Treatment of mild post-hemorrhagic anemia. Features of posthemorrhagic anemia. Diagnostics of the post-hemorrhagic anemia

As is already known, post-hemorrhagic anemia occurs in the human body due to blood loss. Moreover, it will not necessarily be abundant. It is important to understand that even minor bleeding, but occurring often, can become seriously dangerous for the patient.

Posthemorrhagic anemia: ICD-10 code

Distribution of diseases according to this classification (regarding the acute course of the disease) - D62. This classification also indicates that the cause of the disease is considered to be blood loss of any nature.

Posthemorrhagic anemia: severity

The severity of this type of anemia also depends on the hemoglobin value. The first degree of severity is characterized by a hemoglobin content of more than 100 grams per liter of blood and erythrocytes above 3 t / l. If the level of hemoglobin in the blood reaches 66 - 100 g / l and the number of erythrocytes is higher than 2 - 3 t / l, we can talk about the course of moderate severity of post-hemorrhagic anemia. Finally, we are talking about a severe stage of anemia in the event that hemoglobin falls below 66 g / l.

If a mild severity of this type of anemia is detected in time, the patient can still be really helped. In this case, the main goal of treatment is to replenish the iron stores in the body. Taking appropriate iron supplements can help. Only a doctor can prescribe such drugs in accordance with the tests submitted by the patient and his individual complaints. It is important that the preparation contains a component that promotes the complete absorption of iron. This component can be, for example, ascorbic acid. Sometimes inpatient treatment may be required.

With post-hemorrhagic anemia of moderate severity, post-hemorrhagic anemia requires appropriate medication. As for the severe degree, hospitalization of the patient is urgently indicated. Delay in this case can cost the patient his life.

Posthemorrhagic anemia: causes of the disease

Lack of blood in the body may be due to:

Violation of normal hemostasis. Hemostasis is designed to keep the blood in a liquid state, that is, as it should be normal. It is also responsible for normal blood clotting;
Diseases of the lungs. Such diseases can be judged by scarlet bleeding in the form of liquid or clots, which occurs when coughing;
Trauma, due to which the vascular integrity was violated, mainly in large arteries;
Ectopic pregnancy. With such a problem, severe internal bleeding is observed, which causes the development of acute post-hemorrhagic anemia;
Surgical intervention. Almost any operation is associated with blood loss. It is not always abundant, but this may be enough for the development of pathology;
Ulcers of the stomach and duodenum. With such diseases, internal bleeding is common. Such bleeding cannot always be recognized quickly. But if it is not done in time, it could be fatal.

Posthemorrhagic anemia: stages

There are two stages in the course of this pathology - acute and chronic. Acute begins due to rapid and massive blood loss. Such blood loss is often caused by trauma, internal and external bleeding, surgical intervention, during which the vessels are injured. The chronic stage of the course of the disease is characterized by moderate bleeding, which occurs quite often, for example, we are talking about hemorrhoids and peptic ulcer disease. The same goes for girls with menstrual abnormalities and uterine fibromatosis. The same goes for nosebleeds.

Pathogenesis of posthemorrhagic anemia

The key factors of this type of anemia are the phenomena of vascular insufficiency. At the same time, blood pressure decreases, blood supply to tissues and internal organs is disturbed, hypoxia and ischemia are observed, and a state of shock may become likely.

The first phase is called early reflex-vascular. It is also called latent anemia. At the same time, the indicators of hemoglobin and erythrocytes are still close to normal. The second phase is the hydraemic phase of compensation. It is characterized by the entry of tissue fluid into the bloodstream and the normalization of plasma volume. The decrease in the number of red blood cells begins quite abruptly. In the third phase, there is a strong decrease in the number of formed elements in the blood and the situation begins to get out of control.

Acute post-hemorrhagic anemia: ICD-10

What can be said about the stages of this kind of anemia? Chronic post-hemorrhagic anemia is something that is difficult to deal with, since the causes lie in some other disorders in the body. That is why we will focus on acute post-hemorrhagic anemia.

With acute blood loss, which means more than 1000 ml of blood, in a short period of time, the patient may experience collapse and shock.

Acute anemia: causes (post-hemorrhagic) - what are they? They are most often associated with injuries of an unforeseen nature.

If we talk about the symptoms of acute hemorrhagic anemia, they are represented by disorders of the gastrointestinal tract, dizziness, nausea. In addition, the patient may feel weak, his skin may turn pale and blood pressure may drop.

Treatment of posthemorrhagic anemia

Therapy for such a disease is carried out only in a hospital setting. The fact is that bleeding, especially massive, in other conditions, is not always possible to stop. Sometimes you need infusion-transfusion therapy and surgery.

After the bleeding stops, it is necessary to start taking iron-containing drugs, and only at the discretion of the doctor. In the severe stage, it will be necessary to administer the drugs intravenously; at the mild stage, it is enough to take the pills inside. In some cases, combined treatment with both methods is indicated.

What can heartburn lead to, apart from sleepless nights and a deterioration in well-being? This symptom is often underestimated by people. In the hope that this is just a temporary discomfort, the person will not go to the doctor for examination and start treatment.

What complications are observed after diseases accompanied by heartburn? What is post-hemorrhagic anemia, what causes it? Why does it happen with GERD?

Post-hemorrhagic anemia - a consequence of GERD

Those unlucky enough to avoid this condition know that gastroesophageal reflux disease, or GERD, is caused by weakness in the lower esophageal sphincter. The lower round muscle weakens over time for a number of reasons and begins to pass food from the stomach back to 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 ignored even in the initial stages, complications cannot be avoided. These include:

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

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

Causes of post-hemorrhagic anemia

Such a complication of GERD as posthemorrhagic anemia occurs in 2-7% of all complications of gastroesophageal reflux disease. First of all, there is no bleeding, but ulcers appear on the mucous membrane of the esophagus. The delicate mucous membrane is not used to acidic gastric contents with hydrochloric acid. The constant influence of the latter leads to gradual trophic disturbances. Nutrition and blood supply to the superficial mucosa are impaired. If a person continues to ignore all the symptoms that accompany GERD, ulcers appear. Over time, if untreated, they can reach the muscle layer, in which the vessels are affected. Acute and chronic post-hemorrhagic anemia occurs as a result of blood loss from these "exposed" blood vessels.

What are the reasons for post-hemorrhagic anemia?

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

Symptoms of post-hemorrhagic anemia

dry mouth

Acute post-hemorrhagic anemia occurs due to severe massive bleeding, while there is a sharp decrease in the number of erythrocytes and hemoglobin, but not immediately. How is GERD and its complications related to this? If, due to the appearance of ulcers, small vessels are affected, the bleeding will be insignificant, the person will not immediately feel the pronounced changes. A large number of ulcerative lesions of the mucous membrane of the esophagus or when large vessels are involved in the painful process - bleeding is severe.

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

The manifestations of the disease depend on the amount of blood lost. The following symptoms indicate the presence of post-hemorrhagic anemia.

With a large blood loss, a picture of collapse will develop: severe pronounced weakness, bleeding, pallor of the skin, a feeling of dry mouth, vomiting is possible, a person becomes covered with cold sweat.
Posthemorrhagic iron deficiency anemia is characterized by the appearance of a rapid heart rate, severe muscle weakness, dry skin and cracks in the arms and legs, brittle nails. At the same time, there are swelling under the eyes, weakness, constant headaches, nausea, decreased appetite, a person complains of a perversion of taste when eating chalk or clay delivers pleasure.

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

Stages and degrees of post-hemorrhagic anemia

An accurate diagnosis of the disease is made after a full study. A general blood test helps in this. Since posthemorrhagic anemia is a decrease in the level of erythrocytes and hemoglobin in a certain volume of blood, then in the study they look at these indicators in the first place.

The stages of post-hemorrhagic anemia are as follows.

The degree of chronic post-hemorrhagic anemia is determined by the amount of hemoglobin.

With a mild degree, the amount of hemoglobin in the blood ranges from 120 to 90 g / l.
The average degree is set at a hemoglobin content of 90–70 g / l.
A hemoglobin level of less than 70 g / l is a severe anemia.

Diagnosis of the disease

There are three main types of anemia diagnosis:

on clinical grounds;
laboratory diagnostics;
instrumental research methods.

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

Diagnosis of post-hemorrhagic anemia is based on the following examinations.

Determination of the amount of hemoglobin and erythrocytes in a general blood test. Additionally, depending on the stage of anemia, young blood cells and atypical ones can be detected in the analysis.
A person with suspected post-hemorrhagic anemia must be referred for EGD or a functional study of the initial part of the digestive system, so that ulcers and the source of bleeding can be detected. But in rare cases, bleeding is not visible.
A biochemical study or a blood test with the mandatory determination of transferrin and ferritin, hemosiderin are important indicators of changes in blood composition.
Not the last place in the diagnosis of post-hemorrhagic anemia is the examination of a person and his complaints.

Treatment of posthemorrhagic anemia

With acute post-hemorrhagic anemia or with a very low hemoglobin content, treatment should be carried out only in a hospital. If necessary, carry out anti-shock measures, stop bleeding, produce blood transfusions with massive blood loss.

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

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

In conclusion, we repeat that post-hemorrhagic 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. It can be avoided by monitoring the course of GERD and seeing a doctor annually.

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, which includes iron. Its main function is to transfer oxygen with the blood flow to all organs and tissues without exception. If this process is disturbed, rather serious changes begin in the body, which are determined by the etiology and severity of anemia.

Depending on the underlying cause and course of post-hemorrhagic anemias, acute and chronic forms are distinguished. In accordance with the international classification system, the disease is divided as follows:

Secondary iron deficiency anemia after blood loss. ICD code 10 D.50
Acute post-hemorrhagic anemia. ICD code 10 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 post-hemorrhagic anemia is the loss of a large volume of blood over a short period of time, which occurred as a result of:

Injury that caused damage to the great arteries.
Damage to large blood vessels during surgery.
Rupture of the fallopian tube with the development of an ectopic pregnancy.
Diseases of 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 post-hemorrhagic anemia are most often umbilical cord injuries, congenital abnormalities of the blood system, damage to the placenta during cesarean section, early placental abruption, its presentation, birth trauma.

Causes of the chronic course of posthemorrhagic anemia

Chronic posthemorrhagic anemia develops as a result of minor but regular bleeding. They can appear as a result of:

Hemorrhoids, which is accompanied by cracks in the rectum, the appearance of blood impurities in the feces.
Peptic ulcer of the stomach and duodenum.
Heavy menstruation, uterine bleeding while taking hormonal drugs.
Vascular lesions by tumor cells.
Chronic nosebleeds.
Minor chronic blood loss in cancer.
Frequent blood sampling, catheter placement and other similar manipulations.
Severe kidney disease with excretion of blood in the urine.
Infestation by helminths.
Liver cirrhosis, chronic liver failure.

The cause of chronic anemia of a similar etiology can also be hemorrhagic diathesis. This is a group of diseases in which a person has a tendency to bleed due to a violation of homeostasis.

Symptoms and blood picture in anemia as a result of acute blood loss

The clinical picture of acute post-hemorrhagic anemia develops very quickly. Manifestations of general shock as a result of acute bleeding are added to the main symptoms of this disease. In general, the following are observed:

Decreased blood pressure.
Clouding or loss of consciousness.
Great pallor, bluish tinge of the nasolabial fold.
Threaded pulse.
Vomit.
Excessive sweating, and so-called cold sweat is observed.
Chills.
Convulsions.

If the bleeding was successfully stopped, then such symptoms are replaced by dizziness, tinnitus, loss of orientation, visual impairment, shortness of breath, heart rhythm irregularities. The pallor of the skin and mucous membranes, low blood pressure, remain.

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

Reflex phase, which develops on the first day after blood loss. Redistribution and centralization of blood circulation begins, peripheral vascular resistance increases. At the same time, there is a decrease in the number of erythrocytes at normal values of the concentration of hemoglobin and hematocrit.
The hydraemic phase runs 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 value of the color index is still 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 supply of organs and tissues with oxygen activates the processes of hematopoiesis. In addition to decreased hemoglobin, hematocrit, thrombocytopenia and leukopenia, a decrease in the total number of erythrocytes is noted at this stage. When examining a blood smear, the presence of young forms of erythrocytes is noted: reticulocytes, sometimes erythroblasts.

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

Symptoms and diagnosis of anemia in chronic bleeding

Chronic posthemorrhagic anemia in its symptoms is similar to iron deficiency, since regular slight bleeding leads to a deficiency of this trace element. The course of this blood disorder 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 fluctuates depending on age, from 200 in infants to 150 in adolescents.

Grade of post-hemorrhagic chronic anemia Hemoglobin concentration

1 (light) degree 90 - 110 g / l
Grade 2 (moderate) 70 - 90 g / l
Grade 3 (severe) below 70 g / l

At the initial stage of the development of the disease, patients complain of slight dizziness, flashing "flies" before their eyes, increased fatigue. Outwardly noticeable pallor of the skin and mucous membranes.

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

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

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

Treatment of anemia after massive blood loss

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

After identifying the source and stopping the bleeding, it is necessary to urgently restore the blood supply to the vessels. For this, reopolyglucin, hemodez, polyglucin are prescribed. Acute blood loss is also compensated for by blood transfusion, taking into account the compatibility of the Rh factor and the blood group. The volume of blood transfusion is usually 400 - 500 ml. These measures must be carried out very quickly, since the 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 switch to standard treatment, which consists in the administration of iron preparations and enhanced nutrition to replenish the deficiency of vitamins and microelements. Ferrum lek, ferlatum, maltofer are usually prescribed.

Usually, the restoration of a normal blood picture occurs after 6 to 8 weeks, but the use of drugs to normalize hematopoiesis continues for up to six months.

Treatment of chronic post-hemorrhagic anemia

The first and most important stage in the treatment of post-hemorrhagic chronic anemia is to identify the source of bleeding and eliminate it. Even the loss of 10-15 ml of blood per day deprives the body of all the amount of iron that was received during that day with food.

A comprehensive examination of the patient is carried out, which without fail includes consultations of a gastroenterologist, proctologist, hematologist, gynecologist for women, and an endocrinologist. After identifying the disease that caused the development of chronic post-hemorrhagic anemia, treatment is immediately started.

In parallel, medications that contain iron are prescribed. For adults, its daily dose is about 100 - 150 mg. Complex agents are prescribed, which, in addition to iron, contain ascorbic acid and B vitamins, which contribute to its better absorption. These are sorbifer durules, ferroplex, fenuls.

In severe post-hemorrhagic chronic anemia, transfusion of erythrocyte mass and injection of drugs with iron are shown to stimulate the processes of hematopoiesis. Ferlatum, maltofer, likferr and similar medicines are prescribed.

Recovery after the main course of treatment

The duration of the intake of iron-containing drugs is determined by the doctor. In addition to using various medications to restore normal oxygen supply to organs and replenish iron stores in the body, good nutrition is very important.

In the diet of a person who has suffered post-hemorrhagic anemia, proteins and iron must be present without fail. Preference should be given to meat, eggs, dairy products. The leaders in iron content are meat by-products, especially beef liver, meat, fish, caviar, legumes, nuts, buckwheat and oatmeal.

When drawing up 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 rises when eating vegetables and fruits that contain vitamins B and C. These are citrus fruits, black currants, raspberries, etc.

The course and therapy of posthemorrhagic anemia in children

Posthemorrhagic anemia in children is much more severe, especially its acute form. The clinical picture of this pathology practically does not differ from that of an adult, but it develops faster. And if in an adult a certain amount of lost blood is compensated by the protective reactions of the body, then in a child this can be fatal.

Treatment of acute and chronic forms of post-hemorrhagic anemia in children is the same. After identifying the cause and eliminating the bleeding, transfusion of erythrocyte mass is prescribed at the rate of 10-15 ml per kg of weight, iron preparations. Their dosage is calculated individually, depending on the severity of the anemia and the condition of the child.

Early introduction of complementary foods is recommended for children aged about six months, and should start with foods with a high iron content. Babies are shown the transition to special fortified mixtures. If the disease that led to the development of post-hemorrhagic anemia is chronic and does not respond to treatment, then preventive courses of iron supplements must be repeated regularly.

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

V. V. Dolgov, S. A. Lugovskaya,
V. T. Morozova, M. E. Post
Russian Medical Academy
postgraduate education

Post-hemorrhagic anemia- a condition that develops as a result of loss of blood volume, as a result of which this type of anemia is called "Anemia due to blood loss".

Acute post-hemorrhagic anemia

Acute post-hemorrhagic anemia is a condition that develops as a result of the rapid loss of a significant volume of blood. Regardless of the pathogenesis of the disease, with anemia in the body, oxidative processes are disrupted and hypoxia occurs. The degree of anemia depends on the speed and amount of blood loss, the degree of adaptation of the body to new conditions of existence.

The cause of acute blood loss can be a violation of the integrity of the vessel walls due to injury, damage to the pathological process in various diseases (stomach and intestinal ulcers, tumor, tuberculosis, pulmonary infarction, varicose veins of the legs, pathological childbirth), changes in capillary permeability (hemorrhagic diathesis) or violation in the hemostasis system (hemophilia). The consequences of these changes, regardless of the reasons that caused it, are of the same type.

The leading symptoms of extensive bleeding are acute circulating blood volume deficiency (BCC) and impaired homeostasis. In response to the development of BCC deficiency, adaptation mechanisms are activated to compensate for it.

At the first moment after blood loss, signs of collapse are observed: severe weakness, drop in blood pressure, pallor, dizziness, fainting, tachycardia, cold sweat, vomiting, cyanosis, convulsions. In case of a favorable outcome, the actual anemic symptoms appear, caused by a decrease in the respiratory function of the blood and the development of oxygen starvation.

The normal reaction of the body to blood loss is characterized by the activation of hematopoiesis. In response to hypoxia, the synthesis and secretion of EPO by the kidneys increases, which leads to an increase in erythropoiesis and an increase in the erythropoietic function of the bone marrow. The number of erythroblasts increases sharply. With large blood loss, the yellow bone marrow of tubular bones can be temporarily replaced by an active one - red, foci of extracerebral hematopoiesis appear.

Against the background of the main pathophysiological changes, several phases of the course of the disease are distinguished.

Reflex phase accompanied by spasm of peripheral vessels, which leads to a decrease in the volume of the vascular bed. Initially, blood flow to the vessels of the skin, subcutaneous tissue and muscles decreases. There is a redistribution of blood throughout the organs and systems - the centralization of blood circulation is carried out, which helps to compensate for the deficiency of the BCC. By turning off peripheral vessels from the circulation, blood flow is maintained in vital organs (brain and spinal cord, myocardium, adrenal glands). The compensatory mechanism leading to vasospasm is based on the additional release of catecholamines by the adrenal glands, which have a pressor effect. With insufficient blood circulation of the kidneys, the secretion of renin by the cells of the juxtaglomerular apparatus (JGA) increases. Under the influence of renin, angiotensinogen is formed in the liver, which narrows the vessels, stimulates the secretion of aldosterone by the adrenal glands, which activates sodium reabsorption in the proximal tubules of the kidneys. For sodium, water returns to the blood plasma. Retention of sodium leads to increased reabsorption of water in the tubules and a decrease in urination. The secretion of aldosterone activates hyaluronidase, which causes depolymerization of hyaluronic acid, pores are formed in the basement membrane of the collecting ducts and water goes into the interstitial tissue of the medulla of the kidney. This is how water is retained in the body. A decrease in renal blood flow and its movement from the cortical layer to the medulla by the type of juxtaglomerular shunt occurs due to spasm of the vessels of the glomeruli, excluded from the circulation. As a result of hormonal changes and a decrease in renal blood flow, filtration in the renal glomeruli stops and the formation of urine is disrupted. These changes lead to a sharp decrease in urine output with a subsequent drop in blood pressure (BP) in the glomeruli below 40 mm Hg. Art.

The reflex phase, according to various sources, lasts 8-12 hours and rarely more.

Laboratory indicators ... A decrease in the total volume of the vascular bed leads to the fact that, despite the absolute decrease in the amount of erythrocyte mass, the hemoglobin and erythrocyte indices per unit of blood volume approach the initial figures and do not reflect the degree of anemization, the hematocrit value does not change, while the BCC is sharply reduced. Immediately after blood loss, latent anemia occurs, the number of leukocytes rarely exceeds 9.0-10.0 x 10 9 / l. Leukopenia and neutropenia are more common. During the period of bleeding, due to the high consumption of platelets, which are mobilized to stop it, their content may decrease.

Compensation phase (hydraemic) develops 2-3 hours after blood loss, is characterized by the mobilization of interstitial fluid and its entry into the bloodstream. These changes do not immediately cause "thinning" of the circulating blood. Immediately after blood loss, "latent anemia" occurs. The post-hemorrhagic period is accompanied by the release of erythrocytes from the depot and an increase in BCC, followed by a decrease in blood viscosity and an improvement in its rheology. This adaptive mechanism is termed "autohemodilution reaction". Thus, conditions are created for the restoration of central and peripheral hemodynamics and microcirculation.

Hemodilution phase depending on the size and duration of blood loss, it can last from several hours to several days. It is characterized by an increase in the permeability of the vessel walls, which leads to the entry of tissue fluid into the bloodstream. The inflow of tissue fluid restores the BCC and contributes to a simultaneous uniform decrease in the amount of hemoglobin and erythrocytes per unit of blood volume.

The body easily tolerates blood loss in 10-15% of the BCC, up to 25% of the BCC - with minor hemodynamic disturbances. With blood loss of more than 25%, their own adaptation mechanisms turn out to be untenable. The loss of about 50% of circulating red blood cells is not fatal. At the same time, a 30% decrease in the volume of circulating plasma is incompatible with life.

Prolonged spasm of peripheral vessels (lack of autohemodilution) with large blood loss can lead to impaired capillary blood flow.

When blood pressure falls below 80 mm Hg. Art. blood accumulates in the capillaries, the speed of its movement slows down, which leads to the formation of aggregates from erythrocytes (sludge syndrome) and stasis. As a result of changes in capillary blood flow, the formation of microclots occurs, which leads to a violation of microcirculation, with the subsequent development of hemorrhagic shock and irreversible changes in organs.

Laboratory indicators ... Anemia developing 1-2 days after blood loss is normochromic: the color index is close to 1.0. The saturation of erythrocytes with hemoglobin and its concentration in one erythrocyte depend on the presence of iron reserves in the body. An increase in the number of reticulocytes takes place already from the third day, as a result of the activation of bone marrow hematopoiesis, reaching a maximum on days 4-7. If the number of reticulocytes does not decrease by the beginning of the second week, this may indicate ongoing bleeding. At the height of the hydraemic stage, the macro-erythrocyte shift in the blood reaches a maximum, but it is not sharply expressed, and the average diameter of erythrocytes does not exceed 7.4-7.6 microns.

The severity of anemia is diagnosed by indicators of hemoglobin, erythrocytes, reticulocytes, iron metabolism (concentration of serum iron, TIBC, plasma ferritin, etc.).

The greatest changes in hematological parameters of peripheral blood are usually observed 4-5 days after blood loss. These changes are due to the active proliferation of bone marrow elements. The criterion for the activity of hematopoiesis (erythropoiesis) is the increase in the peripheral blood of the number of reticulocytes up to 2-10% or more, polychromatophiles. Reticulocytosis and polychromatophilia, as a rule, develop in parallel and indicate enhanced regeneration of erythrokaryocytes and their entry into the blood. The size of red blood cells after bleeding increases slightly (macrocytosis). Erythroblasts may appear. On 5-8 days after bleeding, moderate leukocytosis usually occurs (up to 12.0-20.0 x 10 9 / l) and other indicators of regeneration - stab shift (less often to myelocytes). Persistent leukocytosis occurs in the presence of an associated infection. The platelet count increases to 300-500 x 10 9 / l. Sometimes, within a few days, thrombocytosis of up to 1 million is observed, indicating a large blood loss.

With small blood loss, the deposited iron enters the bone marrow, where it is consumed for the synthesis of hemoglobin. The degree of increase in serum iron depends on the level of reserve iron, the activity of erythropoiesis and the concentration of plasma transferrin. With a single acute blood loss, there is a transient decrease in the level of serum iron in plasma. With large blood loss, serum iron remains low. Deficiency of reserve iron is accompanied by sideropenia and the development of iron deficiency anemia. The degree of anemia is influenced by the volume and rate of blood loss, the time from the moment of bleeding, the reserve of iron in the depot organs, the initial number of erythrocytes and hemoglobin.

Tissue hypoxia, which develops during blood loss, leads to the accumulation of under-oxidized metabolic products in the body and to acidosis, which at first has a compensated character. The progression of the process is accompanied by the development of uncompensated acidosis with a decrease in blood pH to 7.2 and below. In the terminal stage, alkalosis joins acidosis. The tension of carbon dioxide (pCO 2) is significantly reduced as a result of hyperventilation of the lungs and the binding of plasma bicarbonates. Respiratory quotient increases. Hyperglycemia develops, the activity of the enzymes LDH and aspartate aminotransferase increases, which confirms the damage to the liver and kidneys. In serum, the concentration of sodium and calcium decreases, the content of potassium, magnesium, inorganic phosphorus and chlorine increases, the concentration of the latter depends on the degree of acidosis and may decrease with its decompensation.

In some diseases, accompanied by a large loss of fluid (diarrhea with ulcerative colitis, vomiting with gastric ulcer, etc.), a compensatory hydraemic reaction may be absent.

Chronic post-hemorrhagic anemia

Hypochromic normocytic anemia, which occurs with prolonged moderate blood loss, for example, with chronic gastrointestinal bleeding (with stomach ulcers, duodenal ulcers, hemorrhoids, etc.), as well as with gynecological and urological diseases, will be described below in the section "Iron deficiency anemia".

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Posthemorrhagic anemia is caused by a single factor - blood loss. It occurs more often than others, since it accompanies injuries, chronic diseases, complicated by bleeding. Treatment of this pathology is impossible without reimbursing the lost corpuscles (erythrocytes, all types of leukocytes, platelets), plasma with protein and microelements.

Changes in the body with blood loss

It is accepted to measure the severity of anemia by a decrease in the level of hemoglobin and the onset of hypoxia (oxygen deficiency) of tissues.

But the clinical course and symptoms of post-hemorrhagic anemia are largely due to a lack of iron, copper, magnesium, potassium, loss of protective functions (drop in immunity), and increased sensitivity to any allergens.

The critical volume for blood loss is 500 ml. This is the maximum amount of vital substances that a healthy body is able to gradually restore without treatment on its own. It is allowed to donate to donors, if necessary.

Small arteries are the first to react to a reduced volume of circulating blood; they spasm in agreement with the sympathetic part of the autonomic nervous system. This is a reflex reaction aimed at maintaining blood pressure at the proper level. However, peripheral resistance increases significantly. Due to a drop in venous blood flow, the heart begins to contract more often, trying to maintain the required minute volume.

The loss of essential trace elements affects myocardial function, the rate of contraction and strength decreases. An ECG at this time can reveal signs of hypoxia and impaired conduction.

Shunts open between small arteries and veins, blood rushes through the anastomoses, bypassing the capillary network. The blood supply to the skin, muscles, and kidney tissue immediately deteriorates. This mechanism allows you to protect the local blood supply to the heart and brain, even with a loss of 10% of the circulating blood volume.

Plasma deficiency is restored rather quickly due to interstitial fluid. The main fatal disorders remain at the level of microcirculation. A significant decrease in blood pressure helps to slow down blood flow in the capillaries, thrombosis and complete closure.

In the severe stage of hemorrhagic changes, microthrombi block arterial glomeruli in the renal tissue, reduce the filtration of fluid through them, this sharply reduces the flow of urine. In parallel, the blood flow in the liver decreases. Long-term irreparable acute post-hemorrhagic anemia can lead to liver failure.

As a result of general hypoxia, under-oxidized substances accumulate in the tissues, which act as poisons on the cells of the brain, causing a shift towards acidosis (acidification by toxins). In severe anemia, alkaline reserves are reduced and metabolic acidosis cannot be compensated for.

Despite a decrease in the number of platelets, blood clotting is accelerated due to a reflex increase in the concentration of certain factors

This condition lasts for several days. Then the general clotting is normalized. Thrombohemorrhagic syndrome may occur due to the growth of procoagulant substances.

Pathological changes require urgent corrective measures to eliminate the causes that caused them.

Types of posthemorrhagic anemia

Clinical classification identifies 2 forms of anemia associated with blood loss:

acute post-hemorrhagic anemia - occurs against the background of rapid massive blood loss during trauma, external and internal bleeding, during surgery when large vessels are injured;
chronic - accompanies diseases with frequent moderate bleeding (hemorrhoids, peptic ulcer), typical for girls and women with menstrual irregularities, uterine fibromatosis, less often accompanied by nosebleeds.

According to the severity of clinical manifestations, it is customary to take into account the hemoglobin content in the blood and distinguish between:

mild, if hemoglobin is above 90 g / l;
medium degree with a hemoglobin level of 70 to 90 g / l;
severe - hemoglobin index from 50 to 70 g / l;
extremely severe - the amount of hemoglobin is below 50 g / l.

According to ICD-10 (International Classification of Diseases), acute post-hemorrhagic anemia is assigned to the group "Aplastic and others" with the code D62.

As separate conditions associated with the established cause of blood loss, there are:

congenital anemia in the fetus due to blood loss with a code P61.3;
chronic post-hemorrhagic anemia as secondary iron deficiency with D50.0 code.

More about the causes of acute and chronic blood loss

The most common causes of anemia are:

injuries with damage to large vessels of the arterial type;
unforeseen complication of surgical interventions;
pathology of the obstetric and gynecological profile (uterine bleeding with ovarian dysfunction, uterine tumors, ectopic pregnancy, complications in difficult childbirth);
peptic ulcer and 12 duodenal ulcer;
cirrhosis of the liver with portal hypertension and bleeding from the veins of the esophagus;
chronic lung pathology (tuberculosis, bronchiectasis);
chronic hemorrhoids.

Bleeding from an ulcer depends on its location, the internal curvature of the stomach is more injured by food

Signs of acute post-hemorrhagic anemia appear immediately against the background of massive bleeding and after stopping:

the patient has a pale skin color, bluish lips;
covered with sticky cold sweat;
complains of severe weakness, dizziness;
fainting conditions are possible;
worried about nausea, rare vomiting;
tongue dry;
heart palpitations, extrasystoles;
weak threadlike pulse;
muffled heart sounds on auscultation;
blood pressure is lowered;
breathing is shallow, rapid;
body temperature is below 36 degrees.

Patients complain about the lack of fresh air, they can hardly tolerate the heat

With different types of bleeding, you can find:

loose bloody stools (from stomach ulcers);
bloody sputum with bright scarlet blood emitted by a stream when coughing (from the pulmonary arteries);
growing swelling at the site of injury, fracture (internal hematoma);
discharge from the uterus in women.

Internal bleeding is difficult to diagnose. Doctors rely on the general condition of the patient.

Stages of the acute form of anemia

The clinic of acute post-hemorrhagic anemia goes through 3 stages:

Vascular reflex- is determined by the inclusion of compensatory mechanisms of self-defense, the opening of arteriovenous anastomoses. There is a drop in blood pressure, pallor of the skin, tachycardia, shortness of breath.
Hydremia stage - begins in 3-5 hours. Liquid enters the plasma from the intercellular spaces and "floods" the vascular bed. Lasts 2-3 days. The number of erythrocytes and hemoglobin in the blood falls.
Stage of bone marrow changes- begins on the 4th - 5th day after the injury. It is caused by the development and progression of hypoxia. Blood erythropoietin and reticulocyte levels increase. By nature, new red blood cells are defined as hypochromic. Leukocyte formula is shifted to the left. Plasma iron levels fall.

Treatment and full recovery of indicators will take at least two months.

With menopause, uterine bleeding is accompanied by hormonal changes

Signs and course of the chronic form

Chronic post-hemorrhagic anemia develops after several months or years. Since the basis of pathological changes is the loss of iron, this form rightly refers to iron deficiency states. Symptoms do not differ from the manifestations of a lack of iron in the diet:

the skin is pale, dry;
the face is swollen;
altered taste sensations and attitudes towards smells;
dull hair, falls out intensively;
brittle, flattened nails;
excessive sweating;
complaints of fatigue, headaches, nausea;
frequent dizziness;
palpitations;
body temperature is slightly above 37 degrees.

Diagnostic methods

Diagnostics aims not only to identify the type of anemia, but also to establish the presence of a bleeding organ or tissues in a chronic process. Therefore, detailed blood tests and additional tests are equally important.

What is found in blood tests?

In case of acute blood loss, the patient must be taken to the hospital, where it is possible to assess the degree of danger of blood loss to a person's life. Changes in the general analysis may indicate the duration of bleeding:

in the first hour - the number of platelets increases, the level of erythrocytes and hemoglobin is within normal limits;
after 2-3 hours - with preserved thrombocytosis, neutrophilia appears, blood clotting is sufficient, the number of erythrocytes and hemoglobin falls, anemia is assessed as normochromic;
after 5 days - the number of reticulocytes increases, a low iron content in the plasma is determined.

In chronic bleeding, oval erythrocytes, leukopenia with lymphocytosis are found in a blood smear. Biochemical tests show the loss of not only iron, but also copper, calcium, and an increase in manganese.

Additional data

To find the place of bleeding, be sure to carry out:

analysis of feces for occult blood and helminths;
fibrogastroscopy is necessary to exclude gastric bleeding from an ulcer, a disintegrating tumor;
colonoscopy - examination of the lower intestines;
sigmoidoscopy - for visual confirmation of the integrity of internal hemorrhoids;
women must be consulted by a gynecologist.

Ultrasound and Doppler studies allow to specify the cause of blood loss.

Treatment

Treatment of the acute form is carried out in the hospital against the background or immediately after the provision of emergency care and the control of bleeding.

To replenish the volume of circulating blood, artificial blood substitutes (Polyglyukin, Gelatinol) are transfused, in severe cases they begin to be injected in a stream. With an increase in blood pressure up to 100/60 mm Hg. Art. continue drip transfusion.

Intravenous catheter allows long-term infusion of fluids with medications

If the patient is in shock, large doses of prednisolone are administered.

Tissue acidosis is removed with a soda solution. Despite the blood loss, Heparin is prescribed to relieve thrombosis at the capillary level. The patient is supplied with humidified oxygen into the breathing tubes.

The question of replacement transfusion of donor blood or erythrocyte mass is decided individually. If the surgical blood loss is less than 1000 ml, then transfusion is considered contraindicated. The procedure can cause complications such as intravascular coagulation syndrome or immune conflict.

Chronic post-hemorrhagic anemia can be treated on an outpatient basis in the absence or exacerbation of the underlying disease. If the cause of the blood loss has been established, then planned surgery may be required.

The patient's diet must necessarily contain foods high in iron, vitamins C, B 12, folic acid.

When treating children, it is imperative to provide the necessary nutrition (complementary foods from 6 months of age). If a child plays sports, then the need for iron increases.

Immunity support is mandatory during the recovery period. People with post-hemorrhagic anemia are susceptible to infection by various microorganisms. For this purpose, you need a complex of vitamins with trace elements, long-term intake of immunostimulants (aloe extract, ginseng root, lemongrass).

Forecast

Fast delivery to the hospital and the beginning of hemostatic measures contribute to the successful recovery of the patient. With a large blood loss from large arteries in the absence of help, the patient dies.

Chronic post-hemorrhagic anemia can be cured only by eliminating the cause. The patient needs to monitor for signs of exacerbation, to start preventive treatment in a timely manner, not to postpone the possibility of an operation if doctors suggest it.

The success of the treatment of complications after blood loss depends on the timeliness of seeking medical help.