2020年11月11日星期三

hemorrhoids diagnosis,Diagnosis and treatment of iron deficiency anemia

    Iron deficiency anemia (hereinafter referred to as IDA) is a very common disease. It has a high incidence among infants and children of childbearing age. About 600 million to 700 million people worldwide suffer from IDA. Due to its diverse causes, clinically The manifestations are different, and it is often difficult for ordinary patients to achieve early detection and treatment.

    Diagnosing IDA is not difficult, but finding its cause is difficult. But the cause of the disease can be summarized as the following three points. 1. Nutritional factors: The lack of sufficient iron in the diet or the unreasonable food structure leads to reduced iron absorption and utilization. For example, babies have high iron requirements due to rapid growth and development, and low iron content in breast milk. If supplementary foods are not added in time, IDA is easy to cause; another example is adolescent women, who have fast growth and development and menstrual cramps. There is more iron lost every month. If the iron intake in the diet cannot meet the body's needs, IDA is also prone to occur. 2. Chronic blood loss and excessive iron loss: Long-term small bleeding is more prone to IDA than one major bleeding. Gastrointestinal bleeding (gastroduodenal bleeding and hemorrhoid bleeding, etc.) is the most common cause of IDA in adult men, while excessive menstruation is the most common cause of IDA in menstrual women, and other causes of chronic blood loss and excessive iron loss The diseases still include hookworm disease, paroxysmal nocturnal hemoglobinuria, and patients undergoing hemodialysis treatment for chronic renal failure. 3. Iron malabsorption disorder: It is most common in patients with gastrectomy, and IDA is also prone to long-term severe diarrhea and malabsorption syndrome caused by various reasons.

    IDA is difficult to find in the early stage, and many patients are often found during examination of the original disease or during physical examination. Its common symptoms are dizziness, headache, pale complexion, fatigue, weakness, heart palpitations, shortness of breath after activities, tinnitus, etc.; changes in mucosal tissues lead to glossitis, angular cheilitis, dysphagia, dry skin, dull hair, easy to break or reverse nails A; severe cases may have peripheral neuritis, increased intracranial pressure, and papilledema; children may be irritable, excited, irritable, and hyperactive.

    The diagnostic criteria of IDA are: 1. Small cell hypochromic anemia; 2. There is a clear cause and clinical manifestations of iron deficiency; 3. Serum iron <10.7 umol/L; 4. Serum iron saturation <15%; 5. Bone marrow iron staining showed that small bone marrow granules could be stained with iron and disappeared, and iron granular red blood cells were less than 15%; 6. Free erythrocyte protopoline> 0.9umol/L (whole blood); 7. Serum ferritin <14ug/L; 8. Iron treatment is effective. It can be diagnosed as IDA if it meets two or more of Articles 1 and 2-8.

    IDA treatment is actually very simple. 1. Etiology treatment is the most important, and it is of great significance to cure anemia and prevent recurrence. For example, hookworm disease requires deworming treatment. 2. Iron supplementation: Oral iron is the preferred method. Commonly used drugs are powerful (150 mg, 1  2 times a day), iron dextran (25 mg, 2  3 times a day), ferrous succinate (100 mg, 3 times a day), etc. If there is no response to treatment within three weeks of treatment, check whether the diagnosis is accurate, whether there is active bleeding, and whether to take the medicine as prescribed by the doctor. Those who cannot tolerate oral iron, late pregnancy, digestive tract malabsorption (such as after subtotal gastrectomy), severe digestive tract disease, or oral iron aggravated symptoms, need to inject iron. The dose of iron should be supplemented (mg) = (normal Hbg/dl-patient Hbg/dl) × 300 + 500. However, iron injection can easily cause adverse reactions such as induration at the injection site, dark skin, nausea and vomiting, fever, measles, and even anaphylactic shock. Every deep intramuscular injection should be injected slowly. If there is a systemic reaction, stop the medication immediately. It is advisable to inject 50 mg every day. Note that the injection site should be replaced. Patients with liver and kidney damage should not use iron injection. Of course, in addition to supplementing iron, nutritional IDA is also very important to increase nutrition. Increasing the intake of high-quality animal protein can increase iron absorption and bioavailability.

    After iron treatment, hemoglobin increased at least 15g/L as the effective standard. The cure criteria are: 1. The clinical symptoms disappeared completely; 2. Hemoglobin returned to normal; 3. The stored iron indexes (such as ferritin, erythrocyte free protopoline, etc.) all returned to normal; 4. The cause of iron deficiency is eliminated.

    The prognosis of IDA depends on whether the primary disease can be treated thoroughly. If the primary disease is cured, iron supplementation can make hemoglobin return to normal quickly.

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