Hemorrhagic anemia drugs for treatment. Posthemorrhagic anemia. Acute and chronic. Pathogenesis. Degrees of severity. Periods of development. Treatment. Promotions and special offers

Posthemorrhagic anemia is a pathology that in medicine belongs to the category of iron deficiency. The cause of its development may be a severe injury with significant bleeding or the presence of a focus of chronic blood loss in the body. Posthemorrhagic anemia can be acute or chronic. Acute form posthemorrhagic anemia- this is an option in which the pathology develops against the background of heavy bleeding, while the chronic form is the result of systematic, but not heavy bleeding.

In the presence of bleeding in the body, a rapid decrease in the volume of circulating blood and, first of all, its plasma is observed. Accordingly, there is a sharp drop in the level of red blood cells, which leads to the development of acute hypoxia and then anemia, which belongs to the group of post-hemorrhagic.

Symptoms

When collecting complaints and anamnesis, the doctor receives the following clinical picture: the patient experiences weakness of the body, strong and frequent dizziness, which can reach fainting. Also, with posthemorrhagic anemia, nausea is observed, and in the acute form of the condition, vomiting may occur. During the course of pathology in the body, trophic disorders, accordingly, structural pathological changes occur skin, hair and nails.

At this option anemia, shortness of breath, angina-type heart pain, and muscle weakness can often be observed. Patients quite often complain of dry mouth and difficult to quench thirst, flashing spots before the eyes, and tinnitus. Also included in the clinical picture of this type of anemia is a sharp decline body temperature.

At heavy bleeding symptoms may develop hemorrhagic shock.

Diagnostics

The presence of posthemorrhagic anemia can only be determined using laboratory methods blood tests. When diagnosing, it is also worth taking into account the patient’s medical history, complaints and results. instrumental studies, which determine the location of the source of bleeding. To the number instrumental methods diagnostics in this case include fibrogastroduodenoscopy and colonoscopy.

Prevention

First of all, you need to try to avoid the disease of posthemorrhagic anemia, therefore, you should avoid as much as possible any injuries that can cause blood loss and bleeding.

Prevention of the development of posthemorrhagic anemia also includes healthy image life and observance proper nutrition, in which the blood and all body systems receive the required amount of microelements and vitamins. The diet must contain iron-containing foods, namely, fresh fruits, lean red meat, legumes, fresh green vegetables, whole grain bread and herbs.

Treatment

The first stage of treatment for posthemorrhagic anemia is aimed at eliminating the source of bleeding and preventing shock. Next, you need to carry out treatment aimed at replenishing lost blood, while heparin must be replenished in the body and the level of red blood cells must be normalized. Thus, the volume of replenished blood should not exceed 3/5 of the volume of lost blood; the remaining deficit is replenished with the help of blood substitutes.

At the third stage of therapy, after stopping bleeding, blood loss is restored, and nothing threatens life, curative therapy with help iron-containing preparations and vitamin complexes.

After eliminating the symptoms of anemia, treatment with iron-containing drugs continues for another 6 months, but the amount taken medicines reduced by half.

Posthemorrhagic anemia is a condition that develops as a result of sudden or prolonged blood loss. It is characterized by a decrease in the filling of the vascular bed, as a result of which the number of red blood cells and hemoglobin decreases, which leads to oxygen starvation, and in severe cases, death. Long-term disruption of hemodynamics causes not only a deterioration in well-being, but also degeneration of tissues and organs, provoking hematopoietic pathologies.

The direct cause of the condition is acute or chronic blood loss resulting from external or internal bleeding:

Due to pathologies and injuries accompanied by blood loss, its volume in the vascular bed decreases. There is a lack of cells containing hemoglobin. And since red blood cells are responsible for the delivery of oxygen, oxygen starvation occurs in the body.

The human body is able to restore up to 500 ml of blood without damage; the disease develops if blood loss exceeds this figure. The loss of half the volume of fluid in the vessels leads to inevitable death.

Main symptoms

Classification of anemia in case of blood loss is carried out according to the degree of development of the condition, distinguished:

Spicy. Massive blood loss occurs due to injuries and damage to large vessels, with internal bleeding.
Chronic. Secondary iron deficiency anemia (IDA) gradually develops as a result of diseases.
Congenital. When the fetus suffers due to blood loss.

Consequently, in patients with posthemorrhagic anemia, symptoms differ depending on the degree of development of the process and the severity of the condition.

Acute form

In acute pathology, the clinical picture progresses rapidly; vascular insufficiency is observed as a result of a sharp depletion of the riverbed. With the onset of blood loss, the following is noted:

hypotension,
dizziness and tinnitus,
tachycardia and shortness of breath,
pallor of the skin and mucous membranes,
severe weakness and dry mouth,
cold sweat,
nausea.

If there is damage to the gastrointestinal tract, the stool becomes dark in color and the temperature may rise.

If blood loss is significant, hemorrhagic collapse develops. The pressure drops sharply to critical levels - thread-like pulse, shallow and rapid breathing. Muscle weakness occurs until it stops motor activity, vomiting, convulsions and loss of consciousness are possible. Lack of blood supply causes oxygen starvation in organs and systems, death occurs due to respiratory and cardiac arrest.

Chronic form

If posthemorrhagic anemia develops slowly, the symptoms are not so pronounced, since adaptation mechanisms. Signs chronic form resemble IDA, since minor bleeding leads to iron deficiency:

dry skin and painful pallor,
face is swollen
hair loss and dullness,
brittleness and thickening of the nail plate,
increased fatigue and dizziness,
heart rhythm disturbance,
sweating

When the hemoglobin concentration drops to 70 g/l or lower, some patients experience low-grade fever. Patients complain of a feeling of numbness and changes in taste preferences. The severe stage is often accompanied by stomatitis and rapidly developing caries.

Diagnostic methods

When making a diagnosis of posthemorrhagic anemia, the basis of measures includes studying the patient’s medical history, a set of laboratory and instrumental studies. To identify the cause of anemia, you will need to consult a surgeon, hematologist, gastroenterologist or gynecologist. As a basic examination and to clarify the duration of blood loss, tests are carried out to determine the degree of anemia, a blood test is taken:

General. Indicates a decrease in erythrocyte mass, their hemoglobin saturation, and platelet volume.
Biochemical. The hemogram gives a detailed idea of the blood elements, their morphology and ratio to the volume of fluid. The study determines an increase in manganese, the enzyme alanine aminotransferase, a decrease in calcium and copper.

Urinalysis gives an initial idea of the condition urinary system and the functioning of the body. To diagnose the site of internal bleeding, examination methods are used:

Study bone marrow carried out in complex cases when the cause of anemia cannot be identified conventional methods. Puncture samples taken show the activity of the red brain, trephine biopsy reveals the replacement of hematopoietic cells with adipose tissue.

Treatment with drugs and folk remedies

For posthemorrhagic anemia, the main goals of treatment are to identify the source of blood loss and stop the bleeding. For external injuries, apply a tourniquet and bandage. If necessary, vessels and damaged tissues and organs are sutured and resection is performed.

In case of massive blood loss, measures are carried out in the hospital:

To restore blood supply and hemodynamics, a transfusion of canned blood and plasma is performed. When hemoglobin is below 8%, plasma substitutes are used: “Hemodez”, “Polyglyukin” or “Reopoliglyukin”. The blood transfusion procedure is carried out promptly, since a quarter of the blood loss is fraught with the death of the patient. The volume of infused fluid in this case exceeds blood loss by a maximum of 30%.
Transfusion of red blood cells is necessary to restore oxygen transport; with rapid loss, its amount can be half a liter.
Shock is treated with Prednisolone.
Recovery acid-base balance During the treatment process, electrolyte and protein compounds are administered intravenously: albumin, glucose, saline solution.
Iron is replenished by such drugs as Ferroplex, Feramide, Conferon, Sorbifer Durules. They are taken orally or by injection.
Microelements are prescribed: cobalt, copper and manganese, as they increase the absorption of iron.

For prolonged bleeding:

In the case of severe chronic anemia, transfusion is carried out in a small volume.
To eliminate symptoms functional disorders Therapeutic measures are used in the functioning of the heart, liver, and kidneys.
For better absorption Fe are prescribed iron-containing products, vitamins C and B groups.
Sometimes surgery is recommended.

Scheme and duration drug treatment in each specific case are individual. Restoration of the normal picture is observed after one and a half or two months, but the patient takes the medicine for up to six months.

Diet and traditional treatment

To restore the body after treatment of posthemorrhagic anemia and replenish hemoglobin, a specific diet is used. Its goal is to provide the body with vitamins and elements, so nutrition should be balanced and high in calories, but with a minimum amount of fat.

The patient's diet requires the presence of foods containing iron, such as meat low-fat varieties and liver.
For enrichment with microelements, valuable amino acids and protein, fish, cottage cheese, and eggs are recommended.
Suppliers of vitamins are vegetables and fruits, natural juices.

Loss of fluid is replenished by consuming water (at least 2 liters per day). To restore strength and support the body, you can also use folk recipes:

Rose hips are brewed and drunk instead of tea; you can add strawberry leaves.
When you lose strength, mix honey (200 ml), Cahors (300 ml) and aloe juice (150 ml). Take a spoon before meals.
Mix 30 g of chicory juice in a glass of milk and drink it a day.
Squeeze the juice from radishes, beets and carrots (1:1:1), pour into a dark glass container, cover with a lid and simmer in the oven for 3 hours. The liquid is drunk on a spoon before meals for a course of 3 months.

Suffering from blood loss immune defense, the body becomes susceptible to infection, so infusions or decoctions based on echinacea, ginseng, lemongrass or marshmallow will help to strengthen and restore the system.

Preventive measures will help prevent the development of posthemorrhagic anemia and its relapses:

Patients with chronic diseases should monitor their condition, undergo regular examinations and take medications. When a specialist insists on surgery, there is no need to refuse: surgical treatment of the underlying disease will eliminate the cause of anemia.
The diet of children and adults must include foods containing iron, vitamins and elements necessary for the body.
It is important for pregnant women to register in time and detect anemia in order to prevent complications dangerous to the health of the mother and newborn.
If a pathology is detected in an infant, it is recommended not to stop breast-feeding. Each child is provided with a healthy environment and good nutrition, rational complementary feeding. To normalize the condition, regular walks are important; medications are given only as prescribed by a doctor.
To prevent dystrophy, rickets and infectious invasions in children, pediatrician supervision is necessary. Special attention are given to babies born to mothers with diagnosed anemia and who are on artificial feeding. Also at risk are babies with multiple pregnancies, premature babies and those who quickly gain weight.
To maintain health, every person needs to lead a correct lifestyle, move actively, and be in the fresh air.

Anemia is a blood pathology characterized by a low hemoglobin content, which is most often accompanied by a general decrease in red blood cells. In medicine, it is generally accepted that the diagnosis “anemia” is not an entirely independent disease. It is considered a symptom of many absolutely various diseases. It’s rare that someone has never encountered this diagnosis throughout their entire life. may be mild or extremely severe. The danger of any type of anemia is that a decrease in hemoglobin will affect the body by severe oxygen starvation of all its tissues and internal organs. Despite the fact that anemia is a symptom, the International Classification of Diseases in the 10th revision (ICD 10) assigned its own code to anemia - D62.

Distinctive signs of posthemorrhagic anemia

Acute posthemorrhagic anemia is the most common medical practice type of iron deficiency anemia. It is distinguished from other types of anemia by the cause of its occurrence - posthemorrhagic anemia occurs only as a result of critical blood loss due to internal or external bleeding. Acceptable rate blood loss for an adult does not exceed 500 ml. This norm is determined by the ability of the injured person’s body to independently replenish both the volume of blood and its qualitative composition. The loss of half the blood volume threatens a person with death and requires emergency measures to save the patient's life.

The body's response to severe blood loss

Blood consists of a liquid component - plasma and the cells of leukocytes, platelets and erythrocytes suspended in it. The volume of blood is always approximately constant and occupies 6–8% of the total mass of a person. Blood is a rapidly renewed tissue, new elements of which are produced in the bone marrow. It circulates in the human body through a closed system of blood vessels as a result of pulsating contractions of the heart muscle. If for any reason a loss occurs large quantity blood, the body begins to react immediately.

The first reaction will be maximum maintenance, and all small arteries will instantly go into spasm. The heart begins to beat faster because it doesn’t have enough blood to normal functioning. The person begins to experience a severe lack of oxygen. The backup mechanism is activated - the opening of the shunts between small arteries and veins. The capillaries completely stop functioning. The body tries to save the functioning of the brain and heart; for these purposes, all possible mechanisms are activated to maintain the required amount of fluid in the vessels, and the spinal cord also begins to work in an enhanced mode.

The plasma itself is restored quite quickly, but the problem remains at the level of the blood supply to the capillaries. In acute hemorrhagic processes, patients quite often experience thrombosis, and sometimes their complete closure. Complications of this kind can spread to the kidney tissue, which, in turn, leads to renal failure. In severe anemia, a state of metabolic acidosis develops.

Causes of posthemorrhagic anemia

Anyone can experience this disease throughout their life. Acute posthemorrhagic anemia has different reasons occurrence, but contains one common symptom - heavy blood loss:

IN modern medicine accepted next classification posthemorrhagic anemia, which is based on the process of blood loss:

Acute posthemorrhagic anemia. In cases where, regardless of the cause, a person loses a very large volume of blood, acute stage anemia. A large volume is considered to be the loss of an eighth of all human blood.
Chronic posthemorrhagic anemia. It is observed in people suffering from diseases that are complicated by constant and fairly heavy blood loss. Such diseases may include pulmonary tuberculosis, peptic ulcers internal organs, gynecological disorders, etc.

Any acute form of posthemorrhagic anemia goes through the following stages:

Stage of vascular reflex changes. During the initial period of blood reduction in the blood vessels, processes responsible for emergency blood compensation are activated to protect the victim’s heart and brain.
The hydremic stage occurs on the second day. Characterized by gradual filling blood vessels tissue fluid and plasma replenishment. Tests usually show a sharp decrease in red blood cells and hemoglobin.
Bone marrow stage - occurs approximately on the 4th - 5th day. There is a greatly reduced iron content in the patient’s blood, but the number of young forms of red blood cells noticeably increases. Provided there are no repeated bleedings, normalization of blood composition occurs after about 3 weeks.

Since the amount of blood loss can vary, doctors divide posthemorrhagic anemia into the following degrees of severity:

Mild degree - hemoglobin level remains above 90 g/l.
Moderate - hemoglobin ranges from 70 to 90 g/l.
Severe degree - the hemoglobin level remains slightly above 50 g/l.
Extremely severe degree - hemoglobin level drops below 50 g/l.

Depending on the severity, treatment methods will be chosen in the future.

If the blood loss was too massive in volume or long in time, posthemorrhagic anemia leads to the depletion of all adaptive capabilities of the body and the development of shock.

Symptoms characteristic of posthemorrhagic anemia

In the case when anemia begins to develop as a result of an external injury with obvious blood loss, then everything is extremely clear for the victim and his environment, but with internal bleeding, the diagnosis is quite difficult. For a correct initial diagnosis, other signs that appear almost immediately are also important.

Signs characteristic of posthemorrhagic anemia:

the skin acquires a pale, sometimes bluish tint, the cyanosis is especially noticeable on the patient’s lips and nails;
with very severe blood loss, cases of loss of consciousness are common;
the patient becomes covered in sticky sweat;
a feeling of dryness appears in the mouth;
Symptoms of nausea and vomiting are quite common;
the victim’s body temperature drops below 36;
breathing becomes rapid and shallow;
in patients, blood pressure drops sharply;
the heartbeat increases greatly, and the pulse becomes thread-like and difficult to hear.

Depending on the disease common features Other symptoms characteristic of a diagnosis of chronic posthemorrhagic anemia may also occur, for example:

for lung diseases - bloody issues when coughing;
for diseases of the stomach or intestines - abundant blood in the stool;
gynecological problems are characterized by bleeding from the uterus;
with fractures, signs of severe swelling often appear, this indicates the appearance of an internal hematoma.

With chronic bleeding, the signs of anemia are somewhat different. These include:

pale and dry skin;
nails become brittle and flat;
hair begins to fall out profusely;
sweating increases;
man complains about constant fatigue, headaches, dizziness and nausea;
the temperature rises slightly;
increased sensitivity to odors;
taste sensations change;
appear frequent attacks rapid heartbeat.

Diagnostics

If there is a suspicion of severe blood loss, the patient mandatory delivered to medical institution, where he is prescribed certain studies. The results of blood tests will be quite revealing.

The next step is to determine where the bleeding is occurring and find out why it happened. Additional examinations may include:

ultrasound examination;
Doppler study;
stool analysis is performed to look for blood or signs of helminthiasis;
gynecological examination of women;
fibrogastroscopy is performed if stomach problems are suspected;
colonoscopy.

Treatment

The main task in the treatment of anemia is to restore normal composition blood

After emergency hospitalization, the patient is given first aid emergency assistance to maintain the life of the victim. The first need of the body at this stage is to maintain the required amount of fluid in the vessels of the patient’s body. For these purposes, transfusion of artificial blood substitutes is usually used. First, the drugs are administered in a stream, and then, after normalization of the pressure, the transfusion is continued in a drip mode. IN severe cases, at states of shock Prednisolone is often administered in large doses. In parallel, patients are administered drugs to prevent blood clotting. This will prevent thrombosis of small vessels. Application of transfusion donated blood or its components in each individual case is an individual matter. The doctor takes into account the risks of blood incompatibility, which can cause a number of unwanted complications.

In some cases, when chronic posthemorrhagic anemia is diagnosed and if a mild degree is diagnosed, treatment on an outpatient basis is allowed.

After passing a life-threatening period to eliminate posthemorrhagic anemia, the doctor will be faced with the task of restoring the normal composition of the blood. For this purpose complexes are prescribed vitamin preparations, products that restore iron levels and. Immunostimulants are prescribed if it is necessary to maintain the patient’s immunity.

Important to remember

Posthemorrhagic anemia is only a symptom of blood loss. At heavy blood loss you must immediately apply for medical care– elimination of blood loss in such a volume is possible only in a hospital. Treatment of posthemorrhagic anemia itself is a rather lengthy but well-studied process. If you suspect chronic blood loss, do not delay your visit to the doctor and refuse surgical treatment, if it is suggested to you by your attending physician.

Posthemorrhagic anemia - a set pathological changes, which 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 located in the section “Anemia associated with nutrition. Iron-deficiency anemia".

Latin defines the word anemia as “lack of blood,” literally speaking. The word can also be translated as “anemia,” which means a lack of hemoglobin. And “hemorrhagic” is translated as “accompanied by bleeding,” the prefix “post” means “after.”

Information about what posthemorrhagic anemia is will allow you to detect its development in time and provide the necessary assistance.

Pathogenesis in posthemorrhagic anemia

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

The severity of posthemorrhagic anemia is determined by the hemoglobin content 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.

Particularly negative on circulatory system affected by iron deficiency, in which the production of new blood cells 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. Healthy body a person with sufficient body weight completely restores the lost elements over time.

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

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

What colour deoxygenated blood can be read.

Read what the heart muscle consists of

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

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

Formation of an arteriovenous shunt, due to which blood does not flow to the capillaries

This system exists to maintain blood flow to the brain and heart, allowing them to continue to function even in the face of severe blood loss.

Interstitial fluid quickly compensates for the lack of plasma (the liquid part of the blood), but microcirculation disturbances persist. If blood pressure drops significantly, blood flow speed will small vessels will decrease, which will lead to thrombosis.

In the severe stage of posthemorrhagic anemia, small blood clots form that 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 is reduced, and harmful substances are retained in the body.

Blood circulation in the liver also weakens. If you don't start timely treatment acute posthemorrhagic anemia, this will lead to liver failure.

With posthemorrhagic anemia, the liver suffers due to lack of blood

Oxygen deficiency in 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 posthemorrhagic anemia is severe, the amount of alkalis is reduced, and the symptoms of acidosis increase.

With blood loss, the level of platelets decreases, but this has little effect on the coagulation processes: the content of other substances that affect coagulation reflexively increases.

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

Causes

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

Acute posthemorrhagic anemia

This is a disorder that develops rapidly due to excessive blood loss. This dangerous condition, which requires the rapid initiation of treatment measures.

Causes of acute anemia:

Chronic posthemorrhagic anemia

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

Causes of chronic anemia:

Hemorrhagic anemia also develops due to vitamin C deficiency.

Kinds

Posthemorrhagic anemia is divided not only by the nature of its 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:

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

There are also individual pathologies included in the ICD:

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

Symptoms

Acute form of anemia

Symptoms in the acute form of posthemorrhagic anemia increase very quickly and depend on the severity of blood loss.

Observed:

A decrease in blood pressure due to massive blood loss is called hemorrhagic shock. Fall intensity blood pressure depends on the severity of blood loss.

The following symptoms are also present:

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

The symptoms of posthemorrhagic anemia and hemorrhagic shock are joined by signs that are inherent to the disease that caused blood loss:

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

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

Stages of acute posthemorrhagic syndrome

Spicy posthemorrhagic syndrome has three stages of development.

Name	Description
Reflex-vascular stage	The level of plasma and red blood cells drops, compensatory processes are activated, blood pressure drops, and the heart rate increases.
Hydremia stage	It develops several hours after blood loss and lasts from 2 to 3 days. Intercellular fluid restores the volume of fluid in the vessels. The content of red blood cells and hemoglobin decreases.
Bone marrow stage	Develops 4-5 days after blood loss due to oxygen starvation. The level of hematopoietin and reticulocytes, the precursor cells of red blood cells, increases in the blood. The amount of iron in the plasma decreases.

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

Signs of chronic form

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

Observed:

People with posthemorrhagic anemia have low immunity and often develop infectious diseases.

Diagnostics

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

Laboratory diagnosis of posthemorrhagic 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 increases, and red blood cells and hemoglobin remain at normal levels;
After 2-4 hours, the excess platelets remain, neutrophil granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, according to the color indicator, anemia is defined as normochromic (normal value);
After 5 days, an increase in reticulocytes is noted, the iron level is insufficient.

What tests need to be taken?

Must be passed general analysis blood, in chronic anemia it reveals the content of elliptocytes, lymphocytes are increased in peripheral blood, but reduced in overall cellular composition.

A deficiency of iron, calcium, and copper is detected. Increased manganese content.

At the same time, tests are carried out to determine the cause of bleeding: stool examination for helminthiasis and occult blood, colonoscopy, urinalysis, bone marrow examination, ultrasonography, esophagogastroduodenoscopy, electrocardiogram.

Who to contact?

Hematologist

Treatment

Acute hemorrhagic anemia at the first stage of treatment, they require eliminating the cause of blood loss and restoring normal blood volume.

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

Artificial blood substitutes. They are infused by drop or stream, depending on the patient’s condition;
When shock develops, the use of steroids (Prednisolone) is indicated;
Soda solution eliminates acidosis;
Anticoagulants are used to eliminate blood clots in small vessels.
If blood loss exceeds a liter, a donor blood transfusion is necessary.

Treatment of chronic anemia not complicated by serious diseases is carried out on an outpatient basis. Nutrition correction with the addition of foods containing iron, vitamins B9, B12 and C is indicated.

In parallel, treatment is carried out for the underlying disease that caused the pathological changes.

Forecast

If, after extensive blood loss, the patient quickly arrives at the hospital and receives the full range of medical procedures, aimed at restoring blood levels and eliminating bleeding, the prognosis is favorable, except in cases where the blood loss is extremely pronounced.

A 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 to treat anemia?

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 that contains iron. Its main function is to transport oxygen through the bloodstream to all organs and tissues without exception. When this process is disrupted, the body begins to experience quite major changes, which are determined by the etiology and severity of anemia.

Depending on the root cause and course of posthemorrhagic anemia, acute and chronic forms are distinguished. According to the system international classification The disease is divided as follows:

Secondary iron deficiency anemia after blood loss. ICD 10 code D.50
Acute posthemorrhagic anemia. ICD 10 code 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 posthemorrhagic anemia is the loss of a large volume of blood over a short period of time, which occurred as a result of:

Trauma that caused damage to the main arteries.
Damage to large blood vessels during surgery.
Gap fallopian tube with the development of an ectopic pregnancy.
Diseases of the 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 pathologies blood system, damage to the placenta during caesarean section, early placental abruption, placental previa, birth trauma.

Causes of chronic posthemorrhagic anemia

Chronic posthemorrhagic anemia develops as a result of small but regular bleeding. They may appear as a result of:

Hemorrhoids, which are accompanied by cracks in the rectum and the appearance of blood in the stool.
Peptic ulcer of the stomach and duodenum.
Heavy menstruation uterine bleeding while taking hormonal drugs.
Damage to blood vessels by tumor cells.
Chronic nosebleeds.
Minor chronic blood loss in cancer.
Frequent blood draws, catheter installations and other similar manipulations.
Severe kidney disease with bleeding in the urine.
Helminth infestation.
Liver cirrhosis, chronic liver failure.

Chronic anemia of this etiology can also be caused by hemorrhagic diathesis. This is a group of diseases in which a person has a tendency to bleed due to disruption of homeostasis.

Symptoms and blood picture of anemia due to acute blood loss

Clinical picture Acute posthemorrhagic anemia develops very quickly. The main symptoms of this disease include manifestations of general shock as a result of acute bleeding. In general, the following are observed:

Reduced blood pressure.
Cloudiness or loss of consciousness.
Severe pallor, bluish tint of the nasolabial fold.
Thready pulse.
Vomit.
Increased sweating, and so-called cold sweat is observed.
Chills.
Cramps.

If the bleeding was successfully stopped, then such symptoms are replaced by dizziness, tinnitus, loss of orientation, blurred vision, shortness of breath, and irregular heartbeat. Pallor of the skin and mucous membranes and low blood pressure still persist.

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Torsunov O.G. About the causes of iron deficiency anemia

Changes in blood test results within a few days after bleeding has stopped and the development of anemia are closely related to compensation mechanisms that “turn on” in the body in response to the loss of a large volume of blood. They can be divided into the following stages:

The reflex phase, which develops on the first day after blood loss. Redistribution and centralization of blood circulation begins, increases peripheral resistance vessels. In this case, there is a decrease in the number of red blood cells with normal values hemoglobin and hematocrit concentrations.
The hydremic phase occurs 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 meaning color index still remains 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 oxygen supply to organs and tissues activates hematopoietic processes. In addition to decreased hemoglobin, hematocrit, thrombocytopenia and leukopenia, at this stage there is a decrease total number red blood cells When examining a blood smear, the presence of young forms of red blood cells is noted: reticulocytes, sometimes erythroblasts.

Similar changes in the blood picture have been described in many situational tasks for future doctors.

Symptoms and diagnosis of anemia in chronic bleeding

Chronic posthemorrhagic anemia is similar in its symptoms to iron deficiency, since regular, mild bleeding leads to a deficiency of this microelement. The course of this blood disease 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 varies depending on age from 200 in infants to 150 in adolescents.

Degree of posthemorrhagic chronic anemia Hemoglobin concentration

1 (light) degree 90 – 110 g/l
2nd degree (moderate) 70 – 90 g/l
Grade 3 (severe) below 70 g/l

At the initial stage of development of the disease, patients complain of slight dizziness, flashing “spots” before the eyes, increased fatigue. Externally, pallor of the skin and mucous membranes is noticeable.

At the second stage, the listed symptoms are added to a decrease in appetite, sometimes nausea, diarrhea or, conversely, constipation, shortness of breath. When listening to heart sounds, doctors note heart murmurs characteristic of chronic posthemorrhagic anemia. The condition of the skin also changes: the skin becomes dry and peels. Painful and inflamed cracks appear in the corners of the mouth. The condition of hair and nails worsens.

A severe degree of anemia is manifested by numbness and a tingling feeling in the fingers and toes, specific taste preferences appear, for example, some patients begin to eat chalk, and the perception of smells changes. Very often this stage of chronic posthemorrhagic anemia is accompanied by rapidly progressing caries and stomatitis.

Diagnosis of posthemorrhagic anemia is based on the results clinical analysis blood. In addition to the decrease in the amount of hemoglobin and red blood cells characteristic of all types of anemia, a decrease in the color index is detected. Its value ranges from 0.5 – 0.6. In addition, with chronic posthemorrhagic anemia, modified red blood cells (microcytes and schizocytes) appear.

Treatment of anemia after massive blood loss

First of all, it is necessary to stop the bleeding. If it is external, then it is necessary to apply a tourniquet and a pressure bandage and take the victim to the hospital. In addition to pallor, cyanosis and confusion, internal bleeding is indicated by severe dry mouth. It is impossible to help a person in this condition at home, so stopping internal bleeding is carried out only in a hospital setting.

After identifying the source and stopping the bleeding, it is urgently necessary to restore the blood supply to the vessels. For this purpose, rheopolyglucin, hemodez, polyglucin are prescribed. Acute blood loss also compensated by blood transfusion, taking into account the compatibility of the Rh factor and blood group. The volume of blood transfusion is usually 400 – 500 ml. These activities must be carried out very quickly, since quick loss even ¼ of the total blood volume can be fatal.

After stopping the state of shock and carrying out all the necessary manipulations, they proceed to standard treatment, which consists of the administration of iron supplements and enhanced nutrition to compensate for the deficiency of vitamins and microelements. Ferrum lek, ferlatum, maltofer are usually prescribed.

Typically, restoration of a normal blood picture occurs after 6–8 weeks, but the use of medications to normalize hematopoiesis continues for up to six months.

Treatment of chronic posthemorrhagic anemia

The first and most important stage in the treatment of posthemorrhagic chronic anemia is to determine the source of bleeding and eliminate it. Even the loss of 10 - 15 ml of blood per day deprives the body of the entire amount of iron that was received during that day with food.

Held comprehensive examination patient, which necessarily includes consultations with a gastroenterologist, proctologist, hematologist, gynecologist for women, and endocrinologist. After identifying the disease that caused the development of chronic posthemorrhagic anemia, treatment begins immediately.

At the same time, medications that contain iron are prescribed. For adults it daily dose is about 100 – 150 mg. Appointed complex means, which in addition to iron contain ascorbic acid and B vitamins, which promote its better absorption. These are sorbifer durules, ferroplex, fenyuls.

At severe course posthemorrhagic chronic anemia, red blood cell transfusion and injection are indicated to stimulate hematopoietic processes medicines with iron. Ferlatum, maltofer, likferr and similar medications are prescribed.

Recovery after the main course of treatment

The duration of taking iron-containing drugs is determined by the doctor. In addition to the use of various medications to restore normal oxygen supply to organs and replenish iron reserves in the body, proper nutrition is very important.

The diet of a person who has suffered posthemorrhagic anemia must contain proteins and iron. Preference should be given to meat, eggs, fermented milk products. The leaders in iron content are meat by-products, especially beef liver, meat, fish, caviar, legumes, nuts, buckwheat and oatmeal.

When creating 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 increases with the consumption of vegetables and fruits that contain vitamins B and C. These are citrus fruits, black currants, raspberries, etc.

Course and treatment of posthemorrhagic anemia in children

Posthemorrhagic anemia in children is much more severe, especially its acute form. The clinical picture of this pathology is practically no different from that of an adult, but develops faster. And if in an adult a certain volume of lost blood is compensated by the body’s protective reactions, then in a child this can lead to death.

Treatment of acute and chronic forms of posthemorrhagic anemia in children is the same. After identifying the cause and eliminating the bleeding, a transfusion of red blood cells is prescribed at the rate of 10 - 15 ml per kg of weight, and iron supplements. Their dosage is calculated individually depending on the severity of anemia and the condition of the child.

For children aged about six months, early introduction of complementary foods is recommended, and you should start with foods with increased content gland. Infants are advised to switch to special fortified formulas. If the disease that led to the development of posthemorrhagic anemia is chronic and cannot be treated, then preventive courses of iron supplements must be repeated regularly.

With timely initiation of treatment and non-critical blood loss, the prognosis is generally favorable. After compensation for iron deficiency, the child quickly recovers.