding. This is due to:

• an increase in blood volume and the number of red blood cells, which requires about 500 mg of iron;
• the need to form the placenta (200 mg);
• ensuring proper development of fetal tissues and organs (300 mg);
• loss of blood during and after childbirth (50-150 mg);
• covering the newborn's needs for this macronutrient (400-500 mg).

During pregnancy and lactation, a woman’s need for iron almost doubles, and with multiple pregnancies it increases even more.

In general, during pregnancy and breastfeeding 1 child, the female body loses about 1 g of iron. Considering the fact that a maximum of 2.5 mg of iron can be absorbed per day, iron deficiency anemia in pregnant women is an almost inevitable condition. But it is within the power of a woman to ensure that it proceeds to the mildest extent through proper preparation for pregnancy, correction of the diet and the use of iron supplements if necessary.

Also, an increase in the body's need for iron occurs during blood loss, which is also most typical for women. Every month, during menstrual bleeding, the female body loses iron. But such losses are physiological and, with proper nutrition, do not lead to the development of IDA. Unfortunately, the lifestyle and diet of most women is not capable of creating sufficient amounts of iron reserves in the body and covering its monthly losses.

But besides menstrual bleeding, other situations accompanied by increased blood loss can lead to iron deficiency anemia in people of any gender and age. But single losses of even a large volume of blood, for example, during severe injuries or operations that violate the integrity of soft tissues, usually do not provoke IDA, since the iron reserves in the body are sufficient to replace them.

Iron deficiency anemia usually develops against the background of chronic and prolonged bleeding, typical of:

• peptic ulcer of the stomach and duodenum;
• hemorrhoids;
• intestinal diverticula;
• Crohn's disease;
• endometriosis;
• uterine fibroids;
• hematuric form of chronic glomerulonephritis;
• frequent nosebleeds;
• systemic vasculitis, systemic lupus erythematosus;
• intestinal polyposis;
• malignant tumors in the terminal stage.

IDA can also occur in donors who donate large volumes of blood more than 4 times a year.

Other reasons for the increased need for this macronutrient are:

• heavy physical labor, active sports;
• period of puberty and active growth;
• parasitic infestations.

Iron malabsorption

Iron absorption occurs through the mucous membrane of the duodenum and the initial parts of the small intestine. This is only possible if their mucous membrane is in normal condition. But there are many diseases that can lead to changes in it, and therefore to disturbances in the absorption of iron from food. These include:

• enteritis is a disease accompanied by inflammation of the intestinal mucosa;
• celiac disease is a hereditary pathology in which the body is not able to absorb gluten, which leads to impaired absorption of all nutrients in the intestines in its presence;
• atrophic and autoimmune gastritis – gastrointestinal pathologies in which destruction of cells of the gastric mucosa is observed;
• resection of the stomach and/or small intestine - surgical interventions performed in the presence of compelling indications, but capable of disrupting the production of hydrochloric acid, which is necessary for the transformation of ferrous iron into ferric iron;
• Crohn's disease is an autoimmune disease of the gastrointestinal tract, accompanied by inflammation of the mucous membranes of the intestines, and sometimes the stomach;
• Helicobacter pylori infection is the main cause of the development of gastritis and peptic ulcers of the stomach and duodenum with impaired formation of hydrochloric acid;
• cystic fibrosis is a hereditary pathology in which the functioning of most glands of the body is disrupted;
• oncological diseases of the stomach and duodenum.

Alcoholism also contributes to damage to the mucous membranes of the gastrointestinal tract, which leads to impaired iron absorption. In addition, alcohol inhibits the activity of red bone marrow, which can aggravate the course of iron deficiency anemia.

Also, the use of a number of medications can provoke disturbances in the absorption of iron in the intestines. This is typical for the use of antacids that reduce the acidity of gastric juice, iron-binding drugs, as well as NSAIDs that are often used by people without prescription and supervision by a doctor (Paracetamol, Ibuprofen, Nurofen, Nise, Diclofenac, Aspirin, etc.). The latter drugs have anti-inflammatory and analgesic properties, but at the same time they negatively affect the condition of the mucous membranes of the gastrointestinal tract and thin the blood.

In such situations, IDA will occur even if there is sufficient intake of heme and non-heme iron in food.

Transportation disruption

The main carrier of iron throughout the body is the protein transferrin. But in a number of situations there is a violation of its synthesis in the body. This is typical for:

• congenital disorders of transferrin production, in which case signs of iron deficiency anemia will be observed from the first months of the child’s life;
• liver pathologies, in particular cirrhosis and hepatitis;
• tuberculosis;
• severe infectious diseases.

Classification of anemia by severity

The severity of anemia, determined by blood parameters depending on the age and gender of the patient, is conventionally divided into mild, moderate and severe. The mild form is characterized by a decrease in hemoglobin concentration to 90 g/l (the patient may experience general weakness and increased fatigue). The average degree is determined by the range from 70 to 90 g/l (patients complain of shortness of breath, tachycardia, headache, sleep disturbance, tinnitus, loss of appetite), and severe - below the limit of 70 g/l (the main danger of this condition is the development heart failure).

Complications of IDA

Complications arise with prolonged anemia without treatment and reduce the patient’s quality of life: decreased immunity, increased heart rate, which leads to heart failure; in pregnant women, the risk of premature birth and fetal growth retardation increases; in children, iron deficiency causes retarded growth and development; a rare and severe complication is hypoxic coma; hypoxia due to iron deficiency complicates the course of existing cardiopulmonary diseases (coronary artery disease, bronchial asthma, chronic cerebral ischemia, etc.) until the development of emergency conditions, such as acute or repeated myocardial infarction and acute cerebrovascular accident (stroke).

Classification of anemia by color index

The color index determines the level of saturation of red blood cells with hemoglobin. It is calculated during a laboratory blood test using a special formula. Depending on the results obtained, there are:

Physiological norms of iron and vitamin B12 and folic acid

In different countries, the average iron intake varies from 10 to 22 mg/day. According to the standards recommended in Russia, for men this level is 8-10 mg/day, for women it is 1.5 times more - 15-20 mg/day. For children - 4-18 mg/day. A sufficient level of folic acid for adults is 400 mcg/day, for children - from 50 mcg every day. Men and women should get at least 3 mcg/day of vitamin B12.

Be healthy!

Author:

Baktyshev Alexey Ilyich, General Practitioner (family doctor), Ultrasound Doctor, Chief Physician

Classification of anemia according to the mechanism of development of the pathological process

The following states are distinguished:

Iron-deficiency anemia

– the name indicates the cause of the pathology. Due to a deficiency of an important microelement, hemoglobin synthesis in the body is disrupted. The supply of oxygen to tissue cells, the stability of redox processes, and the functioning of the immune, nervous and cardiovascular systems depend on the level of iron. Clinical manifestations of iron deficiency anemia are dizziness, fainting, weakness and lethargy, shortness of breath with any exertion, palpitations. Pallor of the skin, brittle nails, thinning hair, and cracks in the corners of the lips are also typical for this disease.

Hemolytic anemia

occurs as a result of the accelerated destruction of erythrocytes (red blood cells) and the rapid accumulation of their breakdown products in the body. The main manifestations are an increased amount of indirect bilirubin in the blood. The patient experiences the development of anemic and icteric syndromes with an enlarged spleen and liver, as well as characteristic staining of feces and urine.

Posthemorrhagic anemia

– hematological changes that appear after acute or prolonged chronic blood loss as a result of external or internal bleeding (trauma, heavy menstruation, hemorrhagic diseases, gastrointestinal and pulmonary bleeding). The main manifestations of posthemorrhagic anemia are palpitations, shortness of breath, severe dizziness, darkening of the eyes, and lethargy. In severe cases - loss of consciousness.

Sideroblastic (sideroachrestic) anemia

occurs as a result of a violation of iron synthesis, causing its deficiency in red blood cells. Due to a failure in the processes of getting this microelement into the hemoglobin molecule, iron in the cells is replaced by sideroblasts (red blood cell precursor cells interspersed with iron in the form of a ring). This condition can be congenital or acquired. Experts believe that the main reason for the development of such anemia is a lack of the substance protoporphyrin. This organic component, combining with iron, turns into heme - part of the hemoglobin molecule. The main symptoms of the disease are disturbances in the functioning of the heart and blood vessels, indigestion, pale skin, dizziness, and memory loss. There is a danger of iron accumulation in various organs, which contributes to the occurrence of serious complications (liver cirrhosis, diabetes mellitus).

B12 deficiency anemia

– a disorder of hematopoiesis as a result of a lack of vitamin B12 in the human body. The main reasons for the development of such anemia are lack of adequate nutrition, impaired absorption of B12 due to inflammatory processes in the gastrointestinal tract, alcoholism, and hereditary predisposition. The pathology develops gradually, causing damage to the digestive organs and disturbances in the functioning of the nervous system.

Iron in the body

In the human body, iron is mainly present in the form of hemoglobin, which contains it. Hemoglobin is a protein with a quaternary structure, responsible for binding oxygen entering the blood during inhalation and transporting it to every cell of the body. Having given them oxygen, it takes carbon dioxide and, entering the lungs with the bloodstream, gives it away, again becoming saturated with oxygen. As a result, during exhalation, a person exhales metabolic products.

In this case, the binding of oxygen and its transportation is ensured precisely by the non-protein part of hemoglobin, or rather by the iron atom directly included in its composition. Therefore, maintaining its amount in the body at the proper level is extremely important.

Hemoglobin is carried by red blood cells and accounts for about 95% of the total intracellular space of each red blood cell. Red blood cells are the most numerous group of blood cells and have a characteristic biconcave disc shape. It is this form of red blood cell that ensures the most efficient performance of the gas exchange function in the body. Therefore, when, due to heredity or the action of other factors, human red blood cells acquire a different shape, for example, a sickle (sickle cell anemia), they are no longer able to maintain gas exchange at the proper level.

But in addition to ensuring the transport of oxygen and carbon dioxide in the body by iron as part of hemoglobin, i.e., performing the function of gas exchange, it is also necessary for:

• synthesis of thyroid hormones;
• maintaining immunity;
• the occurrence of a number of metabolic processes, cell division;
• myelination of nerve fibers (formation of a protective sheath around the nerve);
• DNA products;
• proper breathing, maintaining muscle tone;
• proper functioning of the brain.

The adult body contains an average of 4 g of iron, which depends on gender and age. More than half is concentrated in hemoglobin, 27% is contained in muscles in the form of myoglobin, and 7-8% is deposited in the liver.

Iron is stored or deposited by a specific protein called ferritin. Each ferritin molecule is capable of holding 3000 iron atoms. If there is insufficient supply from the outside, the body begins to use ferritin to meet its needs. But with prolonged iron deficiency, ferritin reserves are depleted, which leads to disruption of metabolic processes and iron deficiency anemia.

Cost of consultation for anemia?

All our services and prices

Diagnostic measures

To treat anemia, it is necessary to determine its type and cause of development. The main diagnostic method for this disease is laboratory blood tests (general and biochemical).

Changes that are observed in the general blood test:

small red blood cells (microcytosis).

Changes that are observed in the biochemical blood test:

In addition, a visual examination of the patient and a detailed history is required. Among the most common symptoms are pale skin and mucous membranes, cracks in the corners of the mouth, a “glossy” tongue, and an enlarged spleen.

To effectively correct the condition, instrumental examination methods may also be required:

computed tomography of the esophagus, stomach, duodenum. colonoscopy. Ultrasound of the liver, spleen, kidneys, genitals. X-rays of light.

Clinical manifestations of IDA

Anemic syndrome - occurs due to a decrease in the level of red blood cells and hemoglobin in the blood, reducing the saturation of cells and tissues with oxygen. The signs of anemic syndrome are difficult to recognize, but they help to suspect the presence of anemia and, in combination with the data of other examinations, make a diagnosis. These are general weakness, high fatigue and decreased performance, dizziness, tinnitus and flashing “spots” before the eyes, periodic palpitations, shortness of breath with little physical exertion, and fainting. Upon examination, pallor of the skin and visible mucous membranes, slight swelling of the legs, feet, face (mainly the area around the eyes), tachycardia, various types of arrhythmia, moderate heart murmurs, and muffled heart sounds are revealed.

Sideropenic syndrome - caused by iron deficiency in tissues, which causes a decrease in the activity of many enzymes (protein substances that regulate many vital functions), manifested by numerous symptoms:

• change in taste (desire to eat unusual foods: sand, chalk, clay, tooth powder, ice, as well as raw minced meat, unbaked dough, dry cereals)
• tendency to eat hot, salty, spicy foods
• distortion of the sense of smell (attracted by the smell of gasoline, acetone, the smell of varnishes, paints, lime)
• decreased muscle strength and atrophy
• dry, flaky skin; fragility and hair loss; dullness, transverse striations, spoon-shaped concavity of nails; Minor injuries and abrasions do not heal for a long time
• dryness and cracks in the corners of the mouth in 10-15% of patients
• feeling of tongue fullness, redness and atrophy, frequent periodontal disease and caries
• dryness of the esophageal mucosa, which causes pain when swallowing and difficulty swallowing solid food, the development of atrophic gastritis and enteritis
• urgency to urinate, inability to hold urine when coughing, laughing, sneezing, episodes of bedwetting
• the symptom of “blue sclera” is characterized by a bluish coloration of the sclera
• prolonged increase in body temperature to subfebrile levels (37.0-37.9°C) for no apparent reason
• frequent ARVI

Treatment of anemia

The course of medical therapy is carried out on the basis of the diagnosis and includes the prescription of a special diet and medications, as well as, if necessary, surgical intervention to eliminate the causes of blood loss.

A balanced diet is of great importance for anemia. It compensates for the lack of iron and microelements involved in hematopoiesis. Nutritionists recommend eating foods rich in vitamin B12, folic acid and iron. The diet must contain meat, offal (liver, heart, tongue), fish, egg yolks, mushrooms, buckwheat, legumes, black currants, pomegranate, strawberries, nuts, apples, rose hip decoction, dried fruits. Vitamin C accelerates the absorption of iron by the body, while strong tea, coffee, and calcium hinder it. Strong alcoholic drinks are harmful to a patient with anemia.

Iron supplements are considered the most effective for combating anemia. They are better absorbed, increase hemoglobin levels faster, restore its reserves in the body, and eliminate weakness and fatigue. Based on blood test data for each patient, depending on a number of indicators (type of anemia, severity of the disease and the cause of its development, age of the patient), an individual daily dose, course duration, and preventive measures are calculated. In severe cases, intramuscular and intravenous administration of ampoule iron preparations in a hospital setting is possible to avoid adverse reactions and allergies.

It is advisable to take iron supplements one hour before meals or two hours after meals. Medicines should not be taken with tea or coffee. These drinks reduce iron absorption. You must use water or juice.

The prognosis for iron deficiency anemia is favorable in most cases. The patients' condition improves significantly, the body's resistance increases, sleep and appetite normalize. The basis for preventing anemia is a balanced diet. Do not get carried away with protein foods and sweets. There should be vegetables, herbs and fruits on the table all year round. Another rule is to maintain a healthy lifestyle, exercise, walks in the fresh air, proper rest and good sleep.

Sign up for an anemia screening

Make an appointment

Replenish iron deficiency

To prevent iron deficiency anemia, in addition to the iron or vitamin supplements prescribed by your doctor, it is recommended to change your diet after receiving test results. It must contain foods rich in iron and microelements (copper, cobalt, manganese, nickel, vitamin C), which help the absorption of this vital essential metal.

Interesting fact. Iron is best absorbed from meat products.