Fast hemorrhagic anemia - dangerous condition for human health and life. Insufficient blood volume leads to the development of a serious pathology - lack of hemoglobin. If the formation process is not stopped in a timely manner posthemorrhagic anemia, there will be a serious threat to life.

The principle of anemia development

Blood contains a lot various cells, which perform separate functions. Among them are red blood cells - red blood cells containing hemoglobin. They perform an important role: they deliver oxygen from the lungs to different parts of the human body.

Anemia is pathological condition when the content of hemoglobin or red blood cells in the blood drops sharply. The most common is a lack of red blood cells associated with prolonged bleeding. This phenomenon is called posthemorrhagic anemia.

The condition itself is rarely diagnosed as a separate disease. Usually the fact of anemia is interpreted as a symptom of another pathology. According to WHO, more than 30% of the world's inhabitants suffer from anemia.

The danger of this condition is that a long-term lack of red blood cells against the background of a reduced amount of blood can cause not only oxygen starvation and vascular insufficiency, but also the development malignant tumors, degeneration of tissues and organs, as well as provoke hematopoietic diseases. This process is most dangerous during pregnancy, when it harms not only the health of the mother, but also her unborn child.

Causes of posthemorrhagic anemia

Can provoke the development of the disease various situations, sometimes arising against the background of existing ailments or due to unexpected force majeure circumstances:

In women it may be following reasons development:

• ectopic pregnancy;
• heavy periods;
• uterine bleeding;
• birth injuries.

Classification of the disease

There are 2 types of posthemorrhagic anemia:

• acute;
• chronic.

Acute red cell deficiency suggests a sharp decline hemoglobin. This form of posthemorrhagic anemia occurs due to blood loss due to trauma or surgery, when a person loses 1/8 or more of the total volume.

In what cases is blood transfusion indicated for low hemoglobin:

Stages of development of the acute form

Doctors distinguish several stages in the development of acute posthemorrhagic anemia:

Features of chronic posthemorrhagic anemia

At chronic anemia there is a small but periodic constant loss of blood over a long period of time. This form is observed in a number of diseases:

• oncology and neoplasms of the gastrointestinal tract;
• peptic ulcer;
• bleeding from varicose hemorrhoidal veins of the rectum;
• erosive processes in the mucous membrane of the esophagus;
• increased bleeding of gums (periodontitis and gingivitis).

The chronic form of anemia is most often observed in women due to bleeding due to inflammatory processes reproductive organs:

Degrees of anemia: mild, moderate, severe

Anemia has 4 degrees of severity. This type of classification is based on the level of hemoglobin in the patient’s blood:

• mild degree - hemoglobin is lower permissible norm, but not less than 90g/l;
• medium degree - hemoglobin level from 70 to 90 g/l;
• severe degree - blood cell level up to 70 g/l;
• extremely severe degree - the amount of hemoglobin is below 50 g/l.

In addition to the above forms, there are 2 types of posthemorrhagic anemia:

• relative: characterized by an increase in blood plasma with significant blood loss, often manifesting itself during pregnancy in women;
• absolute: decrease in hemoglobin due to a decrease in the number of red blood cells.

According to International classification diseases, individual conditions associated with established cause blood loss:

• congenital anemia of the fetus due to blood loss;
• chronic posthemorrhagic anemia due to iron deficiency.

Symptoms of the disease

There is a general set of symptoms that occurs with the development of anemia (anemic syndrome):

• fast fatiguability;
• drowsiness;
• noise in the ears and head;
• dyspnea;
• pallor of the integument.

If progresses acute anemia, then the following symptoms are additionally observed:

• dizziness;
• headache;
• fainting;
• thirst;
• nausea;
• brittle nails;
• profuse sweating;
• dry mouth;
• shallow breathing;
• cardiopalmus;
• decreased body temperature;
• decrease in blood pressure.

Different types internal bleeding may manifest themselves in different ways.

The patient may find the following manifestations illness:

• liquefied bloody stools, which may be evidence of a stomach ulcer;
• cough accompanied by bright red sputum, which is characteristic of bleeding in the lungs;
• increasing swelling at the site of a bruise or fracture, confirming intramuscular or subcutaneous bleeding;
• bloody discharge from the vagina.

If a combination of several symptoms characteristic of anemia occurs, you need to urgently consult a doctor to make a correct diagnosis and prescribe the necessary treatment.

What is the reason for the appearance bloody discharge in between periods:

Diagnosis of anemia, including blood tests

Anemia is diagnosed only after bleeding has stopped. Moreover, parallel to any possible way replenish the volume of lost blood (if necessary).

Initially for maximum effect to bring the patient out of shock and increase to normal arterial pressure, doctors transfuse at least 500 ml of plasma substitute. The initial administration of Polyglyukin is carried out in a stream, and when the systolic pressure reaches 100, the injection is replaced with a drip. Sometimes the dose of the administered solution can reach two liters.

Only after all the necessary manipulations do doctors begin diagnosing the patient’s anemic condition.

Of course, an obligatory stage of diagnosis is collecting anamnesis and identifying possible reasons underlying the disease. The diagnosis itself is made on the basis of a combination of studies: clinical and laboratory.

Basic methods

The diagnosis of posthemorrhagic anemia is based on basic studies:

• general and biochemical blood test;
• Analysis of urine.

When detecting the presence of posthemorrhagic anemia laboratory research blood will show:

• decreased hemoglobin content with a slight decrease in red blood cells;
• decrease in the level of saturation of red blood cells with hemoglobin;
• decreased serum iron levels;
• increased erythrocyte sedimentation rate;
• decreased platelet count.

Additional examination

To locate a place hidden bleeding use additional methods diagnostics:

• analysis feces for the presence of blood and helminths;
• fibrogastroscopy - to exclude or confirm bleeding in the gastrointestinal tract;
• colonoscopy (medical examination under video control of the lower intestines);
• checking the integrity of internal hemorrhoids- sigmoidoscopy;
• Ultrasound and/or x-ray to specify the cause;
• gynecological examination (for women).

In some cases, for staging accurate diagnosis Cytological and histological examination is required bone marrow.

Depending on the type of bleeding, the patient needs to consult one or more specialists, such as:

• hematologist;
• surgeon;
• traumatologist;
• gynecologist;
• proctologist;
• gastroenterologist

Treatment of acute anemia

Very often in cases with posthemorrhagic anemia, “delay is like death.” If not provided in a timely manner health care about acute blood loss, then the result will be disastrous. When a person quickly loses more than a quarter of their blood volume, death can occur.

Immediately carried out surgery at the site of a damaged organ or part of the body to stop bleeding.

Initially, the lost blood volume is replaced. This is done only if blood loss is more than 10%. If blood consumption is no more than 20%, then a small correction is required using blood substitutes:

• Ringer's solution;
• Dextran;
• Gelatinol;
• Longosterol;
• Volenama.

Drugs to compensate for blood loss - photo gallery

Albumin - colloidal preparation
Polyglucin is used in the treatment of posthemorrhagic anemia
Ringer's solution belongs to crystalloid plasma expanders
Reopolyglucin is used to treat massive blood loss. Gelatinol is similar in structure to blood plasma.

The use of glucose solution is highly undesirable. If blood loss is more than 20%, then the patient is transfused with a mixture of red blood cells and a plasma substitute. various combinations.In its purest form donor blood used very rarely. You cannot immediately replace all blood loss, as this can cause “massive transfusion syndrome,” that is, the development of intravascular coagulation or immunoconflict is possible. For correction water-salt balance prescribed in the body intravenous administration sodium chloride solution. It is imperative to use iron-containing preparations for acute anemia:

• Feramid. Active substances: nicotinamide and ferric chloride. Iron levels are low. For maximum effectiveness, additional intake of ascorbic acid is required.
• Ferroplex. This is a combination of ferrous sulfate and vitamin C. It is easily tolerated and has minimal restrictions for use.
• Ferroceron. Active substance - sodium salt orthocarboxybenzoylferrocene. Highly effective. When taking it, it is necessary to exclude fermented, sour and pickled foods from the diet.
• Conference. The activity of the drug is based on the action of sodium dioctyl sulfosuccinate and ferrous sulfate. Easily absorbed. Does not require additional intake ascorbic acid.

After obvious manifestations of anemia cease, iron supplements are taken at half the dose for another six months.

If the patient is in shock, large doses of Prednisolone are used. Promotion pH value in tissues helps to remove baking soda solution. Heparin is used to eliminate thrombus formation at the level of capillary vessels. Sometimes it is necessary to connect humidified oxygen through a breathing tube.

Therapy for chronic posthemorrhagic anemia

The chronic form of the disease requires a different approach. Initially identify the real reason constant blood loss, its source. Sometimes it is so insignificant that it may not be recognized.

In some cases, the doctor prescribes hemostatic medicines(coagulants) that promote blood clotting. Typically, such drugs are used for capillary, parenchymal and uterine bleeding. It can be:

• Vikasol;
• Dicynone;
• Etamsylate;
• hemostatic collagen sponge;
• Ambien;
• Tobarpin;
• Thrombin;
• Prothrombin complex.

Blood transfusions and the use of blood substitutes are rarely used. As in the acute form, iron supplements and vitamins are used to treat chronic anemia. Appointed symptomatic therapy, aimed at eliminating dysfunctions in the body.

Aspects of anemia treatment - video

Application of traditional medicine

One should not hope to cure anemia with only folk remedies. They can only be used as an addition to the main treatment. But before starting therapy, you need to consult a doctor. Most often doctors recommend using:

• burnet;
• strawberry;
• black currant;
• water pepper;
• nettle;
• rose hip.

Nutrition for anemia

An addition to the treatment of posthemorrhagic anemia is special diet. The patient's diet should consist of foods containing high content gland:

• fresh and boiled vegetables;
• lean varieties of beef and pork;
• rabbit meat;
• veal;
• liver;
• cottage cheese;
• egg white;
• greenery;
• sea ​​fish.

Replenishment of fluid in the body is required, so doctors recommend drinking at least 2 liters of water daily. In addition, natural juices will be very useful:

• plum;
• cranberry;
• pomegranate;
• currant;
• grapefruit;
• apple.

Disease prevention

During the period of recovery of the body after an illness, patients need to increase the immune barrier. This is due to susceptibility to infection by various. In this situation, immunostimulants based on extracts of aloe, ginseng, lemongrass, and echinacea are used.

Prevention of the development of posthemorrhagic anemia involves, first of all, maintaining a healthy lifestyle, observing safety rules in any field of activity and at home and timely treatment all current diseases.

Don't forget about good nutrition. Products should be rich in micro- and macroelements and vitamins.

In cases of injury of any type, it is imperative to contact medical institution for timely diagnosis.

Prognosis for successful recovery

Extremely quick help physicians and appropriate hemostatic measures contribute to a favorable outcome. If there is a large loss of blood, the patient may die. Slow but massive blood loss leads to various complications, but it is less dangerous.

The prognosis for the success of treatment of acute posthemorrhagic anemia depends not only on the amount of blood loss itself, but also on the speed of bleeding.

The success of treatment of subsequent complications depends on the timeliness and correctness of the anemia therapy itself. In this case, the regenerative abilities of the bone marrow play an important role, since the duration of treatment for anemia depends on this.

Posthemorrhagic anemia is a disease that requires mandatory medical intervention. Only correct and timely treatment will help save a person from serious complications.

Chronic posthemorrhagic anemia is a phenomenon caused by frequent and small blood losses. Which, in turn, causes iron deficiency in the body, as well as a decrease in red blood cells and a decrease in hemoglobin concentration.

This condition is divided into three types:

1. Acute posthemorrhagic anemia is characterized by a large amount of lost blood.
2. Secondary Iron-deficiency anemia, which occurs after blood loss.
3. In rare cases, congenital anemia occurs; it is observed in unborn children in the womb.

Secondary iron deficiency anemia is most often referred to as chronic posthemorrhagic anemia.

Causes of development of chronic posthemorrhagic anemia

Small but regular bleeding may accompany a person long years, allowing anemia to develop. Conditions such as:

Chronic or iron deficiency anemia leads to an acute lack of iron and hemoglobin. For normal operation the body needs a hemoglobin level in the range of 135-160 g/l, in male body and in women's, 120-140 g/l. IN children's body hemoglobin ranges from 150 to 200 g/l in accordance with his age. So, the symptoms:

1. The first symptoms of chronic posthemorrhagic anemia are incoming dizziness and the appearance of black spots before the eyes. A person gets tired quickly and against this background his skin acquires a pale tint, becomes thin and dry.
2. The next symptom is the patient’s loss of appetite, nausea occurs, and bowel movements are disrupted - diarrhea replaces constipation and vice versa. During this period, extraneous noise may appear in the patient's heart.
3. As the disease progresses, the condition worsens skin, it becomes thin and flaky. At the same stage of the disease, the hair becomes sick and brittle, and the nails split.
4. In a severe stage of anemia, the patient’s perception of taste is impaired, he begins to eat things that are not apparently edible, for example, chalk. He perceives odors inadequately, since the olfactory and taste receptors stop working correctly. At this stage of the disease, the patient’s teeth begin to rapidly deteriorate and caries develops.
5. Blood pressure becomes painfully low.

Diagnosis of chronic posthemorrhagic anemia

Diagnoses anemia of this type, using a blood test. The blood picture is compiled according to the number and condition of red blood cells, microcytes and schizocytes. The causes of the patient’s condition must be established; for this purpose, his condition is determined. internal organs using ultrasonic equipment.

In addition, the patient undergoes examination by specialized specialists, such as a gastroenterologist, proctologist, hematologist, gynecologist for women, and always an endocrinologist. This approach to diagnosis allows, with a high degree of probability, to establish the cause of the disease.

Treatment of posthemorrhagic anemia

However, the most important point in the treatment of this pathology, is the restoration of iron in the body. After all, even a slight loss of blood from 10 to 15 ml deprives the body of the amount of iron that entered it within 24 years with food taken. In this regard, the patient is prescribed a number of drugs containing not only iron, but also a complex of B vitamins. These can be “Sorbifer”, “Durules”, “Ferroplex” or “Fenuls”. All medications are prescribed by the attending physician, who also calculates the dosage based on the patient’s condition and the fact that an adult needs approximately 100-150 mg per day. gland.

If the patient’s condition is severe, he is prescribed injections of drugs such as Ferlatum, Faltofer or Likferr. He also undergoes a procedure called a blood transfusion, in which not all the plasma is transfused, but only the red blood cell mass.

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

The diet is calculated individually for each patient. It definitely contains beef meat. low-fat varieties, chicken eggs, kefir, cottage cheese, goat cheese. It is mandatory to use beef liver, sea ​​fish, caviar, as well as beans, peas, buckwheat, oatmeal and walnuts.

Be sure to include fresh vegetables, fruits and berries in your diet; they help iron to be absorbed by the body faster and better. These can be oranges, tangerines, lemons, persimmons, raspberries and black currants.

Such nutrition should quickly restore proper metabolism in the body. But it is important that it be fractional and multiple. Ideally, the patient should eat 7 times a day in small portions. Alcohol and cigarettes are strictly prohibited.

Treatment of posthemorrhagic anemia in children

Taking all this into account, acute and chronic posthemorrhagic anemia in children is treated in a hospital, under constant medical supervision. First of all, the cause of the bleeding itself is eliminated. Then a blood transfusion is done, as many times as needed, that is, more than once.

It is imperative to prescribe medications containing iron, including injections, for faster absorption. Children under one year of age are given special nutritional mixtures, rich in iron and vitamins.

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

As a rule, restoring the level of iron in a child’s body leads to a positive prognosis and in the future it grows without deviations from the norm. The treatment is carried out by a pediatrician, but he relies on data provided by other specialists.

Prognosis for posthemorrhagic anemia

In general, the prognosis for posthemorrhagic anemia is positive. But only under the condition of correct and competent therapy, including the elimination of chronic bleeding, even if this requires surgery.

Prevention of posthemorrhagic anemia

In order to prevent posthemorrhagic anemia from developing in the body of an adult or child, it is necessary to promptly treat diseases leading to blood loss. But there is a difficulty here - most of these benefits occur unnoticed by a person; he can feel good while a colony of parasites is growing in his body or kidney stones are accumulating. In this regard, it is necessary to regularly, at least once a year, undergo a complete medical examination. It should include examination of internal organs, analysis for the presence of parasites, as well as monitoring blood quality. Namely, the content of iron and red blood cells in it.

What is Acute posthemorrhagic anemia

Acute posthemorrhagic anemia is understood as anemia that develops as a result of quick loss a significant amount of blood.

In the mechanism of development of the main symptoms of acute blood loss, the leading role is played by a rapid decrease in the total volume of blood, especially its plasma. A decrease in the volume of red blood cells leads to acute hypoxia, which is clinically manifested by the appearance of shortness of breath and palpitations.

Collapse (fainting) or hypotension (low blood pressure) is mainly caused by loss of plasma. During bleeding and immediately after it, the adrenal glands release catechol amines, which causes spasm peripheral vessels. A decrease in the volume of the vascular bed helps compensate for the decrease in circulating blood volume. However, prolonged spasm of peripheral vessels has an adverse effect on microcirculation and can lead to the development of shock. One of the main mechanisms of self-regulation of the body is the restoration of blood volume by mobilizing its own interstitial fluid and its release into the vascular bed. This process is called autohemodilution. If autohemodilution is not expressed enough or is depleted, then decompensation occurs, and without treatment the patient dies. As a result of hypoxia associated with blood loss, the content increases

erythropoietin, resulting in increased formation of cells sensitive to it and the release of reticulocytes.

Symptoms of Acute posthemorrhagic anemia

Acute posthemorrhagic anemia primarily causes symptoms of collapse. The patient experiences severe weakness, dizziness, pallor, dry mouth, cold sweat, vomit. Arterial and venous pressure decreases, decreases cardiac output blood, the pulse increases sharply. Pulse filling becomes weak.

The clinical picture is determined by the amount of blood lost, the rate of its flow, and to some extent depends on the source of blood loss. There is evidence of unequal compensation depending on the source of bleeding.

P = K + 44lgIIIU,

Where P - blood loss as a percentage;

TO - coefficient equal to 27 for gastrointestinal blood loss, 33 for abdominal bleeding, 24 for wounds of the extremities and 22 for damage to the chest;

SI - shock index, equal to the ratio of pulse rate to systolic pressure.

In the first hours with large blood loss, there may be a slight decrease in the level of hemoglobin and red blood cells; accordingly, the hematocrit (the part of the blood volume attributable to shaped elements), and only a study of the volume of circulating red blood cells can reveal its significant decrease.

If the bleeding was stopped, then after 2-3 days there is a decrease in the level of hemoglobin and red blood cells due to the penetration of tissue fluid into the blood, therefore, in the first time after blood loss, anemia is normochromic in nature. The platelet content during bleeding may be reduced due to their consumption during the process of thrombus formation.

The diagnosis of occult massive bleeding is based on clinical manifestations, supported by some laboratory data (Gregersen, Weber tests, an increase in the level of residual nitrogen in case of bleeding from upper sections digestive tract).

Treatment of acute posthemorrhagic anemia

Treatment of acute posthemorrhagic anemia begins with stopping bleeding and carrying out anti-shock measures. Indications for blood transfusion in acute blood loss are: prolonged bleeding, a significant drop in systolic blood pressure to 90 mm Hg. Art. and lower, increased heart rate compared to the norm by 20 beats per minute or more. Blood loss within 10-15% of the initial circulating blood volume (BCV) does not require blood replacement, and a loss of even 25% of the BCC requires only a slight correction. Transfusion of blood substitutes is performed for patients with a loss of more than 25% of blood. For replacement therapy use

polyglucin in a volume of up to 2 l/day. In order to improve microcirculation, intravenous administration of rheopolyglucin, gelatinol or albumin is used. Red blood cell mass in a volume of 30-40% of blood loss should be used only after restoration of blood circulation by replenishing the bcc with the above solutions. To improve the rheological properties of blood, red blood cells are diluted with rheopolyglucin or a 5% albumin solution in a 1:1 ratio.

With massive blood loss great importance has a transfusion speed. Typically, venous pressure is sharply reduced, the ulnar veins are collapsed, so you should resort to puncture of the subclavian veins or venous sections, followed by jet injection of solutions into 2-3 veins. It should be emphasized that it is inadmissible to replace all blood loss with blood in order to avoid “massive transfusion syndrome.” It is also necessary to remember about the correction of plasma proteins, for which albumin or protein is used. For the purpose of correction water balance the body produces intravenous infusions 0.9% sodium chloride solution, 5% glucose solution, Ringer-Locke solution. Lactasol is used to normalize blood pH.

Whole blood transfusions are generally inappropriate.

Which doctors should you contact if you have Acute posthemorrhagic anemia?

Hematologist

Therapist

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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. The acute form of posthemorrhagic anemia is an option in which the pathology develops against the background of heavy bleeding, while chronic form- this 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 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. The clinical picture of this type of anemia also includes a sharp decrease in body temperature.

With heavy bleeding, symptoms of hemorrhagic shock may develop.

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 state of 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.