ICD code for chronic iron deficiency anemia - D50.
Iron deficiency can cause many different problems, ranging from fatigue and intense hair loss to anemia. Many people are deficient in this micronutrient without even knowing it. So, how can you recognize chronic iron deficiency anemia? How can you deal with it? We'll talk about all this later.
Iron deficiency in the body: what is it?
About seventy percent of all anemias develop due to iron deficiency. Due to the small amount of this trace element, hemoglobin molecules cease to be produced. As a result, human blood carries less oxygen. Iron deficiency in tissues leads to problems with hair, skin, heart, and in addition, with digestion.
According to medical statistics, chronic iron deficiency anemianearly two billion people are affected. A hidden deficiency of this element is found in three billion. Most often, anemia occurs in women during periods of fertility, and in addition, in pregnant women and adolescents.
Chronic symptoms
Even before the onset of chronic iron deficiency anemia, people show specific signs. Basically, the hair, intestines, skin and heart muscle are affected along with the nervous system. In that case, if you arrange the symptoms of iron deficiency from the most common to the rarest, you get the following list:
- Having dry skin and brittle layered nails.
- Split ends along with their slow growth.
- Presence of fatigue, asthenia and weakness, and with it pallor.
- Taste disorders along with the desire to eat chalk, paint and so on.
- Having a strange taste for smells.
Against the background of a decrease in hemoglobin, there are signs of oxygen deficiency in the form of dizziness and fainting. Often disturbed by palpitations with tinnitus in chronic iron deficiency anemia.
Severities and stages
The lack of such an important trace element increases gradually, passing through several stages. The first stage is called prelatent. At this stage, iron is consumed much more than it enters the body, however, its reserves in the tissues are still present enough. Such a deficiency is quite simple to correct if you change your diet. You can use all kinds of dietary supplements along with special medical nutrition. Similar preventionwill certainly help restore the supply of trace elements and prevent the development of anemia.
In the event that the deficiency has not been eliminated, iron reserves are gradually depleted. Against this background, the level of hemoglobin does not change, but specific signs may occur. When conducting a study, a decrease in transferrin and ferritin can be detected. In the presence of a latent deficiency, it is necessary to review your diet and use special dietary supplements along with vitamin complexes.
If the hidden lack of iron is not corrected, then chronic anemia develops. Mild severity, not to mention moderate and severe, necessarily involves taking appropriate drugs. Therapy usually lasts as long as the body needs iron.
Chronic iron deficiency anemia of mild severity is often diagnosed. This is a condition when the hemoglobin level is above 90 grams per liter.
Mild cases of chronic iron deficiency anemia usually have no symptoms and can only be diagnosed by blood tests.
Therapy most often consists of following a proper diet to normalize hemoglobin levels. The basis of the recovery diet includes foods high in iron and B vitamins.
Chronic moderate iron deficiency anemia has more pronounced symptoms. Against its background, hemoglobin is 70-89grams per litre. Therapy in this case should be started immediately according to the scheme prescribed by the specialist.
There is also severe chronic iron deficiency anemia. The hemoglobin index in this case is less than 70 grams per liter. Treatment of this form of the disease is carried out in a hospital.
Chronic post-hemorrhagic iron deficiency anemia is a complex of clinical and hematological changes that have arisen due to acute or chronic blood loss. The main symptoms: pallor, shortness of breath, darkening of the eyes, dizziness, hypothermia, arterial hypotension. In severe cases - lethargy, thready pulse, shock, loss of consciousness. Pathology is diagnosed according to the clinical picture and complete blood count. In order to establish the source of bleeding, conduct instrumental studies. With the development of this disease, transfusion and symptomatic therapy is necessary.
General information
Diagnosis of anemia is based mainly on information obtained during laboratory tests. First of all, the results with the determination of the degree of hemoglobin concentration are important. According to the norms, the criterion for the onset of anemia in children is a decrease in hemoglobin concentration of less than 110 grams per liter, for women less than 120, and for men less than 130.
The most common in therapeutic practice is chronic iron deficiency anemia of mild severity, which is a painful condition caused by a violation of hemoglobin synthesis due to an acute shortageiron.
According to statistics, about two billion people in the world in one form or another suffer from iron deficiency, most of them are children and women. The frequency of mild and moderate chronic iron deficiency anemia in pregnant women in the world ranges from twenty to fifty percent. And in developing countries, this figure reaches 75 percent.
Features of the process of iron metabolism in the human body
Men typically take in about 18 milligrams of iron per day from food, and as a result, only 1 milligram is absorbed. That is, iron is lost in the urine, sweat, and so on.
Women get 12 milligrams per day with food, and a maximum of 1 milligram is absorbed. But the fact is that women additionally lose iron during the menstrual cycle, and besides, due to pregnancy.
With an increased need for iron, no more than 2 milligrams can be absorbed from food. Thus, in the event that the loss of iron by the body is more than 2 milligrams per day, then anemia develops. Next, let's talk about the main reasons that can affect the decrease in the amount of iron in the human body.
Causes of chronic iron deficiency anemia
The main reasons for the development of this pathology include the following factors:
- The presence of alimentary insufficiency. At the same time, there is a small intake of iron with food, due to a lack of meat products (for example, as a result of starvation or vegetarianism). Such a diet does not allow a person to make up for the loss of iron that occurs due to the destruction of red blood cells.
- Iron absorption failure. This can develop in patients with enteritis of various origins, and in addition, against the background of malabsorption syndrome, a postoperative condition, and this is sometimes associated with the use of drugs that inhibit iron absorption.
- Having an increased need for iron. As a rule, this is due to pregnancy and intensive growth against the background of puberty.
- Often develops secondary chronic iron deficiency anemia due to blood loss. Blood loss is caused by digestive diseases, for example, reflux esophagitis, peptic ulcer, tumor, and so on. Blood loss also causes uterine ailments, such as heavy menstruation. Kidney, nasal and urolithiasis also often lead to blood loss, due to which hemoglobin is lost. The most common is posthemorrhagic anemia, which occurs due to blood loss occurring in the digestive system. Such blood loss is the most common cause of iron deficiency in men and the second most common in women.
- Failure of iron transportation in the presence of hypoproteinemia of various origins. The main mechanism for the development of anemia is the lack of iron in the body, which is the main building material for building the molecules of the iron-containing part, which is called "heme".
Most common clinical manifestations
Severitysymptoms in chronic anemia can be different and depend on the rate of blood loss, age and sex of the patient. The severity of the condition is due to tissue iron deficiency. The appearance of anemic syndrome is due to tissue hypoxia, its manifestation is universal for all types of anemia:
- Occurrence of weakness and fatigue.
- Appearance of pale skin and mucous membranes.
- Headache and throbbing in the temples.
- Presence of dizziness and fainting.
- The appearance of shortness of breath and palpitations during the usual physical exertion.
- Intensification of anginal pain with heart problems.
- Lower overall exercise tolerance.
- Occurrence of resistance to ongoing treatment with vasodilators.
Sideropenic syndrome may be due to tissue iron deficiency, its main manifestations are the following symptoms:
- The presence of dry skin, cracks on the surface of the hands, and in addition, the legs and in the corners of the mouth, when the patient is diagnosed with the so-called angular stomatitis.
- The presence of glossitis, accompanied by atrophy of the papillae, the presence of soreness and redness of the tongue.
- The occurrence of brittleness, thinning and delamination of nails.
- Hair loss coupled with early graying.
- Presence of taste perversion when patients eat chalk, clay, minced meat, sand and the like.
- Having an addiction to unusual odors, such as kerosene, fuel oil, gasoline, acetone, naphthalene, car exhaust, which is completelyresolves after taking iron supplements.
- Having dysphagia, that is, difficulty swallowing solid food.
The presence of secondary immunodeficiency syndrome is characterized by a tendency to frequent relapses of infectious and inflammatory diseases. This syndrome includes:
- The presence of damage to the digestive system in the form of glossitis, dysphagia, decreased acid-forming functions of the stomach, atrophic gastritis, bloating, constipation and diarrhea.
- Presence of hepatobiliary lesion.
- The presence of pathological changes in the cardiac system, which is manifested by the occurrence of shortness of breath, tachycardia, cardialgia, edema in the legs, anginal pain, hypotension, expansion of the boundaries of the heart, and so on.
- Presence of damage to the nervous system, which is manifested by a decrease in memory and the ability to concentrate.
- The presence of damage to the muscular skeleton, which is manifested by muscle weakness during normal exertion, and in addition, mixed urinary incontinence and the like.
Skin in patients suffering from chronic anemia is usually pale, but not icteric. As for the liver, spleen and peripheral lymph nodes, they are not enlarged. Sometimes the skin can even acquire a bluish tint. Such patients sunbathe very badly in the sun, and girls, as a rule, are infantile and often have menstrual disorders ranging from amenorrhea to heavy menstruation.
Laboratorydiagnostics
The main criteria for determining a patient with chronic iron deficiency anemia are:
- Having a low color index.
- Presence of RBC hypochromia and microcytosis.
- Decrease in serum iron.
- Increase in serum iron-binding function and decrease in ferritin.
After determining whether the patient has anemia and its severity, it is necessary to find out the causes and source of bleeding. To do this, a number of various studies should be carried out. The main diagnostic methods include:
- Carrying out an endoscopic examination of the digestive system. As a rule, as part of such a diagnosis, a colonoscopy is performed, possibly with a biopsy.
- Fecal occult blood donation.
- Performing gynecological manual and ultrasound examinations in women.
- Implementation of the study of the urinary system. At the same time, patients undergo a urinalysis, ultrasound examination of the kidneys, and in addition, cystoscopy.
- Chest X-ray.
- Performing examination of sputum and bronchial washings.
In the absence of data that would indicate a clear erosive and ulcerative process, it is necessary to conduct a detailed oncological search.
Providing treatment
The goals of treating chronic anemia are:
- Complete elimination of the causes that hercalled. To do this, first of all, the source of bleeding is identified and eliminated, restoring the processes of iron absorption.
- Replenishment of iron deficiency.
- Preventing the development of dystrophic changes in internal organs along with maintaining their functional ability in full.
Diet as part of treatment
It is impossible to eliminate chronic iron deficiency anemia (ICD-10 code - D50) only through a diet, since the absorption of iron from foods is no more than 2 milligrams per day. But from drugs it can be absorbed twenty times more. But, nevertheless, patients with anemia are recommended foods that contain a sufficient amount of easily absorbed protein and, accordingly, iron.
Meat products contain iron, which is part of the heme, it is absorbed by 25 percent. Iron, which is part of hemosiderin (it is found in the liver, eggs and fish), is absorbed by fifteen percent. And iron from plant products (be it soy along with spinach, dill, lettuce, apricots, prunes) is absorbed by five percent. The use of a large number of pomegranates, apples, carrots and beets is not justified, since against the background of their use there is a low absorption of iron.
People who eat meat get much more iron than vegetarians. Vegetarians develop a serious iron deficiency over time, as vegetables and grains contain components that prevent the absorption of such an important element,in particular, we are talking about phosphates.
It should be noted that a balanced and complete diet in terms of its main components makes it possible only to cover the physiological need of the human body for iron, but does not eliminate its deficiency, and it should be considered as one of the auxiliary components of treatment.
Hemotransfusion in chronic iron deficiency anemia (according to the ICD-10 code - D50 is assigned to the disease) is carried out for patients only for he alth reasons, while the indication is not the level of hemoglobin, but the general condition of the patient and hemodynamics. Basically, they resort to hemotransfusion (carrying out transfusion of erythrocyte mass) in case of a drop in hemoglobin below 40 grams per liter.
Drug therapy
Such treatment of chronic iron deficiency anemia is carried out only with iron preparations, basically all of them are oral, less often parenteral, they are used for a long time, under the control of a blood test. It is worth noting that the rate of recovery of blood parameters does not depend on the route of drug administration. The main principles for the treatment of iron deficiency anemia with oral iron supplements include:
- Prescribing drugs with adequate ferrous content.
- As part of the use of new forms, it is necessary to focus on average therapeutic doses.
- The appointment of iron together with substances that enhance their absorption, we are talking about ascorbic and succinic acid.
- It is necessary to avoid the parallel intake of substances that reduce absorption,we are talking about antacids, tannin, oxalates and so on.
- Use of products that do not contain vitamin components, especially B12.
- Convenient once to twice daily dosing schedule.
- Good bioavailability, absorption and tolerability of iron preparations.
- Sufficient duration of therapy - at least eight weeks until complete normalization of hemoglobin.
- Continue taking half dose medication for four weeks after hemoglobin normalization is achieved.
- It is advisable to prescribe short monthly courses of treatment from three to five days at medium therapeutic doses to patients with polymenorrhagia.
The criterion for the effectiveness of the treatment of chronic iron deficiency anemia (ICD-10 code - D50) with iron preparations is a five-fold increase in reticulocytes on the tenth day from the start of treatment. Iron preparations are classified into the following categories:
- Ionic, which is a s alt or polysaccharide compound.
- Non-ionic compounds that consist of a hydroxide polym altose complex.
Ferrous sulfate, which is included in combined and monocomponent preparations, is well absorbed (usually by ten percent) and is easily tolerated by patients. Chloride compounds may be less well absorbed and have undesirable effects, such as a metallic taste in the mouth, darkening of the teeth and gums, and, in addition,dyspepsia.
Currently, doctors prefer drugs that contain ferrous iron (the fact is that it is better absorbed compared to trivalent drugs), their daily dosage is about 300 milligrams. In no case should you prescribe more than this amount per day, since its absorption does not increase at all.
This is confirmed by case histories of chronic iron deficiency anemia.
It should also be taken into account that a number of substances contained in foods, such as phosphoric acid, along with s alt, calcium, phytin and tannin, inhibit iron absorption. A similar effect is noted with the simultaneous use of ferrous iron, which is found in some medicines, for example, in Almagel.
Indications for parenteral iron medications
Indications for this in chronic iron deficiency anemia are as follows:
- Presence of malabsorption.
- Presence of an absolute intolerance to oral iron preparations.
- Demand for rapid iron saturation (due to emergency surgery).
- Therapy with "Erythropoietin", when the need for iron increases sharply for a short time.
With parenteral administration, in case of an incorrect diagnosis, the development of multiple organ failure and hemosiderosis is likely. Do not use more than 100 milligrams per day parenterally.
Prevention of chronicposthemorrhagic iron deficiency anemia should be carried out in case of hidden signs of iron deficiency or risk factors for the development of such. The study of hemoglobin, as well as serum iron, should be performed at least once a year, and in case of a clinical manifestation, as needed, tests should be taken by the following categories of patients:
- Donors, especially women who donate blood regularly.
- Pregnant women, especially those with frequent pregnancies.
- Women who suffer from long and heavy periods.
- Premature babies and those born from multiple pregnancies.
- Girls at puberty, and in addition, during rapid growth, enhanced by sports and in case of restriction of meat products in the diet.
- Persons with persistent and difficult to eliminate blood loss (gastric, intestinal, nasal, uterine and hemorrhoidal).
- Patients who take non-steroid drugs for a long time.
- People with low material income.
What is secondary affliction?
Chronic iron deficiency anemia (according to the ICD - D50), which occurs against the background of concomitant diseases, is called secondary. Hemoglobin is one of the most important proteins that supports the human body. It is present in red blood cells and is responsible for transporting oxygen. That is, during inhalation, oxygen enters the lungs, and the protein disassembles it into molecules, delivering it to all organs. That's why hemoglobinso valuable. Without it, oxygen simply will not spread throughout the body, which will eventually lead to the failure of all organs and systems.
Secondary anemia is not an independent disease. It basically serves as a consequence of a particular disease. In this regard, when low hemoglobin is detected, it is necessary to undergo a detailed diagnosis in order to identify its true causes and prescribe treatment. The protein hemoglobin is produced in red blood cells, and they depend on the total amount of iron in the human body.
Thus, if iron falls, then under the influence of certain factors, hemoglobin also decreases. If we are talking about primary anemia, then a course of iron is prescribed with a certain diet. After a few weeks, the indicators, as a rule, are restored. And with a secondary form of pathology, it is necessary to understand the causes of its occurrence, and then begin treatment. At the same time, iron alone will not be able to restore the amount of protein, because initially it is required to overcome the main factor in reducing hemoglobin.
