철결핍성빈혈과 하지불안증후군, IDA and restless legs syndrome <원타민>

20대/여자

Anemia (Hb 8.9 g/dL)로 내원하였고 당시 동반된 증상은 귀에서 소리가 나는 증상이었으며, 철분제 복용 후 이 증상 (1)과 자려고 하면 생기는 다리 저림 증상 (2)이 없어짐

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Symptoms of anemia — The usual presenting symptoms in adults with iron deficiency are primarily due to anemia. The same symptoms may also be present in those with severely reduced iron stores and extremely low serum ferritin who are not anemic. Typical symptoms include:

★ Fatigue

★ ica (pagophagia, ice craving)

★ Restless legs syndrome

★ Headache

★ Exercise intolerance

★ Exertional dyspnea

★ Weakness

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이 증상들은 다양한 정도로 존재하며 철분 결핍이 확인되고 치료될 때까지 전혀 인지되지 않을 수 있습니다. 많은 환자들은 그들이 오랫 동안 가졌던 피곤, 기력저하, 운동능력저하, pica 증상들을 철분을 복용한 후에야 후향적으로 인지합니다. These may be present in varying degrees and may not be appreciated at all until after iron deficiency is identified and treated. Many patients recognize in retrospect that they had fatigue, weakness, exercise intolerance, and/or pica only after successful iron repletion. The classic presentation pattern in a patient without comorbidities is a multigravid female who presents with tiredness and fatigue and a complete blood count (CBC) that shows anemia with low MCV (eg, hemoglobin 8 g/dL, MCV 75 fL) and a peripheral blood smear that shows microcytic, hypochromic RBCs. Iron studies are likely to show low iron in the range of 10 mcg/dL, low ferritin (below 30 ng/mL), and increased transferrin (around 400 mcg/dL) or high TIBC, with a low calculated transferrin saturation (TSAT; below 20 percent). Such a patient is likely to have a brisk response to iron therapy. It is also important to consider the possibility of gastrointestinal blood loss, even in a menstruating female.

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처음 내원 시에는 언급하지 않았으나 철분제 복용 후 빈혈이 해결되어 (Hb 8.9 → 12.9 g/dL) 없어졌다고 하는 증상 (자려고 하면 생기는 다리 저림 증상)은 restless legs syndrome입니다. 이것을 다리를 움직이고 싶은 불쾌하거나 불편한 충동이며, 활동하지 않은 동안에 나타나고 가장 두드러진 시기는 저녁이며 다리를 움직일 때 이러한 증상이 호전됩니다.​ The sensation may be difficult for individuals to characterize, and subjective descriptions can be quite varied and suggestible. Common terms used by individuals with RLS to describe their symptoms include: "need to move," "crawling," "tingling," "restless," "cramping," "creeping," "pulling," "electric," "tension," "discomfort," "soreness," and "itching". Typically the sensations are deep rather than superficial. For patients who have difficulty describing their symptoms, it can be helpful to ask questions that target other key aspects of RLS symptomatology:

★ Does the symptom make you want to move your legs?

★ Is the symptom better while moving?

★ Are symptoms worse in the evening or at night?

The sensation of RLS is unpleasant, but not necessarily painful. Patients usually deny that the symptom has a burning or pins and needles quality, commonly experienced in neuropathies or nerve entrapments, although neuropathic pain and RLS can coexist

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REF. UpToDate 2022.05.25

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