Iron deficiency anemia in the elderly
Introduction
Introduction to iron deficiency anemia in the elderly Iron deficiency anemia refers to anemia in which the stored iron in the body is exhausted and cannot meet the needs of normal erythropoiesis. It belongs to small cell hypochromic anemia, which is called iron deficiency in the stage before anemia occurs. Iron is an essential trace element in the human body. In addition to participating in the synthesis of hemoglobin, it also participates in some biochemical processes in the body. Therefore, when anemia occurs, in addition to the symptoms of anemia, there will be some symptoms related to iron deficiency. basic knowledge The proportion of illness: 0.27% Susceptible people: the elderly Mode of infection: non-infectious Complications: atrophic gastritis
Cause
Causes of iron deficiency anemia in the elderly
Insufficient iron intake (30%):
Adults need 1 to 2 mg of iron per day. Women of childbearing age, infants and children in growth and development, the demand for adolescents increases. If the iron content in food is insufficient, or malabsorption, iron deficiency is likely to occur in meat. Heme iron is easily absorbed, while vegetables, cereals, phosphates in tea, phytic acid, tannins, etc. can affect the absorption of iron, so the composition of food has a greater impact on the iron intake.
Drugs or stomach, duodenal diseases can also affect iron absorption, such as metal (gallium, magnesium) intake, antacids (calcium carbonate and magnesium sulfate) and H2 receptor antagonists can inhibit iron Absorption, atrophic gastritis, stomach and duodenal surgery will also reduce iron absorption.
Chronic blood loss (30%):
Chronic blood loss is a common cause of iron deficiency anemia, especially in chronic digestive tract or women with more menorrhagia, such as digestive tract ulcers, digestive tract tumors, hookworm disease, esophageal varices, hemorrhage and taking aspirin Bleeding, etc., uterine fibroids or functional bleeding lead to menorrhagia (monthly bleeding volume > 40ml), in addition, recurrent episodes of paroxysmal nocturnal hemoglobinuria can also be caused by iron excretion of hemoglobin.
When the body is deficient in iron, it can be caused by anemia caused by reduced hemoglobin synthesis:
(1) The activity of ferritase is decreased, which affects the oxidative glycolysis cycle of cell mitochondria.
(2) The accumulation of lactic acid in skeletal muscle after exercise is more than normal, which causes muscle function and physical strength to decrease.
(3) The activity of monoamine oxidase is reduced, which affects the neurological and intellectual development of children.
(4) Keratinization and degeneration of epithelial proteins and reduction of gastric acid secretion.
Other (10%):
Under normal circumstances, the absorption and excretion of iron maintains a dynamic balance, and the iron in the body is in a closed circulation. The human body is generally not prone to iron deficiency. Only when the amount of iron is insufficient, and the iron intake is insufficient and chronic blood loss occurs, iron deficiency will occur. .
Prevention
Iron deficiency anemia prevention in the elderly
Iron deficiency anemia is mostly preventable. For iron-deficient patients, it is best to eat iron-rich diets and fortified foods, eat animal protein, strengthen nutrition knowledge education and maternal and child health care, such as improving infant feeding and promoting breastfeeding. And timely treatment, and actively carry out parasitic control work, for the prevention and treatment of menorrhagia, foreign use of the birth control ring, the daily application of 20g of progesterone, can reduce menstruation.
Complication
Complications of iron deficiency anemia in the elderly Complications atrophic gastritis
Severe anemia can occur stomatitis, glossitis, atrophic gastritis and so on.
Symptom
Symptoms of iron deficiency anemia in the elderly Common symptoms Iron deficiency anemia Skin mucous membrane pale dizziness easy to feel pale pale fatigue nausea attention distraction ocular retinal hemorrhage
Symptom
The occurrence of anemia is slow, early asymptomatic or mild symptoms, patients often adapt well, common symptoms are dizziness, headache, pale, fatigue, fatigue, palpitations after activity, shortness of breath, vertigo and tinnitus.
2. Special performance
The special manifestations of iron deficiency are angular cheilitis, tongue nipple atrophy, glossitis, severe iron deficiency can have spoon-shaped nails (anti-armor), loss of appetite, nausea and constipation, European patients often have difficulty swallowing, angular cheilitis, called Plummer -Vinson syndrome, which may be related to the environment and genes.
3. Symptoms caused by iron deficiency
Children with growth retardation or behavioral abnormalities, manifested as irritability, irritability, inattention to class, decreased academic performance, and eclipse is a special manifestation of iron deficiency. Patients often cannot control certain foods, such as Ice cubes, clay, starch, etc.
4. Signs
The skin mucous membrane is pale, the hair is dry, the lips are keratinized, the nail is flat, the gloss is tarnished, and it is easily broken. About 18% of the patients have anti-A, about 10% of patients with iron deficiency anemia have mild spleen, and no special special is found in the spleen. The pathological changes can disappear after iron deficiency correction, and a few severe anemia patients can see retinal hemorrhage and exudation.
Examine
Examination of iron deficiency anemia in the elderly
1. Blood: present a typical small cell hypochromic anemia (MCV <80%, MCHC <30%), the degree of red blood cell changes is related to the time and extent of anemia, red blood cells can be seen in the blood, the central light-stained area is enlarged, the size Unequal and deformed, most of the reticulocytes are normal or slightly increased, white blood cell counts are normal or slightly reduced, the classification is normal, platelet counts are often high, and infants and children are low.
2. Bone marrow: active bone marrow hyperplasia, increased number of young red blood cells, increased proportion of early red blood cells and young and middle red blood cells, dense chromatin particles, less cytoplasm, purple blue granulocytes and megakaryocyte system are often normal, iron stained iron particles Young cells are significantly reduced, and extracellular iron is reduced or disappeared.
3. Biochemical examination
(1) Determination of serum iron: serum iron decreased, <8.95mol/[(50g/dl), total iron binding capacity increased, >64.44mol/L (360g/dl), transferrin saturation decreased to below 15%, Because the determination of serum iron fluctuates greatly, there should be more factors. In the judgment of the results, combined with clinical considerations, serum iron and total iron binding capacity can be reduced in women 2 to 3 days before menstruation or 3 months after pregnancy. Does not necessarily mean iron deficiency.
(2) serum ferritin determination: serum ferritin is lower than 14g / L, but can be associated with inflammation, tumors and infections, should be combined with clinical or bone marrow iron staining to determine, iron deficiency anemia in patients with bone marrow erythroid cells And extracellular iron is reduced or absent. In the above chronic diseases, iron in the complete erythroid cells is reduced, but the outer iron is increased.
(3) Determination of erythrocyte free protoporphyrin (FEP): elevated FEP indicates heme synthesis disorder, which is used to indicate the presence of iron deficiency, which is a more sensitive method, but in the case of non-iron deficiency (such as lead poisoning and iron granules) When the cell is anemia, FEP can also be increased, and should be combined with clinical and other biochemical tests.
(4) Determination of erythrocyte ferritin: radioimmunoassay or enzyme-linked immunosorbent assay can be used to measure erythrocyte alkaline ferritin, reflecting the status of iron storage in the body, such as <6.5g / L red blood cells, indicating iron deficiency, but the operation is more complicated, still Cannot be used as a regular.
A small number of severe anemia, slit lamp examination can show abnormalities.
Diagnosis
Diagnosis and diagnosis of iron deficiency anemia in the elderly
Diagnostic criteria
The diagnosis of iron deficiency anemia should be included and the cause or primary disease of iron deficiency anemia should be identified.
Clinically, iron deficiency and iron deficiency anemia are divided into three stages: iron deficiency, iron deficiency erythropoiesis and iron deficiency anemia. The diagnostic criteria are as follows:
1. Iron deficiency: or potential iron deficiency period, at this time only the consumption of stored iron in the body, serum ferritin <12g / L or bone marrow iron staining showed that iron granule cells <10%, extracellular iron slightly reduced, However, indicators such as hemoglobin and serum ferritin saturation are normal at this time.
2. Iron deficiency erythropoiesis: At this time, red blood cells intake is less than normal, extracellular iron moderately reduced serum ferritin <12g/L, transferrin saturation <15%, FEP>250g/dl red blood cells , the content of hemoglobin is not significantly reduced, red blood cells are positive anemia.
3. Iron deficiency anemia: At this time, the red iron cells and the external iron are significantly reduced, showing small cell hypochromic anemia.
In order to clarify and identify the cause or primary disease of iron deficiency anemia, it is necessary to further perform some targeted examinations based on medical history and clues found in physical examination, such as fecal occult blood test, urine routine examination, liver and kidney function, Gastroscopy, and corresponding biochemical, immunological examinations, etc.
Differential diagnosis
The differential diagnosis is mainly differentiated from other small cell anemia.
1. Mediterranean anemia: often family history, most target red blood cells in blood, abnormal hemoglobin electrophoresis, serum iron, transferrin saturation and bone marrow iron staining does not decrease.
2. Chronic anemia: often accompanied by tumors, liver and kidney diseases or infections, transferrin saturation is normal or slightly increased, serum ferritin is increased, the number of iron granules in the bone marrow is reduced, and hemosiderin particles are increased.
3. Iron granulocyte anemia: Anemia caused mainly by iron utilization disorders acquired in the congenital or acquired day, which occurs in the elderly, and the transferrin saturation is reduced, serum iron, ferritin and the ring-shaped iron granule cells in the bone marrow Both increased.
