I. Overview.
1.Definition: Anemia that occurs when the body cannot meet the needs of normal red blood cell production due to the depletion of stored iron in the body.
2. Epidemiology: Liu Xueyong, Department of Hematology, Langfang Hospital of Traditional Chinese Medicine, the world’s most anemic
WHO reported in 1985 that 30% of the world suffered from anemia, 50% of which were iron deficiency.
Developing countries: 70% of children and women of childbearing age suffer from anemia, of which 30% have iron deficiency.
Developed countries: 30% of adolescents and women, 60% of pregnant women suffer from anemia, of which 14% of women and 30% of youth have iron deficiency.
Second, the metabolism of iron.
1, the distribution of iron.
Total iron in the body 50~55mg/kg 35~40mg/kg
Distribution: Hemoglobin 66-70 % 66-70 %
Myoglobin 15% 15%
Cellular enzymes 1 % 1 %
Stored iron (in the form of ferritin) 700～1000mg 200～400mg
2.Iron sources and absorption.
Sources of iron.
(1) Exogenous iron: intake from food, 1.0~1.5mg/day.
Kelp, fungus, mushrooms, liver, meat, beans, etc.
The absorbable rate of animal iron is 20%.
Plant iron can be absorbed at a rate of 1-7%.
(2) Endogenous iron: aging or destroyed red blood cells, the absorbable rate is 100%.
(3) Oral iron, intramuscular iron injection, intravenous blood transfusion, etc. in pathological conditions.
Iron absorption
Absorption site: duodenum and upper jejunum
With the help of: vitamin C as an oxidizing agent, so that Fe++ + → Fe++ for easy absorption
3.Iron storage.
Excess iron after synthesis of erythrocytes: stored in the monocyte-macrophage system in the form of ferritin and iron-containing hemoglobin.
4.Iron excretion.
Normal feces <1mg/day
1mg/day in breast milk
Small amount in sweat and urine
C. Etiology.
Normal condition: iron excretion and iron absorption maintain a dynamic balance.
IV. Pathogenesis.
Iron is an essential trace element that is present in all living cells of the body.
It is involved in: Hb synthesis, mitochondrial electron transfer, DNA synthesis, and the function of various bioeffective enzymes in the organism.
In case of iron deficiency.
1. Lactic acid accumulates easily in skeletal muscle after exercise and muscle strength decreases;
2. Decreased activity of monoamine oxidase: poor neurological and intellectual development.
3, iron-containing enzyme activity is reduced: epithelial cell keratinization is accelerated, mucous membrane atrophy, resulting in dry skin, gastric acid must decline, etc.
4.Decrease of peroxidase activity: poor metaplasia of red blood cells and shortened life span
5.It can reduce the platelet adhesion function and aggravate bleeding.
6, macrophage function and spleen natural killer cell function is reduced, the body is easy to infection.
7.Decreased cellular immune function and susceptibility to infection.
V. Clinical manifestations.
The clinical manifestation of iron deficiency anemia consists of anemia, the manifestation of iron deficiency and the disease causing iron deficiency together. The manifestations of anemia progress slowly, and generally people can adapt and continue to work and study.
1.Common symptoms: dizziness, headache, tinnitus, easy tiredness, fatigue, shortness of breath after palpitations and activities, eye blur, etc.
2.Special symptoms: stomatitis, atrophy of tongue papillae, tongue inflammation, anthelmintic, loss of appetite, nausea, constipation, difficulty in swallowing.
3.Non-anemic symptoms of iron deficiency: slow growth or abnormal behavior in childhood, showing irritability, inattention, eating wall dirt and stones, etc.
4.Signs: pale skin and mucous membranes, dry hair, keratinization of mouth and lips and pores, flattened and lusterless nails that are easily broken, rebound nails, enlarged spleen, etc.
VI. Laboratory tests.
1. Blood picture: typical cases show small cell hypochromic anemia.
MCV <80fL, HCH <27pg, HCHC <30%.
2. Bone marrow picture: active proliferation, obvious hyperplasia of the red lineage, low cytoplasm volume.
Few or absent iron granulocytes, extracellular iron deficiency.
3.Biochemical examination.
(1) Serum iron <50mg/dl, total iron binding capacity >360μg/dl.
(2) Serum ferritin <12μg/L.
(3) Erythrocyte ferritin <6.5 ag/erythrocyte (release immunoassay)
4. Other tests.
To clarify anemia, stool occult blood, liver and kidney function, urine routine, gastrointestinal GI, gastroscopy, immune complete set, etc. are also available.
VII. Diagnosis and differential diagnosis.
Diagnosis.
Diagnostic clues can be obtained by careful history taking and physical examination, plus laboratory tests for diagnosis.
1. Serum ferritin <12μg/L;
2, Bone marrow iron staining shows <10% or loss of iron granulocytes and loss of extracellular iron;
3.Transferrin saturation <15%;
4, erythrocyte free protoepiphyrin >0.9μmo1/L or >4.5μg/gHb;
Differential diagnosis.
Differentiate mainly from other small cell hypoerythrocytic anemias.
1. dyscytogenic anemia.
There is often a family history of target-shaped cells in the blood, increased HbF and HbA2 visible in the hemoglobin electric pulse, increased serum iron and bone marrow stained iron
2. Chronic infectious anemia.
Low serum iron but total iron binding capacity does not increase but decreases;
Decreased iron granulocytes in bone marrow and increased iron-containing heme granules.
3, iron granulocytic anemia.
Rarely seen clinically, preferably in the elderly, with impaired iron utilization.
Serum iron is increased but total iron binding capacity is normal.
Iron granules are significantly increased in the bone marrow, and ring-shaped iron granulocytes are seen.
VIII. Treatment.
Etiological treatment.
Get rid of the cause as much as possible in order to treat both the symptoms and the root cause.
Iron supplementation: avoid taking with tea
1, oral after meals for easy.
150~200mg/day (elemental iron)
Ferrous sulfate: Adult 0.3g (containing 60mg of elemental iron) 3 times a day
Ferrous fumarate: Adult 0.2g (containing elemental iron 70mg) 3 times a day
Reticulocytes rise 3-4 days after taking the drug, peak at 7 days
Hb rises after 2 weeks, and reaches normal in 1~2 months.
Insist on taking it again for 3-6 months to make the stored iron sufficient.
2. Those who cannot take orally.
Those who cannot or cannot tolerate the stimulation due to the disease, can be injected intramuscularly with 50-100mg/day of iron dextrose.
Calculation formula.
[150-(patient’s current Hbg/L)] x body weight (kg) x 0.33
= number of days of intramuscular iron infusion
(15 – patient’s present hemoglobin count) × 300 + 500 (stored iron)
Caution.
The first intramuscular injection of 50mg, if no response, the second available 100mg some people (5-15%) can have injection local redness and pain, lymphadenitis, headache, dizziness, fever, urticaria and arthralgia, occasional anaphylaxis, life-threatening emergency available epinephrine.
IX. Prevention
Most of them can be prevented. Pay attention to nutrition and maternal and child health care, improve infant and child feeding, appropriate iron supplementation for women during menstruation and lactation. Pay attention to hygiene, prevention of parasites, such as hookworm infection treatment of chronic gastrointestinal diseases, such as gastritis, ulcer disease, etc.