Edema in iron deficiency anemia
Iron deficiency anemia (sideropenic) -anemia due to iron deficiency in the blood serum and bone marrow, which is accompanied by a violation of heme synthesis, hemoglobin formation and erythrocytes, the development of trophic changes in organs and tissues.
Iron is involved in the transport of oxygen,oxidation-reduction processes, protective reactions. In an adult human body contains 3-5 g of iron. The main part (70%) is part of the hemoglobin, the rest is contained in the cells of different organs, is a part of respiratory enzymes.
Daily loss of iron by the body is insignificant - about 1 mg (with sweat, urine, hair, bowed epithelium of the intestine, bile). Women during menstruation lose 5-15 mg of iron.
The daily need of an adult in iron,necessary to maintain normal biosynthesis of hemoglobin, is 15-30 mg. At the same time, most of the iron comes from the liver - this is the so-called endogenous iron released during the breakdown of red blood cells in the spleen and arriving via the portal vein into the liver.
The main source of recovery of lostiron is food. Especially rich in iron, veal and liver. In the stomach under the action of hydrochloric acid, ferric iron passes into a bivalent iron, which is easily absorbed. Absorption of iron occurs in the duodenum and in the upper parts of the jejunum.
Iron deficiency anemia is the mostwidespread anemia, accounting for more than 80% of all anemia. They are found mainly in young children, in adolescent girls, women of childbearing age. The prevalence of iron deficiency anemia is 12-20% among the entire population, in adolescents - up to 50%, in women of childbearing age - up to 30%.
§ chronic blood loss (acute blood loss occurs without deficiency of iron!);
§ decreased iron absorption;
§ redistributed iron deficiency in infections;
§ increased iron consumption;
§ Insufficient intake of iron into the body;
§ violation of the transport of iron into the bone marrow.
Stages of. latent (deficiency of iron without signs of anemia) and obvious.
There is a general anemic syndrome.
Regardless of the causes of iron deficiency, a number of trophic (sideropenic) disorders are distinguished:
§ Muscle weakness, decreased muscle strength, muscle atrophy;
§ nails brittle, soft, thinned, exfoliated, with longitudinal and transverse striation, often flat (platonic), with raised or concave spoon-like edges (coilonichia);
§ the skin is pale, dry, especially on the face and hands, angular stomatitis (cracks in the corners of the mouth, seizures, cheilosis);
§ The hair is dry, brittle, falls out, grows slowly, ends split;
§ glossitis - the tongue is bright red, shiny, edematous, painful, with a smooth surface, the papillae are smoothened or absent;
§ Atrophic esophagitis (dysphagia, hoarseness);
§ dental caries and their crumbling, abnormal growth, erasability of enamel;
§ distortion of taste and smell, addiction to inedible things (chalk, dental powder, clay, charcoal, dough, cereals, raw meat, etc.), atrophic changes in the gastric mucosa;
§ Atrophy of the mucous membrane of the genitals, accompanied by hyper-, hypo- and amenorrhea;
§ mandatory urges for urination, sphincter disorders.
Syndrome of endogenous metabolic intoxicationmanifested by a violation of thermoregulation (prolonged subfebrile condition), psychoemotional disorders, predisposition to respiratory diseases, chronic infection.
Attention is paid to the pallor of the skin andmucous membranes, the appearance of a yellowish hue around the eyes, tachycardia, hypotension, functional systolic noise at the top due to a violation of blood viscosity against the background of sonorous tones, it is possible the appearance of peripheral edema, "bags" under the eyes in the mornings. With severe anemia, the "whirligig noise" above the cervical veins can be determined.
In the general analysis of blood, hypochromicanemia, sometimes acceleration of ESR. Microcytosis of erythrocytes is observed, sometimes anisocytosis (changes in diameter), poikilocytosis (changes in shape). In the blood serum, the iron content is reduced (in the norm of 12.5-30.4 μmol / l). In iron deficiency anemia, the exchange of copper, cobalt and manganese is also disturbed.
Iron deficiency anemia can be complicated by myocardial dystrophy with arrhythmias and circulatory insufficiency.
Diagnostic criteria: the presence of anemic and sideropenic syndromes, hypochromic anemia in UAC, iron deficiency in blood serum.
In contrast to iron deficiency,Iron-deficient anemia (sideroachrastic) - anemia with low iron content in erythrocytes (hypochromia), not because of its deficiency in the body, but as a result of deficiency or absence of enzymes involved in the synthesis of heme (porphyrins).
Violation of the synthesis of porphyrins can behereditary nature (recessive, linked to the sex, found mainly in boys) and acquired (in persons who have industrial contact with lead, cadmium, nickel, toxic substances). In the general analysis of blood - hypochromic anemia, in biochemical analysis - the level of serum iron is increased.
3. Diagnostic B12 - and folic deficiency anemia
B12 -deficit anemia - a disease caused by a violation of hematopoiesis due to a lack of vitamin B in the body12. Particularly sensitive to the deficiency of this vitamin is the bone marrow and tissues of the nervous system.
In 1855 the English physician Thomas Addison, andthen in 1872 the German physician Anton Birmer described in more detail the disease, which was called malignant (pernicious) anemia. Soon French physician Arman Trusso proposed to call these diseases addison anemia and Addison's disease.
In 1926, J. Whipple, J. Minot and U.Murphy reported that pernicious anemia is treated with an introduction to the diet of raw liver and that the underlying cause of the disease is the inborn inability of the stomach to secrete the substance necessary for absorption of vitamin B12 in the intestine. For this discovery they in 1934 received the Nobel Prize.
Vitamin B12 and folic acid have a gemostimulating effect, are widespread in nature. The main depot of vitamins in the body is the liver. Daily losses of these vitamins are negligible. Absorbed vitamin B12 in the distal parts of the small intestine. Absorption, penetration of vitamin B12 Through the intestinal barrier, the so-calledinternal factor Castle - gastromukoprotein, secreted by the lining of the bottom and body of the stomach. Folic acid deficiency is absorbed in the ileum.
Etiology. The main cause of B12 -deficit anemia is a deficiency of cyanocobalamin and / or folic acid with the development of megaloblastic hematopoiesis. The reasons for this are:
1.1. Inadequate development of the internal factor of the Castle. The main cause of vitamin B deficiency12 (in 90% of patients) is atrophic gastritis, which leads to a violation of the development of the internal factor of the Castle. Less often the disease develops after gastrectomy or resection of the stomach.
1.2. Diseases of the ileum (sprue, enteritis, ileal resection, diverticulosis, etc.), which is the main site of absorption of vitamin B12.
2. Competitive absorption of vitamin B12 when infecting with a wide ribbon, dysbiosis.
3. Taking a number of medications (colchicine, aminosalicylic acid).
4. Inadequate intake of vitamin B12 with food.
5. Violation of the synthesis and structure of transcobalamines.
Megaloblastic anemia is characterized by weakeningsynthesis of DNA, as a result of which the division of all rapidly proliferating cells (hematopoietic cells, skin cells, gastrointestinal tract, mucous membranes) is disrupted. Hemopoietic cells belong to the most rapidly multiplying elements, therefore anemia (often neutropenia and thrombocytopenia) comes to the fore in the clinic.
In adults, endogenous B is especially common12 -deficit anemia (Addison-Burmer anemia,pernicious (from Latin perniciosus - fatal, dangerous), megaloblastic, malignant anemia). Women are more often than 40 years old. The disease develops gradually, slowly, acquiring a chronic recurrent course.
Clinical signs anemia nonspecific: weakness, fatigue, shortness of breath, dizziness, palpitations. The patients are pale, subiclinic.
A characteristic symptom is glossitis - the languagesmooth, shiny (lacquered) due to atrophy of the papillae. Gastric secretion is sharply reduced. With fibrogastroscopy, atrophy of the gastric mucosa is revealed, which is also confirmed histologically. Clinically, the patient notes a decrease in appetite, a feeling of heaviness in the epigastrium after eating, burping food or air. Palpation of the abdomen is accompanied by a moderate pain in the epigastrium, often increases the liver and spleen.
Symptoms of nervous system damage are observed(funicular myelosis), which do not always correlate with the severity of anemia. At the heart of neurological manifestations is the demyelination of nerve fibers. There are: weakness in the legs, especially when climbing the stairs, paresthesia, numbness of the limbs, unsteadiness of the gait, the feeling of cotton under the feet when walking, peripheral polyneuropathy (tingling, burning and / or pain in the feet and hands), sensitivity disorders, increased tendon reflexes.
In this way, for B12 deficiency anemia is characterized by a triad: defeat of blood; GIT; nervous system.
1. Clinical blood test:
• decrease in the number of red blood cells;
• increase in color index (above 1.05);
• Macrocytosis (macrocytic anemia);
• presence in erythrocytes of basophilic granularity and pathological inclusions: Jolly's body and Cabot rings;
Basophilic granularity (puncture) of erythrocytes - granules of blue-violet or blue color, of various sizes, are located more often on the periphery of the erythrocyte or normoblast, represent the remnants of ribosomes.
Taurus Jolly (Howell-Jolly's calf) - small round violet-red inclusions of 1-2 μm in size, occur in 1 (rarely 2-3) in one erythrocyte. They represent the remainder of the nucleus after the removal of its RES.
Rings of the Quota - the remnants of the shell of the nucleus in the form of a figure-eight or ring, are painted red.
2. In stained smears - a typical picture: along with characteristic oval macro-cells, there are erythrocytes of normal size, poikilo- and anisocytosis.
3. Serum bilirubin level is increased due to the indirect fraction
4. Puncture of the bone marrow is mandatory; such a picture on the periphery can be with leukemia, hemolytic anemia, aplastic and hypoplastic conditions (however, hyperchromia is characteristic for B12 -deficit anemia). In the bone marrow there are typical megaloblasts - the main criterion for diagnosing B12 -deficit anemia.
Folic deficiency anemia is more common in young children andyoung women. Among the clinical symptoms, the symptoms of the underlying disease, complicated by anemia, predominate. There are general anemic signs, phenomena of diarrhea, steatorrhea. Rarely are there lesions of the nervous system, achilles. In a general blood test, changes are similar to those in Addison-Birmer anemia. For differential diagnosis, bone marrow smears are stained with alizarin red. In this case, only B12 -deficient megaloblasts and do not stain megaloblasts with a deficiency of folic acid.