Posthemorrhagic anemia: when life flows away with blood. Posthemorrhagic anemia: treatment of acute and chronic forms Posthemorrhagic anemia: treatment of acute and chronic forms Chronic posthemorrhagic anemia

Anemia is a group of syndromes characterized by a decrease in the concentration of hemoglobin and/or the number of red blood cells in human blood. Normally it contains: in men - (4.1-5.15) x10 12 /l of red blood cells, and hemoglobin 135-165 g/l. In women, the number of red blood cells is (3.8-4.8) x10 12 / l and 121-142 g/l Hb. Posthemorrhagic anemia- a condition that occurs after chronic or acute bleeding. This syndrome can complicate a large number of diseases in gastroenterology, surgery, gynecology and other areas of medicine.

There are several classifications of this syndrome. This is how acute and chronic posthemorrhagic anemia are distinguished. Acute posthemorrhagic anemia develops after sudden bleeding. Etiological factors may include trauma, vascular damage, surgical complications. Chronic posthemorrhagic anemia develops in pathologies that are accompanied by frequent, not very large bleeding:

• haemorrhoids;
• peptic ulcer;
• disruption of the menstrual cycle;
• fibromatosis of the uterus.

Severity of anemia

There is also a classification according to severity. Mild, moderate and severe degrees are divided according to the hemoglobin content in the blood. There are three stages of post development hemorrhagic anemia:

• mild degree - hemoglobin level is below normal, but above 90 g/l;
• average - Hb within 90-70 g/l;
• severe - hemoglobin value less than 70 g/l.

Causes of posthemorrhagic anemia

As the name suggests, acute posthemorrhagic anemia is caused by acute or chronic blood loss. Below are some etiological factors for the occurrence of posthemorrhagic anemia:

• various injuries, often with damage to large vessels;
• postoperative, intraoperative bleeding;
• stomach ulcer;
• chronic hemorrhoids;
• DIC syndrome, hemophilia;
• violations menstrual cycle, menorrhagia;
• liver cirrhosis with portal hypertension, bleeding from esophageal varices;
• tumor processes with destruction of surrounding tissues;
• various infections manifested with hemorrhagic syndrome;
• The severity of anemia depends on the sources.

Among hemorrhagic anemias, special attention should be paid to their development during pregnancy. Usually a noticeable decrease in hemoglobin in a woman indicates such serious illnesses like placental abruption, ectopic pregnancy, chorioangioma, placental hematomas.

Diagnostics

Diagnosis of posthemorrhagic anemia is based on:

• clinical picture data;
• physical examination;
• laboratory;
• instrumental methods.

When interviewing the patient, you can find out that there was some kind of bleeding, or there are diseases that could lead to this. The patient complains about constant feeling weaknesses.

When examining a patient, you should pay attention to anemic skin, hypotension, big number breathing movements. The pulse is usually weakly filled and frequent (due to a decrease in blood volume, a drop in pressure, and a reflex increase in heart contractions). There is muffled heart sounds and a systolic murmur at the apex. It is necessary to monitor the patient's diuresis and monitor indicators blood pressure to prevent decompensation of the condition.

Anemia is diagnosed based on changes in general analysis blood. At acute anemia there is a drop in the number of red blood cells or a decrease in hemoglobin levels. The number of young red blood cells increases to 11%, and red blood cells with a changed shape also appear. There is an increase in the number of leukocytes with a shift in the leukocyte formula to the left. IN early period an increased platelet count may be detected. This is probably due to the activation of the hemostatic system, trying to stop bleeding.

A few months later it happens full recovery content of red blood cells and hemoglobin. But its synthesis requires iron, so the consequence of acute posthemorrhagic anemia can be Iron-deficiency anemia.

In chronic posthemorrhagic anemia, signs of hypochromic anemia are noted in a general blood test. In some cases, leukopenia may be detected, in leukocyte formula Sometimes minor lymphocytosis occurs. It is also observed reduced level iron in plasma. In a general urine test, there may be various changes associated with both bleeding and a drop in pressure (possible development of oligo- or anuria - changes characteristic of acute renal failure).

For difficult to diagnose bleeding, a study is sometimes used bone marrow flat bones. In bone marrow punctate with this type of anemia, signs of high red brain activity can be detected. In trephine biopsy samples, yellow bone marrow is replaced with red.

X-rays, ultrasound, FGDS, and MRI can be used as auxiliary diagnostic methods. Using these imaging tools, it is possible to detect hemorrhage in the body cavity. On the ECG, the height of the T wave in standard and precordial leads may be reduced. You should also take a stool test for occult blood. Patients need to undergo consultations to establish the cause of the condition and patient management tactics:

• hematologist;
• surgeon;
• gastroenterologist;
• gynecologist.

To establish the cause and tactics of patient management.

Symptoms and signs

The clinical picture depends on the duration and volume of blood loss. Common features of posthemorrhagic anemia are anemic skin and tachycardia. Dizziness, sweating, and thirst may occur. Also, posthemorrhagic anemia is accompanied by a decrease in BCC (circulating blood volume), manifested by arterial hypotension. When blood pressure decreases, loss of consciousness is likely. The development of renal failure and hemorrhagic shock is possible.

Acute posthemorrhagic anemia

Acute posthemorrhagic anemia occurs abruptly. The patient complains about headache, weakness, sometimes reaching the point of loss of consciousness. When the patient tries to stand up, orthostatic collapse may occur. Externally, there is pallor of the skin and visible mucous membranes. Tachycardia and hypotension are also noted. With large blood loss, the pulse may be thread-like and arrhythmic. There is a muffled heart sound, as well as a systolic murmur at its apex. Against the background of rapid, massive bleeding, hemorrhagic shock develops. It manifests itself in the following symptoms:

• decreased blood pressure;
• reflex increase in heart rate;
• hypovolemia (vessels become empty);
• decreased diuresis, up to anuria.

A patient in this condition may lose consciousness, be very pale, and have a decreased body temperature.

Chronic posthemorrhagic anemia

Bleeding that occurs periodically over a long period of time leads to depletion of iron reserves in the body. According to its pathogenesis, chronic posthemorrhagic anemia is iron deficiency, and its etiological factor is blood loss. The patient's main complaint will be constant fatigue dizziness. There may also be a buzzing in the ears and flashing “flies”. During the examination it is observed:

• dyspnea;
• heartbeat;
• decrease in pressure.

Upon examination, anemic skin, mucous membranes, and puffiness of the face are noted. Systolic murmurs may be heard on auscultation of the heart and great vessels. You can detect an increase in internal organs: liver and spleen. A complete blood count is an important test. It allows you to detect signs hypochromic anemia(decrease in the amount of hemoglobin, color index and manifestations of micro- or anisocytosis).

There is a drop in the concentration of iron in the blood plasma. All these symptoms are necessary to establish the diagnosis and treatment of chronic posthemorrhagic anemia.

Treatment

Main therapeutic measure, aimed at treating posthemorrhagic anemia, is to find and stop bleeding. It could be:

• application of a tourniquet (temporary stop);
• ligation or suturing of blood vessels;
• coagulation of bleeding ulcers and other treatment methods.

Depending on the rate and magnitude of blood loss, the volume of blood volume is restored, in accordance with the severity of the patient’s condition. The volume of infusions is usually 200-300% of the amount of blood lost. To restore the level of circulating blood, crystalloid drugs are primarily used:

• saline;
• Ringer's solution;
• 7,5% hypertonic solution NaCl;
• "Disol";
• "Trisol".

Colloidal solutions are presented:

• dextran derivatives (polyglucin, rheopolyglucin)
• hydroethyl starch;
• gelatin.

The former help to quickly restore bcc, the volume of interstitial fluid and return the acid-base state to normal. The latter simulate plasma proteins, help increase the oncotic pressure of the blood, and retain the injected fluid in the bloodstream.

Also, do not forget about using a 25% albumin solution. When blood loss exceeds 15% of the blood volume, the use of plasma preparations, as well as tissue coagulation factors, is allowed. For severe blood loss of more than 30-40%, red blood cells and plasma are used. In the treatment of severe bleeding, the so-called “ blue blood" - the drug "Perftoran", which is an artificial blood substitute that has rheological, hemodynamic and other effects.

In the first hour, it is especially important to monitor the patient’s condition due to the occurrence of complications such as hemorrhagic shock, disseminated intravascular coagulation syndrome, acute renal failure. If hemorrhagic shock develops, the patient is managed according to the following algorithm:

• urgent search and stop of bleeding;
• use of adequate pain relief;
• catheterization central vein with the necessary infusion therapy;
• compensation for developing organ failure;
• staging urethral catheter to control urine output;
• continued elimination of BCC deficiency with the help of colloidal and crystalloid solutions;
• control of diuresis and blood pressure.

After the patient has been stabilized, iron supplements and vitamins B and C (which help this element to be better absorbed in the body) are used to treat posthemorrhagic anemia. You should also use preparations containing cobalt, manganese, and copper. These chemical elements have a beneficial effect on hematopoiesis and restoration of the number of red blood cells.

When treating chronic posthemorrhagic anemia, first of all, it is necessary to find out the cause of this pathology, since neither replenishment of blood volume nor iron supplements will help restore the body one hundred percent. After eliminating or compensating for the disease that caused anemia (in its pathogenesis it is iron deficiency), you should also use ferrum-containing drugs and B vitamins. Do not forget about nutrition. The patient's diet should include more foods containing iron and protein. These are cottage cheese, fish, egg whites, meat dishes.

Forecast

The prognosis of treatment and the consequences of posthemorrhagic anemia depend on the volume and rate of blood loss, as well as on the characteristics of the blood composition. Thus, a person can lose up to 60-70% of red blood cells and remain alive, but if only 30% of plasma is lost, death is likely. A loss of 50% of blood volume is fatal. A sharp decrease in circulating blood volume by a quarter leads to the development of acute anemia and hemorrhagic shock. This severe complication bleeding requiring emergency resuscitation.

At the same time, with chronic (iron deficiency) posthemorrhagic anemia, the prognosis is generally less serious, depending on the disease that caused it. Anemia itself can be compensated for with the use of iron and vitamin C supplements.

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

A loss large quantity blood needs replacement of iron-containing components in plasma. Otherwise, the situation is fraught with serious complications, including the death of the patient.

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

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

Processes in posthemorrhagic anemia

Decreased hemoglobin concentration and the presence oxygen starvation tissues are not the only manifestations of this type of anemia. Blood loss of more than 500 ml causes the following negative changes:

1. Insufficient amounts of components such as iron, potassium and magnesium in the body, which inevitably leads to a significant decrease in immunity.
2. A decrease in BCC (circulating blood volume) is accompanied by spasms and impaired vascular conductivity, and then by a disruption in heart rhythm and instability of blood pressure.
3. Kidney tissue, skin and muscular system lack blood supply.
4. As a result of hemorrhagic anemia, urine output is reduced.
5. Insufficient blood supply to the liver causes liver dysfunction.
6. Due to stagnant processes caused by slow blood flow, the body becomes acidified with waste products (acidosis), the presence of which is detrimental to the condition of the bone marrow.
7. Severe anemia provokes depletion of alkaline reserves, which inevitably leads to the inability to compensate for them.

Similar pathological processes cause the need to urgently correct the patient’s condition in order to avoid irreversible processes.

Causes

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

• mechanical injuries resulting in damage to large arteries;
• surgical operations that provoked a complication in the form of bleeding;
• stomach ulcer or duodenum;
• pathological changes in the liver, accompanied by venous bleeding;
• diseases genitourinary system and kidneys;
• chronic tuberculosis;
• heavy and prolonged menstruation, incorrect attachment fetus, difficult labor, cancer reproductive organs;
• haemorrhoids;
• oncological diseases gastrointestinal organs.

In adults, significant blood loss can also be caused by nosebleeds, dental procedures, tooth extraction.

Clinical picture

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

Among the most expressive signs it should be noted:

• pallor skin;
• feeling of weakness, difficulty breathing;
• ear congestion and noise;
• dryness of the mucous membranes of the nose and throat;
• chills, feeling of chilliness in the extremities;
• frequent but weakened pulse;
• decrease in blood pressure.

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

Possible consequences

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

• malnutrition of internal organs and tissues;
• dystrophic changes in the liver, heart muscle (myocardium) and other organs;
• violations related to the activities of the central nervous system;
• convulsions, loss of consciousness;
• critical decrease in blood pressure.

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

The symptoms of posthemorrhagic anemia are especially difficult for infants.

Classification

Clinical picture pathological condition gives grounds to distinguish two types of posthemorrhagic anemia.

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

Damage to arteries in the process surgical intervention also accompanied by anemic syndrome.

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

Important indicators

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

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

Identification of indicators below the last indicated indicates that the patient’s condition is extremely severe.

Stages of pathology development

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

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

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

Among the most expressive signs:

• dry and pale skin;
• swelling;
• dull hair, brittle nail plates;
• active sweating, indicating weakness;
• increased heart rate;
• borderline temperature (37 °C).

Lack of timely therapeutic activities to eliminate prolonged bleeding leads to depletion of the body’s compensatory forces, as a result of which the preconditions for hemorrhagic shock develop.

Diagnostic measures

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

The goals of examining the patient are to determine the nature of anemia and detect the tissue or organ that caused the bleeding.

The main diagnostic stages are as follows:

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

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

• examination of feces for the presence hidden blood And helminthic infestation;
• fibrogastroscopy;
• colonoscopy;
• sigmoidoscopy;

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

Treatment

Therapeutic course for acute course disease involves restoring the required amount of blood and normalizing all body systems. Treatment is carried out in a hospital.

To this end:

• artificial blood products are introduced - Gelatinol, Poliglyukin;
• at hemorrhagic shock significant doses of Prednisolone are prescribed;
• symptoms of acidosis are relieved using a soda solution;
• Heparin is used to prevent blood clots.

Direct blood transfusion is used in exceptional cases, because this procedure may lead to immune-based conflict.

Chronic anemia of this type is treated with iron supplements, unless there is an exacerbation of the disease that caused blood loss. In some cases, surgery is performed to eliminate it.

Medical nutrition

Prevention

During recovery period the body needs the support of immune forces. Therefore, doctors recommend eating foods rich in vitamins and essential microelements.

Beneficial influence on recovery processes provide medicinal extracts lemongrass, aloe and ginseng.

The chronic form of such a serious disease as posthemorrhagic anemia requires special attention patient to their health. Signs of exacerbation are a mandatory indication for immediate consultation with a doctor.

Forecasts with timely delivery professional help favorable and guarantee a successful outcome.

What can heartburn lead to, except sleepless nights and deterioration in health? This symptom is often underestimated by people. Hoping that this is just a temporary uncomfortable condition, a person will not go to the doctor for examination and begin treatment.

What complications are observed after diseases accompanied by heartburn? What is posthemorrhagic anemia and what causes it? Why does it happen with GERD?

Posthemorrhagic anemia - a consequence of GERD

Those unlucky enough to avoid this disease know that gastroesophageal reflux disease, or GERD, occurs due to weakness of the lower esophageal sphincter. The teres inferior muscle weakens over time for a number of reasons and begins to pass food from the stomach back into the esophagus. In the stomach the environment is acidic, in the esophagus, on the contrary, it is alkaline. Therefore, when gastric contents enter here, a person often feels heartburn. If the symptom of heartburn is even initial stages ignore - complications cannot be avoided. These include:

• Barrett's esophagus;
• strictures or narrowing of the esophagus;
• ulcers of the esophagus and, as a consequence, posthemorrhagic anemia.

Posthemorrhagic anemia is a decrease in the amount of hemoglobin in the blood due to bleeding, which developed as a complication of GERD. Anemia occurs after the appearance of ulcerative defects in the mucous membrane of the esophagus or the initial part of the stomach.

Causes of posthemorrhagic anemia

A complication of GERD, such as posthemorrhagic anemia, occurs in 2–7% of cases of all complications of gastroesophageal reflux disease. First of all, it is not bleeding that occurs, but ulcers that appear on the mucous membrane of the esophagus. The delicate mucous membrane is not accustomed to the acidic gastric contents with hydrochloric acid. Constant exposure to the latter leads to gradual trophic disorders. Nutrition and blood supply to the superficial mucous membrane deteriorate. If a person continues to ignore all the symptoms that accompany GERD, ulcers appear. Over time, if left untreated, they can reach the muscle layer, where the vessels are affected. Acute and chronic posthemorrhagic anemia occurs due to blood loss from these “naked” blood vessels.

What are the reasons for posthemorrhagic anemia?

In almost 15% of cases, perforation (breakthrough) of the esophageal wall into the mediastinal cavity occurs, and the entire contents of the esophagus through the resulting hole can leak into the mediastinum. chest. Besides food and gastric juice, blood flows out from the affected vessels there.

Symptoms of posthemorrhagic anemia

dry mouth

Acute posthemorrhagic anemia occurs due to severe massive bleeding, while a sharp decline the number of red blood cells and hemoglobin, but not immediately. How is GERD and its complications related to this? If due to the appearance of ulcers they are affected small vessels- bleeding will be minor, pronounced changes a person will not feel it right away. A large number of ulcerative lesions mucous membrane of the esophagus or when in painful process large vessels are involved - bleeding can be severe.

Acute posthemorrhagic anemia develops after the loss of a large amount of blood in a short period of time. In some cases, the person himself does not know about the presence of ulcers of the esophagus and the appearance of such a complication of GERD as bleeding.

Manifestations of the disease depend on the amount of blood lost. The presence of posthemorrhagic anemia is indicated following symptoms.

1. With large blood loss, a picture of collapse will develop: severe weakness, bleeding, pale skin, a feeling of dry mouth, possible vomiting, and the person breaks out in a cold sweat.
2. Posthemorrhagic iron deficiency anemia is characterized by the appearance rapid heartbeat, pronounced muscle weakness, dry skin and the appearance of cracks in the arms and legs, brittle nails. In this case, swelling under the eyes, weakness, constant headaches, nausea appear, appetite decreases, the person complains of a perversion of taste when eating chalk or clay brings pleasure.

In case of large blood loss, symptoms appear almost immediately. At chronic anemia all of the above symptoms will not occur simultaneously, but will develop depending on the amount of blood loss and the frequency of bleeding. In this case, the symptoms will be regular; in a blood test, changes in a person’s indicators are constantly noted, until the source of bleeding is detected.

Stages and degrees of posthemorrhagic anemia

Accurate diagnosis The disease is diagnosed after a full examination. A general blood test helps with this. Since posthemorrhagic anemia is a decrease in the level of red blood cells and hemoglobin in a certain volume of blood, these indicators are looked at first when studying.

The stages of posthemorrhagic anemia are as follows.

The degree of chronic posthemorrhagic anemia is determined by the amount of hemoglobin.

1. At mild degree the amount of hemoglobin in the blood ranges from 120 to 90 g/l.
2. Average degree is set at a hemoglobin content of 90–70 g/l.
3. A hemoglobin level of less than 70 g/l is severe anemia.

Diagnosis of the disease

There are three main types of anemia diagnosis:

• By clinical signs;
• laboratory diagnostics;
• instrumental methods research.

Each of them is important, because with their help you can detect the disease, the source of bleeding, and establish the stage.

Diagnosis of posthemorrhagic anemia is based on the following examinations.

1. Determination of the amount of hemoglobin and red blood cells in a general blood test. Additionally, depending on the stage of anemia, the analysis can detect young and atypical blood cells.
2. A person with suspected posthemorrhagic anemia must be referred for an FGDS or functional study primary department digestive system, thanks to which ulcers and the source of bleeding can be detected. But in rare cases, bleeding is not visible.
3. Biochemical study or blood test with mandatory determination of transferrin and ferritin, hemosiderin - important indicators changes in blood composition.
4. Not the least place in the diagnosis of posthemorrhagic anemia is the examination of a person and his complaints.

Treatment of posthemorrhagic anemia

In case of acute posthemorrhagic anemia or very low hemoglobin levels, treatment should be carried out only in a hospital. If necessary, anti-shock measures are carried out, bleeding is stopped, and blood transfusion is performed in case of massive blood loss.

Treatment of posthemorrhagic chronic anemia consists of prescribing a long course of:

• iron-containing preparations;
• vitamins C and group B (some complex medicines contain both iron and vitamins);
• prescribe a diet with optimal iron content in foods, preference is given to meat with vegetables (lean beef and pork, rabbit, pork and beef liver, veal, fish).

In conclusion, we repeat that posthemorrhagic anemia develops due to blood loss. If you start GERD and completely ignore the manifestations of this disease, such a complication is not far off. You can avoid it if you control it course of GERD and see a doctor annually.

Chronic posthemorrhagic anemia develops as a result of either a single, but heavy blood loss, or minor but prolonged repeated blood loss (Fig. 38).

Most often, chronic posthemorrhagic anemia is observed with bleeding from the gastrointestinal tract (ulcer, cancer, hemorrhoids), kidney, or uterine. Even occult blood loss during ulcerative or neoplastic processes in gastrointestinal tract or insignificant hemorrhoidal bleeding, repeated day after day, can lead to severe anemia.

Often the source of bleeding is so minor that it goes unrecognized. To imagine how small blood losses can contribute to the development of significant anemia, it is enough to cite the following data: the daily amount of dietary iron required to maintain hemoglobin balance in the body is about 5 mg for an adult. This amount of iron is contained in 10 ml of blood.

Consequently, the daily loss of 2-3 teaspoons of blood during defecation not only deprives the body of it daily requirement in iron, but over time leads to a significant depletion of the body’s “iron fund,” resulting in the development of severe iron deficiency anemia.

Other than that equal conditions The easier the development of anemia will be, the less iron reserves in the body and the greater (in total) blood loss.

Clinic. The complaints of patients are reduced mainly to severe weakness, frequent dizziness and usually correspond to the degree of anemia. Sometimes, however, one is struck by the discrepancy between subjective state the patient and his appearance.

The patient's appearance is very characteristic: severe pallor with a waxy tint to the skin, bloodless mucous membranes of the lips, conjunctiva, puffy face, lower limbs pasty, sometimes due to hydremia and hypoproteinemia, general edema (anasarca) develops. As a rule, patients with anemia are not malnourished, unless the malnutrition is caused by an underlying disease (stomach or intestinal cancer). Anemic heart murmurs are noted, most often a systolic murmur is heard at the apex, conducted at pulmonary artery; a “spinning top noise” is noted on the jugular veins.

Picture of blood. The blood picture is characterized by iron deficiency anemia with a sharp decrease in the color index (0.6-0.4); degenerative changes erythrocytes prevail over regenerative ones; hypocytochromia and microcytosis, poikilocytosis and schizocytosis of erythrocytes (Table 18); leukopenia (if there are no special factors contributing to the development of leukocytosis); shift of the neutrophil row to the left and relative lymphocytosis; The platelet count is normal or slightly decreased.

The next phase of the disease is characterized by a decline in the hematopoietic activity of the bone marrow - anemia takes on a hyporegenerative character. At the same time, along with the progressive development of anemia, an increase in the color index is observed, which approaches one; anisocytosis and anisochromia are observed in the blood: along with pale microcytes, more intensely colored macrocytes are found.

The blood serum of patients with chronic posthemorrhagic anemia is pale in color due to the reduced bilirubin content (which indicates reduced blood breakdown). A feature of chronic posthemorrhagic anemia is also a sharp decrease in the level serum iron, often determined only in the form of traces.

Bone marrow hematopoiesis. In acute cases, previously healthy individuals often experience a normal physiological reaction to blood loss with the production of first immature, polychromatophilic elements, and then mature, fully hemoglobinized red blood cells. In cases of repeated bleeding, leading to depletion of the body’s “iron fund,” a violation of erythropoiesis is noted in the phase of hemoglobinization of normoblasts. As a result, some of the cells die without having time to bloom, or enter the peripheral blood in the form of sharply hypochromic poikilocytes and microcytes. Subsequently, as anemia becomes chronic, the initial intensity of erythropoiesis decreases and is replaced by a picture of its inhibition. Morphologically, this is expressed in the fact that the processes of division and differentiation of erythronormoblasts are disrupted, as a result of which erythropoiesis takes on a macronormoblastic character.

Described functional disorders hematopoiesis is reversible, since we are talking about a hyporegenerative (not hypoplastic) state of the bone marrow (see Hyporegenerative anemia).

Treatment. In cases where this is possible, best method treatment is to remove the source of blood loss, such as excision hemorrhoids, resection of the stomach for a bleeding ulcer, extirpation of a fibromatous uterus, etc. However, a radical cure of the underlying disease is not always possible (for example, with inoperable gastric cancer).

To stimulate erythropoiesis, as well as replacement therapy it is necessary to perform repeated blood transfusions, preferably in the form of red blood cell transfusions. The dosage and frequency of blood (packed red blood cell) transfusions vary depending on individual conditions; they are mainly determined by the degree of anemia and the effectiveness of therapy. At moderate degree anemization, medium-dose transfusions are recommended: 200-250 ml of whole blood or 125-150 ml of red blood cells with an interval of 5-6 days.

In case of sudden anemia of the patient, blood transfusions are performed in a higher dosage: 400-500 ml of whole blood or 200-250 ml of red blood cells with an interval of 3-4 days.

The purpose of iron is very important. Iron treatment is carried out according to general rules treatment of iron deficiency anemia (see below).

Therapy with vitamin B12 for iron deficiency posthemorrhagic anemia is indicated for hyporegenerative forms occurring with the macronormoblastic type of erythropoiesis and macroplania of erythrocytes.

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 of the skin worsens, 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, the condition of his internal organs is determined using ultrasound 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.

In parallel, the patient is prescribed 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 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 mandatory 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.