What provokes iron deficiency anemia?

There are more than 10 types of iron metabolism disorders, leading to the development of iron deficiency anemia. The most important are:

• iron deficiency in food, important in the development of iron deficiency conditions in children from the earliest to adolescence, and in adults and the elderly;
• violation of absorption of iron in the duodenum and upper parts of the small intestine as a result of inflammation, allergic edema of the mucous membrane, lambliasis, infection of Helicobacter jejuni, with bleeding;
• violation of the transition of Fe ³⁺ - »Fe ²⁺ due to a deficiency of androgens, ascorbic acid, atrophic gastritis, leading to insufficient formation of gastroferrin.
• Initially low iron content in the body;
• inadequate food intake;
• increased need;
• discrepancy between intake and losses of iron;
• violation of iron transport.

Each patient can be affected by either of these factors or a combination of both.

It is advisable to identify risk factors for the development of iron deficiency from the mother and child and the causes of iron deficiency anemia in children of different ages. In young children, factors of prenatal iron deficiency and factors determining the inconsistency of the need and intake of iron in the body predominate. In older children, conditions leading to increased (pathological) blood loss are in the first place.

Risk factors and causes of iron deficiency in women and children of different ages

Risk factors for the development of iron deficiency
At mother:	The child has:
more than 5 pregnancies; the interval between pregnancies is less than 3 years; multiple fertility; gestosis; IDA is pregnant; abundant tension; chronic infections; playing sports; donation; vegetarianism; occupational hazard	intensive growth in early and pubertal age; rickets; frequent infections, acute intestinal infections, SARS; dysbiosis; violation of the menstrual cycle; playing sports; vegetarianism
Causes of iron deficiency
Young children:	Older children:
Factors of prenatal deficiency of Fe: previa, placental abruption; rupture of the umbilical cord; fetofetal and fetoplacental transfusions; prematurity, large birth weight; Factors causing insufficient intake of Fe in the body: defects in feeding; malabsorption syndrome, cow milk intolerance, recurrent OCI; Factors causing blood loss: abnormalities of the digestive tract; tumors; telangiectasia; Violation of iron transport: hypo- and atransferrinemia	Factors causing blood loss: abnormality of the gastrointestinal tract (duplicate mucosa, polyposis, diverticulosis, varicose veins, erosive gastritis, peptic ulcer, ulcerative necrotic colitis, hernia of the esophageal aperture, tumor, telangiectasia; helminthiases: trichocephalus, ankylostomidosis, ascariasis; juvenile bleeding; hemorrhagic diathesis, thrombocytopathy, thrombocytopenia, coagulopathy; pulmonary hemosiderosis; endometriosis; glomus tumors; frequent blood fetuses for examination (iatrogenic blood loss). Endocrine diseases hypothyroidism; dysfunction of the ovaries. Hematuria :. Tuberculosis; Malabsorption syndrome, resection of the stomach and small intestine Violation of iron transport, hypo- and atransferrinemia Extracorporeal methods of treatment. Alimentary insufficiency.

The main causes of iron deficiency anemia in children and adolescents

• Alimentary iron deficiency due to unbalanced nutrition;
• iron deficiency at birth;
• increased needs of the body in the gland due to the rapid growth of the child;
• loss of iron, exceeding physiological.

AND I. The horse (2001) cites 3 main nutritional factors in the development of iron deficiency in children:

• reduced intake of iron from food;
• reduced absorption;
• increased losses.

Consider the following reasons for reduced iron intake from food:

• absence of breastfeeding;
• the use in nutrition of young children of partially adapted and unadapted formula, not enriched with iron porridge;
• later introduction of complementary foods;
• reduced intake of vitamin C, etc.

To reduce the absorption of iron leads to the use of a large number of plant fibers in the diet, an excess of protein, calcium, polyphenols. Increased iron losses are possible with the early introduction of whole milk and kefir into the baby's nutrition, which leads to diapedesis bleeding from the stomach and small intestine and loss of hemoglobin by excretion with feces.

For the prevention of iron deficiency, work is still important to increase the prevalence of breastfeeding. Breastmilk contains iron with the highest bioavailability - 50%, which has no analogues.

The human diet provides heme and non-heme food; non-haemal food products predominate (90%), heme deposits account for about 10%. The degree of assimilation of iron from these types of foods is also different. Assimilation of iron from rice, corn, soybeans, beans, beans, spinach, flour makes up 1-7% of its content in the product. The assimilation of iron from meat products ranges from 18-20 to 30%.

Perennial nutrition with plant products - suppliers of hard-to-digest non-heme iron - and rejection of meat products rich in easily digestible heme iron can lead to iron deficiency anemia. This is confirmed by a survey of vegetarians. "Civilized" vegetarians of Western countries necessarily use multivitamins, trace elements, including iron preparations against the background of a plant diet, which allows them to have a normal level of hemoglobin.

Causes of iron deficiency anemia in pregnant women

Anemia of pregnant women is usually caused by 2 reasons: a negative balance of iron in the body and its inadequate intake. Deficiency of iron in the body of a pregnant woman is fraught with numerous risks for herself and for the fetus, in particular:

• placental insufficiency;
• intrauterine fetal death;
• miscarriage;
• premature birth;
• low birth weight of the child;
• pre-eclampsia;
• pyelonephritis;
• postpartum infections;
• bleeding.

The needs of the pregnant woman in the gland are so increasing that they can not be covered with the usual diet, even with the absorption of iron, which has increased several times. The total costs of iron pregnant are composed of:

• additional erythrocytes of the mother - 450 mg;
• fetal tissues, placenta and umbilical cord - 360 mg;
• blood loss in the course of childbirth - 200-250 mg;
• daily loss through the gastrointestinal tract and with sweat - 1 mg;
• loss with milk when breastfeeding - 1 mg.

The total loss of iron is more than 1000 mg.

Criteria for anemia in pregnant women consider a decrease in hemoglobin concentration of less than 110 g / L in the I and III trimesters of pregnancy and less than 105 g / L in the IV trimester.

As is known, hemoglobin concentration in 30% of women after birth is below 100 g / l, and in 10% of women - below 80 g / l, which corresponds to anemia of moderate severity requiring treatment and aggravated due to the lactation period. Causes of postpartum anemia in women:

• depletion of iron stores in the depot during pregnancy;
• loss of blood during delivery.

The loss of blood during physiologically occurring childbirth is 400-500 ml (200-250 mg of iron), and in case of multiple pregnancy or by caesarean section, up to 900 ml (450 mg of iron) is increased. Traditional methods of treatment of postpartum anemia:

• transfusion of erythrocyte mass in severe cases requiring urgent treatment;
• the use of iron preparations for ingestion in cases of mild anemia.

The use of intravenous iron in the treatment of postpartum anemia has proved to be an effective and rapid method of treatment. This is extremely important due to the fact that women are discharged early from the maternity hospital and they have a lactation period that requires at least 1 mg of iron per day. As the results of studies have shown, the use of the preparation venofer [iron (III) hydroxide sucrose complex; 3 intravenous injections of 200 mg during the week] leads to a revolutionary result: in a group of 30 women, an average hemoglobin concentration increased from 70.7 to 109.3 g / l. Thus, the transition of severe anemia to the lung in record time was demonstrated. Such treatment serves as an alternative to blood transfusion.

Chronic posthemorrhagic anemia associated with prolonged loss of a small volume of blood is also referred to as iron deficiency anemia and treated according to the principles of iron deficiency anemia. In the treatment of chronic posthemorrhagic anemia, first of all, it is necessary to detect the source of blood loss and eliminate it. For male patients, losses from the gastrointestinal tract caused by:

• ulcerous bleeding;
• polyps of the large intestine;
• ulcerative colitis;
• angiomatosis of the intestine;
• presence of Meckelian diverticulum;
• tumors of the stomach and intestines (in adults);
• hemorrhages from hemorrhoidal formations (in adults).

In female patients, bleeding due to juvenile uterine bleeding in girls of pubertal age and prolonged and profuse menstruation observed in 12-15% of women of reproductive age is in the first place. Loss of hemoglobin from the digestive tract occupy the second place in women.

Donors who often donate blood (regular donors) are at risk for developing iron deficiency conditions or already have iron deficiency anemia. Overcoming iron deficiency in donors is possible with the help of:

• interruptions in the delivery of blood (at least 3 months);
• adequate nutrition;
• the appointment of iron preparations for ingestion.

The only drawback of these recommendations is the need for their long-term implementation. Rapidly overcoming the iron deficiency of regular donors is principally possible with the introduction of intravenous iron preparations, for example, using a venofer drug registered in our country. For this, the following justifications are available:

• venous access with blood sampling is provided;
• the amount of blood loss is known;
• the amount of loss of iron from the body is calculated based on the volume of blood donated (a one-stage exfusion of 500 ml of whole blood leads to a loss of 250 mg of iron).

At the same time, the cost of whole blood and its components increases, but it is necessary first of all to take into account the donor's well-being, a decrease in the quality of his life during the period of overcoming iron deficiency anemia. It is possible that the use of intravenous iron drugs will allow donors to donate blood more often, which is important with the current donor deficit.

[1], [2], [3], [4], [5], [6], [7], [8],

Stages of development of iron deficiency

Prelatent iron deficiency is characterized by a decrease in iron stores, a decrease in hemosiderin in macrophages of the bone marrow, an increase in the absorption of radioactive iron from the gastrointestinal tract, the absence of anemia and changes in serum iron metabolism.

Latent (Latent) Iron Deficiency: along with depletion of the depot, the transferrin saturation coefficient decreases, the level of protoporphyrins in erythrocytes increases.

Explicit iron deficiency anemia: in addition to the above signs, clinical manifestations of iron deficiency are observed.