Working with gifted children

Criteria for expert assessment of signs of giftedness of students:

    Ease and speed of achieving high results in a particular type of activity (quickly and easily learns new ways of activity);

    Activity and self-regulation in activity (high motivation and independence in activity);

    Ability to solve creative problems (in search of new ways it goes beyond the task).

Levels of student giftedness

1st rank - high level manifestations of giftedness (all assessment criteria appear constantly);

2nd category - above average(all assessment criteria appear often, but not always);

3rd category -average level(all assessment criteria are equally manifested and not manifested);

4th rank -below average(evaluation criteria are rarely manifested);

5th category - low level(the evaluation criteria do not appear at all).

Conditions for the application of the method of expert assessment of the giftedness of students by teachers.

    The teacher must be psychologically literate, that is, to be aware of the task of gifted schoolchildren assigned to him.

    The teacher must objectively establish the relationship between this grade and the school distribution of pupils according to their academic progress, which is familiar to the teacher.

    The assessment should be based on the teacher's continued acquaintance with the students.

    The assessment should be multifaceted, that is, based on the independent characteristics of the expert group of teachers.

    Assessment of the giftedness of schoolchildren requires comparison with others who are in other respects in similar conditions (group, class, age).

Expert assessment of signs of giftedness of students

Stage 1

    the names of the students to be assigned are placed in alphabetical order in the 1st column of the form filled in by the teacher;

    students of a certain class are distributed according to the grades of giftedness (1- high level of giftedness, 2- level above average, 3- average level, 4- level below average, 5- low level);

    within each category, the surnames of students are recorded in columns by degrees of giftedness;

    the distribution of students obtained in this way will make it possible not only to identify gifted students (1st category), but also to determine the degree of giftedness (position in the column in descending order).

Expert assessment of the level of manifestation of gifted students:

Stage 2

Diagnostic technique "Intellectual and creative abilities"

Purpose: determination of the level of development of intellectual and creative abilities of students.

Dear Colleague! This scale will help you assess the level of development of the basic intellectual and creative abilities of students. We think that your observation, knowledge of children and objectivity will help you in this.

Here is a list of qualities, the severity of which must be assessed in each child according to the following level system:

High level - this quality is always shown.

Above average - this quality appears often, but not

always.

Average level - this quality is equally manifested and not manifested.

Below average - this quality is manifested, but rarely enough.

Low level - this quality does not manifest itself at all.

Diagnostic technique "Personality traits".

Purpose: to determine the degree of development of certain personality traits of students.

Dear Colleague! This scale will help you assess the degree of development of certain personality traits of students. We think that your observation, knowledge of children and objectivity will help you in this.

Here is a list of features, the severity of which needs to be assessed according to the following level system:

High level - this trait always appears.

Above average - this trait appears often, but not

always.

Average level - this trait is equally manifested and not manifested.

Below average - this trait manifests itself, but rarely enough.

Low level - this trait does not appear at all.

Indicators

V.S.

NS.

1. Memory - the child's ability to quickly memorize and keep various information in memory for a long time.

2. Attention - the child's ability to quickly concentrate, tune in to an activity and engage in it for a long time without being distracted.

3. Ability to analyze and synthesize - the child's ability to quickly "decompose" the proposed information into its constituent parts, or, conversely, to assemble a whole from several parts (to draw a conclusion).

4. Productivity of thinking - the child's ability to find a large number of solutions to any problem posed to him.

5. Perfectionism (diligence) - the child's desire to bring the results of their activities to the highest standards.

6. Flexibility of thinking - the child's ability to quickly change his behavior, to make adjustments to his activities, depending on the changed circumstances, to combine knowledge and skills from various areas of life in his activity.

7. Originality of thinking - the child's ability to put forward new, non-standard ideas, to see the unusual in the ordinary.

Indicators

V.S.

NS.

1. Self-esteem - a real assessment of your personal qualities and abilities.

2. Egocentrism - focus on oneself.

3. Demonstration - desire to always be in the spotlight.

4. Emotionality- susceptibility, sensitivity to the phenomena of the surrounding world

5. Arbitrary behavior - the ability to subordinate your desires to requirements and needs.

6. Ability to evaluate - critical thinking.

N. P. Ansimova, A. V. Zolotareva, E. N. Lekomtseva

Methodological and methodological foundations for assessing the effectiveness of the work of teachers

with gifted children

The article was prepared within the framework of the state assignment of the Ministry of Education and Science of the Russian Federation, YaGPU im. K. D. Ushinsky No. 27.4348.2017 / NM on the topic "Development of scientific and methodological foundations

work of a teacher with gifted children "

Based on the analysis of scientific literature, this article describes the characteristics of the main methodological approaches to improving the effectiveness of a teacher's work with gifted children, as well as formulates the principles of work to improve the performance of teachers with gifted children and youth. In addition, the article presents the rationale for the choice of a set of criteria and indicators for assessing the performance of a teacher working with gifted children.

Key words: gifted student, activity approach, personality-oriented approach, competence-based approach, teacher performance, principles of work to improve performance.

N. P. Ansimova, A. V. Zolotariova, E. N. Lekomtseva

Methodological and Methodical Bases of Assessing Teachers "Work Effectiveness

with Gifted Children

In the present article, on the basis of the analysis of scientific literature the characteristic of the main methodological approaches of increase in the teacher "s work effectiveness with gifted children is presented and also the principles of work on increase in teachers" activity effectiveness with gifted children and youth are formulated. Besides, justification of the choice of a complex of criteria and indicators of assessment of activity effectiveness of the teacher working with gifted children is presented in the article.

Keywords: gifted pupil, activity, personal focused, competence-based approaches, criteria, indicators, methods of assessing the teacher "s activity effectiveness, work principles on effectiveness increase.

The search for new forms to identify gifted children, new pedagogical technologies for the development of children's giftedness gives rise to the problem of staffing the process of identifying and developing children's giftedness. The success of working with gifted students largely depends on the teacher. Even KD Ushinsky noted that in school matters nothing can be improved by bypassing the teacher's head. It is the teacher who is the key figure in all innovative processes; it depends on his qualifications and professionalism whether a student's giftedness can be formed.

The main methodological approaches to increasing the effectiveness of the teacher's work with gifted children can be activity-based, personality-oriented, competence.

The competence-based approach is a relatively new direction in scientific and pedagogical methodology. It is widely used in vocational training, since it involves the formation of an independent, responsible, successful specialist who has

giving not only the necessary knowledge, skills and abilities, but also the most important personal qualities and abilities for effective activity.

The competence-based approach is seen as a kind of instrument for enhancing the social dialogue of higher education with the world of work; focuses on the result of education, which is not the volume of assimilated information, but a person's ability to act in various problem situations; the result itself is revealed through the totality of various kinds of competencies.

At the same time, the concept of “competence” includes not only cognitive and operational-technological components, but also motivational, ethical, social and behavioral ones.

The concepts of “competence” and “competence” are used as the basic concepts of the competence-based approach. In modern science, the definition of competence, proposed by I.A.Zimnyaya, who understands by competence internal,

© Ansimova N.P., Zolotareva A.V., Lekomtseva E.N., 2017

potential psychological neoplasms (knowledge, ideas, action programs, value systems and attitudes), manifested in a person's competencies. In this case, competence is considered as a result of mastering the corresponding competence.

Competencies, manifested in the behavior and activities of a person, become his personal qualities, properties. Accordingly, they become competencies, which are characterized by motivational, semantic, relational, and regulatory components, along with knowledge and experience.

Academician V.D.Shadrikov, deepening and concretizing these provisions, considers competence as a systemic manifestation of knowledge, skills, abilities and personal qualities. Competencies are formed on the basis of knowledge, skills, abilities, personal qualities, and these knowledge and skills themselves act as conditions for the formation of competencies.

A teacher who works with gifted children, naturally, must have the necessary set of competencies that will allow him to successfully cope with the tasks of educational practice. And the increase in the effectiveness of his activities will depend on how complete he will have a set of competencies and what the level of their formation will be.

The implementation of a competency-based approach to increase the effectiveness of a teacher's work with gifted children, therefore, should have some features:

The competence-based approach presupposes not so much the presence of certain knowledge and skills, but rather the readiness to use them to resolve specific situations that arise in pedagogical practice;

The competence-based approach considers professional competencies not as frozen formations, but as constantly changing, developing, requiring continuous self-improvement from the teacher;

The competence-based approach presupposes the manifestation of competencies in real activities, which necessitates the development of a system of criteria and performance indicators;

The competence-based approach provides for the assessment of competencies on the basis of objective and subjective performance indicators, and the assessment of improved performance - through tracking the positive dynamics of its main indicators;

The competence-based approach involves considering the process of increasing the effectiveness of the work of teachers with gifted children, at least from two sides - the effectiveness of the activity and the personal and professional development of the teacher.

The idea of ​​the activity approach arose in psychology and was formulated in the works of L. S. Vygotsky, S. L. Rubinstein and A. N. Leontiev.

An indispensable condition for the effectiveness of activity, the development of personality in the context of the activity approach is the reliance on a person's own strengths, on the internal logic of his development. Activity, on the other hand, acts as an integrating basis for all mental properties, functions, and personal qualities.

The activity approach as a whole, therefore, proceeds from the concept of the unity of personality and activity. This unity is manifested in the fact that as a result of activity, changes occur in the personality, and the personality, in turn, makes a choice of adequate types and forms of activity and transformation of activity that meet the needs of personal development.

The implementation of an activity-based approach to increase the effectiveness of the teacher's work with gifted children, therefore, should also have some features:

The activity approach involves considering the activity from two sides - external and internal, and therefore, the effectiveness of the teacher's activity with gifted children should be represented by at least two groups of indicators: external manifestations and internal conditions that ensure the effectiveness of these manifestations;

The activity approach proclaims the idea of ​​subjectivity of the participant in the activity, according to which the activity must acquire meaning for all its participants, in this case, teachers and gifted children;

The activity approach determines the use of an assessment of the effectiveness of the teacher's work with gifted children from both groups of participants - adults and children;

The activity approach, based on the unity of personality and activity, involves taking into account the interests and motivation of teachers and students in general to ensure its effectiveness.

The personality-oriented approach is based on taking into account the personality of the student, his individual psychological characteristics, life

experience, motivation in the organization of education, both general and professional.

I.S. Yakimanskaya argues that in personality-oriented learning, the child's personality, its originality and intrinsic value, its subjective experience, which is first studied and then taken into account when selecting the content of education, is at the forefront. From the point of view of M.A. Akopova, personality-oriented education should be based on a special organization of interaction between the subjects of the educational process, in which the maximum possible conditions are created for the development of its participants' abilities for self-education, self-determination, independence and self-realization in all spheres of activity. The personality-oriented approach assumes the possibility of making a free choice of educational priorities, individual trajectories for the formation of personal experience.

Personally-oriented developmental education aims to ensure the development of each student, taking into account his individual characteristics, based on the integration of the individual personal experience of each student and the learned scientific concepts. Transforming a pedagogical learning situation into a problematic one, and then into an educational learning situation, the teacher ensures the student's transition to self-study and self-development.

The implementation of a personality-oriented approach to increase the effectiveness of the teacher's work with gifted children, therefore, should have some features:

The personality-oriented approach assumes, as a prerequisite for increasing the effectiveness of the teacher's work with gifted children, the professional and personal development of both the teacher himself and the students;

The personality-oriented approach involves taking into account the existing level of development of the participants in the educational process - their motivation, dominant interests, personal qualities, accumulated experience of life and work;

The personality-oriented approach necessitates real interaction in the process of joint activities, adaptation to each other;

A personality-oriented approach involves taking into account the patterns of age, professional and individual development for the organization of effective activities and

increasing its effectiveness, as well as their regular monitoring to make the necessary adjustments to the activities;

The personality-oriented approach necessitates the creation of motivational, informational, organizational, regulatory, methodological, material and technical conditions for increasing the effectiveness of the teacher's activities with gifted children;

A personality-oriented approach involves taking into account the characteristics of the development of the personality of teachers and gifted students in the development of content, technologies and methods of work and assessment.

The highlighted methodological approaches made it possible to formulate some principles of work to improve the performance of teachers with gifted children and youth:

The principle of activating and developing the subjective professional and educational position of an adult student, which implies the formation of a personal meaning of the activity being carried out and the ability to take responsibility for its results, the ability to accept the personality of any student, to create a creative and free learning atmosphere;

The principle of the unity of theoretical and practical training of teachers, necessitating both the availability of appropriate knowledge and understanding of the specifics of working with gifted children, and the implementation of this knowledge in practice and the accumulation of real work experience;

The principle of unity and differentiation of general and special education of a teacher, which allows to work effectively with different categories of children, different types of giftedness, in different subject areas and directions, for teachers of different positions and specialization, without losing common goals of activity;

The principle of freedom of choice of individual educational routes and additional educational services, both for teachers and for children, which makes it possible to take into account the level of their actual development and the zone of proximal development;

The principle of objectivity and versatility in assessing performance results through modern assessment procedures, technologies, tools, which makes it possible to formulate necessary and sufficient performance criteria and develop adequate methods for assessing them;

The principle of clustering, which involves the development and implementation of personalized vocational and educational programs for teachers of various profiles, different levels of qualifications and specialization, creating the necessary internal conditions for increasing the effectiveness of their activities;

The principle of complexity, which involves the involvement of all participants in the educational process - teachers, administration, parents, psychologists, social educators and other specialists - to work with gifted children and youth, as well as the use of a set of tools for assessing the effectiveness of their activities;

The principle of reflexivity, the use of which in the process of organizing work with gifted children helps the teacher to track the process and the results of his activities, find mistakes and effective ways of working, and understand the causes and consequences of his actions.

To determine a set of criteria and indicators for assessing the performance of a teacher working with gifted children, the following grounds were proposed:

Since the effectiveness is manifested in the characteristics of the activity and attitude towards it, the indicators should reflect both objective and subjective signs of the effectiveness of the teacher's activity;

Due to the fact that the participants in the activity are gifted children and teachers, the indicators should reflect the success of not only teachers, but also students;

The assessment of subjective performance indicators should be carried out not only by the direct participants in the activity, but also by its indirect and direct “customers” - parents of gifted children, teachers-experts, heads of educational systems, etc .;

When assessing, it is important to take into account not only the results that have been achieved at a specific point in time, but also the dynamics of their changes over a certain period of time - a year, half a year, a quarter, etc.

These grounds made it possible to single out four criteria for assessing the performance of a teacher working with gifted children, and to select for each of them a set of specific indicators of their manifestation:

Satisfaction with the results of the activities of a teacher working with gifted children.

Achievements of teachers for the assessed period (year).

Achievements of gifted children for the assessed period (year, six months).

The availability of methodological support for the work of a teacher with gifted children.

The first criterion - Satisfaction with the performance of a teacher working with gifted children - can be represented by the following indicators:

The teacher's own satisfaction with working with talented children:

Interest (positive attitude) in working with talented children;

Striving for self-improvement in working with talented children;

Desire to continue working with talented children;

Ease of establishing contact with a gifted child.

Satisfaction of talented children with the work of a teacher:

Comfortable relationship with the teacher;

Confidence that the accompanying teacher played a leading role in achieving the child's results;

Desire to interact with the teacher;

Satisfaction with your success.

The satisfaction of parents of talented children with the work of a teacher:

The consent of the parent to continue the interaction between the teacher and the child;

Positive statements by parents about the work of a teacher;

The desire of parents to consult with a teacher on issues related to education, upbringing, development of a talented child, and the solution of his problems.

The second criterion - Achievements of teachers over the assessed period - is represented by the following indicators:

Educational and methodological performance (achievements in the activities of the teacher):

Active participation in professional competitions, grants, scientific and practical conferences (at the all-Russian, regional, municipal level);

Participation in the dissemination of advanced pedagogical experience in working with talented students - conducting open lessons, master classes, creative reports (on

all-Russian, regional, municipal level);

The presence of a personal website for the teacher;

Systematic participation in updating the school website;

Use of new educational technologies (indicating the list of technologies);

Development and implementation of an advanced educational program (availability of a program and an expert opinion on it);

Availability of scientific articles and scientific and methodological developments;

The dynamics of the effectiveness of the activities of teachers (increase, decrease, stability).

The third criterion - Achievements of gifted children over the assessed period - is characterized by the following indicators:

Teaching and educational performance (achievements in the activities of gifted children):

The quality of knowledge of gifted students in the subject (the number of students with final grades "4" or "5");

The effectiveness of the GIA, USE of gifted students (average score);

Participation of talented students in creative competitions, in scientific and practical conferences (at the all-Russian, regional, municipal level);

Victories of gifted students in olympiads, contests, competitions (at the all-Russian, regional, municipal level);

Implementation of additional projects by gifted students - group and

individual projects of students, social projects;

The dynamics of children's success (increase,

decline, stability).

The fourth criterion - the availability of methodological support for the work of a teacher with gifted children - is reflected in the following indicators:

The quality of documentation and methodological developments to support the educational process (teaching materials, the development of open lessons and activities to support talented students) - timely submission of reports, maintenance of documentation established by local acts of the institution;

Availability of IOM, portfolio of gifted students;

Having a plan of extracurricular work in the subject, including work with gifted students;

The presence of a plan of interaction with the class teacher of a talented student, with a psychologist of the educational institution, a social teacher;

Existence of an action plan to ensure interaction with the parents of talented students;

Availability of a report on consultations with parents of talented students.

The above methodological grounds for assessing the effectiveness of the activities of teachers working with gifted children and young people made it possible to develop a set of methodological tools that can be used to track the effectiveness of the teacher's work (see Table 1). The proposed tools are based on survey (questionnaire) and documentation analysis methods.

Table 1

A set of methodological tools and indicators for tracking the effectiveness of the teacher's work with gifted children and youth_

I. Satisfaction with the results of the activities of the teacher working with gifted children

1.1. The teacher's own satisfaction with working with talented children

interest (positive attitude) to working with talented children "Methodology for determining integral job satisfaction" (A. V. Batarshev, adapted version) Once a year

striving for self-improvement in working with talented children results of the teacher's work on the topic of self-education, participation in methodological and expert work once a year

desire to continue working with talented children questionnaire to determine the teacher's motivational readiness to work with gifted children (document from the website www.sitemoy31.edusite.ru) once a year

ease of establishing contact with a gifted child questionnaire "Determination of the teacher's inclinations to work with gifted children" (D. B. Bogoyavlenskaya, A. V. Brushlinsky) Once a year

achievements of teachers for the assessed period (year) participation in professional competitions, grants, scientific and practical conferences once a year

achievements of gifted children for the assessed period (year, half a year) card of the success of a gifted student once a year

availability of methodological support for the work of a teacher with gifted children lesson plans, methodological developments once a year

1.2. Satisfaction of talented children with the work of a teacher

desire to interact with the teacher determining the degree of student satisfaction with the lessons with the teacher (adapted version of the questionnaire developed by A.A. Andreev) once a year

satisfaction with their successes self-assessment 2 times a year

1.3. Satisfaction of parents of talented children with the work of a teacher

parental consent to continue the interaction between the teacher and the child; minutes of parenting meetings, a schedule of consultations for parents; availability of an action plan that ensures interaction with the parents of talented students once a year

positive statements by parents about the teacher's work written gratitude to the institution, higher organizations once a year

the desire of parents to consult with the teacher on issues related to the education, upbringing, development of a talented child, solving his problems; Methods for studying parental satisfaction with the work of a teacher (developed by E.N. Stepanov, adapted version) 2 times a year

II. Achievements of teachers for the assessed period

2.1. Educational and methodological performance (achievements in the activities of the teacher)

active participation in professional competitions, grants, scientific and practical conferences (at the all-Russian, regional, municipal level) all the certified documents that the teacher has, confirming his individual achievements: diplomas of laureates and participants of competitions, letters of honor, letters of thanks, certificates, grants (documents for receipt), etc., once a year

participation in the dissemination of advanced pedagogical experience in working with talented students - conducting open lessons, master classes, creative reports (at the all-Russian, regional, municipal level) data on advanced training and professional training once a year

availability of methodological support for the work of a teacher with gifted children; methodological developments 1 time per year

the presence of the teacher's personal website screenshot once a year

systematic participation in updating the school website having a page once a year

use of new pedagogical technologies (indicating the list) description of technologies once a year

development and implementation of an advanced educational program; availability of a program and an expert opinion for this program once a year

availability of scientific articles and scientific and methodological developments list of scientific articles and scientific and methodological developments 1 time per year

dynamics of children's success (increase, decrease, stability) map of the success of a gifted student 2 times a year

III. Achievements of gifted children during the assessed period

3.1. Teaching and educational performance (achievements in the activities of gifted children)

the quality of knowledge of gifted students in the subject (the number of students with final grades "4" or "5"); the quality of knowledge of gifted students in the subject 1 time per quarter

the effectiveness of the GIA, USE of gifted students (average score) the results of the GIA, USE of gifted students 1 time per year

participation of talented students in creative competitions, in scientific and practical conferences (at the all-Russian, regional, municipal level) card of the success of a gifted student 2 times a year

victories of gifted students in olympiads, contests, competitions (at the all-Russian, regional, municipal level) card of a gifted student's success 2 times a year

implementation of additional projects by gifted students - group and individual projects of students, social projects map of the success of a gifted student 2 times a year

dynamics of the performance of teachers (increase, decrease, stability) analysis of the results of the final academic performance 1 time in a quarter

IV. The availability of methodological support for the work of a teacher with gifted children

quality of documentation and methodological developments to support the educational process (teaching materials, development of open lessons and events to support talented students) verification of documentation 2 times a year

timely submission of reports, maintenance of documentation established by local acts of the institution; verification of reports On request

availability of IOM, portfolio of gifted students checking the portfolio of gifted students, report on the implementation of IOM 2 times a year

having a plan of extracurricular work in the subject, including work with gifted students; checking the plan of extracurricular work in the subject once a quarter

having a plan of interaction with the class teacher of a talented student, with the psychologist of the educational institution, social teacher checking the plan of interaction with the class teacher of the talented student, with the psychologist of the educational institution, social teacher 1 time in a quarter

the presence of an action plan that ensures interaction with the parents of talented students; verification of the action plan, ensuring interaction with the parents of talented students 1 time per quarter

As a conclusion, we note that the assessment of the effectiveness of the activities of teachers who work with gifted children and youth is a serious step towards organizing systematic work with gifted children, the need for which has been discussed for a long time.

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Introduction

Nutrition is the most important physiological requirement of the body. It is necessary for the construction and continuous renewal of cells and tissues; the supply of energy necessary to replenish the energy costs of the body; intake of substances from which enzymes, hormones, and other regulators of metabolic processes and vital activity are formed in the body. Metabolism, function and structure of all cells, tissues and organs depend on the nature of the diet. Nutrition is a complex process of intake, digestion, absorption and assimilation of nutrients in the body.

Therapeutic nutrition (diet therapy) is based on data on physiology, biochemistry and food hygiene, in particular, knowledge about the role of individual nutrients and foods, about the importance of balance and diet.

Nutritional therapy is a mandatory method of complex therapy. The founder of Soviet dietetics, M.I. Pevzner, wrote that the patient's nutrition is the main background against which other therapeutic factors should be applied. Where there is no nutritional therapy, there is no rational treatment.

Nutritional therapy can be the only method of treatment (for example, with hereditary disorders in the assimilation of certain nutrients) or one of the main methods (for diseases of the digestive system, kidneys, diabetes mellitus, obesity, blood diseases). In other cases, nutritional therapy enhances the effect of various types of therapy, preventing complications and progression of the disease (circulatory failure, hypertension, gout, etc.). In infectious diseases, tuberculosis, injuries, after operations, nutritional therapy helps to increase the body's defenses, normal tissue recovery, accelerate recovery and prevent the transition of the disease into a chronic form.

In clinical practice, especially in recent decades, a very wide range of pharmacological agents has been used for therapeutic purposes, which makes it possible to significantly increase the effectiveness of treatment, especially in the acute phase of the disease and in emergency conditions. Long-term use of drug therapy for chronic diseases with frequent exacerbations is often accompanied by side effects, which significantly reduces the therapeutic effect, and sometimes leads to the emergence of new pathological conditions. This circumstance determines the growing interest of specialists in non-drug methods of treatment and prevention of diseases based on the use of natural natural factors, essentially eliminating undesirable consequences.

This interest is most pronounced in relation to dietary therapy, balanced not only in its main components, but also in irreplaceable nutritional factors, adapted to the level and nature of disorders caused by the disease.

The combination of dietary therapy with pharmacological, on the one hand, increases the effectiveness of treatment, and on the other hand, it mitigates or prevents the side effects of drugs, which, under these conditions, have an effect at a lower dosage.

Overview of Blood Disorders

Anemias

Anemia - a condition characterized by a decrease in hemoglobin per unit volume of blood due to a decrease in its total amount in the body. In most cases, anemia is accompanied by a drop in the concentration of erythrocytes per unit volume of blood, with the exception of certain types (iron deficiency anemia, etc.). Blood thinning due to tissue fluid should be distinguished from true anemia.

The development of anemia is based on a variety of pathological processes, in connection with which all anemias are divided into the following groups:

- anemia after acute blood loss;

- iron deficient;

- associated with impaired synthesis or utilization of erythrocyte components;

- associated with impaired synthesis of RNA and DNA;

- associated with pathological destruction of erythrocytes;

- associated with impaired reproduction and development of bone marrow cells.

Each of these options for anemic conditions has a different cause (for example, iron deficiency anemia can be observed with bleeding from the gastrointestinal tract, uterine bleeding, heavy menstruation, pregnancy, impaired iron absorption, etc.). However, in some cases, the most careful diagnostic search fails to reveal the underlying disease.


Manifestations of anemias extremely varied and defined:

- pathogenetic variant of anemia;

- the reasons that caused it;

- changes caused by the body's response to a decrease in tissue oxygen supply, impaired respiratory function of the blood (oxygen delivery to tissues) - circulatory-hypoxic syndrome.

This syndrome is expressed in the form of weakness, increased fatigue, shortness of breath on exertion, palpitations, "anemic" noise in large vessels, an increase in the volume of circulating blood, and accelerated blood flow. Circulatory-hypoxic syndrome is observed to a greater or lesser extent in all types of anemic conditions; its severity depends on the degree of hypoxia (reduced oxygen delivery).

The severity of symptoms depends on a number of contributing factors. With the rapid development of anemia, there is not enough time for the full development of compensatory processes, and the patient's symptoms may be more pronounced than with the gradual development of anemia of the same degree. In addition, the patient's complaints may depend on local vascular disease. For example, angina pectoris, intermittent claudication, or transient cerebrovascular accident can be exacerbated by anemia.

Moderate anemia is often asymptomatic. The patient may complain of fatigue, shortness of breath and palpitations, especially after exercise. With a severe form of anemia, symptoms often persist even in a patient at rest, he cannot tolerate physical activity. The patient is able to be aware of this condition and complain of palpitations and rapid pulse. The development of heart failure is possible.

It is known that symptoms in severe anemia extend to other organ systems. There are complaints of dizziness and headaches, tinnitus up to fainting. Many sufferers become irritable, have insomnia, or have difficulty concentrating. Because blood flow to the skin is reduced, the patient may become sensitive to cold. Symptoms from the gastrointestinal tract appear - for example, decreased or lack of appetite, dyspepsia and even nausea, as well as dysfunction of the large intestine. In women, the menstrual cycle is usually disturbed, which is manifested both by the cessation of menstruation and by heavy bleeding. Men may complain of impotence or loss of libido.

Pallor of the skin is the main symptom associated with anemia. However, its usefulness is limited by other factors that determine skin color. So, in different individuals, the thickness and structure of the skin varies significantly. In addition, the blood flow in it can change. Depending on the location of the vessels and the type of blood circulation in the capillaries, a yellowish, painful skin tone may appear even in a healthy person, while in patients with anemia, it may acquire a reddish tint due to hot flush at the time of excitement or after it. Another important factor in determining skin color is the concentration of the melanin pigment in the epidermis. Light-skinned people appear pale even if they are not anemic, and, conversely, in a very dark person it is rather difficult to recognize pallor of the skin. Finally, acquired pigmentation disorders or jaundice can mask the pallor of the skin. However, even in dark-skinned people, anemia can be suspected by the color of the palmar surfaces or mucous membranes of the oral cavity, nail bed and conjunctiva of the eyelids. The color of the skin on the folds of the palmar surface is considered an informative sign. If, in terms of pallor, they are the same as the surrounding skin, then the patient's hemoglobin level, as a rule, is less than 70 g / l.

The development of pallor of the skin with anemia is facilitated by two factors, one of which is undoubtedly a decrease in the concentration of hemoglobin in the blood entering the vessels of the skin and mucous membranes, and the other is the movement of blood bypassing the vessels of the skin and other peripheral tissues, which contributes to increased blood supply vital organs. Redistribution of blood flow is one of the important mechanisms for compensating for anemia.

Other clinical signs associated with anemia include increased heart rate and significant fluctuations in blood pressure. After correction of anemia, this symptomatology disappears. Patients with anemia caused by increased pathological destruction of erythrocytes are often icteric, they have an enlarged spleen, sometimes superficial skin ulcerations develop in the area of ​​the calcaneus.

Anemia with decreased production of red blood cells

Anemias caused by insufficient production of erythrocytes can be conditionally divided into three large groups: micro-, macro- and normocytic.

Microcytic anemia(in which red blood cells are smaller than normal) include iron deficiency and some other rare types of anemias. In general, they indicate a defect in the function or synthesis of one of the three large components of the hemoglobin molecule: iron, porphyrin and globin. Since hemoglobin makes up 90% of the protein in red blood cells, it is not surprising that insufficient synthesis leads to the formation of small and pale red blood cells. These disorders include ineffective erythrocyte formation, expressed to varying degrees. It should be added that anemia in chronic inflammation and tumors can be partly microcytic. This phenomenon is caused by a defect in the mechanism of iron absorption. However, most often with these diseases, anemia is normocytic. Accounting for serum iron and its iron-binding capacity, as well as assessing the content of iron in bone marrow cells are used in the differential diagnosis of these forms of anemia.

Macrocytic anemias(erythrocytes are increased in size compared to the norm) arise with the pathology of bone marrow cells. In most cases, with a deficiency of vitamin B 12 or folic acid, the process of DNA synthesis is disrupted in them. Such anemias (usually to a lesser extent) also occur in acute blood loss, with increased destruction or decreased production of red blood cells and alcoholism, liver disease and hypothyroidism.

Normocytic anemias(red blood cells of normal size), due to a decrease in red blood cell production, include a number of disorders. This group can be conditionally divided into two categories: conditions secondary to the underlying disease, and due to congenital pathology with involvement of the bone marrow in the process.

Iron-deficiency anemia

The essence of iron deficiency anemia consists in a lack of iron in the body (depletion of iron stores in the depot organs), as a result of which the synthesis of hemoglobin is disrupted, which is why each erythrocyte contains less than normal amounts of hemoglobin. Iron deficiency anemia occurs more often than all other forms of anemia, which is explained by many circumstances leading to iron deficiency in the body.


The main causes of iron deficiency are identified.

1. Bleeding:

- uterine (ovarian dysfunction, uterine fibroids, cervical cancer, endometriosis, etc.);

- gastrointestinal (peptic ulcer, hemorrhoids, cancer, diaphragmatic hernia, ulcerative colitis, polyposis);

- pulmonary (cancer, bronchiectasis).

2. Increased iron consumption:

- pregnancy, lactation;

- the period of growth and puberty;

- chronic infections, tumors.

3. Impaired absorption of iron:

- resection of the stomach;

- pathology of the small intestine.

4. Violation of iron transport.

5. Congenital iron deficiency (this mechanism is possible with iron deficiency anemia in the mother during pregnancy).


From the listed reasons, it follows that iron deficiency anemia develops more often in women as a result of profuse uterine bleeding, repeated pregnancies, and also in adolescents.

Iron deficiency anemia occurs primarily as a result of a violation of hemoglobin synthesis, since iron is part of the heme. Insufficient formation of hemoglobin causes tissue hypoxia and the development of circulatory-hypoxic syndrome. Iron deficiency also contributes to a violation of the synthesis of tissue enzymes, which leads to a change in tissue metabolism. In this case, rapidly renewing tissues are primarily affected - the mucous membrane of the gastrointestinal tract, the skin and its derivatives - nails and hair.


The manifestation of the disease consists of the following syndromes:

- damage to epithelial tissues (gastroenterological disorders, trophic disorders of the skin and its derivatives);

- hematological (signs of iron deficiency).


In addition to these syndromes, the clinical picture is also determined by the disease on the basis of which iron deficiency anemia has developed (for example, stomach or duodenal ulcer with repeated bleeding, menstrual irregularities, some kind of chronic infection, etc.). The stage of the flow matters.

1. The stage of latent iron deficiency, manifested by a decrease in the level of iron in the blood serum in the absence of a decrease in the hemoglobin content.

2. Tissue syndrome (manifested by gastrointestinal disorders, trophic changes in the skin and its appendages).

3. Iron deficiency anemia (decreased hemoglobin levels).


With the development of a fairly pronounced anemia, complaints of weakness, tinnitus, palpitations, shortness of breath during exercise, aching pains in the heart (manifestations of circulatory-hypoxic syndrome) appear. The manifestations of disorders of the gastrointestinal tract in the form of perversion of taste, decrease and perversion of appetite (desire to eat chalk, dry pasta, tooth powder) are very peculiar, difficulty in swallowing, vague pain in the stomach are noted. Often, patients notice a slight increase in temperature.

With moderate anemia and iron deficiency, all of these complaints may be expressed slightly or absent.

Examination reveals symptoms of epithelial tissue damage and trophic disorders of the skin and its derivatives (hair, nails). So, it is possible to reveal the smoothness of the papillae of the tongue, dryness and peeling of the skin, brittle nails, dryness and hair loss.

The skin and mucous membranes are usually pale. The size of the spleen is usually normal; its moderate increase is usually found in those patients who received numerous blood transfusions.

In the study of peripheral blood, a decreased level of hemoglobin, an increase in the number of erythrocytes of small diameter and a decrease in the saturation of erythrocytes with iron, as well as the average content of hemoglobin in an erythrocyte (weight and percentage) are revealed.

When examining the gastrointestinal tract, a decrease in gastric secretion is often detected, as well as atrophic changes in the mucous membrane of the esophagus and stomach.

With pronounced circulatory-hypoxic syndrome, there may be signs of myocardial damage (myocardial dystrophy due to anemia) in the form of moderate expansion of the heart (determined by X-ray examination) and changes in the electrocardiogram.


Laboratory criteria for iron deficiency and anemia are: hemoglobin level below 120 g / l in men and below 116 g / l in women, a decrease in the color index below 0.86, a decrease in the average hemoglobin content in erythrocytes, an average hemoglobin concentration in erythrocytes (below 30%), an increase in the number of erythrocytes with a diameter less than 6 μm (more than 20%), a decrease in serum iron - less than 11.6 μmol / L (65 μg%) and other indicators.

To establish the cause of an iron deficiency state, first of all, it is necessary to find the source of the bleeding. For this, along with a thorough clinical examination, it is necessary to carry out endoscopic (esophagogastroduodenoscopy, sigmoidoscopy and colonoscopy, bronchoscopy) and other research methods. Women must be examined by a gynecologist.

Treatment

They act on causal factors (removal of the source of bleeding, fight against infection, anticancer therapy, prevention of congenital iron deficiency) and eliminate iron deficiency (diet therapy is of primary importance in this case).

Forecast

Elimination of the cause of blood loss, as well as the implementation of adequate therapy, lead to a complete recovery. In persons with profuse uterine blood loss, it is necessary to systematically monitor the level of hemoglobin (such patients are registered in the dispensary).

Prophylaxis

Persons at risk of iron deficiency (premature babies, children from multiple pregnancies, girls during puberty with rapid growth, women with heavy, prolonged menstruation, pregnant women) should eat food with a sufficient iron content (primarily meat). They should be periodically tested for latent iron deficiency and anemia.

B 12 deficiency anemia

The essence of B 12 deficiency anemia consists in a violation of the formation of deoxyribonucleic acid (DNA) due to a lack of vitamin B 12 (cyanocobalamin) in the body, which leads to a violation of hematopoiesis, the appearance of abnormal blood cells in the bone marrow, intraosseous destruction of immature forms of erythrocytes, a decrease in the number erythrocytes, hemoglobin and other formed elements of peripheral blood, as well as changes in a number of organs and systems (gastrointestinal tract, central nervous system).


B 12-deficiency anemia is much less common than iron deficiency, and can be caused by:

- a violation of the production of certain proteins (with hereditary atrophy of the glands of the stomach, with organic diseases of the stomach (polyposis, cancer), after resection or removal of the stomach);

- an increase in the consumption of vitamin B 12 (with invasion of a broad tapeworm, activation of the intestinal flora, diverticula of the large intestine);

- impaired absorption of vitamin B 12 (with organic bowel diseases (inflammation, cancer), condition after bowel resection, hereditary malabsorption);

- violation of the transport of vitamin B 12 (with a deficiency of transport proteins).

Folic acid deficiency, similar to B 12 deficiency, is caused by:

- increased consumption (pregnancy);

- feeding children with goat milk;

- malabsorption (organic bowel disease, alcoholism);

- taking certain medications (anticonvulsants, anti-tuberculosis drugs, phenobarbital, contraceptives, etc.).


Deficiency of vitamin B 12 causes a violation of DNA synthesis, as a result of which the division and maturation of blood cells are disrupted. The metabolism of fatty acids is also disturbed, as a result of which the accumulation of toxic products occurs in the body and damage to the spinal cord develops.

Clinical picture

Manifestations of B 12-deficiency anemia consist of the following syndromes:

- circulatory-hypoxic (with sufficient severity of anemia and oxygen starvation of tissues);

- gastrointestinal;

- neurological;

- hematological (manifestations of anemia).

In addition to these syndromes, the clinical picture will also be determined by the disease on the basis of which B 12 deficiency anemia developed.

With a sufficiently pronounced anemia, symptoms caused by circulatory-hypoxic syndrome can be observed: weakness, increased fatigue, shortness of breath during exercise, palpitations, pain in the heart. In the case of unsharp oxygen starvation of tissues, these complaints may be absent. Decreased appetite, aversion to meat, pain in the tip of the tongue and burning sensation, a feeling of heaviness in the stomach after eating, alternating diarrhea and constipation are caused by damage to the gastrointestinal tract and, in particular, severe secretory insufficiency of the stomach. When the central nervous system is damaged, complaints of headache, unstable gait, chilliness, feeling of numbness in the extremities, feeling of "creeping creeps" appear. The severity of these complaints does not always correspond to the degree of anemia; during the period of remission of the disease, complaints may be absent. It is very important that if all the listed complaints are presented by an elderly person, then the likelihood of the presence of B 12 -deficiency anemia increases.

In a family, patients with suspected B 12 deficiency anemia may have patients with this disease. Alcohol abuse can also be one of the reasons for the development of anemia. The development of anemia after a patient's stay near large bodies of water and eating raw or insufficiently processed fish suggests diphyllobothriasis (helminthic invasion) as a possible cause. If the disease occurs in an elderly person suffering from chronic gastritis and develops slowly, one can think of B 12 deficiency anemia against the background of gastrointestinal pathology. In the case when symptoms from the gastrointestinal tract are combined with a decrease in body weight and rapidly progress, it should be assumed that a malignant neoplasm is the cause of the disease. Finally, information about the successful treatment of a patient with diet therapy with an increased content of vitamin B 12 or its intramuscular administration makes it possible with great confidence to consider the existing symptomatology as a manifestation of B 12 deficiency anemia.

  • Nutrition in the prevention and treatment of anemia

    Almost all diseases of the hematopoietic system occur with the phenomena of anemia, in which the number of erythrocytes and hemoglobin decreases.

    Anemia is a decrease in the amount of hemoglobin per unit of blood volume, more often with a simultaneous decrease in the number of red blood cells (or the total volume of red blood cells). The term "anemia" without detailing does not define a specific disease, but indicates changes in blood tests, i.e. anemia is one of the symptoms of various pathological conditions.

    Anemia can be an independent disease or a consequence of another pathological process.

    • Nutrition in the prevention and treatment of iron deficiency anemias

      Most often (up to 80% of cases) in clinical practice, there are anemias caused by iron deficiency. Iron deficiency anemia is a disease caused by the depletion of iron stores in the body, which leads to a violation of the synthesis of iron-containing proteins.

      Due to the violation of the synthesis of iron-containing proteins, the body is insufficiently supplied with oxygen, inhibition of respiratory processes in cells, tissues and organs occurs with the development of dystrophy in them and impairment of their functions.

      The main factor determining the level of plasma iron is the interaction of the processes of synthesis and decay of erythrocytes. For the needs of hematopoiesis, iron from the blood depot is used. Iron losses are replenished by the iron in food. The body of an adult contains about 3-5 g of iron in bound form. More: The biological role of iron. 70% of the body's iron is contained in bound form. The daily requirement for iron in general must be provided with nutrition. Therefore, the nutritional factor is of particular importance in the development of iron deficiency anemias.

      The risk group for the development of anemia includes women of childbearing age (due to pregnancy and chronic menstrual blood loss), children due to an increased need for iron, and people who do not consume enough iron-containing foods: vegetarians, the elderly and the elderly.

      Iron taken from food is absorbed only by 10–20%, and the amount of iron consumed should be 5–10 times more than the daily requirement. The daily requirement for iron intake is on average 10 mg / day for men, and 18-20 mg / day for women.

      If the balance of iron intake in the body is negative, then the iron depot in the body is activated.

      Iron loss occurs through the intestines, as well as urine, sweat, epithelium, hair and nails. In a man, iron loss is almost 1 mg / day. Women of childbearing age lose approximately 40-200 mg during menstruation, resulting in an average loss of nearly 1.8-2 mg / day.

      The task of diet therapy for anemia is to provide the body with nutrients necessary for hematopoiesis, primarily iron, against the background of physiological adequate nutrition. The role of individual foods as sources of iron is determined not so much by their quantity as by the degree of assimilation of iron from them.

      • Basic principles of building a diet for patients with iron deficiency anemia
        • To achieve the efficiency of absorption of iron from various foods in the intestine.
        • Balance the ratio of heme and non-heme iron compounds in food, taking into account the iron content in various foods.
        • Balance the amount of intake of substances that enhance and inhibit the absorption of iron.
        • Balance the content of proteins, fats, carbohydrates in food.
        • Choose a sufficient calorie diet.

      diet number 11 (high protein diet).


      Healthy people absorb approximately 5 to 10% of the iron in their diet, while those who are iron deficient absorb approximately 10–20%. The absorption of iron from food depends on many factors. Better absorbed heme iron, which is found in animal products. The absorption of iron from plant foods is enhanced with a mixed diet (foods containing heme iron increase the absorption of non-heme iron).

      Adding meat and meat products or fish to every meal increases the absorption of iron from plant foods.

      The addition of citrus juice, fruits of other fruits and berries without pulp, rosehip decoction, compote with the addition of ascorbic acid (25-50 mg) or citric acid also increases the absorption of iron, since ascorbic acid plays the main physiological role in the absorption of iron. When using fruit juice from citrus fruits, the absorption of iron from cereals, bread, eggs increases, although there is little iron in the citrus fruits themselves.

      Strong tea inhibits the absorption of iron, as well as a high content of dietary fiber in the diet (wheat bran, for example, prevents the absorption of iron from bread as much as possible). Oxalic acid and tannins impair iron absorption, so spinach, sorrel, rhubarb, blueberries, dogwood, persimmon, chokeberry, or quince are not essential sources of iron. Egg yolk, cocoa, chocolate impair the absorption of iron.

      Iron is poorly absorbed from foods high in phytate - wheatgrass, legume oil, spinach, lentils, and beet tops.

      Often sulphate ferrous and oxide iron, gluconate and glycerophosphate of iron are added to food products. In addition, highly refined reduced iron is used. It is fortified with milk, grain products, bread, rice, table salt, sugar and fruit juices.


  • Nutritional therapy for leukopenia and thrombocytopenia

    When compiling special diets for patients with leukopenia and thrombocytopenia, it is advisable to include in the diet foods containing substances necessary for building the stroma of blood elements, hemoglobin synthesis, differentiation and maturation of blood cells. It is also important to exclude substances that have an inhibitory effect on certain aspects of hematopoiesis.

    The composition of the diet for leukopenia and agranulocytosis corresponds to that for anemia, with changes towards an increase in food folic and ascorbic acids, vitamin B12; complete protein (amino acids - methionine, choline, lysine).

    It is believed that with leukopenia and agranulocytosis, purine metabolism increases sharply, therefore, the amount of meat, liver, kidneys in the diet is reduced, but at the same time the amount of protein increases due to vegetable (soy). Limit animal fat and increase the amount of vegetable oil. Preference is given to vegetables, fruits, berries, herbs.

    The principles of nutritional therapy for leukopenia and thrombocytopenia:

    • To build the stroma of blood cells, you should introduce a sufficient amount of proteins containing amino acids such as lysine, methionine, tryptophan, tyrosine, lecithin, choline.
    • For the differentiation of blood elements, as well as for the transformation of yellow bone marrow into active red, cobalt, vitamin B 12, folic and ascorbic acids are needed. In addition, an adequate intake of vitamin B 6 (pyridoxine) and riboflavin is essential.
    • Thiamine and nitrogenous extractives are required to stimulate and regulate the release of ready blood cells from blood depots.
    • In the diet for patients with low hematopoiesis, the introduction of fat, foods rich in lead, aluminum, selenium and gold are moderately limited. These substances have a negative effect on some phases of erythropoiesis and leukopoiesis.

    Nutrition in the absence of concomitant gastrointestinal diseases can be based on diet number 11. The high protein diet (high protein diet) is now recommended in hospitals.

  • Nutritional therapy for acute leukemia

    The pathogenetic principles of diet therapy in acute leukemia are based on increasing the consistency of the immune system, correcting metabolic disorders, reducing the manifestations of intoxication, and correcting vitamin deficiency. A physiologically complete and easily digestible diet is required, enriched with vitamin C and B vitamins, as well as sources of iron and other hematopoietic microelements: cobalt, copper, manganese, nickel, zinc, molybdenum. Arsenic has a cytostatic effect. Vanadium, titanium, chromium affect redox processes.

    Nutrition in the absence of concomitant gastrointestinal diseases can be based on diet number 11. The high protein diet (high protein diet) is now recommended in hospitals.

    Special requirements for dietary therapy for certain types of chemotherapy:

    • When treating with glucocorticosteroids, the breakdown of protein in the body increases, the formation of fat in it increases, the body's tolerance to glucose decreases, sodium and water retention occurs, the release of potassium and calcium increases, irritation of the mucous membranes is observed. Accordingly, it is necessary to increase the protein quota in the diet up to 120 g / day, while 60-65% due to animal protein, low-fat cottage cheese, fish, seafood, lean meat, egg white. Reduce the amount of carbohydrates to 300 g and primarily due to simple carbohydrates (sugar and products containing it). Oatmeal and buckwheat dishes are recommended. In the diet, it is necessary to limit fat to 70–75 g, of which 30–35% should be vegetable fats. Reduces the content of table salt (up to 4 g / day), oxalic acid, cholesterol. They increase the content of potassium, calcium, vitamins C, A, D, E. The intake of free liquid is limited. Cooking is in accordance with the principles of mechanical, thermal and chemical sparing.
    • When treating with cytostatics, particular importance is attached to reducing intoxication and sparing the digestive tract.
  • Nutritional therapy for erythremia

    In the presence of erythremia, the hematopoietic activity of the bone marrow increases, which leads to an increase in blood mass due to erythrocytes, and sometimes also leukocytes and platelets - polycythemia.

    At the initial stage of the disease, physiologically good nutrition is recommended - diet No. 15 is recommended. Limit foods that increase blood formation, such as the liver. They recommend food rich in fat (up to 150-200 g / day), dairy, vegetable products.

    In the expanded stage of erythremia, a diet similar to the diet for gout is shown, in which meat and fish products are sharply limited or excluded, especially meat of internal organs, legumes - diet No. 6 is recommended.