Georgieva Z, Georgieva M
Department of Propedeutics of Internal Medicine, Medical University of Varna, Bulgaria.
Clin Hemorheol Microcirc. 1997 Jan-Feb;17(1):21-30.
The severity of alterations in the microcirculatory bed and the incidence rate of myocardial dysfunction in 299 female patients with differently severe iron-deficiency anaemia (IDA) as a mechanism of compensation and adaptation towards chronic anaemic hypoxia was investigated. Significant changes, mainly in the venular and capillary part of the microcirculatory bed in conjunctival biomicroscopy were observed. An increased diameter and a decreased linear density of the venules along with microcongestion foci, microhaemorrhages, an enhanced undulation and irregularity of both venules and capillaries and a 'sludge-phenomenon' were demonstrated. Echocardiographically, a significant enlargement of telediastolic and telesystolic dimensions and volumes of the left ventricle, a hyperdynamic working regimen of the heart with increased cardiac output and stroke volume were observed with advancing severity of IDA and microcirculatory alterations. A slight reduction of myocardial contractility was found only in the cases with a severe degree of anaemia. The treatment performed with parenteral iron induced a complete reversibility of both myocardial and microcirculatory changes with the moderate and slight degree of IDA while there was a delayed reversibility concerning normalization of the values of haemoglobin and serum iron that required a more prolonged follow-up of these patients.
对299例不同严重程度缺铁性贫血（IDA）女性患者的微循环床改变严重程度及心肌功能障碍发生率进行了研究，以探讨其作为对慢性贫血性缺氧的一种代偿和适应机制。在结膜生物显微镜检查中观察到微循环床有显著变化，主要发生在微静脉和毛细血管部分。显示微静脉直径增加、线性密度降低，伴有微充血灶、微出血，微静脉和毛细血管的起伏及不规则性增强，以及“淤滞现象”。超声心动图检查发现，随着IDA严重程度和微循环改变的进展，左心室舒张末期和收缩末期内径及容积显著增大，心脏呈高动力工作状态，心输出量和每搏输出量增加。仅在重度贫血患者中发现心肌收缩力略有降低。对于中度和轻度IDA患者，胃肠外补铁治疗可使心肌和微循环改变完全逆转，而血红蛋白和血清铁值的正常化存在延迟逆转，这些患者需要更长时间的随访。
