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},
"code": "D50",
"name": "Железодефицитная анемия",
"icd_name": "Железодефицитная анемия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
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"periodicity": 1,
"slug": "d50_zhelezodeficitnaya_anemiya",
"lead": "Нарушение здоровья, относящееся к группе анемии, связанные с питанием",
"description": "<p>Железодефицитная анемия — гематологический синдром, характеризующийся нарушением синтеза гемоглобина вследствие дефицита железа и проявляющийся анемией и сидеропенией. Основными причинами ЖДА являются кровопотери и недостаток богатой железом пищи и питья.</p>",
"etiology": "<ol>\r\n<li>Повышенная потребность организма в железе:</li>\r\n</ol>\r\n<ul>\r\n<li>Подростки в период полового созревания;</li>\r\n<li>Беременные женщины.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Недостаточное поступление железа в организм:</li>\r\n</ol>\r\n<ul>\r\n<li>Искусственное вскармливание детей раннего возраста неадаптированными молочными смесями;</li>\r\n<li>Вскармливание детей раннего возраста коровьим или козьим молоком;</li>\r\n<li>Умышленное недоедание или голодание с целью похудения;</li>\r\n<li>Вегетарианство.</li>\r\n</ul>\r\n<ol start=\"3\">\r\n<li>Нарушение всасывания железа в кишечнике:</li>\r\n</ol>\r\n<ul>\r\n<li>Синдром мальабсорбции;</li>\r\n<li>Дисбактериоз кишечника;</li>\r\n<li>Нарушение минерального обмена (связывание железа в ЖКТ оксалатами, фосфатами, солями кальция).</li>\r\n</ul>\r\n<ol start=\"4\">\r\n<li>Кровотечения – хронические (рецидивирующие) кровопотери.</li>\r\n</ol>\r\n<p>Желудочно-кишечные кровотечения:</p>\r\n<ul>\r\n<li>Кровоточащие эрозии и язвы в пищеводе, желудке или кишечнике;</li>\r\n<li>Геморрой (геморроидальные кровотечения);</li>\r\n<li>Кровоточащие раковые опухоли желудка или кишечника.</li>\r\n</ul>\r\n<p>Маточные кровотечения:</p>\r\n<ul>\r\n<li>Нарушения овариально-менструальной функции у юных девушек и молодых женщин;</li>\r\n<li>Маточные кровотечения у взрослых женщин (при миоме, эндометриозе)</li>\r\n</ul>\r\n<p>Носовые кровотечения.</p>",
"pathogenesis": "<p>Железодефицитная анемия связана с физиологической ролью железа в организме и его участием в процессах тканевого дыхания. Оно входит в состав гема — соединения, способного обратимо связывать кислород. Гем представляет собой простетическую часть молекулы гемоглобина и миоглобина (белок скелетных мышц, связывающий кислород). В депонировании железа в организме основное значение имеет ферритин и гемосидерин. Транспорт железа в организме осуществляет белок трансферрин.</p>\r\n<p>Организм только в незначительной степени может регулировать поступление железа из пищи и не контролирует его расходование. При отрицательном балансе обмена железа вначале расходуется железо из депо (латентный дефицит железа), затем возникает тканевый дефицит железа, проявляющийся нарушением ферментативной активности и дыхательной функции в тканях, и только позже развивается железодефицитная анемия.</p>",
"diagnostics": "<p>Диагностика ЖДА включает:</p>\r\n<ol>\r\n<li>Клинический анализ крови с подсчетом ретикулоцитов и тромбоцитов – характерно уменьшение содержания гемоглобина и количества эритроцитов, увеличение количества ретикулоцитов.</li>\r\n<li>Биохимические показатели обмена железа – снижение содержания сывороточного железа, повышение лабораторных показателей общей и латентной железосвязывающей способности сыворотки крови;</li>\r\n<li>Биохимические показатели пигментного обмена (билирубина) – уровень билирубина при ЖДА не изменен;</li>\r\n<li>Проба с десфералом;</li>\r\n<li>Эндоскопическое и рентгенологическое обследование ЖКТ – ЭФГДС, рентгенография желудка, ректороманоскопия, ирригоскопия, фиброколоноскопия;</li>\r\n<li>Узи органов брюшной полости;</li>\r\n<li>Анализ кала на скрытую кровь;</li>\r\n<li>Анализ кала на яйца глистов;</li>\r\n<li>Стернальная пункция с анализом костного мозга – миелограмма.</li>\r\n</ol>",
"treatment": "<p>Препараты выбора для лечения ЖДА – пероральные препараты трехвалентного железа. При плохой переносимости или неэффективности пероральных препаратов железа, эрозивном гастродуодените, язве желудка или двенадцатиперстной кишки, синдроме мальабсорбции (нарушении всасывания), анемии 2-3 степени острой постгеморрагической анемии назначают парентеральные препараты железа. При анемии 2-3 степени, неэффективности монотерапии препаратами железа, полидефицитной анемии смешанного генеза назначаются прпараты витамина В12 и фолиевая кислота.</p>",
"prevention": "<p>Основа профилактики ЖДА – здоровый образ жизни и рациональное питание с употреблением продуктов, богатых железом, витаминами и микроэлементами (мясные продукты, печень, рыба, икра, греча, овощи, фрукты). Профилактический прием препаратов железа в группах риска:</p>\r\n<ul>\r\n<li>Юные девушки с нарушением овариально-менструальной функции;</li>\r\n<li>Молодые женщины с гиперменструальным синдромом;</li>\r\n<li>Беременные и кормящие матери;</li>\r\n<li>Дети младшего возраста.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>",
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