RU2624383C2 - Method for diagnostics and rehabilitation of children of school age in iron-defective condition - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: preliminary questioning is carried out and peripheral blood is taken with determination of hemoglobin level, colour index, ferritin, total iron binding ability of serum, serum iron. The results obtained are evaluated using a point system. If a colour index corresponding to the norm is revealed, serum iron level is 14-15 μmol/l, ferritin corresponds to the norm and the level of total iron binding capacity of the serum is less than 63 μmol/l, each indicator is assigned a point equal to 1 - iron deficiency degree coefficient K₁, and the condition is concluded with its compliance with the state of prelatent iron deficiency. If the colour index is normal, serum iron is less than 14 μmol/l, ferritin is 10-11 μg/l, the total iron binding capacity of the serum is also less than 64-69 μmol/l, each indicator is assigned a point equial to 2 - K₂, and condition compliance with the state of latent iron deficiency is concluded. With a hemoglobin decrease relative to the norm and colour index less than 86%, serum ironless than 12 μmol/L, ferritin less than 10 μg/l and the total iron binding capacity of 70 μmol/l and more, each indicator is assigned 3 points - K₃, the state of iron deficiency anemia is concluded. Then the questionnaire is reviewed to identify symptoms such as weakness, fatigue, malaise, poor sleep, decreased concentration, physical development, paleness of skin and mucous membranes, dry skin and hair, layering and lateral pectoral nails, taste perversion, dizziness, headaches, angular stomatitis, shortness of breath at moderate and low physical activity, systolic murmur, clearly heard in the vessels. At that, each identified symptom is assigned 1 point - K₄. The total ΣK value is then determined by the formula ΣK=K₁+K₂+K₃+K₄. If the total of points is 1-10, the schoolchild shall walk in the fresh air for at least 2 hours, eat meat products of not less than 120 g per day, an increased amount of fruits and vegetables, rich in iron, receive herbal infusions, oxygen cocktails, mineral adenous water. At ΣK equal to 11-20 points, multivitamin complexes courses and homeopathic ferrin drug at a dose of 5 granules under the tongue until complete resorption 3 times a day for 2-3 months are added to the above mentioned prescriptions also without missing classes. When ΣK above 20 points, the treatment course includes the scheme provided for schoolchildren with prelatent iron deficiency in combination with the introduction of medicinal iron-containing drugs prescribed by the paediatrician in outpatient or inpatient settings.

EFFECT: increased accuracy and simplification of early preclinical diagnostics of early stages of iron deficiency, increased efficiency of rehabilitation of patients with iron deficiency.

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Description

The proposed study relates to medicine, namely to pediatrics, and can be used for early diagnosis and timely rehabilitation of school-age children with iron deficiency conditions.

A sharp deterioration in the socio-economic situation, inadequate nutrition of pregnant and lactating women, unsustainable feeding of infants, environmental degradation - all this is an incomplete list of factors that adversely affect an intensively growing organism, the development of nutritional-dependent diseases, including anemia (Shcheplyagina L.A. . et al., 2001). Iron deficiency is an urgent public health problem due to its high prevalence, as well as in connection with the negative consequences for both the adult and the children's body (I. Zakharova et al., 2013). Iron deficiency is classified as preferential iron deficiency (APD), latent iron deficiency (APD), and anemia (Samsygina G.A. et al., 2006). According to WHO (2008), 1.62 billion people are affected by anemia worldwide, which corresponds to 24.8% of the population. In preschool children, the incidence of anemia is 47.4%. Of all the anemia, iron deficiency (IDA) is the most common, accounting for approximately 80% of all anemia. It has been proven that it leads to damage to many organs and systems, a decrease in the body's defenses and is a cause of impaired growth and development of children (Rumyantsev A.G. et al., 2001). According to the All-Russian Children's Clinical Examination (2002), the level of IDA in children in Russia is about 50% in young children, more than 20% in older children. The prevalence and incidence of anemia over the past 10 years has been steadily increasing. So, from 1992 to 2002, the incidence of anemia in children aged 0-14 years increased by 4 times (from 452.0 in 1992 to 1821.8 per 100 thousand children of the corresponding age in 2002), increased in adolescents 15-17 years old 5.7 times (from 102.8 in 1992 to 591.5 per 100 thousand children of the corresponding age in 2002). The algorithm for diagnosing anemia is simple and possible at a doctor’s appointment at an outpatient clinic. The differential diagnosis of anemia and their treatment is carried out at a specialized stage. Identification of children at the preferential and latent stages of iron deficiency development allows timely rehabilitation measures, which makes it possible to prevent the development of anemia.

There is a method of determining the preferential deficit of iron stores in tissues and treating this condition by prescribing only a balanced diet containing an increased amount of iron ("Anemia in Children", edited by Prof. Kalinichev NI - L .: Medicine, 1983). The essence of the method is that in the macrophages of the bone marrow, the hemosiderin content and the level of absorption of radioactive iron from the gastrointestinal tract are determined, and with a decrease in hemosiderin or its absence in bone marrow macrophages and an increase in intestinal iron resorption, preferential iron deficiency is detected.

The disadvantages of this method is the technical complexity of the diagnosis, trauma, because involves bone marrow capture, the limited and insecure use in connection with the use of radioactive iron for diagnostic purposes, which in children can cause a large number of side effects. In addition, the appointment of only a balanced diet is ineffective, due to the poor absorption of iron by the child’s body, the duration of treatment.

Also known is a method for detecting iron deficiency by determining the level of iron in the serum and treatment. In addition to diet therapy, iron preparations are used in combination with multivitamins (Guide for the local pediatrician. Uzbekistan. Medicine, 1986; RF patent No. 2012334, class A61K 31/295, 1994). However, this treatment regimen is not effective enough. Firstly, taking iron preparations is justified only with established iron deficiency anemia, the drugs are poorly tolerated, causing dyspeptic symptoms. While with preferential and latent iron deficiencies it is possible to do without them. Secondly, iron contained in food is absorbed only by 25%.

Closest to the claimed one, taken as the closest analogue, is a method for the prevention and treatment of blood damage syndrome in children, including selecting children for treatment according to the results of clinical and laboratory diagnostics (with preliminary blood sampling) and carrying out preventive and therapeutic measures by administering ascorbic acid to background corrective diet. In this case, ascorbic acid is pre-irradiated with a laser, administered to the patient orally 2 times a day, and after taking the drug, an additional irradiation of the elbow projection of the vein is carried out (RF patent No. 2101043, class A61N 5/06, A61K 31/375, 1998).

The disadvantages of the above method are the complexity of the technical design (the need for a laser installation), the unjustified use of laser irradiation for preventive measures for preferential and latent iron deficiencies, the inefficiency of only a balanced diet, due to poor digestibility. In addition, this treatment regimen can contribute to disruption of the student in the educational process. Tasks:

- providing early preclinical diagnosis of iron deficiency;

- simplification of the method for diagnosing the early stages of iron deficiency;

- improving accuracy;

- increasing the efficiency of rehabilitation of patients with iron deficiency;

- adjustment of the rehabilitation program with the condition of primary treatment without interruption of the student from school.

The essence of the invention is that in the group of schoolchildren who have identified a color indicator corresponding to the norm, serum iron levels of 14-15 μmol / L, ferritin corresponding to the norm, the total iron binding capacity of the serum is less than 63 μmol / L, assign a score of 1 - iron deficiency degree coefficient K ₁ and the matching condition of iron deficiency prelatent provided color index values in normal serum iron less than 14 mol / l, ferritin of 10-11 g / l, total iron binding capacity sy orotki 64-69 .mu.mol / l K ₂ is assigned equal to 2 points, and matching the latent iron deficiency; and under the condition of indicators: a decrease in hemoglobin relative to the norm and color index less than 86%, serum iron less than 12 μmol / l, ferritin less than 10 and a total iron binding capacity of 70 and higher μmol / l, assign a state of 3 points - K ₃ and determine iron deficiency anemia; then additionally reveal the amount in all groups (K ₄ ): weakness, fatigue, malaise, poor sleep, decreased concentration, lag in physical development, pale skin and visible mucous membranes, dry skin and hair, lamination and transverse striation of nails, taste perversion, dizziness, headaches, angular stomatitis, shortness of breath with moderate and insignificant physical exertion, systolic murmur, well heard on the vessels, in the presence of an indicator assign it 1 point, after which predelyayut total sum value (ΣK) points according to the formula ΣK = K ₁ + K ₂ + K ₃ = K _4, and provided the total points 1-10 student performs walking outdoors for at least 2 hours consume meat products at least 120 g per day, an increased amount of fruits and vegetables rich in iron, herbal decoctions, oxygen cocktails, mineral glandular water; at ∑K of 11–20 points, multivitamin complexes are added to the above prescriptions by courses and the homeopathic preparation Ferrin is used for 3 doses over 10 years old, over 10 years old 5 granules 3 times a day before meals for 2-3 months, also without separation from school, and at ∑K equal to above 20 points, the course of treatment includes a regimen prescribed for schoolchildren with a preferential iron deficiency in combination with the administration of iron-containing drugs as prescribed by the pediatrician on an outpatient or inpatient basis.

The technical result of this method is that the efficiency of early diagnosis and rehabilitation in full of schoolchildren with iron deficiency conditions is significantly increased. The method basically eliminates the use of specific therapy in the early stages of iron deficiency. The method is quite simple, and the elimination of the need for complex technical equipment makes the proposed method economical.

The method was tested on 1230 students of one of the comprehensive schools of Krasnodar. Among them were 637 boys and 573 girls. Of these, 38 schoolchildren were found to have preferential iron deficiency (PAD), in 22 schoolchildren - latent iron deficiency (PAD), in 14 schoolchildren - iron deficiency anemia (IDA).

The method is as follows: all schoolchildren are questioned and in the process of clinical examination at schoolchildren, peripheral blood is sampled in a known manner with the determination of hemoglobin level, color index, ferritin, total iron binding capacity of blood serum, and serum iron. The results are evaluated by a point system according to table 1 (see the end of the description). Next, the survey data is estimated by the sum of the scores according to table 2 (see the end of the description). Then, depending on the amount of points, the presence of preferential, latent iron deficiencies, iron deficiency anemia is determined.

In schoolchildren who scored from 1 to 10 points, preferential iron deficiency is determined. Children perform: walks in the fresh air for at least 2 hours; a diet with meat products (at least 120 g of meat per day), fruits (pomegranates, apples, citrus fruits) and vegetables; apply herbal medicine (decoctions of nettle, dog rose, St. John's wort); drink oxygen cocktails; they use ferruginous mineral water (in the Krasnodar Territory it is “Swallow”, “Polyustrovsky”, “Jermuk”).

Pupils with 11 to 20 points are given latent iron deficiency. Children perform: walks in the fresh air for at least 2 hours; a diet with meat products (at least 120 g of meat per day), fruits (pomegranates, apples, citrus fruits) and vegetables; apply herbal medicine (decoctions of nettle, dog rose, St. John's wort); drink oxygen cocktails; they use ferruginous mineral water (Swallow, Polyustrovsky, Jermuk), multivitamin complexes with courses, a homeopathic preparation ferrin for 2–3 months (up to 10 years, 3 granules, older than 10 years, 5 granules per tongue per 20 minutes before meals, until complete resorption 3 times a day).

Students who receive a score of 21 or more are diagnosed with iron deficiency anemia. And execution: walks in the fresh air for at least 2 hours; diets with the use of meat products (at least 120 g of meat per day), fruits (pomegranates, apples, citrus fruits) and vegetables; apply herbal medicine (decoctions of nettle, wild rose, St. John's wort), oxygen cocktails; the use of glandular mineral water (for example, "Swallow", "Polyustrovsky", "Jermuk"); taking multivitamin complexes courses; taking iron-containing medicines (as prescribed by the pediatrician on an outpatient or inpatient basis).

After 2-3 months, a control examination of schoolchildren is carried out (questionnaire, laboratory examination), the results of which give an assessment of the effectiveness of the rehabilitation.

Examples

1. At the 11-year-old schoolchildren during the clinical examination during the examination, attention was drawn to the pallor of the skin and visible mucous membranes, dry skin. From a questionnaire filled out by my mother, rapid fatigue and frequent complaints of a headache were noted. During laboratory examination: hemoglobin 123 g / l, color index 0.91%, ferritin 15 μg / l, serum iron 15.5 μmol / l, total iron binding capacity of blood serum 55 μmol / l.

According to the available data in tables No. 1 and No. 2, the total score was calculated - 9 (∑K = 1 (fatigue) +1 (headache) +1 (pallor of the skin and visible mucous membranes) +1 (dry skin) +1 ( hemoglobin 123 g / l) +1 (color indicator 0.91%) +1 (ferritin 15 μg / l) +1 (serum iron 15.5 μmol / l) +1 (total iron binding capacity of blood serum 55 μmol / l) ), i.e. was diagnosed with: Prolate iron deficiency.

He was prescribed a corrective diet with the inclusion of an increased amount of foods rich in iron (meat products at least 120 g per day), broths of nettle and wild rose in alternation daily, oxygen cocktails daily for 10 days on the basis of the school’s medical room, drinking mineral glandular water ( "Polyustrovsky", "Swallow", "Jermuk") daily. After the end of the course of treatment, after 1 month a control examination was carried out, in which skin integuments and visible mucous membranes of a physiological color were noted. According to my mother, complaints about a headache decreased, school performance improved. Hematological indicators are satisfactory. Relapses over the next 6 months were not observed.

2. A 14-year-old schoolgirl complained of weakness, rapid fatigability, poor sleep, dryness and peeling of the skin, increased hair loss, brittleness and layering of nails during the clinical examination. The survey also revealed that menstruation began at age 13, was irregular for the last 5-6 months, and heavy. An objective examination noted: pallor of the skin and visible mucous membranes, dryness and peeling of the skin, layering of nails, auscultatory-systolic murmur in the second intercostal space on the left. During laboratory examination: hemoglobin 109 g / l, color index 0.81%, ferritin 8 μg / l, serum iron 10.5 μmol / l, total iron binding capacity of blood serum 83 μmol / l.

According to the available data in tables No. 1 and No. 2 (see the end of the description), the total score is calculated - 23 (∑K = 1 (weakness) +1 (poor sleep) +1 (fast fatigue) +1 (dry and peeling skin ) +1 (increased hair loss) +1 (brittle and layered nails) +1 (pallor of the skin and visible mucous membranes) +1 (systolic murmur in the 2nd intercostal space on the left) +3 (hemoglobin 109 g / l) +3 ( color indicator 0.81%) +3 (ferritin 8.1 μg / L) +3 (serum iron 10.5 μmol / L) +3 (total iron binding capacity of serum 83 μmol / L), i.e. a diagnosis was made : Iron deficiency anem I said. The girl was sent to a local pediatrician for the purpose of iron preparations. a course of therapy with ferrum-lek in age dosage was performed.

A month later, a control examination was conducted, hematological parameters improved. It was recommended to extend the treatment. After 2 months, iron levels returned to normal. Control examination after 6 months. There are no complaints. Iron deficiency anemia was not detected during follow-up examination.

2. A 12-year-old schoolboy complained of frequent headaches during an examination. According to the class teacher, the boy began to lag behind the school curriculum, academic performance over the past 3-4 months has worsened. From the questionnaire it became known that in the last 5-6 months the child does not receive meat products (the child’s mother switched to vegetarianism, meat products in the family were replaced by soy). Objectively, pallor of the skin and mucous membranes, dry skin, and brittle nails were noted. During laboratory examination: hemoglobin 119 g / l, color index 0.93%, ferritin 11 μg / l, serum iron 13.2 μmol / l, total iron-binding ability of blood serum 66 μmol / l. According to the criteria of tables No. 1 and No. 2, the total score was calculated - 15 (∑K = 1 (decrease in concentration) +1 (headaches) +1 (dry skin) +1 (brittle nails) +1 (pale skin and visible mucous membranes) +3 (hemoglobin 119 g / l) +1 (color index 0.93%) +2 (ferritin 11 μg / l) +2 (serum iron 13.2 μmol / l) +2 (total iron binding capacity of serum 66 μmol / L), i.e. was diagnosed with Latent iron deficiency.

A conversation was held with mom about the mandatory inclusion of meat products in the diet. He was prescribed a corrective diet with the inclusion of an increased number of foods rich in iron (meat products at least 120 g per day), broths of nettle and wild rose in alternating daily, oxygen cocktails daily for 10 days on the basis of the school’s medical room, drinking mineral glandular water ( "Polyustrovsky", "Swallow", "Jermuk") daily, multivitamin complex "Alphabet", homeopathic preparation Ferrin in a dosage of 5 granules under the tongue until completely resorbed 3 times a day, before meals, for 1 month.

After the end of the treatment course, after 1 month a control examination was carried out, the skin and visible mucous membranes of physiological color. There were no complaints of a headache, school performance improved (according to the class teacher). Hematological parameters improved, serum iron and ferritin levels increased to 15 μmol / L and 12 μg / L, respectively. Relapses over the next 6 months were not observed. In the future, it was recommended that a full-fledged diet with the mandatory inclusion in the diet of meat (at least 120 g per day).

Claims (1)

A method for the diagnosis and rehabilitation of schoolchildren with an iron deficiency state, characterized in that they pre-conduct a survey and take peripheral blood to determine the level of hemoglobin, color index, ferritin, the total iron binding capacity of blood serum, serum iron, then the results are evaluated by a point system, namely, when a color indicator is found that corresponds to the norm, the level of serum iron is 14-15 μmol / l, ferritin is consistent with the norm and the level of the total iron-binding ability of serum is less than 63 μmol / L, each indicator is assigned a score equal to 1 - coefficient of iron deficiency K ₁ , and a conclusion is drawn on the correspondence of the state and the correspondence of the state to preferential iron deficiency; when the value of the color index is normal, serum iron is less than 14 μmol / l, ferritin 10-11 μg / l, the total iron binding capacity of serum is also less than 64-69 μmol / l, each indicator is assigned a score of 2 - K ₂ , and conclude on the compliance of the state with latent iron deficiency; and with a decrease in hemoglobin relative to the norm and color index less than 86%, serum iron less than 12 μmol / l, ferritin less than 10 μg / l and a total iron binding capacity of 70 μmol / l and higher, each indicator is assigned 3 points - K ₃ and conclude on the conformity of iron deficiency anemia; Further, questionnaire data are evaluated to identify symptoms such as weakness, fatigue, malaise, poor sleep, decreased concentration, lag in physical development, pale skin and visible mucous membranes, dry skin and hair, layering and transverse striation of nails, taste perversion , dizziness, headaches, angular stomatitis, shortness of breath with moderate and insignificant physical exertion, systolic murmur, heard well on the vessels, while each symptom detected 1 point is gained - K ₄ , after which the total total value of ΣK points is determined by the formula ΣK = K ₁ + K ₂ + K ₃ + K ₄ and, provided that the sum of points is 1-10, the student takes walks in the fresh air for at least 2 hours, use meat products of at least 120 g per day, an increased amount of fruits and vegetables rich in iron, herbal decoctions, oxygen cocktails, mineral glandular water; at ΣK of 11-20 points, multivitamin complexes are added to the above appointments in courses and a homeopathic preparation Ferrin in a dosage of 5 granules under the tongue until it is completely absorbed 3 times a day, for 2-3 months, also without interruption, and at ΣK equal to above 20 points, the course of treatment includes a regimen prescribed for schoolchildren with a preferential iron deficiency in combination with the introduction of iron-containing drugs as prescribed by the pediatrician on an outpatient or inpatient basis.