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Пульмонология, гематология (англ,рус)

•         Kidney disease: The kidneys help the bone marrow to make red blood cells.

•         Pregnancy: Water weight gain during pregnancy dilutes the red blood cells.

•         Poor nutrition: Vitamins and minerals are required to make red blood cells.

•         Alcoholism.

•         Uncommon causes of anemia: bleeding disorders, liver disease, thalassemia, infection, cancer, arthritis, enzyme deficiency, sickle cell disease, hypothyroidism, toxins, or hereditary conditions.

 

Signs and symptoms

Signs of anemia may include the following:

•Black and tarry stools (sticky and foul smelling)

•Maroon, or visibly bloody stools

•Rapid heart rate

•Rapid breathing

•Pale or cold skin

•Jaundice

•Low blood pressure

•Heart murmur

•Enlargement of the spleen

Symptoms of anemia may include the following:

•Fatigue

•Trouble breathing

•Chest pain

•Abdominal pain

•Weight loss

•Weakness

•Dizziness and passing out, especially upon standing

 

Diagnosis

lThe only way to diagnose anemia is with a blood test. Generally, a full blood count is done. Apart from reporting the amount of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells, which is an important tool in distinguishing between the causes.

lOccasionally, other tests are required to further distinguish the cause for anemia. These are discussed with the differential diagnosis (below). The doctor may also decide to take some other screening blood tests that might identify the cause of fatigue; glucose levels, ESR, ferritin, renal function tests and electrolytes may be part of such a workup.

Doctor has a lot of questions in case of patient with anemia:

l1. What is the reason of anemia? Is this anemia an independent  disease or only syndrome, the complication of present patient`s pathology? Is this anemia the sign of the blood system disease?

l2. What is the minimum of diagnostic measures, necessary for finding out of anemia character?

l3. Do we need the consultation of hematologist? And if this so, what is their urgency?

l4. What is the treatment?

 

STANDARDS

DIAGNOSTICS AND TREATMENT OF IRON DEFICIECY ANEMIA

Iron deficiency is defined as a decreased total iron body content.

Iron deficiency anemia occurs when iron deficiency is sufficiently severe to diminish erythropoiesis and cause the development of anemia. Iron deficiency is the most prevalent single deficiency state on a worldwide basis.

In healthy people, the body concentration of iron (approximately 60 parts per million [ppm]) is regulated carefully by absorptive cells in the proximal small intestine, which alter iron absorption to match body losses of iron. Persistent errors in iron balance lead to either iron deficiency anemia or hemosiderosis. Both are disorders with potential adverse consequences.

 

Principal reasons of IDA are:

l1. Diseases of GIT.

l2. Diseases of kidneys which are accompanied by mikro- and makrohematuria.

l3. Diseases of the cardio-vascular system.

l4. Breathing diseases.

l5.  Pathology of the blood system.

l6.  Hemorrhagic diatesis.

l7.  Meno- and metrorhagia

l8.  Pregnancy

l9.  Invasion of intestinal worms.

l10. Malignant tumors

 

Clinical symptoms of IDA

A. Sideropenia.

B. Circulatory-hypoxic syndrome.  C. Anemic syndrome.

 

 

CLINICAL CLASSIFICATION

OF IRON DEFICIENCY ANEMIA

І. Preclinical stage

1.1.  Prelatent deficit of iron.

1.2.  Latent deficit of iron (bleeding, unregulated participating in a donorship, increasing necessity in iron and others like that).

ІІ. Clinical stage

2.1. No complicated form is caused by:

2.1.1.  Chronic bleeding;

2.1.2.  Increased necessity in iron (pregnancy, lactation, period of growth and ripening, for sportsmen);

2.1.3.  An insufficient initial level of iron in organism;

2.1.4.  Insufficient resorbtion of iron in a GIT;

2.1.5.  Disturbances of transport and utilizations of iron (gipo- and atransferinemia, enzimopathia, autoimmunic processes);

2.1.6.  Alimentary insufficiency of iron;

2.2. Complicated form is caused by:

2.2.1. Anemic hypoxia (signs: light, middle and severe, severe with the dystrophic changes of organs - hypoxic myocardial dystrophy, encephalopathia and others like that);

2.2.2. Sideropenic syndrome (signs : neurological disorders of emotional sphere, taste, sense of smell, dizuric disorders, changes of mucus shell of GIT, skin and its additions and others like that);

2.2.3. Metabolic endogenous intoxication.

ІІІ. Mixed forms of iron deficiency anemia:

      3.1.  Dimorphic anemia (combination of iron deficiency anemia with vitamin В12 deficiency anemia);

      3.2.  Combination of iron deficiency anemia with the deficit of vitamins (group B, E, C);

      3.3.  Combination of iron deficiency anemia with the deficit of microelements;

      3.4. Polydeficiency anemia (combination of iron deficiency anemia with the deficit of vitamins and microelements).

 

Treatment of iron deficiency anemia

-  liquidation of reasons which caused the deficit of iron;

- addition to the supplies of iron (therapy of satiation): using, mainly, peroral preparations of iron in day's dose of 2-3 mg of elementary  (Fe++) iron on 1 kg of mass.

Adopting iron is required simultaneously with ascorbic acid. More rapid getting up of indexes  of red blood is observed at simultaneous application of antioxidants.

 

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