1.Basic situation of iron deficiency anemia
Iron deficiency anemia is anemia that occurs because the body’s iron stores cannot meet the needs of normal red blood cell production. It is caused by insufficient iron intake, reduced absorption, increased need, impaired iron utilization or excessive loss. The morphological manifestation is small cell hypochromic anemia, characterized by a lack of stainable iron in the bone marrow, liver, spleen and other tissues. Xiping Dai, Department of Hematology, Guangdong Provincial Hospital of Traditional Chinese Medicine
Iron deficiency anemia is the most common clinical anemia and is prevalent throughout the world. It affects approximately 700 million people worldwide and is particularly common in women of childbearing age and in infants and children. It is particularly prevalent and severe in areas where hookworm disease is endemic.
Clinical symptoms include symptoms of anemia such as dizziness, fatigue, palpitations after activity, shortness of breath and tinnitus, and poor appetite, and symptoms of iron deficiency such as delayed growth, poor concentration, decreased academic performance and heterophilia in children, as well as symptoms of the underlying disease causing the iron deficiency.
2.Iron deficiency anemia health care principles and methods
For iron deficiency anemia with clear etiology, active treatment of the cause of iron deficiency and the primary disease, as well as treatment with iron and herbal medicine and appropriate application of iron-rich food can achieve satisfactory results.
(1) Prevention and treatment of etiology
The main causes of iron deficiency anemia are: (1) nutritional factors; (2) chronic blood loss; and (3) absorption disorders. Most of iron deficiency anemia can be prevented and treated, and health education and preventive measures should be emphasized in special groups prone to this type of anemia. These include.
①Improve breastfeeding methods for infants and add timely and appropriate supplementary foods such as egg yolk, green vegetables, meat and liver, which contain more iron. For children during the growth period, strengthen dietary nutrition, appropriately supplement iron-rich foods, and correct bad partial eating habits.
The World Health Organization has proposed to add medicinal iron to the food of pregnant women and infants to prevent iron deficiency anemia, which is an effective remedy.
③At present, due to the aging of our population and the increase in the number of people who have lost weight, the prevalence of iron deficiency anemia in these people has increased greatly and should be of great concern. In particular, factors such as tumor, chronic inflammation and infection should be excluded for iron deficiency anemia in the elderly. It is important to educate the dieting population to adopt correct and reasonable weight loss methods to avoid causing malnutritional iron deficiency anemia.
④ Conduct large-scale parasitic disease control in hookworm endemic areas and promptly deal with peptic ulcers, digestive tract tumors, and chronic bleeding foci.
⑤ Once suffering from iron deficiency anemia, actively search for the cause and primary disease causing iron deficiency and treat the cause accordingly so that the disease can be cured at the root. This is especially true for iron deficiency anemia caused by gastrointestinal tumors and long-term diarrhea.
(2) Rest and exercise
Due to the presence of different degrees of anemia, patients often cannot tolerate normal or even strenuous labor and physical exercise, and are prone to dizziness, dizziness, nausea, panic, shortness of breath and other symptoms of hypoxia, which are very detrimental to health. However, this does not mean that patients with anemia absolutely cannot do any kind of sports and labor and can only rest in bed. The amount of daily activities should be decided according to the degree of anemia, age, physical fitness and cardiopulmonary compensatory function of the patient, and bed rest, appropriate activities and sports should be used respectively.
For young patients with mild anemia, they should be encouraged to participate in some physical exercise programs with little exercise, such as short-distance jogging, walking, brisk walking, doing radio exercises, practicing crane pile qigong, playing taijiquan, etc., for 1 hour, in order not to produce the above-mentioned symptoms of hypoxia, and stop the activity if they feel fatigue, dizziness, panic, etc.; for young patients with moderate anemia and elderly patients with mild anemia, rest should be the main reason. If possible, they can engage in light housework such as cooking, dishwashing, laundry and mopping, because moderate physical activities and labor are beneficial to the recovery of iron deficiency anemia, which can enhance physical fitness, improve appetite and promote the absorption of nutrients in the gastrointestinal tract. Patients with severe anemia should rest for 1 to 2 weeks, rest in bed if necessary, and get up and move around when the anemia symptoms improve. In addition, all patients with anemia should ensure sufficient sleep and avoid staying up late and heavy physical labor, so as not to increase the burden on the heart and lungs and affect the function of the gastrointestinal tract and the absorption of nutrients, which is conducive to the recovery of physical health.
(3) Oxygen therapy and blood transfusion
Generally speaking, most of the iron deficiency anemia belongs to the range of chronic mild to moderate anemia, with hemoglobin higher than 60g/L. After 2 weeks of treatment by etiology and iron supplementation, the anemia can be gradually improved, so oxygen therapy and blood transfusion are not necessary. The targets of oxygen therapy and blood transfusion are a few patients suffering from severe iron deficiency anemia, or elderly patients, or patients with underlying diseases such as heart and lung, whose compensatory function for ischemia and hypoxia is insufficient. For such patients, transfusion of concentrated red blood cells should be treated differently. It is appropriate for young patients to have hemoglobin of 60g/L after transfusion; elderly patients or those with underlying diseases such as heart and lung should have hemoglobin of 80g/L or more after transfusion. Oxygen therapy can be taken at the same time to correct hypoxia and improve the quality of life, and appropriate activities and exercises can be carried out when the condition improves significantly.
The direct effect of oxygen therapy is to increase the partial pressure of arterial oxygen, which can only be partially improved by conventional oxygen administration in cases of anemia. The exact indication for the administration of oxygen is the arterial partial pressure of oxygen. Oxygen is required for partial pressure below 60 mmHg (8 kPa). Oxygen saturation is usually above 90% when the partial pressure of oxygen is above 60 mmHg (8 kPa), and oxygen is not required in most cases. The main method of oxygen therapy for anemic patients is oxygen administration by nasal cannula or nasal plug. The oxygen flow rate is 1~3L/min for adults and 0.5~1L/min for infants and children, and the concentration of inhaled oxygen can reach about 30~40%. It is especially important to point out that oxygen therapy should be combined with the correction of anemia, and oxygen therapy alone has no great significance for the correction of anemia. Long-term oxygen therapy should prevent oxygen toxicity, and the concentration of inhaled oxygen should not exceed 50-60%.
(4) Dietary conditioning
Dietary conditioning is very important for iron deficiency anemia and can achieve good results. Usually, animal blood has the highest iron content and absorption rate, animal liver such as pig liver has the second highest content and absorption rate, egg yolk has higher iron content but lower absorption rate, other foods with higher iron content are sesame, mustard, celery, nori, fungus, kelp, etc. in order. Fruits such as apricots, peaches, plums, raisins, dates and cherries contain more iron.
For patients with iron deficiency anemia, they should consume more animal foods such as animal blood, animal liver, lean meat, eggs, squid, jellyfish, shrimp, etc., and plant foods such as sesame, kelp, black fungus, nori, shiitake mushroom, soybean, black bean, bean curd, red curd, celery, capers, red dates, sunflower seeds, walnuts, etc. Research shows that vitamin C, meat, fructose, amino acids, fat can increase the absorption of iron, while tea, coffee, buttermilk, plant acids, wheat bran, etc. can inhibit the absorption of iron, so the diet should pay attention to a reasonable mix of food. In particular, B vitamins and vitamin C, such as fresh green leafy vegetables and fruits (such as apples, tomatoes, cauliflower, potatoes, cabbage, etc.) can promote the absorption of iron in the intestine. If necessary, you can take oral vitamin C tablets to promote the absorption of iron. Promote the use of iron wok to stir-fry vegetables. It should be noted that iron deficiency anemia patients should not drink more tea and coffee after meals, especially do not drink strong tea for a long time, because tea and coffee contain tannic acid, which affects the absorption of iron when combined with iron. Daily cooking can be applied to the following dietary and therapeutic recipes for blood supplementation.
①Pork liver and spinach porridge. Pig liver, japonica rice 100 grams each, spinach 150 grams. Add pork liver and spinach, add a little green onion, ginger and salt to taste, until the pork liver is cooked. It can be taken for breakfast and dinner or as a snack. Efficacy: nourish liver and blood. Indications: Anemia conditioning or winter health conditioning.
②Egg and pork loin congee. 1 egg, 1 pork loin, 60g glutinous rice. Remove the loin of the pig and slice it, break the egg and add the seasoning to mix, cook the porridge with glutinous rice, and add the egg and loin of the pig when it is ready and cook slightly. It can be served as breakfast, dinner or snack. Effects: Tonifying the kidney and strengthening the spleen. Indications: Anemia belonging to spleen and kidney deficiency.
③Pig’s blood and spinach congee. 100 grams of pig’s blood, fresh spinach, 100 grams of round-grained rice. Cut the pig’s blood into small pieces and put it into boiling water, then take it out, put the spinach into boiling water, scald it slightly, take it out and cut it finely, add water to japonica rice and cook the porridge, put the pig’s blood and spinach into the porridge when it is ready, and season it. Serve as breakfast and dinner, can often eat. Efficacy: nourish the liver and blood, laxative and laxative. Indications: Anemia belongs to liver and kidney deficiency, intestinal dryness and constipation.
④Red bean porridge. 100 grams of glutinous rice, 50 grams of red beans, 10 red dates. Wash the three things, put them together in a pot with an appropriate amount of water and cook the porridge. Eat it every morning and evening, or take it as a snack. Effects: Strengthening the spleen and stomach, clearing heat and detoxification, promoting water retention, reducing swelling and promoting lactation. Indications: Anemia, edema, postpartum lactation deficiency due to weakness of spleen and stomach.
(5) Medication
You can use traditional Chinese medicine to regulate, or combine medicine and food to regulate. Commonly used Chinese medicines are as follows.
(1) Xiao Wen Zhong Pill. 1.5~3 grams each time, 3 times a day. Effects: Strengthening the spleen and nourishing blood, clearing heat and resolving dampness. Indications: Yellow disease of spleen labor.
② Vajra Pill. 1.5 grams each time, 3 times a day. Effects: Drying dampness and transporting the spleen, dipping the liver and eliminating stagnation. Indications: strong liver and weak spleen, noma, yellow skin swelling like earth, distended heart and abdomen, tired and weak limbs, able to eat but not digest.
③Gui Shen Wan. 8 to l0 pills each time, 3 times daily. Effects: Benefiting Qi and strengthening the spleen, nourishing blood and calming the mind. Indications: Heart and spleen deficiency with shortness of breath and palpitations, insomnia and dreaminess, dizziness, weakness, loss of appetite, and blood in the stool.
④Ba Zhen Granules. 1 sachet each time, 3 times daily. Efficacy: Double tonic for Qi and Blood. Indications: Used for the deficiency of both qi and blood caused by yellowing, dizziness, weakness of limbs, loss of appetite, cold hands and feet.
⑤ Compound Saponin Pills. Take 7-9 pills once, 3 times a day, immediately after meals. Effects: Warming the kidney and strengthening the marrow, benefiting the qi and nourishing the yin, stopping bleeding and producing blood. Indications: Bone marrow damage caused by radiotherapy and chemotherapy, iron deficiency anemia belonging to spleen and kidney deficiency. Avoid tea.
Commonly used medicated dietary recipes include.
① Astragalus chicken juice porridge. 1 hen, 15 grams of astragalus, 100 grams of round-grained rice. Clean the hen, decoct thick chicken juice, decoct the juice of astragalus, each time to 100 grams of round-grained rice and add chicken juice and juice to cook porridge. Eat it in the morning and evening while it is still hot. Effects: Benefit the vital energy and blood, fill in the essence, replenish the qi and raise the yang, solidify the surface and stop sweating. Indications: Patients with anaemia who have been sick for a long time and have a deficiency of both qi and blood and are malnourished.
②Quail egg with cinnamon. 12 grams of cinnamon meat, 4 quail eggs, 15 grams of brown sugar. Break the quail eggs, put them in a bowl with cinnamon meat and brown sugar, add 60-100 ml of water and steam them on rice. Eat once a day in the morning. Efficacy: tonifying the qi and blood, calming the mind and educating the mind, plumping the muscle and moistening the skin. Indications: Blood strain, insomnia, palpitation, neurasthenia, memory loss. Not suitable for those with internal heat and pregnant women.
③ Peanut and red dates soup. Peanuts with 200 grams, red dates 30-50 grams. Red dates, peanuts with the pot with the right amount of water to boil until the peanuts are cooked. Eat red dates, peanuts, drink soup. Efficacy: strengthen the spleen and generate blood. Indications: Anemia due to spleen deficiency and blood weakness. Not suitable for those with internal heat.
④Ginseng and wolfberry dog meat soup. 1000 grams of dog meat, 20 grams of ginseng, 10 grams of Chinese wolfberry, 10 grams of codonopsis, 5 grams of sand, 15 grams of hyssop. The above, except for the dog meat, into a casserole with water for 30 minutes, then pour out the juice. Cut the dog into small pieces, add soy sauce, sugar, yellow wine, onion, ginger, monosodium glutamate and other seasonings, marinate to taste, put into a pot, add the juice and appropriate amount of water, boil, simmer slowly until the dog is cooked. Serve with meals. Efficacy: Benefit Qi and nourish Yin, warm Yang and replenish blood. Indications: Anemia caused by deficiency of spleen, kidney, yin and yang. Not suitable for those with yin deficiency and fire.
⑤ Divine Duck. 1 duck, 3 grams of ginseng, 20 grams of longan meat, 50, grams of lotus seeds, and 50 jujubes. Remove the hair and guts of the duck, chop off the feet, wash and drain. Slice the ginseng, swell the lotus seeds with water and remove the skin and heart, core the jujube and wash the longan meat. Mix 5 grams of salt, 50 ml of soy sauce and 30 ml of cooking wine and apply on the surface and inside of the duck. Mix the ginseng, longan, lotus seeds and jujube, fill the duck’s belly, put it in a casserole and steam it in a cage with martial fire until the duck is cooked. Serve with meals. Effects: Strengthening the spleen and benefiting the qi. Indications: Anaemia after illness and anaemia in old age.