Posthemorrhagic anemia treatment drugs. Posthemorrhagic anemia is a complication of herb. Causes of posthemorrhagic anemia

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

Changes in the body during blood loss

It is customary to measure the severity of anemia by a decrease in hemoglobin levels and the resulting hypoxia (oxygen deficiency) of tissues.

But the clinical course and symptoms of posthemorrhagic anemia are largely due to a lack of iron, copper, magnesium, potassium, loss protective functions(decrease in immunity), hypersensitivity to any allergens.

The critical volume of blood loss is 500 ml. This maximum amount vital important substances, which healthy body able to gradually recover without treatment on its own. It is allowed to be donated to donors if necessary.

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

A loss essential microelements affects myocardial function, contraction speed and strength decrease. An ECG at this time can reveal signs of hypoxia and impaired conductivity.

Shunts open between small arteries and veins, and 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 quite quickly due to interstitial fluid. The main irreparable disorders remain at the level of microcirculation. A significant decrease in blood pressure contributes to a slowdown in blood flow in the capillaries, thrombosis and complete closure.

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

As a result of general hypoxia, under-oxidized substances accumulate in tissues, which act as poisons on brain cells and cause a shift towards acidosis (acidification by wastes). With severe anemia, alkaline reserves decrease, and the condition metabolic acidosis impossible to compensate.

Despite the 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 overall coagulability is normalized. Thrombohemorrhagic syndrome may occur due to the growth of procoagulant substances.

Pathological changes require urgent measures correction, elimination of the causes that caused them.

Types of posthemorrhagic anemia

The clinical classification distinguishes 2 forms of anemia associated with blood loss:

acute posthemorrhagic anemia - occurs against the background of rapid massive blood loss due to injuries, external and internal bleeding, during surgery for injury of large vessels;
chronic - accompanies diseases with frequent moderate bleeding (hemorrhoids, peptic ulcer), typical for girls and women with disorders menstrual cycle, fibromatosis of the uterus, is 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;
average degree with a hemoglobin level from 70 to 90 g/l;
severe - hemoglobin level from 50 to 70 g/l;
extremely severe - the amount of hemoglobin is below 50 g/l.

According to ICD-10 ( International classification diseases), acute posthemorrhagic anemia is classified in the group “Aplastic and other” with code D62.

How are individual conditions associated with established cause blood loss, distinguished:

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

Learn more about the causes of acute and chronic blood loss

Most common reasons anemia are:

injuries with damage to large arterial vessels;
unexpected complication surgical interventions;
obstetric and gynecological pathology (uterine bleeding due to ovarian dysfunction, uterine tumors, ectopic pregnancy, complications during difficult childbirth);
peptic ulcer of the stomach and duodenum;
liver cirrhosis with portal hypertension and bleeding from the esophageal veins;
chronic pathology lungs (tuberculosis, bronchiectasis);
chronic hemorrhoids.

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

Signs of acute posthemorrhagic anemia appear immediately against the background of massive bleeding and after stopping:

the patient has pale color skin, blue lips;
covered with sticky cold sweat;
complains of severe weakness, dizziness;
possible fainting;
nausea, occasional vomiting;
dry tongue;
rapid heartbeat, extrasystoles;
weak thready pulse;
Heart sounds are muffled on auscultation;
arterial pressure reduced;
breathing is shallow, rapid;
body temperature below 36 degrees.

Patients complain of a lack fresh air, have a hard time withstanding the heat

At different types bleeding can be detected:

loose bloody stool (from a stomach ulcer);
bloody sputum with bright scarlet blood released in a stream when coughing (from pulmonary arteries);
increasing swelling at the site of a bruise or fracture (internal hematoma);
discharge from the uterus in women.

Internal bleeding is difficult to diagnose. Doctors base their diagnosis on the general condition of the patient.

Stages of acute anemia

The clinical picture of acute posthemorrhagic anemia goes through 3 stages:

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

For treatment and full recovery indicators will take at least two months.

During menopause uterine bleeding accompany hormonal changes

Signs and course of the chronic form

Chronic posthemorrhagic anemia develops after several months or years. Since the basis of pathological changes is iron loss, this form rightly refers to iron deficiency conditions. The symptoms are no different from those of iron deficiency in the diet:

skin is pale, dry;
face is swollen;
altered taste sensations and perception of smells;
hair is dull and falls out rapidly;
nails are brittle, flattened;
increased sweating;
complaints of fatigue, headaches, nausea;
frequent dizziness;
heartbeat;
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 tissue during a chronic process. Therefore, detailed blood tests and additional investigations are equally important.

What does a blood test show?

At acute blood loss the patient must be taken to a 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, the level of red blood cells and hemoglobin increases within normal limits;
after 2–3 hours - with preserved thrombocytosis, neutrophilia appears, blood clotting is sufficient, the number of erythrocytes and hemoglobin decreases, anemia is assessed as normochromic;
after 5 days - the number of reticulocytes increases, low iron content in plasma is determined.

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

Additional data

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

stool analysis occult blood and helminths;
fibrogastroscopy is necessary to exclude gastric bleeding from an ulcer or a disintegrating tumor;
colonoscopy - examination of the lower intestines;
sigmoidoscopy - to visually confirm the integrity of internal hemorrhoids;
Women must be consulted by a gynecologist.

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

Treatment

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

To replenish the volume of circulating blood, artificial blood substitutes (Polyglukin, Gelatinol) are transfused; in severe cases, they are injected in a stream. When blood pressure rises to 100/60 mm Hg. Art. continue drip transfusion.

An intravenous catheter allows long-term transfusion of fluids from medicines

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

Tissue acidosis is relieved soda solution. Despite the blood loss, Heparin is prescribed to relieve thrombosis at the capillary level. The patient is connected to humidified oxygen breathing tubes.

Question about replacement transfusion donated blood or red blood cell 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 posthemorrhagic anemia can be treated on an outpatient basis in the absence or exacerbation of the underlying disease. If the cause of blood loss is determined, elective surgery may be required.

The patient's diet must include foods with high content iron, vitamins C, B12, folic acid.

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

IN mandatory During the recovery period, immune support is needed. People with posthemorrhagic anemia are susceptible to infection by various microorganisms. For this purpose, a complex of vitamins and microelements is needed, long-term use immunostimulants (aloe extract, ginseng root, lemongrass).

Forecast

Quick delivery to the hospital and initiation of hemostatic measures contribute to the successful recovery of the patient. If there is large blood loss from large arteries and there is no help, the patient dies.

Chronic posthemorrhagic anemia can be cured only by eliminating the cause. The patient needs to monitor for signs of exacerbation, start preventive treatment in a timely manner, and not delay the possibility of surgery if doctors offer it.

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

What it is?

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

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

Severity of anemia after blood loss

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

Lightweight

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

Heavy

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

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

Kinds

Acute posthemorrhagic anemia

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

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

Chronic posthemorrhagic anemia

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

Signs of anemia after bleeding

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

When the blood loss is large, the victim necessarily experiences shortness of breath, the heart rate increases, and a sharp drop in pressure is observed;
The skin/mucous membranes turn pale;
The patient complains of dizziness. There is a noise in his ears and darkness in his eyes;
Vomiting often occurs;
A sudden feeling of dryness in the mouth indicates the development of internal bleeding;
When there is bleeding in the digestive organs, a sharp rise in body temperature and signs of intoxication are observed;
One sign of internal bleeding will be the patient reporting a feeling of squeezing. internal organs;
The stool turns black.

Cause of posthemorrhagic anemia

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

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

Diagnosis based on blood test

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

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

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

Treatment

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

To replenish the patient's blood volume, in the event of a sharp drop in pressure, it is necessary to transfuse a blood substitute (by jet injection). When the blood pressure can be raised to 100 to 60, the transfusion can be switched to drip mode.

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

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

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

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

Features of the treatment of posthemorrhagic anemia

In children

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

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

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

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

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

light – two months;
average – up to four months;
at severe course Treatment of the disease lasts at least five months.

In older people

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

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

For the sick old age important:

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

Prevention

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

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

Posthemorrhagic anemia is a condition that develops as a result of sudden or prolonged blood loss. It is characterized by a decrease in the filling of the vascular bed, as a result of which the number of red blood cells and hemoglobin decreases, which leads to oxygen starvation, and in severe cases, death. Long-term disruption of hemodynamics causes not only a deterioration in well-being, but also degeneration of tissues and organs, provoking hematopoietic pathologies.

The direct cause of the condition is acute or chronic blood loss resulting from external or internal bleeding:

Due to pathologies and injuries accompanied by blood loss, its volume in the vascular bed decreases. There is a lack of cells containing hemoglobin. And since red blood cells are responsible for the delivery of oxygen, the body forms oxygen starvation.

The human body is able to restore up to 500 ml of blood without damage; the disease develops if blood loss exceeds this figure. The loss of half the volume of fluid in the vessels leads to inevitable death.

Main symptoms

Classification of anemia in case of blood loss is carried out according to the degree of development of the condition, distinguished:

Spicy. Massive blood loss occurs due to injuries and damage to large vessels, with internal bleeding.
Chronic. Secondary Iron-deficiency anemia(IDA) gradually develops due to diseases.
Congenital. When the fetus suffers due to blood loss.

Consequently, in patients with posthemorrhagic anemia, symptoms differ depending on the degree of development of the process and the severity of the condition.

Acute form

In acute pathology, the clinical picture progresses rapidly; vascular insufficiency is observed as a result of a sharp depletion of the riverbed. With the onset of blood loss, the following is noted:

hypotension,
dizziness and tinnitus,
tachycardia and shortness of breath,
pallor of the skin and mucous membranes,
severe weakness and dry mouth,
cold sweat,
nausea.

If there is damage to the gastrointestinal tract, the stool becomes dark in color and the temperature may rise.

If blood loss is significant, hemorrhagic collapse develops. The pressure drops sharply to critical levels - thread-like pulse, shallow and rapid breathing. Muscle weakness occurs until it stops motor activity, vomiting, convulsions and loss of consciousness are possible. Lack of blood supply causes oxygen starvation in organs and systems, death occurs due to respiratory and cardiac arrest.

Chronic form

If posthemorrhagic anemia develops slowly, the symptoms are not so pronounced, since adaptation mechanisms. Signs chronic form resemble IDA, since minor bleeding leads to iron deficiency:

dry skin and painful pallor,
face is swollen
hair loss and dullness,
brittleness and thickening of the nail plate,
increased fatigue and dizziness,
heart rhythm disturbance,
sweating

When the hemoglobin concentration drops to 70 g/l or lower, some patients experience low-grade fever. Patients complain of a feeling of numbness and changes in taste preferences. The severe stage is often accompanied by stomatitis and rapidly developing caries.

Diagnostic methods

When making a diagnosis of posthemorrhagic anemia, the basis of measures includes studying the patient’s medical history, a set of laboratory and instrumental studies. To identify the cause of anemia, you will need to consult a surgeon, hematologist, gastroenterologist or gynecologist. As a basic examination and to clarify the duration of blood loss, tests are carried out to determine the degree of anemia, a blood test is taken:

General. Indicates a decrease in erythrocyte mass, their hemoglobin saturation, and platelet volume.
Biochemical. The hemogram gives a detailed idea of the blood elements, their morphology and ratio to the volume of fluid. The study determines an increase in manganese, the enzyme alanine aminotransferase, a decrease in calcium and copper.

Urinalysis gives an initial idea of the condition urinary system and the functioning of the body. To diagnose the site of internal bleeding, examination methods are used:

Bone marrow examination is performed in difficult cases when the cause of anemia cannot be identified conventional methods. Puncture samples taken show the activity of the red brain, trephine biopsy reveals the replacement of hematopoietic cells with adipose tissue.

Treatment with drugs and folk remedies

For posthemorrhagic anemia, the main goals of treatment are to identify the source of blood loss and stop the bleeding. For external injuries, apply a tourniquet and bandage. If necessary, vessels and damaged tissues and organs are sutured and resection is performed.

In case of massive blood loss, measures are carried out in the hospital:

To restore blood supply and hemodynamics, a transfusion of canned blood and plasma is performed. When hemoglobin is below 8%, plasma substitutes are used: “Hemodez”, “Polyglyukin” or “Reopoliglyukin”. The blood transfusion procedure is carried out promptly, since a quarter of the blood loss is fraught with the death of the patient. The volume of infused fluid in this case exceeds blood loss by a maximum of 30%.
Transfusion of red blood cells is necessary to restore oxygen transport; with rapid loss, its amount can be half a liter.
Shock is treated with Prednisolone.
Recovery acid-base balance During the treatment process, electrolyte and protein compounds are administered intravenously: albumin, glucose, saline solution.
Iron is replenished by such drugs as Ferroplex, Feramide, Conferon, Sorbifer Durules. They are taken orally or by injection.
Microelements are prescribed: cobalt, copper and manganese, as they increase the absorption of iron.

For prolonged bleeding:

In the case of severe chronic anemia, transfusion is carried out in a small volume.
To eliminate symptoms functional disorders Therapeutic measures are used in the functioning of the heart, liver, and kidneys.
For better absorption of Fe, iron-containing products, vitamins C and B groups are prescribed.
Sometimes surgery is recommended.

Scheme and duration drug treatment in each specific case are individual. Restoration of the normal picture is observed after one and a half or two months, but the patient takes the medicine for up to six months.

Diet and traditional treatment

To restore the body after treatment of posthemorrhagic anemia and replenish hemoglobin, a specific diet is used. Its goal is to provide the body with vitamins and elements, so nutrition should be balanced and high in calories, but with a minimum amount of fat.

The patient's diet requires the presence of foods containing iron, such as meat low-fat varieties and liver.
For enrichment with microelements, valuable amino acids and protein, fish, cottage cheese, and eggs are recommended.
Suppliers of vitamins are vegetables and fruits, natural juices.

Loss of fluid is replenished by consuming water (at least 2 liters per day). To restore strength and support the body, you can also use folk recipes:

Rose hips are brewed and drunk instead of tea; you can add strawberry leaves.
When you lose strength, mix honey (200 ml), Cahors (300 ml) and aloe juice (150 ml). Take a spoon before meals.
Mix 30 g of chicory juice in a glass of milk and drink it a day.
Squeeze the juice from radishes, beets and carrots (1:1:1), pour into a dark glass container, cover with a lid and simmer in the oven for 3 hours. The liquid is drunk on a spoon before meals for a course of 3 months.

When blood loss occurs, the immune defense suffers and the body becomes susceptible to infection, so infusions or decoctions based on echinacea, ginseng, lemongrass or marshmallow will help to strengthen and restore the system.

Help prevent the development of posthemorrhagic anemia and its relapses preventive measures:

Patients with chronic diseases should monitor their condition, undergo regular examinations and take medications. When a specialist insists on surgery, there is no need to refuse: surgical treatment of the underlying disease will eliminate the cause of anemia.
The diet of children and adults must include foods containing iron, vitamins and elements necessary for the body.
It is important for pregnant women to register in time and detect anemia in order to prevent complications dangerous to the health of the mother and newborn.
If a pathology is detected in an infant, it is recommended not to stop breast-feeding. Each child is provided with a healthy environment and nutritious nutrition, rational complementary feeding. To normalize the condition, regular walks are important; medications are given only as prescribed by a doctor.
To prevent dystrophy, rickets and infectious invasions in children, pediatrician supervision is necessary. Special attention given to babies born to mothers with diagnosed anemia and who are bottle-fed. Also at risk are babies with multiple pregnancies, premature babies and those who quickly gain weight.
To maintain health, every person needs to lead a correct lifestyle, move actively, and be in the fresh air.

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

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

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

Severity of anemia

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

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

Causes of posthemorrhagic anemia

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

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

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

Diagnostics

Diagnosis of posthemorrhagic anemia is based on:

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

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

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

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

After a few months, the content of red blood cells and hemoglobin is completely restored. But its synthesis requires iron, so iron deficiency anemia can be a consequence of acute posthemorrhagic anemia.

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

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

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

hematologist;
surgeon;
gastroenterologist;
gynecologist.

To establish the cause and tactics of patient management.

Symptoms and signs

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

Acute posthemorrhagic anemia

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

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

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

Chronic posthemorrhagic anemia

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

dyspnea;
heartbeat;
decrease in pressure.

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

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

Treatment

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

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

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

saline;
Ringer's solution;
7.5% hypertonic NaCl solution;
"Disol";
"Trisol".

Colloidal solutions are presented:

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

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

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

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

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

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

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

Forecast

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

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

Often what threatens our lives is not what is in plain sight. Suspecting some kind of serious illness, which is on everyone's lips, we ignore, for example, a stomach ulcer, which only causes us inconvenience from time to time. But such an inconspicuous wound can be much more dangerous than many famous diseases. Losing blood drop by drop, undermining the health of its owner long months and years, it provokes the appearance of unpredictable posthemorrhagic anemia.

Danger of excessive blood loss

The total volume of blood in the body of an adult is from 3.5 to 5 liters. Circulating throughout the body, it performs many functions:

distributes nutrients and oxygen;
removes decay products from tissues;
transports hormones from glands to sensitive organs;
supports constant temperature And chemical composition body;
participates in wound closure and subsequent tissue regeneration;
carries out immune responses to external threats.

If the amount of fluid in the vessels drops by more than 10%, the victim clearly feels it. The weakening of the above properties of blood occurs - and the more significant the more serious the blood loss. The transport function is the first to suffer - brain tissue begins to experience oxygen starvation within a few seconds.

Types of posthemorrhagic anemia

The ensuing symptoms are collectively known as posthemorrhagic anemia. Anemia from blood loss, or posthemorrhagic anemia, is a deficiency of red blood cells in the plasma resulting from excessive blood loss. IN clinical practice There are two known forms of the disease: acute and chronic. The first develops with a single injury to the body that provokes

quick loss

large volume of blood. The reasons for this condition may be:

Chronic anemia is possible with small but frequent blood losses, leading to a gradual decrease in the number of circulating red blood cells. The causes of the pathology coincide with those in an acute condition, but differ in the less intense impact on the body.

One of the main reasons for the wide spread of posthemorrhagic anemia in the recent past was the fashion for bloodletting. According to the latest data, it was this procedure that accelerated the death of Mozart. Having fallen ill in 1791, the composer was subjected to a treatment that was innovative at that time, as a result of which he lost about two liters of blood and died in less than a month.

Clinical picture in acute condition

From the first moments heavy bleeding the human body uses all its resources to compensate for the losses that have occurred.

The production of red blood cell precursor cells called erythroblasts increases sharply. The number of red cells per unit volume of plasma remains constant, although in absolute terms their number decreases. Walls peripheral vessels quickly spasm, limiting blood flow to the skin and skeletal muscles. At the same time, security is maintained for as long as possible nutrients

central nervous system, heart and adrenal glands.
The victim's pulse quickens.
Breathing becomes harsh and shallow.
The skin and mucous membranes turn pale.
There is a feeling of dizziness, weakness in the limbs, tinnitus, and possibly nausea.

Feces may be dark brown or red in color.

This phase of anemia, which combines the body's immediate reactions to blood loss, is called reflex. It lasts up to 12 hours, after which it becomes compensatory, or hydremic.

At this stage, the body extracts the maximum number of red blood cells from the depot, and interstitial fluid begins to move into the vessels. The filtration properties of the kidneys are adjusted to retain water in the body, resulting in decreased urine production. Red cells are distributed in the plasma, causing the relative concentration of hemoglobin to sharply decrease.

The next phase, the bone marrow phase, occurs 4–5 days after the event of blood loss. By this time, the production of erythroblasts and the maturation of red blood cells reach their maximum values. Prolonged spasm of peripheral vessels can provoke cell gluing in small capillaries, causing them to become clogged. Large blood clots can cause tissue and organ death.

Signs of chronic form

The symptoms of chronic posthemorrhagic anemia show milder manifestations than in the case of an acute course:
- skin manifestations:
- pallor;
- slight swelling;
- dryness;
roughness;
- hair defects:
- fragility;
dropping out;
tachycardia;
decreased blood pressure;
- general symptoms:
- dizziness;
- weakness;
- decreased appetite;

noise in ears.

Features of posthemorrhagic anemia in children Children are more prone to manifestations of acute posthemorrhagic anemia than to chronic one. The reason for this is obvious - even small blood losses by the standards of an adult body become a difficult test for fragile body

Alarming symptoms in this case are considered:

pale skin;
smoothness of the tongue;
growth retardation;
change in behavior (apathy or tearfulness);
hair fragility;
violation of taste preferences - a tendency to eat clay and chalk;
general weakness;
weight loss.

Weakened by injury children's body becomes sensitive to infectious diseases, so anemia can lead to the development of sore throat, laryngitis, otitis media,.

Stages (degrees) of the disease: mild, moderate, severe

Depending on the intensity of blood loss, there are several stages, or degrees of severity, of posthemorrhagic anemia.

Determining the severity of the disease plays a critical role in planning further treatment. For example, mild anemia may not require drug therapy, while severe is an absolute indication for immediate hospitalization of the victim.

Stages of posthemorrhagic anemia - table

Degree/Stage	Content, gram/l.	Pulse rate, beats/min.	Systolic (upper) blood pressure, mmHg.
Light	90 and above	Up to 80	Above 110
Average	70–90	80–100	90–110
Heavy	Less than 70	More than 100	Below 90

Diagnostics

The mandatory primary stage of diagnosis is an external examination of the patient, which allows:

determine the location of damage in case of superficial injury to the body;
assess the general condition of the victim in relation to the severity of blood loss;
find out about the patient’s predisposition to bleeding of a certain type (gastric, intestinal, pulmonary, etc.).

A proctological or gynecological examination is carried out if there is a suspicion of injury to the lower parts of the digestive system and female reproductive organs. Analysis of stool and urine can detect damage gastrointestinal tract and genitourinary system. The most commonly used tests are benzidine (Gregersen) and guaiac (Weber) tests. The reagents used in them change color upon contact with free hemoglobin.

The use of the iron isotope 59 Fe in radioimmunoassay makes it possible to describe the distribution of red blood cells, their integrity and activity.

A blood test for acute posthemorrhagic anemia shows very characteristic results:

During the first hour after the onset of the condition, the number of platelets increases sharply, and after three hours - leukocytes.
Following this, the level of red blood cells drops.
Restoring initial indicators takes at least several weeks.

For internal bleeding, radiography, magnetic resonance (MRI) and computed tomography (CT) are widely used. ultrasound diagnostics. With their help, it is possible to accurately localize damage to hollow organs.

These techniques make it possible to differentiate posthemorrhagic anemia from similar conditions.

Differential diagnosis - table

Name of pathology	Difference from posthemorrhagic anemia	Diagnostic methods
Autoimmune hemolytic anemia	characteristic antibodies are present in the blood; integuments are jaundiced; the spleen is enlarged.	blood analysis;
Hypochromic anemia	normal and altered red blood cells are present; mutant cells are quickly destroyed in the presence of sugar; signs are common.	blood analysis, radioimmunoassay; microscopy.
Megaloblastic anemia	red blood cells are enlarged and have inclusions; B vitamins are deficient; bilirubin level is increased; hemoglobin level is normal; the skin is jaundiced.	visual inspection; blood analysis; microscopy.
Microspherocytic hemolytic anemia	red blood cells are spherical in shape	blood analysis; microscopy.
Partial red cell anemia	antibodies to red blood cell precursors are present in the blood; red Bone marrow loses cells.	blood analysis; red bone marrow puncture.
Thalassemia	hemoglobin in red blood cells forms rings; various precursors of red blood pigment accumulate.	blood analysis

Treatment

The main task in the treatment of posthemorrhagic anemia is to stop the bleeding that provoked it. Subsequent measures are aimed at replenishing the loss of red blood cells, fluid, and nutrients.

Acute therapy

Significant blood loss (more than 1 liter) should be compensated by transfusion of red blood cells with plasma substitutes, but not more than 60% of the lost volume. Exceeding this indicator can provoke intravascular coagulation. It is better to make up the difference with blood substitutes - solutions of albumin, dextran, sodium chloride, gelatinol, rheopolyglucin, Ringer-Locke composition. Lactasol can be used to restore pH values.

After removal acute condition measures are being taken to improve hemoglobin synthesis. Therapy at this stage coincides with the treatment of the chronic form.

Therapy for chronic form

To replenish the amount of lost iron (with iron deficiency states) its preparations containing the metal in a divalent form are used. Such means include:

Maltofer;
Sorbifer;
Feramide;
Ferrocal;
Ferroplex;
Ferrocene.

Multivitamin complexes that include vitamins B, C, and E help increase metabolism.

Treatment of anemia - video

Diet for posthemorrhagic anemia

apricots;
grenades;
mushrooms;
strawberries;
lean meat;
peaches;
liver;
fish;
cottage cheese;
blueberry;
apples;
eggs.