Medications for the treatment of iron deficiency anemia. Iron deficiency anemia (IDA): causes, degrees, signs, diagnosis, how to treat
Interesting Facts
- The first documented mention of iron deficiency anemia dates back to 1554. In those days, this disease mainly affected girls aged 14-17, in connection with which the disease was called “de morbo virgineo”, which means “virgin disease”.
- The first attempts to treat the disease with iron preparations were made in 1700.
- Latent ( hidden) iron deficiency can occur in children during a period of intensive growth.
- The iron requirement of a pregnant woman is twice that of two healthy adult men.
- During pregnancy and childbirth, a woman loses more than 1 gram of iron. With normal nutrition, these losses will be restored only after 3-4 years.
What are erythrocytes?
Erythrocytes, or red blood cells, are the most numerous population of blood cells. These are highly specialized cells lacking a nucleus and many other intracellular structures ( organelle). The main function of erythrocytes in the human body is the transport of oxygen and carbon dioxide. Structure and function of erythrocytes
The size of a mature erythrocyte ranges from 7.5 to 8.3 micrometers ( micron). It has the shape of a biconcave disk, which is maintained due to the presence of a special structural protein, spectrin, in the erythrocyte cell membrane. This form ensures the most efficient process of gas exchange in the body, and the presence of spectrin allows red blood cells to change when passing through the smallest blood vessels ( capillaries) and then return to its original shape.More than 95% of the intracellular space of the erythrocyte is filled with hemoglobin - a substance consisting of the protein globin and the non-protein component - heme. The hemoglobin molecule consists of four globin chains, each of which has a heme in the center. Each red blood cell contains over 300 million hemoglobin molecules.
The non-protein part of hemoglobin, namely the iron atom, which is part of the heme, is responsible for transporting oxygen in the body. Enrichment of blood with oxygen oxygenation) occurs in the pulmonary capillaries, when passing through which each iron atom attaches 4 oxygen molecules to itself ( oxyhemoglobin is formed). Oxygenated blood is carried through the arteries to all tissues of the body, where oxygen is transferred to the cells of organs. Instead, carbon dioxide is released from the cells ( by-product of cellular respiration), which attaches to hemoglobin ( carbhemoglobin is formed) and is transported through the veins to the lungs, where it is released into the environment along with the exhaled air.
In addition to the transport of respiratory gases, additional functions of red blood cells are:
- antigenic function. Erythrocytes have their own antigens, which determine belonging to one of the four main blood groups ( according to the AB0 system).
- transport function. To the outer surface of the erythrocyte membrane antigens of microorganisms, various antibodies and some medications can be attached, which are carried with the bloodstream throughout the body.
- buffer function. Hemoglobin is involved in maintaining the acid-base balance in the body.
- Stop bleeding. Erythrocytes are included in the thrombus, which is formed when the vessels are damaged.
RBC formation
In the human body, red blood cells are formed from so-called stem cells. These unique cells are formed at the stage of embryonic development. They contain a nucleus containing the genetic apparatus ( DNA - deoxyribonucleic acid), as well as many other organelles that provide the processes of their vital activity and reproduction. Stem cells give rise to all the cellular elements of the blood.The normal process of erythropoiesis requires:
- Iron. This trace element is part of the heme ( non-protein part of the hemoglobin molecule) and has the ability to reversibly bind oxygen and carbon dioxide, which determines the transport function of erythrocytes.
- Vitamins ( B2, B6, B9 and B12). Regulate the formation of DNA in the hematopoietic cells of the red bone marrow, as well as the processes of differentiation ( maturation) erythrocytes.
- Erythropoietin. A hormonal substance produced by the kidneys that stimulates the formation of red blood cells in the red bone marrow. With a decrease in the concentration of red blood cells in the blood, hypoxia develops ( lack of oxygen), which is the main stimulator of erythropoietin production.
In the process of becoming an erythrocyte, the stem cell undergoes a number of changes. It decreases in size, gradually loses the nucleus and almost all organelles ( as a result of which its further division becomes impossible), and also accumulates hemoglobin. The final step in erythropoiesis in the red bone marrow is the reticulocyte ( immature erythrocyte). It is washed out of the bones into the peripheral bloodstream, and during the day it matures to the stage of a normal erythrocyte, capable of fully performing its functions.
RBC destruction
The average lifespan of red blood cells is 90-120 days. After this period, their cell membrane becomes less plastic, as a result of which it loses the ability to reversibly deform when passing through the capillaries. "Old" red blood cells are captured and destroyed by special cells of the immune system - macrophages. This process occurs mainly in the spleen, as well as ( to a much lesser extent) in the liver and red bone marrow. An insignificantly small proportion of erythrocytes is destroyed directly in the vascular bed.When an erythrocyte is destroyed, hemoglobin is released from it, which quickly breaks down into protein and non-protein parts. Globin undergoes a series of transformations, resulting in the formation of a yellow pigment complex - bilirubin ( unbound form). It is insoluble in water and highly toxic ( able to penetrate into the cells of the body, disrupting their vital processes). Bilirubin is rapidly transported to the liver, where it binds to glucuronic acid and is excreted along with bile.
The non-protein part of hemoglobin ( gem) is also destroyed, resulting in the release of free iron. It is toxic to the body, so it quickly binds to transferrin ( blood transport protein). Most of the iron released during the destruction of red blood cells is transported to the red bone marrow, where it is reused for the synthesis of red blood cells.
What is iron deficiency anemia?
Anemia is a pathological condition characterized by a decrease in the concentration of red blood cells and hemoglobin in the blood. If the development of this condition is due to insufficient intake of iron in the red bone marrow and the associated violation of erythropoiesis, then anemia is called iron deficiency. The body of an adult contains about 4 grams of iron. This figure varies by gender and age.
The concentration of iron in the body is:
- in newborns - 75 mg per 1 kilogram of body weight ( mg/kg);
- in men - more than 50 mg / kg;
- in women - 35 mg / kg ( associated with monthly blood loss).
- erythrocyte hemoglobin - 57%;
- muscles - 27%;
- liver - 7 - 8%.
The absorption of iron in the human body occurs mainly in the duodenum, while all iron entering the body is usually divided into heme ( bivalent, Fe +2), contained in the meat of animals and birds, in fish, and non-heme ( trivalent, Fe +3), the main source of which are dairy products and vegetables. An important condition necessary for the normal absorption of iron is a sufficient amount of hydrochloric acid, which is part of the gastric juice. With a decrease in its amount, the absorption of iron slows down significantly.
The absorbed iron binds to transferrin and is transported to the red bone marrow, where it is used for the synthesis of red blood cells, as well as to depot organs. Iron stores in the body are mainly represented by ferritin, a complex consisting of the protein apoferritin and iron atoms. Each ferritin molecule contains an average of 3-4 thousand iron atoms. With a decrease in the concentration of this trace element in the blood, it is released from ferritin and used for the needs of the body.
The rate of absorption of iron in the intestine is strictly limited and cannot exceed 2.5 mg per day. This amount is only enough to restore the daily loss of this trace element, which is normally about 1 mg in men and 2 mg in women. Therefore, under various pathological conditions, accompanied by impaired absorption of iron or increased losses, a deficiency of this microelement may develop. With a decrease in the concentration of iron in plasma, the amount of hemoglobin synthesized decreases, as a result of which the resulting red blood cells will be smaller. In addition, the growth processes of erythrocytes are disrupted, which leads to a decrease in their number.
Causes of iron deficiency anemia
Iron deficiency anemia can develop both as a result of insufficient intake of iron in the body, and in violation of the processes of its use. The cause of iron deficiency in the body can be:
- insufficient intake of iron from food;
- increasing the body's need for iron;
- congenital iron deficiency in the body;
- iron absorption disorder;
- disruption of transferrin synthesis;
- increased blood loss;
- the use of medicines.
Insufficient intake of iron from food
Malnutrition can lead to the development of iron deficiency anemia in both children and adults.The main reasons for insufficient intake of iron in the body are:
- prolonged fasting;
- monotonous diet with a low content of animal products.
Increased body needs for iron
Under normal, physiological conditions, there may be an increased need for iron. This is typical for women during pregnancy and during breastfeeding.Although some iron is retained during pregnancy ( due to lack of menstrual bleeding), the need for it increases several times.
Causes of increased iron requirements in pregnant women
| Cause | Approximate amount of consumed iron |
| Increase in circulating blood volume and red blood cell count | 500 mg |
| Iron transferred to the fetus | 300 mg |
| Iron in the placenta | 200 mg |
| Blood loss during childbirth and in the postpartum period | 50 - 150 mg |
| Iron lost in breast milk during the entire feeding period | 400 - 500 mg |
Thus, during the time of bearing and breastfeeding one child, a woman loses at least 1 gram of iron. These figures increase with multiple pregnancy, when 2, 3 or more fetuses can develop simultaneously in the mother's body. Given that the rate of iron absorption cannot exceed 2.5 mg per day, it becomes clear that almost any pregnancy is accompanied by the development of an iron deficiency state of varying severity.
Congenital iron deficiency in the body
The body of the child receives from the mother all the necessary nutrients, including iron. However, in the presence of certain diseases in the mother or fetus, the birth of a child with iron deficiency is possible.The cause of congenital iron deficiency in the body can be:
- severe iron deficiency anemia in the mother;
- multiple pregnancy;
- prematurity.
Iron malabsorption
Absorption of iron in the duodenum is possible only with a normal functional state of the mucous membrane of this section of the intestine. Various diseases of the gastrointestinal tract can damage the mucous membrane and significantly reduce the rate of iron intake into the body.To reduce the absorption of iron in the duodenum can lead to:
- Enteritis - inflammation of the mucous membrane of the small intestine.
- celiac disease a hereditary disease characterized by gluten protein intolerance and associated malabsorption in the small intestine.
- Helicobacter pylori- an infectious agent that affects the gastric mucosa, which ultimately leads to a decrease in the secretion of hydrochloric acid and malabsorption of iron.
- Atrophic gastritis - disease associated with atrophy reduction in size and function) of the gastric mucosa.
- Autoimmune gastritis - a disease caused by a malfunction of the immune system and the production of antibodies to its own cells of the gastric mucosa, followed by their destruction.
- Removal of the stomach and / or small intestine - at the same time, both the amount of hydrochloric acid formed and the functional area of the duodenum, where iron is absorbed, decreases.
- Crohn's disease - an autoimmune disease, manifested by an inflammatory lesion of the mucous membrane of all parts of the intestine and, possibly, the stomach.
- Cystic fibrosis - a hereditary disease manifested by a violation of the secretion of all glands of the body, including the gastric mucosa.
- Cancer of the stomach or duodenum.
Disruption of transferrin synthesis
Violation of the formation of this transport protein can be associated with various hereditary diseases. The newborn will not have symptoms of iron deficiency, since he received this trace element from the mother's body. After birth, the main way iron enters the child's body is absorption in the intestine, however, due to the lack of transferrin, the absorbed iron cannot be delivered to the depot organs and to the red bone marrow and cannot be used in the synthesis of red blood cells.Since transferrin is synthesized only in liver cells, various liver lesions ( cirrhosis, hepatitis and others) can also lead to a decrease in the plasma concentration of this protein and the development of symptoms of iron deficiency anemia.
Increased blood loss
A one-time loss of a large amount of blood usually does not lead to the development of iron deficiency anemia, since the iron stores in the body are sufficient to compensate for the loss. At the same time, with chronic, prolonged, often imperceptible internal bleeding, the human body can lose several milligrams of iron daily, for several weeks or even months.The cause of chronic blood loss can be:
- nonspecific ulcerative colitis ( inflammation of the intestinal mucosa);
- intestinal polyposis;
- disintegrating tumors of the gastrointestinal tract ( and other localization);
- hiatal hernia;
- endometriosis ( proliferation of cells in the inner layer of the uterine wall);
- systemic vasculitis ( inflammation of blood vessels of various localization);
- blood donation by donors more than 4 times a year ( 300 ml of donated blood contains about 150 mg of iron).
Alcoholism
Prolonged and frequent use of alcohol leads to damage to the gastric mucosa, which is associated primarily with the aggressive effects of ethyl alcohol, which is part of all alcoholic beverages. In addition, ethyl alcohol directly inhibits hematopoiesis in the red bone marrow, which can also increase the manifestations of anemia.The use of drugs
Taking certain medications can interfere with the absorption and utilization of iron in the body. This usually occurs with long-term use of large doses of medications.Drugs that can cause iron deficiency in the body are:
- Non-steroidal anti-inflammatory drugs ( aspirin and others). The mechanism of action of these drugs is associated with an improvement in blood flow, which can lead to chronic internal bleeding. In addition, they contribute to the development of stomach ulcers.
- Antacids ( Rennie, Almagel). This group of drugs neutralizes or reduces the rate of secretion of gastric juice containing hydrochloric acid, which is necessary for the normal absorption of iron.
- Iron-binding drugs ( Desferal, Exjade). These drugs have the ability to bind and remove iron from the body, both free and included in the composition of transferrin and ferritin. In case of an overdose, the development of an iron deficiency state is possible.
Symptoms of iron deficiency anemia
Symptoms of this disease are due to a lack of iron in the body and impaired hematopoiesis in the red bone marrow. It is worth noting that iron deficiency develops gradually, so at the beginning of the disease, symptoms can be quite poor. Latent ( hidden) iron deficiency in the body can lead to symptoms of sideropenic ( iron deficiency) syndrome. Somewhat later, an anemic syndrome develops, the severity of which is determined by the level of hemoglobin and erythrocytes in the body, as well as the rate of development of anemia ( the faster it develops, the more pronounced the clinical manifestations will be), compensatory capabilities of the body ( in children and the elderly they are less developed) and the presence of comorbidities. Manifestations of iron deficiency anemia are:
- muscle weakness;
- increased fatigue;
- cardiopalmus;
- changes in the skin and its appendages ( hair, nails);
- damage to the mucous membranes;
- language loss;
- violation of taste and smell;
- susceptibility to infectious diseases;
- intellectual development disorders.
Muscle weakness and fatigue
Iron is part of myoglobin, the main protein in muscle fibers. With its deficiency, the processes of muscle contraction are disrupted, which will be manifested by muscle weakness and a gradual decrease in muscle volume ( atrophy). In addition, for the work of the muscles, a large amount of energy is constantly needed, which can only be formed with an adequate supply of oxygen. This process is disturbed by a decrease in the concentration of hemoglobin and erythrocytes in the blood, which is manifested by general weakness and intolerance to physical activity. People get tired quickly when doing daily work ( climbing stairs, going to work and so on), and this can significantly reduce their quality of life. Children with iron deficiency anemia are characterized by a sedentary lifestyle, they prefer "sitting" games.Shortness of breath and palpitations
An increase in respiratory rate and heart rate occurs with the development of hypoxia and is a compensatory reaction of the body aimed at improving blood supply and oxygen delivery to various organs and tissues. This may be accompanied by a feeling of lack of air, pain behind the sternum, ( arising from insufficient oxygen supply to the heart muscle), and in severe cases - dizziness and loss of consciousness ( due to impaired blood supply to the brain).Changes in the skin and its appendages
As mentioned earlier, iron is part of many enzymes involved in the processes of cellular respiration and division. Deficiency of this trace element leads to damage to the skin - it becomes dry, less elastic, flaky and cracked. In addition, the usual red or pinkish tint to the mucous membranes and skin is given by erythrocytes that are in the capillaries of these organs and contain oxygenated hemoglobin. With a decrease in its concentration in the blood, as well as as a result of a decrease in the formation of red blood cells, pallor of the skin may be noted.Hair becomes thinner, loses its usual shine, becomes less durable, breaks easily and falls out. Gray hair appears early.
Nail involvement is a very specific manifestation of iron deficiency anemia. They become thinner, acquire a matte shade, exfoliate and break easily. Characteristic is the transverse striation of the nails. With a pronounced iron deficiency, koilonychia can develop - the edges of the nails rise and bend in the opposite direction, acquiring a spoon-shaped shape.
Mucosal damage
Mucous membranes are tissues in which the processes of cell division occur as intensely as possible. That is why their defeat is one of the first manifestations of iron deficiency in the body.Iron deficiency anemia affects:
- The mucous membrane of the oral cavity. It becomes dry, pale, areas of atrophy appear. Difficulty chewing and swallowing food. Also characteristic are the presence of cracks on the lips, the formation of jamming in the corners of the mouth ( cheilosis). In severe cases, the color changes and the strength of the tooth enamel decreases.
- The mucous membrane of the stomach and intestines. Under normal conditions, the mucous membrane of these organs plays an important role in the absorption of food, and also contains many glands that produce gastric juice, mucus and other substances. With its atrophy ( caused by iron deficiency) digestion is disturbed, which can be manifested by diarrhea or constipation, abdominal pain, and malabsorption of various nutrients.
- The mucous membrane of the respiratory tract. Damage to the larynx and trachea can be manifested by perspiration, a feeling of having a foreign body in the throat, which will be accompanied by an unproductive ( dry, no moisture) cough. In addition, the mucous membrane of the respiratory tract normally performs a protective function, preventing foreign microorganisms and chemicals from entering the lungs. With its atrophy, the risk of developing bronchitis, pneumonia and other infectious diseases of the respiratory system increases.
- The mucous membrane of the genitourinary system. Violation of its function can be manifested by pain during urination and during sexual intercourse, urinary incontinence ( more common in children), as well as frequent infectious diseases in the affected area.
Tongue lesion
Language changes are a characteristic manifestation of iron deficiency. As a result of atrophic changes in its mucous membrane, the patient may feel pain, burning sensation and fullness. The appearance of the tongue also changes - the normally visible papillae disappear ( which contain a large number of taste buds), the tongue becomes smooth, covered with cracks, irregularly shaped reddening zones may appear ( "geographic language").Taste and smell disorders
As already mentioned, the mucous membrane of the tongue is rich in taste buds, located mainly in the papillae. With their atrophy, various taste disorders may appear, starting with a decrease in appetite and intolerance to certain types of products ( usually sour and salty foods), and ending with a perversion of taste, an addiction to eating earth, clay, raw meat and other inedible things.Olfactory disturbances can be manifested by olfactory hallucinations ( smells that aren't really there) or addiction to unusual smells ( varnish, paint, gasoline and others).
Tendency to infectious diseases
With iron deficiency, the formation of not only erythrocytes is disrupted, but also leukocytes - the cellular elements of the blood that protect the body from foreign microorganisms. The lack of these cells in the peripheral blood increases the risk of developing various bacterial and viral infections, which increases even more with the development of anemia and impaired blood microcirculation in the skin and other organs.
Intellectual Development Disorders
Iron is part of a number of brain enzymes ( tyrosine hydroxylase, monoamine oxidase and others). Violation of their formation leads to a violation of memory, concentration of attention and intellectual development. In the later stages, with the development of anemia, intellectual impairment is exacerbated due to insufficient supply of oxygen to the brain.Diagnosis of iron deficiency anemia
A doctor of any specialty can suspect the presence of anemia in a person, based on the external manifestations of this disease. However, establishing the type of anemia, identifying its cause and prescribing appropriate treatment should be handled by a hematologist. In the process of diagnosis, he can prescribe a number of additional laboratory and instrumental studies, and, if necessary, involve specialists from other fields of medicine. It is important to note that the treatment of iron deficiency anemia will be ineffective if the cause of its occurrence is not identified and eliminated.
In the diagnosis of iron deficiency anemia is used:
- questioning and examination of the patient;
- bone marrow puncture.
Questioning and examining the patient
The first thing a doctor should do if iron deficiency anemia is suspected is to carefully interview and examine the patient.The doctor may ask the following questions:
- When and in what sequence did the symptoms of the disease begin to appear?
- How fast did they develop?
- Do family members or close relatives have similar symptoms?
- How is the patient eating?
- Does the patient suffer from any chronic diseases?
- What is your attitude towards alcohol?
- Has the patient taken any medication in the past months?
- If a pregnant woman is sick, the gestational age, the presence and outcome of previous pregnancies, and whether she takes iron supplements are specified.
- If a child is sick, his birth weight is specified, whether he was born full-term, whether the mother took iron supplements during pregnancy.
- The nature of nutrition- according to the degree of expression of subcutaneous fat.
- Skin color and visible mucous membranes- special attention is paid to the oral mucosa and tongue.
- skin appendages - hair, nails.
- muscle strength- the doctor asks the patient to squeeze his hand or uses a special device ( dynamometer).
- Arterial pressure - it can be reduced.
- Taste and smell.
General blood analysis
This is the first test given to all patients with suspected anemia. It allows you to confirm or refute the presence of anemia, and also provides indirect information about the state of hematopoiesis in the red bone marrow.Blood for general analysis can be taken from a finger or from a vein. The first option is more suitable if the general analysis is the only laboratory test assigned to the patient ( when a small amount of blood is enough). Before taking blood, the skin of the finger is always treated with cotton wool soaked in 70% alcohol to avoid infection. The puncture is made with a special disposable needle ( scarifier) to a depth of 2–3 mm. Bleeding in this case is not strong and completely stops almost immediately after taking blood.
In the event that it is planned to perform several studies at once ( e.g. general and biochemical analysis) - take venous blood, as it is easier to obtain in large quantities. Before blood sampling, a rubber tourniquet is applied to the middle third of the upper arm, which leads to the filling of the veins with blood and makes it easier to determine their location under the skin. The puncture site should also be treated with an alcohol solution, after which the nurse pierces the vein with a disposable syringe and collects blood for analysis.
The blood obtained by one of the described methods is sent to the laboratory, where it is examined in a hematological analyzer - a modern high-precision device available in most laboratories in the world. Part of the received blood is stained with special dyes and examined under a light microscope, which allows you to visually assess the shape of erythrocytes, their structure, and in the absence or malfunction of a hematological analyzer, to count all the cellular elements of the blood.
In iron deficiency anemia, a peripheral blood smear is characterized by:
- Poikilocytosis - the presence in the smear of erythrocytes of various forms.
- Microcytosis - the predominance of erythrocytes, the size of which is less than normal ( normal erythrocytes may also occur).
- Hypochromia - the color of red blood cells changes from bright red to pale pink.
The results of a complete blood count for iron deficiency anemia
| Researched indicator | What does it mean? | Norm | |
| RBC concentration
(RBC) | With the depletion of iron stores in the body, erythropoiesis in the red bone marrow is disrupted, as a result of which the total concentration of red blood cells in the blood will be reduced. | Men
(M
)
:
4.0 - 5.0 x 10 12 / l. | Less than 4.0 x 10 12 / l. |
| Women(AND):
3.5 - 4.7 x 10 12 / l. | Less than 3.5 x 10 12 / l. | ||
| Average erythrocyte volume
(MCV ) | With iron deficiency, the processes of hemoglobin formation are disrupted, as a result of which the size of the erythrocytes themselves decreases. The hematological analyzer allows you to determine this indicator as accurately as possible. | 75 - 100 cubic micrometers ( µm 3). | Less than 70 µm 3. |
| Platelet concentration (PLT) | Platelets are the cellular elements of the blood responsible for stopping bleeding. A change in their concentration can be observed if iron deficiency is caused by chronic blood loss, which will lead to a compensatory increase in their formation in the bone marrow. | 180 - 320 x 10 9 / l. | Normal or increased. |
| Leukocyte concentration (WBC) | With the development of infectious complications, the concentration of leukocytes can increase significantly. | 4.0 - 9.0 x 10 9 / l. | Normal or increased. |
| Reticulocyte concentration
( RET) | Under normal conditions, the body's natural response to anemia is to increase the rate of red blood cell production in the red bone marrow. However, with iron deficiency, the development of this compensatory reaction is impossible, as a result of which the number of reticulocytes in the blood decreases. | M: 0,24 – 1,7%. | Decreased or is at the lower limit of the norm. |
| AND: 0,12 – 2,05%. | |||
| Total hemoglobin level (HGB) | As already mentioned, iron deficiency leads to impaired hemoglobin formation. The longer the disease lasts, the lower this indicator will be. | M: 130 - 170 g/l. | Less than 120 g/l. |
| AND: 120 - 150 g/l. | Less than 110 g/l. | ||
| The average content of hemoglobin in one erythrocyte
( MCH ) | This indicator more accurately characterizes the violation of hemoglobin formation. | 27 - 33 picograms ( pg). | Less than 24 pg. |
| Hematocrit (hct) | This indicator displays the number of cellular elements in relation to the volume of plasma. Since the majority of blood cells are erythrocytes, a decrease in their number will lead to a decrease in hematocrit. | M: 42 – 50%. | Less than 40%. |
| AND: 38 – 47%. | Less than 35%. | ||
| color index (CPU) | The color index is determined by passing a light wave of a certain length through a suspension of red blood cells, which is absorbed exclusively by hemoglobin. The lower the concentration of this complex in the blood, the lower the value of the color index. | 0,85 – 1,05. | Less than 0.8. |
| Sedimentation rate of erythrocytes (ESR) | All blood cells, as well as the endothelium ( inner surface) vessels have a negative charge. They repel each other, which helps to keep the red blood cells in suspension. With a decrease in the concentration of erythrocytes, the distance between them increases, and the repulsive force decreases, as a result of which they will settle to the bottom of the tube faster than under normal conditions. | M: 3 - 10 mm/hour. | More than 15 mm/hour. |
| AND: 5 - 15 mm/hour. | More than 20 mm/hour. |
Blood chemistry
In the course of this study, it is possible to establish the concentration of various chemicals in the blood. This gives information about the state of internal organs ( liver, kidney, bone marrow and other), and also allows you to identify many diseases.There are several dozens of biochemical indicators determined in the blood. In this section, only those of them that are relevant in the diagnosis of iron deficiency anemia will be described.
Biochemical blood test for iron deficiency anemia
| Researched indicator | What does it mean? | Norm | Possible changes in iron deficiency anemia |
| Serum iron concentration | Initially, this indicator may be normal, since iron deficiency will be compensated by its release from the depot. Only with a long course of the disease, the concentration of iron in the blood will begin to decrease. | M: 17.9 - 22.5 µmol / l. | Normal or reduced. |
| AND: 14.3 - 17.9 µmol / l. | |||
| Ferritin level in the blood | As mentioned earlier, ferritin is one of the main types of iron deposition. With a lack of this element, its mobilization from depot organs begins, which is why a decrease in plasma ferritin concentration is one of the first signs of an iron deficiency state. | Children: 7 - 140 nanograms in 1 milliliter of blood ( ng/ml). | The longer the iron deficiency lasts, the lower the ferritin level. |
| M: 15 - 200 ng / ml. | |||
| AND: 12 - 150 ng / ml. | |||
| Total iron-binding capacity of serum | This analysis is based on the ability of transferrin in the blood to bind iron. Under normal conditions, each transferrin molecule is only 1/3 bound to iron. With a deficiency of this trace element, the liver begins to synthesize more transferrin. Its concentration in the blood increases, but the amount of iron per molecule decreases. Having determined what proportion of transferrin molecules is in a state not bound to iron, one can draw conclusions about the severity of iron deficiency in the body. | 45 - 77 µmol/l. | Significantly above the norm. |
| Erythropoietin concentration | As mentioned earlier, erythropoietin is excreted by the kidneys when the tissues of the body lack oxygen. Normally, this hormone stimulates erythropoiesis in the bone marrow, but this compensatory reaction is ineffective in iron deficiency. | 10 - 30 international milliunits in 1 milliliter ( mIU/ml). | Significantly above the norm. |
Puncture of the bone marrow
This study consists in piercing one of the bones of the body ( usually sternum) with a special hollow needle and taking a few milliliters of bone marrow substance, which is then examined under a microscope. This allows you to directly assess the severity of changes in the structure and function of the organ.At the onset of the disease, there will be no changes in the bone marrow punctate. With the development of anemia, there may be an increase in the erythroid germ of hematopoiesis ( an increase in the number of erythrocyte progenitor cells).
To identify the cause of iron deficiency anemia, the following is used:
- analysis of feces for the presence of occult blood;
- x-ray examination;
- endoscopic studies;
- advice from other experts.
Examination of feces for the presence of occult blood
Cause of blood in stool melena) can become ulcer bleeding, tumor decay, Crohn's disease, ulcerative colitis and other diseases. Abundant bleeding is easily determined visually by a change in the color of feces to bright red ( with bleeding from the lower intestines) or black ( with bleeding from the vessels of the esophagus, stomach and upper intestine).Massive single bleeding practically does not lead to the development of iron deficiency anemia, as they are quickly diagnosed and eliminated. In this regard, the danger is represented by long-term, small-volume blood loss that occurs during damage ( or ulceration) small vessels of gastrointestinal waste. In this case, it is possible to detect blood in the feces only with the help of a special study, which is prescribed in all cases of anemia of unknown origin.
X-ray studies
X-rays with contrast are used to identify tumors or ulcers in the stomach and intestines that could be the cause of chronic bleeding. In the role of contrast, a substance is used that does not absorb x-rays. This is usually a suspension of barium in water, which the patient should drink immediately before the start of the study. Barium covers the mucous membranes of the esophagus, stomach and intestines, as a result of which their shape, contour and various deformations become clearly visible on the x-ray.Before conducting the study, it is necessary to exclude food intake for the last 8 hours, and when examining the lower intestines, cleansing enemas are prescribed.
Endoscopy
This group includes a number of studies, the essence of which is the introduction into the body cavity of a special apparatus with a video camera at one end connected to a monitor. This method allows you to visually examine the mucous membranes of internal organs, evaluate their structure and function, and also identify swelling or bleeding.In order to determine the cause of iron deficiency anemia, the following is used:
- Fibroesophagogastroduodenoscopy ( FEGDS) – introduction of the endoscope through the mouth and examination of the mucous membrane of the esophagus, stomach and upper intestines.
- Sigmoidoscopy - examination of the rectum and lower sigmoid colon.
- Colonoscopy - study of the mucous membrane of the large intestine.
- Laparoscopy - piercing the skin of the anterior wall of the abdomen and inserting an endoscope into the abdominal cavity.
- Colposcopy - examination of the vaginal part of the cervix.
Consultations of other specialists
When a disease of various systems and organs is detected, a hematologist can involve specialists from other fields of medicine in order to make a more accurate diagnosis and prescribe adequate treatment.Consultation may be needed to identify the cause of iron deficiency anemia:
- Nutritionist - upon detection of malnutrition.
- Gastrologist - if you suspect the presence of an ulcer or other diseases of the gastrointestinal tract.
- Surgeon - in the presence of bleeding from the gastrointestinal tract or other localization.
- Oncologist - if you suspect a tumor of the stomach or intestines.
- Obstetrician-gynecologist - if there are signs of pregnancy.
Treatment of iron deficiency anemia
Therapeutic measures should be aimed at restoring the level of iron in the blood, replenishing the reserves of this trace element in the body, as well as identifying and eliminating the cause that caused the development of anemia. Diet for iron deficiency anemia
One of the important directions in the treatment of iron deficiency anemia is proper nutrition. When prescribing a diet, it is important to remember that iron, which is part of meat, is most well absorbed. At the same time, only 25 - 30% of the heme iron ingested with food is absorbed in the intestine. Iron from other products of animal origin is absorbed only by 10 - 15%, and from plant products - by 3 - 5%.Approximate iron content in various foods
| The product's name | Iron content in 100 g of product |
| Animal Products | |
| Pork liver | 20 mg |
| chicken liver | 15 mg |
| beef liver | 11 mg |
| Egg yolk | 7 mg |
| Rabbit meat | 4.5 - 5 mg |
| Lamb, beef | 3 mg |
| Chicken meat | 2.5 mg |
| Cottage cheese | 0.5 mg |
| Cow's milk | 0.1 - 0.2 mg |
| Herbal Products | |
| Dog-rose fruit | 20 mg |
| sea kale | 16 mg |
| Prunes | 13 mg |
| Buckwheat | 8 mg |
| Sunflower seeds | 6 mg |
| Black currant | 5.2 mg |
| Almond | 4.5 mg |
| Peach | 4 mg |
| Apples | 2.5 mg |
Treatment of iron deficiency anemia with medicines
The main direction in the treatment of this disease is the use of iron preparations. Diet therapy, although it is an important stage of treatment, is not able to compensate for iron deficiency in the body on its own.Tablets are the method of choice. Parenteral ( intravenous or intramuscular) the introduction of iron is prescribed if it is impossible to fully absorb this microelement in the intestine ( for example, after removing part of the duodenum), it is necessary to quickly replenish iron stores ( with massive hemorrhage) or with the development of adverse reactions from the use of oral forms of the drug.
Drug therapy for iron deficiency anemia
| Name of the drug | Mechanism of therapeutic action | Dosage and administration | Monitoring the effectiveness of treatment |
| Hemopher prolongatum | The preparation of ferrous sulfate, replenishing the reserves of this microelement in the body. | Take orally, 60 minutes before or 2 hours after a meal, with a glass of water.
Duration of treatment - 4 - 6 months. After normalization of the hemoglobin level, they switch to a maintenance dose ( 30 - 50 mg / day) for another 2-3 months. | The criteria for the effectiveness of treatment are:
|
| Sorbifer Durules | One tablet of the drug contains 320 mg of ferrous sulfate and 60 mg of ascorbic acid, which improves the absorption of this trace element in the intestine. | Take orally, without chewing, 30 minutes before meals with a glass of water.
|
|
| Ferro-foil | A complex medication that contains:
| Take orally, 30 minutes before meals, 1-2 capsules 2 times a day. The treatment period is 1-4 months ( depending on the underlying disease). | |
| Ferrum Lek | Iron preparation for intravenous administration. | Intravenously, drip, slowly. Before administration, the drug must be diluted in a solution of sodium chloride ( 0,9%
) in a ratio of 1:20. The dose and duration of use are determined by the attending physician individually in each case. With intravenous iron, there is a high risk of overdose, so this procedure should be performed only in a hospital under the supervision of a specialist. |
It is important to remember that some drugs ( and other substances) can significantly accelerate or slow down the rate of iron absorption in the intestine. It is worthwhile to use them together with iron preparations, as this can lead to an overdose of the latter, or, conversely, to the absence of a therapeutic effect.
Substances affecting the absorption of iron
| Medications that promote iron absorption | Substances that interfere with the absorption of iron |
|
|
RBC transfusion
With an uncomplicated course and properly conducted treatment, there is no need for this procedure.Indications for erythrocyte transfusion are:
- massive blood loss;
- decrease in hemoglobin concentration less than 70 g/l;
- sustained decrease in systolic blood pressure ( below 70 millimeters of mercury);
- upcoming surgery;
- forthcoming birth.
Prognosis for iron deficiency anemia
At the present stage of development of medicine, iron deficiency anemia is a relatively easily curable disease. If the diagnosis is made in a timely manner, complex, adequate therapy is carried out and the cause of iron deficiency is eliminated, there will be no residual effects. The cause of difficulties in the treatment of iron deficiency anemia may be:
- misdiagnosis;
- unknown cause of iron deficiency;
- late treatment;
- taking insufficient doses of iron preparations;
- violation of the regimen of medication or diet.
Complications of iron deficiency anemia can include:
- Lagging behind in growth and development. This complication is typical for children. It is caused by ischemia and related changes in various organs, including brain tissue. There is both a delay in physical development and a violation of the intellectual abilities of the child, which, with a long course of the disease, may be irreversible. into the bloodstream and body tissues), which is especially dangerous in children and the elderly.
Currently, more than half of the people of our planet suffer from IDA to one degree or another (a decrease in hemoglobin due to a lack of iron in the body), the treatment of which requires the appointment of specialized drugs. These drugs include drugs containing a special metal - iron.
Classification
There are several classifications of iron preparations.You can classify them depending on the method of administration:
- orally, i.e. taking the medicine inside, through the mouth (may contain two or ferric iron);
- parenterally, i.e. in the form of intramuscular injections (ferric iron in combination with sucrose, dextran or sodium gluconate).
Iron is best absorbed, most completely absorbed and causes the least amount of side reactions from compounds with sulfate. Worst of all is the assimilation of ferrous iron from compounds with chloride.
Divalent iron, having entered the body, is absorbed in the small intestine and binds to a special iron carrier - apoferretin, forming a complex that can pass the intestinal barrier. In the cells of the gastrointestinal tract, ferrous iron is oxidized to ferric iron. After that, the iron binds to the transporter, which delivers it to the tissues. In the tissues of the body, this metal is released, which then goes to the bone marrow to build the hemoglobin molecule.
Principles of prescribing iron supplements
In what form and to whom are iron preparations prescribed?The most commonly prescribed drugs for oral administration, as they have a number of advantages:
- Better absorption of iron penetrating through the intestinal wall.
- With injections of an iron preparation, abscesses and infiltrates are very often formed.
- Intramuscular injections cause a greater number of complications, the most common are allergic reactions, up to anaphylactic shock.
- With parenteral administration, there is a high probability of iron deposition in the internal organs.
The second rule is that tablets for iron deficiency anemia should not be chewed or crushed, they should be drunk whole with a small amount of water. In no case should you take the tablets with dairy products.
The third rule is that bivalent iron preparations should be taken together with vitamin C, and trivalent iron preparations should be taken with special amino acids to achieve the most complete therapeutic effect.
The choice of drugs for the treatment of iron deficiency anemia
Iron is best absorbed in capsules, since the latter protects the metal from the damaging effects of gastric juice and allows it to act at the point of application. Therefore, these drugs are in the first place. Next are tablets and solutions.The most effective are the following drugs:
Globiron-N
Foreign-made capsules containing two iron ions (bivalent), cyanocobalamin, folic acid and pyridoxine. It is a combination drug for the treatment of both iron and folate deficiency anemia.The vitamins and folic acid included in its composition reduce the manifestation of neurological disorders, and ferrous iron quickly saturates hemoglobin.
It is allowed for use by pregnant women (reduces the development of perinatal neurological disorders) and children after 3 years.
The average cost of capsules is within 400 rubles.
Heferol
Contains 355 mg of ferrous fumarate, which stimulates the creation of new red blood cells in the bone marrow and the saturation of hemoglobin with iron. The capsule protects the teeth from the damaging effects of iron and the active substance from the destructive effects of saliva and gastric juice.The drug is recommended for use during pregnancy to prevent the development and treatment of IDA in the mother. The capsules are also indicated for the treatment of anemia in a woman during lactation, as it has been proven that iron is not secreted into milk and does not affect the child.
The average cost of the drug is about 150 rubles.
Ferro-foil
A multivitamin complex that contains ferrous iron, vitamins (B12 and C), as well as trace elements. Available in the form of capsules. Ascorbic acid (vitamin C) promotes better absorption of iron from the intestines, cyanocobalamin and folic acid help accelerate the maturation of young red blood cells.The average cost of capsules is 600 rubles.
Sorbifer
Tablets that include ferrous iron (its salt is fumarate) and ascorbic acid for better absorption of the metal in the intestine. It is used both for medicinal purposes for the treatment of iron deficiency anemia, and for prophylactic purposes - in pregnant women and blood donors.The average price ranges from 400-500 rubles.
Ferrum Lek
Available as a solution for intramuscular injection, tablets that can be chewed, and syrup. Unlike the above drugs, it contains ferric iron. The difference lies in the slower penetration through the intestinal wall and, therefore, the effect develops also more slowly.The drug is contraindicated in children under 12 years of age. Side effects when taking it are minimal.
The average price is 150-200 rubles for syrup and 300-500 rubles for chewable tablets.
Maltofer
It also contains three iron ions in the form of an iron hydroxide polymaltose complex. Indications for use in this case are latent iron deficiency (the so-called preanemia, when there are no clinical symptoms yet, but blood iron is lowered) and the prevention of anemic conditions in people at risk. Available as chewable tablets, drops and syrup.The average price is within 300 rubles.
Hemohelper
The composition includes powdered hemoglobin, ascorbic acid and dietary fiber. The drug is indicated for the prevention and treatment of iron deficiency anemia of varying severity, with frequent colds, chronic fatigue and various surgical interventions. Available in the form of capsules and in the form of a chocolate bar, which is perfect even for the smallest children.The average price of such a drug is 700 rubles.
Ferlatum
The drug is in the form of a solution for oral administration. Ferric iron is surrounded by a special carrier protein, which helps protect the gastric mucosa from the irritating effect of the drug. Iron is absorbed into the blood by active transport, which eliminates the possibility of an overdose of the drug.The price ranges from 700 to 900 rubles, depending on the number of ampoules.
Totem
A preparation containing ferric iron, copper and manganese. The latter, getting into the body, help to stimulate the work of cellular enzymes. Available in the form of solutions for internal use.Indicated for the treatment of iron deficiency anemia from 3 months of age, approved for use by pregnant and lactating women.
The average cost is within 500 rubles.
Fenyuls
A multivitamin preparation that, in addition to ferrous iron, contains a whole complex of B vitamins and vitamin C. The drug is available in capsules, which ensures the gradual release of their granules as the previous ones stop.The remedy is indicated for chronic diseases accompanied by blood loss and is aimed at long-term use.
The price of such a complex ranges from 150-250 rubles.
Iron preparations for intramuscular injection
Intramuscular iron is used for intolerance to oral medications and for severe iron deficiencies that require immediate iron replacement. Other indications include: operations on the gastrointestinal tract, pancreatitis and inflammation of the intestines (enteritis and ulcerative colitis).Before the full introduction of the drug, it is necessary to test for tolerability. To do this, half or one third (for children) of the dose is injected intramuscularly, the patient is under supervision, in the absence of side effects, the rest of the volume is administered within 15 minutes.
The most popular and effective drugs for intramuscular injections are the following drugs.
Ferrum Lek
The drug containing ferric iron is available in the form of ampoules of 2 ml. After the injection, after 30 minutes, up to 50% of the drug is in the systemic circulation. The dose of the drug is calculated according to a special formula, depending on the severity of anemia.The average cost is about 1000 rubles for 5 ampoules.
Aktiferrin
An injectable preparation containing ferrous iron (sulfate) and serine (an amino acid that promotes faster iron entry into the systemic circulation).The price is about 500 rubles per pack.
Maltofer
The solution for injection contains ferric iron in the form of an iron-hydroxide polymaltose complex. The maximum concentration of iron is determined in the blood in a day. This drug is prescribed for those patients who do not tolerate drugs for oral administration (by mouth), with diseases of the gastrointestinal tract.The average cost of the drug is about 900 rubles.
Likferr
Preparation for intramuscular injection containing a complex compound of ferric iron. The metal is located in the core of the complex and is protected by sucrose from premature release. Contraindication is children's age.The price of the product is about 2000 rubles.
Venofer
As an active substance, it contains an iron-sucrose complex, which includes ferric iron.The average price of the drug is 2000 rubles.
Rules for taking drugs for the treatment of iron deficiency anemia
To maximize the effect of treatment, you must adhere to the following rules for taking medications:- tablets and capsules must not be chewed, they must be swallowed whole with plenty of water;
- medicines should not be taken with juice, tea and dairy products;
- during the course of treatment, it is recommended to exclude or not consume dairy products from the diet two hours before and two hours after;
- long-term treatment, at least 3 months. After 3 months, a blood test is looked at and, with positive dynamics, treatment should be continued at a maintenance dose of the drug for another 3 months. The total course of treatment is about six months;
- iron preparations are not compatible with antibiotics (tetracyclines and lincosamides), as well as with antacids, since they do not allow iron to be absorbed into the systemic circulation;
- it is necessary to monitor the tolerability of the drug, and if this drug causes side effects, it should be replaced with another one;
- to accelerate the absorption of the drug, it is recommended to take it together with succinic or ascorbic acids;
- it is possible to enhance the systemic effects of iron preparations with their simultaneous use with ACE inhibitors (captopril - used to reduce pressure).
Side effects of drugs
In case of improper use, non-compliance with the recommended dosage or individual intolerance to the drug, a number of side effects may occur, such as irritation of the gastrointestinal tract. This manifests itself in the form of pain in the epigastric region, nausea, vomiting, belching or heartburn, appetite perversion.Possible manifestation of allergic reactions in the form of itching, urticaria, polymorphic rash.
With prolonged use of iron preparations, it is possible to stain the enamel of the teeth black and stain the stool.
With intramuscular injection, pain in the joints and a decrease in blood pressure may occur. If the injection technique is not followed, abscesses and infiltrates are formed.
Thus, in order to cure iron deficiency anemia, it is necessary to choose the right drug that would be suitable in this case. If you follow the correct technique for using iron supplements, then after a few months you will feel better, the symptoms of anemia will decrease or disappear, and no unpleasant side symptoms will occur.
The norms of the daily human need for iron are:
- up to 6 months - 6 mg;
- 6 months - 10 years - 10 mg;
- older than 10 years - 12-15 mg;
- pregnant women - 19 mg (sometimes - up to 50 mg);
- lactating - 16 mg (sometimes - up to 25 mg).
The main part of the iron present in the human body is found in hemoglobin, each molecule of which contains 4 iron atoms. It is not surprising in this regard that the main indication for the appointment of iron preparations is the prevention and treatment of iron deficiency anemia.
Iron is found in many products of both plant and animal origin (meat, fish, legumes, cereals, bread, vegetables, fruits, berries). Of fundamental importance is the fact that iron in food sources can be in two forms:
- iron as part of the hemoglobin molecule - heme iron;
- iron in the form of inorganic salts.
The source of heme iron is meat and fish, but in berries, vegetables and fruits it is represented by inorganic salts. Why is it so important? First of all, because heme iron is absorbed (assimilated) 2-3 times more actively than inorganic iron. That is why it is quite difficult to ensure the proper intake of iron exclusively by plant foods.
Currently in use iron preparations are usually divided into two main groups:
- preparations of ferrous iron - iron sulfate, gluconate, chloride, succinate, fumarate, lactate, etc.;
- ferric iron preparations - iron hydroxide in the form of a polymaltose or sucrose complex.
The vast majority of iron preparations are used for oral administration (drops, solutions, syrups, capsules, plain and chewable tablets are available), but there are also dosage forms intended for parenteral administration - both intramuscularly and intravenously.
Parenteral administration of iron preparations is quite often accompanied by serious adverse reactions (in 0.2-3% of patients, parenteral administration of iron preparations is fraught with severe allergic reactions - up to anaphylactic), therefore it is generally accepted that intravenous or intramuscular administration of iron is carried out only when there is absolutely nowhere to go, when ingestion is completely impossible or completely ineffective - intestinal absorption is disturbed, an operation is performed to remove a significant part of the small intestine, etc.
Adverse reactions are not uncommon with oral iron preparations, but they are predictable and less dangerous. As a rule, there is nausea, pain in the upper abdomen, constipation, diarrhea. At the same time, the severity of reactions in preparations of ferrous iron is much higher. Hence the generally accepted recommendations - start taking ferrous iron preparations at a dose that is 2-4 times less than the average therapeutic dose, and gradually (within 1-2 weeks) increase it, taking into account individual tolerance.
Another important nuance is a very significant and very negative effect of food on the absorption of iron, again taking place precisely when it comes to ferrous iron preparations. No wonder that all drugs in this group are recommended to be taken on an empty stomach - optimally one hour before meals.
There is no particular difference in the clinical effects of various iron salts. The main thing is the correct selection of the dose of the drug, since each specific salt contains a strictly defined amount of iron. So, for example, in ferrous sulfate, it is iron that accounts for about 20% of the mass, respectively, in gluconate - iron 12%, and in fumarate - 33%. But, we emphasize this again, the figures given do not at all indicate that ferrous fumarate is three times better or three times more active than gluconate. Just if you take solutions of the same concentration, you will need 5 drops of fumarate, and 15 drops of gluconate.
|
Ferrous preparations |
|
Aktiferrin (ferrous sulfate),capsules, syrup, oral drops Apo-Ferrogluconate(iron gluconate),tablets Hemofer (iron chloride), oral solution drops Hemopher prolongatum(ferrous sulfate),dragee Iron gluconate 300 (iron gluconate),tablets Ferrous fumarate 200, tablets Iron tunic (iron carbonate), tablets Megaferin (iron gluconate),effervescent tablets Orferon (ferrous sulfate),dragee, oral drops PMS-iron sulfate(ferrous sulfate),tablets Tardyferon (ferrous sulfate),tablets Theospan (ferrous sulfate),capsules Ferrlecite (iron gluconate), injection Ferrogradum (iron sulfate), tablets Ferronal (iron gluconate), tablets Ferronal 35 (iron gluconate),syrup ferronat (ferrous fumarate),oral suspension Heferol (iron fumarate), capsules Ectofer (iron sorbate), injection |
The absorption of ferric iron preparations is practically not associated with food intake, so they can be taken with food. The tolerability of these drugs does not have such a pronounced relationship with the dose, therefore, from the very beginning of treatment, full doses are used.
|
Ferric iron preparations |
|
Argeferr (iron hydroxide sucrose complex), Venofer solution for intravenous administration, solution for injection Dextrafer (iron dextran), injection Iron Sugar-Iron Wine, oral solution CosmoFer (iron hydroxide dextran), solution for intramuscular and intravenous administration Likferr (iron hydroxide sucrose complex),solution for intravenous administration Maltofer (iron hydroxide polymaltose), chewable tablets, syrup, oral solution, injection solution Monofer solution for intravenous administration Profer (iron protein acetyl aspartylate), oral solution Fenyuls Baby drops Fenyuls Complex(iron hydroxide polymaltose),oral drops, syrup Ferbitol (iron chloride hexahydrate), solution for intravenous administration ferinject (iron carboxymaltose),solution for intravenous administration Ferri (iron hydroxide polymaltose),syrup Ferrlecite (iron sorbitol gluconic complex), injection Ferrolek-Health(iron dextran),injection Ferrostat (iron hydroxide sorbitol complex),solution for intramuscular injection Ferrum Lek (iron hydroxide polyisomaltose),solution for intramuscular injection Ferrum Lek (iron hydroxide polymaltose),chewable tablets, syrup ferumbo (iron hydroxide polymaltose),syrup |
The treatment of anemia, as a rule, is complex and, in addition to iron preparations, patients receive other substances that affect the hematopoietic system and metabolism. It is not surprising in this regard that the pharmaceutical market has a significant number of combined preparations, in which, in addition to iron, cyanocobalamin, folic acid, and some other vitamins and microelements are present.
|
Iron preparations in combination with other trace elements and vitamins |
|
Globigen, capsules, syrup Globiron-N, capsules Glorem TR, capsules R.B. Tone , capsules Ranferon-12, capsules totem, oral solution Fenotek , capsules Fenyuls, capsules Feramin-Vita, syrup Feron Forte, capsules Fefol-vit, capsules Hemsey, capsules Esmin, capsules |
Another tool widely used in our country is hematogen.
Hematogen is made from specially processed blood of cattle. The drug is more than 120 years old and the aforementioned methods of “special treatment” of blood have changed and improved many times. Currently, there are several different variants of hematogens, which may or may not contain hemic iron, may be enriched with iron salts. Modern medicine considers hematogen not as a remedy, but as a dietary supplement, i.e. its use for the prevention of iron deficiency anemia may well be justified (in the event, of course, if there is iron in the hematogen), but the treatment of anemia with hematogen - this is wrong, because there are drugs many times more effective.
In conclusion, we formulate 10 basic rules for the treatment of iron deficiency anemiairon preparations:
It is impossible to help a child only by correcting nutrition! The use of iron preparations is always necessary;
whenever possible, iron preparations should be taken orally, but the dose of ferrous iron should be increased gradually, starting with the fourth part of the prescribed;
the average daily therapeutic dose of iron is 2-3 mg / kg (the average prophylactic dose is half the therapeutic dose - 1-1.5 mg per day);
the daily dose is divided into 3 doses, and more or less exact observance of the intervals is very important: the bone marrow responds most optimally to the constant supply of iron, so regular medication dramatically increases the effectiveness of treatment;
the level of hemoglobin begins to rise, as a rule, after 3-4 weeks of treatment, although improvement in well-being may be much earlier;
hemoglobin rises at an average rate of about 10-14 g/l per week. It is obvious in this regard that the duration of treatment is largely determined by the severity of anemia at the time of the start of the use of iron preparations, but in most cases it takes 1-2 months to restore normal hemoglobin values;
normalization of the level of hemoglobin in the blood is not a reason to stop treatment: it is necessary to continue the use of iron preparations in a prophylactic dose for another 1.5-3 months to create iron reserves in the child's body;
parenteral administration of iron preparations, as a rule, is carried out not daily, but 1 time in 2-3 days;
ferrous iron preparations should be taken on an empty stomach, that is, 1-2 hours before meals;
absorption of iron preparations is enhanced in the presence of ascorbic acid, but the risk of side effects also increases.
(This publication is a fragment of the book by E. O. Komarovsky adapted to the format of the article
For citation: Dvoretsky L.I. TREATMENT OF IRON-DEFICIENCY ANEMIA // BC. 1998. No. 20. S. 3
The reasons for the ineffectiveness of therapy with iron preparations, as well as the features of the routes of administration, are considered.
The paper gives recommendations for the use of iron drugs in iron deficiency anemia in different clinical situations.
It considers the causes of ineffective therapy with iron preparations and the specific ways of their administration.
L.
I. Dvoretsky - MMA them. THEM. Sechenov
L. I. Dvoretsky - I. M. Sechenov Moscow Medical Academy
AND
iron deficiency anemia (IDA) is a clinical and hematological syndrome characterized by a violation of hemoglobin synthesis as a result of iron deficiency, which develops against the background of various pathological (physiological) processes, and is manifested by signs of anemia and sideropenia.
At the heart of the development of IDA There are a variety of reasons, among which the most important are the following:
- chronic blood loss different localization (gastrointestinal, uterine, nasal, renal) due to various diseases;
- malabsorption of dietary iron in the intestine (enteritis, resection of the small intestine, insufficient absorption syndrome, "blind loop" syndrome);
- increased need for iron(pregnancy, lactation, intensive growth, etc.);
- nutritional iron deficiency(malnutrition, anorexia of various origins, vegetarianism, etc.).
When the cause of IDA development is identified, the main treatment should be aimed at its elimination (surgical treatment of a tumor of the stomach, intestines, treatment of enteritis, correction of alimentary insufficiency, etc.). In a number of cases, radical elimination of the cause of IDA is not possible, for example, with ongoing menorrhagia, hereditary hemorrhagic diathesis, manifested by nosebleeds, in pregnant women and in some other situations. In such cases, pathogenetic therapy with iron-containing drugs is of primary importance. Iron preparations (ID) are the means of choice for correcting iron deficiency and hemoglobin levels in patients with IDA. Pancreas should be preferred to foods containing iron.
Table 1. Main oral iron preparations
| A drug | Additional components | Dosage form | The amount of ferrous iron, mg |
| Heferol | Fumaric acid | Capsules | |
| Hemopher prolongatum | Dragee | ||
| ferronat | Fumaric acid | Suspension |
10 (in 1 ml) |
| Ferlatum | Protein succinate | Suspension |
2.6 (in 1 ml) |
| Apo-ferrogluconate | Folic acid | Solution | |
| cyanocobalamin | Tablets | ||
| Fefol | Folic acid | Capsules | |
| Irovit | Same | ||
| Vitamin C | |||
| cyanocobalamin | |||
| Lysine monohydrochloride | Capsules | ||
| Ferrograd | Vitamin C | Tablets | |
| Ferretab | Folic acid | Tablets | |
| Ferroplex | Vitamin C | Dragee | |
| Sorbifer durules | Same | Tablets | |
| Fenyuls | Vitamin C | Capsules | |
| Nicotinamide | |||
| B vitamins | |||
| Irradian | Vitamin C | ||
| Folic acid | |||
| cyanocobalamin | |||
| Cysteine, | Dragee | ||
| fructose, yeast | |||
| Tardyferon | Mucoprotease | Tablets | |
| Ginko-tardiferon | Mucoprotease | ||
| Vitamin C | Tablets | ||
| Ferrogradumet | Plastic matrix-gradient | Tablets | |
| Aktiferrin | D,L-serine | Capsules | |
| Syrup | |||
| Maltofer | sodium methyl hydroxybenzoate, | ||
| sodium propyl hydroxybenzoate, | |||
| sucrose | Solution |
50 ml* |
|
| Maltofferfol | Folic acid | Chewable tablets | |
| Totem | Manganese, copper, sucrose, | ||
| sodium citrate and benzoate | Solution |
10 mg |
|
| * Iron is in the form of a trivalent in the form of a complex complex (as in ferritin), which does not have pro-oxidant properties | |||
Currently, the doctor has a large arsenal of medicinal pancreas, characterized by different composition and properties, the amount of iron they contain, the presence of additional components that affect the pharmacokinetics of the drug, and the dosage form. In clinical practice, medicinal prostates are administered orally or parenterally. The route of administration of the drug in patients with IDA is determined by the specific clinical situation.
Oral iron treatment
In most cases, to correct iron deficiency in the absence of special indications, PZh should be administered orally. On the Russian pharmaceutical market, there is a wide range of PZH for oral administration. They differ in the amount of iron salts they contain, including ferrous iron, the presence of additional components (ascorbic and succinic acids, vitamins, fructose, etc.), dosage forms (tablets, dragees, syrups, solutions), tolerance, cost . The main principles of treatment of pancreas for oral administration are as follows:
- the preferred appointment of patients with IDA in the absence of special indications for the use of pancreas parenterally;
- the appointment of pancreas with a sufficient content of ferrous iron;
- the appointment of pancreas containing substances that enhance the absorption of iron;
- avoid the simultaneous intake of food substances and drugs that reduce the absorption of iron;
- inexpediency of the simultaneous appointment of vitamins of group B, B 12
, folic acid without special indications;
- avoid prescribing pancreas inside if there are signs of malabsorption in the intestine;
- sufficient duration of the saturating course of therapy (at least 1-1.5 months);
- the need for maintenance therapy of the pancreas after the normalization of hemoglobin in appropriate situations.
AT table 1 the main medicinal products for oral administration, registered in Russia, are presented.
At choosing a specific drug and the optimal dosing regimen it must be borne in mind that an adequate increase in hemoglobin parameters in the presence of IDA can be ensured by the intake of 30 to 100 mg of ferrous iron into the body. Considering that with the development of IDA, iron absorption increases compared to the norm and amounts to 25-30% (with normal iron reserves - only 3-7%), it is necessary to prescribe from 100 to 300 mg of ferrous iron per day. The use of higher doses does not make sense, since the absorption of iron does not increase. Thus, the minimum effective dose is 100 mg, and the maximum is 300 mg of ferrous iron per day. Individual fluctuations in the amount of iron needed are due to the degree of iron deficiency in the body, depletion of reserves, the rate of erythropoiesis, absorbability, tolerance, and some other factors. With this in mind, when choosing a medicinal pancreas, one should focus not only on the content of the total amount in it, but mainly on the amount of ferrous iron, which is only absorbed in the intestine. So, for example, when prescribing a drug with a low content of ferrous iron (ferroplex), the number of tablets taken should be at least 8-10 per day, while drugs with a high content of ferrous iron (ferrogradum, sorbifer durules, etc.) can be taken in amount of 1 - 2 tablets per day.
With the help of modern technology, pancreas are currently being produced with a delayed release of iron from them due to the presence of inert substances, from which iron gradually enters through small pores. To such preparations include ferrogradum, sorbifer-durules, fenyuls. This provides a prolonged absorption effect and reduces the incidence of gastrointestinal disturbances. Ascorbic acid, cysteine, fructose, which are part of many dosage forms of the pancreas, enhance the absorption of iron. It must be borne in mind that iron absorption may decrease under the influence of certain substances contained in food (phosphoric acid, salts, calcium, phytin, tannin), as well as with the simultaneous use of a number of medications (tetracyclines, almagel, magnesium salts). For better tolerability, PG should be taken with food. At the same time, iron absorption is better when taking medications before meals.
In cases of prescribing pancreas in a sufficient dose, an increase in the number of reticulocytes is observed on the 7-10th day from the start of treatment. Normalization of hemoglobin levels is noted in most cases after 3-4 weeks from the start of treatment. In some cases, the terms of normalization of hemoglobin parameters are delayed up to 6-8 weeks. Sometimes there is a sharp spasmodic increase in hemoglobin. These individual fluctuations in hemoglobin normalization may be due to the severity of IDA, the degree of depletion of iron stores, as well as an incompletely eliminated cause (chronic blood loss and etc.).
Among side effects against the background of the use of pancreas inside, nausea, anorexia, a metallic taste in the mouth, constipation, and less often diarrhea occur most often. The development of constipation is most likely due to the binding of hydrogen sulfide in the intestine, which is one of the stimuli of intestinal motility. In most cases, modern pancreas cause minor side effects that require their abolition and transition to the parenteral route of administration.
Dyspeptic disorders may decrease when taking drugs after meals or by reducing the dose.
Reasons for the ineffectiveness of pancreatic therapy for oral administration:
- lack of iron deficiency (wrong interpretation of the nature of hypochromic anemia and erroneous prescription of pancreas);
- insufficient dosage of the pancreas (underestimation of the amount of ferrous iron in the preparation);
- insufficient duration of treatment of the pancreas;
- violation of the absorption of the pancreas, administered orally in patients with the corresponding pathology;
- concomitant use of drugs that violate the absorption of iron;
- ongoing chronic (undetected) blood loss, most often from the gastric tract;
- combination of IDA with other anemic syndromes (B 12
- deficient, folic acid-deficient).
Treatment of the pancreas for parenteral administration
PZH can be used parenterally in the following clinical situations:
- malabsorption in intestinal pathology (enteritis, malabsorption syndrome, resection of the small intestine, resection of the stomach according to Billroth II with the inclusion of the duodenum);
- exacerbation of peptic ulcer of the stomach or duodenum;
- intolerance to the pancreas for oral administration, not allowing further continuation of treatment;
- the need for faster saturation of the body with iron, for example, in patients with IDA who are to undergo surgery (uterine fibroids, hemorrhoids, etc.).
In table. 2 shows the pancreas used for parenteral administration.
Unlike pancreas for oral administration, iron in injectable preparations is always in the trivalent form.
The total estimated dose of prostate for intramuscular injection required to correct iron deficiency and anemia can be calculated by the formula: A \u003d K. (100 - 6. Hb). 0.0066, where A is the number of ampoules, K is the patient's weight in kg, HB is the hemoglobin content in g%. When calculating the required number of ampoules of ferrum LEK for intravenous administration, you can also use the above formula. At the same time, 1/2 ampoules (2.5 ml) are administered on the 1st day, 1 ampule (5 ml) on the 2nd day, 2 ampoules (10 9 ml) on the 3rd day. Subsequently, the drug is administered 2 times a week until the required calculated total dose is reached.
Against the background of parenteral treatment of the pancreas, especially when administered intravenously, allergic reactions often occur in the form of urticaria, fever, anaphylactic shock. In addition, with intramuscular injection of the pancreas, darkening of the skin at the injection sites, infiltrates, abscesses may occur. With intravenous administration, the development of phlebitis is possible. If pancreas for parenteral administration is prescribed to patients with hypochromic anemia not associated with iron deficiency, there is an increased risk of severe disorders due to iron "overload" of various organs and tissues (liver, pancreas, etc.) with the development of hemosiderosis. At the same time, with an erroneous appointment of the pancreas inside, the occurrence of hemosiderosis is never observed.
Tactics of treatment of IDA in various clinical situations
The treatment of patients with IDA has its own characteristics depending on the specific clinical situation, taking into account many factors, including the nature of the underlying disease and comorbidities, the age of the patients (children, the elderly), the severity of anemic syndrome, iron deficiency, pancreas tolerance, etc. The following are the most situations frequently encountered in clinical practice and some features of the treatment of patients with IDA.
IDA in newborns and children.
The main cause of IDA in newborns is considered to be the presence of IDA or latent iron deficiency in the mother during pregnancy. In young children, the most common cause of IDA is a nutritional factor, in particular, feeding exclusively with milk, since the iron contained in women's milk is absorbed in small quantities. Among the pancreas, which are indicated for newborns and children, along with appropriate nutrition correction (vitamins, mineral salts, animal protein), oral preparations containing small and medium doses of ferrous iron (ferroplex, fenules) should be prescribed. It is preferable to prescribe pancreas in drops or in the form of syrup (aktiferrin, maltofer). In young children, it is convenient to use pancreas in the form of chewable tablets (maltoferfol).
IDA in adolescent girls
is most often the result of insufficient iron stores as a result of iron deficiency in the mother during pregnancy. At the same time, their relative iron deficiency during the period of intensive growth and with the appearance of menstrual blood loss can lead to the development of clinical and hematological signs of IDA. Such patients are indicated for oral therapy. It is advisable to use preparations containing various vitamins (fenules, irradian and etc.), since during the period of intensive growth the need for vitamins of groups A, B, C increases. After the restoration of hemoglobin values to normal values, repeated courses of treatment should be recommended, especially if abundant periods are established or there are other minor blood losses (nasal, gingival).
IDA in pregnant women
is the most common pathogenetic variant of anemia that occurs during pregnancy. Most often, IDA is diagnosed in the II-III trimester and requires correction with medicinal pancreas. It is advisable to prescribe drugs containing ascorbic acid (ferroplex, sorbifer durules, actiferin, etc.). The content of ascorbic acid should exceed 2-5 times the amount of iron in the preparation. With this in mind, ferroplex and sorbifer durules can be optimal drugs. Daily doses of ferrous iron in pregnant women with non-severe forms of IDA may not exceed 50 mg, since at higher doses, various dyspeptic disorders are likely to occur, to which pregnant women are already prone. Combinations of pancreas with vitamin B 12 and folic acid, as well as pancreas containing folic acid (fefol, irrovit, maltoferfol), are not justified, since folic acid deficiency anemia in pregnant women rarely occurs and has specific clinical and laboratory signs.
The parenteral route of administration of the pancreas in most pregnant women without special indications should be considered inappropriate. Treatment of the pancreas in the verification of IDA in pregnant women should be carried out until the end of pregnancy. This is of fundamental importance not only for the correction of anemia in a pregnant woman, but mainly for the prevention of iron deficiency in the fetus.
According to WHO recommendations, all pregnant women during the II-III trimesters of pregnancy and in the first 6 months of lactation should receive pancreas.
IDA in women with menorrhagia.
Regardless of the cause of menorrhagia (myoma, endometriosis, ovarian dysfunction, thrombocytopathy, etc.) and the need to influence the corresponding factor, long-term prostate therapy for oral administration is necessary. The dose, dosing regimen and specific pancreas are selected individually, taking into account the iron content in the preparation, its tolerability, etc. In severe anemia with clinical signs of hyposiderosis, it is advisable to prescribe drugs with a high content of ferrous iron, which allows, on the one hand, to adequately compensate for iron deficiency, and on the other hand, it makes it easier and more convenient to take pancreas (1-2 times a day). After normalization of the hemoglobin level, it is necessary to carry out maintenance therapy of the pancreas within 5-7 days after the end of menstruation. With a satisfactory condition and stable hemoglobin levels, interruptions in treatment are possible, which, however, should not be long, since women's ongoing menorrhagia quickly depletes iron stores with the risk of relapse of IDA.
Table 2. PG for parenteral administration
| A drug | Compound | Route of administration |
Contents of 1 ampoule, ml |
The amount of ironin 1 ampoule, mg |
| Ferrum LEK | Polyisomaltose | intramuscularly | ||
| Ferrum LEK | Sodium Sugar Complex | intravenously | ||
| Ektofer | Sorbitol citrate complex | intramuscularly | ||
| Ferrlecite | Iron gluconate complex | |||
| Venofer | iron saccharate | intravenously |
IDA in patients with malabsorption
(enteritis, resection of the small intestine, blind loop syndrome) requires the appointment of pancreas for parenteral administration along with the treatment of the underlying disease. The pancreas is prescribed for intramuscular (ferrum-LEK, ferlecit) or for intravenous administration (venofer). The course dose of the drug can be calculated according to the proposed forms, taking into account the hemoglobin content, the patient's body weight.
Do not use more than 100 mg of iron per day (content 1 ampoule of the drug), giving complete saturation of transferrin. It should be remembered about the possibility of developing side effects with parenteral administration of the pancreas (phlebitis, infiltrates, darkening of the skin at the injection sites, allergic reactions).
IDA in the elderly and senile
may be of a polyetiological nature. For example, the causes of the development of IDA in this age group may be chronic blood loss against the background of a tumor process in the stomach, large intestine (difficult to detect localization of the tumor in the elderly), malabsorption, alimentary insufficiency of iron and protein. Possible combinations of IDA and B 12 - deficiency anemia. In addition, signs of IDA may appear in patients with B 12 -deficiency anemia (the most common anemic syndrome at a later age) during treatment with vitamin B 12 . The resulting activation of normoblastic hematopoiesis requires an increased consumption of iron, the reserves of which in the elderly can be limited for various reasons.
If, for objective reasons, it is not possible to verify IDA in the elderly (severity of the condition, decompensation of concomitant pathology, refusal to undergo examination, etc.), then it is reasonable to prescribe a trial treatment of the pancreas inside (in the absence of signs of malabsorption), preferably with a high iron content (heferol , sorbifer durules). A guideline for the correctness of the chosen tactics and further continuation of the treatment of the pancreas may be an increase in the number of reticulocytes compared with the original 7-10 days after the start of treatment. Along with the pancreas, patients with concomitant coronary artery disease are recommended to prescribe antioxidants (ascorbic acid, tocopherol). In cases of ineffective treatment of the pancreas for 3–4 weeks or a continuing decrease in hemoglobin levels, hidden blood loss should first be excluded, most often from the gastrointestinal tract, and if there are appropriate symptoms (fever, intoxication) in patients with anemia, an active infectious inflammatory process (tuberculosis, suppurative diseases).
Literature:
1. L.I. The Butler. iron deficiency anemia. Russian Medical Journal, 1997, 5 (19): 1234-42.
2. L.I. The Butler. iron deficiency anemia. M., Newdiamed, 1998.
3. L.I. Idelson. Hypochromic anemia. Medicine, 1981, 115-27.
They belong to the iron-deficient variety. Statistics indicate that about 30% of adults have some degree of iron deficiency, and when they reach the age of 60, the percentage increases to 60%. And among women, this pathology is more common. Iron supplements are the mainstay of treatment for anemia. Only a doctor can choose a list of funds and the optimal form of release. Therefore, do not try to self-medicate.
The role of iron
Every mineral and vitamin found in the human body has a role to play. Iron (ferrum) is incredibly necessary for us.
An adult body includes an average of 2.5 - 3.5 grams of iron, 70% of which is included in hemoglobin. This element is not synthesized by our internal organs, therefore it can only be obtained with food. Hemoglobin binds oxygen molecules in red blood cells, that is, blood cells.
In order for the whole body to function well, it needs to maintain iron levels within optimal levels. With its violation, hemoglobin is formed in a smaller amount. As a result, oxygen does not penetrate actively into tissues, the nutrition of internal organs is disrupted and oxygen starvation is formed.
In our liver, a certain reserve of the mineral is created, presented in the form of hemosiderin. If there is a shortage in the body, then the mineral is removed from the reserves.
Reasons for deficiency
Any mineral and vitamin must be supplied in sufficient quantities. This is an important condition for the proper functioning of the human body.
But it happens that there is a need to take iron supplements for anemia. Anemia itself or anemia occurs in a person against the background of several reasons:
- insufficient amount of iron supplied with food;
- poor absorption of ferrum in the intestine;
- its increased consumption;
- uncompensated growth in the body of the needs of the trace element.
If we do not eat a sufficiently varied diet, eliminating or minimizing iron-containing foods, then deficiency quickly develops and anemia is diagnosed.
The risk group includes athletes because of their excessive physical exertion, vegetarians and lovers of trendy unhealthy diets.
Experts have found that when consumed with protein foods, iron is absorbed only by 20-40%. If you eat fruits and vegetables, then iron minerals are absorbed by 80%. Vitamin C, which is found in fruits and vegetables, plays an important role here. Ascorbic acid is involved in the processes of assimilation of ferrum. If you reduce the consumption of iron-containing foods and foods with vitamin C at the same time, it will start quickly and lead to serious consequences.
Assimilated trace elements are gradually excreted from the body. There are also cases when ferrum does not linger, despite its sufficient amount in the diet. This occurs in diseases associated with the intestines.
In men, the deficiency develops against the background of bleeding due to injuries of the skin or internal organs, and women need to actively compensate for the release of ferrum after menstruation.
Choice of drugs
Doctors select the selection individually, based on the results of tests and examinations. Modern medicine and pharmacology offer highly effective means to resume the normal process of blood formation.
Practice has clearly proven that it is better for people suffering from anemia to drink iron-containing preparations and vitamin C in the form of tablets than to try to compensate for the lack of trace elements with food.
According to the assimilation, the daily dose of the drug exceeds the iron obtained from food by 20 times. Therefore, even if you decide to switch to a diet rich in vitamins, this will not give an effect similar to drugs.
Before starting treatment, it is better to consult with a proven qualified specialist. He will give directions for the necessary tests and additional examinations. Based on them, they individually select a list of remedies for anemia, so that the absorbed iron compensates for the shortage that has arisen.
There are several key rules that are followed when choosing drugs.
- Intramuscular administration is less effective than oral administration. Therefore, during therapy with vitamin complexes, the result is achieved better when taking tablets inside. This confirms the fact that ferrum is better absorbed through the human intestine. Plus, it reduces the likelihood of side effects.
- Content of pure iron. According to the composition, it is possible to determine which of the preparations contain the required amount of the trace element in its pure form. To achieve a therapeutic effect, a drug is chosen that contains from 80 to 160 mg. substances. If it is a sulfate salt, then its allowable limit will be 320 mg. Any drugs that exceed the established norms can cause an overdose and unwanted side effects.
- Swallow, not chew. Tablets are recommended to be swallowed whole and not chewed. At the same time, they must be washed down with a sufficient amount of water so that the medicine immediately enters the stomach. Tablets are better than liquid medicines.
- complex preparations. Some patients, self-medicating, take vitamin complexes, which include the minerals and substances required by the body. But the level of their effectiveness is lower than that of special iron-containing products. This is due to the low dosage.
- form of iron. It is divalent and trivalent. This is important to know when choosing funds. In order for the body to absorb the divalent type of iron, vitamin C must be taken in parallel. When prescribing a trivalent ferrum, you need to use a special type of amino acids. They will help deliver ions to the bone marrow.
- Coated capsules. The optimal form of release are drugs in the form of capsules with a protective shell. They prevent the manifestation of an irritating effect on the mucous membrane of the stomach and esophagus of the patient.
The treatment course lasts for 6 months or longer. Every month, patients undergo control diagnostics, passing repeated blood tests.
When it is possible to normalize the indicators of erythrocytes and, treatment continues for another 1 to 2 months. This is necessary to consolidate the result. For pregnant mothers and lactating women, the duration of drug therapy is selected based on the period of breastfeeding and the trimester. It is important that not only the mother herself drink medicines, but also prevent anemia in the child.
Products with ferrous iron
Choosing iron-containing drugs for the treatment of patients with anemia, the list is compiled taking into account the individual characteristics of the patient and the stage of development of anemia.
In bivalent preparations, ferrum or iron is presented in the form of a sulfate salt with vitamin supplements to improve the quality of absorption.
Consider some of the most popular tools presented in different forms of release:
Make sure that the doctor has not forgotten to prescribe you a parallel intake of vitamin C. This vitamin contributes to better absorption and assimilation of the missing microelements in the body.
Products with ferric iron
Here, polymaltose hydroxide is used as a form of iron to ensure the normal process of blood formation and nutrition of internal organs.
Among the popular drugs are the following:
- "Biofer";
- "Matofer";
- "Ferrum Lek";
- "Fenules";
In rare situations, patients are prescribed medications presented in the form of injections. This is possible if the patient has pathologies of the stomach or intestines, diseases of small vessels or heavy blood loss.
But the intravenous method of administering drugs is potentially capable of provoking thrombophlebitis. This is a condition where the veins become inflamed at the injection site.
All patients who drink self-selected or prescribed anti-anemia medications have the potential to experience adverse reactions in the body. This is usually associated with individual intolerance, allergic reactions to the components included in the preparations or the form of release.
Practice has shown that products without a shell or in the form of a solution can have a strong irritating effect on the digestive system. This can result in constipation and pain. If you feel pain, discomfort in the intestines, or notice allergic manifestations on the body, stop taking the medicine and consult your doctor. He will select alternative medicines and change the tactics of treating anemia.
Determination of the effectiveness of therapy
Usually, the drugs have a visible effect for about 3 weeks from the start of drug therapy. This is determined by the increased level of hemoglobin.
Therapy is considered effective if hemoglobin returns to its normal level within 2 months. But after that, you can not stop taking the medicine. Further use of drugs is a maintenance therapy that helps to consolidate the result and saturate the body with iron.
In parallel, do not forget to follow a diet, there are a large number of products that include vitamins and minerals. The main focus is on fruits, vegetables, fresh juices, protein foods and dairy products.
Never choose medicines on your own. This threatens not only with a lack of treatment results, but also with a number of side effects and the transition of anemia to more severe stages.
