Iron absorption
The body's daily need for iron in women is 1.5-2 mg.
In the gastrointestinal tract of a healthy person, only 10% of the total amount of iron eaten with food (1–2 mg) is absorbed. Improve iron absorption: ascorbic acid, fructose, citrates contained in fresh fruit juices, bananas, red beans, cauliflower. Reduce the absorption of iron from food: phosphates, tanning agents, complex polysaccharides, polyphenols, oxalates contained in cereals, eggs, cheese, tea. The effect of tea containing tannin is especially striking: when consumed, the absorption of iron is reduced sixfold (down to 2%). There are two types of iron in foods: heme (organic) and non-heme (inorganic). Heme iron is absorbed most completely. This iron is found in lean meats, fish, and poultry. The absorption of iron from animal products varies from 6% to 22%, while about 1% of iron is absorbed from plant foods. Fats (lard, butter and vegetable oil), soy protein, coffee, and dairy products inhibit the absorption of iron.
The human body contains about 3-4 g of iron, of which 70% is vital, active, 30% is deposited in tissues and 0.1% is transport. The bulk of iron is concentrated in hemoglobin (about 1500-3000 mg). In the depot (ferritin and hemosiderin of internal organs) there is from 500 to 1500 mg, in myoglobin and various respiratory enzymes - no more than 500 mg.
"We live because we breathe..."
...and iron plays a huge role in this, and at the cellular level. The adult body contains an average of 5 grams of iron. Most of it is found in hemoglobin, which transports oxygen to all organs and tissues, up to 10% is in myoglobin, the “oxygen cushion” for skeletal muscles and myocardium. Our body keeps approximately a quarter of the total amount of iron in reserve - in the liver, muscles, spleen, and bone marrow. And 1% of the mineral is contained in special enzymes that ensure the processes of cellular “respiration”. Iron's position is more than privileged. He even has his own personal “taxi” - the protein transferrin, which “carries” the metal directly to the places of use.
Causes of iron deficiency:
1.Increased need of the body for iron during pregnancy
During pregnancy, a woman’s body spends more than 1000 mg of iron. A woman’s need for iron during pregnancy can reach 15-18 mg/day, while outside of pregnancy the daily need is about 2 mg. This leads to a decrease in stored iron in all women by the end of pregnancy. It takes at least 2-3 years to restore iron reserves consumed during pregnancy, childbirth and breastfeeding.
2. Nutritional iron deficiency.
This type of iron deficiency occurs when there is insufficient supply of iron from food: vegetarianism, a passion for diets low in animal proteins. During pregnancy, a vegetarian diet is unacceptable.
- 3. Presence of a pathological background for the development of anemia
- use of intrauterine contraceptives (they increase menstrual blood loss);
- endometriosis
- uterine fibroids
- abnormal uterine bleeding;
- gynecological diseases accompanied by bleeding;
- heavy and prolonged menstruation;
- hypothyroidism and thyroid dysfunction;
- diseases of the gastrointestinal tract (peptic ulcer of the stomach and duodenum, erosive gastritis, nonspecific ulcerative colitis, etc.);
- diseases of the kidneys and urinary tract (chronic pyelonephritis, glomerulonephritis, etc.);
- multiple pregnancies and births (more than three) with an interval between births of less than two years;
- multiple births;
- pregnancy occurring during lactation;
- frequent abortions and spontaneous termination of pregnancy preceding this pregnancy;
- foci of chronic infection.
Features of the course of pregnancy in the early stages
- vomiting of pregnancy;
- bleeding.
- 5. Puberty and growth
- 6. Iron resorption deficiency
This type of anemia is caused by a decrease in the absorption zone of iron during gastritis, duodenitis, enteritis, resection of the stomach and large areas of the small intestine.
Introduction
Anemia is a global problem: approximately 25–30% of people suffer from this disease, and half of all anemia is caused by iron deficiency [1, 2].
Diagnostic criteria for anemia, according to WHO, are hemoglobin levels below 130 g/l in men of all ages and postmenopausal women, for non-pregnant women of reproductive age less than 120 g/l, for pregnant women - less than 110 g/l. These WHO standards are used by physicians in most countries for professional consistency purposes [3, 4]. According to the degree of severity, according to the level of hemoglobin (Hb), anemia is divided into mild (Hb≥90 g/l), moderate (Hb 90–70 g/l), severe (Hb 69–50 g/l) and extremely severe anemia (<50 g/l) [5, 6].
Iron deficiency anemia (IDA) is an acquired disease that is characterized by a reduced iron content in the blood serum, tissue depots, and bone marrow, resulting in the development of hypochromia and trophic disorders in tissues [7–9]. IDA is one of the most common pathological conditions in the world, and in women of childbearing age it is in first place in terms of occurrence [7].
Complications of pregnancy with iron deficiency anemia
Anemia in pregnant women is a pathological background that contributes to the development of a number of complications of pregnancy and childbirth.
- Premature abruption of a normally located placenta, anomalies of labor.
- Increased blood loss during childbirth and bleeding - in 10% of women.
- In 8–12% of cases, the postpartum period is complicated by purulent-septic diseases and uterine subinvolution.
- A lactation disorder was detected, and both quantitative and qualitative changes in breast milk were observed.
- Adverse effects on the condition of the fetus: contributes to the development of fetal growth retardation syndrome, chronic fetal hypoxia.
- A decrease in adaptation of newborns in the early neonatal period is recorded in half of the cases.
Treatment of IDA
The goal of treatment for IDA is to replenish iron stores in the amount necessary to normalize hemoglobin levels (in women 120–140 g/l) and replenish tissue iron stores (SF>40–60 μg/l). For treatment and prevention, oral preparations of iron salts are used, most often ferrous sulfate; in recent years, iron fumarate, iron gluconate, or combination preparations have also been actively used. The quantitative and qualitative composition of iron medicinal preparations varies greatly; depending on this, the preparations are divided into high- and low-dose, single-component and combined. In accordance with the WHO recommendation, the optimal dose of iron for the treatment of IDA is 120 mg/day, for the prevention of iron deficiency - 60 mg/day [7]. Approximately 20% of patients develop diarrhea or constipation during treatment, which can be relieved with symptomatic therapy. Signs of stomach irritation, such as nausea and epigastric discomfort, are minimized by taking iron supplements with meals or reducing their dose. The use of high-dose iron supplements is accompanied by an increase in the frequency of side effects from the gastrointestinal tract. The duration of treatment is determined by the depth of the initial iron deficiency and can vary from 1 month. up to 3 months [6–9, 19].
There is now accumulating evidence that low-dose iron supplements, given in short courses (2 weeks per month) or in an alternative regimen (every other day for a month), have higher effectiveness and lower incidence of side effects than previously used high-dose preparations. including in the form of repeated (2–3 times a day) doses [7, 33, 34].
It is important to emphasize that high doses of iron supplements may be associated with oxidative cytotoxic effects of unabsorbed iron on the intestinal mucosa, which is clinically manifested by side effects such as nausea, vomiting, constipation or diarrhea. Other adverse effects of unabsorbed iron include disturbances in the composition of the gut microbiome, with a decrease in lactobacilli and bifidobacteria and an increase in potential pathogens ( Enterobacteriaceae
), which entails the development of inflammation and diarrhea [31]. Modification of the iron supplementation regimen, such as switching from daily to alternative and from 2–3 times to once a day, may increase the effectiveness of treatment and improve its tolerability [33–35].
An example of a modern iron drug is the combination drug Ferretab® comp. One capsule of the drug includes 3 mini-tablets containing iron fumarate 163.56 mg (equivalent to 50 mg of iron), 1 mini-tablet of folic acid 0.54 mg (equivalent to 0.5 mg of dry matter) and auxiliary components. The folic acid mini-tablet dissolves within minutes and is rapidly absorbed in the jejunum. Iron is built into the inert matrix of the mini-tablet, which avoids high concentrations upon release and prevents irritation of the mucous membrane. Iron absorption occurs directly in the duodenum and upper jejunum. During the passage of the mini-tablet through the intestines, continuous release and absorption of iron occurs, providing a prolonged effect of the drug with a single daily dose.
The advantage of the drug is its combined composition: active divalent iron (iron fumarate) and folic acid, which is a hematopoietic cofactor vitamin necessary for the growth and differentiation of bone marrow erythroid cells. This increases the effectiveness of treatment, as demonstrated in a meta-analysis in 2015 [36]. During pregnancy, folic acid protects the fetus from the effects of teratogenic factors [37].
The drug does not have a specific taste or smell of iron, does not stain tooth enamel, is well tolerated and convenient for use: 1 tablet per day.
Treatment with parenteral iron is recommended for IDA in cases of ineffectiveness, poor tolerability, or contraindications to the use of oral iron medications [4, 6, 7, 9]. The use of intravenous iron supplements is indicated primarily for absorption disorders due to previous extensive intestinal resection, for inflammatory bowel diseases (ulcerative colitis, Crohn's disease) and malabsorption syndrome, for chronic kidney disease in the predialysis and dialysis periods, and also if necessary to obtain a quick effect in in the form of replenishing iron reserves and increasing the efficiency of erythropoiesis (for example, before major surgical interventions) [6, 7, 9, 27].
Intravenous infusions of iron preparations are associated with the danger of anaphylactic shock (in 1% of cases), the development of iron overload and toxic reactions associated with the activation of free radical reactions of biological oxidation (lipid peroxidation) by iron ions.
Intramuscular administration of iron preparations has not been used for a long time due to low efficiency, the development of local hemosiderosis and the risk of developing infiltrates, abscesses and even myosarcoma at the injection site.
Manifestations of iron deficiency anemia
Manifestations of anemia consist of 2 main syndromes: sideropenic and general anemic.
Sideropenic syndrome manifests itself:
- Seizures in the corners of the mouth;
- Glossitis - characterized by a feeling of pain, distension in the tongue, redness of its tip, and subsequently atrophy of the papillae;
- Inflammation of the red border of the lips;
- Dystrophic changes in the skin and its appendages (dry and pale skin, premature wrinkles, brittle nails and hair, the appearance of small cracks);
- Difficulty and painful swallowing of dense foods;
- Muscle weakness;
- Perversion of taste (there is a desire to eat inedible objects - chalk, tooth powder, coal, clay, sand, raw dough, minced meat);
- Perversion of the sense of smell (attraction to the smells of gasoline, kerosene, acetone, varnish, paints, dampness);
- Blue sclera syndrome;
- A pronounced predisposition to acute respiratory viral infections and other infectious and inflammatory processes.
General anemic syndrome manifests itself when the level of hemoglobin and red blood cells decreases.
Laboratory check: not just hemoglobin!
The hemoglobin level, of course, is a very important indicator, but it must be remembered that its norm does not exclude the presence of the latent (hidden) iron deficiency we have already mentioned - a condition in which the metal reserves in the body are already depleted. That is why today, for a more accurate diagnosis of an iron deficiency state, in addition to hemoglobin and the number of red blood cells, a whole range of laboratory indicators is used: ferritin and serum iron levels, iron-binding capacity of serum, transferrin saturation with iron, morphological assessment of red blood cells, etc. A full check will help the specialist dot the i's. . If there is a severe lack of iron and anemia, it is necessary to conduct an urgent comprehensive examination to identify possible health problems that are causing it.
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Its manifestations:
- Pale, slight yellowness of the hands and nasolabial triangle;
- Shortness of breath, increased heart rate, fainting (especially with a rapid transition from a horizontal to a vertical position);
- Palpitations, chest pain;
- Increased fatigue;
- Weakness, dizziness, flashing “spots” before the eyes, drowsiness during the day and insomnia at night, impaired concentration, decreased memory, performance, irritability, tearfulness;
- Loss of appetite, nausea, flatulence;
- Swelling of the face in the morning.
Patients often get used to their condition, regarding it as overwork, stress, etc.
Classification of anemia by color index
The color index determines the level of saturation of red blood cells with hemoglobin. It is calculated during a laboratory blood test using a special formula. Depending on the results obtained, there are:
Main symptoms
Anemia or anemia is characterized by obvious symptoms, so a person who cares about his health will always notice them. First of all, the pathological condition is accompanied by rapid fatigue and general weakness. In addition, mental abilities decrease and it is very difficult for a person to concentrate on certain tasks. Because of this, irritation arises for any reason. Unreasonable mood swings are also common.
Other obvious signs of anemia:
- Frequent headaches.
- The occurrence of tinnitus.
- The appearance of shortness of breath at rest or with minimal exertion.
- Periodically there are pains in the heart.
- Pale skin.
- Appetite worsens.
Classification of anemia according to the mechanism of development of the pathological process
The following states are distinguished:
Iron-deficiency anemia
– the name indicates the cause of the pathology. Due to a deficiency of an important microelement, hemoglobin synthesis in the body is disrupted. The supply of oxygen to tissue cells, the stability of redox processes, and the functioning of the immune, nervous and cardiovascular systems depend on the level of iron. Clinical manifestations of iron deficiency anemia are dizziness, fainting, weakness and lethargy, shortness of breath with any exertion, palpitations. Pallor of the skin, brittle nails, thinning hair, and cracks in the corners of the lips are also typical for this disease.
Hemolytic anemia
occurs as a result of the accelerated destruction of erythrocytes (red blood cells) and the rapid accumulation of their breakdown products in the body. The main manifestations are an increased amount of indirect bilirubin in the blood. The patient experiences the development of anemic and icteric syndromes with an enlarged spleen and liver, as well as characteristic staining of feces and urine.
Posthemorrhagic anemia
– hematological changes that appear after acute or prolonged chronic blood loss as a result of external or internal bleeding (trauma, heavy menstruation, hemorrhagic diseases, gastrointestinal and pulmonary bleeding). The main manifestations of posthemorrhagic anemia are palpitations, shortness of breath, severe dizziness, darkening of the eyes, and lethargy. In severe cases - loss of consciousness.
Sideroblastic (sideroachrestic) anemia
occurs as a result of a violation of iron synthesis, causing its deficiency in red blood cells. Due to a failure in the processes of getting this microelement into the hemoglobin molecule, iron in the cells is replaced by sideroblasts (red blood cell precursor cells interspersed with iron in the form of a ring). This condition can be congenital or acquired. Experts believe that the main reason for the development of such anemia is a lack of the substance protoporphyrin. This organic component, combining with iron, turns into heme - part of the hemoglobin molecule. The main symptoms of the disease are disturbances in the functioning of the heart and blood vessels, indigestion, pale skin, dizziness, and memory loss. There is a danger of iron accumulation in various organs, which contributes to the occurrence of serious complications (liver cirrhosis, diabetes mellitus).
B12 deficiency anemia
– a disorder of hematopoiesis as a result of a lack of vitamin B12 in the human body. The main reasons for the development of such anemia are lack of adequate nutrition, impaired absorption of B12 due to inflammatory processes in the gastrointestinal tract, alcoholism, and hereditary predisposition. The pathology develops gradually, causing damage to the digestive organs and disturbances in the functioning of the nervous system.
