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 develops 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 be very different. 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 symptom 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;
- gastric ulcer and duodenal ulcer;
- 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. The doctor at the first appointment should carefully listen to all the patient's complaints. The doctor will certainly examine the patient, and also ask him several clarifying questions:
- When did you first notice the symptoms of the disease?
- Have there been similar problems in the past?
- Do chronic diseases bother you?
- Are there any other health complaints?
- 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 post-hemorrhagic anemia
Therapy for chronic anemia also begins with finding and eliminating the cause of bleeding. Having eliminated this problem, doctors prescribe drug treatment to the patient. It consists of taking one of the following drugs.
Posthemorrhagic anemia is a set of pathological changes that develop in the body due to the loss of a certain amount of blood: it contains iron, and with blood loss it becomes insufficient. It is divided into two types: acute and chronic.
ICD-10 code
Chronic posthemorrhagic anemia has the following ICD-10 code - D50.0, and acute - D62. These disorders are found under Nutritional Anemias. Iron-deficiency anemia".
Latin defines the word "anemia" as "bloodless", literally speaking. Also, the word can be translated as "anemia", which means a lack of hemoglobin. And "hemorrhagic" translates as "accompanied by bleeding", the prefix "post" means "after."
Information about what post-hemorrhagic anemia is will allow to detect its development in time and provide the necessary assistance.
Pathogenesis in post-hemorrhagic anemia
Pathogenesis is a certain sequence of development of pathological changes, which makes it possible to judge the features of the occurrence of post-hemorrhagic anemia.
The severity of post-hemorrhagic anemia is determined by the content of hemoglobin and the severity of tissue hypoxia due to its deficiency, but the symptoms of anemia and its features are associated not only with this indicator, but also with others that decrease with blood loss:
- Iron content;
- Potassium;
- Magnesium;
- Copper.
Iron deficiency affects the circulatory system especially negatively, in which the production of new blood elements is difficult.
The minimum volume of blood that can be lost without the risk of developing serious disorders is 500 ml.
Donors donate blood without exceeding this amount. A healthy human body with sufficient body weight, over time, completely restores the lost elements.
When there is not enough blood, the small blood vessels constrict to compensate for the shortage and keep blood pressure at a normal level.
Due to the lack of venous blood, the heart muscle begins to work more actively to maintain sufficient minute blood flow - the amount of blood that is thrown out by the heart per minute.
What color can the venous blood be read?
Read the heart muscle consists
The functioning of the heart muscle is impaired due to a deficiency of minerals, the heart rate decreases, the pulse weakens.
An arteriovenous shunt (fistula) arises between the veins and arterioles, and the blood flow goes through the anastomoses without touching the capillaries, which leads to impaired blood circulation in the skin, muscular system, and tissues.
Formation of an arteriovenous shunt that prevents blood from reaching the capillaries This system exists to support blood flow in the brain and heart, which allows them to continue to function even with severe blood loss.
The interstitial fluid quickly compensates for the lack of plasma (liquid part of the blood), but microcirculation disorders persist. If the blood pressure drops too much, the speed of blood flow in the small vessels will decrease, leading to thrombosis.
In the severe stage of post-hemorrhagic anemia, small blood clots form, which clog small vessels, which leads to disruption of the functioning of the arterial glomeruli in the kidney tissue: they do not filter fluid properly, and the amount of urine excreted decreases, and harmful substances are retained in the body.
It also weakens blood circulation in the liver. If you do not start timely treatment of acute post-hemorrhagic anemia, it will lead to liver failure.
In post-hemorrhagic anemia, the liver suffers from a lack of blood Oxygen deficiency in the tissues leads to the accumulation of under-oxidized elements that poison the brain.
Acidosis develops: a violation of the acid-base balance towards the predominance of an acidic environment. If post-hemorrhagic anemia is severe, the amount of alkali decreases, and the symptoms of acidosis increase.
With blood loss, the level of platelets decreases, but this does not significantly affect the coagulation processes: the content of other substances that affect coagulation reflexively increases.
Over time, the mechanisms of coagulation return to normal, but there is a risk of developing thrombohemorrhagic syndrome.
Causes
The main factor influencing the development of post-hemorrhagic anemia is blood loss, the causes of which can be different.
Acute post-hemorrhagic anemia
This is a disorder that develops rapidly due to profuse blood loss. This is a dangerous condition that requires a quick start of treatment.
Causes of acute anemia:
Chronic post-hemorrhagic anemia
A condition that develops with systematic blood loss over a long period of time. It is able to remain unnoticed for a long time if the blood loss is mild.
The causes of chronic anemia:
Also, hemorrhagic anemia develops due to vitamin C deficiency.
Kinds
Posthemorrhagic anemia is divided not only by the nature of the course (acute or chronic), but also by other criteria.
The severity of anemia is assessed by the amount of hemoglobin in the blood.
Depending on its content, anemia is divided into:
- Easy. With a mild severity of anemia, hemoglobin begins to lack iron, its production is impaired, but the symptoms of anemia are practically absent. Hemoglobin does not fall below 90 g / l.
- Average. Symptoms with moderate severity are moderately expressed, the hemoglobin concentration is 70-90 g / l.
- Heavy. In severe cases, serious organ dysfunctions are observed, heart failure develops, the structure of hair, teeth, and nails changes. The hemoglobin content is 50-70 g / l.
- Extremely severe degree. If the hemoglobin level is below 50 g / l, there is a risk to life.
There are also certain pathologies included in the ICD:
- Congenital anemia in newborn and fetus due to blood loss (code P61.3);
- Chronic posthemorrhagic anemia, which is secondary iron deficiency (code D50.0).
Symptoms
Acute anemia
Symptoms in the acute form of post-hemorrhagic anemia grow very quickly and depend on the severity of blood loss.
Observed:
A decrease in blood pressure against a background of massive blood loss is called hemorrhagic shock. The intensity of the drop in blood pressure depends on the severity of blood loss.
The following symptoms are also present:
- Tachycardia;
- The skin is cold and pale, with a moderate to severe degree it has a cyanotic (bluish) color;
- Impaired consciousness (stupor, coma, loss of consciousness);
- Weak pulse (if the stage is severe, it can be felt only on the main vessels);
- Reduction in the amount of urine excreted.
The symptoms of post-hemorrhagic anemia and hemorrhagic shock are joined by signs that are inherent in the disease that caused the blood loss:
- With an ulcer, black or red stools are observed;
- Swelling in the impact area (if injured);
- When the arteries rupture in the lungs, there is a cough with blood of a bright scarlet color;
- Intense bloody discharge from the genitals with uterine bleeding.
The source of bleeding is revealed by indirect signs, depending on the clinical picture.
Stages of acute post-hemorrhagic syndrome
Acute post-hemorrhagic syndrome has three stages of development.
| Name | Description |
|---|---|
| Reflex-vascular stage | The level of plasma and erythrocyte mass falls, compensatory processes are activated, the pressure drops, the heartbeat is rapid. |
| Hydremia stage | It develops several hours after blood loss and lasts from 2 to 3 days. The intercellular fluid restores the volume of fluid in the vessels. The content of red blood cells and hemoglobin decreases. |
| Bone marrow stage | It develops 4-5 days after blood loss due to oxygen deprivation. In the blood, the level of hematopoietin and reticulocytes, the precursor cells of erythrocytes, increases. The amount of iron in the plasma is reduced. |
The body fully recovers after blood loss after two to three months or more.
Signs of a chronic form
Chronic bleeding gradually leads to post-hemorrhagic anemia, which develops gradually, and its symptoms are closely related to the severity of hemoglobin deficiency.
Observed:
People with post-hemorrhagic anemia have low immunity and often develop infectious diseases.
Diagnostics
In case of acute blood loss, the patient remains hospitalized so that the risks can be assessed and timely assistance provided.
Laboratory diagnostics of post-hemorrhagic anemia is carried out repeatedly, and the results vary depending on the stage and severity of the disorder.
Laboratory signs of acute anemia:
- In the first two hours, the concentration of platelets rises, and erythrocytes and hemoglobin are kept at a normal level;
- After 2-4 hours, the excess of platelets remains, neutrophilic granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, according to the color index, anemia is defined as normochromic (the value is normal);
- After 5 days, there is an increase in reticulocytes, the level of iron is insufficient.
What tests do I need to take?
It is necessary to pass a general blood test, in case of chronic anemia, it reveals the content of elliptocytes, lymphocytes are increased in the peripheral blood, but reduced in the total cellular composition.
Deficiency of iron, calcium, copper is revealed. The manganese content is high.
At the same time, tests are carried out to determine the cause of bleeding: fecal examination for helminthiasis and occult blood, colonoscopy, urinalysis, bone marrow examination, ultrasound examination, esophagogastroduodenoscopy, electrocardiogram.
Who to contact?
Hematologist
Treatment
Acute hemorrhagic anemias in the first stage of treatment require elimination of the cause of blood loss and restoration of normal blood volume.
Operations are performed to suture wounds, blood vessels, the following medications are prescribed:
- Artificial blood substitutes. They are poured in by drip or jet, depending on the patient's condition;
- With the development of shock, the use of steroids (Prednisolone) is indicated;
- Soda solution eliminates acidosis;
- To eliminate blood clots in small vessels, anticoagulants are used.
- If the blood loss exceeds a liter, a donor blood transfusion is required.
Treatment of chronic anemia, not aggravated by serious diseases, is carried out on an outpatient basis. Shown nutritional correction with the addition of foods that contain iron, vitamins B9, B12 and C.
In parallel, the treatment of the underlying disease, which caused the pathological changes, is carried out.
Forecast
If, after extensive blood loss, the patient quickly arrived at the hospital and received the full range of medical procedures aimed at restoring blood levels and eliminating bleeding, then the prognosis is favorable, except in cases where the blood loss is extremely pronounced.
The chronic type of pathology is successfully eliminated by curing the disease that caused it. The prognosis depends on the severity of concomitant diseases and the degree of neglect of anemia. The sooner the cause is identified and treatment is started, the greater the chances of a favorable outcome.
Video: Anemia. How is anemia treated?
Posthemorrhagic anemia is a disease that is accompanied by a decrease in the number of red blood cells and hemoglobin concentration due to massive acute bleeding or as a result of even minor, but chronic blood loss.
Hemoglobin is a protein complex of an erythrocyte, which includes iron. Its main function is to transfer oxygen with the blood flow to all organs and tissues without exception. If this process is disturbed, rather serious changes begin in the body, which are determined by the etiology and severity of anemia.
Depending on the underlying cause and course of post-hemorrhagic anemias, acute and chronic forms are distinguished. In accordance with the international classification system, the disease is divided as follows:
- Secondary iron deficiency anemia after blood loss. ICD code 10 D.50
- Acute post-hemorrhagic anemia. ICD code 10 D.62.
- Congenital anemia after fetal bleeding - P61.3.
In clinical practice, secondary iron deficiency anemia is also called posthemorrhagic chronic anemia.
Causes of the acute form of the disease
The main reason for the development of acute post-hemorrhagic anemia is the loss of a large volume of blood over a short period of time, which occurred as a result of:
- Injury that caused damage to the great arteries.
- Damage to large blood vessels during surgery.
- Rupture of the fallopian tube with the development of an ectopic pregnancy.
- Diseases of internal organs (most often the lungs, kidneys, heart, gastrointestinal tract), which can lead to acute massive internal bleeding.
In young children, the causes of acute posthemorrhagic anemia are most often umbilical cord injuries, congenital abnormalities of the blood system, damage to the placenta during cesarean section, early placental abruption, its presentation, birth trauma.
Causes of the chronic course of posthemorrhagic anemia
Chronic posthemorrhagic anemia develops as a result of minor but regular bleeding. They can appear as a result of:
- Hemorrhoids, which is accompanied by cracks in the rectum, the appearance of blood impurities in the feces.
- Peptic ulcer of the stomach and duodenum.
- Heavy menstruation, uterine bleeding while taking hormonal drugs.
- Vascular lesions by tumor cells.
- Chronic nosebleeds.
- Minor chronic blood loss in cancer.
- Frequent blood sampling, installation of catheters and other similar manipulations.
- Severe kidney disease with excretion of blood in the urine.
- Infestation by helminths.
- Liver cirrhosis, chronic liver failure.
The cause of chronic anemia of a similar etiology can also be hemorrhagic diathesis. This is a group of diseases in which a person has a tendency to bleed due to a violation of homeostasis.
Symptoms and blood picture in case of anemia as a result of acute blood loss
The clinical picture of acute post-hemorrhagic anemia develops very quickly. Manifestations of general shock as a result of acute bleeding are added to the main symptoms of this disease. In general, the following are observed:
- Decreased blood pressure.
- Clouding or loss of consciousness.
- Great pallor, bluish tinge of the nasolabial fold.
- Threaded pulse.
- Vomit.
- Excessive sweating, and so-called cold sweat is observed.
- Chills.
- Convulsions.
If the bleeding was successfully stopped, then such symptoms are replaced by dizziness, tinnitus, loss of orientation, impaired vision, shortness of breath, heart rhythm irregularities. The pallor of the skin and mucous membranes, low blood pressure, remain.
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Changes in blood test results within a few days after stopping bleeding and the development of anemia are closely related to the compensation mechanisms that are “turned on” in the body in response to the loss of a large volume of blood. They can be divided into the following stages:
- Reflex phase, which develops on the first day after blood loss. Redistribution and centralization of blood circulation begins, peripheral vascular resistance increases. At the same time, there is a decrease in the number of erythrocytes at normal values of the concentration of hemoglobin and hematocrit.
- The hydraemic phase runs from the second to the fourth day. Extracellular fluid enters the vessels, glycogenolysis is activated in the liver, which leads to an increase in glucose content. Gradually, symptoms of anemia appear in the blood picture: the concentration of hemoglobin decreases, the hematocrit decreases. However, the color index value is still normal. Due to the activation of thrombus formation processes, the number of platelets decreases, and due to the loss of leukocytes during bleeding, leukopenia is observed.
- The bone marrow phase begins on the fifth day after bleeding. Insufficient supply of organs and tissues with oxygen activates the processes of hematopoiesis. In addition to decreased hemoglobin, hematocrit, thrombocytopenia and leukopenia, a decrease in the total number of erythrocytes is noted at this stage. When examining a blood smear, the presence of young forms of erythrocytes is noted: reticulocytes, sometimes erythroblasts.
Similar changes in the blood picture are described in many situational tasks for future doctors.
Symptoms and diagnosis of anemia in chronic bleeding
Chronic posthemorrhagic anemia in its symptoms is similar to iron deficiency, since regular slight bleeding leads to a deficiency of this trace element. The course of this blood disorder depends on its severity. It is determined depending on the concentration of hemoglobin. Normally, in men it is 135 - 160 g / l, and in women 120 - 140 g / l. In children, this value fluctuates depending on age, from 200 in infants to 150 in adolescents.
Grade of post-hemorrhagic chronic anemia Hemoglobin concentration
- 1 (light) degree 90 - 110 g / l
- Grade 2 (moderate) 70 - 90 g / l
- Grade 3 (severe) below 70 g / l
At the initial stage of the development of the disease, patients complain of slight dizziness, flashing "flies" before their eyes, increased fatigue. Outwardly noticeable pallor of the skin and mucous membranes.
At the second stage, a decrease in appetite, sometimes nausea, diarrhea, or, conversely, constipation, shortness of breath, are added to the listed symptoms. When listening to heart sounds, doctors note heart murmurs characteristic of chronic post-hemorrhagic anemia. The condition of the skin also changes: the skin becomes dry, flakes. Painful and inflamed cracks appear in the corners of the mouth. The condition of hair and nails deteriorates.
A severe degree of anemia is manifested by numbness and a tingling sensation in the fingers and toes, specific taste preferences appear, for example, some patients begin to eat chalk, the perception of smells changes. Very often this stage of chronic post-hemorrhagic anemia is accompanied by rapidly progressive caries and stomatitis.
Diagnosis of post-hemorrhagic anemia is based on the results of a CBC. In addition to the decrease in the amount of hemoglobin and erythrocytes characteristic of all types of anemias, a decrease in the color index is revealed. Its value ranges from 0.5 to 0.6. In addition, with chronic post-hemorrhagic anemia, modified erythrocytes (microcytes and schizocytes) appear.
Treatment of anemia after massive blood loss
First of all, you need to stop the bleeding. If it is external, then it is necessary to apply a tourniquet, a pressure bandage and take the victim to the hospital. In addition to pallor, cyanosis and confusion of consciousness, internal bleeding is indicated by severe dry mouth. It is impossible to help a person in this condition at home, therefore, stopping internal bleeding is carried out only in a hospital setting.
After identifying the source and stopping the bleeding, it is urgent to restore the blood supply to the vessels. For this, rheopolyglucin, hemodez, polyglucin are prescribed. Acute blood loss is also compensated for by blood transfusion, taking into account the compatibility of the Rh factor and the blood group. The volume of blood transfusion is usually 400 - 500 ml. These measures must be carried out very quickly, since the rapid loss of even ¼ of the total blood volume can be fatal.
After stopping the state of shock and carrying out all the necessary manipulations, they switch to standard treatment, which consists in the administration of iron preparations and enhanced nutrition to replenish the deficiency of vitamins and microelements. Ferrum lek, ferlatum, maltofer are usually prescribed.
Usually, the restoration of a normal blood picture occurs after 6 to 8 weeks, but the use of drugs to normalize hematopoiesis continues for up to six months.
Treatment of chronic post-hemorrhagic anemia
The first and most important stage in the treatment of posthemorrhagic chronic anemia is to identify the source of bleeding and eliminate it. Even the loss of 10-15 ml of blood per day deprives the body of all the amount of iron that was received during that day with food.
A comprehensive examination of the patient is carried out, which without fail includes consultations of a gastroenterologist, proctologist, hematologist, gynecologist for women, and an endocrinologist. After identifying the disease that caused the development of chronic post-hemorrhagic anemia, treatment is immediately started.
In parallel, medications that contain iron are prescribed. For adults, its daily dose is about 100 - 150 mg. Complex agents are prescribed, which, in addition to iron, contain ascorbic acid and B vitamins, which contribute to its better absorption. These are sorbifer durules, ferroplex, fenuls.
In severe post-hemorrhagic chronic anemia, transfusion of erythrocyte mass and injection of drugs with iron are shown to stimulate the processes of hematopoiesis. Ferlatum, maltofer, likferr and similar medicines are prescribed.
Recovery after the main course of treatment
The duration of the intake of iron-containing drugs is determined by the doctor. In addition to using various medications to restore normal oxygen supply to organs and replenish iron stores in the body, good nutrition is very important.
In the diet of a person who has suffered post-hemorrhagic anemia, proteins and iron must be present without fail. Preference should be given to meat, eggs, dairy products. The leaders in iron content are meat by-products, especially beef liver, meat, fish, caviar, legumes, nuts, buckwheat and oatmeal.
When drawing up a diet, attention should be paid not only to how much iron a particular product contains, but also to the degree of its absorption in the body. It rises when eating vegetables and fruits that contain vitamins B and C. These are citrus fruits, black currants, raspberries, etc.
The course and therapy of posthemorrhagic anemia in children
Posthemorrhagic anemia in children is much more severe, especially its acute form. The clinical picture of this pathology practically does not differ from that of an adult, but it develops faster. And if in an adult a certain amount of lost blood is compensated by the protective reactions of the body, then in a child this can be fatal.
Treatment of acute and chronic forms of post-hemorrhagic anemia in children is the same. After identifying the cause and eliminating the bleeding, transfusion of erythrocyte mass is prescribed at the rate of 10-15 ml per kg of weight, iron preparations. Their dosage is calculated individually, depending on the severity of the anemia and the condition of the child.
Early introduction of complementary foods is recommended for children aged about six months, and should start with foods with a high iron content. Babies are shown the transition to special fortified mixtures. If the disease that led to the development of post-hemorrhagic anemia is chronic and cannot be treated, then preventive courses of iron supplements must be repeated regularly.
With the timely initiation of treatment and non-critical blood loss, the prognosis is generally favorable. After compensating for the iron deficiency, the child quickly recovers.
Posthemorrhagic anemia is a symptom complex that appears due to the presence of bleeding in the human body. Pathology is characterized by a number of specific clinical and diagnostic signs by which it can be recognized and treated.
Classification of posthemorrhagic anemia
Experts offer several classifications of post-hemorrhagic anemia. In accordance with the type of flow, the following forms are distinguished:- Sharp. Symptoms are acute and rapidly progressing. This type of anemia usually occurs with severe trauma, internal bleeding, or surgical damage to large arteries.
- Chronic. Signs of anemia develop gradually, they are usually less pronounced than in the acute form. Most often, such anemia occurs with peptic ulcer, hemorrhoidal bleeding, menstrual irregularities in patients.
- light - above 90 g / l;
- medium - 70-90 g / l;
- heavy - 50-70 g / l;
- very heavy - less than 50 g / l.
Causes of the disease
The direct reason for the occurrence of a post-hemorrhagic form of anemia in a patient can be considered the presence of hemorrhage, which can be internal (without blood coming out to the skin surface) or external.Acute form of the disease appears in the following cases:
- violation of the integrity of large arteries and veins (traumatic or surgical wounds);
- rupture of the walls of the heart with heart attacks;
- pulmonary hemorrhage;
- rupture of aneurysms (stretched walls) of blood vessels;
- ectopic pregnancy accompanied by rupture of the fallopian tube;
- heavy menstrual bleeding (menorrhagia);
- rupture of the spleen as a result of severe trauma;
- severe bleeding from a duodenal ulcer or stomach.
Chronic posthemorrhagic anemia occurs when the patient's body loses small amounts of blood, but constantly. There are the following factors in the development of chronic post-hemorrhagic anemia:
- slight hemorrhages with peptic ulcer;
- hemorrhoidal bleeding;
- hematuria (loss of blood in the urine due to kidney damage);
- persistent nosebleeds;
- tumors of the gastrointestinal tract (colon cancer, neoplasms in the stomach);
- blood clotting disorders (disseminated intravascular coagulation syndrome, hemophilia).
Symptoms of post-hemorrhagic anemia
The clinical picture of the disease is generally monotonous, but the severity of symptoms depends on the rate and amount of blood loss.The acute form of the disease is characterized by the occurrence of the following symptoms:
- dizziness;
- pale skin and visible mucous membranes (mouth, nose);
- shortness of breath, rapid breathing;
- severe weakness;
- apathy;
- the appearance of tinnitus;
- flashing of flies before the eyes, a sharp decrease in visual acuity;
- dry mouth;
- the occurrence of cold sweats;
- a decrease in the temperature of the skin, especially of the hands and feet.
With prolonged acute blood loss, normal blood circulation in the vital organs is disrupted, therefore symptoms of their damage are added. Development of multiple organ failure is possible.
Advanced post-hemorrhagic anemia leads to the patient developing hemorrhagic shock. It has the following symptoms:
- threadlike pulse on the radial artery;
- shallow rapid breathing;
- repeated vomiting;
- convulsions;
- a sharp decrease in pressure;
- loss of consciousness.
The course of chronic anemia is characterized by less severe symptoms. Patients usually feel unwell, they often feel dizzy, tinnitus, flashes before their eyes. For a long time, blood loss is compensated by the reserve capabilities of the body, therefore, chronic bleeding does not lead to the development of acute life-threatening conditions.
Diagnosis of the disease
Diagnostics is carried out using the analysis of clinical data, laboratory and instrumental studies. The volume of the diagnostic complex is determined by the doctor individually in each case. It is important not only to determine the presence of anemia, but also to identify the disease that caused it.
Confirming the diagnosis of anemia
When contacting a doctor, the patient describes his clinical picture in detail.It is important to talk about all the symptoms, even the smallest ones, and also describe in detail how they have developed over time.
After that, the doctor conducts an examination. He pays attention to the following signs of anemia:
- low blood pressure;
- rapid shallow breathing;
- increased heart rate, violation of its rhythm;
- muffled heart sounds;
- systolic murmurs listening at the apex of the heart.
- general blood and urine tests;
- biochemical blood test;
- ultrasonography;
- according to indications - bone marrow puncture.
With insignificant blood loss or with a chronic form of the disease, changes in the general blood test may not be determined immediately. They can usually be detected only for 3-4 days, since up to this moment pathological disorders are compensated by the reserve capabilities of the blood system.
Detection of acute anemia, especially in severe forms, requires the initiation of therapy immediately after the diagnosis is made.
In severe cases of posthemorrhagic anemia, when it is difficult to establish the cause of its occurrence, a bone marrow puncture may be required. This study helps to assess the activity of hematopoiesis and detect signs characteristic of pathology.
With prolonged post-hemorrhagic anemia, characteristic changes also occur in other organs of hematopoiesis - the liver and spleen. They determine the foci in which the formation of new erythrocytes occurs.
Determination of the factor causing anemia
The cause of the appearance of posthemorrhagic anemia is determined with the help of other studies. So, for example, in the general analysis of urine, a large number of red blood cells can be found, which suggests that a decrease in hemoglobin in the blood is associated with kidney disease.On the ECG, you can establish violations of the heart. With an ultrasound examination, doctors determine signs of damage to internal organs (liver, spleen). Symptoms of liver failure can be determined using biochemical analysis, which detects an increase in the level of enzymes and bilirubin, indicating a violation of the organ.
If there is a suspicion of gastrointestinal bleeding arising from a peptic ulcer of the duodenum or stomach, the patient undergoes an endoscopic examination - EGD. It makes it possible to detect a defect in the organ wall and, if possible, eliminate bleeding using coagulation.
Treatment of post-hemorrhagic anemia
Of primary importance in the treatment of the disease is the immediate identification of the source of bleeding (damaged blood vessels) and its elimination. Depending on the area in which the damage is localized, this can be used:- suturing or ligation of blood vessels;
- electrocoagulation, laser stopping of bleeding;
- the use of local agents for rapid blood clotting (hemostatic sponges);
- resection or removal of organs (in severe cases - with extensive bleeding from stomach ulcers or ruptured spleen).
An obligatory component for acute post-hemorrhagic anemia is infusion-transfusion therapy. Depending on the blood loss, the patient receives transfusions:
- crystalloids (Ringer's solution, Trisol, Disol);
- colloids (dextrans, albumin);
- frozen plasma;
- blood components (erythrocyte, platelet mass).
During the administration of solutions, it is necessary to monitor the patient's condition. The doctor must control the level of his blood pressure and pulse, as this makes it possible to assess the rate of normalization of blood circulation.
Treatment of chronic post-hemorrhagic anemia does not require emergency measures. With this form, the main goal of treatment is to eliminate the cause of the bleeding. The patient is prescribed iron preparations that stimulate the synthesis of hemoglobin in the body.
Forecast
The prognosis for a patient depends on the type of anemia. A patient with a chronic form of the disease, with proper treatment, quickly recovers, his hemoglobin count returns to normal.In the acute form, the degree of blood loss affects the prognosis. Loss of 1/4 of the circulating blood volume is a serious threat to the patient's life and requires resuscitation.
In the absence of treatment and the progression of blood loss, hemorrhagic shock develops. This condition leads to the appearance of acute hypoxia in the vital organs. Insufficient oxygen supply to the brain causes paralysis of the respiratory center, which can lead to death of the patient.
Prophylaxis
The basis for the prevention of post-hemorrhagic anemia is the implementation of the recommendations of experts:- It is necessary to formulate the diet correctly so that it includes all the necessary micro and macro elements, as well as vitamins and a sufficient amount of protein.
- You need to actively play sports, walk in the fresh air.
- Treat chronic diseases in time.
- Seek medical attention promptly if symptoms of bleeding are detected.
Posthemorrhagic anemia - video
See also a video about the types, pathogenesis, diagnosis and treatment of the disease:Posthemorrhagic anemia is a serious illness that can lead to serious complications. The pathology has a progressive course, which can lead to the death of the patient, therefore, in case of signs of blood loss, it is recommended to go to the doctor and sign up for an examination.
The minimum blood loss that poses a danger to the health of an adult is 500 ml. Symptoms are caused by the phenomena of acute vascular insufficiency due to the rapid emptying of the vascular bed, loss of plasma. With massive blood loss due to the loss of erythrocytes, when compensation no longer occurs due to increased heart rate, hypoxia develops.
The prognosis depends on the cause, the rate of bleeding, the amount of blood loss, and the adequacy of therapy. With a loss of BCC of more than 50%, the prognosis is poor.
Causes of acute post-hemorrhagic anemia
Possible causes of blood loss causing acute post-hemorrhagic anemia:
- trauma;
- surgical intervention;
- diseases of the digestive tract (ulcers, tumors, hemorrhoids, varicose veins of the esophagus);
- hemostasis disorders;
- ectopic pregnancy ;
- menstrual irregularities;
- neoplasms in the uterus;
- lung diseases and others.
Symptoms of acute post-hemorrhagic anemia
Vascular disorders: a drop in arterial and venous pressure, pallor of the skin and mucous membranes, tachycardia, shortness of breath. The severity of these changes is not related to the degree of blood loss, since collapse often occurs in response to pain from an injury that caused blood loss.
In the first minutes of blood loss, the hemoglobin content may even be relatively high due to a decrease in blood volume. Due to the entry of tissue fluid into the vascular bed, these indicators decrease even when bleeding stops. The hematocrit, as a rule, is within the normal range, since both erythrocytes and iron are simultaneously lost (normochromic anemia). On the 2nd day, the level of reticulocytes increases, reaching a maximum on the 4th-7th day (hyperregenerative anemia).
The severity of the condition is determined not only by the amount of blood lost, but also by the rate of blood loss. The source is of great importance: bleeding from the digestive tract can be accompanied by fever, signs of intoxication, an increase in the level of urea in the blood (with a normal content of creatinine); cavity bleeding, even with small blood loss, can cause symptoms of organ compression and so on.
Diagnostics of the acute post-hemorrhagic anemia
Diagnosis of hemorrhagic anemia should be based on information about acute blood loss that has occurred. With external bleeding, diagnosis is usually not difficult. With internal bleeding and collapse, other causes of the condition should be excluded.
Treatment of acute post-hemorrhagic anemia
Treatment begins with stopping bleeding. A rapid decrease in hemoglobin levels below 80 g / l, hematocrit below 25%, plasma proteins below 50 g / l is considered the basis for transfusion therapy (blood transfusion). The loss of red blood cells is enough to make up for one third. The primary task of the doctor is to restore the volume of circulating blood by transfusing colloidal solutions. If polyglucinol and gelatinol are not available, the glucose solution can be poured.
Rheopolyglyukin and its analogs should not be used in conditions of possible renewal or ongoing bleeding, since they can exhibit the properties of antiplatelet agents - to reduce blood coagulation. To replace erythrocytes, erythrocyte mass is transfused. The indication in this case is the obvious massive blood loss (more than 1 liter), preservation of pallor of the skin and mucous membranes, shortness of breath and tachycardia, despite the restoration of circulating blood volume with the help of plasma substitutes.
Fresh frozen plasma and plasma substitutes are injected in a larger volume than was lost, and erythrocytes - in a much smaller volume. Massive transfusions of whole blood or erythrocytes exacerbate the appearance of microstasis associated with shock and contribute to the development of DIC.
Small blood loss is replenished with albumin and saline solutions. Whole blood is transfused in the absence of red blood cells. If there is no canned blood, then fresh citrated blood (just prepared) or direct transfusion is used. Without extreme necessity, it is highly undesirable to carry out it due to the presence of microclots in such blood. With operating blood loss of less than 1 liter, the erythrocyte mass is usually not transfused.
After the end of the acute period, iron preparations, vitamins of groups B, C, E are prescribed. After the signs of anemia disappear, iron preparations in a half dose are prescribed for another 6 months.
Prepared based on materials:
- Davydkin I.L., Kurtov I.V. et al. Diseases of the blood in outpatient practice. M .: GEOTAR-Media, 2011, p. 192.
- Ershov V.I. - M .: GEOTAR-Media, 2008, p. 116.
- Zayko N. N., Byts Yu. V., Ataman A. V. et al. Pathological physiology. - K .: Logos, 1996.
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