Iron deficiency anemia (IDA) is a clinical and hematological syndrome arising during the development of iron deficiency due to various pathological (physiological) processes and is characterized by lower hemoglobin level (to a lesser extent red blood cells), along with clinical signs of anemia and sideropenia.
Clinical management of patients with IDA recommendations include: - identifying the cause of IDA and if needed - correction - training of patients with IDA - the decision to prescribing iron (RV) - a choice of medicinal RV - RV route of administration (oral or parenteral); - duration of treatment and the need for maintenance therapy - tolerance control RV and correction for poor tolerability; - evaluation of the effectiveness and to identify reasons for the absence or lack of effect - the correction of identified causes of ineffectiveness.
Identifying the cause of IDA and the possibility of its correction
After verifying the nature of iron deficiency anemia, ie, syndrome with IDA, it is necessary to brand name viagra identify the reasons underlying this variant of anemia (nosological diagnosis). For the clinician this stage is no less important, and yet the most difficult and responsible, as the basis of the available IDA may lie potentially kurabelnye disease. The presence of ICD-10 category "Iron-deficiency anemia, unspecified" reserves for the doctor "loophole" in cases where no apparent cause anemia, "liberating" it from the scrutiny and deepening of the diagnostic search during the nosological diagnosis. Should emphasize the role of the doctor-internist at the stages of the Syndrome and nosological diagnosis, because the vast majority of patients with IDA (regardless of the specific reason) go first and foremost, like many other patients to the therapist, rather than to a hematologist or other specialist. In identifying the causes of IDA treatment should be directed at eliminating this cause (if possible) or correction of existing violations - treatment of erosive-ulcerative processes in the stomach, surgical treatment for tumors of the gastrointestinal tract, uterine fibroids, treatment of enteritis, correction of malnutrition, etc.
Education of patients
Essential component of management of patients with IDA is to raise their educational level in relation to this pathology, creating motivation for treatment, patient involvement in the monitoring of their condition and laboratory parameters. Necessary to explain the essence of IDA, the reasons for its emergence, the real possibilities of correction of iron deficiency and normalization of hemoglobin levels. Of particular importance are educational programs for pregnant women with IDA and patients suffering from menorrhagia. In pregnant women should motivate the need to correct iron deficiency in order to prevent iron deficiency in the fetus. Patients should be aware of possible side effects of drugs in the treatment of iron, to follow the doctor's prescription, including regular admission RV. Be sure to point out the inadmissibility of attempts to correct iron deficiency through a variety of foods, as well as the strict indications for injectable forms of the pancreas.
Deciding on the prescribing of iron
All the patients with IDA shows pathogenetic therapy with iron. It should be stressed error of opinion about the possibility of correcting iron deficiency through food with high iron content, which is one of the myths in perceptions about the management of patients with IDA. About this need to be aware of patients that should be considered as an important educational component of this category of patients. Of course, the food should be rich in foods containing iron. However, one should Lucky bear in mind the different degrees of absorbability of iron from different foods. For example, the iron contained in meat is in the form of heme, is absorbed by 40-50%, while vegetable products, fruits, vegetables soaked up only 3-5% contained iron in them. Therefore, the drug of choice for the correction of iron deficiency and hemoglobin levels in patients with IDA are the drugs of iron. The pharmaceutical market in Russia currently has a large arsenal of the pancreas in various dosage forms, with varying content of iron, the presence of additional components that affect the bioavailability of iron, different values (Fig. 1). From PSG iron is absorbed into the divalent form, later transformed into trehvaletnoe, which binds to transferrin and is used for the construction of the hemoglobin molecule. In the VLS iron is in trivalent form and is absorbed as it were in finished form. In VLC, in particular, gidrooksipolimaltoznom complex, due both to the physiological state of the molecule ferritin. There are differences in the mechanisms of iron absorption from the PSG and the VLC. Absorption of iron from the PSG is mainly in the form of passive diffusion according to concentration gradient and to a lesser degree of activity, while the absorption of iron from the VLS is an active process in the form of competitive exchange. This leads to different levels of iron in serum, the volume of distribution constants of elimination after absorption. Absorption of iron from the VLS and the increase of its concentration in serum has been slow, but it quickly goes into stocks. In applying the PSG can lead to abnormalities in oxidative processes (oxidative damage) due to the conversion of ferrous ions to ferric, which is connected with transferrin and is included in the hemoglobin molecule. During the oxidation the formation of free radicals that cause cellular damage such as lipid peroxidation, disturbance of membrane and cellular proteins, damage cellular DNA and RNA. VLC unlike PSG does not cause "oxidative stress", since the iron ions do not change its valence during suction (Table 1). For best absorption PSG is recommended to take one hour before meals is on an empty stomach, which can cause disturbances in the stomach, intestines and other side effects. Modern technologies of production of iron preparations allow PSG delayed release of iron in the intestine, which reduces the toxic effects of iron ions on gastric mucosa. The rate of adverse effects in the treatment of VLS compared with PSG, which provides the best Compliance of patients with IDA. PSG interact with some food products (tannins, phytates, calcium salts) and medicine (the film-forming drugs, tetracyclines, calcium supplements), reducing the bioavailability of iron. In this regard, PSG should not be taken simultaneously with those of food and medicines. At the same time, food and medicines have no effect on iron absorption from the VLS. Growth rate of hemoglobin in the application of PSG and VLS about the same.
The route of administration of iron preparations
In most cases, correction of iron deficiency in the absence of specific evidence of RV should be given by mouth. Route of administration of the pancreas in patients with IDA defined by a specific clinical situation, in particular, the intestinal absorption and tolerability of oral RV.
The main indications for parenteral administration of RV are: - The pathology of the intestine with malabsorption (various enteritis, suction deficiency syndrome) - small bowel resection - resection of the Billroth II with the formation of "blind loop" - erosive-ulcerative processes in the stomach (exacerbation peptic ulcer, etc.) - RV intolerance for oral administration. Many doctors justify the appointment of parenteral RV severity of anemia, based on their supposedly greater effect, which also does not have sufficient grounds and confirmed by clinical practice. Growth rate of hemoglobin level in the appointment of RV inside and parenteral were approximately the same, therefore the preference for RV in injection forms by the need for more rapid normalization of hemoglobin (for example, when preparing for surgery) should be considered unreasonable. RV for parenteral administration may be appointed by poor tolerability of oral pancreatic, but most modern PSG and VLS carry relatively well. In connection with this decision on the appointment of parenteral RV should be done only after a series of "medical maneuver" (reduction of the dose of RV reception with food, change of RV for ingestion, etc.).
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