В литературе давно обсуждается негативное влияние анемии на течение и исходы хронической сердечной недостаточности (ХСН). Доказана тесная связь между этими синдромами, причем до сих пор дискутируется роль первичного этиологического фактора. Описано множество механизмов развития анемии при ХСН, по-казана более высокая ее частота при наличии сопутствующей хронической почечной недостаточности и сахарного диабета. В качестве основных патогенетических направлений рассматриваются нефрогенный, воспалительный, постгеморрагический характер анемии, нарушения всасывания микроэлементов, гемодилюция. Однако наибольше значение в настоящее время отводится фактору железодефицита, который, помимо нарушения кроветворения, приводит к снижению работоспособности сердечной мышцы.
Anemia is a frequent systemic complication and extra-intestinal manifestation of inflammatory bowel diseases (IBD). Despite significant progress in IBD treatment, late diagnosis and insufficient correction of concomitant anemia remain a problem in routine clinical practice. The review describes the main pathophysiological mechanisms of IBD-associated anemia, such as iron deficiency, chronic inflammation (anemia of chronic disease) and B9 and B12 deficiencies. The authors highlight the main diagnostic principles of these conditions, present the strategy for their differential diagnosis, describe the state-of-theart approaches to the correction of iron-deficient anemia in IBD, and delineate the role of oral and parenteral medications for replacement therapy. Optimal treatment goals and prevention methods of an iron-deficient condition are given. Special attention is focused on the principles on red cell mass transfusions in acute massive blood loss. The authors describe the main differentiating features of anemia of chronic disease and its treatment in IBD patients with various grades of the inflammation. The paper contains the indications and treatment regimens for B12 and foliate-deficient anemia with consideration of the IBD course. The authors of the article are members of the Working Group of the Russian Society on the study of IBD and believe that the literature analysis performed would allow for its use to issue the Russian clinical guidelines on the management of patients with anemia in ulcerative colitis and Crohn's disease.
Aim. To determine the characteristics of erythrocyte parameters, iron metabolism, erythropoiesis, inflammation markers in patients with heart failure (CHF) and anemia.Material and methods. The study included 68 patients with HF to describe the characteristics of anemia (general group). Patients of the general group were divided into 3 subgroups depending on the serum ferritin (SF) and transferrin saturation (TS).Results. Anemia in HF is not always associated with iron deficiency (ID), characterized by inadequate production of erythropoietin, increased levels of C-reactive protein and hepcidin. From the general group of patients, the following were distinguished: absolute ID (43%), functional ID (19%), and non-ID anemia (38%).Conclusion. In the general group of patients with HF, anemia is normochromic, normocytic, characterized by high levels of C-reactive protein, hepcidin, and inadequate production of erythropoietin. Patients with absolute and functional ID do not differ in the main iron metabolism parameters and in general account for 62% (p=0,01). In these two subgroups, iron supplements should be prescribed at further stages.
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