Anemia por Deficiência de Ferro

Descrição Geral

Definição

A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é definida como um nível de hemoglobina que está 2 desvios padrão abaixo da média para a idade, sexo e etnia do paciente. Como o ferro é um componente fundamental para a constituição da hemoglobina, uma deficiência deste mineral pode resultar em diminuição da produção de hemoglobina e, consequentemente, em anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types.

Epidemiologia

• Causa mais MAIS Androgen Insensitivity Syndrome comum de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types em todo o mundo (50% de todas as anemias)
• Mais MAIS Androgen Insensitivity Syndrome prevalente nos países em desenvolvimento
• 5%–10% das mulheres menstruadas são afetadas.
• Os lactentes (6-24 meses) que consomem leite de vaca têm uma maior incidência de deficiência de ferro porque o consumo de leite de vaca leva ao aumento das perdas GI de ferro.
• Mais MAIS Androgen Insensitivity Syndrome comum em famílias com baixo rendimento/baixas condições socioeconómicas

Etiologia

• Diminuição da absorção
  • Dietas restritivas
    • Dietas vegan/vegetarianas com baixo teor em ferro
    • Dietas ricas em leite (por exemplo, uma criança que consome leite de vaca)
  • Má-absorção:
    • Produção insuficiente de ácido gástrico que facilita a absorção de ferro (por exemplo, pacientes medicados com inibidor da bomba de protões (IBP))
    • Doença celíaca
    • Doença inflamatória intestinal
    • Após gastrectomia/resseção do intestino delgado
• Aumento das perdas
  • Hemorragia (por exemplo, trauma, menorragia, cancro, doença ulcerosa péptica)
  • Hemólise
  • Parasitas do trato GI
  • Hemorragia GI crónica
  • Hemossiderose urinária/pulmonar
• Aumento das necessidades
  • Durante a gravidez, aumento da necessidade devido à expansão do volume de sangue materno/necessidades fetais
  • Tratamento com eritropoietina no contexto de DRC
• Deficiência funcional
  • Visto em doenças crónicas
  • O ferro da degradação da Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange não é libertado para a circulação pelos macrófagos.
  • Devido à inflamação crónica e à produção de hepcidina

Fisiopatologia

• O metabolismo do ferro é um equilíbrio entre absorção, uso e excreção de ferro.
• Necessidades normais de ferro: 0,5-1 mg/dia
  • Mulheres menstruadas: 1-2 mg/dia
  • Mulheres grávidas: 3-5 mg/dia
• Síntese do grupo Heme:
  • Envolve a combinação de ferro ferroso (Fe²⁺) com protoporfirina
  • A diminuição da biodisponibilidade do ferro resulta na deficiência de síntese do grupo heme e na sua capacidade de transporte de oxigénio.
  • Os baixos níveis de Fe²⁺ desencadeiam a eritropoiese e a regulação dos receptores de transferrina nos GV para melhorar o fornecimento de ferro aos tecidos.
• Etapas da depleção de ferro:
  • Homeostase normal do ferro
  • Deficiência de ferro sem anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types:
    • As reservas de ferro estão esgotadas, mas é obtido ferro suficiente a partir da decomposição da Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange antiga para sintetizar Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange de novo.
    • Nenhuma anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é evidente, mas o indivíduo é vulnerável a esta.
  • Deficiência de ferro com anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types:
• Quando a oferta do Fe²⁺ diminui, os seguintes processos também são afetados:
  • A ferritina, a forma de armazenamento do excesso de ferro no corpo, diminui.
  • A transferrina, uma proteína que se liga ao ferro no sangue, aumenta.

Apresentação Clínica

Sinais e sintomas

• Palidez
• Fadiga
• Dispneia
• Tonturas
• Síncope
• Coiloníquia (unhas em forma de colher, frágeis)
• Cabelo frágil
• Síndrome de Pica Pica Pica is an eating disorder characterized by a desire or recurrent compulsion to eat substances that are nonnutritive and not food. These compulsions and ingested substances are inappropriate for age or culture. Pica (desejo de ingestão de objetos não alimentares: terra, gelo, tinta, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).)
• Síndrome das Pernas Inquietas
• Perturbações do humor Humor Defense Mechanisms: irritabilidade, menor capacidade de atenção

Síndrome de Plummer-Vinson

• Disfagia: apenas para sólidos, devido às membranas esofágicas
• Glossite: língua vermelha e áspera
• Quilose
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro

Diagnóstico

O diagnóstico de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é clínico, mas para qualificá-la como anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro são necessários exames laboratoriais.

• Hemograma:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types microcítica hipocrómica
  • ↓ Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange
  • ↓ VCM ( < 70)
  • ↓ HCM HCM Hypertrophic cardiomyopathy (HCM) is the most commonly inherited cardiomyopathy, which is characterized by an asymmetric increase in thickness (hypertrophy) of the left ventricular wall, diastolic dysfunction, and often left ventricular outflow tract obstruction. Hypertrophic Cardiomyopathy (< 25)
  • ↑↑ amplitude de distribuição do tamanho dos GV (RDW, pela sigla em inglês)
  • Trombocitose: ↑ plaquetas
• Estudo da cinética do ferro:
  • ↓ Ferro
  • ↓↓ Ferritina
  • ↑↑ Capacidade total de ligação do ferro
  • ↑ Transferrina
  • ↓↓ Saturação da transferrina
• Esfregaço de sangue periférico
  • Microcitose e GV hipocrómicos
  • Anisocitose
  • Células em alvo
  • Células em bico de lápis
• Aspiração de medula óssea
  • Método gold standard (raramente feito)
  • Coloração com azul da Prússia: diminuição do ferro nos eritroblastos
• Encontrar a causa subjacente: Estudo aprofundado do trato GI em homens e mulheres na pós-menopausa
• 1 dos seguintes achados é necessário para o diagnóstico:
  • Ferritina do soro < 30 ng/mL
  • Saturação da transferrina < 19%
  • A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types resolve com a suplementação com ferro.
  • O aspirado de medula óssea mostrasem coloração do ferro

Tratamento

Tratar a causa subjacente

• Diminuir a ingestão de leite de vaca na criança.
• Suspender fármacos que possam ter interferência.
• Tratar a doença inflamatória intestinal.

Suplementação

• Oral
  • Sulfato ferroso/gluconato ferroso/fumarato ferroso
  • Duração: 3-6 meses
  • Aumenta a absorção com sumo ácido (diminui o pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance)
• IM/IV: indicado nos pacientes que não toleram a ingestão oral ou que têm má absorção
• Transfusão de sangue: para pacientes severamente anémicos com taquicardia de base

Verificação da resposta ao tratamento

Os reticulócitos devem aumentar em 1 semana.

Diagnóstico Diferencial

• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types da doença crónica: anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types resultante de doença crónica que se apresenta com aprisionamento de ferro em macrófagos ou em ferritina. Mais MAIS Androgen Insensitivity Syndrome frequentemente encontrado na insuficiência renal crónica devido ao défice de síntese da eritropoietina. A capacidade total de ligação do ferro é baixa e os níveis de hepcidina estão aumentados nestes casos.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types Sideroblástica: tipo de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types em que os níveis de ferro são normais, mas o ferro não pode ser incorporado no grupo heme. As causas de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types sideroblástica incluem envenenamento por chumbo, deficiência de vitamina B₆ e toma de isoniazida.
• Talassemia: hemoglobinopatia hereditária que apresenta um quadro clínico semelhante ao da anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro. No entanto, o estudo da cinética do ferro são normais na talassemia e, portanto, a suplementação com ferro pode ser prejudicial.