Iron deficiency anemia (IDA) is a small cell hypochromic anemia caused by iron deficiency in the body that affects hemoglobin synthesis. It is characterized by a lack of stainable iron in the bone marrow, liver, spleen and other tissues, a decrease in serum ferritin concentration, and a decrease in both serum iron concentration and serum transferrin saturation.
I. Etiology of iron deficiency anemia.
1.Increased need of iron and insufficient intake: In fast growing infants, children, women with excessive menstruation, pregnancy or lactation, the need of iron increases, and if the diet is lacking, it is easy to cause iron anemia.
2.Iron malabsorption: Iron deficiency anemia occurs relatively rarely due to iron absorption disorders, such as chronic gastritis.
3, blood loss: especially chronic blood loss is the most common and important cause of iron deficiency anemia. Gastrointestinal bleeding such as ulcer disease, cancer, hookworm disease, esophageal variceal bleeding, hemorrhoid bleeding, gastric sinusitis after taking salicylates and other diseases that can cause chronic bleeding, excessive menstruation in women and hemolytic anemia with iron-containing hemoglobinuria or hemoglobinuria can all cause iron deficiency anemia. The development of iron deficiency anemia is gradual over a long period of time. During the iron depletion period, the stored iron is depleted and the serum ferritin is reduced, at which time there is no anemia, if the iron deficiency is further aggravated. When the stored iron is depleted, serum ferritin and serum iron decrease, total iron binding capacity increases, and iron deficiency anemia appears.
II. Stages of iron deficiency anemia: iron deficiency period, iron deficiency erythropoietic period, iron deficiency anemia period.
Third, there are those manifestations of iron deficiency anemia: the clinical manifestations of this disease are.
(1) clinical manifestations of the primary disease.
(2) symptoms caused by anemia itself.
(3) Symptoms caused by the reduced activity of iron-containing enzymes resulting in respiratory disorders in tissues and organs.
(1) Symptoms caused by damage to epithelial tissues: The decrease in intracellular iron-containing enzymes is the main cause of epithelial changes. Stomatitis and tongue inflammation: About 10-70% of patients have stomatitis, smooth tongue surface and tongue papilla atrophy, especially in the elderly. Esophageal webbing. Atrophic gastritis with gastric acid deficiency. Skin and nail changes: dry skin, keratinization and atrophy, hair folding and shedding; nails are not shiny, flat nail, anti nail and gray nail.
2. Neurological symptoms: about 15-30% of patients show neuralgia (mainly headache), sensory abnormalities, and in severe cases, increased intracranial pressure and optic papilledema. 5-50% of patients have mental and behavioral abnormalities, such as inattention, agitation, mental retardation and omnivorism. The reason is that iron deficiency not only affects the oxidative metabolism and neurotransmission of brain tissue, but also leads to a decrease in the activity of mitochondrial monoamine oxidase, which is related to behavior.
IV. Iron deficiency anemia examination.
1. Blood picture: early or mild iron deficiency can have no anemia or only very mild anemia. Late or severe iron deficiency has typical microcytic hypochromic anemia. The degree of decrease in erythrocyte pressure and hemoglobin concentration is determined by the degree of decrease in red blood cell count.
2. Bone marrow picture: active bone marrow proliferation, reduced granulocyte-red ratio, and markedly active proliferation of the red blood cell system. The proportion of middle-aged and young red blood cells increased, the volume was slightly smaller than the general middle-aged and young red blood cells, the edges were not neat, the cytoplasm was small, the staining was blue, and the nucleus was fixed like late young red blood cells, indicating that the cytoplasm development lagged behind the nucleus, and the number and morphology of granulocytes and megakaryocytes were normal.
3.Bone marrow iron staining: iron staining inside and outside the bone marrow cells is reduced or disappeared.
4.Serum ferritin: serum ferritin is significantly reduced.
V. Treatment of iron deficiency anemia.
1.The principles of treating iron deficiency anemia are
(1) Etiological treatment: remove the causes of iron deficiency and anemia as much as possible.
(2) Replenish sufficient amount of iron for the body to synthesize hemoglobin and replenish the body’s iron stores to normal level.
(2) Etiological treatment: Etiological treatment is important for the effectiveness, speed and prevention of recurrence of anemia correction.
3.Iron therapy.
(1) Oral iron: the most commonly used preparations are ferrous sulfate and iron fumarate (fulvic acid). Avoid tea when taking the drug, so that iron is not absorbed by the precipitation of tannic acid.
(2) Injectable iron: Generally try to treat with oral medication, and apply injectable iron only in the following cases.
(i) malabsorption of iron by the intestine, such as after gastrectomy or gastrointestinal anastomosis, chronic diarrhea, steatorrhea, etc.
(ii) Gastrointestinal diseases can be aggravated by oral iron administration, such as peptic ulcer, ulcerative colitis, segmental colitis, gastrointestinal dysfunction after gastrectomy and persistent vomiting during pregnancy.
③Severe gastrointestinal reactions despite reduction of oral iron doses. Commonly used iron injections include iron dextran and iron sorbitol citrate.
(3) Adjunctive treatment: strengthen nutrition and increase iron-rich food.
VI. Dietary treatment of iron deficiency anemia.
The dietary principles are.
1.Supply iron-rich foods.
2.Supply high protein diet to promote iron absorption and synthesis of hemoglobin.
3.Supply foods with high vitamin C to reduce trivalent iron to easily absorbed divalent iron.
4.Correct poor dietary habits, overcome long-term partial vegetarian diet and other bad habits.
In meal preparation on the basis of sufficient daily calories carefully selected iron-rich foods, such as: liver, waist, kidney, red lean meat, fish and poultry animal blood, eggs and milk, hard fruits, dried fruits (grape ten, dried apricots, dried dates), mushrooms, fungus, mushrooms, kelp and soy products green leafy vegetables, etc.. The food with high absorption rate of iron are lean meat, fish and poultry, blood, offal, containing heme iron. The absorption rate is 10% – 20%. Other foods containing non-heme iron are dairy eggs, cereals, hard fruits, dried fruits of vegetables (of which egg yolk is 3% and wheat is 5%) have a lower absorption rate of 10% or less. Also avoid foods containing high oxalic, phytic and tannic acids that interfere with the reduced absorption rate, such as spinach, amaranth and hollow vegetables. Pay attention to equip with vegetables high in vitamin C such as tomatoes, persimmon peppers, bitter gourd, rape, chard, etc. The protein intake should be high, 1.5 grams per kilogram of body weight per day, for the synthesis of hemoglobin. Cooking utensils should be made of iron. Do not drink tea when consuming iron-supplemented diet, as it may affect the absorption of iron. Reasonable arrangement of meals and content, patients with poor appetite and little stomach can eat small amounts of multiple meals.