From Big Medical Encyclopedia

IRON (Ferrum, Fe) — element VIII of group of a periodic system of D. I. Mendeleyev; is a part of respiratory pigments, including hemoglobin, participates in process of binding and transfer of oxygen to fabrics in an organism of animals and the person; stimulates function of the hemopoietic bodies; it is applied as medicine at anemic and some other morbid conditions. Radioisotope 59 Fe is used as a radiotracer in a wedge, laboratory researches. Sequence number 26, at. weight 55,847.

In the nature 4 stable isotopes are found. with mass numbers 54 (5,84%), 56 (91,68%), 57 (2,17%) and 58 (0,31%).

Iron meets everywhere, as on Earth, especially in its kernel, and in meteorites. Contains in crust 4,2 weight, or 1,5 atomic, percent. Contents. in stone meteorites averages 23%, and sometimes reaches 90% (such meteorites call iron). In the form of complex organic compounds Zh. is a part of vegetable and animal organisms

. is a part of many minerals representing iron oxides (red iron ore — Fe 2 O 3 , loadstone — FeO-Fe 2 O 3 , brown iron ore — 2Fe 2 O 3 - 3H 2 O), or carbonates (siderite — FeCO 3 ), or sulfur compounds (iron pyrite, magnetic pyrite), or, at last, silicates (e.g., olivine, etc.). it is found in subsoil waters and waters of various reservoirs. In sea water Zh. contains in concentration 5•10 - 6  %.

In the equipment Zh. it is applied in the form of alloys with other elements which significantly change its properties. Alloys Zh have the greatest value. with carbon.

Physical and chemical properties of iron and its connections

Pure. — brilliant ductile metal, white with a grayish shade; t ° pl 1539 ± 5 °, t ° kip apprx. 3200 °; ud. weight 7,874; possesses in comparison with other pure metals the highest ferromagnetic properties, i.e. ability to gain properties of a magnet under the influence of external magnetic field.

Two crystal modifications are known.: alpha and gamma iron. The first, alpha modification, is steady lower than 911 ° and higher than 1392 °, the second, gamma modification — in the range of temperatures from 911 ° till 1392 °. At temperatures over 769 ° alpha iron nemagnitno, and lower than 769 ° — magnitno. Non-magnetic alpha iron is called sometimes beta iron, and high-temperature alpha modification by delta iron. easily interacts with divorced to-tami (e.g., with salt, sulfuric, acetic) with a hydrogen release and formation of the corresponding protosalts Zh., i.e. Fe (II) salts [FeCl 2 , FeSO 4 , (CH 3 COO) 2 Fe etc.]. Interaction. with strongly divorced nitric to - that happens without hydrogen release to formation of protoxidic nitrate salt Zh. — Fe (NO 3 ) 2 and azotnoammoniyny salt — NH 4 NO 3 . At interaction. with konts. nitric to - that forms oxide salt Zh., i.e. Fe (III) salt — Fe (NO 3 ) 3 , and nitrogen oxides are at the same time emitted.

In a dry air. becomes covered thin (thickness apprx. 3 nanometers) by a film of an oxide (Fe 2 O 3 ), but does not rust. At high temperature in the presence of air Zh. is oxidized, forming a cinder — mix of protoxide (FeO) and an oxide (Fe 2 O 3 ). In the presence of moisture and air Zh. is exposed to corrosion; it is oxidized with formation of a rust, edges are represented by mix of the hydrated oxides Zh. For protection. from rustiness it is covered with a thin coat of other metals (zinc, nickel, chrome, etc.) or oil paints and varnishes or try to obtain education on a surface. a pellicle of mixed oxide — Fe 3 O 4 (burnishing of steel)

. belongs to transition elements and therefore its connections are capable to take part in redoxreactions. Connections of two are known - three - and hexavalent Zh.

Naiboley connections of two - and trivalent are steady. [Fe (II) and Fe (III)]. Oxygen connections Zh. — protoxide (FeO) and oxide (Fe 2 O 3 ) — have the main properties and with to-tami form salts. Hydrates of these Fe (OH) oxides 2 , Fe(OH) 3 are water-insoluble. Salts protoxidic, i.e. bivalent. (FeCl 2 , FeSO 4 etc.), called by Fe (II) salts or ferrosolyam, in an anhydrous state are colourless, and in the presence of crystal water or in the dissolved state have bluish-green color; they dissociate with formation of ions of Fe 2+ . Crystalline hydrate of binary sulfate salt of ammonium and bivalent. (NH 4 ) 2 SO 4 - FeSO 4 - 6H 2 O carries the name of Mohr's salt. Sensitive reaction to Fe (II) salts is education with solution K 3 Fe(CN) 6 draft of a turnbulevy blue — Fe 3 [Fe(CN) 6 ] 2 .

Salts oxide, i.e. trivalent. or Fe(III) called by Fe (III) salts or ferrisolyam are painted in yellow-brown or red-brown color, napr, the ferric chloride going on sale in the form of yellow hygroscopic FeCl crystalline hydrate 3 - 6H 2 O. The binary Fe (III) sulfate salts called by feather alum, napr, iron-ammonium alum are eurysynusic (NH 4 ) 2 SO 4 • Fe 2 (SO 4 ) 3 • 24H 2 O. In solution of Fe (III) salt dissociate with formation of ions of Fe 3+ . Sensitive reactions to Fe (III) salts are: 1) sludge formation of Fe Prussian blue 4 [Fe (CN 6 )] 3 with solution K 4 Fe(CN) 6 and 2) formation of red thiocyanate Fe (CNS) iron 3 at addition of rhodanate salts (NH 4 CNS or KCNS).

Connections hexavalent. represent salts iron to - you (ferrates K2FeO4, BaFeO4). Corresponding to these salts iron to - that (H2FeO4) and its anhydride are unstable and in a stand-at-ease are not received. Ferrates are strong oxidizers, they are unstable and easily decay with release of oxygen.

There is a large number of complex connections Zh. E.g., at addition to salts of protoxidic. potassium cyanide the deposit of cyanic is formed in the beginning. Fe(CN) 2 , which then at surplus of KCN is dissolved with formation of K again 4 Fe(CN)6 [geksatsiano-(II) ferrate of potassium, ferroprussiate, or ferricyanide of potassium]. K can be other example 3 Fe(CN) 6 [geksatsiano-(III) ferrate of potassium, red prussiate of potash, or potassium ferrocyanide], etc. Ferrocyanide gives an ion of Fe (CN) in solution 4 - , and ferritsinid - an ion of Fe (CN) 6 3- ., contained in these anions, does not give qualitative tests on ions of Fe iron 3+ and Fe 2+ . easily forms complex connections with many organic to-tami, and also with nitrogen bases. Formation of the painted complex compounds of iron with and, alfa1-dipiridily or with au phenanthroline is the cornerstone of very sensitive methods of detection y quantitative definition of trace amounts. Gem substances (see. Gemoglobin ) a biogenic origin are also complex connections Zh.

With carbon monoxide Zh. gives volatile compounds — carbonyls. Carbonyl. Fe(CO) 5 is called pentacarbonyl Zh. also it is used for receiving the purest, free from any impurity Zh. for receiving chemical catalysts, and also for some electrotechnical purposes.

See also Chemical elements .


the Organism of the adult contains in a human body on average 4 — 5 g of Fe from which apprx. 70% is in structure hemoglobin , (see), 5 — 10% — in structure myoglobin (see), 20 — 25% in the form of reserve. and no more than 0,1% — in a blood plasma. Nek-roye quantity. is in composition of various organic compounds intracellularly. Apprx. 1%. is also a part of a number of respiratory enzymes (see. Respiratory pigments , Respiratory enzymes , biological oxidation ), catalyzing processes of breath in cells and fabrics

., found in a blood plasma, is a transport form Zh., a cut it is connected with protein the transferrin representing beta globulins and, perhaps, alpha globulins and albumine. Theoretically 1,25 mkg can be connected with 1 mg of protein., i.e. in total in the connected state constantly can be in plasma apprx. 3 mg of Zh. Odnako actually transferrin is saturated. only for 20 — 50% (on average on one third). Additional quantity., a cut in certain conditions can contact transferrin, defines unsaturated iron-binding ability (NZhSS) of blood; total quantity., a cut it can be connected by transferrin, defines the general iron-binding ability (OZhSS) of blood. In blood serum contents. determine by Valkvist (V. Vahlquist) in Hagberg's modification (V. Hagberg) and E. A. Yefimova. The method is based on what zhelezobelkovy complexes in a blood plasma in acid medium dissociate with Zh. Belki's release besiege, and in a protein-free filtrate of Fe (III) transfer to Fe (II) forming the painted soluble complex with au phenanthroline, intensity of coloring to-rogo is proportional to quantity. in solution. For definition take 0,3 ml of negemolizirovanny blood serum, make calculation for a standard curve.

Iron-binding ability of blood serum define after A. Schade in Rat's modification (S. Rath) and Finch (S. Finch). The method is based that at interaction of beta globulins and bivalent. the complex of orange-red color is formed. Therefore at addition ferrosoly (usually Mohr's salts) to blood serum intensity of this coloring increases, edges it is sharply stabilized at a saturation point of protein. By quantity., protein, necessary for saturation, judge NZhSS. This size which is summed up with quantity. in blood serum, reflects OZhSS.

Contents. in a blood plasma it is subject to daily fluctuations — it decreases to the second half of day. Concentration. in a blood plasma depends also on age: at newborns it is equal to 175 mkg of %, children at the age of 1 year have 73 mkg of %; then concentration. again increases to 110 — 115 mkg of % and up to 13 years significantly does not change. At adults distinctions in concentration are noted. in blood serum depending on a floor: contents. at men makes 120 mkg of %, and women have 80 mkg of %. In whole blood this distinction is expressed less sharply. OZhSS of normal blood serum makes 290 — 380 mkg of %. With urine at the person 60 — 100 mkg are removed per day.

At hemosiderosis (see), hemochromatosis (see), hemolitic, alpha, dis-and hypoplastic anemias, iron deficiency anemia (see), acute and hron, infections, cirrhosis, uraemia, malignant new growths, hemolitic and parenchymatous (but not congestive) jaundices the hyper sideremia and simultaneous reduction of NZhSS are observed. The hyposideremia and simultaneous increase in NZhSS are defined at insufficient receipt. with food and at the states which are followed by the requirement increased in it: at pregnancy, acute and hron, blood losses, i.e. at so-called hypochromia anemias, and also at acute infectious diseases.

Exchange. in an organism in many respects depends on normal functioning liver (see), therefore determination of content. in blood serum it can be used as functional hepatic trial. At parenchymatous damages of a liver its function on deposition is broken., since the affected or perishing hepatocyte gives. in blood. At the same time because of loss by hepatocytes of ability to assimilate. the collapsing erythrocytes there is its accumulation in blood serum. Both of these processes cause a hyper sideremia at acute parenchymatous diseases of a liver, to-ruyu it is especially important to consider at epidemic hepatitis since at viral infections contents. in blood serum decreases.

Unlike parenchymatous jaundice mechanical jaundice always proceeds at the normal or a little lowered contents. in blood serum.

Radioactive iron

Is known 6 radioisotopes Zh. with mass numbers from 52 to 61. In medicine three of them are applied: 52 Fe, 55 Fe and 59 Fe. Before others for a wedge, radio isotope researches began to use isotope 59 Fe which is usually received in the nuclear reactor radiation of metal. or its oxides slow neutrons on nuclear reaction 58 Fe (n, scale). In view of the fact that content of isotope 58 Fe in natural. makes only 0,31%, and the section of this nuclear reaction is also not enough (1,01 barns), for receiving 59 Fe of rather high specific activity irradiate the targets enriched on isotope 58 Fe in hundred and more times. Isotope 55 Fe usually also receive radiation in the reactor of the targets which are previously enriched on isotope 54 (the natural maintenance of its 5,84%, section of reaction 2,9 barns). In need of receiving these isotopes Zh. without carrier use radiation of cobalt bystry neutrons (for receiving 59 Fe) and manganese — protons or deuterons (for receiving 55 Fe) with the subsequent chemical release of isotopes Zh. from the irradiated targets. Short-lived isotope 52 Fe receive radiation on a cyclotron of a chromic target ions of helium or a manganese target protons.

59 Fe (half-life makes 44,6 days) breaks up with emission of a difficult range of beta radiation, the main two components to-rogo (46% and 53%) have the maximum energy of 0,274 Mev (MEV according to the SI) and 0,467 Mev, and also the gamma radiation containing 7 lines from which three are most intensive having energy 0,192 (2,8%), 1,099 (56%) and 1,29 Mev (44%).

55 Fe (half-life 2,7 years) breaks up with electron capture (100%) then formed stable 55Mn emits characteristic x-ray emission with energy 5,9 kev (kev according to the SI).

52 Fe (half-life 8,3 hours) breaks up with electron capture (44%) and emission of positrons with the maximum energy of 0,8 Mev (56%), and also gamma radiations with energy of 0,165 Mev (100%) and 0,51 Mev (112%) and formation of affiliated 52 Mn. The last in turn breaks up with the period in 21 min., letting out positrons with the maximum energy of 2,63 Mev (98%) and gamma radiation with energy of 1,434 Mev (100%) and 0,51 Mev (196%); in 2% of cases disintegration happens by isomeric transition to energy of gamma radiation of 0,383 Mev.

For measurement of activity of drugs with 52 Fe, 59 Fe and the dose of radiation created by them use scintillation counters and ionization chambers, and activity 55 Fe measure by means of the proportional 4P-counter.

Radioactive. apply in radio isotope diagnosis, to studying of an erythrogenesis (see. Hemopoiesis ), exchange and absorption., hl. obr. in the form of citrate or chloride. The wide a wedge, application is found by drugs, marked 59 Fe. Drugs, marked 55 Fe, in a wedge, practice are applied seldom because of the long period of removal from an organism and inconvenience of detecting of its radiation. In some cases (scanning of a brain, etc.) short-lived isotope is more preferable to use 52 Fe which creates considerably a smaller exposure dose of an organism.

During the definition of comprehensibility. erythrocytes radioactive. ( 59 Fe) enter into a blood stream. In the next 15 — 20 days with intervals in 2 — 3 days take blood samples and by measurement 59 Fe-activities of erythrocytes determine attenuation range of Sh. by erythrocytes.

It is normal of 75 — 80%. a blood plasma there are on an erythrogenesis, and 20 — 25% — on creation in an organism of other connections with. Decrease in these sizes is observed at the lowered erythropoietic activity of marrow.

Radioactive. treats isotopes of average radio toxicity (group «B»). Annual average admissible concentration 59 Fe in air of workrooms makes 5,2•10 - 11 curie/l. In a workplace without special permission a dignity. - epid. services it is possible to use drugs 59 Fe in solution activity to 10 mkkyura that corresponds to its admissible contents in an organism of personnel (critical body — a spleen) — 0,37 mkkyur.

Medical use of iron

At anemic states medical use. it is caused by its participation in the process of a gemoglobinoobrazovaniye which is made in erythroblasts of marrow.

Indications to use. the iron deficiency anemias of various etiology (anemia from blood losses, alimentary anemias, a chlorosis, anemias of pregnant women, etc.) proceeding with the lowered contents are. in blood and exhaustion of fabric reserves., and also abeyance (asymptomatic) deficit., meeting at 20 — 30% of almost healthy women. Appointment. it is shown also at other conditions of a hyposiderosis (insufficiency.), combined with anemia or shown independently: at a sideropenic dysphagy of Rossolimo — Bekhtereva, a koilonychia, a food faddism and sense of smell, fetid cold (ozena).

At In 12 - and foliyevodefitsitny anemias drugs Zh. can be shown in a stage of remission when the accompanying insufficiency comes to light. Drugs Zh. can be recommended also at the long intravascular hemolysis which is followed by continuous loss. (a so-called gemosiderinuriya, or «iron diabetes»), a cut it is removed with urine, at hemorrhagic diathesis, diseases of system of blood (leukoses) complicated by bleedings with development of secondary insufficiency., etc.

To absorption of medicinal. in a digestive tract the following factors promote: existence free salt to - you, necessary for dissociation (ionization) of connections Zh., coming to a stomach; existence of reducers (ascorbic to - you, etc.), necessary for transformation trivalent. in more assimilable form — bivalent., a cut besides irritates a mucous membrane went less. - kish. path; availability of the substances capable to connect iron, forming with it assimilable complexes; such substances in a stomach is the specific glycoprotein, in intestines — protein apoferritin, and also some amino acids, napr, the methionine or cysteine containing connecting. sulphhydryl (SH-) groups and promoting penetration. in epithelial cells of a mucous membrane of intestines. Further receipt both medicinal, and food. in a circulatory bed and finally in marrow depends on the sufficient content in blood of free (unsaturated) transferrin (siderophilin).

Experimental and a wedge, by observations it is proved that assimilation. both inorganic, and organic, including gemovy, after blood loss, at an iron deficiency anemia and latent insufficiency. it is raised.

At purpose of drugs Zh. inside it is necessary to consider an anatomofunktsionalny state went. - kish. a path, especially his upper parts — a stomach, a duodenum and the initial department of a jejunum which is the most active sites of absorption. After the bloodlettings activating an erythrogenesis, absorption. increases and is carried out throughout all intestines, including a caecum.

Lech. use. it is caused by need of recovery of normal concentration not only hemoglobin, but also. in fabrics. Insufficient treatment, as a result to-rogo reserves of fabric. are not filled, promotes preservation of latent deficit. and to a bystry recurrence of anemia. For achievement of therapeutic effect at purpose of drugs Zh. inside it is necessary to follow the following rules: 1) a sufficient dosage of drug — absorption. amplifies on condition of its rather high content in a gleam of intestines therefore at treatment of anemias. apply in high doses: 3 — 5 and in days; 2) reception. in the period of the greatest activity of gastric secretion, it is the best of all in time or directly after food; 3) purpose of drugs Zh. together with ascorbic to - that, accelerating absorption. in intestines; 4) persons with an achlorhydria and bent to intestinal frustration are recommended to accept drugs Zh. together with divorced salt to - that (15 — 25 drops on reception) and enzymes (pepsin, Pancreatinum); 4) treatment by drugs Zh. shall be rather long — not less than 1 — 2 month without interruption (at women including days of periods). In case of need after a monthly interval carry out repeated courses of treatment., up to complete elimination of deficit. in an organism. Administration of drugs. recommend to combine with reception of microelements — copper, cobalt, manganese.

High content in food of calcium and phosphates interferes with absorption., since with them. forms insoluble compounds. Absorption of drugs Zh. it is broken also at systematic use of the pharmaceuticals neutralizing salt to - that a gastric juice.

Promoting a gemoglobinization of normoblasts. stimulates an exit of reticulocytes from marrow in blood. Therefore the most right criterion of speed of absorption and receipt in marrow of entered. time of approach of the reticulocytic crisis observed usually on 5 — after an initiation of treatment serves the 8th day. In parallel with normalization of a hemoglobin content in erythrocytes also the number of erythrocytes raises a little. Optimum at oral administration of drugs Zh. in an initiation of treatment daily increase in concentration of hemoglobin by 0,1 — 0,2 g of % is considered. Lack of due strengthening of hemoglobin at treatment by drugs Zh. it is connected or with their insufficient dosage, or with disturbance of absorption. in intestines, or with the concealed hemorrhage, and also a blastoma, an infection, a hypothyroidism or other inhibiting factors.

Criteria of efficiency of treatment by drugs Zh. are considered: 1) increase in a color indicator of blood; 2) increase in number of erythrocytes — an indicator of a hematocrit (to a lesser extent); 3) normalization of size of concentration of serumal.; 4) decrease in the general and latent iron-binding ability of blood serum; 5) increase in saturation of transferrin Zh.; 6) replenishment of fabric reserves., defined by means of desferalovy test (see. Hemosiderosis ). Efficiency factor of treatment by drugs Zh. also involution of trophic disturbances of an epithelium and the endothelium connected with deficit is.

At hyporegenerative conditions of bodies of a hemopoiesis treatment by drugs Zh. combine with systematic hemotransfusions or eritrotsitny weight and purpose of stimulators of a hemopoiesis: polyneuramin 12 , folic to - you, etc.

At use of drugs Zh. inside there can be locks because. in intestines connects the hydrogen sulfide which is fiziol, a stimulator of a vermicular movement. Besides, a part is played also that formed at interaction. with hydrogen sulfide insoluble sulfide Zh. settles on a mucous membrane of intestines and protects it from the irritations strengthening a peristaltics.

Like other heavy metals. it is capable to besiege proteins, forming with them albuminates. On this property Zh. its local action is based, a cut can be knitting or cauterizing.

Parenteral administration. The indication to parenteral administration of drugs Zh. their intolerance at reception of per os which is expressed in the dispeptic phenomena — nausea, vomiting, abdominal pains, ponosa is. The priori indications to purpose of drugs Zh. parenterally a peptic ulcer of a stomach and duodenum, anacid gastritises, coloenterites are, surgical switching off of this or that department went. - kish. a path (a resection of a stomach, a small bowel, an ezofagoyeyunalny anastomosis, a gastroenteroanastomosis, gastrolic fistula, etc.), followed by disturbance of absorption. and development of an anemic state because of deficit of proteins, vitamins and. Parenteral administration of drugs Zh. it is shown also in need of bystreyshy strengthening of hemoglobin and number of erythrocytes (at acute blood loss, training of the patient for operation, to pregnancy, etc. in recent months). Administration of drugs Zh. it is necessary to carry out to blood under control of definition of a hemoglobin content and serumal Zh. Sleduyet to avoid excess introduction., since its excesses are postponed in a liver.

For intravenous administration use complex connections of colloid. with a gluconate of cobalt or a maltose from which in blood ionized is slowly chipped off., contacting transferrin. Intravenous administration of drugs Zh. is followed the patient with iron deficiency anemias by bystry strengthening of serumal., reaching in 5 min. after administration of drug 900 — 1000 mkg of % and further gradually decreasing to initial level in connection with utilization of the most part entered. (not less than 90%) erythroblasts of marrow.

As side effect at intravenous administration of drugs Zh. headaches, dizziness, nausea, vomiting, an erythema, urticaria, tachycardia, stenocardia, falling of the ABP, a collapse can be observed.

These phenomena can be prevented by slow administration of drug in blood and gradual increase in the entered doses. Side effect the drugs Zh used for intramuscular introduction are deprived. ferbitol and a zhektofer which are quickly brought out of an organism.

The method of bystreyshy recovery of normal contents deserves attention. in an organism by single infusion of a so-called total dose of drug Zh., adequate to its deficit in an organism. This drug represents a zhelezodekstranovy complex. Deficit. in an organism it is calculated by a formula: 0,3 X VD, where In — - body weight (in kg), D — deficit of hemoglobin (in of %). The dose of the corresponding drug Zh determined by a special scale. in milliliters (1 ml contains 50 mg.) by method of drop infusion it is entered into a vein in fiziol, solution or 5% solution of glucose (at the rate of no more than 25 ml of drug on 540 ml of solution; to pregnant women in the prenatal period 10 more ml of drug counting on blood losses) in labor are added); practically depending on degree of deficit. from 6 to 96 ml of drug are entered that corresponds to 0,3 — 4,8 g of Zh. Vozmozhna by-effects of an allergic order: small tortoiseshell, arthralgias, mialgiya, fever.

In treatment of patients with iron deficiency anemias and with other manifestations of a hyposiderosis the important place is allocated to the food stuffs rich with connections Zh. (see the table).

Table. CONTENT of IRON IN the MAJOR FOOD &PRODUKTAKHNBSP; (&vnbsp; &mgnbsp; on &100nbsp; d)

The general contents matters not so much. in foodstuff, how many recyclable Zh. Kolichestvo's percent of food acquired by an organism. depends on the total quantity which is contained in food Zh., degrees of its comprehensibility in went. - kish. path and conditions of mechanisms of regulation of this process.

Main source. in a diet of the person animal products (meat, fish, a liver, egg yolk) in which gemovy connections Zh prevail are., being a part of hemoglobin and myoglobin (see). Percentage of assimilable. in animal products fluctuates from 10% (fish) to 20% (veal), and assimilable. the negemovy connections which are contained in vegetable products from 1% (rice and spinach) to 6% (beans of soy).

From the mixed diet at healthy men about 6% are acquired., healthy women have 14%, and at persons with deficit. — 20%. Fruit, vegetables, vegetable and fruit juice, ascorbic to - that, added to vegetable products before their culinary processing, vitamins of group B (B 6 , B 12 , folic and nicotinic to - you), copper, cobalt, Prednisonum improve absorption Zh. Nedostatok of protein in the general diet, fat, milk reduce assimilation of food.

Preventive use

for the purpose of prevention of development of insufficiency. among groups of the population vulnerable in this respect — pregnant women and l of the drawing-up women, children of younger age — the group of experts of WHO recommended (1973) programs of reception. (various connections Zh. with cobalt, copper, ascorbic and folic to-tami), and also purpose of preferential proteinaceous diet and (or) the food stuffs enriched.

On the basis of observations over groups of the pregnant women receiving with the preventive purpose Antianemic drugs in various doses and combinations, it is recommended to almost healthy pregnant women since the third trimester of pregnancy daily in addition to a usual diet to accept 30 mg., and to the pregnant women suffering from an iron deficiency anemia in a varying degree, from 60 — 120 to 240 mg. together with folic to - that on 500 mkg (0,5 mg) a day.

Enrichment. milk and the vegetable products entering a children's diet prevents development in children of a nutritive iron deficiency anemia.

Iron preparations

In medical practice are used by connections of two - and trivalent.

Among drugs Zh. the greatest distribution was gained by the following:

Iron recovered (Ferrum reductum). Soft, gray color the brilliant or opaque powder attracted by a magnet. At an incandescence smolders and passes into black mixed oxide Zh. Let's dissolve in divorced salt to - those and in a gastric juice.

Appoint: the adult on reception on 1 g; to children aged till 1 year — on 0,1 g, 2 years — on 0,15 g, 3 — 4 years — on 0,2 g, 5 — 6 years — on 0,25 g, 7 — 9 years — on 0,3 g, 10 — 14 years — on 0,4 — 0,5 g. Drug is accepted by 3 times a day in time or directly after food. Course of treatment of 8 — 10 weeks.

Appoint in the form of tablets, coated, either pills, or capsules; after reception it is recommended to rinse a mouth carefully. Form of release: powder and tablets, coated, on 0,2 g. Store in well corked container in the dry place.

Gland glycerophosphate (Ferri glycerophosphas; synonym of Ferrum glycerophosphoricum); Fe 2 [PO 3 — O — C 3 H 5 (OH) 2 ] 3 - nH 2 O. Contains apprx. 18%. oxide, 15% of phosphorus. Yellow or ocherous powder with a slight peculiar smell. It is water-insoluble, we will dissolve during the heating in divorced salt to - those.

Appoint inside: the adult on 1 g 3 — 4 times a day, to children on 0,3 — 1 g 2 — 3 times a day.

Forms of release: powder and tablets on 0,5 g. Store in the place protected from light.

Gland protoxidic sulfate [Ferrosi sulfas; synonym: green vitriol, gland (II) sulfate, Ferrum sulfuricum oxydulatum]; FeSO 4 - 7H 2 O.

Prismatic transparent crystals of bluish-green color or crystal pale green powder. Let's dissolve in 2,2 parts of water with formation of greenish solution of astringent taste, subacidic reaction.

Appoint 0,3 — 0,5 g 3 — 4 times a day after food. Store in well corked banks in the light place [in order to avoid transition of Fe (II) to Fe(III)].

Blo's (Tabulettae Blaudi) tablets contain 0,28 g of ferrous sulfate. Appoint on 1 tablet 3 — 5 times a day. Form of release: tablets, coated.

Ferri lactas (Ferri lactas; synonym of Ferrum lacticum).

Greenish-white crystal powder or joints of small acicular crystals with a characteristic smell. Let's difficult and slowly dissolve in a cold water (1: 50), we will dissolve in hot water (1: 19), it is almost insoluble in alcohol, we will easily dissolve in divorced mineral to-takh. Water solutions have subacidic reaction, chartreuse coloring; at contact with air solution grows brown. Like other Fe (II) connections, Ferri lactas is well soaked up from went. - kish. a path, without causing irritation of mucous membranes.

Appoint in powders and pills at hypochromia anemias 1 g to adults, children — on 0,1 — 1 g of 3 — 5 times a day. In case of need at the same time appoint a gastric juice or divorced salt to - that, and also ascorbic to - that.

Form of release: powder. Store in well corked banks in the place protected from light.

Phytoferrolactolum — the tablets containing 0,2 g phytin (see) and 0,2 g of iron of a lactate. Apply at hypochromia anemias, the general decline of food. Appoint inside on 1 tablet 3 times a day.

Acid zhelezoaskorbinovy (Acidum ferroascorbinicum). Complex connection Zh., and ascorbic to - you:

(C 6 H 8 FeO) • 0,5FeSO 4 • 4H 2 O.

Powder of black-violet color with a metal outflow, we will dissolve in water, racks in a dry form, in water solutions it is hydrolyzed. Appoint inside 0,5 — 1 g 2 — 3 times a day.

Form of release: tablets on 0,5 g.

Ferbitol (Ferbitolum). Drug Zh. for intramuscular introduction; complex connection of trivalent. with sorbite. Liquid of dark brown color; contains in 1 ml apprx. 0,05 g

of Zh. Primenyayut at treatment of hypochromia anemias, especially at bad portability and insufficient comprehensibility of drugs Zh., accepted inside and also when bystry elimination of deficit is required. in an organism.

Enter intramusculary: the adult on 2 ml daily, to children up to 2 years — on 0,5 — 1 ml; to children 2 years — on 1 — 2 ml are more senior. Course of treatment of 15 — 25 injections. At morbidity in the place of an injection the drug can be administered in 0,5% solution of novocaine.

Form of release: in hermetically the corked bottles on 2 ml. Store at a temperature not over 25 °.

Ferroceronum (Ferroceronum). Sodium salt of an ortokarboksibenzoilferrotsen. Inodorous dark orange crystal powder, bitter taste. Let's easily dissolve in water and alcohol. It is easily soaked up by a mucous membrane went. - kish. path. Appoint inside 0,3 g 3 times a day after food. Course of treatment of 20 — 30 days.

It is usually well transferred. In some cases there is nausea (most often in the first days of treatment; drug withdrawal is not required). At use of Ferroceronum urine is painted in reddish color due to partial release of drug by kidneys.

Form of release: tablets of dark orange color on 0,3 g. Store in the place protected from light.

See also Haemostimulinum , Ferkoven .

== Adjournment of iron in fabrics ==., postponed in body tissues, can have an exogenous and endogenous origin. The exogenous siderosis is observed at some professions as professional harm, in particular at the miners occupied on developments of red iron ore and at electric welders. In these cases there is an adjournment of Fe (III) oxides (Fe 2 O 3 ) in lungs, sometimes with formation of the siderotic small knots diagnosed by means of a X-ray analysis. Histologically small knots represent accumulation of containing. raise dust in a gleam of alveoluses, in desquamated alveolar cells, in interalveolar partitions, in an adventitia of bronchial tubes with development around connecting fabric. Electric welders have a quantity., postponed in lungs, it is usually small; it preferential it is less than 1 micron of part; at miners massive deposits are observed., the quantity to-rogo in both lungs can reach 45 g and make 39,6% of weight of the ashes remaining after combustion of a lung. The pure siderosis of lungs, napr, at electric welders, is not followed by a pneumosclerosis and disturbance of working capacity; at miners, however, the siderosilicosis with development is usually observed pneumosclerosis (see).

The exogenous siderosis of an eyeglobe is observed at implementation in an eye of iron splinters, shavings, etc.; at the same time metal. turns in bicarbonate, then into hydrate of an oxide. also it is postponed in shoots of a ciliary body, an epithelium of an anterior chamber, the capsule of a crystalline lens, episkleralny fabric, a retina and an optic nerve where it can be found by means of the corresponding microchemical reactions. The exogenous local siderosis can be observed around iron splinters., got to fabrics at a home and fighting accident (splinters of grenades, shells, etc.).

In most cases hemoglobin is a source of an endogenous siderosis at out of - and its intravascular destruction. One of end products of disintegration of hemoglobin is the ferriferous pigment hemosiderin which is laid in bodies and fabrics. Hemosiderin was discovered in 1834 by I. Müller, however the term «hemosiderin» was offered by A. Neumann only later, in 1888. Hemosiderin is formed during the splitting gem. It is polymer ferritin (see) [S. Granick]. Chemically hemosiderin represents the unit of a hydroxide Fe (III) which is more or less strongly connected to proteins, mucopolysaccharides and lipids of a cell. Formation of hemosiderin happens in cells of both the mesenchymal, and epithelial nature.

V. V. Serov and V. S. Paukov suggested to call these cells sideroblasts. In siderosomes of sideroblasts there is a synthesis of granules of hemosiderin. Microscopically hemosiderin has an appearance of grains from yellowish till golden-brown color, located mostly in cells, but sometimes and vnekletochno. Granules of hemosiderin contain up to 35%.; hemosiderin never forms crystal forms.

Because a source of hemosiderin in most cases is hemoglobin, focal deposits of the last can be observed in any place of a human body where hemorrhage (took place see. Hemosiderosis ). At a hemosiderosis in places of deposition of hemosiderin comes to light SH-ferri-oozes (a sulphhydryl active form) which has vazoparalitichesky properties. Especially big deposits of the hemosiderin arising from ferritin owing to disturbance of cellular metabolism., are observed at hemochromatosis (see); at the same time in a liver quantity of deposited. often exceeds 20 — 30 g. Deposits. at hemochromatosis, in addition to a liver, are observed in a pancreas, kidneys, a myocardium, bodies of reticuloendothelial system, sometimes mucous glands of a trachea, in a thyroid gland, muscles and an epithelium of language etc.

In addition to deposits of hemosiderin, impregnation is sometimes observed. (ozhelezneniye) of an elastic framework of easy, elastic membranes of vessels of a lung at a brown induration or vessels of a brain in a circle of the center of hemorrhage (see. Brown consolidation of lungs ). It is observed also ozhelezneny separate muscle fibers in a uterus, nervous cells in a brain at some mental diseases (an idiocy, early and senile dementia, an atrophy of Peak, some hyperkinesias). The specified educations become impregnated with colloid., and it is possible to find an ozhelezneniye only by means of special reactions.

For the detection ionized. in fabrics are most widely used reaction of formation of a turnbulevy blue on Tirmanna — to Schmelzer for identification of Fe (II) and reaction of formation of Prussian blue [Perls's method with use of Fe (III)].

Reaction of formation of a turnbulevy blue is made as follows: the prepared cuts place on 1 — 24 hour in 10% solution of ammonium sulfide for convertion only. in bivalent sulphurous Zh. Zatem the cuts which are carefully rinsed in a distilled water postpone to 10 — 20 min. in freshly cooked mix from equal parts 20% of solution of red prussiate of potash and 1% of solution salt to - you. it is painted in bright blue color; kernels it is possible to finish painting a carmine. For carrying of cuts it is necessary to use only glass needles.

By Perls's method cuts place for several minutes in freshly cooked mix from 1 h 2% of water solution of ferroprussiate and 1,5 p.1 of % of solution salt to - you; then cuts rinse with water and kernels dokrashivat a carmine. it is painted in blue color. SH ferritin is revealed by means of cadmium sulfate (N. D. Klochkov).

Bibliography: Biochemical methods of a research in clinic, under the editorship of A. A. Pokrovsky, page 440, M., 1969; In e r about l the island and the p P. And. and At t of e sh e in A. B. Zhelezo in an animal organism, Alma-Ata, 1967, bibliogr.; Glinka N. L. General chemistry, page 682, L., 1973; Kassirsky I. A. and Alekseev G. A. Clinical hematology, page 168, M., 1970, bibliogr.; Levin V. I. Receiving radioisotopes, page 149, M., 1972; Mashkovsky M. D. Pharmaceuticals, p. 2, page 94, M., 1977; The Normal hemopoiesis and its regulation, under the editorship of N. A. Fedorov, page 244, M., 1976; Petrov V. N. and M. M Shcherba. Identification, prevalence and geography of deficit of iron, Klin, medical, t. 50, No. 2, page 20, 1972, bibliogr.; P I-bov am S. I. and G. D Perch. Molecular and genetic aspects of an erythrogenesis, L., 1973, bibliogr.; Shch ER and M. M. Iron deficiency states, L., 197 5; Klinische Hamatologie, hrsg. v. H. Be-gemann, S. 295, Stuttgart, 1970; Pharmacological basis of therapeutics, ed. by L. S. Goodman a. A. Gilman, L., 1975.

Of E. Vladimirov; G. A. Alekseev (gems.), V. V. Bochkaryov (I am glad.), A. M. Vikhert (stalemate. An.), V. V. Churyukanov (pharm.).