Iron-deficiency anemias

Iron-deficiency anemias
Causes:
1. Increased physiological requirement
(a) Growth spurts??Children between ages of 6 months and 2 years, and from 11 to 16 years due to spurts of growth during these periods. (b) Pregnancy.
2. Pathological blood loss
(a) Reproductive system
Menorrhagia
(b) GI tract
Bleeding Atrophic gastritis
Oesophagitis
Oesophageal Inflammatory bowel
Varices disease
Hiatus hernia Haemorrhoids
Peptic ulcer
Malabsorption Coeliac disease
Hemorrhagic
Telangiectasia (rare)
(c) Dietary
Vegans
Elderly
(d) Hookworm infection
Clinical features:
A. Manifestation of underlying conditions -- e.g., pain of peptic ulcer, epigastric lump in carcinoma stomach.
B. Due to anemia -- Insidious onset of easy fatiguability, weakness, headache, bodyache, inability to concentrate, giddiness. With sever anaemia palpitation, exertional dyspnoea, anginal pain and congestive cardiac failure. Heamic murmur may be heard.
C. Due to iron-deficiency anemia
1. Tongue -- Smooth and pale (bald tongue). Sometimes angular stomatitis.
2. Dysphagia -- from formation of mucosal webs at junction of pharynx and oesophagus (believed to be due to reduction in iron containing enzymes in epithelium and GI tract).The combination of splenomegaly, koilonychia and dysphagia is known as Pulmmer-Vinson or Kelly-Paterson syndrome.
3. Atrophic gastritis -- associated with achlorhydria.
4. Nail changes -- Nails may be thin and fragile. Platynychia and koilonychia. More frequent in adults.
5. Hepatosplenomegaly -- usually mild degree may occur, regresses with correction of iron deficiency.
6. Pica -- Perversion of appetite in from of geophagy or pagophagia (excessive eating of rice).
7. Miscellaneous -- (a) Oedema of feet due to CCF, impaired renal function or hypoproteinemia. (b) Amenorrhoea in females, sometimes menorrhagia. (c) Increased intracranial tension and papilloedema rare. (d) In children -- Long-standing anaemia prominence and face resembling that in Cooley??s anaemia . Also reduced attention span and poor learning. (e) Possibly impairment of T cell function and neutrophil killing thus promoting infection.
In traditional Chinese medicine studies, this disease belongs to the categories of xue xu (weakness of blood), xu huang (false jaundice) and huang zhong (yellow coloured swelling); it is closely connected with the spleen and kidneys. The spleen and stomach as the root of the body system, regulate the fluid metabolism and support the heart and blood system; weakness of spleen will cause weakness of Qi and blood, so the blood firstly cannot supply to the head and then body which later caused headache, giddiness, weakness and murmurs in the ears; if the blood cannot support the heart, it will then cause palpitation and dypsnea. The spleen is closely related to the kidneys, if there is insufficient of kidneys Yang, the life is weakening and the spleen will not grow; in contrary, if there is hypofunction of the spleen, it will also further causes the kidney injury, insufficient of Yang of kidneys and spleen whick resulted in inadequate of blood and Qi to the entire body, thus appeared cracks of nails, wrinkles, dry and atrophy of skin, dry and loss of hair. Therefore, in treatment, one must care for the spleen, kidney and support the Qi and blood.