Visual disturbances

[Stanislav]

In current of 5-6 years, after a birth of the child, at me are observed with various periodicity (from half a year up to 2 times a week) disturbances of vision in the form of shining or brilliant shone zmeek before eyes in current of 5-40 minutes. After which the headache begins. Last month flickers have become frequent, I feel a breakdown, giddinesses (poshatyvanija). The beginning of attacks with what it is not connected. After last attacks of headaches was not. Pressure usually normal 110\80. The hemoglobin is lowered till 85-90.

[chicago]

Dear Tatyana!



Inform please full given obshch.analiza the bloods, executed it is desirable on the automatic device. The counter. Your problems can be connected with an anemia or deficiency of iron, write also about a status, hair, fingernails or nails, from heart, GASTROINTESTINAL TRACT, bad habits, sop. Diseases, whether plentifully menstruate and so forth, that disturbs you within last 5 years.

[rita_chun]

Hello! Thanks that have paid attention to my report. The diagnosis zhelezodefi- an anemia to me put after a birth of the first child 14 years ago. Periodically accepted Ferroplexum, ferrumlek, fenjuls. The hemoglobin raised or increased quickly up to 105-110. Last analysis half a year back hemoglobin - 84, erythrocytes - 3.0, tsv.pokazatel - 0,83, reticulocytes - 11, thrombocytes (74:1000) 222,0 leucocytes - 5,1 neutrophils segmented 79 lymphocytes - 18 monocytes-3 an ESR - 8 General or Common fiber - 70u \l, albumins - 50u \l, holestirin 3,4 Iron serumal - 3,9 then has handed over analyses on hormones of blood 4 - 137, 3 - 3,2, TTG - 4,5 On hair and fingernails or nails of complaints is not present. An electrocardiogram in norm or rate though periodically disturb prickings in obl .serdtsa. From GASTROINTESTINAL TRACT complaints is not present, bad habits are not present. A menses plentiful (5-7 days), often from a clot-. Gynecologic complaints are not present. Last years more quickly and is more often I get tired, I require a day time dream (about 1 hour). Headaches almost every day different intensity. But most of all excite visual disturbances since my job demands constant attention. Thanks

[Perla]

Dear Tatyana!



In your situation tactics following: you get the most inexpensive iron preparation with the maintenance or contents of IONIC iron in itself about 60-100 mg and accept it or him on an empty stomach at the rate of 1,5-2 mg of iron on kg of mass of a body, simultaneously with tablets of iron accept 400-600 mg of vitamin C. Try to increase consumption of meat up to 100-150 g in day, to lower - strong tea or coffee. Your course of treatment should make not less than 4-6 mes totally or not less than 2-3 mes still after the hemoglobin becomes above 120-125.

For depression of intensity fiz. krovopoter at presence of premenstrual pains it is possible to accept antiinflammatory or anti-inflammatory preparations as Naproxenum, diclofenac or dr., if pains are not present, it is possible to try from small doses antifibrinolitikov-Acidum aminocapronicum 0,5 g 2-3 race in day during a cycle.

Working capacity, memory, concentration of attention will raise or increase only after full correction zhelezodefitsita in an organism (instead of simply corrections of an anemia), also only then it is possible to expect depression of intensity/termination or discontinuance of a sleepiness, a goal. Pains, narush. Visions.

So, if wish to raise or increase quality of own life - have patience and start to be treated, there will be questions - set.

[psschas]

Hello! The nausea has started to accept sobrifer durules, but at me from this preparation. Prompt, whether it is necessary to accept further or will advise to replace it or him with any other medicine. Thanks

[Julia Alimovna]

Dear Tatyana!

You drink what dose Sorbifera, when (O./in., up to/after meal), what dose askorbinki accept (kol. Tablets, a dose in each tablet). Please is more detailed how and when there is a nausea, whether then it will be possible to solve smodulirovat to you reception sorbifera or is better to pass to another.

[bemom]

Hello, uv. Dr. Vad. sorbifer I accept 1 time day on one tablet 20-40 minutes prior to meal. The nausea comes in an hour after acceptance of a tablet. 2-3 hours proceed. Tried to drink in the morning on an empty stomach, but then at job toshnit. Now I drink before a supper. Toshnit also. Askorbinku I drink 0,05 on 1 t. Once a day from sorbifera.

Thanks.

[DALI]

Dear Tatyana!



Try to increase a dose askorbinki up to 10 tabl for 1 time during the moment of acceptance sorbifera if there will be a sleeplessness, but the nausea will not be, transfer or carry for the morning or a dinner, also it is possible to try to accept after meal in 1-1,5 hours.

Acidum ascorbinicum improves an absorption of iron: the more the gland will be soaked up, the it is less. Action.

If all the above-stated variants do not approach or suit, alternatives the following

Gland fumarat (heferol)

Gland gluconat (ferronal)

Not important how much substance in a tablet, the main thing, that ionic iron would be at least 60-80 mg but no more than 100 mg (especially if your weight of 50-60 kg).

There will be problems, questions - write, the main thing for you to pick up a transferable or tolerable preparation and a dose, it is the basic mortgage of successful treatment.

How think to reduce an abundance monthly?

[Jenny]

Uv. Tatyana and Dr. Vadim,



Certainly, to treat an anemia it is necessary but where more effectively to eliminate or erase;remove its or her reason (referensnye value or meanings;importance for serumal iron 8,95 - 30,43???y/l?). The most obvious reason - disturbances of a menstrual cycle - a menometrorrhagia (clots in norm or rate should not be in general). By the way, what normal value or meanings;importance for TTG in laboratory?





Tatyana to be defined or determined with the reason of a menometrorrhagia will help or assist US and research of flora. And, if it not military secret, how old are you?

[Jaguar]

Dear doctor Tatyana!



Referentnye value or meanings;importance on iron or gland can be and others: napr. - 6.6-26 microns/l, m 11-28 microns/l, but also it not parameters on which it is necessary to lean or base - the most sensitive is the factor of saturation of a transferrin iron: szh/??? and less than 25 % are detsizionnoj size (if there is no opportunity to define or determine a ferritin, certainly).

Clinical example: the man syv. Fe 12,5; O 75, both of a parameter within the limits of ref. Sizes, koeff. 15 %, a ferritin 9.

I shall disagree, that only the US and flora will answer a question on the reason plentiful monthly: their reason can be subclinical deficiency of the factor background Villebranda, napr. Its or his value or meanings;importance within the limits of 55-75 % that does not give typical clinic of illness or disease, and it is shown only superfluous menstrual vydelenijami, at absence of the gynecologic reasons the raised or increased fibrinolitic activity was found out in women with plentiful vydelenijami in a menstrual blood and purpose or appointment antifibrinolitikov reduced their profuseness in 2 times.

You have correctly noted rising TTG and it can be regarded by some endocrinologists as tn *quot; subclinical u?O?ON?*quot;, that by the way through depression of synthesis vWf can strengthen menstrual losses of blood, but in references, how much or as far as I know, it is not shown will replace. gorm. Therapy for correction gipermenorrei at normal value or meanings;importance 4.

[uma]

Uv. Doctor Vadim,



I understand your interest to deficiency of the factor background Villebranda, and personally it is interesting to me also, but if is closer to a real life: defect of the factor background Villebranda is observed less, than at 1 % of the population (including and not expressed forms - in fact about it or this speech?), and gynecologic diseases are almost at 3/4 women with a menometrorrhagia (if not more often). And the the woman is more senior, the the probability of a myoma and an adenomyosis is more.

If TTG exceeds norm or rate (I here would not hurry up, not the fact, what is it so) at normal 4, but it is no more 10 ?Nn/l it is a question about with/to a hypothyrosis and about which, at least, it is necessary to know to Tatyana, you see, a menometrorrhagia - not a unique problem.

[FOTIK25]

Dear doctor Tatyana!



I shall agree with you, that the gynecologic pathology borrows or occupies in the lead position in a genesis of a menometrorrhagia, I meant primary (without presence of the obvious gynecologic reason).

I give reason for the answer:



Blood Coagul Fibrinolysis. 2002 Mar; 13 (2):89-93.



von Willebrand's disease: an important cause of dysfunctional uterine bleeding.



Woo YL, White B, Corbally R, Byrne M, O'Connell N, O'Shea E, Sheppard BL, Bonnar J, Smith OP.



... VWD was diagnosed in five of 38 (13 %) patients with menorrhagia and one of 38 (2.6 %) patients with normal menstrual blood loss. The mean VWF:Ac value was significantly reduced in patients with menorrhagia (mean +/-standard deviation, 84.5 +/-26.7 IU/dl versus 103.9 +/-34.5 IU/dl; P *lt; 0.01) and this effect persisted after exclusion of patients diagnosed with VWD...





J Thromb Haemost. 2003 Mar; 1 (3):477-84.



Platelet functional defects in women with unexplained menorrhagia.



Philipp CS, Dilley A, Miller CH, Evatt B, Baranwal A, Schwartz R, Bachmann G, Saidi P.



Menorrhagia is a common clinical problem and is unexplained in more than 50 % of women... Seventy-four women were studied. Bleeding time was prolonged in 23 women (31.5 %). Maximal percent platelet aggregation was decreased with one or more agonists in 35 (47.3 %) women. The most commonly found platelet function defects were reduced aggregation responses to ristocetin in 22 (29.7 %) women and to epinephrine in 16 women. Sixteen of 22 women with reduced ristocetin aggregation had von Willebrand ristocetin cofactor (VWF:RCo) and von Willebrand factor antigen (VWF:Ag) *gt; 60 %... Ten women (13.5 %) had VWF:RCo and/or VWF:Ag *lt; 60 %.



I.e. at each third woman with not explainable menometrorrhagia it is possible to find depression of the factor background Villebranda, at everyone 7-8 to define or determine disease (depression less than 60 %). Though besides a priori I shall agree, that among all menometrorrhagias the given percent or interest considerably below.



Beck EA, Limoni C.

Subnormal plasma von Willebrand factor (ristocetin cofactor) and iron deficiency anaemia in menstruating women.

Thromb Haemost. 1996 Apr; 75(4) :693.



Interesting observation suggests, that is probable, in itself zhelezodefitsit can cause depression of synthesis/secretion ffv and it in turn can strengthen menstrual losses.



Comparing 2 referentnyh a range of value or meanings;importance TTG (0,23 - 4,0 and 0,27 - 4,2 ?U/ml) it is possible to conclude, that value or meaning;importance 4,5 if is not raised or increased borders on the top border of norm or rate at use of any the test-sets, but it not too confuses me, tk there are observations that there are little changes of hormones SHCHZH (similar to their subclinical deficiency) at deficiency of iron and it can be normalized at correction of an anemia/deficiency of iron.



Exp Clin Endocrinol Diabetes. 1999; 107 (6):356-60.



Incidence of sideropenia and effects of iron repletion treatment in women with subclinical hypothyroidism.



Duntas LH, Papanastasiou L, Mantzou E, Koutras DA.



Endocrine Unit, Evgenidion Hospital, Athens University Medical School, Greece.



Sideropenia affects ca. 20 % of the world population, and iron dependent anemia is the most frequent type of anemia worldwide. The aim of the study was to investigate the incidence of sideropenia and dependent anemia in patients with subtle changes of the thyroid function, such as subclinical hypothyroidism (SH.) 57 women with SH and 61 euthyroid controls (CG) were studied. Serum concentrations of T4, T3, TSH, anti-TPO, anti-Tg, ferrum (Fe), ferritin (Frt) total iron binding capacity (TIBC) and blood count were determined. In SH 17 patients (29.8 %) presented low Fe levels (*lt; 50 microg/dl). 9 (15.7 %) also had decreased Frt, confirming iron deficiency, whereas 8 patients presented additionally diminished hematocrit and hemoglobin levels, suggesting manifested sideropenic anemia. In CG, 10 persons (16 %) had sideropenia, 6 (9.8 %) had low Fe and Frt and only 3 (4.9 %) had blood count alterations suggesting manifested sideropenic anemia. In SH, anti-TPO were positive in 39 patients (68 %), whereas, in CG only 2 (3.2 %) were positive. 8 patients with SH and manifested sideropenic anemia were treated with ironproteinsuccinylate (I-PSL), (80 mg Fe/day, for three months), a new iron compound. The repletion treatment safely led to the clinical and laboratory correction of sideropenia and showed a good tolerability. Furthermore, iron treatment provoked a minor increase of T4 and a mild decline of TSH, but the levels were not significant. These results suggest that sideropenia is a common finding in patients with slightly decreased thyroid activity, and that determination of Frt should be routinely advised. Finally, in the assessment of sideropenia and dependent anemia, evaluation of the thyroid function must be taken into account.

[Natalia Brodko]

Very interesting discussion! But I would like to pay attention to headaches... The Question of a migraine. Dear Tatyana, describe your headaches - where hurts, whether localization of a headache, what character of headaches (blunt, nojushchie, sharp, pulling varies or others), what is the time lasts each attack of a headache, how much or as far as each episode differs from others, whether you suffered headaches up to sorts or labors, prior to the beginning of a menses, whether there passes or there takes place a headache at walk, whether you can work with a headache, whether irritates you at a headache light, sounds. Whether after you began to accept an iron preparation your headaches have changed.

[Someone]

Dear doctor Vadim,



Hypothyrosis/anemia/?NOOOOau?n standard enough combination, I even would tell or say so, classical.

But in general in detail to speak about presence from a hypothyrosis, it is necessary to have result of repeated definition TTG. And, absolutely in an ideal - the conclusion uzi, that will allow to be defined or determined raspingly even, that there with gynecologic diseases. I do not think, that this military secret to us will be slightly opened, but the desire to look in results of biochemical researches at a menometrorrhagia nevertheless is welcomed.