- a complex of clinical and hematological changes resulting from acute or chronic blood loss. Posthemorrhagic anemia is characterized by pallor, shortness of breath, darkening of the eyes, dizziness, hypothermia, arterial hypotension; in severe cases - lethargy, threadlike pulse, shock, loss of consciousness. Posthemorrhagic anemia is diagnosed according to the clinical picture and general blood test; instrumental studies are carried out to establish the source of bleeding. With the development of this condition, it is necessary to eliminate the source of blood loss, conduct transfusion and symptomatic therapy.

General information

Post-hemorrhagic anemia is hypoglobinemia that develops as a result of hemorrhagic syndrome and is accompanied by a noticeable decrease in circulating blood volume (BCC). Posthemorrhagic anemia occurs with erythropenia, but often without a decrease in hemoglobin (Hb) concentration. Normally, the level of total Hb and the volume of circulating erythrocytes is respectively: in men - not less than 130 g / l and 29-30 ml / kg of body weight, in women - not less than 120 g / l and 22-23 ml / kg. Post-hemorrhagic anemia can complicate the course of various pathological conditions in surgery, hematology, gynecology, gastroenterology, cardiology, etc. Post-hemorrhagic anemia can be acute or chronic. The chronic form is a variant of iron deficiency anemia, since the mechanism of development and symptoms of pathology are caused by an increasing iron deficiency.

Causes of posthemorrhagic anemia

The immediate cause of posthemorrhagic anemia is acute or chronic blood loss resulting from external or internal bleeding. Acute post-hemorrhagic anemia occurs with rapid, massive blood loss, usually caused by mechanical damage to the walls of large blood vessels or heart cavities during various injuries and surgical operations, rupture of the walls of the heart chambers in the infarction zone, rupture of the aortic aneurysm and branches of the pulmonary artery, rupture of the spleen, rupture of the fallopian tube with an ectopic pregnancy.

Acute post-hemorrhagic anemia is characteristic of profuse uterine bleeding (menorrhagia, metrorrhagia), and may accompany the course of gastric and duodenal ulcers. In newborns, posthemorrhagic anemia can be caused by placental bleeding, birth trauma.

Chronic post-hemorrhagic anemia is caused by prolonged, often occurring loss of small volumes of blood in gastrointestinal, hemorrhoidal, renal, nosebleeds, disorders of blood coagulation mechanisms (DIC syndrome, hemophilia). Tumor processes (stomach cancer, colon cancer), proceeding with the destruction of tissues and organs, lead to the development of internal bleeding and post-hemorrhagic anemia. Hypohemoglobinemia may be associated with an increase in the permeability of the capillary walls in leukemia, radiation sickness, infectious-septic processes, vitamin C deficiency.

Pathogenesis of posthemorrhagic anemia

The main factors in the development of post-hemorrhagic anemia are the phenomena of vascular insufficiency, hypovolemia with a decrease in the total volume of plasma and circulating corpuscles, in particular, erythrocytes that transport oxygen. This process is accompanied by a decrease in blood pressure, blood filling of internal organs and tissues, hypoxemia, hypoxia and ischemia, and the development of shock.

The severity of the body's protective-adaptive reactions is determined by the volume, speed and source of bleeding. In the early reflex-vascular phase of compensation of blood loss (the first day), due to the excitation of the sympathetic-adrenal system, vasoconstriction and increased resistance of peripheral vessels are observed, hemodynamic stabilization due to the centralization of blood circulation with primary blood supply to the brain and heart, a decrease in blood return to the heart and cardiac output. The concentration of erythrocytes, Hb and hematocrit are still close to normal ("latent" anemia).

The second hydraemic phase of compensation (2-3 days) is accompanied by autohemodilution - the flow of tissue fluid into the bloodstream and replenishment of the plasma volume. Strengthening the secretion of catecholamines and aldosterone by the adrenal glands, vasopressin by the hypothalamus contributes to the stability of the level of electrolytes in the blood plasma. There is a progressive decrease in erythrocyte and Hb indices (total and per unit volume), hematocrit; the value of the color indicator is normal (posthemorrhagic normochromic anemia).

In the third, bone marrow phase of compensation (4-5 days), due to a lack of iron, anemia becomes hypochromic, the formation of erythropoietin by the kidneys increases with activation of the reticuloendothelial system, erythropoiesis of the bone marrow, foci of extramedullary hematopoiesis. In the red bone marrow, hyperplasia of the erythroid lineage and an increase in the total number of normocytes are observed, in the peripheral blood there is a significant increase in the number of young forms of erythrocytes (reticulocytes) and leukocytes. The levels of Hb, erythrocytes and hematocrit are lowered. Normalization of the level of erythrocytes and Hb in the absence of further blood loss occurs in 2-3 weeks. With massive or prolonged blood loss, post-hemorrhagic anemia acquires a hyporegenerative character, with depletion of the body's adaptive systems, shock develops.

Symptoms of post-hemorrhagic anemia

Clinical signs of post-hemorrhagic anemia are of the same type, regardless of the cause of blood loss, and are determined by its volume and duration.

On the first day after acute blood loss, patients have severe weakness, pale skin and mucous membranes, shortness of breath, darkening and flickering of flies in the eyes, dizziness, tinnitus, dry mouth, decreased body temperature (especially of the extremities), cold sweat. The pulse becomes frequent and weak, arterial hypotension appears. The consequence of hemorrhagic syndrome is anemia of internal organs, fatty degeneration of the myocardium, liver, central nervous system and other organs. Children, especially newborns and the 1st year of life, tolerate blood loss much more heavily than adult patients.

Posthemorrhagic anemia with massive and rapid blood loss is accompanied by hemorrhagic collapse, a sharp drop in blood pressure, threadlike arrhythmic pulse, adynamia and lethargy, rapid shallow breathing with the possible development of vomiting, seizures, loss of consciousness. If the pressure drops to a critical level, causing an acute disturbance of the blood supply and hypoxia of organs and systems, death occurs from paralysis of the respiratory center and cardiac arrest.

Slowly developing post-hemorrhagic anemia is characterized by less pronounced manifestations, since it manages to partially compensate due to adaptation mechanisms.

Diagnostics of the post-hemorrhagic anemia

Diagnosis of posthemorrhagic anemia is carried out according to the clinical picture, laboratory and instrumental studies (general and biochemical blood and urine tests, ECG, ultrasound diagnostics, bone marrow puncture, trepanobiopsy). When examining a patient with acute post-hemorrhagic anemia, attention is drawn to hypotension, rapid breathing, weak arrhythmic pulse, tachycardia, muffled heart sounds, a slight systolic murmur at the apex of the heart.

In the blood - an absolute decrease in erythrocyte mass; with continued blood loss, a progressive uniform drop in the content of Hb and erythrocytes is observed. With moderate blood loss, hematological signs of post-hemorrhagic anemia are detected only on days 2-4. It is mandatory to control diuresis, platelet levels, electrolytes and nitrogenous products in the blood, blood pressure and BCC.

In acute post-hemorrhagic anemia, there is no need for bone marrow examination; it is carried out with difficultly diagnosed blood loss. In bone marrow puncture samples, signs of anemia are an increase in the activity of red bone marrow, in trepanobiopsy preparations - replacement of adipose tissue of the bone marrow with red hematopoietic marrow.

In the diagnosis of internal bleeding, acute anemia syndrome and laboratory data are indicative. In the spleen, liver, lymph nodes, foci of extramedullary hematopoiesis are revealed, indicating an increased load on the hematopoietic system; in the blood - a transient decrease in iron levels, a slight increase in ALT.

To identify and eliminate the source of blood loss, patients need advice from a hematologist, surgeon, gynecologist, gastroenterologist and other specialists; conducting ultrasound of the abdominal cavity and small pelvis, EGDS, etc. ECG in posthemorrhagic anemia may demonstrate a decrease in the amplitude of the T-wave in the standard and chest leads.

Treatment and prognosis of posthemorrhagic anemia

Primary in the treatment of post-hemorrhagic anemia is to establish the source of bleeding and its immediate elimination by ligating and suturing blood vessels, resecting and suturing damaged organs and tissues, increasing blood clotting, etc.

To restore the BCC and reduce the degree of hemodynamic disorders, under the supervision of a transfusionist, an urgent transfusion of canned blood, blood substitutes, plasma and plasma substitutes is performed. For minor but prolonged bleeding, transfusion of whole blood or plasma is indicated in small hemostatic doses. With a significant loss of BCC, transfusions should be performed in doses exceeding blood loss by 20-30%. Severe post-hemorrhagic anemia is treated with high-dose blood transfusions ("blood transplants"). During the period of collapse, blood transfusion is supplemented with hypertonic blood-substituting solutions.

After the restoration of the BCC, the qualitative composition of the blood is corrected - the replenishment of its components: erythrocytes, leukocytes, platelets. With a large one-stage blood loss and stopped bleeding, massive doses of erythrocyte mass (> 500 ml) are required. The effectiveness of blood transfusions is judged by an increase in blood pressure, hematological shifts.

It is also necessary to introduce protein and electrolyte solutions (albumin, saline solution, glucose), which restore the water-salt balance. In the treatment of posthemorrhagic anemia, iron preparations, vitamins of group B are used. Symptomatic therapy is prescribed, aimed at normalizing functional disorders of the cardiovascular and respiratory systems, liver, kidneys, etc.

The prognosis of posthemorrhagic anemia depends on the duration and volume of bleeding. A sharp loss of 1/4 of the BCC leads to acute anemia and a state of hypovolemic shock, and the loss of 1/2 of the BCC is incompatible with life. Posthemorrhagic anemia with a slow loss of even significant blood volumes is not so dangerous, since it can be compensated.

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

Changes in the body with blood loss

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

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

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

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

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

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

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

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

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

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

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

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

Types of posthemorrhagic anemia

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

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

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

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

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

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

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

More about the causes of acute and chronic blood loss

The most common causes of anemia are:

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

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

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

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

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

With different types of bleeding, you can find:

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

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

Stages of the acute form of anemia

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

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

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

With menopause, uterine bleeding is accompanied by hormonal changes

Signs and course of the chronic form

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

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

Diagnostic methods

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

What is found in blood tests?

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

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

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

Additional data

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

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

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

Treatment

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

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

Intravenous catheter allows long-term infusion of fluids with medications

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

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

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

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

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

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

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

Forecast

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

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

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

Diseases

Iron-deficient types of anemia account for almost 80% of all cases of this disease. These include post-hemorrhagic anemia, which is considered one of the most commonly diagnosed. This ailment occurs due to severe blood loss. This disease can have both an acute form and turn into a chronic, difficult to diagnose. In the first case, posthemorrhagic develops due to the sudden appearance of profuse blood loss. The chronic form appears with frequent, but small, internal bleeding.

Hemorrhagic anemia

This disease is developing rapidly and carries a real danger to human life. Acute hemorrhagic anemia can be fatal. Therefore, when such a problem arises, the patient should urgently seek medical help. A one-time loss of 500 ml of blood is considered critical. The chronic form of the disease can significantly worsen a person's quality of life. Constant, but not profuse bleeding also often indicates the development of various cardiological, gynecological and gastroenterological problems.

Disease symptoms

Signs of chronic and acute forms of the disease can vary greatly. With regular, but not heavy bleeding, the patient develops mild symptoms. He may complain about:

• pallor of the skin;
• rapid fatigue;
• loss of working capacity;
• dizziness;
• darkening in the eyes;
• decrease in body temperature.

Acute posthemorrhagic anemia causes more pronounced symptoms. It is important to know how to identify profuse internal blood loss in order to immediately call for medical attention. In this state, the patient has:

Dry mouth is a sign of internal bleeding. The person may also develop nausea, vomiting, and confusion. Feces can also indicate a problem. With internal bleeding, they turn black. Against the background of general intoxication of the body, the patient's body temperature may rise. The patient also complains of a feeling of squeezing of the internal organs. The stronger the blood loss, the more pronounced the above symptoms are.

The appearance of this disease is always associated with a lack of blood in the body. Acute post-hemorrhagic anemia occurs most often due to trauma, during which damage to blood vessels and large arteries occurs. In addition, the disease can appear when:

• surgical interventions;
• rupture of the fallopian tube during an ectopic pregnancy;
• peptic ulcer of the stomach and duodenum;
• severe lung diseases;
• violation of hemostasis.

An acute form of anemia occurs with massive blood loss, which can provoke damage to the walls of the heart chambers during a heart attack. Also, the disease often develops with ruptures of the aortic aneurysm. This disease can also appear in infants. They have a problem associated with birth trauma, as well as placental bleeding.

The chronic form of hemorrhagic anemia manifests itself with the loss of small volumes of blood associated with various gastrointestinal, renal, hemorrhoidal and nasal injuries. The problem can appear with uterine bleeding, gingivitis, hemorrhoids and intestinal tumors.

In women, this disease can be observed with very heavy menstruation, dysmenorrhea. Sometimes this disease is diagnosed in pregnant women. Their anemia can be associated with serious pathologies. For example, the problem may appear when:

• rupture of the umbilical cord;
• placental abruption;
• choriangioma;
• placental hematoma.

If a person has symptoms of acute post-hemorrhagic anemia, it is necessary to urgently call emergency medical care. The sooner the resuscitation team arrives, the higher the likelihood of successful treatment. To cope with such a diagnosis, doctors such as:

A patient who observes signs of chronic anemia should seek help from these specialists. He may also need to go through consultations with a hematologist, gastroenterologist, gynecologist, proctologist. At the first visit, the doctor should carefully listen to all the patient's complaints. The doctor will certainly examine the patient, and also ask him several clarifying questions:

1. When did you first notice the symptoms of the disease?
2. Have there been similar problems in the past?
3. Do chronic diseases bother you?
4. Are there any other health complaints?
5. Are you taking any medications?

The survey allows the specialist to draw up a complete clinical picture of the disease. It also helps to find the true root cause of the development of post-hemorrhagic anemia. The doctor must send the patient for examination to confirm the diagnosis. The patient will have to pass general and biochemical blood tests, which will determine the lack of hemoglobin. Ultrasound, ECG, X-ray and FGS are performed in order to determine the cause of internal bleeding.

Treatment features

Therapy can have significant differences, depending on what form of anemia is observed in the patient. If a person has been diagnosed with acute hemorrhagic anemia, then he is urgently hospitalized. All efforts of doctors will be directed to the immediate elimination of bleeding. To do this, they can:

• dressing;
• perform suturing of blood vessels;
• increase blood clotting;
• to carry out resection and suturing of damaged organs.

In the future, hemorrhagic anemia may not require any treatment, since the body will begin to actively restore the lost amount of blood. This is done by activating blood depots, which are located in the liver, lungs, and spleen.

If the patient has lost a lot of blood, then he needs an urgent transfusion. In severe conditions, the patient can also be administered:

• blood replacement solutions;
• B vitamins;
• electrolyte solutions;
• iron preparations.

The prognosis for this disease depends on how quickly the person received qualified medical care. With prolonged and profuse bleeding, acute posthemorrhagic anemia can provoke hypovolemic shock, after which the patient may fall into a coma.

Treatment of posthemorrhagic anemia

Therapy for chronic anemia also begins with finding and eliminating the cause of bleeding. Having eliminated this problem, doctors prescribe medication to the patient. It consists of taking one of the following drugs.

Posthemorrhagic anemia develops as a result of large blood loss. This is the most common type of disease, it is a consequence of injuries and chronic diseases, which are accompanied by prolonged internal bleeding.

The loss of a large amount of blood requires replacement of iron-containing components in the plasma. Otherwise, the situation is fraught with serious complications up to the death of the patient.

The pathological process proceeds against the background of a significant decrease in the amount of circulating blood. However, the hemoglobin concentration may remain normal.

The danger of the disease lies in the fact that it provokes the development of serious complications in the clinical course of surgical, gynecological and hematological pathologies. In addition, the condition of patients with disorders of the cardiovascular system and gastrointestinal tract is significantly worsening.

Processes in post-hemorrhagic anemia

A decrease in the concentration of hemoglobin and the presence of oxygen starvation of tissues are not the only manifestations of this type of anemia. Loss of blood in a volume of more than 500 ml causes the following negative changes:

1. An insufficient amount in the body of such components as iron, potassium and magnesium, which inevitably leads to a significant decrease in immunity.
2. A decrease in the BCC (circulating blood volume) is accompanied by spasms and impaired vascular conduction, and then - a failure in the heart rhythm, instability of blood pressure.
3. The kidney tissue, skin and muscular system lack blood supply.
4. As a result of hemorrhagic anemia, urinary excretion decreases.
5. Insufficient blood supply to the liver causes liver dysfunction.
6. Due to stagnant processes caused by slow blood flow, the body is acidified with slags (acidosis), the presence of which is detrimental to the state of the bone marrow.
7. Severe anemia provokes depletion of alkaline reserves, which inevitably leads to the inability to compensate for them.

Such pathological processes necessitate urgently adjusting the patient's condition in order to avoid irreversible processes.

Causes

The main factor influencing the development of post-hemorrhagic anemia is acute blood loss, which is a consequence of conditions such as:

• mechanical injuries, as a result of which large arteries are damaged;
• surgical operations that provoked a complication in the form of bleeding;
• a stomach or duodenal ulcer;
• pathological changes in the liver, accompanied by venous bleeding;
• diseases of the genitourinary system and kidneys;
• chronic tuberculosis;
• profuse and prolonged menstruation, improper attachment of the fetus, severe labor, cancer of the reproductive organs;
• haemorrhoids;
• oncological diseases of the digestive tract.

In adults, nosebleeds, dental procedures, and tooth extractions can also be the cause of significant blood loss.

Clinical picture

The manifestation of the characteristic symptoms and signs does not depend on the factors that led to the loss of blood. They are related to the amount and duration of bleeding.

Among the most expressive features it should be noted:

• pallor of the skin;
• feeling weak, difficulty breathing;
• ear congestion and noise;
• dryness of the mucous membranes of the nose and throat;
• chills, feeling of chilliness in the limbs;
• fast but weakened pulse;
• lowering blood pressure.

Chronic anemia occurs with less pronounced symptoms, which is explained by the partial compensatory capacity of the body.

Possible consequences

Among the probable complications of large blood loss, the following pathological conditions are observed:

• malnutrition of internal organs and tissues;
• dystrophic changes in the liver, heart muscle (myocardium) and other organs;
• disorders associated with the activity of the central nervous system;
• convulsions, loss of consciousness;
• critical lowering of blood pressure.

Due to a sharp violation of the blood supply to the body's systems and the subsequent critical decrease in blood pressure, hemorrhagic shock and cardiac arrest occur.

The symptoms of post-hemorrhagic anemia are especially difficult for infants.

Classification

The clinical picture of the pathological condition gives grounds to distinguish two types of posthemorrhagic anemia.

The acute form is characterized by profuse bleeding caused by external trauma or intense internal hemorrhage.

Damage to arteries during surgery is also associated with anemic syndrome..

In the chronic course of anemia, moderate blood loss is observed. They are the result of stomach or duodenal ulcers, hemorrhoids, heavy discharge during menstruation, nosebleeds.

Important indicators

The severity of the disease is determined by the presence of a component in the blood such as hemoglobin. Based on this, three categories are distinguished:

1. Grade 1 - easy. This substance is at least 90-95 g / l.
2. 2 - medium. The hemoglobin level drops to 75 g / l.
3. Grade 3 - severe. The concentration of Hb in the blood is only 50-55 g / l.

The identification of indicators below the last indicated indicates that there is an extremely severe degree of the patient's condition.

Stages of development of pathology

The pathogenesis of the acute clinical form is characterized by the manifestation of 3 stages of anemia:

1. The first stage is vascular reflex. At this stage, the body's defense mechanisms are activated, accompanied by the opening of the anastomoses. At the same time, blood pressure significantly decreases, shortness of breath appears, heart rhythm is disturbed, the skin turns pale.
2. The second stage is hydremia. The composition of the plasma changes, the vessels are filled with fluid coming from the tissues of the cells. The concentration of erythrocytes and hemoglobin in the blood is significantly reduced.
3. The third stage is changes in the bone marrow. Typical violations occur on the 3-5th day. Iron levels are extremely low. This situation requires long-term treatment - up to three months.

The chronic form develops over a long period - from several weeks to a year or more. It is justifiably referred to as iron deficiency manifestations of pathology. Symptoms differ significantly from those of acute anemia.

Among the most expressive features:

• dryness and pallor of the skin;
• swelling;
• dull hair, fragility of the nail plates;
• active sweating, indicating weakness;
• increased heart rate;
• border temperature (37 ° C).

The lack of timely therapeutic measures to eliminate prolonged bleeding leads to depletion of the body's compensatory forces, as a result of which the prerequisites for hemorrhagic shock develop.

Diagnostic measures

Diagnosis of hemorrhagic anemia is a complex process. It involves the study of a set of anamnestic, laboratory and instrumental indicators.

The objectives of the patient's examination are to determine the nature of the anemia and to detect the tissue or organ that caused the bleeding.

The main diagnostic steps are as follows:

1. Conversation with the patient. Visual inspection.
2. Clinical blood test. According to laboratory values, as well as the color index of blood, the duration of bleeding and changes in the concentration of its components are determined. For example, within 1 hour, the platelets in the blood rapidly increase. In the next 3-4 hours, blood clotting remains the same, but the concentration of erythrocytes and hemoglobin decreases. On the fifth day, there is a deficiency in iron plasma.
3. A biochemical analysis reveals the following blood picture: in addition to a decrease in the concentration of iron, there is a low level of calcium and copper, and the level of manganese increases.

In addition to blood tests, in order to determine the localization of bleeding, the following is carried out:

• examination of feces for the presence of occult blood and helminthic invasion;
• fibrogastroscopy;
• colonoscopy;
• sigmoidoscopy;

Laboratory indicators and instrumental examination make it possible to specify the localization of the focus and greatly facilitate the identification of the cause of anemia.

Treatment

The therapeutic course for the acute course of the disease provides for the restoration of the required amount of blood and the normalization of all body systems. Treatment is carried out in a hospital.

To this end:

• artificial blood products are introduced - Gelatinol, Polyglyukin;
• with hemorrhagic shock, significant doses of Prednisolone are prescribed;
• the removal of symptoms of acidosis is carried out using a soda solution;
• Heparin is used to prevent blood clots.

Direct blood transfusion is used in exceptional cases, since this procedure can lead to an immune-based conflict.

Chronic anemia of this type is treated with iron preparations, if there is no exacerbation of the disease that caused the blood loss. In some cases, surgery is performed to eliminate it.

Health food

Prophylaxis

During the recovery period, the body needs immune support. Therefore, doctors recommend the use of foods rich in vitamins and essential trace elements.

Medicinal extracts of lemongrass, aloe and ginseng have a beneficial effect on recovery processes.

The chronic form of such a serious disease as post-hemorrhagic anemia requires the patient's special attention to his health. Signs of exacerbation are a mandatory indication for immediate medical attention.

Forecasts with timely professional assistance are favorable and guarantee a successful outcome.

Post-hemorrhagic anemia is a condition associated with a decrease in the level of hemoglobin in the blood. This type of anemia is associated with a loss of more than 12% of the total blood volume.

The main moment of the appearance of this disease is acute post-hemorrhagic anemia or prolonged, albeit non-volumetric, bleeding that has developed due to trauma. At the same time, large veins or other vessels through which blood plasma flows were damaged. Most often this happens when the veins in the forearm, rupture of the arteries in the thigh or the vessels of the abdominal part of the body with a strong blow.

If the loss of blood plasma continues for a long time, then chronic, post-hemorrhagic anemia may develop.

The main source of such bleeding is various tumors, various diseases of the kidneys or liver, inflammation of the veins in the rectum. Disorders of the menstrual cycle, the development of polyps in the patient's body, the occurrence of a hernia, various ulcerative lesions of the stomach and intestines, and many blood diseases of a systemic nature often lead to similar consequences. Ailments affecting the red bone marrow lead to the same result.

Symptoms of hemorrhagic type anemia

The most typical symptom of this disease is the pale coloration of the layers of the membranes of organs such as the nose, genitals, mucous membranes of the pharynx, iris and skin. Along with this, sick people show the following symptoms:

1. A pronounced weakening of the body.
2. Increased fatigue.
3. The onset of dizziness.
4. Noise in the ears.
5. Unreasonable sleepiness.

Additionally, the following signs of anemia may appear:

1. The patient often complains of severe headache.
2. The patient develops shortness of breath.
3. Women may experience an irregular menstrual cycle.

Most of the above phenomena occur because the work of the heart muscle in anemia is aimed at eliminating the lack of oxygen in the blood plasma and poor supply of nutrients to various organs. The cardiovascular system accomplishes this task by increasing the intensive supply of blood, that is, the number of heart beats per unit of time increases. This leads to tachycardia or murmurs in the heart muscle. Indirectly, doctors can judge the appearance of anemia in a patient by bleeding that has already passed or by chronic sources of blood loss, which can be considered:

1. Inflammatory processes on hemorrhoids.
2. Development of signs of dysmenorrhea.
3. An increase in the duration of the menstruation process in a woman.

During an acute type of moderate anemia, when large volumes of blood plasma are poured out, the symptoms of the disease are manifested as follows:

1. The patient is very dizzy.
2. Nausea develops, which can develop into vomiting.
3. A person's consciousness begins to get confused.
4. Deep fainting is possible.
5. In a severe form of the disease, collapse or shock of a hemorrhagic nature may develop.

Post-hemorrhagic anemia in adolescents under 17 years of age and pregnant women

Posthemorrhagic anemia in medical practice during pregnancy occupies a special place. The presence of a large decrease in hemoglobin levels in a woman indicates that she can develop such lesions during pregnancy:

1. Chorionangioma.
2. Hematoma and detachment of placental tissues.
3. Umbilical cord breaks.
4. The presence and rupture in this area of ​​vessels that are located abnormally.

Treatment for the development of post-hemorrhagic anemia

In the acute course of the disease, special rehabilitation teams of ambulance doctors and similar structures in clinics are engaged in the fight against the disease. Their main task is to stop bleeding. Then, the state of the patient's body is assessed and ways of further fight against the disease are outlined.

If the volume of flowing blood is small, and the heart is functioning normally and the blood pressure does not change, then further intervention of doctors may not be required. The body self-repairs the loss of blood plasma due to the production of the necessary enzymes in the spleen, as well as in the red bone marrow and in the liver.

This recovery process can be accelerated by putting the patient on a diet rich in iron.

If a person loses a lot of blood and vascular insufficiency has developed, then an urgent course of therapy and replenishment of the blood plasma lost by the patient is required. To do this, doctors fix a venous catheter for him and make an infusion of substances such as glucose, polyglucin, Ringer's special solution or rheopolyglucin. If necessary, correction is possible with a 4% solution of soda. In a hospital setting, such patients are given an infusion (intravenous) of the mass of erythrocytes or full blood.

The chronic type of the disease is a little more difficult to cure. First, doctors determine the source of the bleeding. After such a site is found and the release of blood plasma is suspended, the patient's hemoglobin level is increased with the help of medicines containing iron. They are given together with ascorbic acid, and the patient is prescribed a special diet.

Iron preparations and products for post-hemorrhagic anemia

Such drugs can be administered in the form of injections or tablets. In order for the body to accept them, it is necessary to drink a medicine containing iron along with ascorbic acid and multivitamins, which contain trace elements such as copper, cobalt, manganese. They increase the body's ability to biosynthesize the desired iron. This leads to an increase in the level of hemoglobin in the patient's body. Today, they use such ferrum-containing preparations as the medicine feramide, lactate and iron glycerophosphate, and the medicine ferrum-lek.

The patient is prescribed a special diet, which must include the following products:

1. Fresh lean meat and fish.
2. Curd and dairy products.

It is also possible to introduce into the diet any fruits and vegetables that are high in iron, for example, apples and bananas. All fatty foods must be removed from consumption, since fats can inhibit the process of blood restoration. In this case, doctors and the patient must take into account the presence of the underlying ailment that caused the hemorrhage.

In any case, when post-hemorrhagic anemia appears, self-medication cannot be performed - this can only complicate the course of the disease.

If there are signs of the disease, you need to urgently seek medical help at the clinic.