Postghemorrhagic anemia -conductible anemia, which develops after blood loss. Postgemorrhagic anemia develops as a result of the loss of a significant amount of blood into the external environment or in the body cavity. The leading pathogenetic link of the data of anemia is to reduce the speed and total blood volume, especially its circulating fraction, which leads to hypoxia, the shears of the acidic - base state, the ion imbalances in cells and outside them. Depending on the speed of blood loss, they allocate sharp (develops after abundant, acute bleeding) and chronic postgemorrhagic anemia (develop after long-term non-bleeding).
Etiology
hemorrhagic diseases (thrombocytopathy, coagulopathy, DVS syndrome, hemorrhagic vasculitis, leukemia, aplastic anemia, dysicial menorgia in girls).
lonantic bleeding, LCD bleeding
Pathogenesis
With a quick blood loss, the volume of circulating blood decreases (olighemic phase). In response to a decrease in circulating blood volume, a compensatory reaction occurs: the excitation of the sympathetic department of the nervous system and the reflex spasm of the vessels, arterial-venous shunting, which initially contributes to the maintenance of blood pressure, adequate venous influx and cardiac emission. Pulse is accelerated and weakened. The vessels in the skin and muscles are as much as possible, minimally - brain vessels, coronary, which ensures better blood supply to vital organs. With the continuation of the process, the phenomena of postgymorrhagic shock begin.
Clinic
In case of posthemorrhagic anemia, the phenomena of acute vascular failure are clinically, due to a sharp devastation of the vascular bed (hypovolemia): - is a heartbeat, shortness of breath, orthostatic collapse). The severity of the state is determined not only by the quantity, but also the speed of blood loss. There is a decrease in the diurus, respectively, the degree of blood loss. The level of hemoglobin and the number of erythrocytes are not a reliable criterion of the degree of blood loss.
In the first minutes, the content of HB due to a decrease in the BCC may even be high. When the tissue fluid is received into the vascular channel, these indicators are reduced even when bleeding. The color indicator is usually normal, as the simultaneous loss and red blood cells and iron occurs, that is, the anemia is normalhromic. On the second day the number of reticulocytes, reaching a maximum of 4 to 7 days, that is, anemia is hyperegenerator.
Diagnostics
In the diagnosis of postghemorrhagic anemia, information about the occurrence of acute blood loss with external bleeding is taken into account; In the case of massive internal bleeding, the diagnosis is based on clinical signs in combination with laboratory tests (Gregersen, Weber), an increase in the level of residual nitrogen during bleeding from the upper departments of the gastrointestinal tract.
With external bleeding, it is easy to diagnose. With internal bleeding from the organ, the collapse of other genesis should be excluded.
Treatment
The most important thing is to eliminate the source of bleeding. Then the blood loss is filled (depending on the severity of anemia - the erythrocyte mass, against the background of the introduction of heparin). The total amount of hemotransphus should not exceed 60% of the circulating blood volume deficit. The remaining volume is replenished with blood substitutes (5% solution of albumin, refooliglukin, ringer mortar, etc.). The hemodilution is considered hematocrit 30 and erythrocytes of more than 3 * 10¹² / l. At the end of the acute period, treatment with iron preparatos, vitamins of the group B, C, E. After the elimination of anemia, iron preparations are prescribed in a half dose to 6 months.
Forecast
The forecast depends on the cause of bleeding, speed, blood loss, rational therapy. With blood loss with a shortage of circulating blood volume more than 50%, the forecast is unfavorable.
Acute postgymorgic anemia
As a result of injuries, accompanied by a violation of the integrity of blood vessels, bleeding from internal organs, more often with damage to the gastrointestinal tract, uterus, lungs, cavities, after acute blood loss in complications of pregnancy and childbirth. The larger the caliber of the affected vessel and the closer to the heart it is located the more dangerous to life bleeding. So, when the aortic arc breaks, it is enough to lose less than 1 liter of blood in order to have death due to a sharp drop in blood pressure and a deficiency of the filling of the heart cavities. Death in such cases occurs before the organs of the organs occurs, and when opening the corpses of the deceased anemization of the organs of the bodies is unlikely. In case of bleeding from the vessels of small caliber, death usually occurs with the loss of more than half of the total blood. If the bleeding turned out to be non-mercy, the blood loss is reimbursed due to regenerative processes in the bone marrow. With acute blood loss (1000 ml and more), signs of collapse and shock are performed for a short time. Anemia begins to hematologically detected only after 1-2 days after bloodsture, when the stage of hydrama compensation is developing. In the first hours, after a sharp blood loss, its reliable indicator can serve as a reduction in blood coagulation time.
Clinical picture Such anemia is characterized by the poverty of the skin and visible mucous membranes, weakness, dizziness, the noise in the ears, cold sticky, then, a sharp decrease in blood pressure and body temperature, violation of vision up to complete amavration (the specific elements of the retina are very sensitive to anoxemia), frequent pulse of weak filling (filamental), exciting, replacing a fainting condition, sometimes vomiting, cyanosis, convulsions. There is a loss of a significant amount of iron (500 mg and more). If it is quickly not to fill the blood loss, the collapse (shock) occurs, the reduction of diuresis, anouria, the renal failure is developing. As a result of a sharp decrease in the mass of erythrocytes, the respiratory function of blood drops and oxygen starvation is developing - hypoxia. The nervous system and senses are especially sensitive in this respect.
Clinical picture With sharp blood loss depends on the volume of lost blood, speed, duration of bleeding. The severity of such anemia, especially at the initial stages of the formation, is largely determined by the decrease in the volume of circulating blood (BCC). On this basis, the following degrees of blood loss are distinguished:
moderate blood loss - up to 30% of the BCC;
massive blood loss - up to 50% OCC;
heavy blood loss - up to 60% OCC;
mortal blood loss - over 60% of the BCC.
For acute postgymorrhagic anemia, the following stages are distinguished:
Reflex and vascular stage Which develops in the first hours after blood loss, is characterized by a proportional decrease in erythrocyte and plasma mass. Arterial pressure drops sharply, the pallor of the skin and mucous membranes is developing, tachycardia and tachipne occur. Hypovolemia and hypoxia arising immediately after the bloodsture activate the sympathetic system, which leads to the peripheral vessels spasm, the opening of arteriovenuclear shunts and the ejection of blood from the organs deposit. Those. The compensatory response of the body is reduced to bringing the volume of the vascular channel in accordance with the volume of circulating blood due to the reflex spasm of the vessels, which prevents the further fall of blood pressure and contributes to the maintenance of adequate venous blood return to the heart. In the reflex-vascular stage, the content of erythrocytes, hemoglobin, leukocytes practically does not change, as a decrease in the total amount of blood is reduced, and in each unit of its volume, changes do not have time. Hematocrit does not change. This is due to the fact that when blood loss is at the same time equivalent volumes of plasma and red blood cells are lost. Thus, despite a clear clinical picture, anemia during this period has no hematological manifestations and is hidden, latent character.
Hydremel Stage It develops into the next 3-5 hours (depending on the blood loss), the BCC is restored due to the income into the vascular channel of the interstitial interstitial fluid. The irritation of the Volumreceptors in connection with hypovolemia launches a standard reflex reaction aimed at maintaining the constancy volume of circulating blood. In the body increases the production of renin, angiotensin II, aldosterone. An increase in the synthesis of aldosterone leads to sodium delay, and in the future, through the stimulation of the secretion of ADG - to the retention of water. All this leads to an increase in the BCC, however, due to the inflammation of the blood, the number of erythrocytes and hemoglobin in a unit of volume decreases. At the same time, the production of plasma proteins of the liver increases into the blood of the tissue fluid. The deficit of proteins is restored for 3-4 days. Anemia at this stage is normal. The phenomena of aniso- and causticity (pathological deviations of the size and forms of erythrocytes) may be observed. The color indicator remains normal due to the fact that in the blood they circulate mature red blood cells, which were in the vascular bed to blood loss. The hematocrit rate begins to decline and extremely low numbers reaches 48-72 hours after blood loss, because the volume of plasma is restored by this time, and the ripening of red blood cells is delays. As for leukocytes and platelets, in the coming hours after the bloodsture due to the deposit-free leukocyte and platelets, and postgimorrhagic thrombocytosis may be observed due to the departure of the depositated entry pool. However, as hemodilutions, the number of leukocytes and platelets in a unit of blood is beginning to decline. The platelet content may also fall connections with their consumption in the process of thrombosis. The stage of hydrama compensation can last 2-3 days.
Bone-brain stage It develops on the second and subsequent days (usually from 4-5 days), and as hypoxia progression is characterized by the activation of erythropoese. A large number of young cells of the erythrocyte hematopoix sprout are found: polychromatophilic and oxyphive red blood cells. Strengthening the proliferation of the erythroid sprout causes an increase in the blood of reticulocytes, up to normal. In mature erythrocytes circulating in the blood, morphological changes are found - the appearance of anisocytes and cane acids, because Acceleration of erythrocytes in the blood is provided by the crossroad through the division stages. Erythrocytes cannot be saturated with hemoglobin (hypochromyia, i.e. color indicator below 0.85), since blood loss led to the loss of iron. Thrombocytosis and moderate neutrophilic leukocytosis with regenerator shift to the left develops. The bone marrow cells of flat and epiphesis of tubular bones are proliferating, the bone marrow becomes juicy and bright. Normalization of blood parameters usually occurs after 3-4 weeks.
An example of a hemogram of a patient with acute postghemorrhagic anemia in the hydrama stage:
anisocytosis;
SE - 16 mm / h;
platelets - 250 · 109 / l;
leukocytes - 5.0 · 109 / l;
eosinophils - 1%;
basophiles - 0%;
neutrophils:
shard-core - 3%;
segmented - 54%
lymphocytes - 38%;
monocytes - 1%
erythrocytes - 2.1 × 1012 / l;
hemoglobin - 60 g / l;
color indicator - 0.86;
reticulocytes - 0.7%;
hematokritis - 0.19 l / l;
The hemogram of the same patient located in the tiered brain stage of acute postgemorgic anemia:
anisocytosis;
poikilocytosis +;
polychromatophilia, single normscites
Soe - 21 mm / h;
platelets - 430 · 109 / l;
leukocytes - 17.0 · 109 / l;
eosinophils - 1%;
basophiles - 0%;
neutrophils:
cauccoidal - 19%;
erythrocytes - 3.6 · 1012 / l;
hemoglobin - 95 g / l;
color indicator - 0.79;
reticulocytes - 9.3%;
hematokritis - 0.30 l / l;
segmenteer - 58%
lymphocytes - 11%;
monocytes - 2%
In treating acute postghemorrhagic anemia among the priority events includes a stopping of bleeding and a stake with shock, and then restore blood composition. Transfusion and substitution therapy is used. The patient is overflowing blood, such blood substitutes are introduced as polyglyukine, albumin solution, as well as saline solutions, their volume depends on the size of the blood loss. Polyglyukin - A good plasma-proof, is held in a vascular bed for several days, providing the stability of the circulating blood volume. Reopolyiglyukin - The best means of preventing and treating microcirculation disorders, reduces blood viscosity, causes a disaggregation of erythrocytes and platelets, preventing thrombosis. Indications for transfusion of whole blood They are only very massive blood loss. Due to the fact that blood loss is accompanied by adrenal insufficiency, corticosteroid hormones must be introduced. After removing a patient from a severe state, anti-diamemine means (iron preparations, a diet rich in proteins, vitamins, bioelements) are prescribed. In certain cases, surgical intervention is shown. - bandageing of a bleeding vessel, stomaching stomach, resection of the stomach, removal of a pregnant phallopyye tube, etc. When bleeding flowing with pain shock phenomena, it is primarily necessary to strive to derive the body from the shock state. Along with the introduction of morphine and cardiovascular funds (Strichnin, caffeine, Stroofantin, etc.) shows intravenous infusion of polyglyukine, plasma (conventional or hypertensive) or other anti-shock liquids. The infusion of hypertensive plasma (160 ml) should be carried out and as an urgent event so that in the future, at the first opportunity to make the transfusion of solid blood. The effectiveness of the infusion of plasma is due to the content of hydrophilic colloids in it - Proteins, thanks to which its isotonia is ensured in relation to the recipient plasma, which contributes to a long-term plasma overfit in the recipient vascular system. This is the indisputable advantage of plasma injections before the injections of the saline, so-called physiological solution. The latter, being introduced intravenously even in large quantities (up to 1 l), is essentially ballast, since it is almost not delayed in the bloodstream. Especially it is necessary to warn from the physiological solution that is common in the practice of the subcutaneous infusion that does not affect the dilated hemodynamics and only leading to the tissue edema.
Forecast depends on the duration of bleeding, the volume of lost blood, the compensatory processes of the organism and the regenerator ability of the bone marrow. A well-known difficulty is diagnosed with the underlying disease in the case of bleeding from the internal organ, for example, during ectopic pregnancy. In these cases, the syndrome of an acutely emerging anemia, supported by laboratory testing of blood, serves as a guide thread that displays a doctor to the correct diagnostic path. The forecast of acute postgemorrhagic anemia (in the first moments) depends not only on the size of blood loss, but also on the rate of blood expiration. The most abundant bloodstures, even a loss of 3/4 of the entire circulating blood, do not lead to death, if they proceed slowly, for a number of days. On the contrary, a rapidly occurring loss of 1/4 of blood volume causes the condition of a hazardous shock, and the sudden loss of half the blood volume is certainly incompatible with life. The drop in blood pressure below the critical figure (70-80 mm for systolic pressure) may be fatal due to a developing collapse and hypoxia. As soon as the normal blood boss is restored due to the tissue fluid, the forecast for life becomes favorable (if the repeated bleeding occurs). The timing of the restoration of the normal blood pattern after one-time blood loss is quite different and depend both on the size of the bloodstream itself and from individual characteristics, in particular from the regenerative ability of the bone marrow and the content of iron in the body. If we take the amount of iron in the erythrocytic mass of the body equal to 36 mg per 1 kg of body weight, then with a loss, for example, 30% of the erythrocytic mass is lost by 1 kg of 10.8 mg of iron per 1 kg. If we take the monthly intake of alimentary iron into the body equal to 2 mg per 1 kg, then the restoration of the normal content of iron, and, consequently, hemoglobin will occur in about 5.5-6 months. Persons, weakened or atmospheric, even before the bloodsture, even after one-time bleeding, annecisive for a longer period. Only energetic therapy can derive their hematopoietic organs from a trapid state and eliminate anemia.
Chronic postgemorgic anemia
Are a private variant of iron deficiency anemia. Retained with an increasing deficiency of iron in the body due to either one-time, but abundant blood loss, or minor, but long, often repetitive bleeding, as a result of the break of vessel walls (with infiltration of tumor cells, venous blood, extramedullary blood formation in them, Gingivitis, ulcerative processes in the wall of the stomach, intestines, skin, subcutaneous tissue, cancer), endocrinopathy (dormriconal amenorrhea), with bleeding of renal, uterine, hemostasis disorders (violation of its vascular, thrombocyte, coagulation mechanisms for hemorrhagic diattes). Lead to the depletion of iron reserves in the body, a decrease in the regenerative ability of the bone marrow. Often the source of bleeding is so insignificant that it remains unrecognized. To imagine how small blood loss can contribute to the development of significant anemia, it suffices to bring the following data: the daily amount of alimentary iron required to maintain the hemoglobin balance in the body is about 5 mg for an adult. This amount of iron is contained in 10 ml of blood. Consequently, the daily loss during defecation of 2-3 teaspoons of the blood not only deprives the body of its daily need for iron, but over time leads to a significant exhaustion of the "Iron Fund" of the body, resulting in severe iron deficiency anemia. All other things being equal in the development of Malokrovia will happen to the easier, the less in the body the stocks of iron and the greater (a total of) blood loss.
Clinic . Complaints of patients are mainly reduced to harsh weakness, frequent dizziness and are usually the degree of anemia. Sometimes, however, the inconsistency is striking between the subjective state of the patient and its appearance. The appearance of the patient is very characteristic: A sharp pallor with a waxless tinge of the skin, bloodless mucous lips, conjunctiva, the face is thoughtful, weakness, fast fatigue, ringing or noise in ears, dizziness, shortness of breath, the lower limbs are pasty, sometimes general edema (anasarka) are developing in connection with hydrama and hypoprosis. As a rule, patients with anemia are not exhausted if only exhaustion is not caused by the main disease (gastric cancer or intestines). Anemic heart noises are noted (heartbeat even with a slight physical activity), the systolic noise at the top, conducted on the pulmonary artery, is noted, on the tier veins.
Painting of blood It is characterized by hypochromyia, microcytosis, low flower indicator (0.6 - 0.4), morphological changes in red blood cells - anisocytosis, cache acidosis, polychromasia; the appearance of degenerative forms of erythrocytes - microcytes and schizocytes; Characteristic leukopenia (if there are no special moments promoting the development of leukocytosis), shift of the neutrophilic series to the left and relative lymphocytosis, the number of platelets is normal or somewhat lowered. The amount of reticulocytes depends on the regenerator ability of the bone marrow, which strongly reduces the exhaustion of reserves of deposited iron. The next phase of the disease is characterized by the decline of the blood-forming activity of the bone marrow - anemia is adopted by hyphegenerator. At the same time, along with the progressive development of Malokrovia, an increase in the color indicator is observed, which is approaching unit, anisocytosis and anisochromia are noted in the blood: along with pale microcytes there are more intense painted macrocytes. The serum of patients with chronic postgemorrhagic anemia is characterized by pale color due to the reduced content of the bilirubin (which indicates a reduced decay of blood).
Bone marrow of the plane bones of the usual view. In the bone marrow of tubular bones, the phenomenon of regeneration and the transformation of the fat bone marrow in red are observed in one or another. Often there are multiple foci of the extracombatar blood formation. In connection with chronic blood loss arises hypoxiatissues and organs, which causes the development of health dystrophy of myocardium ("Tiger heart"), liver, kidneys, dystrophic changes in brain cells. Multiple point hemorrhages appear in serous and mucous membranes, in internal organs.
Fig. 4. Blood with chronic postgemorrhagic anemia: 1 and 2 - schizocytes; 3 - segmented neutrophils; 4 - lymphocyte; 5 - platelets.
By severity of the flow Anemia can be
middle severity (hemoglobin content from 90 to 70 g / l)
Bone marrow blood formation In acute cases, a normal physiological response on blood loss with the development of immature, polychromatophilic elements, and then mature, quite hemoglobinized erythrocytes, are more often observed in healthy. In cases of repeated bleeding, leading to the depletion of the "Iron Fund" of the body, there is a violation of erythropois in the hemoglobinization phase of normosoblasts. As a result, part of the cells die, "not having flourished", or enters peripheral blood in the form of sharply hypochromic acidic acids and microcytes. In the future, as anemia acquires a chronic flow, the initial intensity of erythropoese falls and the picture of his oppression is replaced. Morphologically, this is expressed in the fact that the processes of division and differentiation of erythronormorlamoblasts are disturbed, as a result of which the erythropoes takes macronormural nature. The described functional infringement of blood formation is reversible, since it is a hyphenvertient (non-hypoplastic) state of the bone marrow.
Treatment Includes the earliest detection and elimination of the cause of blood loss, for example, excision of hemorrhoidal nodes, resection of the stomach during a bleeding ulcer, extirpation of a fibromatous uterus, etc. However, the radical cure of the underlying disease is not always possible (for example, with an intoperable stomach cancer). As well as the replenishment of iron deficiency (iron preparations are recommended for 2 - 3 months and more months under the control of the hemoglobin of erythrocytes and the content of iron in the blood serum). To stimulate erythropoese, as well as substitution therapy, it is necessary to produce repeated hemotransphus, preferably in the form of overflowings of the erythrocytic mass. Dosage and frequency of blood transfusions (erythrocytic mass) are different depending on the individual conditions, they are mainly determined by the degree of anemization and the effectiveness of therapy. With a moderate degree of aemization, medium-sized transfuses are recommended: 200-250 ml of solid blood or 125-150 ml of erythrocytic mass with an interval of 5-6 days. With a sharp anemsimization of patient, gemfusion are produced in a greater dosage: 400-500 ml of solid blood or 200-550 ml of erythrocytic mass with an interval of 3-4 days.
Bloodmatory and bleeding in posthamorrhagic anemia.
Acute postgemorrhagic anemia
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- A complex of clinical and hematological changes arising from acute or chronic blood loss. Postghemorrhagic anemia is characterized by pallor, shortness, darkening in eyes, dizziness, hypothermia, arterial hypotension; In severe cases - intensity, filamental pulse, shock, loss of consciousness. Postgemorragic anemia is diagnosed according to the data of the clinical picture and the general blood test; In order to establish a bleeding source, instrumental studies are conducted. In the development of this state it is necessary to eliminate the source of blood loss, carrying out transfusion and symptomatic therapy.
General
Postgemorrhagic anemia - hypochemoglobinemia, developing due to hemorrhagic syndrome and accompanied by a tangible decrease in circulating blood volume (BCC). Postgemorrhagic anemia proceeds with erythroenia, but often without decreasing hemoglobin concentration (HB). Normally, the level of total HB and the volume of circulating blood erythrocytes is respectively: in men - not lower than 130 g / l and 29-30 ml / kg of weight, in women are not lower than 120 g / l and 22-23 ml / kg. Postghemorrhagic anemia may complicate the course of various pathological conditions in surgery, hematology, gynecology, gastroenterology, cardiology, etc. Postghemorrhagic anemia can be acute or chronic. The chronic form is an option for iron deficiency anemia, since the mechanism of development and symptoms of pathology is due to the increasing deficit of iron.
Causes of posthemorrhagic anemia
The immediate cause of posthemorrhagic anemia is an acute or chronic loss of blood, resulting from outdoor or internal bleeding. Acute postgemorrhagic anemia occurs during fast, massive blood loss caused by mechanical damage to the walls of large blood vessels or heart cavities with various injuries and surgical operations, the breakdown of the walls of cardiac cameras in the heart attack area, the gap of the aortic aneurysms and the branches of the pulmonary artery, the separation of the spleen, the discrete of the phallopyan pipe for ectopic pregnancy.
Acute postgemorrhagic anemia is characteristic of abundant uterine bleeding (menorahia, metrophic), can accompany the course of the stomach and 12-rosisse ulcers. In newborns, postgemorrhagic anemia can be caused by placental bleeding, a generic injury.
Chronic postgemorrhagic anemia is due to long-term, often emerging losses of small blood volumes in gastrointestinal, hemorrhoidal, renal, nasal bleeding, violations of blood coagulation mechanisms (DVS-syndrome, hemophilia). Tumor processes (gastric cancer, colon cancer) flowing with the destruction of tissues and organs are carried out to the development of internal bleeding and postghemorrhagic anemia. Hypiomoglobinemia can be associated with an increase in the permeability of the capillar stations during leukes, radiation disease, infectious-septic processes, insufficiency of vitamin C.
Pathogenesis of postgemorrhagic anemia
The main factors for the development of postgemorrhagic anemia are the phenomena of vascular failure, hypovolemia with a decrease in the total volume of plasma and circulating uniform elements, in particular, erythrocytes carrying out oxygen transport. This process is accompanied by a decrease in blood pressure, the blood flow of internal organs and tissues, hypoxhemia, hypoxia and ischemia, the development of shock.
The degree of severity of protective-adaptive reactions of the body is determined by the volume, speed and source of bleeding. In the early reflex-vascular phase of compensation of blood loss (first day) due to the excitation of a sympathetic-adrenal system, vasoconstriction and an increase in the resistance of peripheral vessels are observed, the stabilization of hemodynamics due to the centralization of blood circulation with the priority 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 is still close to the norm ("hidden" anemia).
The second hydrames of compensation (2-3 days) is accompanied by autogriemodilation - the tissue fluid flow and replenishing the volume of plasma in the bloodstream. Strengthening the secretion of catecholamines and aldosterone adrenal glands, vasopressin - hypothalamus contributes to the stability of the level of electrolytes in the blood plasma. There is a progressive decrease in the indicators of erythrocytes and Hb (total and per unit volume), hematocrit; The value of the color indicator is normal (posthemorrhagic normal anemia).
Third, the bone marrow phase of compensation (4-5 days) due to the lack of iron anemia becomes hypochromic, the formation of erythropoietin kidneys increases with the activation of the reticulorendothelial system, the erythropoese of the bone marrow, the foci of extramedullary blood formation. In the red bone marrow, there is a hyperplasia of an erythroid sprout and an increase in the total number of normscites, in peripheral blood - a significant increase in the number of young forms of erythrocytes (reticulocytes) and leukocytes. HB levels, erythrocytes and hematocrites are lowered. Normalization of the level of erythrocytes and HB in the absence of further blood loss occurs after 2-3 weeks. In case of massive or long blood loss, posthemorrhagic anemia acquires a hyphenative character, when the body's adaptation systems is depleted, shock develops.
Symptoms of postgimorrhagic anemia
The clinical signs of post-gemorrhagic anemia of the same type, regardless of the cause of blood loss, are determined by its volume and duration.
In the first day after the acute blood loss, patients have a sharp weakness, a pale hue of the skin and mucous membranes, shortness of breath, darkening and flickering of flies in the eyes, dizziness, noise in the ears, drying in the mouth, decreased body temperature (especially limbs), cold sweat. The pulse becomes frequent and weak, arterial hypotension appears. The consequence of hemorrhagic syndrome is the internal organs of internal organs, myocardial fatty dystrophy, liver, CNS and other organs. Children, especially newborns and the 1st year of life, the blood loss is tolerated much harder than adult patients.
Postghemorrhagic anemia with a massive and fast bloodwall is accompanied by a hemorrhagic collapse, a sharp drop in blood pressure, a filamental arrhythmic pulse, adamisia and intensity, rapidly surfactant with the possible development of vomiting, cramps, loss of consciousness. If the pressure drops to a critical level, causing a sharp violation of blood supply and hypoxia organs and systems, death comes from the paralysis of the respiratory center and stop the heart.
Slowly developing postgemorrhagic anemia is characterized by less pronounced manifestations, as it has time to partially compensate for the adaptation mechanisms.
Diagnosis of postgemorrhagic anemia
The diagnosis of postgemorrhagic anemia is carried out according to the data of the clinical picture, laboratory and instrumental studies (general and biochemical tests of blood and urine, ECG, Uz-diagnosis, bone marrow puncture, trepalobiopsy). When examining a patient with acute postgymorrhagic anemia draws attention to hypotension, frequent breathing, weak arrhythmic pulse, tachycardia, mute heart tones, a slight systolic noise at the top of the heart.
In the blood - an absolute decrease in the erythrocyte mass; With continuing blood loss, there is a progressive uniform drop in the content of HB and red blood cells. With moderate blood loss, hematological signs of postgemorrhagic anemia are found only for 2-4 days. The control of diuresis, platelet levels, electrolytes and nitrogen products in the blood, Hell and BCC are required.
Under acute postghemorrhagic anemia, there is no need for a bone marrow study, it is carried out with difficult to diagnose blood loss. In the samples of bone marrow puncture, signs of anemia are the increase in the activity of the red bone marrow, in the preparations of trepalobiopsy - the replacement of the bone marrow tissue with a red blood-made brain.
In the diagnosis of internal bleeding, the syndrome of acute anesther and laboratory data is indicative. In the spleen, liver, lymph nodes, foci of extramedullary blood formation are detected, pointing to an increased load on the hematopoietic system; In the blood - transient decrease in the level of iron, a slight increase in Alt.
To identify and eliminate the source of blood loss, patients need consultations of the hematologist, surgeon, gynecologist, a gastroenterologist and other specialists; Conducting an ultrasound of the abdominal and small pelvis organs, FGDs, etc. ECG in posthamorrhagic anemia can demonstrate a decrease in the amplitude of the T-prong in standard and breasts.
Treatment and forecast of posthemorrhagic anemia
Primary in the treatment of postghemorrhagic anemia is to establish a source of bleeding and its immediate elimination due to dressing and stitching of vessels, resection and stroke damaged organs and tissues, increasing blood clotting and so on.
For the restoration of the BCC and to reduce the degree of hemodynamic disorders on the observation of the transfusiologist, urgent transfusion of canned blood, blood substitutes, plasma and plasma substitutes is carried out. With minor, but long-term bleeding, the transfusion of solid blood or plasma is shown in small hemostatic doses. With a significant loss of the TCC transfusion should be carried out in doses exceeding blood loss by 20-30%. Severe posthemorrhagic anemia is treated with transfusions of large doses of blood ("blood transplantation"). During the period of the collapse of hemotransfusion is complemented by hypertensive blood-blowing solutions.
After the restoration of the BCC, the correction of the qualitative composition of blood is carried out - the replenishment of its components: red blood cells, leukocytes, platelets. With a large single-stage bloodwall and stopped bleeding, massive doses of erythrocyte mass are needed (\u003e 500 ml). The effectiveness of hemotransphus is judged by improving blood pressure, hematological shifts.
It is also necessary to introduce protein and electrolyte solutions (albumin, physical solutions, glucose), restoring the water-salt balance. In the treatment of postghemorrhagic anemia, iron preparations are used, group vitamins B. The symptomatic therapy is prescribed, aimed at the normalization of functional disorders from cardiovascular and respiratory systems, liver, kidney, etc.
The forecast of posthemorrhagic anemia depends on the duration and volume of bleeding. The sharp loss of 1/4 of the BCC leads to acute anemia and the state of the hypovolemic shock, and the loss of 1/2 of the BCC is incompatible with life. Postgemorrhagic anemia with a slow loss of even significant blood volumes is not so dangerous because it can be compensated.
Postghemorrhagic 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 in the blood loss it becomes not enough. It is divided into two varieties: sharp and chronic.
ICB-10 code
Chronic postgemorgic anemia has the following code on the ICD-10 - D50.0, and acute - D62. These violations are in the section "Feed-related anemia. Iron-deficiency anemia".
Latin determines the word "anemia" as "Breakfast", if we say literally. Also, the word can be translated as "Malokroviya", which denotes the lack of hemoglobin. And hemorrhagic translates as "accompanied by bleeding", the prefix "post" means "after".
Information on what postgemorrhagic anemia will allow you to detect its development in time and provide the necessary assistance.
Pathogenesis in posthemorrhagic anemia
Pathogenesis - a certain sequence of development of pathological changes, which makes it possible to judge the peculiarities of the occurrence of postghemorrhagic anemia.
The severity of postgemorrhagic anemia is determined by the content of hemoglobin and the severity of tissue hypoxia due to its deficiency, but symptoms of anemia and its features are associated not only with this indicator, but also with others, which are reduced during blood loss:
- Iron content;
- Potassium;
- Magnesium;
- Copper.
Especially negatively on the circulatory system affects the deficiency of iron, in which the production of new blood elements is difficult.
The minimum blood volume, which can be lost without the risks of development of serious disorders - 500 ml.
Donors hand over blood without exceeding this amount. A healthy human body with a sufficient body weight over time completely restores lost elements.
When blood becomes not enough, small vessels are narrowed to compensate for the lack and maintain blood pressure at a normal level.
Due to the lack of venous blood, the heart muscle begins to work more active to maintain sufficient minute blood flow - the amount of blood, which is thrown into the heart per minute.
What color is venous blood can be read.
Read the heart muscle
The functioning of the heart muscle is broken due to the deficiency of minerals, the heart rate decreases, the pulse is weakening.
Between the veins and arteriols, arteriovenous shunt arises (fistula), and the blood flow comes according to anastomosis, not the assist capillaries, which leads to a violation of blood circulation in the skin, muscle system, tissues.
The formation of arteriovenous shunt, due to which blood does not go to capillars This system exists to support blood flow in the brain and heart, which allows them to continue to function even with pronounced blood loss.
The interstitial liquid raises the lack of plasma (liquid blood), but the microcirculation disorders are preserved. If blood pressure decreases greatly, the rate of blood flow in small vessels will decrease, which will lead to thrombosis.
With a severe stage of postghemorrhagic anemia, small blood clots are formed, which block small vessels, which leads to a violation of the functioning of arterial glomers in the kidney tissue: they do not filter fluid properly, and the amount of urine released is reduced, and harmful substances are delayed in the body.
Also weakens blood circulation in the liver. If you do not start timely treatment of acute postghemorrhagic anemia, it will lead to liver failure.
In case of posthemorrhagic anemia, the liver suffers due to lack of blood The deficiency of oxygen in the tissues leads to the accumulation of unsafeed elements that poison the brain.
Acidosis develops: disruption of acid-alkaline balance towards the predominance of acidic medium. If posthemorrhagic anemia is hard, the number of alkalis is reduced, and the symptoms of the acidosis increases.
When blood linked, platelet levels decrease, but it affects the processes of coagulation slightly: the content of other substances that affect the coagulation increases.
Over time, the mechanisms of coagulation come back to normal, but there is a risk of developing thrombohemorrhagic syndrome.
The reasons
The main factor affecting the development of postgemorrhagic anemia is the loss of blood, the causes of which may be different.
Acute postgemorrhagic anemia
This is a violation that develops rapidly due to abundant blood loss. This is a dangerous state that requires the rapid start of therapeutic measures.
Causes of acute anemia:
Chronic posthemorrhagic anemia
A condition that develops with systematic blood loss over a long time. It is possible to remain unnoticed for a long time if blood loss is weakly expressed.
Causes of chronic anemia:
Hemorrhagic anemia also develops due to vitamin C shortage
Views
Postghemorrhagic anemia is divided not only by the nature of the flow (acute or chronic), but also by other criteria.
The severity of anemia is estimated by the amount of hemoglobin in the composition of the blood.
Depending on its detention, anemia is divided into:
- Light. With a lightweight severity of anemia, hemoglobin begins to lack iron, its development is disturbed, but the symptoms of anemia are practically absent. Hemoglobin does not fall below 90 g / l.
- Middle. Symptomatomy at a moderate severity is expressed moderately, the concentration of hemoglobin is 70-90 g / l.
- Heavy.With severe, serious disorders of the organs are observed, heart failure develops, the structure of hair, teeth, nails are changing. Hemoglobin content - 50-70 g / l.
- Extremely serious degree.If the hemoglobin level is below 50 g / l, there is a risk to life.
There are also individual pathologies made to the ICD:
- Congenital anemia in newborns and fetus due to blood loss (code p61.3);
- Postghemorrhagic anemia of a chronic type, which is a secondary iron deficiency (code D50.0).
Symptoms
Acute form of anemia
Symptomatomy in the acute form of posthemorrhagic anemia is growing very quickly and depends on the severity of blood loss.
Observed:
Reduced blood pressure on the background of massive blood loss is called hemorrhagic shock. The intensity of the fall of blood pressure depends on the severity of blood loss.
The following symptoms are also present:
- Tachycardia;
- The skin is cold and pale, with medium and severe, has a cyanotic (blue) color;
- Violation of consciousness (copor, coma, loss of consciousness);
- Weak pulse (if the stage is heavy, it can only be forgiven on the main vessels);
- Reducing the amount of urine allocated.
The symptoms of postgymorrhagic anemia and hemorrhagic shock are joined signs that are inherent in the disease that caused blood loss:
- With ulcers there is a black or red chair;
- Swelling in the zone of impact (upon receipt of injury);
- When the arteries are ruptured in the lungs there is a cough with blood bright scarlet;
- Intensive bloody excretions from the genital organs during uterine bleeding.
The source of bleeding is detected by indirect features depending on the clinical picture.
Stages of acute postgymorrhagic syndrome
Acute postgemorrhagic syndrome has three stages of development.
| Name | Description |
|---|---|
| Reflex-vascular stage | The plasma level and erythrocyte mass falls, compensatory processes are activated, the pressure drops, the palpulation is rapidly. |
| Stage of Gidremia | Develops a few hours after blood loss and continues 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 | Developed by 4-5 days after blood loss due to oxygen starvation. The level of hematopoietin and reticulocytes - erythrocyte cells is growing in the blood. The plasma reduces the amount of iron. |
The body is completely restored after the bloodsture after two or three or more months.
Signs of chronic form
Chronic bleeding gradually leads to postgemorrhagic anemia, which develops gradually, and its symptoms are closely related to the degree of severity of the hemoglobin deficit.
Observed:
People with posthemorrhagic anemia have low immunity, they often develop infectious diseases.
Diagnostics
In case of acute blood loss, the patient remains in stationary treatment, so that the risks can be appreciated and to provide timely help.
The laboratory diagnosis of postgymorrhagic anemia is carried out repeatedly, and the results vary depending on the stage and severity of the violation.
Laboratory signs of acute anemia:
- In the first two hours, the concentration of platelets increases, and the erythrocytes and hemoglobin are held at a normal level;
- After 2-4 hours, the excess platelets remain, neutrophilic granulocytes are growing in the blood, the concentration of red blood cells and hemoglobin decreases, the anemia is determined by the color indicator as standard (value normally);
- 5 days later there is an increase in reticulocytes, iron levels are insufficient.
What tests need to take?
It is necessary to hand over a general blood test, with chronic anemia, it reveals the content of elliptocytes, the lymphocytes are increased in peripheral blood, but reduced in a total cellular composition.
Iron deficiency, calcium, copper is revealed. The manganese is increased.
In parallel, analyzes are carried out, which allow to determine the cause of bleeding: a study of feces on helminthia and hidden blood, colonoscopy, urine analysis, bone marrow research, ultrasound examination, esophagastroduodenoscopy, electrocardiogram.
Who to contact?
Hematologist
Treatment
Acute hemorrhagic anemia at the first stage of treatment require the elimination of the cause of blood loss and restore normal blood volume.
Operations of wounds of wounds, vessels are prescribed, the following medicines are assigned:
- Blood substitutes for artificial origin. They are poured with drip or inkjet, depending on the patient's condition;
- When developing shock, the use of steroids (prednisone) is shown;
- Soda solution eliminates acidosis;
- Anticoagulants apply to the elimination of blood clots in small vessels.
- If the loss of blood exceeds the liter, the transfusion of donor blood is necessary.
Treatment of chronic anemia, not burdened by serious diseases, passes outpatient. Power correction is shown with the addition of products containing iron, vitamins B9, B12 and C.
In parallel, the main disease is treated, which caused pathological changes.
Forecast
If, after an extensive blood loss, the patient quickly arrived in the hospital and received the entire spectrum of therapeutic procedures aimed at restoring blood levels and eliminating bleeding, the forecast is favorable, except when the blood loss is extremely pronounced.
Chronic variety of pathology is successfully eliminated when the disease is heal, which caused it. The forecast depends on the severity of concomitant diseases and the degree of neglected anemia. The earlier the reason is revealed and the treatment has begun, the more chances of a favorable outcome.
Video: anemia. How to treat anemia?
Postgemorrhagic anemia is a set of changes in the picture of the blood and in the body of the body as a whole, which develops against the background of acute or chronic blood loss.
Postgemorrhagic anemia is a state life-threatening and accompanied by such symptoms as: the pallor of the skin, pronounced shortness of breath, a sharp darkening in the eyes, significant. In severe cases, the loss of consciousness and development of the shock state is possible.
With postgemorrhagic anemia, the volumes of blood circulating in the body are significantly reduced. In parallel, the level of erythrocytes in the blood is falling. Mary pathology can lead to the development of this violation: diseases of any internal organs complicated by bleeding, injuries and injury and not only. The character of anemia can be sharp and chronic.
A long impaired hemodynamics in posthamorrhagic anemia leads to pronounced tissues of organs with their further dystrophy. In severe cases, postghemorrhagic anemia may end with a fatal outcome.
Acute hemorrhagic anemia develops as a result of acute blood loss. It happens with internal or outer bleeding. It is characterized by massiveness and high speed. Damage to the vascular walls is most often mechanical character. Moreover, large blood pins suffer. Also, bleeding from the cavities of the hearts can also lead to acute postghemorrhagic anemia on the background of injuries obtained or after surgical operations. Infarcates accompanied by a gap of cardiac walls, gaps of aortic aneurysm, violation of the integrity of the pulmonary artery and its large branches - all this can cause acute blood loss with the further development of anemia. Other risk factors include: separation of the spleen, damage to the integrity of the uterus, for example, with the birth in it.
In general, any abundant bleeding from the uterus of the uterus, even with long-term menstruation, can lead to the development of acute postghemorrhagic anemia. It is dangerous in this regard of the disease of the organs of the digestive system, in particular, and.
In children during the newborn, postgemorgic anemia can also develop, which most often manifests against the background of generic injuries or placental bleeding.
Chronic postgemorgic anemia develops with the following violations:
Minor, but regular bleeding for diseases of the gastrointestinal organs.
Often arising nose bleeding.
Bleeding hemorrhoidal nodes.
Periodic renal bleeding.
DVS syndrome and hemophilia. These states are characterized by a violation of blood coagulation process.
Dry in the oral cavity.
The drop in body temperature, which is especially noticeable in the field of the upper and lower extremities.
The awake of sticky and cold sweat.
Passing of pulsation with a decrease in its strength.
Flow of blood pressure.
If the bleeding is developing in a child under year, it will carry it much harder than an adult.
If the bloodstures are abundant, and blood is poured from the vascular bed quickly, a collapse can develop the victim. Hypotension will be extremely pronounced, the pulse is barely talked, or may be absent at all. Breathing becomes superficial, episodes of vomiting and convulsive seizures often occur. Human consciousness in most cases is absent.
Heavy degree anemia can lead to a fatal outcome, which happens against the background of acute hypoxia of internal organs. The work of the heart and respiratory center stops.
Separately, it is necessary to designate the symptoms of chronic bloodsture, in which anemia is developing an easy degree.
This is characterized by the following violations:
The skin becomes dry, cracks appear on it.
Any wounds on the skin are healing for a very long time, can be fed.
The pallor of the skin and mucous membranes is not too much expressed, but not to notice it difficult.
Nails become brittle, loose.
The hair dumps, begin to fall out.
The heart works in a strengthened rhythm, which is often knocked down.
Sweating rises.
Body temperature can last time at the level of subfebrile marks.
In the patient often ulcers appear in the mouth, the formation of carious teeth is possible.
Such symptoms have no clear severity and can disturb the patient from time to time. This is explained by the fact that the body launches compensatory mechanisms and works at the peak of its capabilities. However, sooner or later, they run out.
The diagnosis of postgemorrhagic anemia begins with a poll of the patient's complaints and from its inspection. The doctor must measure the patient's blood pressure, assess the nature of its mucous membranes and skin cover, if the doctor suspects the patient just such a diagnosis, he will send him a number of surveys.
Laboratory tests will be as follows:
The blood test for the determination of the level of hemoglobin and red blood cells, which will be reduced.
Blood chemistry.
Urine analysis with the control of its daily volumes.
Determination of the total circulating blood.
The bone marrow puncture is performed only if the diagnosis remains in doubt. Be sure to establish the cause of postgemorrhagic anemia. For this, an ultrasound examination of the internal organs and the abodes of the small pelvis, FGDS, colonoscopy, reorganosososcopy, remove the electrocardiogram. Grooms should visit the gynecologist.
The diagram of therapeutic impact on the patient depends on what was the cause of the development of postgemorrhagic anemia. Detected bleeding must be stopped as quickly as possible. If blood loss is due to outer bleeding, it is imposed on the wound harness or a bandage, it is possible to stroke vessels and damaged tissues and organs. The victim must be emergency hospitalized.
If the bloodstures are massive, then the following events are shown:
Transfusion of the erythrocyte mass, plasma and plasma substitutes (Reopolyglyukin, hemodez, polyglyukin). This measure must be undertaken, as large blood loss are associated with a high risk of fatal outcome.
Prednisolone (hormonal drug) is introduced in the case when the patient develops a shock state.
Solutions of albumin, glucose, saline - all these substances are injected with a patient intravenously to restore the salt balance in the body.
To repleural iron reserves, the injection of drugs sorbifer durul or ferroplex can be used. However, it is necessary to take into account that their use is associated with a high probability of an allergic reaction.
Heavy anemia requires the introduction of significant blood doses. Doctors call this blood transplant procedure. If, after restoring the total blood volume, blood pressure is normalized in the patient, and its high-quality composition improves, this indicates that the therapy was chosen correctly. To improve the patient's well-being, it is prescribed vitamins of group V.
Symptomatic treatment should be directed to restoring the work of the heart and blood vessels, brain, liver and kidney, as well as other organs affected by hypoxia.
Therapy delayed in time involves the observance of the patient diet, which is aimed at restoring the quality composition of blood. To do this, it will be necessary to use red innocent meat, liver, eggs, fermented milk drinks, vegetables and fruits, cottage cheese, fish. A day should drink at least 2 liters of water, the broth is useful.
The more massive volume of lost blood, the worse the prediction forecast. If a simple person loses? Part of the total blood volume, the probability of the development of hypovolemic shock is extremely high. If blood loss is equal to? parts, the victim will not be able to survive. Provided that anemia is developing in chronic blood loss, it most often it is possible to neutralize, after the source of bleeding is found and eliminated.
Education: In 2013, the Kursk State Medical University was completed and a diploma degree was received. Two years later, the ordinite was completed in the specialty "Oncology". In 2016, graduate school was passed in the National Medical and Surgery Center named after N. I. Pirogov.
Often our life threatens not at all what is in mind. Suspecting a certain serious illness that everyone has a hearing, we ignore, for example, a stomach ulcer, which only from time to time gives us inconvenience. But such an inconspicuous ring may be much more dangerous than many famous diseases. Losing blood dropped by dropping the health of its owner for many months and years, it provokes the emergence of unpredictable postghemorrhagic anemia.
Danger of abundant blood loss
The total blood volume in the organism of an adult is from 3.5 to 5 liters. Circulating through the body, it performs many functions:
- distributes nutrients and oxygen;
- removes decay products from tissues;
- transports hormones from yellowing to sensitive organs;
- maintains the constant temperature and the chemical composition of the body;
- participates in the closure of wounds and subsequent tissue regeneration;
- performs immunity reactions to external threats.
In the event that the amount of fluid in the vessels drops by more than 10%, the victim fits it clearly. There is a weakening of the properties of blood listed above - and the more significant the greater the blood loss. The first passage function - the tissue of the brain begin to test oxygen starvation after a few seconds. The following symptoms are known under the general name "Postghemorgic anemia".
Types of postgameragic anemia
Malokroviya from blood loss, or posthemorrhagic anemia is a deficiency of plasma erythrocytes, which arose due to abundant blood loss. In clinical practice, two forms of illness are known: acute and chronic. The first develops with a single damage to the body, provoked by a quick loss of a large blood volume. The causes of such a state can be:
The chronic course of anemia is possible with small, but frequent blood loss leading to a gradual decrease in the number of circulating erythrocytes. The causes of pathology coincide with those in acute state, but are characterized by a smaller intensity of impact on the body.
One of the main reasons for the widespread proliferation of postgemorrhagic anemia in the nearby past was fashion for bloodsinking. According to the latest data, it is this procedure that accelerated the death of Mozart. Ill in 1791, the composer was subjected to an innovative treatment at that time, as a result of which he lost about two liters of blood and UGAS for an incomplete month.
Mechanism of development and symptoms of the disease
The symptoms of postgymorrhagic anemia will be much varied depending on the form of the disease, the severity of blood loss, as well as the characteristics of the body of the victim.
Clinical picture in acute condition
From the first moments of strong bleeding, the human body uses all the resources to compensate for the loss. The production of erythrocyte predecessors, called Erythroblasts, is sharply increasing. The amount of red calves per unit volume of plasma remains constant, although in absolutely their number falls.
The walls of peripheral vessels are quickly spashed, limiting blood flow to the skin and skeletal muscles. At the same time, the provision of nutrients of the central nervous system, heart and adrenal glands is preserved as long as possible.
- Pulse of the victim is expelled.
- Breathing becomes sharp and shallow.
- The skin and mucous membranes are pale.
- There is a feeling of dizziness, weaknesses in the limbs, noise in the ears, probably the appearance of nausea.
- Caliac masses can be painted in dark brown or red.
This phase of anemia, combining instantaneous body reactions to blood loss, is called reflex. By duration it takes up to 12 hours, after which it goes into compensatory, or hydrama.
At this stage, the body extracts the maximum amount of red blood cells from the depot, and the interstitial fluid begins to move into the vessels. The filtration properties of the kidneys are adjusted to hold water in the body, which leads to a decrease in urine formation. Red cells are distributed in plasma, due to which the relative concentration of hemoglobin decreases sharply.
The next phase is the bone marrow - comes 4-5 days after the case of blood loss. By this time, the production of erythroblasts and the ripening of red blood cells reaches maximum values. A long spasm of peripheral vessels can provoke cell gluing in small capillaries, which is why those are clocked. Large thrombus are able to cause fatty tissues and organs.
Signs of chronic form
Symptoms of chronic postgemorrhagic anemia demonstrates softer manifestations than in case of acute flow:
- skin manifestations:
- pallor;
- lightweight;
- dryness;
- roughness;
- hair defects:
- fragility;
- dropping out;
- tachycardia;
- decrease in blood pressure;
- general symptoms:
- dizziness;
- weakness;
- decline in appetite;
- noise in ears.
Features of postghemorrhagic anemia in children
Children are more prone to manifestations of acute postgymorragian anemia than chronic. The reason for this is obvious - even small blood loss in the standards of the adult organism becomes a heavy test for the fragile body of the child.
Anxiety symptoms in this case are considered:
- pallitude of the skin;
- smoothness of the tongue;
- growth delay;
- changes in behavior (apathematics or fiscaliness);
- hair fragility;
- violation of taste addictions - a tendency to eating clay and chalk;
- general weakness;
- weight loss.
A children's heated injury becomes sensitive to infectious diseases, so that anemia can lead to the development of angina, laryngitis, otitis ,.
Stages (degrees) of the disease: light, medium, heavy
Depending on the intensity of blood loss, several stages are distinguished, or the degrees of gravity, postgemorrhagic anemia.
The definition of the severity of the disease plays a crucial role in planning further treatment. For example, light anemia may not require drug therapy, while severe is an absolute indication for the immediate hospitalization of the victim.
Stage Postghemorrhagic anemia - Table
| Degree / Stage | Content, gram / l. | Pulse frequency, ud / min. | Systolic (top) arterial pressure, mm.rt.st. |
| Light | 90 and higher | Up to 80. | Above 110. |
| Average | 70–90 | 80–100 | 90–110 |
| Heavy | Less than 70. | Over 100. | Below 90. |
Diagnostics
The obligatory primary stage of diagnosis is an external examination of the patient, which allows:
- determine the place of damage in the event of surface injury;
- evaluate the general condition of the victim correlated with the severity of blood loss;
- learn about the patient's predisposition to the bleeding of a certain type (gastric, intestinal, light and so far).
A proctological or gynecological study is carried out in suspected injuries of the lower departments of the digestive system and women's reproductive organs. Cala and urine analysis makes it possible to detect damage to the gastrointestinal tract and the urogenital system. Most often, benzidinis (Gregersen) and Govetak (Weber) samples are used. The reagents used in them change painting when contact with free hemoglobin.
Using Iron Isotope 59 Fe with radioimmunal analysis makes it possible to describe the distribution of red blood cells, their integrity and activity.
The blood test during acute postghemorrhagic anemia demonstrates very characteristic results:
- During the first hour after the start of the state, the amount of platelets increase dramatically, after three hours - leukocytes.
- Following this drops the level of red blood cells.
- Restoration of primary indicators takes at least a few weeks.
With internal bleeding, radiography, magnetic resonance (MRI) and computer (CT) tomography, ultrasonic diagnostics are widely used. With their help, you can accurately localize the damage to the hollow organs.
These techniques allow to differentiate posthemorrhagic anemia with similar states.
Differential Diagnostics - Table
| Name pathology | Difference from posthemorrhagic anemia | Diagnostic methods |
| Autoimmune hemolytic anemia |
|
|
| Hypochromic anemia |
|
|
| Megaloblastic anemia |
|
|
| Microspherocyte hemolytic anemia | erythrocytes have a spherical shape |
|
| Partial color cell anemia |
|
|
| Thalassemia |
| blood test |
Treatment
The main task in the treatment of postgemorrhagic anemia is to stop bleeding, provoked it. Subsequent measures are aimed at replenishing the loss of erythrocytes, liquids, nutrients.
Therapy of acute form
A significant loss of blood (more than 1 liter) should be compensated by overflowing the erythrocyte mass with plasma proofs, but not more than 60% of the lost volume. Excess this indicator is able to provoke intravascular wreck. The difference is better to be filled with blood substitutes - solutions of albumin, dextran, sodium chloride, gelatine, refooliglukin, ringer-Locke. Lactasol can be used to restore pH indicators.
After removing the acute state, measures are taken to improve hemoglobin synthesis. Therapy at this stage coincides with the treatment of chronic form.
Therapy of chronic form
To replenish the amount of lost iron (with iron deficiency), its preparations containing a metal in a divalent version are used. These funds include:
- Malto;
- Soribifer;
- Feramid;
- FerroCal;
- Ferroplex;
- Ferrocene.
Multivitamin complexes are helped to increase the metabolism, including vitamins B, C, E.
Anemia treatment - video
Diet at posthemorrhagic anemia
- apricots;
- grenades;
- mushrooms;
- strawberry;
- non-fat meat;
- peaches;
- liver;
- a fish;
- cottage cheese;
- blueberries;
- apples;
- eggs.
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