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 posthemorrhagic anemia
- anemia caused by rapid and massive blood loss due to injuries, wounds, abdominal 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 ADH secretion, activation of the RAAS, increased KA production
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 heart rate to systolic blood pressure.
4 degrees of severity of blood loss:
Mild severity of blood loss: BCC deficit 10-20%. The patient's condition is satisfactory, general weakness, dizziness, mild nausea. Pulse up to 90, blood pressure normal. Hemoglobin is above 100, hematocrit is more than 0.30.
Moderate severity of blood loss: BCC deficiency is 20-30%, such blood loss causes the development of stage 1 hemorrhagic shock, this stage is well compensated by the body due to the activation of the SAS, the release of CA, and peripheral vasoconstriction. Patient status medium degree heaviness, conscious, calm, notes severe weakness, dizziness, pale skin, cold extremities. Pulse up to 100, weak filling. BP is moderately reduced. Oligouria. Hemoglobin content is 100-70, hematocrit - 0.30 - 0.35.
Severe severity of blood loss: BCC deficiency of 30-40%, such blood loss causes the development of stage 2 of hemorrhagic shock, this stage is decompensated and reversible. At the same time, activation of the SAS and peripheral vasoconstriction cannot compensate for the reduced cardiac output, which leads to a decrease in blood pressure. The patient's condition is serious, conscious, restless, severe weakness, pronounced pallor, cyanosis. Tachycardia, muffled heart sounds. BP syst. up to 60 mmHg. Oligouria, 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, sticky sweat, pale skin, cyanosis, shortness of breath. The pulse is 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 from which peripheral blood parameters can be assessed.
Vascular reflex phase (1-2 days) – indicators remain unchanged, due to compensation mechanisms: generalized vasospasm, increased ADH secretion, activation of the RAAS, increased KA production.
Hydremic phase (2-3 days), there is a large entry of tissue fluid into the bloodstream (autohemodilution) and restoration of the volume of the vascular bed. Hemoglobin and red blood cells are reduced, but CP is normal.
Bone marrow phase (5-6 days after blood loss), occurs increased production erythropoietin by the kidneys. Hypochromic anemia, leukocytosis with a shift to the left, reticulocytosis.
Treatment
Stop bleeding
Normalization of hemodynamic parameters
Improving the rheological properties of blood
To avoid the syndrome of massive blood transfusions, it is unacceptable to replace all blood loss with only blood components. The total volume of blood transfusion should not exceed 60% of the deficit in circulating blood volume. The remaining volume is filled 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 posthemorrhagic anemia
Develops as a result of long-term and frequently recurring bleeding, which leads to iron deficiency, i.e. this type anemia is essentially iron deficiency.
Chronic fasting hemorrhagic anemia also require searching and eliminating sources of chronic bleeding. Without this measure, all further treatment methods will not bring the desired result. After thorough 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 maintaining the necessary diet.
Preparations containing iron for chronic posthemorrhagic anemia
Iron-containing drugs for anemia can be used either as parenteral dosage forms(injections) and in tablet form. To assimilate them, it is necessary to combine a ferrum-containing preparation with ascorbic acid, as well as microelements (cobalt, copper, manganese). The latter contribute to faster biosynthesis of iron in the body and increase hemoglobin levels. Most popular today iron-containing drugs are substances such as ferrum-lek, feramide, iron lactate, iron glycerophosphate.
Posthemorrhagic anemia– a condition that develops as a result of sudden or prolonged blood loss. It is characterized by a decrease in the filling of the vascular bed, as a result of which the number of red blood cells and hemoglobin decreases, which leads to oxygen starvation, and in severe cases to death. Long-term disruption of hemodynamics causes not only a deterioration in well-being, but also degeneration of tissues and organs, provoking hematopoietic pathologies.
The direct cause of the condition is acute or chronic blood loss resulting from external or internal bleeding:
Due to pathologies and injuries accompanied by blood loss, its volume in the vascular bed decreases. There is a lack of cells containing hemoglobin. And since red blood cells are responsible for the delivery of oxygen, the body forms oxygen starvation.
The human body is able to restore up to 500 ml of blood without damage; the disease develops if blood loss exceeds this figure. The loss of half the volume of fluid in the vessels leads to inevitable death.
Main symptoms
Classification of anemia in case of blood loss is carried out according to the degree of development of the condition, distinguished:
- Spicy. Massive blood loss occurs due to injuries and damage to large vessels, when internal bleeding.
- Chronic. Secondary Iron-deficiency anemia(IDA) gradually develops due to diseases.
- Congenital. When the fetus suffers due to blood loss.
Consequently, in patients with posthemorrhagic anemia, symptoms differ depending on the degree of development of the process and the severity of the condition.
Acute form
At acute pathology clinical picture proceeds rapidly, vascular insufficiency is observed as a result of sudden emptying of the riverbed. With the onset of blood loss, the following is noted:
- hypotension,
- dizziness and tinnitus,
- tachycardia and shortness of breath,
- pallor of the skin and mucous membranes,
- severe weakness and dry mouth,
- cold sweat,
- nausea.
If there is damage to the gastrointestinal tract, the stool becomes dark in color and the temperature may rise.
If blood loss is significant, hemorrhagic collapse develops. The pressure drops sharply to critical levels - thread-like pulse, shallow and rapid breathing. Muscle weakness occurs until it stops motor activity, vomiting, convulsions and loss of consciousness are possible. Lack of blood supply causes oxygen starvation in organs and systems, death occurs due to respiratory and cardiac arrest.
Chronic form
If posthemorrhagic anemia develops slowly, the symptoms are not so pronounced, since adaptation mechanisms. Signs chronic form resemble IDA, since minor bleeding leads to iron deficiency:
- dry skin and painful pallor,
- face is swollen
- hair loss and dullness,
- brittleness and thickening of the nail plate,
- increased fatigue and dizziness,
- heart rhythm disturbance,
- sweating
When the hemoglobin concentration drops to 70 g/l or lower, some patients experience low-grade fever. Patients complain of a feeling of numbness and changes in taste preferences. The severe stage is often accompanied by stomatitis and rapidly developing caries.
Diagnostic methods
When making a diagnosis of posthemorrhagic anemia, the basis of measures includes studying the patient’s medical history, a set of laboratory and instrumental studies. To identify the cause of anemia, you will need to consult a surgeon, hematologist, gastroenterologist or gynecologist. As a basic examination and to clarify the duration of blood loss, tests are carried out to determine the degree of anemia, a blood test is taken:
- General. Indicates a decrease in erythrocyte mass, their hemoglobin saturation, and platelet volume.
- Biochemical. The hemogram gives a detailed idea of the blood elements, their morphology and ratio to the volume of fluid. The study determines an increase in manganese, the enzyme alanine aminotransferase, a decrease in calcium and copper.
Urinalysis gives an initial idea of the condition urinary system and the functioning of the body. To diagnose the site of internal bleeding, examination methods are used:
Bone marrow examination is performed in difficult cases when the cause of anemia cannot be identified conventional methods. Puncture samples taken show the activity of the red brain, trephine biopsy reveals the replacement of hematopoietic cells with adipose tissue.
Treatment with drugs and folk remedies
For posthemorrhagic anemia, the main goals of treatment are to identify the source of blood loss and stop the bleeding. For external injuries, apply a tourniquet and bandage. If necessary, vessels and damaged tissues and organs are sutured and resection is performed.
In case of massive blood loss, measures are carried out in the hospital:
- To restore blood supply and hemodynamics, a transfusion of canned blood and plasma is performed. When hemoglobin is below 8%, plasma substitutes are used: “Hemodez”, “Polyglyukin” or “Reopoliglyukin”. The blood transfusion procedure is carried out promptly, since a quarter of the blood loss is fraught with the death of the patient. The volume of infused fluid in this case exceeds blood loss by a maximum of 30%.
- Transfusion of red blood cells is necessary to restore oxygen transport; with rapid loss, its amount can be half a liter.
- Shock is treated with Prednisolone.
- Recovery acid-base balance During treatment, electrolyte and protein compounds are administered intravenously: albumin, glucose, saline.
- Iron is replenished by such drugs as Ferroplex, Feramide, Conferon, Sorbifer Durules. They are taken orally or by injection.
- Microelements are prescribed: cobalt, copper and manganese, as they increase the absorption of iron.
For prolonged bleeding:
- In the case of severe chronic anemia, transfusion is carried out in a small volume.
- To eliminate symptoms functional disorders Therapeutic measures are used in the functioning of the heart, liver, and kidneys.
- For better absorption Fe are prescribed iron-containing products, vitamins C and B groups.
- Sometimes surgery is recommended.
Scheme and duration drug treatment in each specific case are individual. Restoration of the normal picture is observed after one and a half or two months, but the patient takes the medicine for up to six months.
Diet and traditional treatment
To restore the body after treatment of posthemorrhagic anemia and replenish hemoglobin, a specific diet is used. Its goal is to provide the body with vitamins and elements, so nutrition should be balanced and high in calories, but with a minimum amount of fat.
- The patient's diet requires the presence of foods containing iron, such as meat low-fat varieties and liver.
- For enrichment with microelements, valuable amino acids and protein, fish, cottage cheese, and eggs are recommended.
- Suppliers of vitamins are vegetables and fruits, natural juices.
Loss of fluid is replenished by consuming water (at least 2 liters per day). To restore strength and support the body, you can also use folk recipes:
- Rose hips are brewed and drunk instead of tea; you can add strawberry leaves.
- When you lose strength, mix honey (200 ml), Cahors (300 ml) and aloe juice (150 ml). Take a spoon before meals.
- Mix 30 g of chicory juice in a glass of milk and drink it a day.
- Squeeze the juice from radishes, beets and carrots (1:1:1), pour into a dark glass container, cover with a lid and simmer in the oven for 3 hours. The liquid is drunk on a spoon before meals for a course of 3 months.
Suffering from blood loss immune defense, the body becomes susceptible to infection, so infusions or decoctions based on echinacea, ginseng, lemongrass or marshmallow will help to strengthen and restore the system.
Preventive measures will help prevent the development of posthemorrhagic anemia and its relapses:
- Patients with chronic diseases should monitor their condition, undergo regular examinations and take medications. When a specialist insists on surgery, there is no need to refuse: surgical treatment the underlying disease will eliminate the cause of anemia.
- The diet of children and adults must include foods containing iron, vitamins and elements necessary for the body.
- It is important for pregnant women to register in time and detect anemia in order to prevent complications dangerous to the health of the mother and newborn.
- If a pathology is detected in an infant, it is recommended not to stop breast-feeding. Each child is provided with a healthy environment and good nutrition, rational complementary feeding. To normalize the condition, regular walks are important; medications are given only as prescribed by a doctor.
- To prevent dystrophy, rickets and infectious invasions in children, pediatrician supervision is necessary. Special attention are given to babies born to mothers with diagnosed anemia and who are on artificial feeding. Also at risk are babies with multiple pregnancies, premature babies and those who quickly gain weight.
- To maintain health, every person needs to lead a correct lifestyle, move actively, and be in the fresh air.
Posthemorrhagic anemia - a set pathological changes, which develop in the body due to the loss of a certain amount of blood: it contains iron, and with blood loss it becomes insufficient. It is divided into two types: acute and chronic.
ICD-10 code
Chronic posthemorrhagic anemia has the following ICD-10 code - D50.0, and acute - D62. These disorders are located in the section “Anemia associated with nutrition. Iron-deficiency anemia".
Latin defines the word anemia as “lack of blood,” literally speaking. The word can also be translated as “anaemia”, which means a lack of hemoglobin. And “hemorrhagic” is translated as “accompanied by bleeding,” the prefix “post” means “after.”
Information about what posthemorrhagic anemia is will allow you to detect its development in time and provide the necessary assistance.
Pathogenesis in posthemorrhagic anemia
Pathogenesis is a certain sequence of development of pathological changes, which makes it possible to judge the features of the occurrence of posthemorrhagic anemia.
The severity of posthemorrhagic anemia is determined by the hemoglobin content and the severity of tissue hypoxia due to its deficiency, but the symptoms of anemia and its features are associated not only with this indicator, but also with others that decrease with blood loss:
- Iron content;
- Potassium;
- Magnesium;
- Copper.
Particularly negative on circulatory system affected by iron deficiency, in which the production of new blood cells is difficult.
The minimum volume of blood that can be lost without the risk of developing serious disorders is 500 ml.
Donors donate blood without exceeding this amount. Healthy body a person with sufficient body weight completely restores the lost elements over time.
When there is not enough blood, small vessels constrict to compensate for the shortage and maintain blood pressure at normal level.
Due to a lack of venous blood, the heart muscle begins to work more actively to maintain sufficient minute blood flow - the amount of blood that is ejected by the heart per minute.
What colour deoxygenated blood can be read.
Read what the heart muscle consists of
The functioning of the heart muscle is impaired due to mineral deficiency, the heart rate decreases, and the pulse weakens.
An arteriovenous shunt (fistula) occurs between the veins and arterioles, and blood flows through the anastomoses without touching the capillaries, which leads to impaired blood circulation in the skin, muscular system, fabrics.
Formation of an arteriovenous shunt, due to which blood does not flow to the capillaries This system exists to maintain blood flow to the brain and heart, allowing them to continue to function even in the face of severe blood loss.
Interstitial fluid quickly compensates for the lack of plasma (the liquid part of the blood), but microcirculation disturbances persist. If blood pressure drops significantly, blood flow speed will small vessels will decrease, which will lead to thrombosis.
In the severe stage of posthemorrhagic anemia, small blood clots form that clog small vessels, which leads to disruption of the functioning of the arterial glomeruli in the kidney tissue: they do not filter fluid properly, and the amount of urine excreted is reduced, and harmful substances are retained in the body.
Blood circulation in the liver also weakens. If you don't start timely treatment acute posthemorrhagic anemia, this will lead to liver failure.
With posthemorrhagic anemia, the liver suffers due to lack of blood Oxygen deficiency in tissues leads to the accumulation of under-oxidized elements that poison the brain.
Acidosis develops: a violation of the acid-base balance towards the predominance of an acidic environment. If posthemorrhagic anemia is severe, the amount of alkalis is reduced, and the symptoms of acidosis increase.
With blood loss, the level of platelets decreases, but this has little effect on the coagulation processes: the content of other substances that affect coagulation reflexively increases.
Over time, the clotting mechanisms return to normal, but there is a risk of developing thrombohemorrhagic syndrome.
Causes
The main factor influencing the development of posthemorrhagic anemia is blood loss, the causes of which can be different.
Acute posthemorrhagic anemia
This is a disorder that develops rapidly due to excessive blood loss. This dangerous condition, which requires the rapid initiation of treatment measures.
Causes of acute anemia:
Chronic posthemorrhagic anemia
A condition that develops with systematic blood loss over a long period of time. It can go unnoticed for a long time if the blood loss is mild.
Causes of chronic anemia:
Hemorrhagic anemia also develops due to vitamin C deficiency.
Kinds
Posthemorrhagic anemia is divided not only by the nature of its course (acute or chronic), but also by other criteria.
The severity of anemia is assessed by the amount of hemoglobin in the blood.
Depending on its content, anemia is divided into:
- Light. At mild degree With the severity of anemia, hemoglobin begins to lack iron, its production is disrupted, but the symptoms of anemia are practically absent. Hemoglobin does not fall below 90 g/l.
- Average. Symptoms with moderate severity are moderate, hemoglobin concentration is 70-90 g/l.
- Heavy. In severe cases there are serious violations organ function, heart failure develops, the structure of hair, teeth, and nails changes. Hemoglobin content is 50-70 g/l.
- Extremely severe. If the hemoglobin level is below 50 g/l, there is a risk of life.
There are also individual pathologies included in the ICD:
- Congenital anemia in the newborn and fetus due to blood loss (code P61.3);
- Posthemorrhagic anemia chronic type, which is secondary iron deficiency (code D50.0).
Symptoms
Acute form of anemia
Symptoms when acute form posthemorrhagic anemia increases very quickly and depends on the severity of blood loss.
Observed:
A decrease in blood pressure due to massive blood loss is called hemorrhagic shock. The intensity of the fall in blood pressure depends on the severity of blood loss.
The following symptoms are also present:
- Tachycardia;
- The skin is cold and pale, with moderate and severe degrees it has a cyanotic (bluish) color;
- Impaired consciousness (stupor, coma, loss of consciousness);
- Weak pulse (if the stage is severe, it can only be felt on the main vessels);
- Reducing the amount of urine excreted.
The symptoms of posthemorrhagic anemia and hemorrhagic shock are joined by signs that are inherent to the disease that caused blood loss:
- With an ulcer, black or red stool is observed;
- Swelling in the impact area (if injured);
- When the arteries in the lungs rupture, there is a cough with bright scarlet blood;
- Intense bloody discharge from the genitals during uterine bleeding.
The source of bleeding is identified by indirect signs depending on the clinical picture.
Stages of acute posthemorrhagic syndrome
Spicy posthemorrhagic syndrome has three stages of development.
| Name | Description |
|---|---|
| Reflex-vascular stage | The level of plasma and red blood cells drops, compensatory processes are activated, blood pressure drops, and the heart rate increases. |
| Hydremia stage | It develops several hours after blood loss and lasts from 2 to 3 days. Intercellular fluid restores the volume of fluid in the vessels. The content of red blood cells and hemoglobin decreases. |
| Bone marrow stage | Develops 4-5 days after blood loss due to oxygen starvation. The level of hematopoietin and reticulocytes, the precursor cells of red blood cells, increases in the blood. The amount of iron in the plasma decreases. |
The body fully recovers after blood loss after two to three or more months.
Signs of chronic form
Chronic bleeding gradually leads to posthemorrhagic anemia, which develops gradually, and its symptoms are closely related to the severity of hemoglobin deficiency.
Observed:
People with posthemorrhagic anemia have low immunity and often develop infectious diseases.
Diagnostics
In case of acute blood loss, the patient remains on inpatient treatment so that risks can be assessed and timely assistance provided.
Laboratory diagnosis of posthemorrhagic anemia is carried out repeatedly, and the results vary depending on the stage and severity of the disorder.
Laboratory signs of acute anemia:
- In the first two hours, the concentration of platelets increases, and red blood cells and hemoglobin remain at normal levels;
- After 2-4 hours, the excess platelets remain, neutrophil granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, color index anemia is defined as normochromic (normal value);
- After 5 days, an increase in reticulocytes is noted, the iron level is insufficient.
What tests need to be taken?
Must be passed general analysis blood, in chronic anemia it reveals the content of elliptocytes, lymphocytes are increased in peripheral blood, but reduced in overall cellular composition.
A deficiency of iron, calcium, and copper is detected. Increased manganese content.
At the same time, tests are carried out to determine the cause of bleeding: stool examination for helminthiasis and occult blood, colonoscopy, urinalysis, bone marrow examination, ultrasonography, esophagogastroduodenoscopy, electrocardiogram.
Who to contact?
Hematologist
Treatment
Acute hemorrhagic anemia at the first stage of treatment requires eliminating the cause of blood loss and restoring normal blood volume.
Surgeries are performed to suture wounds and blood vessels, and the following medications are prescribed:
- Artificial blood substitutes. They are infused by drop or stream, depending on the patient’s condition;
- When shock develops, the use of steroids (Prednisolone) is indicated;
- Soda solution eliminates acidosis;
- Anticoagulants are used to eliminate blood clots in small vessels.
- If blood loss exceeds a liter, a donor blood transfusion is necessary.
Treatment of chronic anemia not complicated by serious diseases is carried out on an outpatient basis. Nutrition correction with the addition of foods containing iron, vitamins B9, B12 and C is indicated.
In parallel, treatment is carried out for the underlying disease that caused the pathological changes.
Forecast
If, after extensive blood loss, the patient quickly arrives at the hospital and receives the full range of medical procedures, aimed at restoring blood levels and eliminating bleeding, the prognosis is favorable, except in cases where the blood loss is extremely pronounced.
A chronic type of pathology is successfully eliminated by curing the disease that caused it. The prognosis depends on the severity of concomitant diseases and the degree of neglect of anemia. The sooner the cause is identified and treatment is started, the greater the chances of a favorable outcome.
Video: Anemia. How to treat anemia?
Often what threatens our lives is not what is in plain sight. Suspecting some kind of serious illness, which is on everyone's lips, we ignore, for example, a stomach ulcer, which only causes us inconvenience from time to time. But such an inconspicuous wound can be much more dangerous than many famous diseases. Losing blood drop by drop, undermining the health of its owner long months and years, it provokes the appearance of unpredictable posthemorrhagic anemia.
Danger of excessive blood loss
The total volume of blood in the body of an adult is from 3.5 to 5 liters. Circulating throughout the body, it performs many functions:
- distributes nutrients and oxygen;
- removes decay products from tissues;
- transports hormones from glands to sensitive organs;
- supports constant temperature And chemical composition body;
- participates in wound closure and subsequent tissue regeneration;
- carries out immune responses to external threats.
If the amount of fluid in the vessels drops by more than 10%, the victim clearly feels it. The weakening of the above properties of blood occurs - and the more significant the more serious the blood loss. The transport function is the first to suffer - brain tissue begins to experience oxygen starvation within a few seconds. The ensuing symptoms are collectively known as posthemorrhagic anemia.
Types of posthemorrhagic anemia
Anemia from blood loss, or posthemorrhagic anemia, is a deficiency of red blood cells in the plasma resulting from excessive blood loss. IN clinical practice There are two known forms of the disease: acute and chronic. The first develops with a single injury to the body that provokes quick loss large volume of blood. The reasons for this condition may be:
Chronic anemia is possible with small but frequent blood losses, leading to a gradual decrease in the number of circulating red blood cells. The causes of the pathology coincide with those in an acute condition, but differ in the less intense impact on the body.
One of the main reasons for the wide spread of posthemorrhagic anemia in the recent past was the fashion for bloodletting. According to the latest data, it was this procedure that accelerated the death of Mozart. Having fallen ill in 1791, the composer was subjected to a treatment that was innovative at that time, as a result of which he lost about two liters of blood and died in less than a month.
Mechanism of development and symptoms of the disease
The symptoms of posthemorrhagic anemia vary significantly depending on the form of the disease, the severity of blood loss, and the characteristics of the victim’s body.
Clinical picture in acute condition
From the first moments heavy bleeding the human body uses all its resources to compensate for the losses that have occurred. The production of red blood cell precursor cells called erythroblasts increases sharply. The number of red cells per unit volume of plasma remains constant, although in absolute terms their number decreases.
Walls peripheral vessels quickly spasm, limiting blood flow to the skin and skeletal muscles. At the same time, security is maintained for as long as possible nutrients central nervous system, heart and adrenal glands.
- The victim's pulse quickens.
- Breathing becomes harsh and shallow.
- The skin and mucous membranes turn pale.
- There is a feeling of dizziness, weakness in the limbs, tinnitus, and possibly nausea.
- Feces may be dark brown or red in color.
This phase of anemia, which combines the body's immediate reactions to blood loss, is called reflex. It lasts up to 12 hours, after which it becomes compensatory, or hydremic.
At this stage, the body removes from the depot maximum amount red blood cells, and interstitial fluid begins to move into the vessels. The filtration properties of the kidneys are adjusted to retain water in the body, resulting in decreased urine production. Red cells are distributed in the plasma, causing the relative concentration of hemoglobin to sharply decrease.
The next phase, the bone marrow phase, occurs 4–5 days after the event of blood loss. By this time, the production of erythroblasts and the maturation of red blood cells reach their maximum values. Prolonged spasm of peripheral vessels can provoke cell gluing in small capillaries, causing them to become clogged. Large blood clots can cause tissue and organ death.
Signs of chronic form
The symptoms of chronic posthemorrhagic anemia show milder manifestations than in the case of an acute course:
- skin manifestations:
- pallor;
- slight swelling;
- dryness;
- roughness;
- hair defects:
- fragility;
- dropping out;
- tachycardia;
- decreased blood pressure;
- general symptoms:
- dizziness;
- weakness;
- decreased appetite;
- noise in ears.
Features of posthemorrhagic anemia in children
Children are more prone to manifestations of acute posthemorrhagic anemia than to chronic one. The reason for this is obvious - even small blood losses by the standards of an adult body become a difficult test for fragile body child.
Alarming symptoms in this case are considered:
- pale skin;
- smoothness of the tongue;
- growth retardation;
- change in behavior (apathy or tearfulness);
- hair fragility;
- violation of taste preferences - a tendency to eat clay and chalk;
- general weakness;
- weight loss.
Weakened by injury children's body becomes sensitive to infectious diseases, so anemia can lead to the development of sore throat, laryngitis, otitis media,.
Stages (degrees) of the disease: mild, moderate, severe
Depending on the intensity of blood loss, there are several stages, or degrees of severity, of posthemorrhagic anemia.
Determining the severity of the disease plays a critical role in planning further treatment. Eg, mild anemia may not require drug therapy, while heavy is absolute indication for immediate hospitalization of the victim.
Stages of posthemorrhagic anemia - table
| Degree/Stage | Content, gram/l. | Pulse rate, beats/min. | Systolic (upper) arterial pressure, mmHg. |
| Light | 90 and above | Up to 80 | Above 110 |
| Average | 70–90 | 80–100 | 90–110 |
| Heavy | Less than 70 | More than 100 | Below 90 |
Diagnostics
The mandatory primary stage of diagnosis is an external examination of the patient, which allows:
- determine the location of damage in case of superficial injury to the body;
- estimate general state the victim in relation to the severity of blood loss;
- find out about the patient’s predisposition to bleeding of a certain type (gastric, intestinal, pulmonary, etc.).
A proctological or gynecological examination is carried out if there is a suspicion of injuries to the lower sections digestive system and women's reproductive organs. Analysis of stool and urine can detect damage gastrointestinal tract And genitourinary system. The most commonly used tests are benzidine (Gregersen) and guaiac (Weber) tests. The reagents used in them change color upon contact with free hemoglobin.
The use of the iron isotope 59 Fe in radioimmunoassay makes it possible to describe the distribution of red blood cells, their integrity and activity.
A blood test for acute posthemorrhagic anemia shows very characteristic results:
- During the first hour after the onset of the condition, the number of platelets increases sharply, and after three hours - leukocytes.
- Following this, the level of red blood cells drops.
- Restoring initial indicators takes at least several weeks.
For internal bleeding, radiography, magnetic resonance (MRI) and computed tomography (CT) are widely used. ultrasound diagnostics. With their help, it is possible to accurately localize damage to hollow organs.
These techniques make it possible to differentiate posthemorrhagic anemia from similar conditions.
Differential diagnosis - table
| Name of pathology | Difference from posthemorrhagic anemia | Diagnostic methods |
| Autoimmune hemolytic anemia |
|
|
| Hypochromic anemia |
|
|
| Megaloblastic anemia |
|
|
| Microspherocytic hemolytic anemia | red blood cells are spherical in shape |
|
| Partial red cell anemia |
|
|
| Thalassemia |
| blood analysis |
Treatment
The main task in the treatment of posthemorrhagic anemia is to stop the bleeding that provoked it. Subsequent measures are aimed at replenishing the loss of red blood cells, fluid, and nutrients.
Acute therapy
Significant blood loss (more than 1 liter) should be compensated by transfusion of red blood cells with plasma substitutes, but not more than 60% of the lost volume. Exceeding this indicator can provoke intravascular coagulation. It is better to make up the difference with blood substitutes - solutions of albumin, dextran, sodium chloride, gelatinol, rheopolyglucin, Ringer-Locke composition. Lactasol can be used to restore pH values.
After removal acute condition measures are being taken to improve hemoglobin synthesis. Therapy at this stage coincides with the treatment of the chronic form.
Therapy for chronic form
To replenish the amount of lost iron (with iron deficiency states) its preparations containing the metal in a divalent form are used. Such means include:
- Maltofer;
- Sorbifer;
- Feramide;
- Ferrocal;
- Ferroplex;
- Ferrocene.
Multivitamin complexes that include vitamins B, C, and E help increase metabolism.
Treatment of anemia - video
Diet for posthemorrhagic anemia
- apricots;
- grenades;
- mushrooms;
- strawberries;
- lean meat;
- peaches;
- liver;
- fish;
- cottage cheese;
- blueberry;
- apples;
- eggs.
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