Anemia is a serious disease that is associated with a decrease in the level of hemoglobin in the blood. It is a protein found in red blood cells and is responsible for transporting oxygen in the body. Anemia of the 1st degree is especially dangerous, since there are no clinical manifestations yet, and changes are already beginning to develop.
Degrees of anemia
According to their classification, all anemias are divided into 3 degrees of severity:
- light;
- average;
- heavy.
Anemia of the first degree refers to a mild variant of the course of the disease. Laboratory indicators are reduced to 90 g / l. Almost always, this is the only symptom of anemia, and the patient may not know anything about it. Any changes in the state occur only with physical exertion that exceeds daily norms.
Serious symptoms appear already at more severe stages of the disease. With moderate anemia, fatigue and shortness of breath begin to bother with the usual load for the body. In a clinical blood test, the amount of hemoglobin will be from 70 to 90 g / l.
With a severe degree of the disease, laboratory indicators become less than 70 g / l.
Causes of anemia
Conditions leading to iron deficiency:
- prolonged bleeding;
- intestinal disorders that lead to a decrease in digestible iron;
- increased need for iron during pregnancy and lactation;
- diet violation.
Folic acid deficiency is associated with the following reasons:
- the use of sulfa drugs;
- increased alcohol consumption.
The development of hemolytic anemia is possible:
- when transfusing incompatible blood;
- with autoimmune diseases;
- with tumors;
- with heavy metal poisoning;
- with Rh-conflict between mother and child.
Aplastic anemia appears in the following cases:
- insufficiency of stem cells in the bone marrow;
- changes in the normal functioning of stem cells;
- hepatitis A;
- mononucleosis.
signs
There are 4 types of anemia, each of which is characterized by its own symptoms.
Iron-deficiency anemia
With a lack of iron or IDA, the patient begins to experience general malaise, weakness. Against this background, there is a decrease in efficiency. Iron deficiency anemia in the initial stage does not greatly affect the functioning of the body, although characteristic signs can already be detected:
- dry skin;
- tingling sensation on the tongue;
- increase in heart rate;
- shortness of breath with little physical exertion;
- pale skin color;
- hair loss;
- fragility of nails;
- there may be a desire to eat only a certain type of food.
Anemia due to lack of folic acid and vitamin B12
With this variant of anemia, the initial stage of development is characterized by the appearance of mild itching on the extremities. In addition, there are "goosebumps", numbness and tingling. The skin itself changes its color and becomes yellow.
A striking symptom is a change in the mucous membrane of the tongue. The papillae become inflamed and cause a tingling sensation.
The general condition also changes. Irritability and depressive mood appear, appetite worsens.
Hemolytic anemia
At the first degree of the disease, the patient's condition changes. Weakness appears, and efficiency decreases. Dizziness, shortness of breath and tachycardia may occur. Sometimes this type of anemia is confused with liver disease, since the resulting pain in the right hypochondrium is very similar to the manifestations of hepatitis.
aplastic anemia
With aplastic anemia, a lack of oxygen and tachycardia are added to the general change in the patient's condition. The key symptom of this disease is bruising, which occurs spontaneously. In the oral cavity, there is increased bleeding of the gums. The patient himself looks pale.
Manifestations during pregnancy
Anemia of the 1st degree very often develops in pregnant and lactating women. This is due to the increased need for vitamins and minerals in the body. The most common is iron deficiency anemia or B12 deficiency.
This disease is detected after the delivery of a general blood test. Until the results are obtained, the patient may not feel any changes. Although the fetus is already experiencing a lack of nutrients and oxygen. The risk of placental abruption, premature birth and bleeding increases.
All pregnant women should carefully monitor their diet. Balanced nutrition is the basis for the full development of the baby. Maintaining a diet will prevent the transition to a more severe stage of the disease.
Must be consumed
- language;
- turkey;
- cocoa;
- fruits and berries, apricots are especially recommended;
- nuts, in particular almonds;
- dried fruits;
- buckwheat porridge;
- legumes.
If any signs of anemia are found, these products should be in the diet from the first trimester of pregnancy. The prescribed diet is maintained until the very birth.
Anemia in pregnancy
Anemia treatment
The main aspect of the treatment of anemia is the elimination of the underlying cause that led to the development of the disease.
With a lack of iron, drugs are used: Zhektofer, Conferon, Feramide and others. In addition to medicines, it is recommended to eat more meat, legumes and fresh herbs.
If vitamin B12 deficiency has led to the development of anemia, then its intramuscular administration is prescribed up to 500 mcg per day. But it is also necessary to increase the consumption of the following products:
- liver;
- seafood;
- milk;
- eggs;
- hard cheeses.
Folic acid deficiency is corrected by taking medications. The recommended dose is 5 mg per day. Be sure to use the following products:
- fruits;
- fresh greens;
- broccoli;
- cauliflower;
- cereal porridge.
Symptoms affect the treatment of hemolytic anemia. If there are practically no signs of the disease, then therapy is not prescribed. For preventive purposes, drugs are prescribed that improve the flow of bile, for example, Allochol and other antispasmodics.
Aplastic anemia is treated only in a hospital, as it is caused by quite serious diseases. The patient is hospitalized regardless of the degree of symptoms.
A more specific treatment can only be prescribed by a doctor after a complete examination of the whole body and the identification of the underlying cause.
With timely access to a specialist, anemia will not develop further, and a mild degree will not turn into a more severe one. In the initial stage, it is much easier to stop the progression of the disease and completely restore the normal functioning of the body.
Video: How to treat anemia?
Anemia of the 1st degree is the easiest manifestation of a whole complex of diseases that are characterized by a decrease in the concentration of hemoglobin or the number of red blood cells. As a result of anemia, many changes begin in the body, which are caused by insufficient oxygen supply to organs and tissues. Manifestations and pathological changes in the body directly depend on the severity of the course of the disease.
Classification
The classification of anemia is quite simple. They are distinguished depending on the causes of occurrence into the following types:
- Posthemorrhagic anemia, which develops as a result of a decrease in the number of blood cells, erythrocytes, as a result of acute or chronic blood loss. Their causes may be trauma, heavy and frequent childbirth, heavy menstruation, stomach ulcers. In infants, posthemorrhagic anemia most often develops as a result of birth trauma, internal hemorrhages, placental bleeding, and hemorrhagic diathesis.
- Hemolytic anemia results from the abnormal breakdown of red blood cells. This form of the disease is quite rare and occurs under the influence of various autoimmune and hereditary factors.
- Deficiency anemia due to impaired erythropoiesis. This group of anemias is the most common. It includes iron deficiency anemia, which occurs in the vast majority of cases, megaloblastic anemia, due to a lack of vitamin or folic acid. Sometimes so-called multifactorial anemia develops, caused by a simultaneous deficiency of iron and B12.
- Hypoplastic and aplastic anemia resulting from impaired bone marrow function. This variety is extremely rare. It is either hereditary or develop after severe chronic diseases, the action of drugs, chemicals.
In addition, to prescribe the correct treatment regimen, it is required to determine the degree of anemia by hemoglobin. This is calculated based on the deviation of the hemoglobin value from the norm. Hemoglobin is the main iron-containing coloring element of red blood cells, which is "responsible" for the transport of oxygen with blood throughout the body.
For an adult male, the hemoglobin concentration is 135 - 160 g / l. For women, this value is somewhat lower and ranges from 120 to 140 g/l. For children, the norm of hemoglobin content depends on age. These values are shown in the table:
Age
For teenagers over 16 years old, adult rules apply.
Causes
Most of the iron contained in the body is part of the erythrocytes, there are also reserves of this substance in the muscles, liver and bone marrow. The daily requirement of an adult for iron is about 10-15 mg. Of this amount, no more than 1.5 mg is absorbed into the blood, approximately the same amount is normal daily physiological losses with sweat, urine and feces. For children, the daily iron requirement for an infant is 0.5 to 1.2 mg, which increases with age, and a two-year-old child needs about 10 mg of iron per day.
Anemia How to treat anemia?
Anemia-Symptoms and Treatment
9 POSSIBLE SIGNS OF ANEMIA THAT ARE HIDDEN AT FIRST SIGHT
Iron deficiency anemia 1
Anemia.Symptoms.Causes.Treatment
Causes of anemia - Dr. Komarovsky
Iron deficiency anemia | What to do | How to treat | Symptoms | pregnancy | Disease | Dr. Phil
About the most important thing: Anemia, a lump in the throat, spider veins on the face
Anemia or anemia can be cured with folk remedies
Vegetarian/Anemia/Slow Death
Anemia. Symptoms and types of anemia
What is terrible anemia
Anemia, treatment
About the most important thing: Anemia, often stomach ache, dry mouth
All about blood. Anemia. Hemoglobin. Olga Butakova ACADEMY OF HEALTH
Nutrition for anemia
ANEMIA. HOW TO TREAT. SYMPTOMS. ANALYSIS. FGS. DRIVER. TABLETS. HAIR LOSS #anemia
B 12 - DEFICIENCY ANEMIA
Anemia. How to increase hemoglobin naturally?
Torsunov O.G. About the causes of iron deficiency anemia
The causes of iron deficiency anemia are most often not too abundant, but chronic blood loss during hemorrhoidal bleeding, acute peptic ulcer, strong menstruation and other similar conditions. In the development of iron deficiency anemia, insufficient intake of iron with food or a violation of its absorption after undergoing surgery on the stomach also plays a certain role.
Often, iron deficiency anemia develops in premature babies, since many of the substances necessary for normal hematopoiesis are formed precisely in the last two months of pregnancy. The cause of this disease in infants may also be iron deficiency anemia of varying severity in a woman during the period of bearing a child.
B12 - deficiency anemia develops due to insufficient intake of this vitamin with food, since it is not synthesized in the body. B12 is absorbed in the gastrointestinal tract with the help of a special enzyme called gastromucoprotein (also called the Castle factor). After resection of the stomach, with gastritis, chronic alcohol consumption, the secretion of the Castle factor sharply decreases and, as a result, B12 deficiency develops.
There are certain reserves of folic acid in our body. It also comes from food and is absorbed in the duodenum and ileum. This process can be disturbed under the influence of alcohol, long-term use of hormonal contraceptives, anticonvulsants, certain antibacterial drugs, in particular trimethoprim or sulfamethoxazole.
Clinical manifestations
Symptoms largely depend on the severity of the disease. Moreover, with each subsequent stage, existing symptoms are aggravated and new ones may appear.
- Anemia of the first degree is almost asymptomatic. Sometimes a person complains of mild weakness, malaise, fatigue. There is a noticeable pallor of the skin, sweating, loss of appetite. Mild anemia in infants is characterized by increased excitability of the child, tearfulness, profuse regurgitation after feeding (or vomiting in older children).
- Anemia of moderate severity is manifested by headaches, dizziness associated with insufficient oxygen supply. Children with this form of anemia get tired very quickly, they can hardly endure even the lightest physical exertion. A child under one year old may even experience a regression in the development of motor skills. Roughness or dryness of the skin is noted, very painful cracks in the corners of the mouth, digestive disorders may occur, which manifest themselves in the form of diarrhea or constipation, flatulence. From the side of the cardiovascular system, tachycardia, heart murmurs may be noted.
- Anemia of the 3rd degree is characterized by changes in the structure of nails and hair (they become dull and become very brittle), hair loss, a feeling of cold and numbness of the extremities, a perverted perception of smells and tastes. Stomatitis and caries (up to tooth decay) may appear. Children may lag behind in physical and psychological development. On ultrasound of the abdominal organs, an increase in the liver and spleen is noticeable. If left untreated, severe anemia is dangerous and can cause extremely serious consequences.
The severity of symptoms may vary depending on the general condition of the child or adult suffering from anemia. Also, the likelihood of a particular clinical sign depends on the cause of the disease.
Diagnostics
It is possible to assume the development of this disease in oneself or in a child by a simple clinical blood test, which can be taken without a doctor's referral in any laboratory. When the concentration of hemoglobin drops below normal, it is imperative to contact a general practitioner or pediatrician.
Then a biochemical blood test is prescribed. There is a decrease in the amount of serum iron, the level of ferritin (a protein that maintains the supply of iron), and the saturation of transferrin with iron.
Naturally, the doctor pays attention to the general symptoms of anemia and conducts a comprehensive examination to determine what changes this disease has caused in the body.
Treatment of anemia of the first degree
Anemia of the 1st degree in children and adults is usually very mild and in most cases does not require medical correction. It is enough to make certain changes in the diet and daily routine. Long walks in the fresh air, moderate physical activity are recommended.
If anemia of the 1st degree is detected, then the diet for children and adults should be based on the following principles:
- Increase your protein intake. To do this, you need to eat eggs, dairy products, liver, kidneys, fish and meat.
- Limit milk and strong tea, as these drinks slow down the absorption of iron from the gastrointestinal tract. Preservatives, oxalates, phosphates and some drugs, such as antacids and antibiotics of the tetracycline group, have the same effect.
- Instead of animal fats, vegetable fats should be preferred. It is necessary to use butter, dress salads with a variety of vegetable oils (sunflower, olive, grape and the like).
- If the problem with being overweight is not acute, then the amount of carbohydrates in the diet can not be limited.
- Vitamins C and group B contribute to better absorption of iron. Therefore, it is advisable to introduce products that contain them into the menu. These are citrus fruits, herbs, legumes, many berries, etc.
- The use of iron-containing foods (beef liver, rabbit and turkey meat, buckwheat and oatmeal, millet, caviar).
It is worth noting that it is imperative to monitor the dynamics of the blood and control the level of hemoglobin. In most cases, with proper dieting, its value rises to normal numbers, and further prescription of drugs is not required.
Treatment of anemia 2 and 3 degrees
Therapy of anemia of moderate and more severe forms consists in the appointment of special medications, depending on the cause of the development of the disease. Thus, iron deficiency anemia requires long-term treatment with iron preparations at a dosage of 100-120 mg per day. It is worth noting that medication should be continued even after the patient's condition is normalized and hemoglobin levels are restored. This is due to the fact that in addition to eliminating the state of deficiency, it is necessary to replenish iron stores in the body. In most cases, for the convenience of the patient, medications are prescribed in tablets. Parenteral administration is indicated for violation of the absorption of this element in the digestive tract.
Treatment of B12 deficiency anemia is carried out with the help of injections of cyanocobalamin or hydroxocobalamin at a dosage of 400-500 mcg per day during the first week. Then they switch to maintenance therapy, during which the same injection is done once every 7 days. The total duration of therapy is about two months. In the event that the cause of such anemia cannot be eliminated, then it is necessary to give prophylactic injections of cyanocobalamin several times a year to maintain a normal level of B12.
Treatment of 2 and 3 degrees of folate deficiency anemia is the same. Assigned to 5 mg of folic acid three times a day.
Therapy for rarer forms of anemia is much more difficult. With hemolytic anemia, a long course of prednisolone is indicated. Aplastic anemia was previously considered incurable and often ended in death. At the moment, the treatment of this disease is carried out with the help of bone marrow transplantation.
Features of the treatment of anemia in children
Therapy of anemia should be carried out under the strict supervision of a physician. If babies are bottle-fed, then special mixtures with a high iron content are recommended. A child with iron deficiency anemia is advised to introduce complementary foods a few weeks earlier and start with applesauce and oatmeal and buckwheat porridge.
Anemia of the 2nd degree in children is not treated with a simple correction of nutrition. Requires the use of drugs that contain ferric iron. These are maltofer, ferrum lek, ferlatum, etc. With this form of the disease, they are given in the form of drops or syrup. Parenteral administration of drugs is indicated for anemia of the third degree. In parallel with these medications, multivitamin complexes are also prescribed, because this disease is accompanied by beriberi.
With the development of severe anemia in infants, recombinant human erythropoietin is also prescribed. These are drugs such as recormon, eprex, epokrin. The same drugs are also prescribed for premature babies born 4 to 5 weeks ahead of schedule. Usually the dosage of such drugs is 250 IU per kg of body weight three times a week, but the younger the child, the greater the dose required for effective treatment.
In addition to drug therapy, long walks, a strict daily regimen, and the elimination of psychological stress are recommended. The effect of the treatment of anemia in children is noticeable already on the seventh day. If there is no effect after two weeks of therapy, then a second examination is carried out or the dose of medication is adjusted.
In general, the most common types of deficiency anemia are easily treatable, even at the most severe stage of the course. However, taking medications can be avoided with a proper diet and an active lifestyle.
The patient can only hear the diagnosis of "anemia" from a doctor. It often raises a number of questions. The first of them - what does this concept mean? Anemia is a disorder in the hemostasis system, which is characterized by a decrease in hemoglobin levels. Hemoglobin is a protein substance that contains iron atoms in its composition. Hemoglobin is part of erythrocytes - red blood cells.
Normally, the hemoglobin level in a healthy person is 110-155 g / l. If, according to the results of the examination, hemoglobin values are reduced to 110 g / l, they speak of anemia of the 1st degree. The maximum allowable hemoglobin norm for men is considered to be 110-120 g / l. However, this is not enough for the full functioning of the body.
Anemia 1 degree - how to determine?
It is possible to suspect anemia of the 1st degree by some symptoms, but this is not always possible. Often, pathology at such early stages of development does not give itself away. Therefore, a person learns about his diagnosis only in the doctor's office, having come for the results of a blood test.
The asymptomatic course of the disease should not be misleading. Outwardly, a person may look completely healthy. The absence of any signs only indicates that the body has launched compensatory mechanisms designed to block violations in the functioning of organs and systems, but sooner or later its reserves will be exhausted. The fact that anemia is dangerous should always be remembered.
Anemia 1 degree and hemoglobin level
Anemia can have several degrees. The first degree of anemia is considered the easiest. It is characterized by a decrease in hemoglobin to a level of 90-110 g / l. In this case, the symptoms of the disease may be absent during this period. A person continues to lead a normal life, not suspecting that his body suffers from a lack of hemoglobin.
Although some signs of anemia of the 1st degree still manifest themselves. However, they become noticeable in conditions of increased physical activity.
Should anemia be treated?
Anemia of 1 degree must be treated. Otherwise, the violation will progress and lead to serious health problems. Do not assume that anemia can go away on its own. Without therapy, it will go first to the second, and then to the third stage. It should be understood that anemia of the third degree is a life-threatening condition.
Anemia of the 1st degree can be present in a person for a long time. The level of erythrocytes often decreases slowly, but systematically. Sometimes it happens that a patient comes to the doctor with a severe degree of anemia and its multiple complications, and it all started with the usual malaise and fatigue.
Symptoms of anemia of the 1st degree are primarily due to the fact that organs and tissues begin to suffer from a lack of oxygen. Signs of hypoxia increase gradually, they depend on the stage of the disease.
In general, anemia of the 1st degree is characterized by the following symptoms:
During physical effort and during training, a person develops shortness of breath, which was not there before.
The patient notices that he began to get tired faster.
Possible pre-fainting state.
Often begins to disturb dizziness.
Another indirect sign of anemia is orthostatic tachycardia.
If you carefully listen to the signals that the body gives, you can diagnose anemia on your own, without visiting a doctor's office. Of course, this is not a reason for prescribing treatment. Therapy is selected only by the doctor and only on the basis of the tests performed. However, the sooner a person seeks medical help, the faster recovery will come.
If a patient develops normocytic normochromic anemia, then the ESR and the mean concentration of hemoglobin in the erythrocyte (MCHC) may remain within the normal range.
Normocytic normochromic anemia can develop for the following reasons:
Home treatments for anemia include:
Juice intake. The use of freshly squeezed juices allows you to get rid of anemia in the shortest possible time. However, you need to drink fresh juices, and not bought in stores. Otherwise, the effect will not be achieved. You can cook carrot, beetroot and apple juice. It is good to mix them, or dilute with vegetable juices. Honey can be added to the drink.
There is a rule regarding the intake of beetroot juice. So, it can not be consumed immediately after preparation. The drink must be kept. The exposure time is 2 hours, but not less. During this time, harmful substances will evaporate from it. Therefore, immediately after preparation, the juice does not need to be covered with a lid. Otherwise, don't twist it too tightly.
Beetroot juice can be drunk half an hour before a meal, or in between meals. Large volumes should not be consumed. It is enough to drink 2 tablespoons of juice 2-3 times a day. This is true for all drinks.
Infusion of yarrow. To prepare an infusion of yarrow, you need to pour the grass of the plant with boiling water and keep it in a thermos. Take the infusion should be 2 tablespoons 3 times a day.
Vitamin cocktail. It is very useful for anemia of the 1st degree to eat a vitamin mixture. For its preparation, you will need 100 g of dried fruits (raisins, dates, figs, prunes). The fruits are passed through a meat grinder, lemon juice and 3 tablespoons of honey are added to the resulting "minced meat". The mixture is stored in the refrigerator. Eat 2 teaspoons 2-3 times a day. Such a useful vitamin mixture will not only help get rid of anemia, but also saturate the body with vitamins.
Education: In 2013, he graduated from the Kursk State Medical University and received a diploma in General Medicine. After 2 years, the residency in the specialty "Oncology" was completed. In 2016, she completed postgraduate studies at the Pirogov National Medical and Surgical Center.
Reading 6 min. Views 979
Anemia is a common disease affecting a quarter of the population. The symptoms depend on the stage, the easiest is anemia of the 1st degree, what it is, how to deal with it, the specialist will tell you after a detailed study of the tests and the general condition of the patient.
How and why is severity calculated?
It is quite difficult to establish the presence of pathology on your own; for this, it is necessary to undergo a diagnostic study. The reason for contacting a medical institution may be fatigue, constant fatigue after minor physical exertion. To make a diagnosis, you should pass a general and biochemical blood test, undergo a myelogram. These tests will help to establish the disease and determine the degree of anemia, since the complex of treatment will depend on these indicators.
The following data is taken into account:
- hemoglobin level (including the amount in individual red blood cells);
- color index;
- the level of iron in the blood serum;
- change in the shape and size of red blood cells.
Anemia and its severity in terms of hemoglobin levels entails a deterioration in the state of protein in the blood. The norm for an adult is 100-155 g / l, a decrease in this indicator to the lower limit or more is a sign of the disease.
How often do you take a blood test?
Poll Options are limited because JavaScript is disabled in your browser.
Only by appointment of the attending physician 31%, 1742 vote
Once a year and I think it's enough 17%, 962 vote
At least twice a year 15%, 839 votes
More than twice a year but less than six times 11%, 642 vote
I monitor my health and take it once a month 6%, 341 voice
I'm afraid of this procedure and try not to pass 4%, 237 votes
21.10.2019
The causes of the first, second or third degree of severity of anemia are:
- big blood loss;
- disturbed nutrition;
- changes in bowel function that interfere with the absorption of iron;
- the period of pregnancy and lactation (increased need for iron).
But the development of anemia is characteristic not only with a decrease in hemoglobin in the blood. Exists, varieties have both similarities and differences:
- B12-deficient and folate-deficient. Due to the lack of these substances, a slight itching appears in the upper and lower extremities, inflammation and burning of the tongue, the skin acquires a yellowish tint, appetite decreases, and the person becomes irritated.
- Iron deficiency. Most often, unpleasant symptoms occur after physical exertion. This is fatigue, shortness of breath, slight tachycardia, pallor of the skin, increased brittleness of nails, hair, etc.
- Aplastic. It appears against the background of an insufficient number of red blood cells in the bone marrow, therefore, the characteristic symptoms are frequent dizziness, general malaise, lack of air, heart palpitations, tinnitus, etc. With this disease, bruises easily remain on the skin, the risk of nosebleeds and bleeding gums increases.
- Hemolytic. Due to hereditary pathologies, there is an increased destruction of red blood cells, which lead to weakness, tachycardia, and mild pain in the left hypochondrium.
- Posthemorrhagic. Occurs after a large blood loss. The chronic form may be the result of a slight bleeding with a stomach ulcer or during menstruation, as a result of which it passes into iron deficiency. It is accompanied by a decrease in working capacity, weakness, and the appearance of shortness of breath.
First mild degree
Mild anemia is quite difficult to determine visually, as a person looks healthy at first glance. Testing is required to make a diagnosis. The hemoglobin level is 90-110 g / l, and this indicator is more often characteristic only because of physical exertion.
RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2013
Iron deficiency anemia, unspecified (D50.9)
Hematology
general information
Short description
Approved by the minutes of the meeting
Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan
No. 23 dated 12/12/2013
Iron deficiency anemia (IDA)- clinical and hematological syndrome, characterized by a violation of hemoglobin synthesis as a result of iron deficiency, which develops against the background of various pathological (physiological) processes, and manifests itself with signs of anemia and sideropenia (L.I. Dvoretsky, 2004).
Protocol name:
IRON-DEFICIENCY ANEMIA
Protocol code:
ICD-10 code(s):
D 50 Iron deficiency anemia
D 50.0 Posthemorrhagic (chronic) anemia
D 50.8 Other iron deficiency anemias
D 50.9 Iron deficiency anemia, unspecified
Protocol development date: 2013
Abbreviations used in the protocol:
J - iron deficiency
DNA - deoxyribonucleic acid
IDA - iron deficiency anemia
WDS - iron deficiency state
CPU - color indicator
Protocol Users: hematologist, therapist, gastroenterologist, surgeon, gynecologist
Classification
There is currently no generally accepted classification of iron deficiency anemia.
Clinical classification of iron deficiency anemia (for Kazakhstan).
In the diagnosis of iron deficiency anemia, it is necessary to highlight 3 points:
Etiological form (to be specified after additional examination)
- Due to chronic blood loss (chronic post-hemorrhagic anemia)
- Due to increased iron consumption (increased iron requirement)
- Due to insufficient initial iron levels (in newborns and young children)
- Alimentary (nutritive)
- due to inadequate intestinal absorption
- Due to impaired iron transport
stages
A. Latent: reduced Fe in the blood serum, iron deficiency without anemia clinic (latent anemia)
B. Clinically detailed picture of hypochromic anemia.
Severity
Light (Hb content 90-120 g/l)
Medium (Hb content 70-89 g/l)
Severe (Hb content below 70 g/l)
Example: Iron deficiency anemia, postgastrectomy, stage B, severe.
Diagnostics
List of main diagnostic measures:
- Complete blood count (12 parameters)
- Biochemical blood test (total protein, bilirubin, urea, creatinine, ALT, AST, bilirubin and fractions)
- Serum iron, ferritin, TIBC, blood reticulocytes
- General urine analysis
List of additional diagnostic measures:
- Fluorography
- Esophagogastroduodenoscopy,
- Ultrasound of the abdomen, kidneys,
- X-ray examination of the gastrointestinal tract according to indications,
- X-ray examination of the chest organs according to indications,
- Fibrocolonoscopy,
- sigmoidoscopy,
- Ultrasound of the thyroid gland.
- Sternal puncture for differential diagnosis, after consulting a hematologist, according to indications
Diagnostic criteria*** (description of reliable signs of the disease depending on the severity of the process).
1) Complaints and anamnesis:
History information:
Chronic posthemorrhagic IDA
1. Uterine bleeding . Menorrhagia of various origins, hyperpolymenorrhea (menses for more than 5 days, especially with the appearance of the first menstruation up to 15 years, with a cycle of less than 26 days, the presence of blood clots for more than a day), impaired hemostasis, abortion, childbirth, uterine fibroids, adenomyosis, intrauterine contraceptives, malignant tumors .
2. Bleeding from the gastrointestinal tract. If chronic blood loss is detected, a thorough examination of the digestive tract "from top to bottom" is carried out with the exception of diseases of the oral cavity, esophagus, stomach, intestines, and helminthic invasion by hookworm. In adult men, women after menopause, the main cause of iron deficiency is bleeding from the gastrointestinal tract, which can provoke: peptic ulcer, diaphragmatic hernia, tumors, gastritis (alcohol or due to treatment with salicylates, steroids, indomethacin). Violations in the hemostasis system can lead to bleeding from the gastrointestinal tract.
3. Donation (in 40% of women it leads to a latent iron deficiency, and sometimes, mainly in female donors with many years of experience (more than 10 years), it provokes the development of IDA.
4. Other blood loss : nasal, renal, iatrogenic, artificially induced in mental illness.
5. Hemorrhages in confined spaces : pulmonary hemosiderosis, glomic tumors, especially with ulceration, endometriosis.
IDA associated with increased iron requirements:
Pregnancy, lactation, puberty and intensive growth, inflammatory diseases, intensive sports, vitamin B 12 treatment in patients with B 12 deficiency anemia.
One of the most important pathogenetic mechanisms for the development of anemia in pregnant women is inadequately low production of erythropoietin. In addition to the states of hyperproduction of pro-inflammatory cytokines caused by pregnancy itself, their hyperproduction is possible in concomitant chronic diseases (chronic infections, rheumatoid arthritis, etc.).
IDA associated with impaired iron intake
Malnutrition with a predominance of flour and dairy products. When collecting an anamnesis, it is necessary to take into account the peculiarities of nutrition (vegetarianism, fasting, diet). In some patients, impaired intestinal absorption of iron may be masked by general syndromes such as steatorrhea, sprue, celiac disease, or diffuse enteritis. Iron deficiency often occurs after resection of the intestine, stomach, gastroenterostomy. Atrophic gastritis and concomitant achlorhydria can also reduce iron absorption. Poor absorption of iron can be facilitated by a decrease in the production of hydrochloric acid, a decrease in the time required for iron absorption. In recent years, the role of Helicobacter pylori infection in the development of IDA has been studied. It is noted that in some cases, the exchange of iron in the body during the eradication of Helicobacter pylori can be normalized without additional measures.
IDA associated with impaired iron transport
These IDA are associated with congenital antransferrinemia, the presence of antibodies to transferrin, a decrease in transferrin due to a general protein deficiency.
a. General anemic syndrome:weakness, fatigue, dizziness, headaches (more often in the evening), shortness of breath on exertion, palpitations, syncope, flickering of “flies” before the eyes with a low level of blood pressure, There is often a moderate increase in temperature, often drowsiness during the day and poor falling asleep at night, irritability, nervousness, conflict, tearfulness, memory and attention loss, loss of appetite. The severity of complaints depends on adaptation to anemia. The slow rate of anemization contributes to better adaptation.
b. Sideropenic Syndrome:
- changes in the skin and its appendages(dryness, peeling, easy cracking, pallor). Hair is dull, brittle, split, turns gray early, falls out intensely, changes in nails: thinning, brittleness, transverse striation, sometimes spoon-shaped concavity (koilonychia).
- Mucosal changes(glossitis with atrophy of the papillae, cracks in the corners of the mouth, angular stomatitis).
- Changes in the gastrointestinal tract(atrophic gastritis, atrophy of the esophageal mucosa, dysphagia). Difficulty swallowing dry and hard food.
- Muscular system. Myasthenia gravis (due to the weakening of the sphincters, there is an imperative urge to urinate, the inability to hold urine when laughing, coughing, sometimes bedwetting in girls). The consequence of myasthenia gravis can be miscarriage, complications during pregnancy and childbirth (decrease in the contractility of the myometrium
Addiction to unusual smells.
Perversion of taste. It is expressed in the desire to eat something inedible.
- Sideropenic myocardial dystrophy- Tendency to tachycardia, hypotension.
- Disturbances in the immune system(the level of lysozyme, B-lysins, complement, some immunoglobulins decreases, the level of T- and B-lymphocytes decreases, which contributes to a high infectious morbidity in IDA and the appearance of secondary immunodeficiency of a combined nature).
2) physical examination:
. pallor of the skin and mucous membranes;
. "blue" sclera due to their dystrophic changes, slight yellowness of the area of the nasolabial triangle, palms as a result of a violation of carotene metabolism;
. koilonychia;
. cheilitis (seizures);
. indistinct symptoms of gastritis;
. involuntary urination (due to weakness of the sphincters);
. symptoms of damage to the cardiovascular system: palpitations, shortness of breath, chest pain and sometimes swelling in the legs.
3) laboratory research
Laboratory indicators for IDA
| Laboratory indicator | Norm | Changes in IDA | |
| 1 | Morphological changes in erythrocytes |
normocytes - 68% microcytes - 15.2% macrocytes - 16.8% |
Microcytosis is combined with anisocytosis, poikilocytosis, anulocytes, plantocytes are present |
| 2 | color indicator | 0,86 -1,05 | Hypochromia score less than 0.86 |
| 3 | Hemoglobin content |
Women - at least 120 g / l Men - at least 130 g / l |
reduced |
| 4 | SIT | 27-31 pg | Less than 27 pg |
| 5 | ICSU | 33-37% | Less than 33% |
| 6 | MCV | 80-100 fl | lowered |
| 7 | RDW | 11,5 - 14,5% | enlarged |
| 8 | Mean erythrocyte diameter | 7.55±0.099 µm | reduced |
| 9 | Reticulocyte count | 2-10:1000 | Not changed |
| 10 | Efficient erythropoiesis coefficient | 0.06-0.08x10 12 l / day | Not changed or reduced |
| 11 | Serum iron |
Women - 12-25 microml / l Men -13-30 µmol/l |
Reduced |
| 12 | Total iron-binding capacity of blood serum | 30-85 µmol/l | Increased |
| 13 | Serum latent iron-binding capacity | Less than 47 µmol/l | Above 47 µmol/l |
| 14 | Transferrin saturation with iron | 16-15% | reduced |
| 15 | Desferal test | 0.8-1.2 mg | Decrease |
| 16 | The content of protoporphyrins in erythrocytes | 18-89 µmol/l | Upgraded |
| 17 | Painting on iron | Bone marrow contains sideroblasts | Disappearance of sideroblasts in punctate |
| 18 | ferritin level | 15-150 µg/l | Decrease |
4) instrumental studies (X-ray signs, EGDS - a picture).
In order to identify sources of blood loss, pathology of other organs and systems:
- X-ray examination of the gastrointestinal tract according to indications,
- X-ray examination of the chest organs according to indications,
- fibrocolonoscopy,
- sigmoidoscopy,
- Ultrasound of the thyroid gland.
- Sternal puncture for differential diagnosis
5) indications for consultation of specialists:
gastroenterologist - bleeding from the organs of the gastrointestinal tract;
dentist - bleeding from the gums,
ENT - nosebleeds,
oncologist - a malignant lesion that causes bleeding,
nephrologist - exclusion of kidney diseases,
phthisiatrician - bleeding on the background of tuberculosis,
pulmonologist - blood loss against the background of diseases of the bronchopulmonary system, gynecologist - bleeding from the genital tract,
endocrinologist - decreased thyroid function, the presence of diabetic nephropathy,
hematologist - to exclude diseases of the blood system, the ineffectiveness of the conducted ferrotherapy
proctologist - rectal bleeding,
infectiologist - if there are signs of helminthiasis.
Differential Diagnosis
| Criteria | IDA | MDS (RA) | B12-deficient | Hemolytic anemia | |
| Hereditary | AIGA | ||||
| Age | Most often young, up to 60 years |
Over 60 years old |
Over 60 years old | - | After 30 years |
| RBC shape | Anisocytosis, poikilocytosis | Megalocytes | Megalocytes | Sphero-, ovalocytosis | Norm |
| color indicator | lowered | Normal or increased | Promoted | Norm | Norm |
| Price-Jones curve | Norm | Shift right or normal | shift right | Normal or Right Shift | Shift left |
| Longevity of Erythra. | Norm | Normal or shortened | shortened | shortened | shortened |
| Coombs test | Negative | Negative sometimes positive | Negative | Negative | Positive |
| Osmotic resistance Er. | Norm | Norm | Norm | Increased | Norm |
| Peripheral blood reticulocytes |
Relates magnification, absolute decrease |
Reduced or increased |
lowered, on the 5-7th day of treatment reticulocyte crisis |
Enlarged | Increase |
| Peripheral blood leukocytes | Norm | Reduced | Possible downgrade | Norm | Norm |
| Platelets in peripheral blood | Norm | Reduced | Possible downgrade | Norm | Norm |
| Serum iron | Reduced | Increased or normal | Upgraded | Increased or normal | Increased or normal |
| Bone marrow | Increase in polychromatophils | Hyperplasia of all hematopoietic lineages, signs of cell dysplasia | Megaloblasts | Increased erythropoiesis with an increase in mature forms | |
| Blood bilirubin | Norm | Norm | Possible increase | Increasing the indirect fraction of bilirubin | |
| urine urobilin | Norm | Norm | Possible appearance | Persistent increase in urine urobilin | |
Differential diagnosis of iron deficiency anemia is carried out with other hypochromic anemias caused by impaired hemoglobin synthesis. These include anemia associated with a violation of the synthesis of porphyrins (anemia with lead poisoning, with congenital disorders of the synthesis of porphyrins), as well as thalassemia. Hypochromic anemia, unlike iron deficiency anemia, occurs with a high content of iron in the blood and depot, which is not used to form heme (sideroachresia); in these diseases, there are no signs of tissue iron deficiency.
The differential sign of anemia due to a violation of the synthesis of porphyrins is hypochromic anemia with basophilic puncture of erythrocytes, reticulocytes, enhanced erythropoiesis in the bone marrow with a large number of sideroblasts. Thalassemia is characterized by a target-like shape and basophilic puncture of erythrocytes, reticulocytosis, and the presence of signs of increased hemolysis.
Treatment
Treatment goals:
- Correction of iron deficiency.
- Comprehensive treatment of anemia and complications associated with it.
- Elimination of hypoxic conditions.
- Normalization of hemodynamics, systemic, metabolic and organ disorders.
Treatment tactics***:
non-drug treatment
With iron deficiency anemia, the patient is shown a diet rich in iron. The maximum amount of iron that can be absorbed from food in the gastrointestinal tract is 2 g per day. Iron from animal products is absorbed in the intestines in much greater quantities than from plant products. Divalent iron, which is part of the heme, is best absorbed. Meat iron is absorbed better, and liver iron is worse, since iron in the liver is found mainly in the form of ferritin, hemosiderin, and also in the form of heme. Small amounts of iron are absorbed from eggs and fruits. The patient is recommended the following products containing iron: beef, fish, liver, kidneys, lungs, eggs, oatmeal, buckwheat, beans, porcini mushrooms, cocoa, chocolate, herbs, vegetables, peas, beans, apples, wheat, peaches, raisins , prunes, herring, hematogen. It is advisable to take koumiss in a daily dose of 0.75-1 l, with good tolerance - up to 1.5 l. In the first two days, the patient is given no more than 100 ml of koumiss for each dose, from the 3rd day the patient takes 250 ml 3-4 times a day. It is better to take koumiss 1 hour before and 1 hour after breakfast, 2 hours before and 1 hour after lunch and dinner.
In the absence of contraindications (diabetes mellitus, obesity, allergies, diarrhea), honey should be recommended to the patient. Honey contains up to 40% fructose, which increases the absorption of iron in the intestines. Iron is best absorbed from veal (22%), from fish (11%); from eggs, beans, fruits, 3% of iron is absorbed, from rice, spinach, corn - 1%.
drug treatment
Separately list
- list of essential medicines
- list of additional medicines
*** in these sections, it is necessary to provide a link to a source that has a good evidence base, indicating the level of reliability. Links should be indicated in square brackets with numbering as they occur. This source should be listed in the list of references under the appropriate number.
Treatment of IDA should include the following steps:
- Relief of anemia.
B. Saturation therapy (recovery of iron stores in the body).
B. Supportive care.
The inclusion of ascorbic acid in iron salt preparations improves its absorption. For iron (III) polymaltose hydroxide doses can be higher, about 1.5 times in relation to the latter, because. the drug is non-ionic, it is tolerated much better than iron salts, while only the amount of iron that the body needs and only in an active way is absorbed.
It should be noted that iron is better absorbed with an "empty" stomach, so it is recommended to take the drug 30-60 minutes before a meal. With adequate administration of iron preparations in a sufficient dose, an increase in reticulocytes is noted on days 8-12, the Hb content increases by the end of the 3rd week. Normalization of red blood counts occurs only after 5-8 weeks of treatment.
All iron preparations are divided into two groups:
1. Ionic iron-containing preparations (salt, polysaccharide compounds of ferrous iron - Sorbifer, Ferretab, Tardiferon, Maxifer, Ranferon-12, Aktiferin, etc.).
2. Non-ionic compounds, which include ferric iron preparations, represented by an iron-protein complex and a hydroxide-polymaltose complex (Maltofer). Iron (III)-hydroxide polymaltose complex (Venofer, Kosmofer, Ferkail)
Table. Essential Iron Oral Medicines
| A drug | Additional components | Dosage form | The amount of iron, mg |
| Monocomponent preparations | |||
| Aristoferon | ferrous sulfate |
syrup - 200 ml, 5 ml - 200 mg |
|
| Ferronal | iron gluconate | tab., 300 mg | 12% |
| Ferrogluconate | iron gluconate | tab., 300 mg | 12% |
| Hemopher prolongatum | ferrous sulfate | tab., 325 mg | 105 mg |
| iron wine | iron saccharate |
solution, 200 ml 10 ml - 40 mg |
|
| Heferol | ferrous fumarate | capsules, 350 mg | 100 mg |
| Combined drugs | |||
| Aktiferin |
ferrous sulfate, D,L-serine ferrous sulfate, D,L-serine, glucose, fructose ferrous sulfate, D,L-serine, glucose, fructose, potassium sorbate |
caps., 0.11385 g syrup, 5 ml-0.171 g drops, 1 ml - 0.0472 g |
0.0345 g 0.034 g 0.0098 g |
| Sorbifer - durules |
ferrous sulfate, ascorbic acid |
tab., 320 mg | 100 mg |
| Ferrstab | tab., 154 mg | 33% | |
| Folfetab | ferrous fumarate, folic acid | tab., 200 mg | 33% |
| Ferroplect |
ferrous sulfate, ascorbic acid |
tab., 50 mg | 10 mg |
| Ferroplex |
ferrous sulfate, ascorbic acid |
tab., 50 mg | 20% |
| Fefol | ferrous sulfate, folic acid | tab., 150 mg | 47 mg |
| Ferro foil |
ferrous sulfate, folic acid, cyanocobalamin |
caps., 100 mg | 20% |
| Tardiferon - retard | ferrous sulfate, ascorbic | dragee, 256.3 mg | 80 mg |
| acid, mucoproteosis | |||
| Gino-Tardiferon |
ferrous sulfate, ascorbic acid, mucoproteose, folic acid |
dragee, 256.3 mg | 80 mg |
| 2Macrofer | ferrous gluconate, folic acid |
effervescent tablets, 625 mg |
12% |
| Fenyuls |
ferrous sulfate, ascorbic acid, nicotinamide, vitamins group B |
caps., | 45 mg |
| Irovit |
ferrous sulfate, ascorbic acid, folic acid, cyanocobalamin, lysine monohydro- chloride |
caps., 300 mg | 100 mg |
| Ranferon-12 | Ferrous fumarate, ascorbic acid, folic acid, cyanocobalamin, zinc sulfate | Caps., 300 mg | 100 mg |
| Totem | Ferrous gluconate, manganese gluconate, copper gluconate | Ampoules with solution for drinking | 50 mg |
| Globiron | Ferrous fumarate, folic acid, cyanocobalamin, pyridoxine, sodium docusate | Caps., 300 mg | 100 mg |
| Gemsineral-TD | Ferrous fumarate, folic acid, cyanocobalamin | Caps., 200 mg | 67 mg |
| Ferramin-Vita | Ferrous Aspartate, Ascorbic Acid, Folic Acid, Cyanocobalamin, Zinc Sulfate | Tablet, 60 mg | |
| Maltofer |
Drops, syrup, 10 mg Fe in 1 ml; Tab. chewable 100 mg |
||
| Maltofer Fall | iron polymaltose hydroxyl complex, folic acid | Tab. chewable 100 mg | |
| Ferrum Lek | iron polymaltose hydroxyl complex | Tab. chewable 100 mg |
For relief of mild IDA:
Sorbifer 1 tab. x 2 p. per day 2-3 weeks, Maxifer 1 tab. x 2 times a day, 2-3 weeks, Maltofer 1 tablet 2 times a day - 2-3 weeks, Ferrum-lek 1 tab x 3 r. in d. 2-3 weeks;
Moderate severity: Sorbifer 1 tab. x 2 p. per day 1-2 months, Maxifer 1 tab. x 2 times a day, 1-2 months, Maltofer 1 tablet 2 times a day - 1-2 months, Ferrum-lek 1 tab x 3 r. in d. 1-2 months;
Severe severity: Sorbifer 1 tab. x 2 p. per day 2-3 months, Maxifer 1 tab. x 2 times a day, 2-3 months, Maltofer 1 tablet 2 times a day - 2-3 months, Ferrum-lek 1 tab x 3 r. in d. 2-3 months.
Of course, the duration of therapy is influenced by the level of hemoglobin on the background of ferrotherapy, as well as a positive clinical picture!
Table. Iron preparations for parenteral administration.
| Trade name | INN | Dosage form | The amount of iron, mg |
| Venofer IV | Iron III hydroxide sucrose complex | Ampoules 5.0 | 100 mg |
| Fercale i/m | Iron III dextran | Ampoules 2.0 | 100 mg |
| Cosmofer i/m, i/v | Ampoules 2.0 | 100 mg | |
| Novofer-D in / m, in / in | Iron III hydroxide-dextran complex | Ampoules 2.0 | 100 mg/2ml |
Indications for parenteral administration of iron preparations:
. Intolerance to iron preparations for oral administration;
. Iron malabsorption;
. Peptic ulcer of the stomach and duodenum during the period of exacerbation;
. Severe anemia and the vital need to quickly replenish iron deficiency, for example, preparation for surgery (refusal of hemocomponent therapy)
For parenteral administration, ferric iron preparations are used.
The course dose of iron preparations for parenteral administration is calculated by the formula:
A \u003d 0.066 M (100 - 6 Hb),
where A is the course dose, mg;
M is the patient's body weight, kg;
Hb is the content of Hb in the blood, g/l.
IDA treatment regimen:
1. At a hemoglobin level of 109-90 g/l, a hematocrit of 27-32%, prescribe a combination of drugs:
A diet that includes iron-rich foods - beef tongue, rabbit meat, chicken, porcini mushrooms, buckwheat or oatmeal, legumes, cocoa, chocolate, prunes, apples;
Salt, polysaccharide compounds of ferrous iron, iron (III)-hydroxide polymaltose complex in a total daily dose of 100 mg (oral intake) for 1.5 months with the control of a complete blood count 1 time per month, if necessary, extending the course of treatment up to 3 months;
Ascorbic acid 2 others x 3 r. in the house 2 weeks
2. If the hemoglobin level is below 90 g/l, hematocrit is below 27%, consult a hematologist.
Salt or polysaccharide compounds of ferrous iron or iron (III)-hydroxide polymaltose complex in a standard dosage. In addition to previous therapy, give iron (III)-hydroxide polymaltose complex (200 mg/10 ml) intravenously every other day. The amount of iron administered should be calculated according to the formula given in the manufacturer's instructions or iron dextran III (100 mg/2 ml) a day, intramuscularly (calculated according to the formula), with an individual selection of the course depending on hematological parameters, at this moment the intake of oral iron preparations is temporarily stopped;
3. When the hemoglobin level is normalized more than 110 g/l and the hematocrit is more than 33%, prescribe a combination of preparations of salt or polysaccharide compounds of ferrous iron or iron (III)-hydroxide polymaltose complex 100 mg 1 time per week for 1 month, under the control of hemoglobin levels, ascorbic acid 2 others x 3 r. in d. 2 weeks (not applicable for pathology of the gastrointestinal tract - erosion and ulcers of the esophagus, stomach), folic acid 1 tab. x 2 p. in d. 2 weeks.
4. If the hemoglobin level is less than 70 g/l, inpatient treatment in the hematology department, in case of exclusion of acute gynecological or surgical pathology. Mandatory preliminary examination by a gynecologist and surgeon.
With severe anemic and circulatory-hypoxic syndromes, leukofiltered erythrocyte suspension, further transfusions strictly according to absolute indications, according to the Order of the Minister of Health of the Republic of Kazakhstan dated July 26, 2012 No. 501. Minister of Health of the Republic of Kazakhstan dated November 6, 2009 No. 666 "On approval of the Nomenclature, Rules for the procurement, processing, storage, sale of blood and its components, as well as the Rules for the storage, transfusion of blood, its components and preparations"
In the preoperative period, in order to quickly normalize hematological parameters, transfusion of leukofiltered erythrocyte suspension, according to order No. 501;
Salt or polysaccharide compounds of ferrous iron or iron (III) hydroxide polymaltose complex (200 mg / 10 ml) intravenously every other day according to calculations according to the instructions and under the control of hematological parameters.
For example, the scheme for calculating the amount of the administered drug relative to Cosmofer:
Total dose (Fe mg) = body weight (kg) x (necessary Hb - actual Hb) (g / l) x 0.24 + 1000 mg (Fe reserve). Factor 0.24 = 0.0034 (iron content in Hb is 0.34%) x 0.07 (blood volume 7% of body weight) x 1000 (transition from g to mg). Heading dose in ml (with iron deficiency anemia) in terms of body weight (kg) and depending on the Hb values (g / l), which corresponds to:
60, 75, 90, 105 g/l:
60 kg - 36, 32, 27, 23 ml, respectively;
65 kg - 38, 33, 29, 24 ml, respectively;
70 kg - 40, 35, 30, 25 ml, respectively;
75 kg - 42, 37, 32, 26 ml, respectively;
80 kg - 45, 39, 33, 27 ml, respectively;
85 kg - 47, 41, 34, 28 ml, respectively;
90 kg - 49, 42, 36, 29 ml, respectively.
If necessary, treatment is signed in stages: emergency care, outpatient, inpatient.
Other treatments- No
Surgical intervention
Indications for surgical treatment are ongoing bleeding, an increase in anemia, due to causes that cannot be eliminated by drug therapy.
Prevention
Primary prevention is carried out in groups of people who do not currently have anemia, but there are circumstances predisposing to the development of anemia:
. pregnant and breastfeeding;
. adolescent girls, especially those with heavy periods;
. donors;
. women with profuse and prolonged menstruation.
Prevention of iron deficiency anemia in women with heavy and prolonged menstruation.
2 courses of prophylactic therapy lasting 6 weeks are prescribed (the daily dose of iron is 30-40 mg) or after menstruation for 7-10 days every month during the year.
Prevention of iron deficiency anemia in donors, children of sports schools.
1-2 courses of preventive treatment are prescribed for 6 weeks in combination with an antioxidant complex.
During the period of intensive growth of boys, iron deficiency anemia may develop. At this time, preventive treatment with iron preparations should also be carried out.
Secondary prevention is carried out for persons with previously cured iron deficiency anemia in the presence of conditions that threaten the development of a relapse of iron deficiency anemia (heavy menstruation, uterine fibromyoma, etc.).
These groups of patients after the treatment of iron deficiency anemia are recommended a prophylactic course lasting 6 weeks (daily dose of iron - 40 mg), then two 6-week courses per year or taking 30-40 mg of iron daily for 7-10 days after menstruation. In addition, it is necessary to consume at least 100 g of meat daily.
All patients with iron deficiency anemia, as well as persons with risk factors for this pathology, should be registered with a general practitioner at a polyclinic at the place of residence with a mandatory general blood test and a study of serum iron content at least 2 times a year. At the same time, dispensary observation is also carried out, taking into account the etiology of iron deficiency anemia, i.e. the patient is on the dispensary account for the disease that caused iron deficiency anemia.
Further management
Clinical blood tests should be done monthly. In severe anemia, laboratory monitoring is carried out every week; in the absence of positive dynamics of hematological parameters, an in-depth hematological and general clinical examination is indicated.
Information
Sources and literature
- Minutes of the meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
- List of used literature: 1. WHO. Official annual report. Geneva, 2002. 2. Iron deficiency anemia assessment, prevention and control. A guid for program managers - Geneva: World Health Organization, 2001 (WHO/NHD/01.3). 3. Dvoretsky L.I. IDA. Newdiamid-AO. M.: 1998. 4. Kovaleva L. Iron deficiency anemia. M: Doctor. 2002; 12:4-9. 5. G. Perewusnyk, R. Huch, A. Huch, C. Breymann. British Journal of Nutrition. 2002; 88:3-10. 6. Strai S.K.S., Bomford A., McArdle H.I. Iron transport across cell membranes:molecular holding of duodenal and placental iron uptake. Best Practice & Research Clin Haem. 2002; 5:2:243-259. 7. Schaeffer R.M., Gachet K., Huh R., Krafft A. Iron letter: recommendations for the treatment of iron deficiency anemia. Hematology and Transfusiology 2004; 49(4):40-48. 8. Dolgov V.V., Lugovskaya S.A., Morozova V.T., Pochtar M.E. Laboratory diagnosis of anemia. M.: 2001; 84. 9. Novik A.A., Bogdanov A.N. Anemia (from A to Z). A guide for doctors / ed. Acad. Yu.L. Shevchenko. - St. Petersburg: "Neva", 2004. - 62-74 p. 10. Papayan A.V., Zhukova L.Yu. Anemia in children: hands. For doctors. - St. Petersburg: Peter, 2001. - 89-127 p. 11. Alekseev N.A. anemia. - St. Petersburg: Hippocrates. - 2004. - 512 p. 12. Lewis S.M., Bane B., Bates I. Practical and laboratory hematology / transl. from English. ed. A.G. Rumyantsev. - M.: GEOTAR-Media, 2009. - 672 p.
Information
List of protocol developers with qualification data
A.M. Raisova - head. otd. therapy, Ph.D.
O.R. Khan - Assistant of the Department of Therapy of Postgraduate Education, Hematologist
Indication of no conflict of interest: No
Reviewers:
Indication of the conditions for the revision of the protocol: every 2 years.
Attached files
Attention!
- By self-medicating, you can cause irreparable harm to your health.
- The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
- The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
- The MedElement website and mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" are exclusively information and reference resources. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
- The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.
