Posthemorrhagic anemia is a complication of herd. Post-hemorrhagic anemia: treatment of acute and chronic forms Post-hemorrhagic anemia: treatment of acute and chronic forms Chronic post-hemorrhagic anemia

The minimum blood loss that poses a danger to the health of an adult is 500 ml. Symptoms are caused by the phenomena of acute vascular insufficiency due to the rapid emptying of the vascular bed, loss of plasma. With massive blood loss due to the loss of erythrocytes, when there is no longer compensation due to increased heart rate, hypoxia develops.

The prognosis depends on the cause, the rate of bleeding, the amount of blood loss, and the adequacy of therapy. With a loss of BCC of more than 50%, the prognosis is poor.

Causes of acute post-hemorrhagic anemia

Possible causes of blood loss causing acute post-hemorrhagic anemia:

trauma;
surgical intervention;
diseases of the digestive tract (ulcers, tumors, hemorrhoids, varicose veins of the esophagus);
disorders of hemostasis;
ectopic pregnancy ;
menstrual irregularities;
neoplasms in the uterus;
lung diseases and others.

Symptoms of acute post-hemorrhagic anemia

Vascular disorders: a drop in arterial and venous pressure, pallor of the skin and mucous membranes, tachycardia, shortness of breath. The severity of these changes is not related to the degree of blood loss, since collapse often occurs in response to pain from an injury that caused blood loss.

In the first minutes of blood loss, the hemoglobin content may even be relatively high due to a decrease in blood volume. Due to the entry of tissue fluid into the vascular bed, these indicators decrease even when bleeding stops. The hematocrit, as a rule, is within the normal range, since both erythrocytes and iron are simultaneously lost (normochromic anemia). On the 2nd day, the level of reticulocytes increases, reaching a maximum on the 4th-7th day (hyperregenerative anemia).

The severity of the condition is determined not only by the amount of blood lost, but also by the rate of blood loss. The source is of great importance: bleeding from the digestive tract can be accompanied by fever, signs of intoxication, an increase in the level of urea in the blood (with a normal content of creatinine); cavity bleeding, even with small blood loss, can cause symptoms of organ compression and so on.

Diagnostics of the acute post-hemorrhagic anemia

Diagnosis of hemorrhagic anemia should be based on information about acute blood loss that has occurred. With external bleeding, diagnosis is usually not difficult. With internal bleeding and collapse, other causes of the condition should be excluded.

Treatment of acute post-hemorrhagic anemia

Treatment begins with stopping bleeding. A rapid decrease in hemoglobin levels below 80 g / l, hematocrit below 25%, plasma proteins below 50 g / l is considered the basis for transfusion therapy (blood transfusion). The loss of erythrocytes is enough to make up for one third. The primary task of the doctor is to restore the volume of circulating blood by transfusing colloidal solutions. If polyglucinol and gelatinol are not available, the glucose solution can be poured.

Rheopolyglyukin and its analogs should not be used in conditions of possible renewal or ongoing bleeding, since they can exhibit the properties of antiplatelet agents - to reduce blood coagulation. To replace erythrocytes, erythrocyte mass is transfused. The indication in this case is the obvious massive blood loss (more than 1 liter), the preservation of pallor of the skin and mucous membranes, shortness of breath and tachycardia, despite the restoration of circulating blood volume with the help of plasma substitutes.

Fresh frozen plasma and plasma substitutes are infused in a larger volume than was lost, and erythrocytes - in a much smaller volume. Massive transfusions of whole blood or erythrocytes exacerbate the appearance of microstasis due to shock and contribute to the development of DIC.

Small blood loss is replenished with albumin and saline solutions. Whole blood is transfused in the absence of red blood cells. If there is no canned blood, then fresh citrated blood (just prepared) or direct transfusion is used. Without extreme necessity, it is highly undesirable to carry out it due to the presence of microclots in such blood. With operating blood loss of less than 1 liter, the erythrocyte mass is usually not transfused.

After the end of the acute period, iron preparations, vitamins of groups B, C, E are prescribed. After the signs of anemia disappear, iron preparations in a half dose are prescribed for another 6 months.

Prepared based on materials:

Davydkin I.L., Kurtov I.V. et al. Diseases of the blood in outpatient practice. M .: GEOTAR-Media, 2011, p. 192.
Ershov V.I. - M .: GEOTAR-Media, 2008, p. 116.
Zayko N. N., Byts Yu. V., Ataman A. V. et al. Pathological physiology. - K .: Logos, 1996.

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

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

Acute post-hemorrhagic anemia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chronic post-hemorrhagic anemia

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

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Kozinets G.I. Physiological systems of the human body, the main indicators. - M., Triada-X, 2000.
Kozinets G.I., Khakimova Ya.Kh., Bykova I.A. and other Cytological features of erythron in anemia. - Tashkent: Medicine, 1988.
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Ryaboe S.I., Shostka G.D. Molecular genetic aspects of erythropoiesis. - M .: Medicine, 1973.
Hereditary anemias and hemoglobinopathies / Ed. Yu.N. Tokareva, S.R. Hollan, F. Corral-Almonte. - M .: Medicine, 1983.
Troitskaya O.V., Yushkova N.M., Volkova N.V. Hemoglobinopathy. - M .: Publishing house of the Peoples' Friendship University of Russia, 1996.
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A source: V.V.Dolgov, S.A. Lugovskaya, V.T. Morozova, M.E. Pochtar. Laboratory diagnosis of anemia: A guide for doctors. - Tver: "Provincial Medicine", 2001

Posthemorrhagic anemia is a complex of changes in the blood picture and in the state of the body as a whole, which develops against the background of acute or chronic blood loss.

Posthemorrhagic anemia is a life-threatening condition and is accompanied by symptoms such as: pallor of the skin, severe shortness of breath, sharp darkening in the eyes, significant. In severe cases, loss of consciousness and the development of a shock state are possible.

With post-hemorrhagic anemia, the volume of blood circulating in the body is significantly reduced. In parallel, the level of red blood cells in the blood falls. A wide variety of pathologies can lead to the development of this violation: diseases of any internal organs, complicated by bleeding, injuries and trauma, and not only. The nature of anemia can be acute or chronic.

Long-term disturbance of hemodynamics in post-hemorrhagic anemia leads to pronounced organ tissues with their further degeneration. In severe cases, post-hemorrhagic anemia can be fatal.

Acute hemorrhagic anemia develops as a result of acute blood loss. This happens with internal or external bleeding. It is characterized by massiveness and high speed. Damage to the vascular walls is most often mechanical. Moreover, large blood vessels are affected. Also, acute post-hemorrhagic anemia can result from bleeding from the cavities of the heart against the background of injuries or after undergoing surgery. Heart attacks accompanied by rupture of the chambers of the heart walls, rupture of the aortic aneurysm, violation of the integrity of the pulmonary artery and its large branches - all this can cause acute blood loss with further development of anemia. Other risk factors include: rupture of the spleen, damage to the integrity of the epididymis, for example, when life begins in it.

In general, any profuse bleeding from the uterine cavity, even with prolonged menstruation, can lead to the development of acute post-hemorrhagic anemia. Dangerous in this regard, diseases of the digestive system, in particular, and.

In children during the neonatal period, post-hemorrhagic anemia can also develop, which most often manifests itself against the background of birth injuries or placental bleeding.

Chronic post-hemorrhagic anemia develops with the following disorders:

Minor, but regular bleeding in diseases of the gastrointestinal tract.

Frequent nosebleeds.

Bleeding hemorrhoids.

Recurrent renal bleeding.

DIC and hemophilia. These conditions are characterized by a violation of the blood clotting process.

Dry mouth.

A drop in body temperature, which is especially noticeable in the area of the upper and lower extremities.

The ingress of clammy and cold sweat.

Increased pulsation with a decrease in its strength.

Drop in blood pressure.

If bleeding develops in a child under one year old, then it will be much more difficult for him to endure than an adult.

If the blood loss is profuse, and blood flows out of the vascular bed quickly, then the victim may develop a collapse. Hypotension will be extremely pronounced, the pulse is barely palpable, or it may be absent altogether. Breathing becomes shallow, and episodes of vomiting and seizures are common. In most cases, human consciousness is absent.

Severe anemia can be fatal, which occurs against the background of acute hypoxia of internal organs. The work of the heart and respiratory center stops.

Separately, the symptoms of chronic blood loss, in which mild anemia develops, should be designated.

This is characterized by the following violations:

The skin becomes dry and cracked.

Any wounds on the skin take a very long time to heal and may fester.

The pallor of the skin and mucous membranes is not too pronounced, but it is difficult not to notice it.

Nails become brittle, exfoliate.

Hair grows dull, begins to fall out.

The heart works in an increased rhythm, which often breaks down.

Sweating increases.

Body temperature can remain at the level of subfebrile marks for a long time.

The patient often has ulcers in the mouth, possibly the formation of carious teeth.

Such symptoms do not have a clear severity and can disturb the patient from time to time. This is due to the fact that the body triggers compensatory mechanisms and works at the peak of its capabilities. However, sooner or later, they will run out.

Diagnosis of post-hemorrhagic anemia begins with questioning the patient's complaints and examining him. The doctor must measure the patient's blood pressure, assess the nature of his mucous membranes and skin. If the doctor suspects such a diagnosis in the patient, he will refer him to a series of examinations.

The laboratory tests will be as follows:

A blood test to determine the level of hemoglobin and erythrocytes, which will be reduced.

Blood chemistry.

Analysis of urine with control of its daily volumes.

Determination of the total volume of circulating blood.

Bone marrow puncture is performed only if the diagnosis remains in doubt. It is imperative to establish the cause of post-hemorrhagic anemia. For this, an ultrasound examination of the internal organs and organs of the small pelvis, FGDS, colonoscopy, sigmoidoscopy, and an electrocardiogram are taken. Wives should visit a gynecologist.

The scheme of the therapeutic effect on the patient depends on what exactly caused the development of post-hemorrhagic anemia. Detected bleeding should be stopped as soon as possible. If the blood loss is due to external bleeding, then a tourniquet or bandage is applied to the wound, suturing of vessels and damaged tissues and organs is possible. The victim must be urgently hospitalized.

If the blood loss is massive, then the following measures are shown:

Transfusion of erythrocyte mass, plasma and plasma substitutes (Reopolyglyukin, Gemodez, Polyglyukin). This measure must be taken promptly, since large blood loss is associated with a high risk of death.

Prednisolone (a hormonal drug) is administered when the patient develops a shock state.

Solutions of albumin, glucose, saline - all these substances are administered to the patient intravenously to restore the salt balance in the body.

To replenish iron stores, injections of Sorbifer Durules or Ferroplex can be used. However, it must be borne in mind that their use is associated with a high likelihood of an allergic reaction.

Severe anemia requires the administration of large doses of blood. Doctors call this procedure a blood transplant. If, after the restoration of the total blood volume, the patient's blood pressure normalizes, and its qualitative composition improves, then this indicates that the therapy was selected correctly. To improve the patient's well-being, he is prescribed B vitamins.

Symptomatic treatment should be aimed at restoring the functioning of the heart and blood vessels, brain, liver and kidneys, as well as other organs affected by hypoxia.

Delayed therapy involves the patient's adherence to a diet that is aimed at restoring the quality composition of the blood. To do this, you will need to eat low-fat red meat, liver, eggs, fermented milk drinks, vegetables and fruits, cottage cheese, fish. You should drink at least 2 liters of water per day, a rosehip decoction is useful.

The more massive the volume of lost blood, the worse the prognosis for recovery. What if a person loses at once? part of the total blood volume, then the likelihood of developing hypovolemic shock is extremely high. Should blood loss be equated to? parts, then the victim will not be able to survive. Provided that anemia develops with chronic blood loss, then most often it can be neutralized after the source of bleeding has been found and eliminated.

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016, completed postgraduate studies at the National Medical and Surgical Center named after N.I. Pirogov.

Chronic post-hemorrhagic anemia is a phenomenon caused by frequent and low blood loss. This, in turn, causes a deficiency of iron in the body, as well as a decrease in erythrocytes and a decrease in the concentration of hemoglobin.

This condition is divided into three types:

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

Secondary iron deficiency anemia is most often referred to as chronic post-hemorrhagic anemia.

Reasons for the development of chronic post-hemorrhagic anemia

Small but regular bleeding can accompany a person for many years, allowing anemia to develop. It is caused by such conditions as:

Chronic or iron deficiency anemia leads to an acute shortage of iron and hemoglobin. For normal functioning, the body needs a hemoglobin level in the range of 135-160 g / l, in the male body and in the female, 120-140 g / l. In a child's body, hemoglobin ranges from 150 to 200 g / l, in accordance with its age. So the symptoms:

The first symptoms of chronic post-hemorrhagic anemia are dizziness and the appearance of blackheads in front of the eyes. A person quickly gets tired and against this background his skin becomes pale, becomes thin and dry.
The next symptom is a loss of appetite by the patient, he has nausea, while stool is disturbed - diarrhea replaces constipation and vice versa. During this period, extraneous noises may appear in the patient's heart.
With the development of the disease, the condition of the skin worsens, it becomes thin and flaky. At the same stage of the disease, the hair becomes sore and brittle, and the nails exfoliate.
In a severe stage of anemia, the patient's perception of taste is disturbed, he begins to eat outwardly non-edible things, for example, chalk. He perceives odors inadequately, since the olfactory and taste buds stop working correctly. At this stage, the patient's teeth begin to deteriorate rapidly, and caries develops.
Blood pressure becomes painfully low.

Diagnostics of the chronic post-hemorrhagic anemia

Diagnoses this type of anemia using a blood test. At the same time, the blood picture is compiled according to the number and state of erythrocytes, microcytes and schizocytes. The reasons for the patient's condition must be established, for this the state of his internal organs is determined using ultrasound equipment.

In addition, the patient is examined by narrow specialists, this is a gastroenterologist, a proctologist, a hematologist, a gynecologist for women and an endocrinologist, such an approach to diagnosis allows, with a high degree of probability, to establish the cause of the disease.

Treatment of post-hemorrhagic anemia

However, the most important point in the treatment of this pathology is the restoration of iron in the body. After all, even an insignificant loss of blood from 10 to 15 ml, deprives the body of that amount of iron that entered it within 24 with food intake. In this regard, the patient is prescribed a number of preparations containing not only iron, but also a complex of vitamins of group B. It can be Sorbifer, Durules, Ferroplex or Fenyuls. All drugs are prescribed by the attending physician, he also calculates the dosage based on the patient's condition and on the fact that an adult needs about 100 -150 mg per day. gland.

If the patient's condition is serious, then he is prescribed injections of drugs such as "Ferlatum", "Faltofer" or "Likferr". He also undergoes such a procedure as a blood transfusion, while not all plasma is transfused, but only the erythrocyte mass.

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

The diet is calculated individually for each patient. It necessarily includes lean beef, chicken eggs, kefir, cottage cheese, goat cheese. It is mandatory to use beef liver, sea fish, caviar, as well as beans, peas, buckwheat, oatmeal and walnuts.

The presence of fresh vegetables, fruits and berries in the diet is imperative, they help the 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 the correct 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

Considering all this, acute and chronic post-hemorrhagic anemia in children is treated in a hospital under the constant supervision of a doctor. First of all, the very cause of bleeding is eliminated. Then a blood transfusion is done, and as many times as necessary, that is, not once.

Necessarily prescribed preparations containing iron, including injections, for faster absorption. For children under one year old, special nutritional mixtures rich in iron and vitamins are introduced into the diet.

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

As a rule, the restoration of the iron level in the 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 narrow specialists.

Prognosis for posthemorrhagic anemia

In general, the prognosis for post-hemorrhagic anemia is positive. But only under the condition of correct and competent therapy, which includes the elimination of chronic bleeding, even if this requires a surgical operation.

Prevention of post-hemorrhagic anemia

In order for post-hemorrhagic anemia not to develop in the body of an adult or a child, it is necessary to timely treat diseases leading to blood loss. But there is a difficulty - most of these are more beneficial to proceed unnoticed by a person, he can feel good while a colony of parasites grows in his body or kidney stones accumulate. In this regard, it is necessary to undergo a full medical examination regularly, at least once a year. It should include the study of internal organs, analysis for the presence of parasites, as well as monitoring the quality of blood. Namely - the content of iron and erythrocytes in it.

Posthemorrhagic anemia is a set of pathological changes that develop in the body due to the loss of a certain amount of blood: it contains iron, and with blood loss it becomes insufficient. It is divided into two types: acute and chronic.

ICD-10 code

Chronic posthemorrhagic anemia has the following ICD-10 code - D50.0, and acute - D62. These disorders are found under Nutritional Anemias. Iron-deficiency anemia".

Latin defines the word "anemia" as "bloodless", literally speaking. Also, the word can be translated as "anemia", which means a lack of hemoglobin. And "hemorrhagic" translates as "accompanied by bleeding", the prefix "post" means "after."

Information about what post-hemorrhagic anemia is will allow to detect its development in time and provide the necessary assistance.

Pathogenesis in post-hemorrhagic anemia

Pathogenesis is a certain sequence of development of pathological changes, which makes it possible to judge the features of the occurrence of post-hemorrhagic anemia.

The severity of posthemorrhagic anemia is determined by the content of hemoglobin and the severity of tissue hypoxia due to its deficiency, but the symptoms of anemia and its features are associated not only with this indicator, but also with others that decrease with blood loss:

Iron content;
Potassium;
Magnesium;
Copper.

Iron deficiency affects the circulatory system especially negatively, in which the production of new blood elements is difficult.

The minimum volume of blood that can be lost without the risk of developing serious disorders is 500 ml.

Donors donate blood without exceeding this amount. A healthy human body with sufficient body weight over time completely restores the lost elements.

When there is not enough blood, the small blood vessels constrict to compensate for the shortage and keep blood pressure at a normal level.

Due to the lack of venous blood, the heart muscle begins to work more actively to maintain sufficient minute blood flow - the amount of blood that is thrown out by the heart per minute.

What color can the venous blood be read?

Read the heart muscle consists

The functioning of the heart muscle is impaired due to a deficiency of minerals, the heart rate decreases, the pulse weakens.

An arteriovenous shunt (fistula) arises between the veins and arterioles, and the blood flow goes through the anastomoses without touching the capillaries, which leads to impaired blood circulation in the skin, muscular system, and tissues.

Formation of an arteriovenous shunt that prevents blood from reaching the capillaries

This system exists to support blood flow in the brain and heart, which allows them to continue to function even with severe blood loss.

The interstitial fluid quickly compensates for the lack of plasma (liquid part of the blood), but microcirculation disorders persist. If the blood pressure drops too much, the speed of blood flow in the small vessels will decrease, leading to thrombosis.

In the severe stage of post-hemorrhagic anemia, small blood clots form, which clog small vessels, which leads to a malfunction of the arterial glomeruli in the kidney tissue: they do not filter fluid properly, and the amount of urine excreted decreases, and harmful substances are retained in the body.

It also weakens blood circulation in the liver. If you do not start timely treatment of acute post-hemorrhagic anemia, this will lead to liver failure.

In post-hemorrhagic anemia, the liver suffers from a lack of blood

Oxygen deficiency in the tissues leads to the accumulation of under-oxidized elements that poison the brain.

Acidosis develops: a violation of the acid-base balance towards the predominance of an acidic environment. If post-hemorrhagic anemia is severe, the amount of alkali decreases, and the symptoms of acidosis increase.

With blood loss, the level of platelets decreases, but this does not significantly affect the coagulation processes: the content of other substances that affect coagulation reflexively increases.

Over time, the mechanisms of coagulation return to normal, but there is a risk of developing thrombohemorrhagic syndrome.

Causes

The main factor influencing the development of post-hemorrhagic anemia is blood loss, the causes of which can be different.

Acute post-hemorrhagic anemia

This is a disorder that develops rapidly due to profuse blood loss. This is a dangerous condition that requires a quick start of treatment.

Causes of acute anemia:

Chronic post-hemorrhagic anemia

A condition that develops with systematic blood loss over a long period of time. It is able to remain unnoticed for a long time if the blood loss is mild.

The causes of chronic anemia:

Also, hemorrhagic anemia develops due to vitamin C deficiency.

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Posthemorrhagic anemia is divided not only by the nature of the course (acute or chronic), but also by other criteria.

The severity of anemia is assessed by the amount of hemoglobin in the blood.

Depending on its content, anemia is divided into:

Easy. With a mild severity of anemia, hemoglobin begins to lack iron, its production is impaired, but the symptoms of anemia are practically absent. Hemoglobin does not fall below 90 g / l.
Average. Symptoms with moderate severity are moderately expressed, the hemoglobin concentration is 70-90 g / l.
Heavy. In severe cases, there are serious organ dysfunctions, heart failure develops, the structure of hair, teeth, and nails changes. The hemoglobin content is 50-70 g / l.
Extremely severe degree. If the hemoglobin level is below 50 g / l, there is a risk to life.

There are also certain pathologies included in the ICD:

Congenital anemia in newborn and fetus due to blood loss (code P61.3);
Chronic posthemorrhagic anemia, which is secondary iron deficiency (code D50.0).

Symptoms

Acute anemia

Symptoms in the acute form of post-hemorrhagic anemia grow very quickly and depend on the severity of blood loss.

Observed:

A decrease in blood pressure against a background of massive blood loss is called hemorrhagic shock. The intensity of the drop in blood pressure depends on the severity of blood loss.

The following symptoms are also present:

Tachycardia;
The skin is cold and pale, with a moderate to severe degree it has a cyanotic (bluish) color;
Impaired consciousness (stupor, coma, loss of consciousness);
Weak pulse (if the stage is severe, it can be felt only on the main vessels);
Reducing the amount of urine excreted.

The symptoms of post-hemorrhagic anemia and hemorrhagic shock are joined by signs that are inherent in the disease that caused the blood loss:

With an ulcer, black or red stools are observed;
Swelling in the impact area (if injured);
When the arteries rupture in the lungs, there is a cough with blood of a bright scarlet color;
Intense bloody discharge from the genitals with uterine bleeding.

The source of bleeding is revealed by indirect signs, depending on the clinical picture.

Stages of acute posthemorrhagic syndrome

Acute post-hemorrhagic syndrome has three stages of development.

Name	Description
Reflex-vascular stage	The level of plasma and erythrocyte mass falls, compensatory processes are activated, the pressure drops, the heartbeat is rapid.
Hydremia stage	It develops several hours after blood loss and lasts from 2 to 3 days. The intercellular fluid restores the volume of fluid in the vessels. The content of red blood cells and hemoglobin decreases.
Bone marrow stage	It develops 4-5 days after blood loss due to oxygen deprivation. In the blood, the level of hematopoietin and reticulocytes, the precursor cells of erythrocytes, increases. The amount of iron in the plasma is reduced.

The body fully recovers after blood loss after two to three months or more.

Signs of a chronic form

Chronic bleeding gradually leads to post-hemorrhagic anemia, which develops gradually, and its symptoms are closely related to the severity of hemoglobin deficiency.

Observed:

People with post-hemorrhagic anemia have low immunity and often develop infectious diseases.

Diagnostics

In case of acute blood loss, the patient remains inpatient treatment so that the risks can be assessed and timely assistance provided.

Laboratory diagnostics of post-hemorrhagic anemia is carried out repeatedly, and the results vary depending on the stage and severity of the disorder.

Laboratory signs of acute anemia:

In the first two hours, the concentration of platelets rises, and erythrocytes and hemoglobin are kept at a normal level;
After 2-4 hours, the excess of platelets remains, neutrophilic granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, according to the color index, anemia is defined as normochromic (the value is normal);
After 5 days, there is an increase in reticulocytes, the level of iron is insufficient.

What tests do I need to take?

It is necessary to pass a general blood test, in case of chronic anemia, it reveals the content of elliptocytes, lymphocytes are increased in the peripheral blood, but reduced in the total cellular composition.

Deficiency of iron, calcium, copper is revealed. The manganese content is high.

In parallel, analyzes are carried out that allow you to determine the cause of bleeding: fecal examination for helminthiasis and occult blood, colonoscopy, urine analysis, bone marrow examination, ultrasound examination, esophagogastroduodenoscopy, electrocardiogram.

Who to contact?

Hematologist

Treatment

Acute hemorrhagic anemias in the first stage of treatment require elimination of the cause of blood loss and restoration of normal blood volume.

Operations are performed to suture wounds, blood vessels, the following medications are prescribed:

Artificial blood substitutes. They are poured in by drip or jet, depending on the patient's condition;
With the development of shock, the use of steroids (Prednisolone) is indicated;
Soda solution eliminates acidosis;
Anticoagulants are used to eliminate blood clots in small vessels.
If the blood loss exceeds a liter, a donor blood transfusion is required.

Treatment of chronic anemia, not aggravated by serious diseases, takes place on an outpatient basis. Shown is a nutritional correction with the addition of foods that contain iron, vitamins B9, B12 and C.

In parallel, the treatment of the underlying disease, which caused pathological changes, is carried out.

Forecast

If, after extensive blood loss, the patient quickly arrived at the hospital and received the full range of medical procedures aimed at restoring blood levels and eliminating bleeding, then the prognosis is favorable, unless the blood loss is extremely pronounced.

The chronic type of pathology is successfully eliminated by curing the disease that caused it. The prognosis depends on the severity of concomitant diseases and the degree of neglect of anemia. The sooner the cause is identified and treatment is started, the greater the chances of a favorable outcome.