Treatment of posthemorrhagic anemia. Posthemorrhagic anemia. Acute posthemorrhagic anemia

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

The principle of anemia development

Blood contains a lot various cells, which perform separate functions. Among them are red blood cells - red blood cells containing hemoglobin. They perform an important role: they deliver oxygen from the lungs to different parts of the human body.

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

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

The danger of this condition is that a prolonged lack of red blood cells against the background of a reduced amount of blood can cause not only oxygen starvation and vascular insufficiency, but also the development malignant tumors, degeneration of tissues and organs, as well as provoke hematopoietic diseases. This process is most dangerous during pregnancy, when it harms not only the health of the mother, but also her unborn child.

Causes of posthemorrhagic anemia

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

In women it may be following reasons development:

ectopic pregnancy;
heavy periods;
uterine bleeding;
birth injuries.

Classification of the disease

There are 2 types of posthemorrhagic anemia:

acute;
chronic.

Acute red cell deficiency suggests a sharp decline hemoglobin. This form of posthemorrhagic anemia occurs due to blood loss due to trauma or surgery, when a person loses 1/8 or more of the total volume.

In what cases is blood transfusion indicated for low hemoglobin:

Stages of development of the acute form

Doctors distinguish several stages in the development of acute posthemorrhagic anemia:

Features of chronic posthemorrhagic anemia

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

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

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

Degrees of anemia: mild, moderate, severe

Anemia has 4 degrees of severity. This type of classification is based on the level of hemoglobin in the patient’s blood:

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

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

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

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

congenital anemia of the fetus due to blood loss;
chronic posthemorrhagic anemia due to iron deficiency.

Symptoms of the disease

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

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

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

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

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

The patient may find the following manifestations illness:

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

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

What is the reason for the appearance of bloody discharge between periods:

Diagnosis of anemia, including blood tests

Anemia is diagnosed only after bleeding has stopped. Moreover, parallel to any possible way replenish the volume of lost blood (if necessary).

Initially for maximum effect To bring the patient out of shock and increase blood pressure to normal, doctors transfuse at least 500 ml of plasma substitute. The initial administration of Polyglyukin is carried out in a stream, and when the systolic pressure reaches 100, the injection is replaced with a drip. Sometimes the dose of the administered solution can reach two liters.

Only after all the necessary manipulations do doctors begin diagnosing the patient’s anemic condition.

Of course, an obligatory stage of diagnosis is collecting anamnesis and identifying possible reasons underlying the disease. The diagnosis itself is made on the basis of a combination of studies: clinical and laboratory.

Basic methods

The diagnosis of posthemorrhagic anemia is based on basic research:

general and biochemical analysis blood;
Analysis of urine.

When detecting the presence of posthemorrhagic anemia laboratory research blood will show:

decreased hemoglobin content with a slight decrease in red blood cells;
decrease in the level of saturation of red blood cells with hemoglobin;
decreased serum iron levels;
increased erythrocyte sedimentation rate;
decreased platelet count.

Additional examination

To detect the site of hidden bleeding, use additional methods diagnostics:

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

In some cases, for staging accurate diagnosis Cytological and histological examination is required bone marrow.

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

hematologist;
surgeon;
traumatologist;
gynecologist;
proctologist;
gastroenterologist

Treatment of acute anemia

Very often in cases with posthemorrhagic anemia, “delay is like death.” If medical assistance for acute blood loss is not provided in a timely manner, the outcome will be disastrous. When a person quickly loses more than a quarter of their blood volume, death can occur.

Surgery is immediately performed at the site of the damaged organ or body part to stop bleeding.

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

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

Drugs to compensate for blood loss - photo gallery

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

The use of glucose solution is highly undesirable. If blood loss is more than 20%, then the patient is transfused with a mixture of red blood cells and a plasma substitute. various combinations.Pure donor blood is used very rarely. You cannot immediately replace all blood loss, as this can cause “massive transfusion syndrome,” that is, the development of intravascular coagulation or immunoconflict is possible. For correction water-salt balance intravenous administration of sodium chloride solution is prescribed in the body. It is imperative to use iron-containing preparations for acute anemia:

Feramid. Active substances: nicotinamide and ferric chloride. Iron levels are low. For maximum effectiveness, additional intake of ascorbic acid is required.
Ferroplex. This is a combination of ferrous sulfate and vitamin C. It is easily tolerated and has minimal restrictions for use.
Ferroceron. Active substance - sodium salt orthocarboxybenzoylferrocene. Highly effective. When taking it, it is necessary to exclude fermented, sour and pickled foods from the diet.
Conference. The activity of the drug is based on the action of sodium dioctyl sulfosuccinate and ferrous sulfate. Easily absorbed. Does not require additional intake ascorbic acid.

After obvious manifestations of anemia cease, iron supplements are taken at half the dose for another six months.

If the patient is in shock, large doses of Prednisolone are used. Promotion pH value in tissues helps to remove baking soda solution. Heparin is used to eliminate thrombus formation at the level of capillary vessels. Sometimes it is necessary to connect humidified oxygen through a breathing tube.

Therapy for chronic posthemorrhagic anemia

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

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

Vikasol;
Dicynone;
Etamsylate;
hemostatic collagen sponge;
Ambien;
Tobarpin;
Thrombin;
Prothrombin complex.

Blood transfusions and the use of blood substitutes are rarely used. As with acute form Iron supplements and vitamins are used to treat chronic anemia. Appointed symptomatic therapy, aimed at eliminating dysfunctions in the body.

Aspects of anemia treatment - video

Application of traditional medicine

One should not hope to cure anemia with only folk remedies. They can only be used as an addition to the main treatment. But before starting therapy, you need to consult a doctor. Most often doctors recommend using:

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

Nutrition for anemia

An addition to the treatment of posthemorrhagic anemia is special diet. The patient's diet should consist of foods containing high content gland:

fresh and boiled vegetables;
lean varieties of beef and pork;
rabbit meat;
veal;
liver;
cottage cheese;
egg white;
greenery;
sea fish.

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

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

Disease prevention

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

Prevention of the development of posthemorrhagic anemia involves, first of all, maintaining a healthy lifestyle, observing safety rules in any field of activity and at home and timely treatment all current diseases.

Don't forget about good nutrition. Products should be rich in micro- and macroelements and vitamins.

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

Prognosis for successful recovery

Extremely quick help physicians and appropriate hemostatic measures contribute to a favorable outcome. If there is a large loss of blood, the patient may die. Slow but massive blood loss leads to various complications, but it is less dangerous.

The prognosis for the success of treatment of acute posthemorrhagic anemia depends not only on the amount of blood loss itself, but also on the speed of bleeding.

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

Posthemorrhagic anemia is a disease that requires mandatory medical intervention. Only correct and timely treatment will help save a person from serious complications.

Anemia is a blood pathology characterized by a low hemoglobin content, which is most often accompanied by a general decrease in red blood cells. In medicine, it is generally accepted that the diagnosis “anemia” is not an entirely independent disease. It is considered a symptom of many absolutely various diseases. It’s rare that someone has never encountered this diagnosis throughout their entire life. may be mild or extremely severe. The danger of any type of anemia is that a decrease in hemoglobin will have a strong effect on the body oxygen starvation all its fabrics and internal organs. Although anemia is a symptom, International classification diseases in the 10th revision (ICD 10) assigned anemia its own code - D62.

Distinctive signs of posthemorrhagic anemia

Acute posthemorrhagic anemia is the most common medical practice type of iron deficiency anemia. It is distinguished from other types of anemia by the cause of its occurrence - posthemorrhagic anemia occurs only as a result of critical blood loss due to internal or external bleeding. Acceptable rate blood loss for an adult does not exceed 500 ml. This norm is determined by the ability of the injured person’s body to independently replenish both the volume of blood and its qualitative composition. The loss of half the blood volume threatens a person with death and requires emergency measures to save the patient's life.

The body's response to severe blood loss

Blood consists of a liquid component - plasma and the cells of leukocytes, platelets and erythrocytes suspended in it. The volume of blood is always approximately constant and occupies 6–8% of the total mass of a person. Blood is a rapidly renewed tissue, new elements of which are produced in the bone marrow. It circulates in the human body through a closed system of blood vessels as a result of pulsating contractions of the heart muscle. If for any reason a loss occurs large quantity blood, the body begins to react immediately.

The first reaction will be maximum maintenance, and all small arteries will instantly go into spasm. The heart begins to beat faster because it doesn’t have enough blood to normal functioning. The person begins to experience a severe lack of oxygen. A backup mechanism is activated - the opening of shunts between small arteries and veins. The capillaries completely stop functioning. The body tries to save the functioning of the brain and heart; for these purposes, all possible mechanisms are activated to maintain the required amount of fluid in the vessels, and the spinal cord also begins to work in an enhanced mode.

The plasma itself is restored quite quickly, but the problem remains at the level of the blood supply to the capillaries. In acute hemorrhagic processes, patients quite often experience thrombosis, and sometimes their complete closure. Complications of this kind can spread to the kidney tissue, which, in turn, leads to renal failure. In severe anemia, a state of metabolic acidosis develops.

Causes of posthemorrhagic anemia

Anyone can experience this disease throughout their life. Acute posthemorrhagic anemia has different reasons occurrence, but contains one common symptom - heavy blood loss:

IN modern medicine accepted next classification posthemorrhagic anemia, which is based on the process of blood loss:

Acute posthemorrhagic anemia. In cases where, regardless of the cause, a person loses a very large volume of blood, acute stage anemia. A large volume is considered to be the loss of an eighth of all human blood.
Chronic posthemorrhagic anemia. It is observed in people suffering from diseases that are complicated by constant and fairly heavy blood loss. Such diseases may include pulmonary tuberculosis, peptic ulcers internal organs, gynecological disorders, etc.

Any acute form of posthemorrhagic anemia goes through the following stages:

Stage of vascular reflex changes. During the initial period of blood reduction in the blood vessels, processes responsible for emergency blood compensation are activated to protect the victim’s heart and brain.
The hydremic stage occurs on the second day. Characterized by gradual filling blood vessels tissue fluid and plasma replenishment. Tests usually show a sharp decrease in red blood cells and hemoglobin.
Bone marrow stage - occurs approximately on the 4th - 5th day. There is a greatly reduced iron content in the patient’s blood, but the number of young forms of red blood cells noticeably increases. Provided there are no repeated bleedings, normalization of blood composition occurs after about 3 weeks.

Since the amount of blood loss can vary, doctors divide posthemorrhagic anemia into the following degrees of severity:

Mild degree - hemoglobin level remains above 90 g/l.
Moderate - hemoglobin ranges from 70 to 90 g/l.
Severe degree - the hemoglobin level remains slightly above 50 g/l.
Extremely severe degree - hemoglobin level drops below 50 g/l.

Depending on the severity, treatment methods will be chosen in the future.

If the blood loss was too massive in volume or long in time, posthemorrhagic anemia leads to the depletion of all adaptive capabilities of the body and the development of shock.

Symptoms characteristic of posthemorrhagic anemia

In the case when anemia begins to develop as a result of external trauma with obvious blood loss, then everything is extremely clear for the victim and his environment, but when internal bleeding diagnosis is quite difficult. For a correct initial diagnosis, other signs that appear almost immediately are also important.

Signs characteristic of posthemorrhagic anemia:

the skin acquires a pale, sometimes bluish tint, the cyanosis is especially noticeable on the patient’s lips and nails;
with very severe blood loss, cases of loss of consciousness are common;
the patient becomes covered in sticky sweat;
a feeling of dryness appears in the mouth;
Symptoms of nausea and vomiting are quite common;
the victim’s body temperature drops below 36;
breathing becomes rapid and shallow;
in patients, blood pressure drops sharply;
the heartbeat increases greatly, and the pulse becomes thread-like and difficult to hear.

Depending on the disease common features Other symptoms characteristic of a diagnosis of chronic posthemorrhagic anemia may also occur, for example:

for lung diseases – bloody discharge when coughing;
for diseases of the stomach or intestines - abundant blood in the stool;
gynecological problems are characterized by bleeding from the uterus;
with fractures, signs of severe swelling often appear, this indicates the appearance of an internal hematoma.

With chronic bleeding, the signs of anemia are somewhat different. These include:

pale and dry skin;
nails become brittle and flat;
hair begins to fall out profusely;
sweating increases;
man complains about constant fatigue, headaches, dizziness and nausea;
the temperature rises slightly;
increased sensitivity to odors;
taste sensations change;
appear frequent attacks rapid heartbeat.

Diagnostics

If there is a suspicion of severe blood loss, the patient mandatory delivered to medical institution, where he is prescribed certain studies. The results of blood tests will be quite revealing.

The next step is to determine where the bleeding is occurring and find out why it happened. Additional examinations may include:

ultrasound examination;
Doppler study;
stool analysis is performed to look for blood or signs of helminthiasis;
gynecological examination of women;
fibrogastroscopy is performed if stomach problems are suspected;
colonoscopy.

Treatment

The main task in the treatment of anemia is to restore normal composition blood

After emergency hospitalization, the patient is given first aid emergency assistance to maintain the life of the victim. The first need of the body at this stage is to maintain the required amount of fluid in the vessels of the patient’s body. For these purposes, transfusion of artificial blood substitutes is usually used. First, the drugs are administered in a stream, and then, after normalization of the pressure, the transfusion is continued in a drip mode. IN severe cases, in cases of shock, Prednisolone is often administered in large doses. In parallel, patients are administered drugs to prevent blood clotting. This will prevent thrombosis small vessels. Application of transfusion donated blood or its components in each individual case is an individual matter. The doctor takes into account the risks of blood incompatibility, which can cause a number of unwanted complications.

In some cases, when chronic posthemorrhagic anemia is diagnosed and if a mild degree is diagnosed, treatment on an outpatient basis is allowed.

After passing a life-threatening period to eliminate posthemorrhagic anemia, the doctor will be faced with the task of restoring the normal composition of the blood. For this purpose complexes are prescribed vitamin preparations, products that restore iron levels and. Immunostimulants are prescribed if it is necessary to maintain the patient’s immunity.

Important to remember

Posthemorrhagic anemia is only a symptom of blood loss. At heavy blood loss It is necessary to immediately seek medical help - elimination of blood loss in such an amount is only possible in a hospital. Treatment of posthemorrhagic anemia itself is a rather lengthy but well-studied process. If you suspect chronic blood loss, do not delay your visit to the doctor and refuse surgical treatment, if it is suggested to you by your attending physician.

Posthemorrhagic anemia is a pathology that in medicine belongs to the category of iron deficiency. The cause of its development may be a severe injury with significant bleeding or the presence of a lesion in the body chronic blood loss. Posthemorrhagic anemia can be acute or chronic. The acute form of posthemorrhagic anemia is an option in which the pathology develops against the background of heavy bleeding, while chronic form- this is the result of systematic, but not heavy bleeding.

In the presence of bleeding in the body, a rapid decrease in the volume of circulating blood and, first of all, its plasma is observed. Accordingly, there is a sharp drop in the level of red blood cells, which leads to the development of acute hypoxia and then anemia, which belongs to the group of post-hemorrhagic.

Symptoms

When collecting complaints and anamnesis, the doctor receives the following clinical picture: the patient experiences weakness of the body, strong and frequent dizziness, which can reach fainting. Also, with posthemorrhagic anemia, nausea is observed, and in the acute form of the condition, vomiting may occur. During the course of pathology in the body, trophic disorders, accordingly, structural pathological changes occur in the skin, hair and nails.

At this option anemia, shortness of breath, angina-type heart pain, and muscle weakness can often be observed. Patients quite often complain of dry mouth and difficult to quench thirst, flashing spots before the eyes, and tinnitus. The clinical picture of this type of anemia also includes a sharp decrease in body temperature.

At heavy bleeding symptoms of hemorrhagic shock may develop.

Diagnostics

The presence of posthemorrhagic anemia can only be determined using laboratory methods blood tests. When diagnosing, it is also worth taking into account the patient’s medical history, complaints and results. instrumental studies, which determine the location of the source of bleeding. To the number instrumental methods diagnostics in this case include fibrogastroduodenoscopy and colonoscopy.

Prevention

First of all, you need to try to avoid the disease of posthemorrhagic anemia, therefore, you should avoid as much as possible any injuries that can cause blood loss and bleeding.

Prevention of the development of posthemorrhagic anemia also includes healthy image life and observance proper nutrition, in which the blood and all body systems receive the required amount of microelements and vitamins. The diet must contain iron-containing foods, namely, fresh fruits, lean red meat, legumes, fresh green vegetables, whole grain bread and herbs.

Treatment

The first stage of treatment for posthemorrhagic anemia is aimed at eliminating the source of bleeding and preventing shock. Next, you need to carry out treatment aimed at replenishing lost blood, while heparin must be replenished in the body and the level of red blood cells must be normalized. Thus, the volume of replenished blood should not exceed 3/5 of the volume of lost blood; the remaining deficit is replenished with the help of blood substitutes.

At the third stage of therapy, after stopping bleeding, blood loss is restored, and nothing threatens life, curative therapy with help iron-containing preparations and vitamin complexes.

After eliminating the symptoms of anemia, treatment with iron-containing drugs continues for another 6 months, but the amount taken medicines reduced by half.

Posthemorrhagic anemia - iron deficiency anemia, which develops after blood loss. Posthemorrhagic anemia develops as a result of the loss of a significant amount of blood into the external environment or into the body cavity. The leading pathogenetic link of these anemias is a decrease in the speed and total volume of blood, especially its circulating fraction, which leads to hypoxia, shifts in the acid-base state, and an imbalance of ions in and outside the cells. Depending on the rate of blood loss, acute (develops after heavy, acute bleeding) and chronic posthemorrhagic anemia (develops after prolonged, light bleeding) are distinguished.

Etiology

hemorrhagic diseases (thrombocytopathies, coagulopathy, disseminated intravascular coagulation syndrome, hemorrhagic vasculitis, leukemia, aplastic anemia, dysovarian menorrhagia in girls).
pulmonary hemorrhage, gastrointestinal bleeding

Pathogenesis

With rapid blood loss, the volume of circulating blood decreases (oligemic phase). In response to a decrease in the volume of circulating blood, a compensatory reaction occurs: excitation of the sympathetic nervous system and reflex vascular spasm, arterial-venous shunting, which initially helps maintain blood pressure, adequate venous inflow and cardiac output. The pulse is accelerated and weakened. The vessels in the skin and muscles are narrowed to the maximum, the vessels of the brain and coronary vessels are minimally narrowed, which ensures better blood supply to vital organs. As the process continues, the phenomena of posthemorrhagic shock begin.

Clinic

With posthemorrhagic anemia, clinically, the phenomena of acute vascular insufficiency due to sudden emptying of the vascular bed (hypovolemia) come to the fore: palpitations, shortness of breath, orthostatic collapse). The severity of the condition is determined not only by the quantity, but also by the rate of blood loss. There is a decrease in diuresis according to the degree of blood loss. Hemoglobin level and red blood cell count are not reliable indicators of the degree of blood loss.

In the first minutes, the Hb content may even be high due to a decrease in bcc. When tissue fluid enters the vascular bed, these indicators decrease even when bleeding stops. The color index, as a rule, is normal, since there is a simultaneous loss of both red blood cells and iron, that is, normochromic anemia. On the second day, the number of reticulocytes increases, reaching a maximum on days 4–7, that is, the anemia is hyperregenerative.

Diagnostics

In the diagnosis of posthemorrhagic anemia, information about acute blood loss that occurred due to external bleeding is taken into account; in the case of massive internal bleeding, the diagnosis is based on clinical signs in combination with laboratory tests (Gregersen, Weber), an increase in the level of residual nitrogen in bleeding from the upper gastrointestinal tract.

With external bleeding, the diagnosis is easy to make. In case of internal bleeding from an organ, collapse of another origin must be excluded.

Treatment

The most important thing is to eliminate the source of bleeding. Then the blood loss is replaced (depending on the severity of anemia - red blood cells, against the background of heparin administration). 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 (5% albumin solution, rheopolyglucin, Ringer's solution, etc.). The limit of hemodilution is considered to be a hematocrit of 30 and red blood cells of more than 3*10¹²/l. At the end of the acute period, treatment with iron supplements and vitamins B, C, E is necessary. After anemia is eliminated, iron supplements are prescribed in half the dose for up to 6 months.

Forecast

The prognosis depends on the cause of bleeding, speed, volume of blood loss, and rational therapy. With blood loss with a deficit of circulating blood volume of more than 50%, the prognosis is unfavorable.

Acute posthemorrhagic anemia

They develop as a result of injuries accompanied by a violation of the integrity of blood vessels, bleeding from internal organs, more often with damage to the gastrointestinal tract, uterus, lungs, heart cavities, after acute blood loss due to complications of pregnancy and childbirth. The larger the caliber of the affected vessel and the closer to the heart it is located, the more life-threatening the bleeding. Thus, when the aortic arch ruptures, it is enough to lose less than 1 liter of blood for death to occur due to a sharp drop in blood pressure and a deficiency in filling the cavities of the heart. Death in such cases occurs before bleeding of the organs occurs, and during autopsy of the corpses of the deceased, anemia of the organs is hardly noticeable. With bleeding from small vessels, death usually occurs when more than half of the blood is lost. total number blood. If the bleeding turns out to be non-fatal, then the blood loss is compensated by regenerative processes in the bone marrow. With acute blood loss (1000 ml or more) within a short time, signs of collapse and shock come first. Anemia begins to be detected hematologically only 1-2 days after blood loss, when the stage of hydremic compensation develops. In the first hours after acute blood loss, a decrease in blood clotting time can serve as a reliable indicator.

Clinical picture such anemia is characterized by pallor of the skin and visible mucous membranes, weakness, dizziness, tinnitus, cold sticky sweat, a sharp decrease in blood pressure and body temperature, blurred vision up to complete amaurosis (specific elements of the retina are very sensitive to anoxemia), frequent pulse of weak filling (thread-like), agitation, followed by fainting, sometimes vomiting, cyanosis, convulsions. A significant amount of iron is lost (500 mg or more). If blood loss is not quickly replaced, collapse (shock), decreased diuresis, anuria occur, and renal failure develops. As a result of a sharp decrease in the mass of red blood cells, the respiratory function of the blood decreases and oxygen starvation develops - hypoxia. The nervous system and sensory organs are especially sensitive in this regard.

Clinical picture in acute blood loss depends on the volume of blood lost, speed, and duration of bleeding. The severity of such anemia, especially in the initial stages of formation, is largely determined by a decrease in circulating blood volume (CBV). Based on this feature, the following degrees of blood loss are distinguished:

moderate blood loss - up to 30% of blood volume;

massive blood loss - up to 50% of the blood volume;

severe blood loss - up to 60% of blood volume;

fatal blood loss - over 60% of the blood volume.

For acute posthemorrhagic anemia, the following stages are distinguished:

Reflex-vascular stage, which develops in the first hours after blood loss, is characterized by a proportional decrease in the mass of erythrocytes and plasma. Blood pressure drops sharply, pallor of the skin and mucous membranes develops, tachycardia and tachypnea occur. Hypovolemia and hypoxia, occurring immediately after blood loss, activate the sympathoadrenal system, which leads to spasm peripheral vessels, the opening of arteriovenular shunts and the release of blood from the organs that deposit it. Those. The compensatory reaction of the body is reduced to bringing the volume of the vascular bed in line with the volume of circulating blood due to reflex vascular spasm, which prevents a further drop in blood pressure and helps maintain adequate venous return of blood to the heart. In the reflex-vascular stage, the content of erythrocytes, hemoglobin, and leukocytes practically does not change, since the total amount of blood decreases, and changes do not have time to occur in each unit of its volume. The hematocrit does not change either. This is due to the fact that during blood loss, equivalent volumes of plasma and red blood cells are simultaneously lost. Thus, despite the clear clinical picture, anemia during this period does not have any hematological manifestations and is hidden, latent in nature.

Hydremic stage develops in the next 3-5 hours (depending on blood loss), the volume of circulating blood is restored due to the entry of interstitial interstitial fluid into the vascular bed. Irritation of volume receptors due to hypovolemia triggers a standard reflex reaction aimed at maintaining a constant volume of circulating blood. The body increases the production of renin, angiotensin II, and aldosterone. An increase in aldosterone synthesis leads to sodium retention, and subsequently, through stimulation of ADH secretion, to water retention. All this leads to an increase in blood volume, but due to blood thinning, the number of red blood cells and hemoglobin per unit volume decreases. Simultaneously with the mobilization of tissue fluid into the blood, the production of plasma proteins by the liver increases. Protein deficiency is restored in 3-4 days. Anemia at this stage is normochromic. Phenomena of aniso- and poikilocytosis (pathological deviations in the size and shape of red blood cells) may be observed. The color index remains normal due to the fact that mature red blood cells that were in the vascular bed before blood loss circulate in the blood. The hematocrit begins to decline and reaches extremely low numbers 48-72 hours after blood loss, because the plasma volume is restored by this time, and the maturation of red blood cells is delayed. As for leukocytes and platelets, in the immediate hours after blood loss, redistribution leukocytosis and posthemorrhagic thrombocytosis can be observed due to the release of the deposited parietal pool of leukocytes and platelets into the blood. However, as hemodilution progresses, the number of leukocytes and platelets per unit volume of blood begins to decrease. The platelet content may also fall due to their consumption during the process of thrombus formation. The stage of hydremic compensation can last 2-3 days.

Bone marrow stage develops on the second and subsequent days (usually from 4-5 days), and as hypoxia progresses, it is characterized by activation of erythropoiesis. Detected big number young cells of the erythrocyte germ of hematopoiesis: polychromatophilic and oxyphilic erythrocytes. Increased proliferation of the erythroid germ causes an increase in reticulocytes in the blood, up to normoblasts. In mature erythrocytes circulating in the blood, morphological changes are detected - the appearance of anisocytes and poikilocytes, because acceleration of the entry of red blood cells into the blood is ensured by a jump through the stages of division. Red blood cells cannot be saturated with hemoglobin (hypochromia, i.e. color index below 0.85), since blood loss has led to loss of iron. Thrombocytosis and moderate neutrophilic leukocytosis develop with a regenerative shift to the left. Bone marrow cells of squamous and epiphyses tubular bones proliferate, the bone marrow becomes juicy and bright. Normalization of blood counts usually occurs after 3-4 weeks.

An example of a hemogram of a patient with acute posthemorrhagic anemia in the hydremic stage:

erythrocytes - 2.1·1012/l;

hemoglobin - 60 g/l;

color index - 0.86;

reticulocytes - 0.7%;

hematocrit - 0.19 l/l;

anisocytosis +;
ESR - 16 mm/h;
platelets - 250·109/l;
leukocytes - 5.0·109/l;
eosinophils - 1%;
basophils - 0%;
neutrophils:
stab - 3%;
segmented - 54%
lymphocytes - 38%;
monocytes - 1%

Hemogram of the same patient, who is in the bone marrow stage of acute posthemorrhagic anemia:

erythrocytes - 3.6·1012/l;

hemoglobin - 95 g/l;

color index - 0.79;

reticulocytes - 9.3%;

hematocrit - 0.30 l/l;

anisocytosis +;
poikilocytosis +;
polychromatophilia, single normocytes
ESR - 21 mm/h;
platelets - 430·109/l;
leukocytes - 17.0·109/l;
eosinophils - 1%;
basophils - 0%;
neutrophils:
stab - 19%;

segmented - 58%

lymphocytes - 11%;

monocytes - 2%

During treatment In acute posthemorrhagic anemia, priority measures include stopping bleeding and combating shock, and then restoring blood composition. Transfusion and replacement therapy. The patient is given a blood transfusion, blood substitutes such as polyglucin, albumin solution, and saline solutions, their volume depends on the amount of blood loss. Poliglyukin- a good plasma substitute, retained in the vascular bed for several days, ensuring stability of the circulating blood volume. Reopoliglyukin - the best remedy prevention and treatment of microcirculation disorders, reduces blood viscosity, causes disaggregation of erythrocytes and platelets, preventing thrombus formation. Indications for whole blood transfusion are only very massive blood losses. Due to the fact that blood loss is accompanied by adrenal insufficiency, it is necessary to administer corticosteroid hormones. After removing the patient from a serious condition, antianemic drugs are prescribed (iron supplements, a diet rich in proteins, vitamins, bioelements). In certain cases, surgery is indicated- ligation of a bleeding vessel, suturing of an ulcer, resection of the stomach, removal of a pregnant woman fallopian tube etc. In case of bleeding occurring with symptoms of painful shock, it is necessary first of all to strive to bring the body out of the state of shock. Along with the administration of morphine and cardiovascular drugs (strychnine, caffeine, strophanthin, etc.), intravenous infusion of polyglucin, plasma (regular or hypertonic) or other anti-shock fluids is indicated. An infusion of hypertonic plasma (160 ml) should also be carried out as an emergency measure so that in the future, at the first opportunity, a whole blood transfusion can be performed. The effectiveness of plasma infusions is determined by the content of hydrophilic colloids in it- proteins, which ensure its isotonicity in relation to the recipient’s plasma, which contributes to a long-term retention of transfused plasma in the recipient’s vascular system. This is the undeniable advantage of plasma infusions over saline infusions, the so-called saline solution. The latter, when administered intravenously even in large quantities (up to 1 liter), is essentially ballast, since it almost does not linger in the bloodstream. Particular caution should be given to the practice of subcutaneous infusion of saline solution, which does not have any effect on disrupted hemodynamics and only leads to tissue edema.

Forecast depends on the duration of bleeding, the volume of lost blood, the body’s compensatory processes and the regenerative capacity of the bone marrow. A known difficulty is the diagnosis of the underlying disease in the case of bleeding from an internal organ, for example, during an ectopic pregnancy. In these cases, the syndrome of acute anemia, supported by a laboratory blood test, serves as a guiding thread that leads the doctor to the correct diagnostic path. The prognosis of acute posthemorrhagic anemia (in the first moments) depends not only on the amount of blood loss, but also on the rate of blood flow. The most extensive blood losses, even the loss of 3/4 of all circulating blood, do not lead to death if they occur slowly over a number of days. On the contrary, a rapid loss of 1/4 of the blood volume causes a state of dangerous shock, and a sudden loss of half the blood volume is certainly incompatible with life. A drop in blood pressure below a critical figure (70-80 mm for systolic pressure) can be fatal due to developing collapse and hypoxia. As soon as normal blood supply to the vessels is restored due to tissue fluid, the prognosis for life becomes favorable (if re-bleeding does not occur). The time frame for restoring a normal blood picture after a single blood loss is very different and depends both on the magnitude of the blood loss itself and on individual characteristics, in particular on the regenerative ability of the bone marrow and the iron content in the body. If we take the amount of iron in the erythrocyte mass of the body to be 36 mg per 1 kg of body weight, then if, for example, 30% of the erythrocyte mass is lost, the body will lose 10.8 mg of iron per 1 kg. If we take the monthly intake of alimentary iron into the body as equal to 2 mg per 1 kg, then the restoration of normal iron content, and therefore hemoglobin, will occur within approximately 5.5-6 months. Persons who are weakened or anemic even before blood loss, even after a single small bleeding, become anemic for a longer period. Only vigorous therapy can bring their hematopoietic organs out of the torpid state and eliminate anemia.

Chronic posthemorrhagic anemia

They are a particular variant of iron deficiency anemia. They are associated with increasing iron deficiency in the body due to either a single but heavy blood loss, or minor but prolonged, often repeated bleeding as a result of rupture of the walls of blood vessels (with the infiltration of tumor cells into them, venous stagnation of blood, extramedullary hematopoiesis, gingivitis, ulcerative processes in the wall of the stomach, intestines, skin, subcutaneous tissue, cancer), endocrinopathies (dishormonal amenorrhea), with renal, uterine bleeding, hemostasis disorders (disturbance of its vascular, platelet, coagulation mechanisms during hemorrhagic diathesis). They lead to depletion of iron reserves in the body and a decrease in the regenerative capacity of the bone marrow. Often the source of bleeding is so minor that it goes unrecognized. To imagine how small blood losses can contribute to the development of significant anemia, it is enough to cite the following data: the daily amount of dietary iron required to maintain hemoglobin balance in the body is about 5 mg for an adult. This amount of iron is contained in 10 ml of blood. Consequently, the daily loss of 2-3 teaspoons of blood during defecation not only deprives the body of its daily need for iron, but over time leads to a significant depletion of the body’s “iron fund,” resulting in the development of severe iron deficiency anemia. All other things being equal, the easier the development of anemia will be, the less iron reserves in the body and the greater (in total) blood loss.

Clinic . The complaints of patients are mainly reduced to severe weakness, frequent dizziness and usually correspond to the degree of anemia. Sometimes, however, one is struck by the discrepancy between subjective state the patient and his appearance. The patient's appearance is very characteristic: sharp pallor with a waxy tint to the skin, bloodless mucous membranes of the lips, conjunctiva, puffy face, weakness, fatigue, ringing or noise in the ears, dizziness, shortness of breath, the lower extremities are pasty, sometimes general edema (anasarca) develops due to hydremia and hypoproteinemia. As a rule, patients with anemia are not malnourished, unless the malnutrition is caused by an underlying disease (stomach or intestinal cancer). Anemic heart murmurs are observed (palpitations even with slight physical exertion), most often a systolic murmur is heard at the apex, conducted to the pulmonary artery, and a “topping noise” is noted on the jugular veins.

Blood picture characterized by hypochromia, microcytosis, low color indicator(0.6 - 0.4), morphological changes in erythrocytes - anisocytosis, poikilocytosis, polychromasia; the appearance of degenerative forms of erythrocytes - microcytes and schizocytes; Leukopenia is characteristic (if there are no special moments contributing to the development of leukocytosis), a shift of the neutrophil series to the left and relative lymphocytosis, the platelet count is normal or slightly reduced. The number of reticulocytes depends on the regenerative capacity of the bone marrow, which is greatly reduced by depletion of stored iron. The next phase of the disease is characterized by a decline in the hematopoietic activity of the bone marrow - anemia takes on a hyporegenerative character. At the same time, along with the progressive development of anemia, an increase in the color index is observed, which approaches one; anisocytosis and anisochromia are observed in the blood: along with pale microcytes, more intensely colored macrocytes are found. The blood serum of patients with chronic posthemorrhagic anemia is pale in color due to the reduced bilirubin content (which indicates reduced blood breakdown).

Bone marrow of flat bones of normal appearance. In the bone marrow of tubular bones, the phenomena of regeneration and transformation of fatty bone marrow into red, expressed to varying degrees, are observed. Multiple foci of extramarrow hematopoiesis are often observed. Due to chronic blood loss, hypoxia tissues and organs, which causes the development of fatty degeneration of the myocardium (“tiger heart”), liver, kidneys, and dystrophic changes in brain cells. Multiple pinpoint hemorrhages appear in the serous and mucous membranes and in the internal organs.

Rice. 4. Blood in chronic posthemorrhagic anemia: 1 and 2 - schizocytes; 3 - segmented neutrophils; 4 - lymphocyte; 5 - platelets.

According to severity anemia may be

moderate severity (hemoglobin content from 90 to 70 g/l)

Bone marrow hematopoiesis In acute cases, previously healthy individuals often experience a normal physiological reaction to blood loss with the production of first immature, polychromatophilic elements, and then mature, fully hemoglobinized red blood cells. In cases of repeated bleeding, leading to depletion of the body’s “iron fund,” a violation of erythropoiesis is noted in the phase of hemoglobinization of normoblasts. As a result, some of the cells die without having time to bloom, or enter the peripheral blood in the form of sharply hypochromic poikilocytes and microcytes. Subsequently, as anemia becomes chronic, the initial intensity of erythropoiesis decreases and is replaced by a picture of its inhibition. Morphologically, this is expressed in the fact that the processes of division and differentiation of erythronormoblasts are disrupted, as a result of which erythropoiesis takes on a macronormoblastic character. The described functional disorders of hematopoiesis are reversible, since we are talking about a hyporegenerative (not hypoplastic) state of the bone marrow.

Treatment includes most early detection and eliminating the cause of blood loss, for example, excision of hemorrhoids, gastric resection for a bleeding ulcer, extirpation of a fibromatous uterus, etc. However, a radical cure of the underlying disease is not always possible (for example, with inoperable gastric cancer). As well as replenishing iron deficiency (iron supplements are recommended for 2 - 3 or more months under the control of erythrocyte hemoglobin and iron content in the blood serum). To stimulate erythropoiesis, as well as as replacement therapy, it is necessary to perform repeated blood transfusions, preferably in the form of red blood cell transfusions. The dosage and frequency of blood (packed red blood cell) transfusions vary depending on individual conditions, but are mainly determined by the degree of anemia and the effectiveness of therapy. With a moderate degree of anemia, medium-dose transfusions are recommended: 200-250 ml of whole blood or 125-150 ml of red blood cells with an interval of 5-6 days. In case of sudden anemia of the patient, blood transfusions are performed in higher dosages: 400-500 ml of whole blood or 200-250 ml of red blood cells with an interval of 3-4 days.

Hematopoiesis and blood destruction in posthemorrhagic anemia.

Acute posthemorrhagic anemia

http://medichelp.ru/posts/view/6145

http://anaemia. people. ru/postgem. htm

http://www.medchitalka.ru/klinicheskaya_gematologiya/anemii/19333.html

http://www.medical-enc.ru/1/anemia_1-2.shtml

Chronic posthemorrhagic anemia is a phenomenon caused by frequent and small blood losses. Which, in turn, causes iron deficiency in the body, as well as a decrease in red blood cells and a decrease in hemoglobin concentration.

This condition is divided into three types:

Acute posthemorrhagic anemia is characterized by a large amount of lost blood.
Secondary iron deficiency anemia, which occurs after blood loss.
In rare cases, congenital anemia occurs; it is observed in unborn children in the womb.

Secondary iron deficiency anemia is most often referred to as chronic posthemorrhagic anemia.

Causes of development of chronic posthemorrhagic anemia

Small but regular bleeding may accompany a person long years, allowing anemia to develop. Conditions such as:

Chronic or iron deficiency anemia leads to an acute lack of iron and hemoglobin. For normal operation the body needs a hemoglobin level in the range of 135-160 g/l, in male body and in women's, 120-140 g/l. IN children's body hemoglobin ranges from 150 to 200 g/l in accordance with his age. So, the symptoms:

The first symptoms of chronic posthemorrhagic anemia are incoming dizziness and the appearance of black spots before the eyes. A person gets tired quickly and against this background his skin acquires a pale tint, becomes thin and dry.
The next symptom is the patient’s loss of appetite, nausea occurs, and bowel movements are disrupted - diarrhea replaces constipation and vice versa. During this period, extraneous noise may appear in the patient's heart.
As the disease progresses, the condition worsens skin, it becomes thin and flaky. At the same stage of the disease, the hair becomes sick and brittle, and the nails split.
In a severe stage of anemia, the patient’s perception of taste is impaired, he begins to eat things that are not apparently edible, for example, chalk. He perceives odors inadequately, since the olfactory and taste receptors stop working correctly. At this stage of the disease, the patient’s teeth begin to rapidly deteriorate and caries develops.
Blood pressure becomes painfully low.

Diagnosis of chronic posthemorrhagic anemia

Diagnoses anemia of this type, using a blood test. The blood picture is compiled according to the number and condition of red blood cells, microcytes and schizocytes. The causes of the patient’s condition must be established; for this purpose, the condition of his internal organs is determined using ultrasound equipment.

In addition, the patient undergoes examination by specialized specialists, such as a gastroenterologist, proctologist, hematologist, gynecologist for women, and always an endocrinologist. This approach to diagnosis allows, with a high degree of probability, to establish the cause of the disease.

Treatment of posthemorrhagic anemia

However, the most important point in the treatment of this pathology, is the restoration of iron in the body. After all, even a slight loss of blood from 10 to 15 ml deprives the body of the amount of iron that entered it within 24 years with food taken. In this regard, the patient is prescribed a number of drugs containing not only iron, but also a complex of B vitamins. These can be “Sorbifer”, “Durules”, “Ferroplex” or “Fenuls”. All medications are prescribed by the attending physician, who also calculates the dosage based on the patient’s condition and the fact that an adult needs approximately 100-150 mg per day. gland.

If the patient’s condition is severe, he is prescribed injections of drugs such as Ferlatum, Faltofer or Likferr. He also undergoes a procedure called a blood transfusion, in which not all the plasma is transfused, but only the red blood cell mass.

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

The diet is calculated individually for each patient. It definitely contains beef meat. low-fat varieties, chicken eggs, kefir, cottage cheese, goat cheese. It is mandatory to use beef liver, sea fish, caviar, as well as beans, peas, buckwheat, oatmeal and walnuts.

Be sure to include fresh vegetables, fruits and berries in your diet; they help iron be absorbed by the body faster and better. These can be oranges, tangerines, lemons, persimmons, raspberries and black currants.

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

Treatment of posthemorrhagic anemia in children

Taking all this into account, acute and chronic posthemorrhagic anemia in children is treated in a hospital, under constant medical supervision. First of all, the cause of the bleeding itself is eliminated. Then a blood transfusion is done, as many times as needed, that is, more than once.

It is mandatory to prescribe medications containing iron, including injections, for faster absorption. Children under one year of age are given special nutritional mixtures, rich in iron and vitamins.

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

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

Prognosis for posthemorrhagic anemia

In general, the prognosis for posthemorrhagic anemia is positive. But only under the condition of correct and competent therapy, including the elimination of chronic bleeding, even if this requires surgery.

Prevention of posthemorrhagic anemia

In order to prevent posthemorrhagic anemia from developing in the body of an adult or child, it is necessary to promptly treat diseases leading to blood loss. But there is a difficulty here - most of these benefits occur unnoticed by a person; he can feel good while a colony of parasites is growing in his body or kidney stones are accumulating. In this regard, it is necessary to regularly, at least once a year, undergo a complete medical examination. It should include examination of internal organs, analysis for the presence of parasites, as well as monitoring blood quality. Namely, the content of iron and red blood cells in it.