Post-hemorrhagic anemia is a dangerous condition for human health and life. Insufficient blood volume leads to the development of a serious pathology - a lack of hemoglobin. If the process of the formation of post-hemorrhagic anemia is not stopped in a timely manner, then there will be a serious threat to life.

The principle of development of anemia

There are many different cells in the blood that perform separate functions. Among them are red blood cells - erythrocytes containing hemoglobin. They play an important role: they deliver oxygen from the lungs to different parts of the human body.

Anemia is a pathological condition when the content of hemoglobin or red blood cells in the blood drops sharply. The most common red blood cell deficiency associated with prolonged bleeding. This phenomenon is called posthemorrhagic anemia.

The condition itself is rarely diagnosed as a separate disease. Usually, the fact of anemia is interpreted as a symptom of another pathology. According to the WHO, more than 30% of the world's inhabitants suffer from anemia.

The danger of this condition is that a long-term lack of erythrocytes against a background of a reduced amount of blood can cause not only oxygen starvation and vascular insufficiency, but also the development of malignant tumors, tissue and organ dystrophy, and also provoke hematopoietic diseases. This process is most dangerous during pregnancy, when not only the health of the mother is harmed, but also her unborn child.

Reasons for the appearance of post-hemorrhagic anemia

Various situations can provoke the development of the disease, sometimes arising against the background of existing ailments or due to unexpected force majeure circumstances:

In women, these may be the following reasons for development:

• ectopic pregnancy;
• profuse menstruation;
• uterine bleeding;
• birth trauma.

Classification of the disease

There are 2 types of post-hemorrhagic anemia:

• sharp;
• chronic.

Acute red cell failure suggests a sharp decrease in hemoglobin. This form of post-hemorrhagic anemia occurs as a result of blood loss due to trauma or surgery, when a person loses 1/8 or more of the total volume.

When a blood transfusion is indicated for low hemoglobin:

Stages of development of the acute form

Doctors distinguish several stages in the development of acute post-hemorrhagic anemia:

Features of chronic post-hemorrhagic anemia

In chronic anemia, there is a small but intermittent constant blood loss over a long period of time. This form is observed in a number of diseases:

• oncology and neoplasms of the gastrointestinal tract;
• peptic ulcer;
• bleeding from varicose veins of the rectum;
• erosive processes in the mucous membrane of the esophagus;
• increased bleeding of the gums (periodontitis and gingivitis).

The chronic form of anemia is most often observed in women due to bleeding against the background of inflammatory processes of the reproductive organs:

Degrees of anemia: mild, moderate, severe

Anemia has 4 degrees of severity. A classification of this kind is based on indicators of the level of hemoglobin in the patient's blood:

• mild degree - hemoglobin is below the permissible norm, but not less than 90 g / l;
• medium degree - hemoglobin index from 70 to 90 g / l;
• severe degree - blood cell level up to 70 g / l;
• extremely severe - the amount of hemoglobin is below 50 g / l.

In addition to the above forms, there are 2 types of posthemorrhagic anemia:

• relative: characterized by an increase in blood plasma with significant blood loss, often manifesting itself during pregnancy in women;
• absolute: a decrease in hemoglobin due to a decrease in the number of red blood cells.

According to the International Classification of Diseases, certain conditions associated with the established cause of blood loss are distinguished:

• congenital anemia of the fetus against the background of blood loss;
• chronic post-hemorrhagic anemia associated with iron deficiency.

Symptoms of the disease

There is a general complex of symptoms that occurs with the development of anemia (anemic syndrome):

• fast fatiguability;
• drowsiness;
• noise in the ears and head;
• dyspnea;
• pallor of integuments.

If acute anemia progresses, then the following symptoms are additionally observed:

• dizziness;
• headache;
• fainting;
• thirst;
• nausea;
• brittle nails;
• profuse sweating;
• dry mouth;
• shallow breathing;
• cardiopalmus;
• lowering body temperature;
• lowering blood pressure.

Different types of internal bleeding can manifest themselves in different ways.

The patient can detect the following manifestations of the disease:

• liquefied bloody stools, which may be evidence of a stomach ulcer;
• cough accompanied by bright red phlegm, which is characteristic of bleeding in the lungs;
• increasing swelling at the site of a bruise or fracture, confirming intramuscular or subcutaneous bleeding;
• spotting from the vagina.

With the manifestation of a combination of several symptoms characteristic of anemia, you need to urgently consult a doctor to make the correct diagnosis and prescribe the necessary treatment.

What is the reason for the appearance of spotting in the intervals between periods:

Diagnosis of anemia, including blood tests

Diagnosis of anemia is carried out only after stopping bleeding. At the same time, in parallel, in any possible way, the volume of lost blood is replenished (if necessary).

Initially, for maximum effect, in order to bring the patient out of shock and increase blood pressure to normal, doctors carry out a transfusion of at least 500 ml of plasma substitute. The primary introduction of Polyglyukin is performed in a stream, and when the systolic pressure reaches 100, the injection is replaced with a drip. Sometimes the dose of the injected solution can reach two liters.

Only after all the necessary manipulations do doctors begin to diagnose the patient's anemic condition.

Of course, an obligatory stage of diagnosis is the collection of anamnesis and the identification of possible causes underlying the disease. The diagnosis itself is made on the basis of a set of studies carried out: clinical and laboratory.

Basic methods

The diagnosis of post-hemorrhagic anemia is based on basic studies:

• general and biochemical blood test;
• Analysis of urine.

When detecting the presence of post-hemorrhagic anemia, laboratory blood tests will show:

• low hemoglobin content with a slight decrease in erythrocytes;
• a decrease in the level of saturation of erythrocytes with hemoglobin;
• decreased serum iron levels;
• increasing the value of the erythrocyte sedimentation rate;
• decreased platelet count.

Additional examination

To detect the place of hidden bleeding, additional diagnostic methods are used:

• analysis of feces for the presence of blood and helminths;
• fibrogastroscopy - to exclude or confirm the outflow of blood in the digestive tract;
• colonoscopy (medical examination under video control of the lower intestine);
• checking the integrity of internal hemorrhoids - sigmoidoscopy;
• Ultrasound and / or x-rays to specify the cause;
• gynecological examination (for women).

In some cases, a cytological and histological examination of the bone marrow is required to make an accurate diagnosis.

Depending on the type of bleeding, the patient needs to consult one or more specialists, such as:

• hematologist;
• surgeon;
• traumatologist;
• gynecologist;
• proctologist;
• gastroenterologist.

Treatment of acute anemia

Very often, in cases of post-hemorrhagic anemia, "delay is like death." If medical assistance for acute blood loss is not provided in a timely manner, the result will be disastrous. When a person quickly loses more than a quarter of their blood volume, it can be fatal.

Surgical intervention is immediately performed on the site of the damaged organ or body part in order to stop bleeding.

Initially, the lost blood volume is replenished. This is done only if the blood loss is more than 10%. If the blood consumption is no more than 20%, then a small correction is required with the use of blood substitutes:

• Ringer's solution;
• Dextran;
• Gelatinol;
• Longosterol;
• Volenama.

Preparations for reimbursing blood loss - photo gallery

Albumin is a colloidal preparation
Polyglucin is used in the treatment of post-hemorrhagic anemia
Ringer's solution belongs to crystalloid plasma substitutes
Reopolyglucin is used to treat massive blood loss Gelatinol is similar in structure to blood plasma

The use of a glucose solution is highly undesirable. If the blood loss is more than 20%, then a mixture of erythrocyte mass with a plasma substitute in various combinations is transfused to the patient. Pure donated blood is rarely used. It is impossible to immediately replenish all the blood loss, as this can cause "massive transfusion syndrome", that is, the development of intravascular coagulation or immunoconflict is possible. To correct the water-salt balance in the body, intravenous administration of a sodium chloride solution is prescribed. Be sure to use iron-containing drugs for acute anemia:

• Feramide. Active ingredients: nicotinamide and ferric chloride. The iron content is low. For the greatest effectiveness, an additional intake of ascorbic acid is required.
• Ferroplex. It is a combination of ferrous sulfate and vitamin C. It is easily tolerated and has minimal restrictions on its use.
• Ferrocerone. The active ingredient is the sodium salt of orthocarboxybenzoylferrocene. Highly efficient. When taking it, it is necessary to exclude sour, sour and pickled food from the diet.
• Conferon. The activity of the drug is based on the action of sodium dioctyl sulfosuccinate and ferrous sulfate. Easily absorbed. Does not require additional intake of ascorbic acid.

At the end of the obvious manifestations of anemia, iron preparations are taken in half the dose for another six months.

If the patient is in shock, use large doses of Prednisolone. An increase in the pH in the tissues helps to remove the baking soda solution. Heparin is used to eliminate blood clots at the level of capillary vessels. Sometimes it is required to connect humidified oxygen through a breathing tube.

Therapy for chronic post-hemorrhagic anemia

The chronic form of the disease requires a different approach. Initially, the true cause of constant blood loss, its source, is identified. Sometimes it is so insignificant that it may not be recognized.

In some cases, the doctor prescribes hemostatic drugs (coagulants) that promote blood clotting. Usually, such drugs are used for capillary, parenchymal and uterine bleeding. It can be:

• Vikasol;
• Dicinon;
• Etamsilat;
• hemostatic collagen sponge;
• Amben;
• Tobarpin;
• Thrombin;
• Prothrombin complex.

Blood transfusion and the use of blood substitutes are rare. As in the acute form, iron preparations and vitamins are used to treat chronic anemia. Symptomatic therapy is prescribed, aimed at eliminating dysfunctions in the body.

Aspects of anemia treatment - video

The use of traditional medicine

One should not hope for the possibility of curing anemia with the help of only folk remedies. They can be used only as an addition to the main treatment. But before starting therapy, a doctor's consultation is required. Most often, doctors recommend using:

• burnet;
• strawberry;
• black currant;
• water pepper;
• nettle;
• rose hip.

Nutrition for anemia

A special diet is an adjunct to the treatment of post-hemorrhagic anemia. The patient's diet should be dominated by foods with a high iron content:

• fresh and boiled vegetables;
• lean beef and pork;
• rabbit meat;
• veal;
• liver;
• cottage cheese;
• egg white;
• greens;
• sea ​​fish.

Replenishment of fluid in the body is required, so doctors recommend drinking at least 2 liters of water daily. In addition, natural juices will be very useful:

• plum;
• cranberry;
• pomegranate;
• currant;
• grapefruit;
• apple.

Disease prevention

During the recovery period of the body after a previous illness, patients need to increase the immune barrier. This is due to the susceptibility to infection by various pathogenic microorganisms. In this situation, immunostimulants based on aloe, ginseng, lemongrass, and echinacea extract are used.

Prevention of the development of post-hemorrhagic anemia involves, first of all, maintaining a healthy lifestyle, observing safety rules in any field of activity and in everyday life, and timely treatment of all current diseases.

Do not forget about good nutrition. Products should be rich in micro- and macronutrients, vitamins.

In cases with any type of injury, it is imperative to contact a medical institution for timely diagnosis.

Prognosis for a successful recovery

Extremely fast medical assistance and appropriate hemostatic measures contribute to a favorable outcome. With a large loss of blood, the patient may die. Slow but volumetric blood loss leads to various complications, but it is less dangerous.

The prognosis of the success of the treatment of acute post-hemorrhagic anemia depends not only on the amount of blood loss itself, but also on the speed of blood flow.

The success of the treatment of subsequent complications depends on the timeliness and correctness of the therapy of anemia itself. In this case, an important role is played by the regenerative abilities of the bone marrow, since the duration of the treatment of anemia depends on this.

Post-hemorrhagic anemia is a disease requiring compulsory medical intervention. Only correct and timely treatment will help save a person from serious complications.

Diseases

Iron-deficient types of anemia account for almost 80% of all cases of this disease. These include post-hemorrhagic anemia, which is considered one of the most commonly diagnosed. This ailment occurs due to severe blood loss. This disease can have both an acute form and turn into a chronic, difficult to diagnose. In the first case, post-hemorrhagic develops due to the sudden appearance of profuse blood loss. The chronic form appears with frequent, but small, internal bleeding.

Hemorrhagic anemia

This disease is developing rapidly and carries a real danger to human life. Acute hemorrhagic anemia can be fatal. Therefore, when such a problem arises, the patient should urgently seek medical help. A one-time loss of 500 ml of blood is considered critical. The chronic form of the disease can significantly worsen a person's quality of life. Constant, but not profuse bleeding also often indicates the development of various cardiological, gynecological and gastroenterological problems.

Disease symptoms

Signs of chronic and acute forms of the disease can be very different. With regular, but not heavy bleeding, the patient develops mild symptoms. He may complain about:

• pallor of the skin;
• rapid fatigue;
• loss of working capacity;
• dizziness;
• darkening in the eyes;
• decrease in body temperature.

Acute posthemorrhagic anemia causes more pronounced symptoms. It is important to know how to identify profuse internal blood loss in order to immediately call for medical attention. In this state, the patient has:

Dry mouth is a sign of internal bleeding. The person may also develop nausea, vomiting, and confusion. Feces can also indicate a problem. With internal bleeding, they turn black. Against the background of general intoxication of the body, the patient's body temperature may rise. The patient also complains of a feeling of squeezing of the internal organs. The stronger the blood loss, the more pronounced the above symptoms are.

The appearance of this disease is always associated with a lack of blood in the body. Acute post-hemorrhagic anemia occurs most often due to trauma, during which damage to blood vessels and large arteries occurs. In addition, the disease can appear when:

• surgical interventions;
• rupture of the fallopian tube during an ectopic pregnancy;
• peptic ulcer of the stomach and duodenum;
• severe lung diseases;
• violation of hemostasis.

An acute form of anemia occurs with massive blood loss, which can provoke damage to the walls of the heart chambers during a heart attack. Also, the disease often develops with ruptures of the aortic aneurysm. This disease can also appear in infants. They have a problem associated with birth trauma, as well as placental bleeding.

The chronic form of hemorrhagic anemia manifests itself with the loss of small volumes of blood associated with various gastrointestinal, renal, hemorrhoidal and nasal injuries. The problem can appear with uterine bleeding, gingivitis, hemorrhoids and intestinal tumors.

In women, this disease can be observed with very heavy menstruation, dysmenorrhea. Sometimes this disease is diagnosed in pregnant women. Their anemia can be associated with serious pathologies. For example, the problem may appear when:

• rupture of the umbilical cord;
• placental abruption;
• choriangioma;
• placental hematoma.

If a person has symptoms of acute post-hemorrhagic anemia, it is necessary to urgently call emergency medical care. The sooner the resuscitation team arrives, the higher the likelihood of successful treatment. To cope with such a diagnosis, doctors such as:

A patient who observes signs of chronic anemia should seek help from these specialists. He may also need to go through consultations with a hematologist, gastroenterologist, gynecologist, proctologist. At the first visit, the doctor should carefully listen to all the patient's complaints. The doctor will certainly examine the patient, and also ask him several clarifying questions:

1. When did you first notice the symptoms of the disease?
2. Have there been similar problems in the past?
3. Do chronic diseases bother you?
4. Are there any other health complaints?
5. Are you taking any medications?

The survey allows the specialist to draw up a complete clinical picture of the disease. It also helps to find the true root cause of the development of post-hemorrhagic anemia. The doctor must send the patient for examination to confirm the diagnosis. The patient will have to pass general and biochemical blood tests, which will determine the lack of hemoglobin. Ultrasound, ECG, X-ray and FGS are performed in order to determine the cause of internal bleeding.

Treatment features

Therapy can have significant differences, depending on what form of anemia is observed in the patient. If a person has been diagnosed with acute hemorrhagic anemia, then he is urgently hospitalized. All efforts of doctors will be directed to the immediate elimination of bleeding. To do this, they can:

• dressing;
• perform suturing of blood vessels;
• increase blood clotting;
• to carry out resection and suturing of damaged organs.

In the future, hemorrhagic anemia may not require any treatment, since the body will begin to actively restore the lost amount of blood. This is done by activating blood depots, which are located in the liver, lungs, and spleen.

If the patient has lost a lot of blood, then he needs an urgent transfusion. In severe conditions, the patient can also be administered:

• blood replacement solutions;
• B vitamins;
• electrolyte solutions;
• iron preparations.

The prognosis for this disease depends on how quickly the person received qualified medical care. With prolonged and profuse bleeding, acute posthemorrhagic anemia can provoke hypovolemic shock, after which the patient may fall into a coma.

Treatment of post-hemorrhagic anemia

Therapy for chronic anemia also begins with finding and eliminating the cause of bleeding. Having eliminated this problem, doctors prescribe medication to the patient. It consists of taking one of the following drugs.

Chronic post-hemorrhagic anemia is a phenomenon caused by frequent and low blood loss. This, in turn, causes a deficiency of iron in the body, as well as a decrease in erythrocytes and a decrease in the concentration of hemoglobin.

This condition is divided into three types:

1. Acute post-hemorrhagic anemia is characterized by a large amount of lost blood.
2. Secondary iron deficiency anemia that occurs after blood loss.
3. In rare cases, congenital anemia occurs, it is observed in unborn children in the womb.

Secondary iron deficiency anemia is most often referred to as chronic post-hemorrhagic anemia.

Reasons for the development of chronic post-hemorrhagic anemia

Small but regular bleeding can accompany a person for many years, allowing anemia to develop. It is caused by such conditions as:

Chronic or iron deficiency anemia leads to an acute shortage of iron and hemoglobin. For normal functioning, the body needs a hemoglobin level in the range of 135-160 g / l, in the male body and in the female, 120-140 g / l. In a child's body, hemoglobin ranges from 150 to 200 g / l, in accordance with its age. So the symptoms:

1. The first symptoms of chronic post-hemorrhagic anemia are dizziness and the appearance of blackheads in front of the eyes. A person quickly gets tired and against this background his skin becomes pale, becomes thin and dry.
2. The next symptom is a loss of appetite by the patient, he has nausea, while stool is disturbed - diarrhea replaces constipation and vice versa. During this period, extraneous noises may appear in the patient's heart.
3. With the development of the disease, the condition of the skin worsens, it becomes thin and flaky. At the same stage of the disease, the hair becomes sore and brittle, and the nails exfoliate.
4. In a severe stage of anemia, the patient's perception of taste is disturbed, he begins to eat outwardly non-edible things, for example, chalk. He perceives odors inadequately, since the olfactory and taste buds stop working correctly. At this stage, the patient's teeth begin to deteriorate rapidly, and caries develops.
5. Blood pressure becomes painfully low.

Diagnostics of the chronic post-hemorrhagic anemia

Diagnoses this type of anemia using a blood test. At the same time, the blood picture is compiled according to the number and state of erythrocytes, microcytes and schizocytes. The reasons for the patient's condition must be established, for this the state of his internal organs is determined using ultrasound equipment.

In addition, the patient is examined by narrow specialists, this is a gastroenterologist, a proctologist, a hematologist, a gynecologist for women and an endocrinologist, such an approach to diagnosis allows, with a high degree of probability, to establish the cause of the disease.

Treatment of post-hemorrhagic anemia

However, the most important point in the treatment of this pathology is the restoration of iron in the body. After all, even an insignificant loss of blood from 10 to 15 ml, deprives the body of that amount of iron that entered it within 24 with food intake. In this regard, the patient is prescribed a number of preparations containing not only iron, but also a complex of vitamins of group B. It can be Sorbifer, Durules, Ferroplex or Fenyuls. All drugs are prescribed by the attending physician, he also calculates the dosage based on the patient's condition and on the fact that an adult needs about 100 -150 mg per day. gland.

If the patient's condition is serious, then he is prescribed injections of drugs such as "Ferlatum", "Faltofer" or "Likferr". He also undergoes such a procedure as a blood transfusion, while not all plasma is transfused, but only the erythrocyte mass.

In parallel, the patient is assigned a special diet consisting of foods rich in iron and vitamins. Products containing animal and vegetable protein are also prescribed.

The diet is calculated individually for each patient. It necessarily includes lean beef, chicken eggs, kefir, cottage cheese, goat cheese. It is mandatory to use beef liver, sea fish, caviar, as well as beans, peas, buckwheat, oatmeal and walnuts.

The presence of fresh vegetables, fruits and berries in the diet is imperative, they help the iron to be absorbed by the body faster and better. These can be oranges, tangerines, lemons, persimmons, raspberries and black currants.

Such nutrition should quickly restore the correct metabolism in the body. But it is important that it be fractional and multiple. Ideally, the patient should eat 7 times a day in small portions. Alcohol and cigarettes are strictly prohibited.

Treatment of posthemorrhagic anemia in children

Considering all this, acute and chronic post-hemorrhagic anemia in children is treated in a hospital under the constant supervision of a doctor. First of all, the very cause of bleeding is eliminated. Then a blood transfusion is done, and as many times as necessary, that is, not once.

Necessarily prescribed preparations containing iron, including injections, for faster absorption. For children under one year old, special nutritional mixtures rich in iron and vitamins are introduced into the diet.

Treatment continues even after the condition has returned to normal. Sometimes therapy lasts up to 6 months, as the metabolism of children is constantly changing and they are in a phase of rapid growth.

As a rule, the restoration of the iron level in the child's body leads to a positive prognosis and in the future it grows without deviations from the norm. The treatment is carried out by a pediatrician, but he relies on data provided by other narrow specialists.

Prognosis for posthemorrhagic anemia

In general, the prognosis for post-hemorrhagic anemia is positive. But only under the condition of correct and competent therapy, which includes the elimination of chronic bleeding, even if this requires a surgical operation.

Prevention of post-hemorrhagic anemia

In order for post-hemorrhagic anemia not to develop in the body of an adult or a child, it is necessary to timely treat diseases leading to blood loss. But there is a difficulty - most of these are more beneficial to proceed unnoticed by a person, he can feel good while a colony of parasites grows in his body or kidney stones accumulate. In this regard, it is necessary to undergo a full medical examination regularly, at least once a year. It should include the study of internal organs, analysis for the presence of parasites, as well as monitoring the quality of blood. Namely - the content of iron and erythrocytes in it.

Following from the name, it is clear that fasting is after, and hemorrhagic is bleeding, which means post-hemorrhagic anemia, this is the anemia that develops after bleeding.

She may be:

- acute

- chronic

Acute post-hemorrhagic anemia

Is anemia caused by rapid and massive blood loss due to trauma, wounds, cavity bleeding, etc.

Pathogenesis

Acute blood loss

Decreased total blood volume

Decreased volume of circulating red blood cells and plasma

Hypoxia, anemia, ischemia of organs and tissues

Compensatory adaptive reactions

Increased production of erythropoietin → increased number of erythrokaryocytes and reticulocytes

Autohemodilution

Increased secretion of ADH, activation of RAAS, increased production of CA

generalized vasospasm

Mobilization of blood from the depot

The degree of blood loss is determined by the Algover shock index.

The Algover index is the ratio of the pulse rate to the level of systolic blood pressure.

4 degrees of severity of blood loss:

Mild severity of blood loss: BCC deficiency 10-20%. The patient's condition is satisfactory, general weakness, dizziness, slight nausea. Pulse up to 90, blood pressure is normal. Hemoglobin is over 100, hematocrit is over 0.30.

Moderate severity of blood loss: BCC deficit of 20-30%, such blood loss causes the development of stage 1 of hemorrhagic shock, this stage is well compensated by the body due to the activation of SAS, release of CA, peripheral vasoconstriction. The patient's condition is moderate, conscious, calm, notes severe weakness, dizziness, pale skin, cold extremities. Pulse up to 100, weak filling. Blood pressure is moderately reduced. Oliguria. Hemoglobin content 100-70, hematocrit - 0.30 - 0.35.

Severe severity of blood loss: BCC deficiency is 30-40%, such blood loss causes the development of stage 2 hemorrhagic shock, this stage is decompensated and reversible. At the same time, activation of the SAS and peripheral vasoconstriction cannot compensate for the decreased cardiac output, which leads to a decrease in blood pressure. The patient's condition is serious, conscious, restless, severe weakness, pallor is significantly pronounced, cyanosis. Tachycardia, muffled heart sounds. HELL syst. up to 60 mm Hg. Oliguria, Hemoglobin 70-50, hematocrit 0.25.

Extremely severe severity of blood loss: BCC deficiency over 40%, decompensated, irreversible shock develops. The condition is extremely serious, unconscious. Cold, clammy sweat, pale skin, cyanosis, shortness of breath. Pulse threadlike, more than 140. Systolic blood pressure is not determined. Oligoanuria. Hemoglobin is below 50, hematocrit is 0.25-0.20.

There are also periods of blood loss by which the indicators of peripheral blood can be assessed.

Vascular reflex phase (1-2 days) - indices are unchanged due to compensation mechanisms: generalized vasospasm, increased secretion of ADH, activation of RAAS, increased production of CA.

Hydraemic phase (2-3 days), there is a large flow of tissue fluid into the bloodstream (autohemodilution) and restoration of the volume of the vascular bed. Hemoglobin and erythrocytes are reduced, but CP is normal.

Bone marrow phase (5-6 days after blood loss), there is an increased production of erythropoietin by the kidneys. Hypochromic anemia, leukocytosis with left twisting, reticulocytosis.

Treatment

Stopping bleeding

Normalization of hemodynamic parameters

Improving the rheological properties of blood

In order to avoid the syndrome of massive blood transfusions, it is unacceptable to reconcile all blood loss with only blood components. The total volume of blood transfusion should not exceed 60% of the circulating blood volume deficit. The rest of the volume is replenished with blood substitutes.

For the correction of VEO and CBS: isotonic sodium chloride solution, 5% glucose solution, lactasol, Ringer's solution.

To replenish plasma proteins - albumin solution, lactoprotein, fresh frozen plasma.

Chronic post-hemorrhagic anemia

It develops as a result of long-term and often repeated bleeding, which leads to iron deficiency, i.e. this type of anemia, in fact, is iron deficiency.

Chronic post-hemorrhagic anemias also require finding and eliminating the sources of chronic bleeding. Without this measure, all further treatment methods will not bring the desired result. After careful hemostasis, the level of hemoglobin in the blood is adjusted by prescribing iron supplements to the patient in combination with ascorbic acid, as well as following the required diet.

Iron preparations for chronic post-hemorrhagic anemia

Iron-containing preparations for anemia can be used both in the form of parenteral dosage forms (injections) and in tablet form. For their assimilation, it is necessary to combine a ferrum-containing preparation with ascorbic acid, as well as with trace elements (cobalt, copper, manganese). The latter contribute to a more rapid biosynthesis of iron in the body and an increase in the level of hemoglobin. The most popular iron-containing drugs today are such substances as ferrum-lek, feramide, iron lactate, iron glycerophosphate.

What it is?

When a person in blood plasma, after obvious blood loss, is diagnosed with a lack of elements containing iron, then they talk about post-hemorrhagic anemia. Its other name, or rather a more general concept, is anemia - a decrease in the amount of hemoglobin in the blood, not tied to its loss.

Post-hemorrhagic deficiency of iron-containing blood elements can be acute and chronic. If the patient suffers from frequent bleeding, even if in a small amount, this is a chronic form of anemia. If the loss of blood occurred suddenly, and in no small amount, we are talking about acute anemia. The minimum amount of life-threatening blood loss for adults is 500 ml.

The severity of anemia after blood loss

In total, four degrees of blood loss are distinguished - light, medium, severe and massive, consider the two most significant of them.

Easy

Treatment of a timely detected ailment is not particularly difficult. It is often enough to resort to taking medications that will compensate for the iron deficiency in the body and the patient will recover. As a rule, a course therapy is needed, which will take at least three months. The patient can be temporarily hospitalized.

Heavy

In case of severe anemia, the victim of the loss of a large volume of blood is immediately placed in a hospital of a medical institution. To take the patient out of a dangerous state, the following measures are taken:

• stopping bleeding;
• replenishment of blood loss by any means;
• transfusion of an artificial plasma substitute in a volume of at least 500 milliliters;
• measures to raise and stabilize blood pressure.

Views

Acute post-hemorrhagic anemia

With large blood loss, usually with damage to the main arteries, or during the operation, when the patient loses about 1/8 of the total blood volume, posthemorrhagic anemia develops in an acute form, which in turn has several stages.

• In the reflex-vascular stage, the pressure of the arterial mucous membranes drops sharply, and the skin turns pale, tachycardia occurs. Peripheral vessels spasm due to lack of oxygen, which flows to the internal organs. The body, independently trying to prevent a decrease in pressure to critical values, uses the mechanisms of plasma removal from the organs and compensatory return of blood to the heart.
• The patient can stay in the hydraemic compensatory stage for several days. Approximately five hours after the blood loss, a base will be created for the flow of interstitial fluid into the blood vessels. When irritated, the necessary receptors begin to be involved in maintaining the volume of fluid that circulates through the vessels. Aldosterone is intensively synthesized, preventing the excretion of sodium from the body, which in turn retains water. But at the same time, plasma liquefaction occurs, which leads to a decrease in the level of hemoglobin and erythrocytes.
• Acute posthemorrhagic anemia passes into the bone marrow stage in about five days from the onset of bleeding. Progression of hypoxia is observed. Erythropoietin values ​​become higher. The formation of red blood cells is increasing, but the hemoglobin values ​​are reduced. This stage is characterized as hypochromic, due to a sharp deficiency of iron in the blood.

Chronic post-hemorrhagic anemia

This type of post-hemorrhagic anemia, after emergency assistance to the patient to restore the full volume of blood plasma and eliminate iron deficiency, requires treatment of the disease that caused the development of chronic blood loss.

Signs of anemia after bleeding

After blood loss, the development of anemia is manifested by the following symptoms:

• When the loss of blood is large, the victim must have shortness of breath, the heartbeat increases, there is a sharp drop in pressure;
• The integuments of the skin / mucous membranes turn pale;
• The patient complains of dizziness. It makes a noise in his ears, but darkens in his eyes;
• Vomiting is not uncommon;
• A sudden sensation of dryness in the oral cavity indicates the development of internal bleeding;
• With bleeding in the digestive organs, there is a sharp rise in body temperature, signs of intoxication;
• One of the signs of bleeding inside will be the patient's message about the feeling of squeezing of the internal organs;
• The feces become black.

Cause of post-hemorrhagic anemia

Posthemorrhagic anemia can develop due to blood loss in the following cases:

• in case of injury with damage to an artery or other blood vessels;
• with a disease of pulmonary ailments, when when a patient coughs blood comes out;
• as a result of the operation;
• with the onset of heavy bleeding in a woman due to an ectopic pregnancy;
• with a peptic ulcer in the digestive tract, when internal bleeding develops;
• when hemostasis is impaired.

Diagnosis based on a blood test

First of all, when a victim of bleeding is admitted to the hospital, it is necessary to conduct a study of his blood in the form of a detailed analysis, which will help to correctly diagnose the degree of anemia and assess the patient's condition. To do this, determine:

• platelet count;
• the level of hemoglobin and red blood cells;
• the presence of neutrophilic leukocytosis;
• determination of the growth of the number of reticulocytes;
• plasma iron levels.

Blood tests are necessary throughout the patient's recovery period. Depending on the form of anemia, the duration of rehabilitation is different.

Treatment

After providing urgent care, when the bleeding has stopped, the victim needs treatment in an inpatient department of a medical institution.

In order to replenish the patient's blood volume, in the event of a sharp drop in pressure, a blood substitute (jet) must be transfused. When the blood pressure values ​​can be raised to 100 to 60, the transfusion can be switched to drip mode.

If the patient is in a state of shock, it may be necessary to administer humidified oxygen, an intravenous catheter for the infusion of blood substitutes, and a number of medications.

In some cases, when the volume of blood loss is more than one liter, donor blood transfusions are required, but this measure is contraindicated with a smaller amount of lost blood - it is fraught with complications in the form of an immune conflict or the development of intravascular coagulation syndrome.

Chronic posthemorrhagic anemia provides for outpatient treatment in cases where there are no exacerbations of the underlying ailment or there is none at all. The appointment of an operation after the cause of the bleeding is established is not excluded.

In the treatment of anemia, one cannot do without immunostimulants and complex vitamin preparations in order to support the patient's immune system, who, during the recovery period, is especially vulnerable to infection with pathogens.

Features of the treatment of posthemorrhagic anemia

In children

In order to reduce chronic blood loss in young patients, prevention of nasal bleeding is necessary. In adolescent girls, care must be taken to ensure that the menstrual cycle is correct.

In the presence of anemia in infants, it is necessary to check the state of health of his mother. You may need to start treatment with her.

Iron preparations have a children's form of release. As a rule, they are dosed, taking into account the baby's body weight.

Children are mainly prescribed medication by mouth. In the form of injections, babies receive treatment in a hospital, when there are any contraindications.

The duration of therapy for children is set according to the severity of the anemia:

• easy - two months;
• medium - up to four months;
• with a severe course of the disease, treatment lasts at least five months.

In older people

It is very difficult to treat anemia in older patients due to:

• the symptoms of anemia are often disguised as various diseases of a chronic nature;
• in many cases, anemia in an elderly patient can be combined with acute / chronic infectious diseases;
• neoplasms can be identified, the state of which is severely neglected;
• a set of reasons for the development of anemia;
• the risk of drug overdose.

For elderly patients, it is important:

• organize a balanced diet;
• carry out individual dosage of medicines and prescribe the optimal minimum dose;
• diagnose and treat inflammatory diseases, tumors.

Prophylaxis

Preventive measures for the occurrence of anemia after blood loss are reduced to caution and a healthy lifestyle. Necessary:

• monitor your health and treat diseases in a timely manner;
• to refuse from bad habits;
• avoid injury;
• eat well.