Juvenile chlorosis is a special variant of iron deficiency anemia (IDA) in girls during puberty. Pathology occurs against the background of hormonal changes in puberty, predisposing factors are an unbalanced diet, heavy menstruation, stomach diseases. Chlorosis is manifested by pale skin with a greenish tinge, weakness, dystrophic changes in hair and nails. Often girls are worried about fainting, shortness of breath, perversion of taste. For diagnosis, hemogram indicators, an analysis of the level of iron in the blood are required. The basis of treatment is iron-containing drugs in oral or parenteral form.
Juvenile (early) chlorosis is a term that has fallen out of use in the official medical classification, but continues to be used by some specialists as a separate pathogenetic variant of IDA. The name “chlorosis” comes from the Greek word “chloros” — pale green. The pathology was first described by the German physician Johann Lange in 1554, calling it “the disease of virgins”. According to modern data, among teenage girls up to 26.4% suffer from iron deficiency anemia of varying severity.
Early chlorosis is formed when there is a discrepancy between the intake of iron through the gastrointestinal tract, its amount in the body depot and the increased need for trace elements in girls of the puberty period. Anemia develops with disorders of neuroendocrine regulation, sudden jumps in estrogen, hormonal changes that are characteristic of the juvenile period. Among the provoking factors are the following:
- Chronic blood loss. The maximum risk of chlorosis in girls with copious prolonged menstruation, when blood loss in 1 cycle is more than 80-100 ml. Anemia occurs in most patients with dysfunctional uterine bleeding.
- The nature of nutrition. Many girls of juvenile age worry excessively about their figure, adhere to strict diets or vegetarianism in order to lose weight. Restrictions in meat products, which are the main source of heme iron, cause a severe deficiency of this trace element.
- Gastrointestinal diseases. Most often, juvenile chlorosis is diagnosed with hypoacid gastritis, because due to a decrease in the acidity of gastric juice, iron is less absorbed. Chronic gastroenterological pathologies also disrupt appetite, create the need to adhere to a therapeutic diet, which aggravates the patient’s condition.
There are iron reserves in the body, which begin to be consumed when there is insufficient intake or large losses during menstruation. During this period, juvenile chlorosis does not manifest clinically, but there is a prelatent deficiency — the emptying of the microelement depot while maintaining transport and hemoglobin funds. When iron from these funds begins to be spent, a latent deficit is diagnosed.
When all the reserves of the substance are used, the process of formation of the non-protein part of hemoglobin is disrupted, a reduced number of erythrocytes with a low heme content is formed in the bone marrow. Iron is also involved in the work of the body’s enzyme systems (cytochromes, catalase, succinate dehydrogenase), so soon there is a shortage of it in the tissues — the processes of tissue respiration and energy formation are disrupted.
The clinical picture of the disease consists of two syndromes: anemic and sideropenic. Symptoms are detected in adolescents aged 14-18 years. Common signs of juvenile chlorosis include weakness, fatigue, frequent dizziness. Patients also complain of exercise intolerance, shortness of breath, palpitations. The skin becomes too pale, acquires a specific greenish tint (which explains the name of the disease “chlorosis”).
Sideropenic symptoms are caused by tissue iron deficiency. With juvenile anemia, angular stomatitis (congestion in the corners of the mouth), fragility and hair loss, striated nails are noted. With a prolonged course of juvenile chlorosis, a spoon-shaped deformation of the nail plates (coilonychia) is formed. A characteristic symptom is taste perversions: a tendency to eat inedible objects (clay, chalk, starch), a sudden craving for spicy, salty, spicy food.
With the long-term existence of the juvenile form of chlorosis, immunity decreases, frequent acute respiratory infections and bacterial infections worry. Disorders of the heart are manifested by tachycardia, low blood pressure, fainting, as a result of which the girl can get a dangerous injury to the head or limbs. Severe iron deficiency, combined with insufficient caloric intake, is fraught with a delay in physical and sexual development.
Examination for juvenile chlorosis is carried out by a district pediatrician or hematologist. The doctor evaluates the color of the skin, the condition of the skin appendages, asks the girl about the features of the menstrual cycle. Physical examination includes measurement and evaluation of anthropometric indicators. To verify the diagnosis of adolescent IDA , the following are prescribed:
- Hemogram. In the blood test, there is a decrease in the number of red blood cells, a decrease in the amount of hemoglobin less than 120 g / l. The color index of red blood cells is less than 0.85, which indicates a hypochromic variant of anemia. Typical signs of juvenile chlorosis are microcytosis, anisocytosis, poikilocytosis.
- Indicators of Fe exchange. A drop in ferritin levels below 12 ng/ml in blood serum is the most accurate indicator of IDA. The total blood iron in those suffering from juvenile chlorosis is sharply reduced (less than 12 mmol/ L), the total iron-binding capacity of serum (OHSS) is increased, the transferrin saturation index with iron is reduced (less than 16%).
- Instrumental diagnostics. Gynecological examination with ultrasound of the pelvic organs is indicated with too much painful menstruation. To exclude gastroenterological pathology, ultrasound examination of the abdominal cavity, EFGDS, intragastric pH-metry is recommended.
In the treatment of juvenile chlorosis, iron-containing drugs are used to normalize hemoglobin levels and restore trace element reserves. With the normal functioning of the gastrointestinal tract, the advantage is given to oral forms of medications that are well absorbed, do not cause severe adverse reactions. Treatment of IDA is prolonged — hematological indicators normalize after 2-3 months. It is necessary to continue taking medications for another 3-6 months to saturate the depot with iron.
Girls with serious stomach diseases, when oral medications are practically not digested, parenteral forms of iron-containing drugs are shown. Intravenous infusions are performed only in a hospital, as there is a risk of hypersensitivity reactions. In case of extremely severe anemia, the introduction of erythrocyte mass is recommended.
In addition to medical treatment, diet therapy is prescribed. The advantage is given to meat products (beef, lamb), in which heme iron is present with the maximum possible bioavailability — up to 25%. Pork, chicken, liver and fish are also considered good sources of trace elements. Vegetable products (vegetables, fruits, nuts) contain non-heme iron, which is absorbed by only 1-5%, so they are ineffective.
Prognosis and prevention
With proper medical correction, the improvement of well-being occurs after 1-2 weeks, and after 3-4 months, all manifestations of juvenile chlorosis disappear. The prognosis is favorable. Prevention of the disease involves the use of meat food in sufficient quantities, the course administration of drugs with iron to girls suffering from heavy menstruation, timely correction of juvenile uterine bleeding.