The human circulatory system circulates three liters of blood. This stream is continuously moving through the veins, arteries and capillaries, ensuring supply of essential nutrients to organs and tissues. "Starts" and supports blood circulation heart, which acts as a pump. We do not think about it when the circulatory system healthy and functioning normally. But we immediately feel the concentration of red blood cells in the blood falls below the normal level. This condition is called anemia.
Anemia is always secondary, is a symptom of a common disease. Along with frequent and easily diagnosable forms of anemia are very rare and of anemia requiring difficult to diagnose instructional techniques.
What is macrocytic anemia
Macrocytic anemia - a condition where the increased size of red blood cells - red blood cells. The cause of macrocytic anemia is a deficiency of folic acid or vitamin B12 due to poor diet, certain diseases of the gastrointestinal tract, e.g., sprue or liver diseases, which affect the storage and use of erythrocyte maturation factor. Macrocytic anemia during pregnancy may be the result of both poor nutrition and malabsorption major hematopoietic factors. The causes malabsorption of vitamin B12 in the defeat of the intestine may be severe chronic enteritis, terminal ileitis, diverticulosis of the small intestine, the appearance of a blind loop of the small intestine after surgery on it. In the occurrence of vitamin A deficiency in the latter cases, the important role played by his absorbing excess which developed intestinal microbial flora.
Macrocytic anemia associated with vitamin B12 deficiency, regardless of the reason for this deficiency is characterized by the appearance of the bone marrow megapoblastov, vnutrikostnomoegovym destruction of red blood cells, thrombocytopenia, and neutropenia
Neutropenia - immunity under attack
, Atrophic changes of the mucosa of the gastrointestinal tract, and the nervous system changes as funikulyarnogo mieloza.
Macrocytic anemia can develop at any age, but according to statistics more common among the elderly, because the reasons causing it, are more typical for older people. In rare cases, one of the causes of the violation of the internal allocation factor (a protein that is isolated intestinal cells) can be chronic alcohol intoxication when it is accompanied by a toxic lesion of the gastric mucosa.
Vitamin B12 is essential not only for the prevention of macrocytic anemia, but also for the normal functioning of the nervous system and hematopoiesis. A balanced diet that includes all the main sources of vitamin B12, - eggs, meat and dairy products - provides the body with the necessary amount of vitamin B12. The first signs of macrocytic anemia is pallor, shortness of breath, fatigue and weakness.
Causes
The reason folievodefitsitnoy macrocytic anemia may not be enough folic acid in the diet (the main source of it - the liver and greens), chronic alcohol intoxication, increased need for folic acid (during pregnancy, malignancies, hemolysis, certain dermatitis), malabsorption at celiac disease
Celiac disease - not quite intestinal pathology
Under the influence of drugs, oppressive (methotrexate, triamterene, anticonvulsants, barbiturates, metformin) increased excretion of folic acid from the body (liver diseases, hemodialysis). Folievodefitsitnoy macrocytic anemia occurs much less frequently than B12 deficiency.
B12-deficient macrocytic anemia is caused by insufficient intake of vitamin B12, found mainly in the elderly
. Pathogenesis of vitamin B12 deficiency often associated with the production of the glycoprotein violation connecting to dietary vitamin B12 and provides its absorption (internal factors)
. Often the first signs of the disease appear after suffering enteritis, hepatitis
. In the first case it is due to malabsorption of vitamin B12 in the small intestine, in the second - with the expenditure of its reserves in the liver, which is the main depot of vitamin B12
. However, both provoking moment can play a role only when the trigger mechanism has previously been hidden deficiency of this vitamin due to violation of secretion of intrinsic factor
. The development of B12-deficiency anemia after total gastrectomy (when fully wound secretion of intrinsic factor) occurs after 5-8 years or more after surgery
. During this time patients live vitamin reserves in the liver with minimal replenishment due to its negligible absorption in the small intestine are not connected to the intrinsic factor vitamin
.
Signs and symptoms
The clinical picture of macrocytic anemia has almost no characteristic features - patients worried about fatigue, headache, insomnia, palpitations; On examination revealed pallor of the lips, nails, bright red tongue. Signs of the gastro-intestinal tract, and nervous system are absent. An examination reveals hyperchromic macrocytic anemia, leukopenia, thrombocytopenia; Trial therapy with vitamin B12 does not cause increase in the number of reticulocytes. If necessary, the diagnosis is confirmed by determination of folate in serum and erythrocytes.
One of the characteristic signs of B12 deficiency anemia - funicular myelosis. Gastric secretion is suppressed, can be resistant achlorhydria. Often there are signs of glossitis
Glossitis - when it hurts language
- "Polished" language, a burning sensation in it. The skin of patients sometimes slightly yellowness in increased serum levels of indirect bilirubin (due to increased deaths gemoglobinsoderzhaschih megaloblasts bone marrow). Determined slight enlargement of the spleen, liver rarely.
Often B12-deficiency anemia can be diagnosed only by blood picture of patients without any complaints: A modest, usually hyperchromic anemia, leukopenia, thrombo-cytopenia. In the bone marrow in all cases are a large percentage of megaloblasts. However, if the patient for a few days before the bone marrow puncture received an injection of vitamin B12, the megaloblastoz bone marrow may either not be very pronounced, or absent altogether.
The next stage of the diagnosis - determining the cause of deficiency of folic acid or vitamin B12. Keep in mind that sometimes the vitamin B12 deficiency combined with gastric cancer
Stomach cancer: genetics and lifestyle
As well as gastric cancer more often occurs in people suffering from this form of anemia. In addition to conducting all investigations required (to avoid infestation broad tapeworm, enteritis), make sure with the help of gastroscopy or X-ray examination in the absence of stomach cancer.
Complications
There is no evidence that macrocytic anemia in itself can lead to complications, although it is clear that violations lead to complications, which causes an increase in the size of red blood cells (macrocytosis).
In patients suffering from jaundice or hepatitis, can be marked macrocytosis, which is secondary to increased levels of cholesterol and phospholipids in the membranes of red blood cells.
Treatment
Treatment of anemia macrocytic performed on an outpatient or hospital mode, depending on its severity. Assign a diet with high content of protein, mainly animal products. Drug therapy is the appointment tsiankobalamina within 1 1, 5 months. In order to prevent a recurrence of life administered cyanocobalamin.
Vitamin B12 is essential not only for the prevention of macrocytic anemia, but also for the normal functioning of the nervous and hematopoietic systems.
