What is Acute posthemorrhagic anemia

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

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

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

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

Symptoms of Acute posthemorrhagic anemia

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

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

P = K + 44lgIIIU,

Where P - blood loss as a percentage;

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

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

In the first hours, with large blood loss, there may be a slight decrease in the level of hemoglobin and red blood cells; accordingly, the hematocrit (the part of the blood volume accounted for by the formed elements) is not reduced, and only a study of the volume of circulating red blood cells can reveal its significant decrease.

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

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

Treatment of acute posthemorrhagic anemia

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

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

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

Whole blood transfusions are generally inappropriate.

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

Hematologist

Therapist

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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:

1. Acute posthemorrhagic anemia is characterized by a large amount of lost blood.
2. Secondary Iron-deficiency anemia, which occurs after blood loss.
3. 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 the male body and in the female body, 120-140 g/l. In a child's body, hemoglobin ranges from 150 to 200 g/l in accordance with his age. So, the symptoms:

1. 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.
2. 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.
3. As the disease progresses, the condition of the skin worsens, it becomes thin and flaky. At the same stage of the disease, the hair becomes sick and brittle, and the nails split.
4. 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.
5. 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, his condition is determined. internal organs using ultrasonic 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, then 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.

In parallel, the patient is prescribed 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 necessarily includes lean beef meat, chicken eggs, kefir, cottage cheese, goat cheese. Beef liver must be consumed 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 to 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.

Posthemorrhagic anemia- is a lack of iron-containing elements in human blood plasma. Anemia resulting from blood loss is one of the most common anemias. Doctors distinguish two forms of this disease: chronic and acute.

Posthemorrhagic anemia of a chronic nature occurs after small, but for some time, frequent bleeding. The acute form of this disease occurs due to sudden, heavy blood loss.

The minimum volume of blood loss in an adult that is dangerous to human life is 500 ml.

By International classification diseases of the 10th revision, posthemorrhagic anemia belongs to the category “Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism.” Subsection: “Anemia associated with nutrition. Iron deficiency anemia.” The classification of diseases with codes is as follows:

• Iron deficiency anemia secondary to blood loss (chronic) – code D50.0.
• Acute posthemorrhagic anemia - code D62.
• Congenital anemia due to fetal blood loss - code P61.3

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ICD-10 code

D62 Acute posthemorrhagic anemia

D50.0 Iron deficiency anemia secondary to blood loss, chronic

Causes of posthemorrhagic anemia

The etiology of a lack of blood in the body can be:

• Trauma resulting in a violation of the integrity of blood vessels, especially large arteries.
• Surgical intervention. Any surgical intervention is always a risk. When starting even the simplest operation for a seemingly ordinary person, the surgeon is not able to foresee all its nuances and consequences.
• Ulcer duodenum and stomach. These diseases are often accompanied by internal bleeding. And the difficulty of their timely detection is that the bleeding occurs inside the body and externally it can be recognized by an amateur by certain signs and an ambulance can be called in time. Otherwise, delay may result in death for the patient.
• Impaired hemostasis. This factor is designed to maintain blood in a liquid state, being responsible for the blood clotting rate, which makes it possible to maintain circulating blood volumes within normal limits and normalize the composition (“formula”) of blood.
• Ectopic pregnancy. This pathology is accompanied by acute heavy bleeding, which leads to acute posthemorrhagic anemia.
• Pulmonary diseases. This bleeding is manifested by scarlet discharge with a liquid or clot-like consistency that occurs during coughing.

Pathogenesis

Pathogenesis, or the sequence of occurring phenomena, constitutes the phenomena of vascular insufficiency, due to a sudden emptying of blood (plasma) from the vascular bed. These factors lead to a lack of oxygen-carrying red blood cells, which in turn leads to general oxygen starvation body. Independently this loss, due to more active work heart, the body will not be able to replenish.

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Symptoms of posthemorrhagic anemia

Knowledge won't hurt anyone. And in order to be able to recognize bleeding (especially if it is internal), it is necessary to know the symptoms of posthemorrhagic anemia and its manifestations in order to provide first aid in time medical care or call an ambulance.

• With heavy blood loss, vascular manifestations come first: shortness of breath, rapid heartbeat (tachycardia), and decreased blood pressure (both arterial and venous).
• The patient's skin and mucous membranes become pale.
• The patient begins to feel darkening in the eyes, tinnitus and slight dizziness.
• A gag reflex may appear.
• An acute sign of internal bleeding can be considered severe dry mouth. The severity of the clinic is determined not only by the total volume of sweat, but also by the rate at which the victim loses blood.
• The location of the injury is also an important factor. So defeat gastrointestinal tract accompanied by a sharp increase in body temperature.
• Obvious manifestations of intoxication.
• The level of residual nitrogen in the plasma also increases its performance (while the urea level remains normal).
• Even with small amounts of internal bleeding, the patient feels compression of the organs.
• Fecal discharge can also be an indicator of internal damage. Due to the excreted blood, they turn black.

Acute posthemorrhagic anemia

If a person loses, as a result of injury (the consequence of which is damage to a large artery), an operation being performed or an exacerbation of any disease, an eighth of the total volume of working blood, an acute form of posthemorrhagic anemia occurs.

Doctors distinguish several stages of development acute form anemia:

1. Reflex-vascular stage. It is expressed by a sharp decrease in blood pressure, pallor of the skin and mucous membranes, and tachycardia. A sudden lack of oxygen reaching the organs leads to spasms of peripheral blood vessels. To prevent a further drop in pressure, the body opens arteriole-venular shunts, leading to the removal of plasma from the organs. This therapy itself works to adequately compensate the return of blood fluid to the heart.
2. Hydremic stage. After three to five hours, the basis for hydremic compensation is created, caused by the flow of fluid from the interstitial area into the blood vessels. In this case, certain receptors are irritated, which are involved in maintaining the volume of fluid circulating through the vessels. Increased synthesis of aldosterone blocks the removal of sodium from the body, which stimulates water retention. However, this also leads to plasma dilution, and as a consequence, a decrease in the content of red blood cells and hemoglobin. This stage of compensation can take place within two to three days.
3. Bone marrow stage - this stage occurs four to five days from the moment of bleeding. Hypoxia progresses. Erythropoietin levels are increasing. In the peripheral blood, the number of newly formed red blood cells (reticulocytes), which have a reduced amount of hemoglobin, increases. The characteristic of this stage becomes hypochromic. In addition, a sharp lack of blood causes a decrease in iron in the blood.

Chronic posthemorrhagic anemia

This type of anemia, chronic posthemorrhagic anemia, occurs in a patient if he gradually, over a period of time, loses blood in fractions. This type of anemia can occur in a number of diseases. For example, such as: intestinal cancer, peptic ulcer of the duodenum or stomach, gingivitis, hemorrhoids, and many others. Frequent but minor bleeding leads to general exhaustion of the body. Iron deficiency occurs. Due to this, this pathology according to etiology it is classified as posthemorrhagic anemia, according to pathogenesis this pathological condition can be attributed to iron deficiency anemia.

Based on this, the main goal of therapy for posthemorrhagic anemia, in any of its forms, is to restore the full volume of blood plasma circulating in the vessels, and, as a consequence, to overcome iron deficiency and lack of erythropoiesis. But this " ambulance"for the body. After emergency resuscitation, it is necessary to turn your attention to the root cause that caused the bleeding. And it’s simpler - you need to start treating the underlying disease.

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Posthemorrhagic iron deficiency anemia

Today, doctors note that posthemorrhagic iron deficiency anemia is beginning to become quite widespread. In short, iron deficiency anemia is a condition of the body characterized by a pathological lack of iron ions. Moreover, the mass concentration of this element decreases everywhere: in the blood plasma, in the bone marrow, and in the so-called storage room, where the body accumulates everything it needs in reserve. As a result, a failure occurs in the heme synthesis system, resulting in a deficiency of myoglobin and tissue enzyme.

Modern statistical studies voice a figure of 50% - this is the amount of the population that suffers from anemia in one form or another. Compounds in which metals occur naturally are poorly absorbed or not absorbed at all human body. When the balance in the intake of iron into the body and its use is disturbed, we get iron deficiency anemia.

Most often in the adult population, iron deficiency is associated with acute or chronic blood loss. This diagnosis can occur, although quite rarely, with nosebleeds, dental aspects of blood loss, as well as with trauma... Identified and exceptional cases, when iron deficiency anemia developed in a donor who “frequently gave blood.” Moreover, strange as it may sound, such deviations are found in female donors.

In women, the causes of the disease can be both uterine bleeding and pregnancy itself, as well as painful, pathological disruptions in the menstrual cycle. Laboratory studies show that uterine fibroids can also lead to posthemorrhagic anemia with iron deficiency, which contributes to the leaching of iron and the subsequent appearance of anemic symptoms.

The second place in the frequency of diseases is occupied by blood loss during acute diseases gastrointestinal tract, which are diagnosed on early stages quite problematic. Pulmonary hemorrhage is a fairly rare manifestation of iron deficiency, as is blood loss from the urinary tract and kidneys.

Newborns and infants may suffer from iron deficiency due to improper placenta previa, or if it is damaged during surgical intervention (caesarean section). And there are also cases intestinal bleeding as manifestations of an infectious disease.

The reason for the lack of iron in older children may also be a poor diet. Baby just doesn't get it sufficient quantity element along with the foods it eats. Anemia can also be caused by a lack of iron in the mother during her pregnancy, as well as in premature babies or babies of twins and triplets... Quite rarely, but the cause of this disease can also be the mistake of the obstetrician, who, without waiting for the pulsation to stop, cut the umbilical cord early.

You should not ignore the situation when (for example, with large physical activity, pregnancy, etc.) the body’s need for it increases sharply. Therefore, the likelihood of posthemorrhagic iron deficiency anemia increases.

The lack of this element in the body causes significant harm immune system person. But, strange as it may sound, patients suffering from iron deficiency get sick less infectious diseases. It's simple. Iron is an excellent nutrient medium for some bacteria. However, in light of other problems, iron deficiency in the human body cannot be ignored. There are often cases when a lack of iron in the blood is indicated by changed eating habits. For example, a previously unobserved craving for peppery or salty foods appears.

Doctors highlight and psychological aspect iron deficiency. Often it occurs in people who do not care about their health, and, consequently, about themselves: diets, limited nutrition, physical inactivity, lack of fresh air, minimum positive emotions. All this does not contribute, but rather inhibits the metabolic processes that occur in the body. After conducting a study, scientists found that behind all this, as a rule, there is deep depression and psychological trauma.

Today, medicine is equipped with a fairly large arsenal in the form of iron preparations: conferon, feramide, jectofer, sorbifer and quite a lot of others. There are also liquid forms, for example, maltofer, the degree of absorption of which depends on the level of iron deficiency in the body. This drug is approved for use even for newborns (even premature babies).

Posthemorrhagic anemia in children

Posthemorrhagic anemia in children occurs quite often and, like in adults, can be acute (quite common) or chronic (less common).

Newborns are quite vulnerable. In them, posthemorrhagic anemia quite often occurs due to birth injuries or can occur even with excessive blood sampling during laboratory research. In older and middle-aged children, the main cause of anemia is often helminths, which, by sticking to the wall of the gastrointestinal tract, injure the body and provoke microbleeding.

Symptoms for which parents should raise the alarm:

• The same as for adults.
• But the first manifestations are lethargy, loss of appetite, growth cessation occurs, and the baby begins to gain weight worse.
• One of primary signs The initial stage of the disease may be a change in the baby’s taste preferences, to the point that children tend to eat earth, chalk, clay... This is the result of iron deficiency and a lack of mineral components in the baby’s body. Sometimes these changes are not so radical.
• There is also a change in behavior. Kids become capricious and whiny, or, in contrast, apathetic.
• There is also a manifestation of external signs: brittle hair and nails, peeling skin.
• “Vacquered” smooth tongue.
• In teenage girls, interruptions in the menstrual cycle.
• Quite often, against the background of posthemorrhagic anemia, complications of an infectious nature are observed: otitis media, pneumonia...

The first thing to do in a situation where a child is in a state of hemorrhagic shock- This resuscitation measures to stop bleeding and antishock therapy. Blood substitutes are administered by stream and drip. During this period, the baby’s blood type and Rhesus status are determined. Resuscitation is carried out with freshly citrated blood. If one is not available, a direct transfusion from the donor is performed. In parallel with this, glycoside support for cardio vascular system and a diet rich in protein and vitamins is attributed.

Treatment of posthemorrhagic anemia in children involves identifying and treating the root cause of bleeding, that is, the disease that caused blood loss.

Stages

Doctors also have a so-called working classification of the stages of anemia severity, which is determined on the basis of laboratory tests:

• when the hemoglobin content in the blood is more than 100 g/l and erythrocytes are above 3 t/l - a mild stage.
• when the hemoglobin content in the blood is within 100÷66 g/l and erythrocytes above 3÷2 t/l - the middle stage.
• when the hemoglobin content in the blood is less than 66 g/l – a severe stage.

Mild posthemorrhagic anemia

More early detection illness allows the child to get back on his feet in a shorter period of time. At mild stage sometimes the disease is enough iron-containing preparations, to replenish the lack of iron in the body. The course of treatment often lasts three months or more. IN in this case temporary hospitalization of the patient is possible. This issue is decided by the doctor based on the patient’s condition.

Severe posthemorrhagic anemia

Severe posthemorrhagic anemia is an unconditional hospitalization.

Only in inpatient conditions the patient can receive qualified and full medical care and there is no point in delaying it. In this situation, “delay is like death.”

Having received the patient at their disposal, doctors, first of all, must do everything to stop the bleeding, while at the same time trying to compensate for blood loss by any means. To obtain the maximum hemodynamic effect (removing the patient from state of shock, obtaining higher blood pressure, etc.), a transfusion of at least half a liter of polyglucin (an artificial plasma substitute) is performed. In the acute traumatic form, this drug is administered initially as a bolus, and the doctor is required to monitor the blood pressure. If the pressure was brought to the following values: systolic - 100÷110 mm, diastolic - 50÷60 mm, the dropper is switched from jet to drip feed. The total dose of the administered solution can reach, if necessary, one and a half liters (maximum 2÷3 l).

Only after stopping the bleeding and removing the main shock symptoms, the medical staff proceeds to a further, planned protocol for removing the patient from the anemic state.

Diagnosis of posthemorrhagic anemia

Modern medicine cannot be imagined without laboratories and modern medical equipment. But without highly professional specialists, no equipment will help. And in the case of diagnosing posthemorrhagic anemia, the situation is as follows: the diagnosis of acute or chronic posthemorrhagic anemia can be made based on a combination of clinical, laboratory and anamnestic data. Basic are clinical indicators.

Having external source bleeding, it is not difficult to make a clear diagnosis; it is more difficult to diagnose it with internal blood loss. The main thing is to accurately determine the location of the outflow.

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Blood test for posthemorrhagic anemia

The first thing doctors need to do is urgently do a detailed blood test so that they can assess the level of blood loss and, accordingly, the danger to the patient. During the first half hour of acute blood loss, the number of platelets increases sharply, which leads to a reduction in the period of time during which blood clotting occurs, which is quite important in case of blood loss. The level of red blood cells and hemoglobin in plasma remains within normal limits for some time, although their total number (red blood cells) decreases.

After two to three hours, thrombocytosis in the blood is still observed, but tests show the appearance of neutrophilic leukocytosis. A high level of thrombocytosis and a short period during which the blood clots is a criterion showing heavy blood loss. Next comes a decrease in the number of red blood cells and hemoglobin. This is an indicator of the development of normochromic posthemorrhagic anemia.

After five to six days from the critical moment, the number of reticulocytes increases (the formation of young leukocytes). If no repeated bleeding is observed during this period, then after a couple of weeks, the composition of the peripheral blood returns to normal, as tests show. If posthemorrhagic anemia was observed in severe form, then the recovery period will be longer.

Even in the case of a single acute bleeding, biochemical analysis shows a sharp drop in plasma iron levels. With small reserves of this element in the body itself, its quantitative restoration is quite slow. During this period, the active appearance of new red blood cells in the red bone marrow is also visible.

Clinical analysis during the illness shows the presence of leukopenia with slight lymphocytosis. Due to low level iron, there is an increase in the ability to bind serum iron.

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Treatment of posthemorrhagic anemia

If a mild form of posthemorrhagic anemia can be treated at home, then its acute manifestations must be stopped only in a hospital setting. The main goal of all measures taken is to stop blood loss and restore normal, full blood circulation.

The first stage of treatment is to stop the bleeding. A drop in hemoglobin level to 80 g/l and below (8 g), plasma hematocrit - below 25%, and protein - less than 50 g/l (5 g%) is an indication for transfusion therapy. During this period, it is necessary to replenish the content of red blood cells by at least a third. There is an urgent need to replenish normal plasma volume. In this regard, the patient receives colloidal solutions polyglucin or gelatinol by transfusion. If such solutions are not available, they can be replaced with 1000 ml of glucose (10%), and then 500 ml of a 5% solution. Reopolyglucin (and analogues) are not used in this situation, as they reduce blood clotting ability, which can provoke re-bleeding.

To restore the level of red blood cells, the patient receives packed red blood cells. In case of acute blood loss, when the platelet count also drops, doctors resort to direct transfusion or transfusion of blood immediately taken before the procedure.

Today, if blood loss during surgery is less than 1 liter, packed red blood cells and transfusion are not used. Full compensation of blood loss is not carried out, since the danger lies in the possibility of disseminated intravascular coagulation syndrome, as well as immune conflict.

Divalent iron is most often used in medicine. Medicines based on it are taken by the patient as prescribed by the doctor either 1 hour before eating or 2 hours after eating. In the treatment of posthemorrhagic anemia, the following iron-containing drugs are used:

• Feramide is a drug based on a compound of nicotinamide and ferric chloride. The dose is taken three times a day, 3÷4 tablets. The disadvantage of this drug is the low iron content in the tablet. For getting maximum effect, along with the medicine you need to take ascorbic acid.
• Conferon – complex content of sodium dioctyl sulfosuccinate with iron sulfate. Release form: capsules. This drug is well absorbed by the intestinal mucosa. Take it 3 times a day, 1÷2 capsules. Additional reception no ascorbic acid is required.
• Ferrocal. Composition - iron sulfate with calcium fructose diphosphate. Prescribed after meals, 1÷2 tablets three times a day.
• Ferroplex is a combination of ferrous sulfate and ascorbic acid. The dose is 2÷3 tablets three times a day. The tolerability and absorption properties of the drug are excellent.
• Ferroceron. The basis of the drug - sodium salt ortho-carboxybenzoylferrocene. The medicine is well absorbed by the gastrointestinal mucosa. Take 1÷2 tablets three times a day. Easy to carry. Hydrochloric and ascorbic acids should not be introduced into the body along with this medicine. It is absolutely necessary to remove lemons and other acidic foods from food.

Other drugs are also used.

Nutrition plays an important role in the treatment of posthemorrhagic anemia. A patient with anemia should include in his diet foods containing large amounts of iron and protein substances. This is both meat and egg white, and fish, cottage cheese... At the same time, remove fatty foods from your diet.

Prevention

Prevention of posthemorrhagic anemia must begin, no less, in the womb. If the mother of the unborn child suffers from iron deficiency, the newborn will be born already having the same problem. Therefore, it is necessary to first eliminate this problem in a pregnant woman. Then, the already born child should receive natural, rational and natural feeding. It is necessary that the baby is surrounded by a normal healthy environment. Constant monitoring by a pediatrician is also needed so as not to miss the development of rickets, infectious diseases and dystrophy.

A special risk group for iron deficiency includes children born from an anemic mother, premature babies and babies from multiple pregnancies, as well as infants receiving artificial, irrational feeding and growing rapidly. For such children, the pediatrician usually prescribes iron supplements or infant formula containing a higher percentage of this element.

For children in the first year of life, as a preventive measure for posthemorrhagic anemia, it is necessary to include vegetables and fruits, cereals and herbs, meat and fish, milk and cheeses in their diet. That is, diversify your diet. To maintain within normal limits auxiliary elements(copper, manganese, cobalt, zinc) it is necessary to give the baby beets, yolks and fruits (apples, peaches, apricots). And the child is also obliged to receive the necessary amount of fresh air - walks on fresh air required. Protect children from contact with harmful chemicals, especially volatile ones. Medicines Use only as prescribed by a doctor and under his supervision.

Prevention of anemia for an adult is similar to that for children. These are the same foods rich in iron and microelements, as well as an active healthy lifestyle and fresh air.

IN childhood The use of iron supplements prophylactically not only prevents the development of iron deficiency in a child, but also reduces the incidence of his ARVI. In case of aggravated hereditary anemia, the medical prognosis directly depends on the frequency of crises and their severity.

In any situation, one must not give up and it is preferable to recognize any disease as soon as possible, at its earlier stages. Be more attentive to yourself and your loved ones. Preventive actions with posthemorrhagic anemia are not as complicated as it might seem. Just live, eat well, actively spend your time in nature with your family and friends, and this trouble will bypass you. But if something irreparable has happened and trouble has come to your home, don’t panic, call the doctors and fight with them. After all, life is beautiful and worth this struggle.

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

Posthemorrhagic anemia: code according to ICD-10

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

Posthemorrhagic anemia: severity levels

The severity of this type of anemia also depends on the hemoglobin level. The first degree of severity is characterized by a hemoglobin content in the blood of more than 100 grams per liter of blood and red blood cells above 3 t/l. If the hemoglobin level in the blood reaches 66 - 100 g/l and the number of red blood cells is above 2 - 3 t/l, we can talk about the occurrence of moderate severity of posthemorrhagic anemia. Finally, we are talking about a severe stage of anemia if hemoglobin drops below 66 g/l.

If discovered in time mild degree depending on the severity of this type of anemia, it is still possible to really help the patient. In this case main goal treatment is to replenish iron reserves in the body. Taking appropriate iron supplements can help with this. Only a doctor can prescribe such drugs in accordance with the patient’s tests and his individual complaints. It is important that the preparation contains a component that promotes the complete absorption of iron. This component could be, for example, ascorbic acid. Sometimes hospital treatment may be required.

For posthemorrhagic anemia moderate severity Posthemorrhagic anemia requires taking appropriate medications. As for the severe degree, hospitalization of the patient is urgently indicated. Delay in this case could cost the patient his life.

Posthemorrhagic anemia: causes of the disease

A lack of blood in the body can be caused by:

1. Violation of normal hemostasis. Hemostasis is designed to keep the blood in a liquid state, that is, as it should be normally. It is also responsible for normal blood clotting;
2. Lung diseases. Such diseases can be judged by scarlet bleeding in the form of liquid or clots that occurs when coughing;
3. Trauma due to which vascular integrity was compromised, mainly affecting large arteries;
4. Ectopic pregnancy. With this problem there are strong internal bleeding, which causes the development of acute posthemorrhagic anemia;
5. Surgical intervention. Almost any operation involves blood loss. It is not always abundant, but this may be enough for the development of pathology;
6. Stomach and duodenal ulcers. Internal bleeding is common with such diseases. Such bleeding cannot always be quickly recognized. But if this is not done on time, death is possible.

Posthemorrhagic anemia: stages

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

Pathogenesis of posthemorrhagic anemia

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

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

Acute posthemorrhagic anemia: ICD-10

What can be said about the stages of this type of anemia? Chronic posthemorrhagic anemia is something that is difficult to combat, since the causes lie in some other disorders in the body. That is why we will talk about acute posthemorrhagic anemia.

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

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

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

Treatment of posthemorrhagic anemia

Therapy for this disease is carried out only in a hospital setting. The fact is that bleeding, especially massive bleeding under other conditions, cannot always be stopped. Sometimes infusion-transfusion therapy and surgical intervention are needed.

After bleeding has stopped, you should start taking iron supplements, and only at the discretion of your doctor. In the severe stage, it will be necessary to administer drugs intravenously; in the mild stage, taking tablets orally is sufficient. In some cases, combined treatment with both methods is indicated.

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

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

Posthemorrhagic anemia - a consequence of GERD

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

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

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

Causes of posthemorrhagic anemia

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

What are the reasons for posthemorrhagic anemia?

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

Symptoms of posthemorrhagic anemia

dry mouth

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

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

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

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

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

Stages and degrees of posthemorrhagic anemia

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

The stages of posthemorrhagic anemia are as follows.

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

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

Diagnosis of the disease

There are three main types of anemia diagnosis:

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

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

Diagnosis of posthemorrhagic anemia is based on the following examinations.

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

Treatment of posthemorrhagic anemia

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

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

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

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