Posthemorrhagic anemia is a disease that is accompanied by a decrease in the number of red blood cells and hemoglobin concentration due to massive acute bleeding or as a result of even minor but chronic blood loss.

Hemoglobin is a protein complex of an erythrocyte that contains iron. Its main function is to transport oxygen through the bloodstream to all organs and tissues without exception. When this process is disrupted, quite serious changes begin in the body, which are determined by the etiology and severity of anemia.

Depending on the root cause and course of the fast hemorrhagic anemia There are acute and chronic forms. In accordance with the international classification system, the disease is divided as follows:

• Secondary Iron-deficiency anemia after blood loss. ICD 10 code D.50
• Acute posthemorrhagic anemia. ICD 10 code D.62.
• Congenital anemia after fetal bleeding – P61.3.

IN clinical practice Secondary iron deficiency anemia is also called posthemorrhagic chronic anemia.

Causes of the acute form of the disease

The main reason for the development of acute posthemorrhagic anemia is the loss of a large volume of blood over a short period of time, which occurred as a result of:

• Trauma that caused damage to the main arteries.
• Damage to large blood vessels during surgery.
• Gap fallopian tube with the development of an ectopic pregnancy.
• Diseases of the internal organs (most often the lungs, kidneys, heart, gastrointestinal tract), which can lead to acute massive internal bleeding.

In young children, the causes of acute posthemorrhagic anemia are most often umbilical cord injuries, congenital pathologies blood system, damage to the placenta during caesarean section, early placental abruption, placental previa, birth trauma.

Causes of chronic posthemorrhagic anemia

Chronic posthemorrhagic anemia develops as a result of small but regular bleeding. They may appear as a result of:

• Hemorrhoids, which are accompanied by cracks in the rectum and the appearance of blood in the stool.
• Peptic ulcer of the stomach and duodenum.
• Heavy menstruation uterine bleeding while taking hormonal drugs.
• Damage to blood vessels by tumor cells.
• Chronic nosebleeds.
• Minor chronic blood loss in cancer.
• Frequent blood draws, catheter installations and other similar manipulations.
• Severe kidney disease with bleeding in the urine.
• Helminth infestation.
• Liver cirrhosis, chronic liver failure.

Chronic anemia of this etiology can also be caused by hemorrhagic diathesis. This is a group of diseases in which a person has a tendency to bleed due to disruption of homeostasis.

Symptoms and blood picture of anemia due to acute blood loss

Clinical picture Acute posthemorrhagic anemia develops very quickly. The main symptoms of this disease include manifestations of general shock as a result of acute bleeding. In general, the following are observed:

• Reduced blood pressure.
• Cloudiness or loss of consciousness.
• Severe pallor, bluish tint of the nasolabial fold.
• Thready pulse.
• Vomit.
• Increased sweating, and the so-called cold sweat.
• Chills.
• Cramps.

If the bleeding was successfully stopped, then such symptoms are replaced by dizziness, tinnitus, loss of orientation, blurred vision, shortness of breath, and irregular heartbeat. Still pale skin and mucous membranes, low blood pressure.

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Changes in blood test results within a few days after bleeding has stopped and the development of anemia are closely related to compensation mechanisms that “turn on” in the body in response to the loss of a large volume of blood. They can be divided into the following stages:

• The reflex phase, which develops on the first day after blood loss. Redistribution and centralization of blood circulation begins, increases peripheral resistance vessels. In this case, there is a decrease in the number of red blood cells with normal values hemoglobin and hematocrit concentrations.
• The hydremic phase occurs from the second to the fourth day. Extracellular fluid enters the vessels, glycogenolysis is activated in the liver, which leads to an increase in glucose content. Gradually, symptoms of anemia appear in the blood picture: the concentration of hemoglobin decreases, the hematocrit decreases. However, the meaning color index still remains normal. Due to the activation of thrombus formation processes, the number of platelets decreases, and due to the loss of leukocytes during bleeding, leukopenia is observed.
• The bone marrow phase begins on the fifth day after bleeding. Insufficient oxygen supply to organs and tissues activates hematopoietic processes. In addition to decreased hemoglobin, hematocrit, thrombocytopenia and leukopenia, at this stage there is a decrease total number red blood cells When examining a blood smear, the presence of young forms of red blood cells is noted: reticulocytes, sometimes erythroblasts.

Similar changes in the blood picture have been described in many situational tasks for future doctors.

Symptoms and diagnosis of anemia in chronic bleeding

Chronic posthemorrhagic anemia is similar in its symptoms to iron deficiency, since regular, mild bleeding leads to a deficiency of this microelement. The course of this blood disease depends on its severity. It is determined depending on the concentration of hemoglobin. Normally, in men it is 135–160 g/l, and in women 120–140 g/l. In children, this value varies depending on age from 200 in infants to 150 in adolescents.

Degree of posthemorrhagic chronic anemia Hemoglobin concentration

• 1 (light) degree 90 – 110 g/l
• 2nd degree ( moderate severity) 70 – 90 g/l
• Grade 3 (severe) below 70 g/l

At the initial stage of development of the disease, patients complain of slight dizziness, flashing “spots” before the eyes, and increased fatigue. Externally, pallor of the skin and mucous membranes is noticeable.

At the second stage, the listed symptoms are added to a decrease in appetite, sometimes nausea, diarrhea or, conversely, constipation, shortness of breath. When listening to heart sounds, doctors note heart murmurs characteristic of chronic posthemorrhagic anemia. The condition of the skin also changes: the skin becomes dry and peels. Painful and inflamed cracks appear in the corners of the mouth. The condition of hair and nails worsens.

A severe degree of anemia is manifested by numbness and a tingling feeling in the fingers and toes, specific taste preferences appear, for example, some patients begin to eat chalk, and the perception of smells changes. Very often this stage of chronic posthemorrhagic anemia is accompanied by rapidly progressing caries and stomatitis.

Diagnosis of posthemorrhagic anemia is based on the results clinical analysis blood. In addition to the decrease in the amount of hemoglobin and red blood cells characteristic of all types of anemia, a decrease in the color index is detected. Its value ranges from 0.5 – 0.6. In addition, with chronic posthemorrhagic anemia, modified red blood cells (microcytes and schizocytes) appear.

Treatment of anemia after massive blood loss

First of all, it is necessary to stop the bleeding. If it is external, then it is necessary to apply a tourniquet and a pressure bandage and take the victim to the hospital. In addition to pallor, cyanosis and confusion, internal bleeding is indicated by severe dry mouth. It is impossible to help a person in this condition at home, so stopping internal bleeding carried out only in a hospital setting.

After identifying the source and stopping the bleeding, it is urgently necessary to restore the blood supply to the vessels. For this purpose, rheopolyglucin, hemodez, polyglucin are prescribed. Acute blood loss is also compensated by blood transfusion, taking into account the compatibility of the Rh factor and blood group. The volume of blood transfusion is usually 400 – 500 ml. These measures must be carried out very quickly, since a rapid loss of even ¼ of the total blood volume can be fatal.

After stopping the state of shock and carrying out all the necessary manipulations, they proceed to standard treatment, which consists of the administration of iron supplements and enhanced nutrition to compensate for the deficiency of vitamins and microelements. Ferrum lek, ferlatum, maltofer are usually prescribed.

Typically, restoration of a normal blood picture occurs after 6–8 weeks, but the use medicines To normalize hematopoiesis, continue for up to six months.

Treatment of chronic posthemorrhagic anemia

The first and most important stage in the treatment of posthemorrhagic chronic anemia is to determine the source of bleeding and its elimination. Even the loss of 10 - 15 ml of blood per day deprives the body of the entire amount of iron that was received during that day with food.

Held comprehensive examination patient who is mandatory includes consultations with a gastroenterologist, proctologist, hematologist, gynecologist for women, and endocrinologist. After identifying the disease that caused the development of chronic posthemorrhagic anemia, treatment begins immediately.

At the same time, medications that contain iron are prescribed. For adults it daily dose is about 100 – 150 mg. Appointed complex means, which in addition to iron contain ascorbic acid and B vitamins, which promote its better absorption. These are sorbifer durules, ferroplex, fenyuls.

At severe course posthemorrhagic chronic anemia, red blood cell transfusion and injection are indicated to stimulate hematopoietic processes medicines with iron. Ferlatum, maltofer, likferr and similar medications are prescribed.

Recovery after the main course of treatment

Duration of admission iron-containing preparations determined by the doctor. In addition to the use of various medications to restore normal oxygen supply to organs and replenish iron reserves in the body, proper nutrition is very important.

The diet of a person who has suffered posthemorrhagic anemia must contain proteins and iron. Preference should be given to meat, eggs, fermented milk products. The leaders in iron content are meat by-products, especially beef liver, meat, fish, caviar, legumes, nuts, buckwheat and oatmeal.

When creating a diet, attention should be paid not only to how much iron a particular product contains, but also to the degree of its absorption in the body. It increases with the consumption of vegetables and fruits that contain vitamins B and C. These are citrus fruits, black currants, raspberries, etc.

Course and treatment of posthemorrhagic anemia in children

Posthemorrhagic anemia in children is much more severe, especially its acute form. The clinical picture of this pathology is practically no different from that of an adult, but develops faster. And if in an adult a certain volume of lost blood is compensated by the body’s protective reactions, then in a child this can lead to death.

Treatment of acute and chronic forms of posthemorrhagic anemia in children is the same. After identifying the cause and eliminating the bleeding, a transfusion of red blood cells is prescribed at the rate of 10 - 15 ml per kg of weight, and iron supplements. Their dosage is calculated individually depending on the severity of anemia and the condition of the child.

For children aged about six months, early introduction of complementary foods is recommended, and you should start with foods with increased content gland. Infants are advised to switch to special fortified formulas. If the disease that led to the development of posthemorrhagic anemia is chronic and cannot be treated, then preventive courses of iron supplements must be repeated regularly.

With timely initiation of treatment and non-critical blood loss, the prognosis is generally favorable. After compensation for iron deficiency, the child quickly recovers.

Anemia is a group of syndromes characterized by a decrease in the concentration of hemoglobin and/or the number of red blood cells in human blood. Normally it contains: in men - (4.1-5.15) x10 12 /l of red blood cells, and hemoglobin 135-165 g/l. In women, the number of red blood cells is (3.8-4.8) x10 12 / l and 121-142 g/l Hb. Posthemorrhagic anemia is a condition that occurs after chronic or acute bleeding. This syndrome can complicate a large number of diseases in gastroenterology, surgery, gynecology and other areas of medicine.

There are several classifications of this syndrome. This is how acute and chronic posthemorrhagic anemia are distinguished. Acute posthemorrhagic anemia develops after sudden bleeding. Etiological factors may include trauma, vascular damage, surgical complications. Chronic posthemorrhagic anemia develops in pathologies that are accompanied by frequent, not very large bleeding:

• haemorrhoids;
• peptic ulcer;
• disruption of the menstrual cycle;
• fibromatosis of the uterus.

Severity of anemia

There is also a classification according to severity. Mild, moderate and severe degrees are divided according to the hemoglobin content in the blood. There are three stages of development of posthemorrhagic anemia:

• mild degree - hemoglobin level is below normal, but above 90 g/l;
• average - Hb within 90-70 g/l;
• severe - hemoglobin value less than 70 g/l.

Causes of posthemorrhagic anemia

As the name suggests, acute posthemorrhagic anemia is caused by acute or chronic blood loss. Below are some etiological factors for the occurrence of posthemorrhagic anemia:

• various injuries, often with damage to large vessels;
• postoperative, intraoperative bleeding;
• stomach ulcer;
• chronic hemorrhoids;
• DIC syndrome, hemophilia;
• menstrual irregularities, menorrhagia;
• liver cirrhosis with portal hypertension, bleeding from esophageal varices;
• tumor processes with destruction of surrounding tissues;
• various infections manifested with hemorrhagic syndrome;
• The severity of anemia depends on the sources.

Among hemorrhagic anemias, special attention should be paid to their development during pregnancy. Usually, a noticeable decrease in a woman’s hemoglobin indicates such serious diseases as placental abruption, ectopic pregnancy, chorioangioma, placental hematomas.

Diagnostics

Diagnosis of posthemorrhagic anemia is based on:

• clinical picture data;
• physical examination;
• laboratory;
• instrumental methods.

When interviewing the patient, you can find out that there was some kind of bleeding, or there are diseases that could lead to this. The patient complains about constant feeling weaknesses.

When examining a patient, you should pay attention to anemic skin, hypotension, big number breathing movements. The pulse is usually weakly filled and frequent (due to a decrease in blood volume, a drop in pressure, and a reflex increase in heart contractions). There is muffled heart sounds and a systolic murmur at the apex. It is necessary to monitor the patient's diuresis and monitor indicators blood pressure to prevent decompensation of the condition.

Anemia is diagnosed based on changes in general analysis blood. At acute anemia there is a drop in the number of red blood cells or a decrease in hemoglobin levels. The number of young red blood cells increases to 11%, and red blood cells with a changed shape also appear. There is an increase in the number of leukocytes with a shift in the leukocyte formula to the left. In the early period, an increased number of platelets can be detected. This is probably due to the activation of the hemostatic system, trying to stop bleeding.

A few months later it happens full recovery content of red blood cells and hemoglobin. But its synthesis requires iron, so iron deficiency anemia can be a consequence of acute posthemorrhagic anemia.

In chronic posthemorrhagic anemia, signs of hypochromic anemia are noted in a general blood test. In some cases, leukopenia may be detected, in leukocyte formula Sometimes minor lymphocytosis occurs. It is also observed reduced level iron in plasma. In a general urine test, there may be various changes associated with both bleeding and a drop in pressure (possible development of oligo- or anuria - changes characteristic of acute renal failure).

For difficult to diagnose bleeding, a study is sometimes used bone marrow flat bones. In bone marrow punctate with this type of anemia, signs of high red brain activity can be detected. In trephine biopsy samples, yellow bone marrow is replaced with red.

X-rays, ultrasound, FGDS, and MRI can be used as auxiliary diagnostic methods. Using these imaging tools, it is possible to detect hemorrhage in the body cavity. On the ECG, the height of the T wave in standard and precordial leads may be reduced. You should also take a stool test for occult blood. Patients need to undergo consultations to establish the cause of the condition and patient management tactics:

• hematologist;
• surgeon;
• gastroenterologist;
• gynecologist.

To establish the cause and tactics of patient management.

Symptoms and signs

The clinical picture depends on the duration and volume of blood loss. Common features of posthemorrhagic anemia are anemic skin and tachycardia. Dizziness, sweating, and thirst may occur. Also, posthemorrhagic anemia is accompanied by a decrease in BCC (circulating blood volume), manifested by arterial hypotension. When blood pressure decreases, loss of consciousness is likely. The development of renal failure and hemorrhagic shock is possible.

Acute posthemorrhagic anemia

Acute posthemorrhagic anemia occurs abruptly. The patient complains about headache, weakness, sometimes reaching the point of loss of consciousness. When the patient tries to stand up, orthostatic collapse may occur. Externally, there is pallor of the skin and visible mucous membranes. Tachycardia and hypotension are also noted. With large blood loss, the pulse may be thread-like and arrhythmic. There is a muffled heart sound, as well as a systolic murmur at its apex. Against the background of rapid, massive bleeding, hemorrhagic shock develops. It manifests itself in the following symptoms:

• decreased blood pressure;
• reflex increase in heart rate;
• hypovolemia (vessels become empty);
• decreased diuresis, up to anuria.

A patient in this condition may lose consciousness, be very pale, and have a decreased body temperature.

Chronic posthemorrhagic anemia

Bleeding that occurs periodically over a long period of time leads to depletion of iron reserves in the body. According to its pathogenesis, chronic posthemorrhagic anemia is iron deficiency, and its etiological factor is blood loss. The patient's main complaint will be constant fatigue dizziness. There may also be a buzzing in the ears and flashing “flies”. During the examination it is observed:

• dyspnea;
• heartbeat;
• decrease in pressure.

Upon examination, anemic skin, mucous membranes, and puffiness of the face are noted. Systolic murmurs may be heard on auscultation of the heart and great vessels. You can detect an increase in internal organs: liver and spleen. A complete blood count is an important test. It allows you to detect signs hypochromic anemia(decrease in the amount of hemoglobin, color index and manifestations of micro- or anisocytosis).

There is a drop in the concentration of iron in the blood plasma. All these symptoms are necessary to establish the diagnosis and treatment of chronic posthemorrhagic anemia.

Treatment

Main therapeutic measure, aimed at treating posthemorrhagic anemia, is to find and stop bleeding. It could be:

• application of a tourniquet (temporary stop);
• ligation or suturing of blood vessels;
• coagulation of bleeding ulcers and other treatment methods.

Depending on the rate and magnitude of blood loss, the volume of blood volume is restored, in accordance with the severity of the patient’s condition. The volume of infusions is usually 200-300% of the amount of blood lost. To restore the level of circulating blood, crystalloid drugs are primarily used:

• saline;
• Ringer's solution;
• 7,5% hypertonic solution NaCl;
• "Disol";
• "Trisol".

Colloidal solutions are presented:

• dextran derivatives (polyglucin, rheopolyglucin)
• hydroethyl starch;
• gelatin.

The former help to quickly restore bcc, the volume of interstitial fluid and return the acid-base state to normal. The latter simulate plasma proteins, help increase the oncotic pressure of the blood, and retain the injected fluid in the bloodstream.

Also, do not forget about using a 25% albumin solution. When blood loss exceeds 15% of the blood volume, the use of plasma preparations, as well as tissue coagulation factors, is allowed. For severe blood loss of more than 30-40%, red blood cells and plasma are used. In the treatment of severe bleeding, the so-called “ blue blood" - the drug "Perftoran", which is an artificial blood substitute that has rheological, hemodynamic and other effects.

In the first hour, it is especially important to monitor the patient’s condition due to the occurrence of complications such as hemorrhagic shock, disseminated intravascular coagulation syndrome, acute renal failure. If hemorrhagic shock develops, the patient is managed according to the following algorithm:

• urgent search and stop of bleeding;
• use of adequate pain relief;
• catheterization central vein with the necessary infusion therapy;
• compensation for developing organ failure;
• staging urethral catheter to control urine output;
• continued elimination of BCC deficiency with the help of colloidal and crystalloid solutions;
• control of diuresis and blood pressure.

After the patient has been stabilized, iron supplements and vitamins B and C (which help this element to be better absorbed in the body) are used to treat posthemorrhagic anemia. You should also use preparations containing cobalt, manganese, and copper. These chemical elements have a beneficial effect on hematopoiesis and restoration of the number of red blood cells.

When treating chronic posthemorrhagic anemia, first of all, it is necessary to find out the cause of this pathology, since neither replenishment of blood volume nor iron supplements will help restore the body one hundred percent. After eliminating or compensating for the disease that caused anemia (in its pathogenesis it is iron deficiency), you should also use ferrum-containing drugs and B vitamins. Do not forget about nutrition. The patient's diet should include more foods containing iron and protein. These are cottage cheese, fish, egg whites, meat dishes.

Forecast

The prognosis of treatment and the consequences of posthemorrhagic anemia depend on the volume and rate of blood loss, as well as on the characteristics of the blood composition. Thus, a person can lose up to 60-70% of red blood cells and remain alive, but if only 30% of plasma is lost, death is likely. A loss of 50% of blood volume is fatal. A sharp decrease in circulating blood volume by a quarter leads to the development of acute anemia and hemorrhagic shock. This severe complication bleeding requiring emergency resuscitation.

At the same time, with chronic (iron deficiency) posthemorrhagic anemia, the prognosis is generally less serious, depending on the disease that caused it. Anemia itself can be compensated for with the use of iron and vitamin C supplements.

What it is?

When a person’s blood plasma, after obvious blood loss, is diagnosed with a lack of elements containing iron, then they speak of posthemorrhagic anemia. Another name for it, more precisely general concept, this is anemia - a decrease in the amount of hemoglobin in the blood not related to its loss.

Posthemorrhagic deficiency of iron-containing blood elements can be acute and chronic. If the patient is suffering frequent bleeding, even if in a small volume, this chronic form anemia. If blood loss occurs suddenly and in considerable quantities, we are talking about acute anemia. The minimum amount of blood loss for adults that poses a threat to life is considered to be 500 ml.

Severity of anemia after blood loss

In total, there are four degrees of blood loss - light, moderate, severe and massive, let's consider the two most significant of them.

Lightweight

Treatment of a timely identified disease is not particularly difficult. It is often enough to resort to taking medications that will replenish the iron deficiency in the body and the patient will recover. As a rule, a course of therapy is required, which will take at least three months. The patient may be temporarily hospitalized.

Heavy

If severe anemia develops, the victim from loss of a large volume of blood is immediately placed in a hospital medical institution. To remove the patient from a dangerous condition, 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.

Kinds

Acute posthemorrhagic anemia

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

• In the reflex-vascular stage, arterial pressure in the mucous membranes drops sharply, the skin turns pale, and tachycardia occurs. Peripheral vessels spasm due to lack of oxygen supplied to internal organs. The body, independently trying to prevent pressure from decreasing to critical values, uses mechanisms for removing plasma from the organs and compensatory return of blood to the heart.
• The patient may remain in the hydremic compensatory stage for several days. Approximately five hours after blood loss, the basis 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 sodium from being removed from the body, which in turn retains water. But at the same time, plasma dilution occurs, which leads to a decrease in the level of hemoglobin and red blood cells.
• Acute posthemorrhagic anemia passes into the bone marrow stage approximately five days after the onset of bleeding. Progression of hypoxia is observed. Erythropoietin levels become higher. The formation of red blood cells increases, but hemoglobin levels are reduced. This stage is characterized as hypochromic, due to a sharp deficiency of iron in the blood.

Chronic posthemorrhagic anemia

This type of posthemorrhagic anemia, after emergency assistance 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 blood loss is large, the victim necessarily experiences shortness of breath, the heart rate increases, and a sharp drop in pressure is observed;
• The skin/mucous membranes turn pale;
• The patient complains of dizziness. There is a noise in his ears and darkness in his eyes;
• Vomiting often occurs;
• Sudden feeling of dryness in oral cavity indicates the development of internal bleeding;
• When there is bleeding in the digestive organs, a sharp rise in body temperature and signs of intoxication are observed;
• One of the signs of internal bleeding will be the patient reporting a feeling of compression of the internal organs;
• The stool turns black.

Cause of posthemorrhagic 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;
• when suffering from pulmonary ailments, when the patient coughs and produces blood;
• as a result of the operation;
• with the onset heavy bleeding in a woman due to an ectopic pregnancy;
• at peptic ulcer in the digestive tract, when internal bleeding develops;
• when hemostasis is impaired.

Diagnosis based on blood test

First of all, when a bleeding victim is admitted to the hospital, it is necessary to conduct a blood test 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, define:

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

Blood tests are necessary throughout the patient’s recovery period. Depending on the form of anemia, the duration of rehabilitation varies.

Treatment

After rendering urgent help When the bleeding has stopped, the victim needs treatment in the inpatient department of a medical institution.

To replenish the patient's blood volume, in the event of a sharp drop in pressure, it is necessary to transfuse a blood substitute (by jet injection). When the blood pressure 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 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, however, this measure is contraindicated when the amount of blood lost is smaller - it is fraught with complications in the form of an immune conflict or the development of intravascular coagulation syndrome.

Posthemorrhagic anemia chronic type provides ambulatory treatment in cases where there are no exacerbations of the underlying disease or there is none at all. It is possible to prescribe surgery after the cause of bleeding has been established.

When treating anemia, it is impossible to do without immunostimulants and complex vitamin preparations, in order to support immune system a patient who is particularly vulnerable to infection by pathogens during the recovery period.

Features of the treatment of posthemorrhagic anemia

In children

In order to reduce chronic blood loss in young patients, prevention of nosebleeds is necessary. For girls in adolescence you need to ensure that the menstrual cycle is correctly formed.

If there is anemia in infants, it is necessary to check the health status of their mother. Perhaps treatment will need to start with her.

Iron supplements are available in a pediatric form. As a rule, they are dosed taking into account the baby’s body weight.

Children are usually prescribed oral medications. In the form of injections, children receive treatment in a hospital setting, when there are any contraindications.

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

• light – two months;
• average – up to four months;
• in case of severe disease, treatment lasts at least five months.

In older people

Treat anemia in older patients age category very difficult, due to:

• symptoms of anemia are often disguised as various diseases chronic;
• in many cases, anemia in an elderly patient can be combined with infectious diseases of an acute/chronic nature;
• neoplasms can be identified whose condition is very advanced;
• a combination of reasons for the development of anemia;
• risk of drug overdose.

For the sick old age important:

• organize a balanced diet;
• carry out individual dosing of medications and prescribe optimal minimum doses;
• diagnose and treat inflammatory diseases and tumors.

Prevention

Preventive measures for the occurrence of anemia after blood loss come down to caution and healthy image life. Necessary:

• monitor your health and promptly treat diseases;
• to refuse from bad habits;
• avoid injury;
• eat well.

What is Acute posthemorrhagic anemia

Acute posthemorrhagic anemia is understood as anemia that develops as a result of quick loss a significant amount of blood.

In the mechanism of development of the main symptoms of acute blood loss, the leading role is played by a rapid decrease in the total volume of blood, especially its plasma. A decrease in the volume of red blood cells leads to acute hypoxia, which is clinically manifested by the appearance of shortness of breath and palpitations.

Collapse ( fainting) or hypotension (low blood pressure) are caused mainly by loss of plasma. During bleeding and immediately after it, the adrenal glands release catechol amines, which causes spasm of peripheral vessels. A decrease in the volume of the vascular bed helps to compensate for the decrease in circulating blood volume. However, prolonged spasm of peripheral vessels has an adverse effect on microcirculation and can lead to the development of shock. One of the main mechanisms of self-regulation of the body is the restoration of blood volume by mobilizing its own interstitial fluid and its release into the vascular bed. This process is called autohemodilution. If autohemodilution is not expressed enough or is depleted, then decompensation occurs, and without treatment the patient dies. As a result of hypoxia associated with blood loss, the content increases

erythropoietin, resulting in increased formation of cells sensitive to it and the release of reticulocytes.

Symptoms of Acute posthemorrhagic anemia

Acute posthemorrhagic anemia primarily causes symptoms of collapse. The patient experiences severe weakness, dizziness, pallor, dry mouth, cold sweat, and vomiting. Arterial and venous pressure decreases, decreases cardiac output blood, the pulse increases sharply. Pulse filling becomes weak.

The clinical picture is determined by the amount of blood lost, the rate of its flow, and to some extent depends on the source of blood loss. There is evidence of unequal compensation depending on the source of bleeding.

P = K + 44lgIIIU,

Where P - blood loss as a percentage;

TO - coefficient equal to 27 for gastrointestinal blood loss, 33 for abdominal bleeding, 24 for wounds of the extremities and 22 for damage to the chest;

SI - shock index, equal to the ratio of pulse rate to systolic pressure.

In the first hours with large blood loss, there may be a slight decrease in the level of hemoglobin and red blood cells; accordingly, the hematocrit (the part of the blood volume attributable to shaped elements), and only a study of the volume of circulating red blood cells can reveal its significant decrease.

If the bleeding was stopped, then after 2-3 days there is a decrease in the level of hemoglobin and red blood cells due to the penetration of tissue fluid into the blood, therefore, in the first time after blood loss, anemia is normochromic in nature. The platelet content during bleeding may be reduced due to their consumption during the process of thrombus formation.

The diagnosis of occult massive bleeding is based on clinical manifestations, supported by some laboratory data (Gregersen, Weber tests, an increase in the level of residual nitrogen in case of bleeding from upper sections digestive tract).

Treatment of acute posthemorrhagic anemia

Treatment of acute posthemorrhagic anemia begins with stopping bleeding and carrying out anti-shock measures. Indications for blood transfusion acute blood loss are: prolonged bleeding, a significant drop in systolic blood pressure to 90 mm Hg. Art. and lower, increased heart rate compared to the norm by 20 beats per minute or more. Blood loss within 10-15% of the initial circulating blood volume (BCV) does not require blood replacement, and a loss of even 25% of the BCC requires only a slight correction. Transfusion of blood substitutes is carried out for patients with a loss of more than 25% of blood. For replacement therapy use

polyglucin in a volume of up to 2 l/day. To improve microcirculation, use intravenous administration rheopolyglucin, gelatinol or albumin. Red blood cell mass in a volume of 30-40% of blood loss should be used only after restoration of blood circulation by replenishing the bcc with the above solutions. To improve the rheological properties of blood, red blood cells are diluted with rheopolyglucin or a 5% albumin solution in a 1:1 ratio.

With massive blood loss great importance has a transfusion speed. Typically, venous pressure is sharply reduced, the ulnar veins are collapsed, so you should resort to puncture of the subclavian veins or venous sections, followed by jet injection of solutions into 2-3 veins. It should be emphasized that it is inadmissible to replace all blood loss with blood in order to avoid “massive transfusion syndrome.” It is also necessary to remember about the correction of plasma proteins, for which albumin or protein is used. For the purpose of correction water balance the body produces intravenous infusions 0.9% sodium chloride solution, 5% glucose solution, Ringer-Locke solution. Lactasol is used to normalize blood pH.

Whole blood transfusions are generally inappropriate.

Which doctors should you contact if you have Acute posthemorrhagic anemia?

Hematologist

Therapist

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What can heartburn lead to, except sleepless nights and deterioration in health? This symptom is often underestimated by people. Hoping that this is just a temporary uncomfortable condition, a person will not go to the doctor for examination and begin treatment.

What complications are observed after diseases accompanied by heartburn? What is posthemorrhagic anemia and what causes it? Why does it happen with GERD?

Posthemorrhagic anemia - a consequence of GERD

Those unlucky enough to avoid this disease know that gastroesophageal reflux disease, or GERD, occurs due to weakness of the lower esophageal sphincter. The teres inferior muscle weakens over time for a number of reasons and begins to pass food from the stomach back into the esophagus. In the stomach the environment is acidic, in the esophagus, on the contrary, it is alkaline. Therefore, when gastric contents enter here, a person often feels heartburn. If the symptom of heartburn is even initial stages ignore - complications cannot be avoided. These include:

• Barrett's esophagus;
• strictures or narrowing of the esophagus;
• ulcers of the esophagus and, as a consequence, posthemorrhagic anemia.

Posthemorrhagic anemia is a decrease in the amount of hemoglobin in the blood due to bleeding, which developed as a complication of GERD. Anemia occurs after the appearance ulcerative defects in the mucous membrane of the esophagus or the initial part of the stomach.

Causes of posthemorrhagic anemia

A complication of GERD, such as posthemorrhagic anemia, occurs in 2–7% of cases of all complications of gastroesophageal reflux disease. First of all, it is not bleeding that occurs, but ulcers that appear on the mucous membrane of the esophagus. The delicate mucous membrane is not accustomed to the acidic gastric contents with hydrochloric acid. Constant exposure to the latter leads to gradual trophic disorders. Nutrition and blood supply to the superficial mucous membrane deteriorate. If a person continues to ignore all the symptoms that accompany GERD, ulcers appear. Over time, if left untreated, they can reach the muscle layer, where the vessels are affected. Acute and chronic posthemorrhagic anemia occurs due to blood loss from these “naked” blood vessels.

What are the reasons for posthemorrhagic anemia?

In almost 15% of cases, perforation (breakthrough) of the esophageal wall into the mediastinal cavity occurs, and the entire contents of the esophagus through the resulting hole can leak into the mediastinum. chest. Besides food and gastric juice, blood flows out from the affected vessels there.

Symptoms of posthemorrhagic anemia

dry mouth

Acute posthemorrhagic anemia occurs due to severe massive bleeding, while a sharp decline the number of red blood cells and hemoglobin, but not immediately. How is GERD and its complications related to this? If due to the appearance of ulcers they are affected small vessels- bleeding will be minor, pronounced changes a person will not feel it right away. A large number of ulcerative lesions mucous membrane of the esophagus or when in painful process large vessels are involved - bleeding can be severe.

Acute posthemorrhagic anemia develops after loss large quantity blood in a short period of time. In some cases, the person himself does not know about the presence of ulcers of the esophagus and the appearance of such a complication of GERD as bleeding.

Manifestations of the disease depend on the amount of blood lost. The presence of posthemorrhagic anemia is indicated following symptoms.

1. With large blood loss, a picture of collapse will develop: severe weakness, bleeding, pale skin, a feeling of dry mouth, possible vomiting, and the person breaks out in a cold sweat.
2. Posthemorrhagic iron deficiency anemia is characterized by the appearance rapid heartbeat, pronounced muscle weakness, dry skin and the appearance of cracks in the arms and legs, brittle nails. In this case, swelling under the eyes, weakness, constant headaches, nausea appear, appetite decreases, the person complains of a perversion of taste when eating chalk or clay brings pleasure.

In case of large blood loss, symptoms appear almost immediately. With chronic anemia, all of the above symptoms will not occur simultaneously, but will develop depending on the amount of blood loss and the frequency of bleeding. In this case, the symptoms will be regular; in a blood test, changes in a person’s indicators are constantly noted, until the source of bleeding is detected.

Stages and degrees of posthemorrhagic anemia

Accurate diagnosis The disease is diagnosed after a full examination. A general blood test helps with this. Since posthemorrhagic anemia is a decrease in the level of red blood cells and hemoglobin in a certain volume of blood, these indicators are looked at first when studying.

The stages of posthemorrhagic anemia are as follows.

The degree of chronic posthemorrhagic anemia is determined by the amount of hemoglobin.

1. At mild degree the amount of hemoglobin in the blood ranges from 120 to 90 g/l.
2. Average degree is set at a hemoglobin content of 90–70 g/l.
3. A hemoglobin level of less than 70 g/l is severe anemia.

Diagnosis of the disease

There are three main types of anemia diagnosis:

• By clinical signs;
• laboratory diagnostics;
• instrumental methods research.

Each of them is important, because with their help you can detect the disease, the source of bleeding, and establish the stage.

Diagnosis of posthemorrhagic anemia is based on the following examinations.

1. Determination of the amount of hemoglobin and red blood cells in a general blood test. Additionally, depending on the stage of anemia, the analysis can detect young and atypical blood cells.
2. A person with suspected posthemorrhagic anemia must be sent to an FGDS or a functional study of the initial part of the digestive system, thanks to which ulcers and the source of bleeding can be detected. But in rare cases, bleeding is not visible.
3. Biochemical study or blood test with mandatory determination of transferrin and ferritin, hemosiderin - important indicators changes in blood composition.
4. Not the least place in the diagnosis of posthemorrhagic anemia is the examination of a person and his complaints.

Treatment of posthemorrhagic anemia

In case of acute posthemorrhagic anemia or very low hemoglobin levels, treatment should be carried out only in a hospital. If necessary, anti-shock measures are carried out, bleeding is stopped, and blood transfusion is performed in case of massive blood loss.

Treatment of posthemorrhagic chronic anemia consists of prescribing a long course of:

• iron-containing preparations;
• vitamins C and group B (some complex medicines contain both iron and vitamins);
• prescribe a diet with optimal iron content in foods, preference is given to meat with vegetables ( low-fat varieties beef and pork, rabbit, pork and beef liver, veal, fish).

In conclusion, we repeat that posthemorrhagic anemia develops due to blood loss. If you start GERD and completely ignore the manifestations of this disease, such a complication is not far off. You can avoid it if you control it course of GERD and see a doctor annually.