What Are the Symptoms of Iron Deficiency Anemia?

When the body's iron demand and supply are unbalanced, it leads to depletion of iron stored in the body (ID), followed by iron deficiency in the red blood cells (IDE), and eventually causes iron deficiency anemia (IDA). IDA is the final stage of iron deficiency (including ID, IDE and IDA), manifested by small cell hypochromic anemia and other abnormalities caused by iron deficiency. IDA is the most common anemia. Its incidence has increased significantly in developing countries, economically underdeveloped regions, and infants and women of childbearing age. The population survey in Shanghai shows that the annual incidence of iron deficiency ranges from 75.0% to 82.5% in infants between 6 months and 2 years old, 66.7% in women who are more than 3 months pregnant, 43.3% in women of childbearing age, and 13.2% in adolescents between 10 and 17 years old. ; The prevalence of IDA in the above population was 33.8% -45.7%, 19.3%, 11.4%, and 9.8%, respectively. Iron deficiency is mainly related to the following factors: insufficient supplementary food for infants and young children, partial eclipse in adolescents, excessive menstrual flow in women / pregnancy / lactation and certain pathological factors (such as major gastric resection, chronic blood loss, chronic diarrhea, atrophy Gastritis and hookworm infection, etc.).

Basic Information

nickname

Small cell anemia

English name

iron deficiency anemia

Visiting department

Hematology

Multiple groups

Infants, women of childbearing age

Common causes

Caused by chronic wasting disease, malnutrition, hookworm infection, etc.

Common symptoms

Fatigue, fatigue, dizziness, headache, dizziness, tinnitus, palpitations, etc.

Contagious

no

Causes of iron deficiency anemia

1. Increased iron demand and insufficient iron intake

More common in infants, young children, pregnant and lactating women. Infants and young children need more iron, if not supplemented with eggs, meat and other high-iron supplementary foods, it is likely to cause iron deficiency. Adolescents are prone to iron deficiency. Women's increased menstruation, pregnancy or breastfeeding require an increase in iron demand. IDA can easily be caused if high-iron foods are not supplemented.

2. Iron absorption disorders

Commonly after major gastric resection, insufficient gastric acid is secreted and food quickly enters the jejunum, bypassing the main iron absorption site (duodenum) and reducing iron absorption. In addition, IDA can occur due to iron absorption disorders due to gastrointestinal dysfunction caused by various reasons, such as chronic unexplained diarrhea, chronic enteritis, and clonal disease.

3. Excessive iron loss

Chronic long-term iron loss and uncorrected cause IDA. Such as: chronic gastrointestinal blood loss (including hemorrhoids, gastroduodenal ulcers, hiatal hernias, gastrointestinal polyps, gastrointestinal tumors, parasitic infections, esophageal / fundus varices rupture, etc.), excessive menstrual flow ( Intrauterine placement of birth control rings, uterine fibroids and menstrual disorders such as menstrual disorders), hemoptysis and alveolar hemorrhage (pulmonary hemosiderin, pulmonary hemorrhage-nephritis syndrome, tuberculosis, bronchiectasis, lung cancer, etc.), hemoglobinuria (array Sleep-onset hemoglobinuria, cold antibody autoimmune hemolysis, cardiac prosthetic valve, marching hemoglobinuria, etc.) and others (hereditary hemorrhagic telangiectasia, hemodialysis for chronic renal failure, multiple blood donations, etc.) .

Clinical manifestations of iron deficiency anemia

1. Iron deficiency symptoms

Such as women with heavy menstrual flow, peptic ulcer / tumor / hemorrhoids caused by black stools / blood stools / abdominal discomfort, abdominal pain / feces changes caused by intestinal parasite infections, weight loss of tumor diseases, hemoglobinuria, etc.

2. Anemia manifestation

Weakness, fatigue, dizziness, headache, dizziness, tinnitus, palpitations, shortness of breath, poor appetite, paleness, and increased heart rate.

3. Organization iron deficiency performance

Abnormal mental behavior, such as irritability, irritability, inattention, and pica; physical strength and endurance decline; susceptibility to infection; child growth retardation and mental retardation; stomatitis, glossitis, tongue papillary atrophy, cleft palate, difficulty in swallow Hair is dry and shedding; skin is dry and shrunk; fingernails lack luster, are brittle and fragile, and those with severe fingernails are flattened and even concave like a spoon (trans nail).

Check for iron deficiency anemia

Blood image

It was a small cell hypochromic anemia. The average red blood cell volume (MCV) is <80fl, the average red blood cell hemoglobin content (MCH) is <26pg, and the average red blood cell hemoglobin concentration (MCHC) is less than 0.32. Blood corpuscles showed small red blood cells and enlarged centrally stained areas. Reticulocyte counts were usually normal or slightly elevated. Leukocyte and platelet counts can be normal or decreased.

Bone marrow

Hyperplasia is active or obviously active; mainly red-line hyperplasia, no obvious abnormalities in granulocytes and megakaryocytes; red-line cells are mainly medium and late young red blood cells, with small volume, dense nuclear chromatin, few cytoplasm, and irregular edges , There is a poor manifestation of hemoglobin formation ("nuclear old plasma").

3. Iron metabolism

Bone marrow smears were stained with potassium ferrocyanide (Prussian blue reaction). There were no dark blue hemosiderin particles in the bone marrow pellets. The iron pellets were reduced or disappeared in the red blood cells, and the iron granulocytes were less than 0.15; serum Ferritin decreased (<12 g / L); serum iron decreased (<8.95 mol / L), total iron binding capacity increased (> 64.44 mol / L), and transferrin saturation decreased (<15%). sTfR (soluble transferrin receptor) concentration exceeds 8mg / L.

4. Red blood cell endorphyrin metabolism

FEP (erythrocyte free protoporphyrin)> 0.9 mol / L (whole blood), ZPP (zinc protoporphyrin)> 0.96 mol / L (whole blood), FEP / Hb (hemoglobin)> 4.5 g / gHb.

Diagnosis of iron deficiency anemia

IDA is the final result of long-term negative iron balance. During its progressive onset, it can be divided into three stages according to the degree of iron deficiency.

1.ID

(1) Serum ferritin <14 g / L;

(2) Bone marrow iron staining shows that small particles of bone marrow stainable iron disappear, and iron granulocytes <0.15;

(3) Hemoglobin and serum iron are normal.

2.IDE

(1) (1) + (2) of the ID;

(2) Transferrin saturation <0.15;

(3) FEP / Hb> 4.5g / gHb;

(4) Hemoglobin is still normal.

3.IDA

(1) IDE's (1) + (2) + (3);

(2) Small cell hypochromic anemia: Hb <120g / L in males, Hb <110g / L in females, Hb <100g / L in pregnant women; MCV <80fl, MCH <27pg, MCHC <0.32.

4. Etiology diagnosis should be emphasized

IDA can only cure if the cause is clear; sometimes the cause of iron deficiency is more severe than anemia itself. For example, IDA caused by gastrointestinal malignant tumor with chronic blood loss or residual cancer after gastric cancer surgery should be checked for fecal occult blood multiple times, if necessary, gastrointestinal tract X-ray or endoscopy; for menstrual women, check for gynecology disease.

Differential diagnosis of iron deficiency anemia

It should be distinguished from the following small cell anemia.

Iron granulocyte anemia

Genetically or unexplained erythrocyte iron utilization disorder anemia. It showed small cell anemia, but the serum ferritin concentration increased, the bone marrow granules contained hemosiderin particles increased, iron granulocytes increased, and circular iron granulocytes appeared. Serum iron and iron saturation increased, and total iron binding was not low.

2. Thalassemia

Have family history. Hemolytic manifestations. A large number of target red blood cells can be seen in the blood film. Fetal hemoglobin or hemoglobin A2 is increased. Serum ferritin, bone marrow stainable iron, serum iron and iron saturation are not low and often increased.

3. Anemia in chronic diseases

Anemia of iron metabolism caused by chronic inflammation, infection or tumor. Anemia is small cell. Increased iron storage (serum ferritin and bone marrow-containing hemosiderin). Serum iron, serum iron saturation, and total iron binding decreased.

4. Transferrin deficiency

Autosomal recessive (congenital) or severe liver disease, tumor secondary (acquired). Presented as small cell hypochromic anemia. Serum iron, total iron binding capacity, serum ferritin, and bone marrow hemosiderin were significantly reduced. Congenital, young children with morbidity, dysplasia, and multiple organ function involvement. Acquired with primary disease manifestations. ^[1-2]

Treatment of Iron Deficiency Anemia

Treatment principle

The principles of treating IDA are: cure the cause; make up iron storage.

2. Etiology treatment

Infants, adolescents, and pregnant women with IDA due to undernutrition should improve their diet. IDA caused by excessive menstruation should regulate menstruation. Parasitic infections should be treated with deworming. Malignant tumors should be treated with surgery or radiotherapy or chemotherapy; upper gastrointestinal ulcers should be treated with acid suppression.

3. Iron supplement treatment

There are two types of therapeutic iron: inorganic iron and organic iron. Inorganic iron is represented by ferrous sulfate, and organic iron includes dextran, ferrous gluconate, iron sorbitol, ferrous fumarate, and polysaccharide iron complexes. The side reaction of inorganic iron agent is more obvious than organic iron agent.

Oral iron is preferred. Such as: ferrous sulfate or iron dextran. Gastrointestinal reactions after meals are small and easily tolerated. Consumption of cereals, milk, and tea inhibits iron absorption. Fish, meat, and vitamin C can enhance iron absorption. The effective manifestation of oral iron was firstly increased peripheral blood reticulocytes, and the peak was 5 to 10 days after starting the medication, and the hemoglobin concentration increased after 2 weeks, and usually returned to normal in about 2 months. Ferritic therapy should be continued for 2 to 3 months after hemoglobin returns to normal, and discontinuation after ferritin is normal.

If oral iron can not be tolerated or changes in the normal anatomical part of the gastrointestinal tract affect iron absorption, iron can be injected intramuscularly. ^[3]

Prognosis of iron deficiency anemia

Those who are simply undernourished can easily return to normal. Those secondary to other diseases depend on whether the primary disease can be cured.

Prevention of iron deficiency anemia

Emphasis is placed on nutritional care for infants, young children and women. For infants and young children, iron-rich foods such as eggs, liver, and spinach should be added as early as possible; for adolescents, partial eclipses should be corrected, and parasite infections should be checked and treated regularly; iron supplements can be added to pregnant women and lactating women; Women should prevent excessive menstruation. Do a good job of preventing and treating people with tumorous diseases and chronic bleeding diseases. ^[4]

References:

[1] Ye Guoxiang, Ye Zhenglong, He Guangsheng. The value of detecting serum iron and transferrin for early iron deficiency anemia. Zhejiang Clinical Medicine. 2011, 13 (10)

[2] He Guangsheng, Fu Rong. Minutes of the 11th National Conference on Red Blood Cell Diseases of Hematology Branch of Chinese Medical Association. Chinese Journal of Internal Medicine. 2008, 47 (01).

[3] Lu Zaiying, Zhong Nanshan. Internal Medicine (7th Edition) Beijing: People's Medical Publishing House. 2008, 571-574.

[4] Chen Yizhu, Practical Internal Medicine (12th Edition). Beijing: People's Medical Publishing House, 2005, 2343-2348.