Introducere: Adolescenţa este perioada cu risc sporit pentru instalarea deficitului de fier (DF), fiind cea mai frecventă cauză a anemiilor (80-85%). DF prelatent are un debut insidios, iar manifestările clinice sunt subtile, criteriul de diagnostic fiind aprecierea feritinei serice. Medicul de familie este specialistul care supraveghează starea de sănătate a
adolescenţilor, fiind cel mai frecvent solicitat, cu orice problemă de sănătate, în mod oportun, poate aprecia riscul pentru defi citul de fier.
Material şi metode: În studiul randomizat au fost incluse 220 de adolescente, cu vârsta medie 16,9±0,04 ani, care au fost investigate sociologic, clinic şi paraclinic. Examenul clinic focusat a evidenţiat sindroamele anemic şi sideropenic, iar cel paraclinic – determinarea feritinei, transferinei, fi erului seric şi hemoglobinei (Hb). Conţinutul feritinei
serice mai jos de 10 ηg/ml, cu nivelurile fierului seric şi hemoglobinei în limitele normei, a apreciat lotul adolescentelor cu deficit de fier prelatent.
Rezultate şi discuţii: Din lotul total de 220 de subiecţi, cu indicatorii sangvini în limitele normei au fost 114 adolescente (51,8%), cu deficit de fier prelatent – 68 de adolescente (30,9%), în stadiul latent – 22 (10%) şi cu anemie feriprivă – 16 adolescente (7,27%). Valorile-limită ale concentraţiei feritinei serice au fost de la 3 la 114,1 ηg/l, concentraţia
medie fiind de 16,6±1,19 ηg/l, iar valori sub normă a feritinei s-au înregistrat chiar şi la concentraţii ale Hb de 130-139 g/l, media fi ind 1,4±0. Cele mai evidente şi diverse manifestări clinice au fost identifi cate la subiecţii cu DF anemic, urmate de cei cu DF latent şi prelatent. La adolescentele cu DF prelatent, semnele sindromului anemic s-au înregistrat în 8,8±7,16% – 2,9±1,34% cazuri. Cel mai frecvent s-a constatat cefaleea şi dispnee la efort fi zic – câte 8,8±1,16%, paloarea tegumentelor şi dereglarea somnului – câte 7,4±1,62%, slăbiciuni generale – 5,9±1,99%, labilitatea emoţională – 4,4±1,25%, ameţeli, obosea lă şi tahicardie – câte 2,9±1,34% dintre cazuri. Sindromul sideropenic a fost consemnat mai frecvent, inclusiv : părul friabil – 60,3±6,76%, unghii fragile (koilonichie) – 54,4±8,53%, pervertirea mirosului – 51,5±9,15%, piele uscată – 36,8±10,62, ragade – 20,6±9,8%, gargumente intestinale – 17,6±9,35%, glosită –16,2±9,08%, pervertirea poftei de mâncare – 13,2±8,44, fisuri calcaniene – 11,8±8,06% şi disfagie sideropenică în 2,9±4,34%.
Concluzii: În stadiul prelatent al deficitului de fier manifestările clinice sunt modeste, cu prevalarea semnelor uşoare ale sindromului sideropenic, la care medicul de familie trebuie să fie vigilent. Testul la feritină a fost cel mai sensibil şi informativ în diagnosticarea DF.
Introduction: Adolescence is the high-risk period of iron deficiency (ID), which is the most common cause of
anemia (80-85%). Prelate ID is insidious in its onset with moderate clinical manifestations, whereas the assessment
of serum ferritin is the only diagnostic criterion. The family doctor is the specialist who monitors the health condition of
adolescents, being the most frequently addressed to, regarding any kind of health problem and who can timely assess
the risk of iron deficiency.
Materials and methods: 220 adolescent girls, aged 16.9±0.04 years old, were included in a randomized study.
They were sociologically, clinically and paraclinically investigated. The focus clinical examination showed anemic and
sideropenic syndromes, whereas the paraclinical examination determined the level of ferritin, transferrin, serum iron, and hemoglobin (Hb). The serum ferritin content below 10 ηg/ml with iron serum and hemoglobin levels within normal
limits has identified the teenage group with prevalent iron deficiency.
Results and discussions: Of the total group of 220 patients, there were 114 adolescents (51.8%) with blood indices
within normal levels, 68 adolescents (30.9%) with prelatentiron deficiency, 22 cases (10%) with latent ID, and 16 adolescents (7.27%) presented iron deficiency anemia. The limit values of serum ferritin concentration ranged from 3 to 114.1 ηg/ml, the mean concentration being 16.6±1.19 ηg/ml, and low ferritin values have been recorded even in
concentrations of 130-139 g/l, the average values being of 4,5±2.67ηg/ml. The most obvious and various clinical manifestations were identified in patients with anemic ID, followed by those with latent and prelatent ID. Signs of the anemic
syndrome were recorded in 8.8±7.16% – 2.9±1.34% of adolescents with prelatent ID. The most commonly found were
the headache and dyspnea to physical exertion in 8.8±1.16% cases, pale skin and sleeping disorders in 7.4±1.62% of
cases, general weaknesses – 5.9±1.99%, emotional lability – 4.4±1.25%, dizziness, fatigue, and tachycardia in each
2.9±1.34% of every case. The sideropenic syndrome was reported more commonly as brittle hair – 60.3±6.76%, fragile nails – 54.4±8.53%, smell distortion – 51.5±9.15%, dry skin – 36.8±10.62, rages – 20.6±9.8%, intestinal garguimente
– 17.6±9.35%, glossitis– 16.2±9.08%, taste disorders – 13,2±8.44, calcaneal cracks – 11.8±8.06%, and siderophenic dysphagia at 2.9±4.34%.
Conclusions: The clinical manifestations are quite modest within prelatent iron deficiency stage, with a predominance
of mild signs of the sideropenic syndrome, to which the family doctor should be vigilant. The ferritin test was the most
sensitive and informative in iron deficiency diagnosis.
