Chronic iron deficiency anemia: causes, symptoms, diagnosis and treatment

The ICD code for chronic iron deficiency anemia is D50.

Iron deficiency can cause many different problems, ranging from fatigue and intense hair loss to anemia. Many people are deficient in this microelement, not even knowing about it. So, how can chronic iron deficiency anemia be recognized? How can I deal with her? We will talk about all this further.

Iron deficiency in the body: what is it?

Due to iron deficiency, people develop approximately seventy percent of all anemia. Due to the small amount of this trace element, hemoglobin molecules cease to be produced. As a result, a person’s blood carries less oxygen. Deficiency of iron in tissues leads to problems with hair, skin, heart, and in addition, digestion.

According to medical statistics, nearly two billion people suffer from chronic iron deficiency anemia. A hidden deficit of this element is found in three billion. Most often, anemia is found in women during periods of fertility, and in addition, in pregnant women and adolescents.

Symptoms of a chronic form

Even before the occurrence of chronic iron deficiency anemia, specific symptoms appear in people. It mainly affects the hair, intestines, skin and heart muscle along with the nervous system. In that case, if you place the symptoms of iron deficiency from the most frequent to rarer, you get the following list:

• The presence of dry skin and brittle layered nails.
• Split ends of hair along with their slow growth.
• The presence of fatigue, asthenia and weakness, and at the same time pallor.
• Violations of taste along with the desire to eat chalk, paint and so on.
• The presence of a strange addiction to odors.

Against the background of a decrease in hemoglobin, signs of oxygen deficiency in the form of dizziness and fainting are observed. Often worries about a heartbeat with tinnitus in chronic iron deficiency anemia.

Severity and stage

The lack of such an important trace element grows gradually, passing through several stages. The first stage is called prelate. At this stage, iron is consumed much more than it enters the body, however, its reserves in the tissues are still sufficient. Such a deficit is quite simple to correct if you change your diet. You can use all kinds of dietary supplements along with special medical nutrition. Such prophylaxis will certainly help to restore the supply of trace elements and prevent the development of anemia.

In the event that the deficit has not been eliminated, iron reserves are gradually depleted. Against this background, the hemoglobin level does not change, but specific signs may occur. During the study, a decrease in transferrin and ferritin can be detected. If there is a latent deficiency, you need to review your diet and use special dietary supplements along with vitamin complexes.

If the latent lack of iron is not corrected, then chronic anemia develops. Mild severity, not to mention moderate and severe, necessarily involves taking the appropriate drugs. Therapy usually lasts all the time until the body feels the need for iron.

Often diagnosed with mild chronic iron deficiency anemia. This is a condition where the hemoglobin level is above 90 grams per liter.

Usually, with mild severity of chronic iron deficiency anemia, there are no symptoms, and the disease can be determined only on the basis of laboratory blood tests.

Therapy most often consists in following a proper diet to normalize hemoglobin levels. The basis of the recovery diet includes foods high in iron and B vitamins.

Chronic iron deficiency anemia of moderate severity has more pronounced symptoms. Against this background, hemoglobin is 70–89 grams per liter. In this case, therapy should be started immediately according to the schedule prescribed by a specialist.

Severe chronic iron deficiency anemia also occurs . The hemoglobin index in this case is less than 70 grams per liter. Treatment of this form of the disease is carried out in a hospital.

Chronic posthemorrhagic iron deficiency anemia is a complex of clinical and hematological changes that have arisen due to acute or chronic blood loss. The main symptoms: pallor, shortness of breath, darkening in the eyes, dizziness, hypothermia, arterial hypotension. In severe cases - lethargy, threadlike pulse, shock, loss of consciousness. Pathology is diagnosed according to the clinical picture and general blood test. In order to establish the source of bleeding, instrumental studies are performed. With the development of this ailment, transfusion and symptomatic therapy is necessary.

General information

Diagnosis of anemia is based mainly on information obtained during laboratory tests. First of all, the results with determining the degree of concentration of hemoglobin are important. According to the standards, the criterion for the onset of anemia in children is a decrease in hemoglobin concentration of less than 110 grams per liter, for women less than 120, and for men less than 130.

Most often, in therapeutic practice, mild chronic iron deficiency anemia is encountered, which is a painful condition caused by a violation of hemoglobin synthesis due to acute iron deficiency.

According to statistics, in the world about two billion people in one form or another suffer from a lack of iron, most of them are children and women. The frequency of mild to moderate severity of chronic iron deficiency anemia in pregnant women in the world ranges from twenty to fifty percent. And in developing countries, this figure reaches 75 percent.

Features of the process of iron metabolism in the human body

In men, with food, as a rule, about 18 milligrams of iron per day is ingested, and as a result only 1 milligram is absorbed. That is, iron is lost in urine, then and so on.

In women, 12 milligrams per day is ingested and a maximum of 1 milligram is absorbed. But the fact is that women additionally lose iron during the menstrual cycle, and in addition, due to pregnancy.

With increased demand for iron, no more than 2 milligrams can be absorbed from food. Thus, if the body’s loss of iron is more than 2 milligrams per day, then anemia develops. Next, let's talk about the main causes that can affect the decrease in the amount of iron in the human body.

Causes of Chronic Iron Deficiency Anemia

The main factors for the development of this pathology include the following factors:

• The presence of nutritional deficiency. At the same time, there is a small intake of iron with food, due to a lack of meat products (for example, as a result of starvation or vegetarianism). This diet does not allow a person to make up for the loss of iron that occurs due to the destruction of red blood cells.
• Iron absorption failure. This can develop in patients with enteritis of various origins, and in addition, against the background of malabsorption syndrome, postoperative condition, and also this is sometimes associated with the use of drugs that inhibit the absorption of iron.
• The presence of increased demand for iron. As a rule, this is due to pregnancy and intensive growth against the background of puberty.
• Secondary chronic iron deficiency anemia often develops due to blood loss. Blood loss is caused by digestive diseases, for example, reflux esophagitis, peptic ulcer disease, tumor, and so on. Blood loss also causes uterine ailments, for example, heavy menstruation. Renal, nasal and urolithic diseases also often lead to blood loss, which causes hemoglobin to be lost. The most common is posthemorrhagic anemia, which occurs due to blood loss occurring in the digestive system. Such blood loss is the most common cause of iron deficiency in men and the second most common in the fairer sex.
• Failure of iron transportation in the presence of hypoproteinemia of different genesis. The main mechanism for the development of anemia is the lack of iron in the body, which is the main building material for building molecules of the iron-containing part, which is called "heme".

The most common clinical manifestations

The severity of symptoms in chronic anemia can be different and depends on the speed of blood loss, age and gender of the patient. The severity of the condition is due to tissue deficiency of iron. The appearance of anemic syndrome is due to tissue hypoxia, its manifestation is universal for all types of anemia:

• The occurrence of weakness and fatigue.
• The appearance of pallor of the skin and mucous membranes.
• The occurrence of headache and throbbing in the temples.
• Presence of dizziness and fainting.
• The appearance of shortness of breath and palpitations with habitual physical exertion.
• Increased anginal pain with heart problems.
• Decrease in general tolerance to physical activities.
• The emergence of resistance to ongoing treatment with vasodilators.

Sideropenic syndrome may be due to tissue deficiency of iron, its main manifestations are the following symptoms:

• The presence of dry skin, cracks on the surface of the hands, and in addition, the legs and in the corners of the mouth, when the patient is diagnosed with so-called angular stomatitis.
• The presence of glossitis, accompanied by atrophy of the papillae, the presence of soreness and redness of the tongue.
• The occurrence of brittleness, thinning and delamination of nails.
• The presence of hair loss in combination with their early graying.
• The presence of a perversion of taste when patients eat chalk, clay, minced meat, sand and the like.
• The presence of addiction to unusual odors, for example, to kerosene, fuel oil, gasoline, acetone, naphthalene, exhaust gases of cars, which completely disappears after taking iron preparations.
• The presence of dysphagia, that is, difficulty swallowing solid food.

The presence of secondary immunodeficiency syndrome is prone to frequent relapses of infectious and inflammatory diseases. This syndrome includes:

• The presence of damage to the digestive system in the form of glossitis, dysphagia, decreased acid-forming functions of the stomach, atrophic gastritis, bloating, constipation and diarrhea.
• The presence of damage to the hepatobiliary system.
• The presence of pathological changes in the cardiac system, which is manifested by the occurrence of shortness of breath, tachycardia, cardialgia, swelling in the legs, anginal pain, hypotension, expansion of the borders of the heart, and so on.
• The presence of damage to the nervous system, which is manifested by a decrease in memory and ability to concentrate.
• The presence of damage to the muscular skeleton, which is manifested by muscle weakness under normal loads, and in addition, mixed urinary incontinence and the like.

The skin of patients with chronic anemia is usually pale, but not jaundice. As for the liver, spleen and peripheral lymph nodes, they are not enlarged. Sometimes the skin can even acquire a bluish tint. Such patients sunbathe very poorly in the sun, and girls are usually infantile and they often observe a menstrual cycle disorder, ranging from amenorrhea to the presence of heavy menstruation.

Laboratory diagnostics

The main criteria for determining a patient's chronic iron deficiency anemia are:

• The presence of a low color index.
• The presence of red blood cell hypochromia and microcytosis.
• Decrease in an indicator of serumal iron.
• Increased serum iron-binding function and decreased ferritin content.

After determining the presence of anemia in the patient and the level of its severity, it is necessary to find out the causes and source of bleeding. To do this, a number of various studies should be carried out. The main diagnostic methods include:

• Conducting endoscopic examination of the digestive system. As a rule, in the framework of such diagnostics, a colonoscopy is performed, possibly with a biopsy taken.
• Submission of feces for occult blood.
• Gynecological manual and ultrasound examination in women.
• Examination of the urinary system. In this case, patients undergo a urinalysis, an ultrasound examination of the kidneys, and in addition, cystoscopy.
• X-ray examination of the organs of the chest cavity.
• A study of sputum and rinsing water of the bronchi.

In the absence of data that would indicate a clear erosive and ulcerative process, a detailed oncological search is necessary.

Treatment

The goals of treating chronic anemia are:

• Complete elimination of the reasons that caused it. For this, the source of bleeding is first identified and eliminated, restoring the processes of iron absorption.
• Replenishment of iron deficiency.
• Prevention of the development of dystrophic changes in internal organs along with the preservation of their functional ability in full.

Diet as part of treatment

It is impossible to eliminate chronic iron deficiency anemia (code according to ICD-10 - D50) only through diet, since the absorption of iron from products is no more than 2 milligrams per day. But from drugs it can be absorbed twenty times more. But, nevertheless, patients with anemia are recommended products that contain a sufficient amount of easily absorbed protein and, accordingly, iron.

In meat products, there is iron, which is part of the heme, it is absorbed by 25 percent. The iron that is part of hemosiderin (it is found in the liver, eggs and fish) is absorbed by fifteen percent. And iron from plant products (whether soy along with spinach, dill, lettuce, apricots, prunes) is absorbed by five percent. The use of a large number of pomegranates, apples, carrots and beets is not justified, since against the background of their use, low absorption of iron is noted.

People who eat meat get much more iron than vegetarians. Vegetarian followers develop a serious iron deficiency over time, since vegetables and cereals contain components that prevent the absorption of such an important element, in particular phosphates.

It should be noted that a balanced and complete diet with respect to the main components makes it possible only to cover the physiological need of the human body for iron, but does not eliminate its deficiency, and it should be considered as one of the auxiliary components of treatment.

Blood transfusion in chronic iron deficiency anemia (ICD-10 disease is assigned a code of D50) is carried out for patients only for health reasons, while the indication is not the level of hemoglobin, but the general condition of the patient and hemodynamics. Basically resorted to blood transfusion (carrying out transfusion of red blood cell mass) in the event of hemoglobin falling below 40 grams per liter.

Drug therapy

Such treatment of chronic iron deficiency anemia is carried out only with iron preparations, basically all of them are oral, less often parenteral, they are used for a long time, under the control of a blood test. It is worth noting that the rate of restoration of blood counts does not depend on the route of administration of drugs. The main principles of the treatment of iron deficiency anemia through iron preparations for oral use include:

• Prescribing drugs with a sufficient content of ferrous iron.
• In the framework of using new forms, it is necessary to focus on average therapeutic doses.
• The purpose of iron in conjunction with substances that enhance their absorption, we are talking about ascorbic and succinic acid.
• It is necessary to avoid the parallel intake of substances that reduce absorption, we are talking about antacids, tannins, oxalates and so on.
• Use of preparations not containing vitamin components, in particular B ₁₂ .
• Convenient dosage regimen from one to two times a day.
• The presence of good bioavailability, absorbability and tolerability of iron preparations.
• A sufficient duration of therapy is at least eight weeks until the hemoglobin is completely normalized.
• Continue to take the drug in half the dose for four weeks after achieving normalization of the amount of hemoglobin.
• It is advisable to prescribe short monthly courses of treatment from three to five days in medium therapeutic doses to patients with polymenorrhagia.

The criterion for the effectiveness of the treatment of chronic iron deficiency anemia (ICD-10 code is D50) with iron preparations is an increase in reticulocytes five times on the tenth day from the start of treatment. Iron preparations are classified into the following categories:

• Ionic, which are a salt or polysaccharide compound.
• Non-ionic compounds that consist of a hydroxidepolymaltose complex.

Iron sulfate, which is part of combined and monocomponent preparations, is well absorbed (usually by ten percent) and is easily tolerated by patients. Chloride compounds can be absorbed worse and have undesirable effects, namely a metallic taste in the mouth, darkening of the teeth and gums, and in addition, dyspepsia.

Currently, doctors prefer drugs that contain ferrous iron (the fact is that they are better absorbed than ferric drugs), their daily dosage is about 300 milligrams. In no case should you prescribe more than this amount per day, since its absorption does not increase at the same time.

This is confirmed by the history of chronic iron deficiency anemia.

It should also be borne in mind that a number of substances contained in food products, for example, phosphoric acid along with salt, calcium, phytin and tannin, inhibit the absorption of iron. A similar effect is noted with the simultaneous use of ferrous iron, which is found in some medicines, for example, in Almagel.

Indications for parenteral administration of iron drugs

Indications for this in chronic iron deficiency anemia are as follows:

• The presence of a violation of intestinal absorption.
• The presence of absolute intolerance to oral preparations with iron.
• The need for rapid saturation with iron (due to emergency surgery).
• Erythropoietin therapy, when the need for iron increases sharply for a short time.

With parenteral administration, in the case of an incorrectly established diagnosis, the development of multiple organ failure and hemosiderosis is likely. Do not use parenterally more than 100 milligrams per day.

Prevention of chronic posthemorrhagic iron deficiency anemia should be carried out if there are hidden signs of iron deficiency or risk factors for the development of such. A study of hemoglobin, as well as serum iron, should be performed at least once a year, and if there is a clinical manifestation, if necessary, tests should be passed to the following categories of patients:

• Donors, especially women who donate blood constantly.
• Pregnant women, especially those with frequent pregnancies.
• Women who suffer prolonged and heavy menstruation.
• Premature babies and those born from multiple pregnancy.
• For girls during puberty, and in addition, during rapid growth, intensified by sports and in case of restriction of meat products in the process of nutrition.
• Persons with persistent and difficult to eliminate blood loss (gastric, intestinal, nasal, uterine and hemorrhoidal).
• Patients who take non-steroid drugs for a long time.
• Persons with low material wealth.

What is a secondary ailment?

Chronic iron deficiency anemia (according to the ICD - D50) that occurs against a background of concomitant diseases is called secondary. Hemoglobin is one of the most important proteins that supports the human body. It is present in red blood cells and is responsible for the transport of oxygen. That is, during inspiration, oxygen penetrates the lungs, and the protein disassembles it into molecules, delivering it to all organs. This is why hemoglobin is so valuable. Without it, oxygen simply will not spread throughout the body, which will ultimately lead to the failure of all organs and systems.

Secondary anemia is not an independent disease. It mainly serves as a consequence of a particular disease. In this regard, when detecting low hemoglobin, it is necessary to undergo a detailed diagnosis in order to identify its true causes and prescribe treatment. The hemoglobin protein is produced in red blood cells, and they depend on the total amount of iron in the human body.

Thus, if iron falls, then hemoglobin also decreases under the influence of certain factors. If we are talking about primary anemia, then a course of iron with a certain diet is prescribed. After a few weeks, the indicators are usually restored. And with the secondary form of pathology, it is necessary to understand the causes of its occurrence, and then begin treatment. In this case, only one iron can not restore the amount of protein, because initially it is required to overcome the main factor in reducing hemoglobin.