Low hemoglobin - Anemia. Causes, symptoms and treatment of low levels of red blood cells, or anemia

Anemia, or the condition of anemia, is a pathology in which a low content of functionally full red cells - erythrocytes - is noted in the blood. They contain iron-containing pigment - hemoglobin, which just gives blood red color.

For a better understanding of the causes of lowering hemoglobin in the blood, you need to know the mechanism of its formation in the body. Hemoglobin is a complex combination of iron and protein found in red blood cells - erythrocytes.

The main function of hemoglobin is to participate in the transfer of oxygen molecules to the organs and tissues of the body, by continuously capturing oxygen in the lungs and giving it back to all needy structures for further oxidation-reduction reactions and obtaining energy for the vital functions of the body.

You need to know which doctors are treated with low hemoglobin. You may need the help of such specialists, depending on the cause of the pathology:

1. Therapist.
2. Surgeon.
3. Gynecologist.
4. Infectionist.
5. Nephrologist.
6. Oncologist.
7. The gastroenterologist.

Conditions for sufficient hemoglobin generation

The following conditions are necessary for hemoglobin formation:

• Sufficient iron content in consumed food.
• Normal absorption of iron in the stomach and small intestine.
• The presence of animal protein in food.
• Of particular importance is the vitamin B12 and folic acid content, which are also absorbed in the upper gastrointestinal tract and are of immediate importance for the formation of red blood cells in the bone marrow of a person. With a decrease in the number of erythrocytes, the amount of hemoglobin in recalculation per one liter of blood decreases accordingly.
• Absence of pathology in the system of blood formation( hereditary and acquired blood diseases).

What is the norm of hemoglobin in the blood?

The normal values ​​of hemoglobin in the blood are:

1. For men, 130-160 grams per liter of blood.
2. For women 120-147 g / l.
3. For pregnant women, the lower limit of the norm is 110 g / l.

Diagnosis of iron deficiency anemia

For the diagnosis of iron deficiency anemia( low hemoglobin), the following tests are required:

1. Complete blood test( taken from a finger) - on modern hematology analyzers, we determine the hemoglobin count per one liter of blood, identify the color index,the hemoglobin content in erythrocyte( norm 0.81-1.05).We measure the average volume and the diameter of the erythrocyte( norm 7.0-7.8 μm).The number of reticulocytes( precursors of erythrocytes) whose norm is 4-12% speaks about the regenerative capacity of the bone marrow. The deviation of these indicators may indicate to the doctor the cause of low hemoglobin.
2. Concentration of iron in serum( taken from the vein - the norm of 12.0 to 26.0 μmol / L).A decrease in this indicator indicates a lack of iron in the food consumed or insufficient absorption of it in the gastrointestinal tract.
3. The total iron-binding capacity of blood serum( taken from the vein - the norm is 42.3-66.7 μmol / l).The increase in this indicator also confirms the lack of iron in foods or the poor performance of the digestive system.

Having obtained the results of the tests, and having found out that the diagnosis of low hemoglobin is confirmed, we proceed to determine the reasons for its lowering. By collecting anamnesis, is excluded from the vegetarianism of .

Next, find out the state of the gastrointestinal tract. This is fibrogastroscopy ( FGS), not very pleasant, but the necessary procedure allows you to judge the condition of the mucosa of the stomach and duodenum involved in the absorption of iron and vitamin B12( allows to exclude atrophic gastritis, peptic ulcer of the stomach and duodenum).

It is necessary to visit the surgeon , who will exclude hemorrhoids upon external examination and finger examination. In the event of suspicion of other diseases, more complicated procedures are appointed, such as the sigmoidoscopy ( examination of the rectum with a sigmoidoscope through the back passage).

Large intestine examination is called fibrocolonoscopy , this is even more laborious examination, when the colonoscope reaches a distance of more than three meters through the rectum and actually allows to study the entire large intestine( in these examinations, colitis and oncological diseases are excluded first).These procedures require preparation, that is, cleansing the intestine. Recommendations before they are given to you should be given at the time of recording for the examination.

Irrigoscopy - X-ray examination of the small intestine using contrast medium, allows to exclude the pathology of the small intestine.

In case the diagnosis after all the above-mentioned examinations remains unclear, any clinic has the right to use its available quotas for high-tech help, in this case it is a computer and magnetic resonance imaging using a contrast medium.

Next, for women, of course, the examination with the gynecologist , which if necessary appoints ultrasound of the pelvic organs , which excludes myoma of the uterus and ovarian cysts, polymenorrhea.

In even more complex cases, to exclude blood diseases, a specialist consultation is required - hematologist .

Causes of loss of hemoglobin by the body, why is this happening?

1. Explicit and latent blood loss .To the apparent can be attributed visible bleeding in conditions such as polymentorrhea( profuse, prolonged, more than five days a month) in women. With hemorrhoids, bleeding gums, as well as blood loss in injuries and operations. Hidden are blood loss in diseases of the gastrointestinal tract. There is also the concept of pseudo blood loss in women with diseases such as the ovarian cyst, uterine fibroids, diseases in which there are, cavities in the myomium or ovaries periodically filled with blood, with further conversion of hemoglobin into another compound and gradual resorption with sufficient periodicity of the process.
2. Processes of in the body of leading to a reduction in the lifespan of red blood cells or to their destruction( autoimmune and infectious diseases, hereditary pathologies).
3. Personnel donation ( when a person regularly surrenders blood).
4. One of the causes of low hemoglobin, especially in pre-school children, is , the unbalanced for the vitamin-mineral composition powered by .

Having ascertained the process of formation and loss of hemoglobin, it is possible to understand the symptoms manifested with reduced hemoglobin.

Low hemoglobin: symptoms of anemia

Asthenic symptom , manifested as general weakness, fatigue, drowsiness, dizziness, headaches, heart palpitations, low blood pressure, in severe cases fainting.

The dystrophic symptom , manifested as a decrease in hemoglobin in the blood in most cases is an indirect sign of a lack of iron in the organs and tissues of the body. Consequently, the following manifestations occur:

1. Changes in nail plates, they become brittle, thinner, delaminated, striated.
2. Dry skin, painful cracks in the corners of the mouth.
3. Hair loss or slow growth.
4. Disorders of taste and smell, up to eating inedible substances( chalk, dental powder, coal, earth, clay, sand, matchheads) and raw products( cereals, dry pasta, dough, minced meat, etc.).).As the most pleasant patients note the smell of acetone, nail polish, paints, rubber, naphthalene, car exhausts.
5. Unreasonable subfebrile condition( slight increase in body temperature within 37-37.5 degrees).

Characteristic of is the appearance of patient with unfolded picture of hemoglobin deficiency in the blood. This is primarily the pallor of the skin and visible mucous membranes. With a decrease in hemoglobin caused by a lack of vitamin B12, typically a change in the mucous tongue, the so-called glossitis is "polished," a bright red, painful tongue. In some forms of anemia with a decrease in the level of hemoglobin, due to increased destruction of red blood cells, the skin can take an icteric color.

It should be borne in mind that in the initial stages of iron deficiency anemia, clinical manifestations may be mild, and in some cases, generally, asymptomatic.

Anemia accompanies a variety of diseases and is often only their symptom.

Diseases in which decreased hemoglobin is one of the symptoms of

Chronic post-hemorrhagic iron deficiency anemia ( IDA)( various blood loss, described above).

Allied iron deficiency anemia ( IDA) is the cause of iron deficiency in food.

for with increased iron consumption ( pregnancy, lactation, growth and maturation period).

Diseases associated with with a violation of iron absorption and of vitamin B12 in the gastrointestinal tract:

• Chronic atrophic gastritis( thinned gastric mucosa).
• Chronic enteritis( inflammation of the small intestine is one of the reasons that can be dysbacteriosis or irritable bowel syndrome, which occurs against a background of frequent stresses).
• Postrezektsionnaya IDA( with the removed part of the stomach or small intestine).

Diseases associated with as a disorder in the human immune system characterized by the pathological formation of immune complexes with the participation of erythrocytes, resulting in premature death of erythrocytes. These include: glomerulonephritis, rheumatoid arthritis, lupus erythematosus and other systemic vasculitis.

Reduction of hemoglobin can occur with long-term infectious diseases ( gastroenterocolitis in folk speech called dysentery and salmonellosis, chronic hepatitis C and B, long-term pneumonia, tuberculosis, pyelonephritis).The reason is also in the early destruction of red blood cells and the increased need for iron in the body to restore homeostasis.

Glistular invasion is a wide ribbon that absorbs a large amount of vitamin B12 from the body.

Blastomatous ( malignant) of the blood diseases .

Malignant neoplasm of , especially of the gastrointestinal tract with them, the decrease in hemoglobin occurs due to impaired absorption of iron, and also due to latent blood loss. With all other tumor localizations, a decrease in hemoglobin occurs to a lesser extent, apparently due to a change in metabolic processes in the organism occurring in these diseases. But this is considered a very important feature that requires attention, especially in men who have had high hemoglobin values ​​throughout their life and suddenly decreased even within normal limits.

It should be borne in mind that the first four groups of diseases are the cause of decreased hemoglobin in more than 90% of the cases.

Iron deficiency anemia with hemoglobin deficiency: treatment and prevention

Therapeutic tactics for iron deficiency anemia should be aimed not only at normalization of hematological parameters( hemoglobin, erythrocytes, color index), but also restoration of serum iron concentration, adequate stores in the depot organs( primarily the spleen and liver, and also muscle tissue).

Treatment should be started as soon as possible with measures to eliminate the cause of its development, primarily hidden small and obvious blood loss( removal of fibroids of the uterus, excision of hemorrhoids, hormonal correction of dysfunctional uterine bleeding, treatment of gastroduodenal ulcers, gastroduodenitis, enteritis, etc.).

The main pathogenetic method for the treatment of iron deficiency anemia( decreased hemoglobin) is the appointment of iron preparations, and taking the latter inside, preferably before parenteral administration( administration of drugs intramuscularly and intravenously).Injections of iron preparations should preferably be performed in a hospital, since there is a high percentage of allergic reactions to iron preparations.

The dose of iron preparations should be sufficient to obtain a therapeutic effect, but also not excessive, not causing the phenomenon of intolerance.

Usually, this dose ranges from 100 to 300 mg of elemental iron per day. With good tolerability should be used at the maximum dose to restore the level of hemoglobin and erythrocytes. When normal hemoglobin figures are reached, treatment does not stop, but continues usually within 2-3 months, under the control of the quantity of iron in erythrocytes and serum. So, that you need to adjust for long-term treatment, at least 2-6 months.

After reaching normal values ​​of peripheral blood, taking medications in a daily dose is 2-3 times less than that with which hemoglobin is normalized. Therapy is carried out before replenishment of iron stores in iron depot organs. This is controlled by blood indicators such as serum iron, the total iron binding ability of blood serum. Antiretroviral therapy of chronic anemia is performed in patients with unresolved etiologic factors( profuse and prolonged menstruation and uterine bleeding, blood loss associated with hemorrhoids, intestinal diseases).

Therapy is carried out individually selected by small doses of iron preparations( 30-60 mg of iron per day) in the form of one-month repeated( 2-3 times a year) courses, or the appointment of such iron therapy for 7-10 days monthly( usually during and after menstruation), under the control of hemoglobin level and iron metabolism.

When low hemoglobin is associated with inadequate intake of vitamin B12( megaloblastic anemia), subcutaneous injections of vitamin B12( cyanocobalamin) are prescribed. Enter a dose of 200-500 mcg once a day, for four to six weeks. After normalization of hemopoiesis and blood composition, which usually occurs after 1.5-2 months, the introduction of the vitamin once a week continues for another 2-3 months.

In the process of treatment with iron preparations, it is not worth waiting for an increase in the amount of hemoglobin earlier than in a month of treatment. The doctor judges the effectiveness of treatment by changing the number of reticulocytes( the precursors of erythrocytes) in a general blood test. After 8-10 days after the initiation of therapy with vitamin B12 and iron preparations, the amount of reticulocytes rises several times, a so-called "reticulocyte crisis" is observed. That speaks about the success of the therapy. Often, B12 deficiency anemia is accompanied by a deficiency in the body also folic acid. In this case, folic acid is added to the treatment, at a dose of 5-15 mg per day, with a course of 20-30 days.

In terms of hemoglobin reduction, iron deficiency anemia is divided:

Latent iron deficiency anemia is in cases where the hemoglobin content in erythrocytes is normal, and serum iron is lowered, but symptoms of decreased hemoglobin can already be observed. In these cases, the correction of the condition is achieved by low doses of iron( 30-40 mg per day) for 1-1.5 months according to indications 2 to 3 times a year. This condition is also characteristic during pregnancy. Over-the-counter drug in this case ferretab composite containing 0.154 g of iron fumarate and folic acid 0.005 g. Depending on the parameters of serum iron and total iron binding capacity of blood serum, 1-3 capsules per day are prescribed for not less than 4 weeks.

1. Light degree( hemoglobin 110-90 g / l).
2. Medium degree( hemoglobin 90-70 g / l).
3. Severe degree( hemoglobin below 70 g / l).

Medications for the treatment of IDA

OTC drugs, the most commonly used to correct iron deficiency conditions.

1. Low hemoglobin( anemia). Ferretab composite ( 0.154 g of iron fumarate and 0.005 g of folic acid).In addition, the reception of ascorbic acid in a daily dose of 0.2-0.3 g) is desirable.
2. Sorbifer durulis ( 0.32 g of ferrous sulfate and 0.06 g of vitamin C) is released in a pellet daily dosage, depending on the degree of anemia 2-3 times a day.
3. Totem - is released in vials of 10 milliliters, the content of the elements is the same as in the sorbifer. It is applied orally, it can be diluted with water, it is possible to administer it with intolerance to tabletted forms of iron. The daily dose of 1 to 2 admission.
4. Fenulles
5. Fenulles ( 0.15g, ferrous sulphate, 0.05g of vitamin C, vitamins B2, B6, 0.005g of calcium pantothenate.
6. Vitamin B12 in ampoules of 1 ml 0.02% and 0.05%.
7. Folic acid

Ampoule preparations of iron, for intramuscular and intravenous injection, are sold only on prescription and require injections only in hospital due to the high incidence of allergic reactions to these drugs.

Given the best absorption, iron preparations are prescribed before meals if inthere is no vitamin C, to requires additional intake of ascorbic acid in a daily dose of 0.2-0.3 g.

Some patients have signs of iron intolerance during treatment, especially with prolonged use: loss of appetite, nausea, vomiting, abdominal pain, intestinal dysfunction in the form ofdiarrhea or constipation, which disappear after lowering the initial dosage of the drug and prescribing it on time or after a meal.

In some cases, patients with a predilection for intestinal disorders iron preparations are prescribed together with enzymes( mezim forte, festal, panzinorm).When exacerbation against the background of treatment, gastritis, peptic ulcer of the stomach or duodenal ulcers, at the same time, antiretroviral drugs( almogel, ranitidine, omez) are prescribed.

Increasing hemoglobin with folk remedies

Treatment of iron deficiency anemia should be conducted against a background of a diet rich in iron and animal proteins, the main sources of which are meat and meat products, especially beef.

Recommended vegetables and fruits are generally useful as a source of a large number of vitamins, especially ascorbic acid, which promotes better absorption of iron. Here, dishes containing black currant, citrus, kiwi, dog rose, strawberry will be useful.

In cases of anemia with unresolved risk factors( hyperpolymenorrhea - profuse monthly, microhematuria with hemorrhoids, frequent nasal bleeding), it is advisable to use the following infusion from the phytospora containing nettle leaves, yarrow herb, hips and mountain ash. Apply 1/3 or 1/2 cup 2-3 times a day. Courses for two weeks during profuse menstrual periods, also in the period of exacerbation of diseases accompanied by micro bleeding.

Naturally, it is necessary to eliminate the causes of low hemoglobin as soon as possible by timely treatment of all diseases contributing to its reduction( see the "causes of hemoglobin loss", "diseases of which one of the signs is a decreased hemoglobin", set forth above).

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