Iron deficiency anemias

Iron deficiency anemias (anaemia sideropriva gastroenterogenlea) arise at deficiency of iron in an organism of haemoglobin of erythrocytes necessary for construction. This type of an anaemia is observed at patients at an insufficient absorption of iron owing to a stomach - resection «agastric anaemia»; excisions rather the small bowel most part, especially its proximal part, at the diseases of an intestine proceeding with a syndrome of insufficiency of an absorption, etc., at a disadvantage of iron of nutrition (at adults meets was rarely; it is more often observed at children against a long milk food and deficiency of copper). The raised requirement for iron can meet in intensive growth of an organism; at girls in this season formation of a menstrual cycle (promoting a loss of blood and iron ions) can be accompanied by occurrence of a so-called juvenile iron deficiency anaemia (an early chlorosis). To iron deficiency the anaemia concerns also at chronic blood loss.

Repeated, even not abundant, blood losses gradually lead to an anemisation owing to attrition in an organism of stores of the iron necessary for production of haemoglobin of erythrocytes. Daily entering in an organism of iron with nutrition is insignificant, about 11-28 mg, and is soaked up from it nearby If, i.e. Approximately as much, how many contains in 15 ml of blood. Therefore daily loss of it and even smaller quantity of blood inevitably leads to reduction of stores of iron in an organism and to iron deficiency anaemia occurrence.

Chronic blood losses and chronic posthemorrhagic anaemia (anaemia posthaemorrhagica chronica) accompany many diseases of an internals and first of all a gastrointestinal tract. It is a stomach and duodenum peptic ulcer, a cancer, stomach and intestine polypostures, a hemorrhoids, some helminthic invasions more often. The chronic posthemorrhagic anaemia is quite often observed also at tumours of nephroses, a cavernous pulmonary tuberculosis, uterine bleedings.

A number of accessory factors and first of all what can serve as the cause of reduction of stores of iron in an organism promotes occurrence of an anaemia. So, at patients with concomitant secretory insufficiency of a stomach and an enteritis against even a small chronic blood loss the anaemia is taped faster and proceeds more hardly. Gravity of the chronic posthemorrhagic anaemia arising at breaking up tumours of a gastrointestinal tract, a nephros, a uterus, is aggravated with toxic action of a tumour on a hemopoietic tissue, plural metastasises of a tumour in an osteal brain etc. Gastric juice Acidum hydrochloricum promotes restoration of trivalent iron in divalent which is easier acquired, but as have shown researches of last years, does not play a main role in activation of its absorption.

At insufficient entering in an organism of iron and use of its stores synthesis not only haemoglobin, but also ferriferous enzymes of cells of the different tissues which are taking part in oxidative processes is broken, synthesis of a myoglobin, etc. It leads to disturbances of a trophicity of tissues and defines occurrence of many symptoms of disease. Thus, the clinical picture of iron deficiency anemias, on the one hand, speaks insufficient transport of oxygen to tissues and with another - immediate disturbance of cellular breath.

The clinical picture (months, years) iron deficiency anaemia development allows an organism to use the compensatory possibilities to the full. Therefore the majority of patients well enough adapt to disease and quite well tolerate even an appreciable anemisation.

Characteristic complaints of patients - delicacy, giddiness, a dyspnea, especially at physical exercise, undue fatigability, a sonitus, bent to syncopal conditions. At many patients the various dispeptic phenomena - appetite depression, a food faddism, a nausea, fast saturability, gravity in epigastric range after meal, an eructation become perceptible; quite often there is a predilection to diarrheas. Easy paresthesias in the form of sensation of a pricking or crawling of jimjams on a skin are possible. In especially serious cases sometimes there is an excruciating dysphagia at ingestion of dry and firm nutrition - a so-called sideropenic dysphagia. Dysphagia occurrence speaks as diffusion of atrophic process of a stomach on an esophagus mucosa, so in some cases development in its proximal part of tender connective tissue membranes and intersections.

At survey attracts attention pallor of patients. As implication of the general deficiency of iron becomes perceptible a number of trophic disturbances from a skin, its appendages and mucosas. The skin of patients is dry, quite often slightly husks. A hair fragile, early grows grey and drops out. Fingernails become flat, sometimes become bent, lose shine, are spotted by cross-section cords, ломкиt (koilonychia - clumsy fingernails). There are fractures in mouth angles, delection of papillas of tongue - an atrophic glossitis becomes perceptible. Dens lose shine, are quickly blasted, despite the most careful care of them. At long application of iron preparations dens can blacken, as iron reacts with the hydrogen sulphide excreted in carious lumens owing to rotting, with formation of its Sodium sulfitum of black colour. The purulent inflammation of a mucosa of gums round necks of dens a-alveolar pyorrhea educes.

Physical inspection can tap, as well as at other types of anemias, unsharp augmentation of a left ventricle of heart, systolic hum at its apex, "nun's murmur" on a bulbar vein, more often on the right. Lymph nodes, a liver and a lien are not enlarged.

The blood analysis finds maintenance depression in it of erythrocytes and still larger falling of haemoglobin so the colour indicator appears less than 0,85, and it is peer serious cases 0,6-0,5 and even more low. At microscopy attracts attention an acyanotic coloration of erythrocytes (their hypochromia), the anisocytosis, a poikilocytosis is observed. Average diameter of erythrocytes less normal (microcythemia). The quantity of reticulocytes is insignificant. To an anaemia usually accompanies thrombocytoleukopenia, the relative monocytosis, a lymphocytosis and an eosinopenia are quite often observed. The maintenance of iron of Serum is lowered (in 1 '/2-2 '/2 time and more low); the percent of saturation of a transferrin (less than 15) decreases also.

Depression of activity of ferriferous enzymes of histic breath promotes development (or to advance existing earlier) atrophic changes of a mucosa of a gastrointestinal tract. At gastric juice research the achlorhydria or even an achylia is in most cases taped, the total of received juice is considerably reduced. At a X-ray inspection attracts attention some smoothness of cords of a mucosa of an esophagus and a stomach. Esophagoscopy and a gastroscopy confirm presence of an atrophy of a mucosa of an esophagus and a stomach.

Flow. Chronic if deficiency of iron in an organism is enlarged, gradually progressing.

Treatment. It is spent by iron preparations (Haemostimulinum, etc.). At gastritises and a peptic ulcer it is better to take advantage of iron preparations for intramuscular or intravenous application (Ferbitolum, Fercovenum, etc.). Treatment gives rather fast and a permanent effect: working capacity is quickly recovered, within 3-5 weeks the maintenance of erythrocytes and blood haemoglobin is normalised. However further in order to avoid disease relapses it is necessary regularly, some times in a year, to spend preventive courses of treatment by iron preparations. Products should enter into a diet sick of an iron deficiency anaemia with the high maintenance of salts of iron in a considerable quantity: a liver, beef, eggs, apples, dried fruit. At an anaemia caused by a chronic blood loss, efficacyy of treatment depends on possibility of elimination of a source of a blood loss.