Russians were told signs of iron deficiency in the body

Ferritin is often referred to as the main indicator of iron reserves in the body, but its decrease can occur long before the development of anemia. Fatigue, hair loss, decreased concentration and a constant feeling of lack of energy often appear even at the stage of latent deficiency, when the hemoglobin level remains normal. On September 18, "Izvestia" was told by general practitioner, gastroenterologist, geriatrician Elena Pavlova and Candidate of Medical Sciences, gynecologist-reproductologist Tatiana Gvozdikova about how to correctly assess ferritin levels, why iron can decrease and how to replenish its reserves.

Ferritin shows iron reserves before anemia appears

Ferritin is an intracellular protein complex that stores iron and releases it as needed. In contrast, hemoglobin reflects the current supply of iron to the body, but does not show the volume of its reserves.

According to Pavlova, the body tries to maintain hemoglobin levels because lack of oxygen is critical for its functioning. Therefore, if there is insufficient iron intake or loss, accumulated reserves are first consumed and ferritin decreases. Hemoglobin begins to fall later, when the reserves are already depleted.

A condition in which iron reserves are already reduced, but hemoglobin still remains normal, is called latent, or latent, iron deficiency. According to the doctor, his diagnostic criterion is the serum ferritin level of less than 30 micrograms / liter with normal hemoglobin.

Iron deficiency can occur already at this stage, since the element is necessary not only for hemoglobin, but also for the work of various tissue enzymes and myoglobin. Pavlova mentioned chronic fatigue, rapid fatigue, decreased concentration, "fog in the head," hair loss, brittle nails, dry skin, and restless legs syndrome as possible signs.

With the latter, there is an irresistible desire to move your legs at rest, especially in the evening. According to the expert, with restless legs syndrome, the issue of iron deficiency deserves special attention.

My own doctor: what is the danger of uncontrolled medication intake

The consequences of self—medication can be serious, from stomach ulcers to ischemic stroke.

Why are women more likely to experience iron deficiency?

Women are more prone to iron deficiency than men for physiological reasons. According to Gvozdikova, in addition to menstruation, active losses occur during pregnancy, childbirth and lactation. It is also important to have a smaller iron depot in myoglobin due to the lower average muscle mass.

Menstrual bleeding remains the main regular source of iron loss in women of reproductive age. With blood loss of 30-80 ml per cycle, the body can lose up to 40 mg of iron.

At the same time, iron deficiency, according to the expert, is dangerous at any age. Special attention should be paid to situations when menstruation becomes prolonged or too abundant, as well as spotting outside the cycle.

Gvozdikova attributed indirect signs of heavy menstruation to its duration of more than eight days, a cycle shorter than 24 days, the need to change hygiene products every one to two hours, the simultaneous use of a tampon and pads, the appearance of clots of 2.5 cm in size, the consumption of more than 20 pads or tampons per cycle and nocturnal leakage.

Hair loss, brittle nails, dry skin, and constant fatigue can also indirectly indicate a lack of iron. However, Gvozdikova stressed that these manifestations are non-specific, so their cause can be determined only after examination.

What is important to consider when treating iron deficiency

Simply increasing ferritin is not enough — it is necessary to identify the source of the deficiency. If the cause persists, iron reserves may decrease again after discontinuation of medications.

Among the common gynecological causes, Gvozdikova named uterine fibroids, adenomyosis, polyps and endometrial hyperplasia. However, a woman's iron deficiency cannot be attributed solely to menstrual blood loss.

According to the specialist, examination of the gastrointestinal tract in iron deficiency is a mandatory option. It is especially important to consult a gastroenterologist if gynecological blood loss does not explain the severity of the deficiency, additional alarming symptoms are present, or iron deficiency first appeared after menopause.

On the part of the gastrointestinal tract, two main mechanisms are possible — impaired absorption of iron and its loss. Among the potential causes, Gvozdikova listed atrophic gastritis, Helicobacter pylori infection, celiac disease, Crohn's disease, ulcerative colitis, gastric resection or bariatric surgery, polyps and tumors of the gastrointestinal tract, hemorrhoids, NSAID enteropathy.

Pavlova also stressed that iron deficiency should be perceived as a manifestation of a specific cause, and not as an independent problem. Self-administration of drugs can delay the diagnosis of a disease that has led to a lack of an element.

Why Ferritin analysis alone is not enough

Ferritin cannot be evaluated in isolation. This is not only an indicator of iron reserves, but also an acute phase protein, the level of which can increase during inflammatory processes.

In viral and bacterial infections, autoimmune diseases, exacerbation of chronic diseases, injuries, and other conditions, ferritin levels can increase regardless of actual iron reserves. As a result, the indicator may turn out to be normal or high, even with the existing deficit.

For a more complete assessment of the state of iron, the specialist recommends taking into account not only ferritin, but also a general blood test, MCV and MCH values, serum iron, transferrin, total serum iron binding capacity, transferrin saturation coefficient and C-reactive protein.

Serum iron is of auxiliary importance, since its level varies throughout the day. The transferrin saturation coefficient below 16-20% may indicate an iron deficiency even with an ambiguous ferritin test result.

Additionally, the doctor recommends evaluating total protein, albumin, AST and ALT. In difficult cases, tests for soluble transferrin receptors may be prescribed.

Increased ferritin does not always indicate an excess of iron: it can increase with inflammation, infections, metabolic syndrome and liver diseases. With hemochromatosis, a high index is usually combined with elevated serum iron and a transferrin saturation coefficient above 45-50%, therefore it is incorrect to evaluate ferritin separately.

Side defect: Russians have become more likely to have iron deficiency

Among the common reasons are fashionable gastric reduction surgeries, mono—diets and taking medications to correct weight.

How to replenish iron reserves correctly

Treatment tactics depend on the level of ferritin, the reason for its decrease, symptoms, and other tests. According to Pavlova, iron deficiency is diagnosed with ferritin levels below 30 micrograms per liter, but treatment targets are determined individually.

You should not take iron on your own without finding out the cause of the deficiency. It can be caused by heavy menstruation, hidden bleeding from the gastrointestinal tract, ulcers, polyps, oncological diseases, celiac disease, Helicobacter pylori or atrophic gastritis. Incorrectly selected drug and dosage can lead to side effects.

It takes time to restore iron reserves: improvement in well-being may appear in one to two weeks, hemoglobin growth begins in three to four weeks, and normalization of indicators is possible in a few months. Ferritin is restored more slowly, since iron is first directed to the current needs of the body, and then to reserves.

After normalization of hemoglobin, medications can be continued as prescribed by a doctor. At the same time, it is important to eliminate the cause of the shortage, otherwise the problem may arise again.