Rüfer A, Criblez D, Wuillemin W A
Departement Innere Medizin, Spezialmedizin 1 (Gastroenterologie, Hämatologie, Infektiologie, Nephrologie), Kantonsspital Luzern, Luzern.
Ther Umsch. 2006 May;63(5):339-43. doi: 10.1024/0040-5930.63.5.339.
The physiology of iron homeostasis, clinical presentation, diagnosis, differential diagnosis and therapeutic options in iron-deficiency anemia are discussed. Iron deficiency is the most common haematological disorder encountered in general practice and iron-deficiency anemia is the most frequently occurring anemia throughout the world. Blood loss is a major cause of iron-deficiency anemia. Gastrointestinal bleeding is the most common cause of iron deficiency in adult men and is second only to menstrual blood loss as a cause in women. Iron-deficiency anemia is not a disease itself but a manifestation of an underlying disease, searching for the latter is therefore crucial and may be of far greater importance to the ultimate well-being of the patient than repleting iron stores. The symptoms and signs of iron deficiency are partially explained by the presence of anemia. However, there also appears to be a direct effect of iron deficiency on the central nervous system. The most important screening investigations for iron deficiency in clinical practice are the haemoglobin, the haematocrit and the mean corpuscular volume (MCV). The single most important measure of iron status is the serum ferritin, values below the lower limit of normal being specific for iron deficiency. In inflammation, hepatopathy and haemolysis serum ferritin is also released leading to falsely elevated values, therefore an analysis of the C-reactive protein (CRP) should always accompany the analysis of serum ferritin. Repleting iron stores is usually done with oral iron therapy, the available preparations are comparable with respect to efficacy, side effects and costs. The main indications for parenteral iron therapy are intolerance to oral iron, intestinal malabsorption and poor compliance to an oral regimen. The iron sucrose preparation should bepreferentially used for that purpose, the total dose is calculated from the amount of iron needed to restore the haemoglobin deficit plus an additional amount to replenish iron stores.
本文讨论了缺铁性贫血中铁稳态的生理学、临床表现、诊断、鉴别诊断及治疗选择。缺铁是全科医疗中最常见的血液系统疾病，缺铁性贫血是全球最常见的贫血类型。失血是缺铁性贫血的主要原因。胃肠道出血是成年男性缺铁的最常见原因，在女性中仅次于月经失血。缺铁性贫血本身并非一种疾病，而是潜在疾病的一种表现，因此寻找潜在疾病至关重要，对患者最终的健康状况而言，这可能比补充铁储备更为重要。缺铁的症状和体征部分可由贫血解释。然而，缺铁似乎也对中枢神经系统有直接影响。临床实践中缺铁最重要的筛查检查是血红蛋白、血细胞比容和平均红细胞体积（MCV）。铁状态的唯一最重要指标是血清铁蛋白，低于正常下限的值对缺铁具有特异性。在炎症、肝病和溶血时，血清铁蛋白也会释放，导致值假性升高，因此血清铁蛋白分析应始终伴有C反应蛋白（CRP）分析。补充铁储备通常采用口服铁剂治疗，现有制剂在疗效、副作用和成本方面相当。胃肠外铁剂治疗的主要适应证是对口服铁剂不耐受、肠道吸收不良和对口服治疗方案依从性差。为此应优先使用蔗糖铁制剂，总剂量根据恢复血红蛋白缺乏所需的铁量加上补充铁储备的额外量来计算。
