Posthemorrhagic iron deficiency anemia. Posthemorrhagic anemia: signs of profuse blood loss and treatment options. Treatment of acute post-hemorrhagic anemia

What it is?

When a person in blood plasma, after obvious blood loss, is diagnosed with a lack of elements containing iron, then they talk about post-hemorrhagic anemia. Its other name, or rather a more general concept, is anemia - a decrease in the amount of hemoglobin in the blood, not tied to its loss.

Posthemorrhagic deficiency of iron-containing blood elements can be acute and chronic. If the patient suffers from frequent bleeding, even if in a small amount, this is a chronic form of anemia. If the loss of blood occurred suddenly, and in no small amount, we are talking about acute anemia. The minimum amount of life-threatening blood loss for adults is 500 ml.

The severity of anemia after blood loss

In total, four degrees of blood loss are distinguished - light, medium, severe and massive, consider the two most significant of them.

Easy

Treatment of a timely detected ailment is not particularly difficult. It is often enough to resort to taking medications that will compensate for the iron deficiency in the body and the patient will recover. As a rule, a course therapy is needed, which will take at least three months. The patient can be temporarily hospitalized.

Heavy

In case of severe anemia, the victim of the loss of a large volume of blood is immediately placed in a hospital of a medical institution. To take the patient out of a dangerous state, the following measures are taken:

stopping bleeding;
replenishment of blood loss by any means;
transfusion of an artificial plasma substitute in a volume of at least 500 milliliters;
measures to raise and stabilize blood pressure.

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Acute post-hemorrhagic anemia

With large blood loss, usually with damage to the main arteries, or during the operation, when the patient loses about 1/8 of the total blood volume, posthemorrhagic anemia develops in an acute form, which in turn has several stages.

In the reflex-vascular stage, the pressure of the arterial mucous membranes drops sharply, and the skin turns pale, tachycardia occurs. Peripheral vessels spasm due to lack of oxygen, which flows to the internal organs. The body, independently trying to prevent a decrease in pressure to critical values, uses the mechanisms of plasma removal from the organs and compensatory return of blood to the heart.
The patient can stay in the hydraemic compensatory stage for several days. Approximately five hours after the blood loss, a base will be created for the flow of interstitial fluid into the blood vessels. When irritated, the necessary receptors begin to be involved in maintaining the volume of fluid that circulates through the vessels. Aldosterone is intensively synthesized, preventing the excretion of sodium from the body, which in turn retains water. But at the same time, plasma liquefaction occurs, which leads to a decrease in the level of hemoglobin and erythrocytes.
Acute posthemorrhagic anemia passes into the bone marrow stage in about five days from the onset of bleeding. Progression of hypoxia is observed. Erythropoietin values become higher. The formation of red blood cells is increasing, but the hemoglobin values are reduced. This stage is characterized as hypochromic, due to a sharp deficiency of iron in the blood.

Chronic post-hemorrhagic anemia

This type of post-hemorrhagic anemia, after emergency assistance to the patient to restore the full volume of blood plasma and eliminate the lack of iron, requires treatment of the disease that caused the development of chronic blood loss.

Signs of anemia after bleeding

After blood loss, the development of anemia is manifested by the following symptoms:

When the loss of blood is large, the victim must have shortness of breath, the heartbeat increases, there is a sharp drop in pressure;
The integuments of the skin / mucous membranes turn pale;
The patient complains of dizziness. It makes a noise in his ears, but darkens in his eyes;
Vomiting is not uncommon;
A sudden sensation of dryness in the oral cavity indicates the development of internal bleeding;
With bleeding in the digestive organs, there is a sharp rise in body temperature, signs of intoxication;
One of the signs of bleeding inside will be the patient's message about the feeling of squeezing of the internal organs;
The feces become black.

Cause of post-hemorrhagic anemia

Posthemorrhagic anemia can develop due to blood loss in the following cases:

in case of injury with damage to an artery or other blood vessels;
with a disease of pulmonary ailments, when when a patient coughs blood comes out;
as a result of the operation;
with the onset of heavy bleeding in a woman due to an ectopic pregnancy;
with a peptic ulcer in the digestive tract, when internal bleeding develops;
when hemostasis is impaired.

Diagnosis based on a blood test

First of all, when a victim of bleeding is admitted to the hospital, it is necessary to conduct a study of his blood in the form of a detailed analysis, which will help to correctly diagnose the degree of anemia and assess the patient's condition. To do this, determine:

platelet count;
the level of hemoglobin and erythrocytes;
the presence of neutrophilic leukocytosis;
determination of the growth of the number of reticulocytes;
plasma iron levels.

Blood tests are necessary throughout the patient's recovery period. Depending on the form of anemia, the duration of rehabilitation is different.

Treatment

After providing urgent care, when the bleeding has stopped, the victim needs treatment in an inpatient department of a medical institution.

In order to replenish the patient's blood volume, in the event of a sharp drop in pressure, a blood substitute (jet) must be transfused. When the blood pressure values can be raised to 100 to 60, the transfusion can be switched to drip mode.

If the patient is in a state of shock, it may be necessary to administer humidified oxygen, an intravenous catheter for the infusion of blood substitutes, and a number of medications.

In some cases, when the volume of blood loss is more than one liter, donor blood transfusions are required, but this measure is contraindicated with a smaller amount of lost blood - it is fraught with complications in the form of an immune conflict or the development of intravascular coagulation syndrome.

Chronic posthemorrhagic anemia provides for outpatient treatment in cases where there are no exacerbations of the underlying ailment or there is none at all. The appointment of an operation after the cause of the bleeding is established is not excluded.

In the treatment of anemia, one cannot do without immunostimulants and complex vitamin preparations in order to support the patient's immune system, who, during the recovery period, is especially vulnerable to infection with pathogens.

Features of the treatment of posthemorrhagic anemia

In children

In order to reduce chronic blood loss in young patients, prevention of nasal bleeding is necessary. In adolescent girls, care must be taken to ensure that the menstrual cycle is correct.

In the presence of anemia in infants, it is necessary to check the state of health of his mother. You may need to start treatment with her.

Iron preparations have a children's form of release. As a rule, they are dosed, taking into account the baby's body weight.

Children are mainly prescribed medication by mouth. In the form of injections, babies receive treatment in a hospital, when there are any contraindications.

The duration of therapy for children is set according to the severity of the anemia:

easy - two months;
medium - up to four months;
with a severe course of the disease, treatment lasts at least five months.

In older people

It is very difficult to treat anemia in older patients due to:

the symptoms of anemia are often disguised as various diseases of a chronic nature;
in many cases, anemia in an elderly patient can be combined with acute / chronic infectious diseases;
neoplasms can be identified, the state of which is severely neglected;
a set of reasons for the development of anemia;
the risk of drug overdose.

For elderly patients, it is important:

organize a balanced diet;
carry out individual dosage of medicines and prescribe the optimal minimum dose;
diagnose and treat inflammatory diseases, tumors.

Prophylaxis

Preventive measures for the occurrence of anemia after blood loss are reduced to caution and a healthy lifestyle. Necessary:

monitor your health and treat diseases in a timely manner;
to refuse from bad habits;
avoid injury;
eat well.

Often, our lives are threatened by something completely different from what is in sight. Suspecting that we have some serious illness that everyone is hearing, we ignore, for example, stomach ulcers, which only occasionally cause us inconvenience. But such an inconspicuous wound can be much more dangerous than many eminent diseases. Losing blood drop by drop, undermining the health of its owner for many months and years, it provokes the appearance of unpredictable post-hemorrhagic anemia.

The danger of profuse blood loss

The total blood volume in an adult's body is 3.5 to 5 liters. Circulating throughout the body, it performs many functions:

distributes nutrients and oxygen;
removes decay products from tissues;
transports hormones from the glands to sensitive organs;
maintains a constant temperature and chemical composition of the body;
participates in the closure of wounds and subsequent tissue regeneration;
carries out immune responses to external threats.

In the event that the amount of fluid in the vessels falls by more than 10%, the victim clearly feels it. There is a weakening of the properties of blood listed above - and the more significant, the more serious the blood loss was. The transport function suffers first - the brain tissues begin to experience oxygen deprivation within a few seconds. The following symptoms are known collectively as posthemorrhagic anemia.

Types of posthemorrhagic anemia

Anemia from blood loss, or posthemorrhagic anemia, is a deficiency of red blood cells in the plasma resulting from profuse blood loss. In clinical practice, two forms of the disease are known: acute and chronic. The first develops with a single damage to the body, which provoked a rapid loss of a large volume of blood. The reasons for this condition can be:

The chronic course of anemia is possible with small but frequent blood loss, leading to a gradual decrease in the number of circulating red blood cells. The causes of the pathology coincide with those in an acute condition, but differ in less intensity of impact on the body.

One of the main reasons for the widespread prevalence of post-hemorrhagic anemia in the recent past was the fashion for bloodletting. According to the latest data, it was this procedure that hastened the death of Mozart. Having fallen ill in 1791, the composer was subjected to an innovative treatment at that time, as a result of which he lost about two liters of blood and died out in less than a month.

The mechanism of development and symptoms of the disease

Symptoms of post-hemorrhagic anemia vary significantly depending on the form of the disease, the severity of blood loss, and the characteristics of the victim's body.

Clinical picture in acute condition

From the first moments of heavy bleeding, the human body uses all resources to compensate for the losses that have arisen. The production of erythrocyte progenitor cells called erythroblasts is dramatically increased. The number of red corpuscles per unit volume of plasma remains constant, although in absolute terms their number is decreasing.

The walls of peripheral vessels quickly spasm, restricting blood flow to the skin and skeletal muscles. At the same time, the supply of nutrients to the central nervous system, heart and adrenal glands remains as long as possible.

The victim's pulse quickens.
Breathing becomes sharp and shallow.
The skin and mucous membranes turn pale.
There is a feeling of dizziness, weakness in the limbs, tinnitus, and nausea is likely.
Feces can be dark brown or red.

This phase of anemia, which combines the body's immediate reactions to blood loss, is called reflex. In duration, it takes up to 12 hours, after which it turns into compensatory, or hydraemic.

At this stage, the body extracts the maximum number of red blood cells from the depot, and the interstitial fluid begins to move into the vessels. The filtration properties of the kidneys are adjusted to retain water in the body, resulting in decreased urine production. Red cells are distributed in plasma, due to which the relative concentration of hemoglobin decreases sharply.

The next phase - bone marrow - occurs 4–5 days after the case of blood loss. By this time, erythroblast production and erythrocyte maturation reach their maximum values. Prolonged spasm of peripheral vessels can provoke adhesion of cells in small capillaries, due to which they become clogged. Large blood clots can cause tissue and organ death.

Signs of a chronic form

The symptomatology of chronic post-hemorrhagic anemia demonstrates milder manifestations than in the case of an acute course:

skin manifestations:
- pallor;
- slight swelling;
- dryness;
- roughness;
hair defects:
- fragility;
- dropping out;
tachycardia;
lowering blood pressure;
general symptoms:
- dizziness;
- weakness;
- decreased appetite;
- noise in ears.

Features of posthemorrhagic anemia in children

Children are more prone to manifestations of acute post-hemorrhagic anemia than chronic. The reason for this is obvious - even small blood loss by the standards of an adult organism becomes an ordeal for the fragile body of a child.

Alarming symptoms in this case are:

pallor of the skin;
smoothness of the tongue;
growth retardation;
change in behavior (lethargy or tearfulness);
brittle hair;
violation of taste preferences - a tendency to eat clay and chalk;
general weakness;
weight loss.

A child's body weakened by trauma becomes sensitive to infectious diseases, so anemia can lead to the development of angina, laryngitis, otitis media ,.

Stages (degrees) of the disease: mild, medium, severe

Depending on the intensity of blood loss, there are several stages, or degrees of severity, of post-hemorrhagic anemia.

Determining the severity of the disease plays a critical role in planning further treatment. For example, mild anemia may not require drug therapy, while severe anemia is an absolute indication for immediate hospitalization of the victim.

Stages of posthemorrhagic anemia - table

Degree / Stage	Content, gram / l.	Pulse rate, beats / min.	Systolic (upper) blood pressure, mm Hg
Easy	90 and above	Up to 80	Above 110
Average	70–90	80–100	90–110
Heavy	Less than 70	Over 100	Below 90

Diagnostics

An obligatory primary stage of diagnosis is an external examination of the patient, which allows:

determine the place of damage in case of superficial injury to the body;
assess the general condition of the victim in relation to the severity of blood loss;
learn about the patient's predisposition to bleeding of a certain type (gastric, intestinal, pulmonary, etc.).

Proctological or gynecological examination is carried out with suspicion of injury to the lower digestive system and female reproductive organs. The analysis of feces and urine can detect damage to the gastrointestinal tract and genitourinary system. The most commonly used are benzidine (Gregersen) and guaiac (Weber) samples. The reagents used in them change color upon contact with free hemoglobin.

The use of the 59 Fe isotope in radioimmunoassay makes it possible to describe the distribution of red blood cells, their integrity and activity.

A blood test for acute post-hemorrhagic anemia demonstrates very characteristic results:

During the first hour after the onset of the condition, the number of platelets increases sharply, after three hours - of leukocytes.
Following this, the level of red blood cells falls.
Recovery of primary indicators takes at least several weeks.

For internal bleeding, radiography, magnetic resonance imaging (MRI) and computed tomography (CT), ultrasound diagnostics are widely used. With their help, it is possible to accurately localize the damage to the hollow organs.

These techniques make it possible to differentiate post-hemorrhagic anemia with similar conditions.

Differential diagnosis - table

Pathology name	Difference from post-hemorrhagic anemia	Diagnostic methods
Autoimmune hemolytic anemia	characteristic antibodies are present in the blood; the integument is icteric; the spleen is enlarged.	blood test;
Hypochromic anemia	normal and altered red blood cells are present; mutant cells are rapidly destroyed in the presence of sugar; signs are frequent.	blood test, radioimmunoassay; microscopy.
Megaloblastic anemia	erythrocytes are enlarged, have inclusions; B vitamins are in short supply; the level of bilirubin is increased; the hemoglobin level is normal; the skin is icteric.	visual inspection; blood test; microscopy.
Microspherocytic hemolytic anemia	erythrocytes are spherical	blood test; microscopy.
Partial red cell anemia	antibodies to erythrocyte precursors are present in the blood; red bone marrow is losing cells.	blood test; puncture of the red bone marrow.
Thalassemia	hemoglobin in erythrocytes forms rings; various precursors of the red blood pigment accumulate.	blood test

Treatment

The main task in the treatment of post-hemorrhagic anemia is to stop the bleeding that provoked it. Follow-up measures are aimed at replenishing the loss of red blood cells, fluid, nutrients.

Acute therapy

Significant blood loss (more than 1 liter) should be compensated for by transfusion of erythrocyte mass with plasma substitutes, but not more than 60% of the lost volume. Exceeding this indicator can provoke intravascular coagulation. It is better to make up the difference with blood substitutes - solutions of albumin, dextran, sodium chloride, gelatinol, rheopolyglucin, Ringer-Locke's composition. Lactasol can be used to restore pH values.

After the removal of the acute condition, measures are taken to improve the synthesis of hemoglobin. Therapy at this stage coincides with the treatment of the chronic form.

Chronic therapy

To replenish the amount of lost iron (in iron deficiency states), its preparations containing metal in a bivalent form are used. These tools include:

Maltofer;
Sorbifer;
Feramide;
Ferrocal;
Ferroplex;
Ferrocene.

Multivitamin complexes, which include vitamins B, C, E, help to increase metabolism.

Anemia treatment - video

Diet for posthemorrhagic anemia

apricots;
grenades;
mushrooms;
strawberries;
lean meat;
peaches;
liver;
a fish;
cottage cheese;
blueberry;
apples;
eggs.

Posthemorrhagic anemia is a lack of iron-containing elements in the human blood plasma. Anemia due to blood loss is one of the most common anemias. Doctors distinguish between two forms of this disease: chronic and acute.

Post-hemorrhagic anemia of a chronic nature occurs after small, but, for some time, frequent bleeding. The acute form of this disease arises as a result of a sudden, profuse blood loss.

The minimum amount of blood loss in an adult, dangerous for human life, is 500 ml.

According to the International Classification of Diseases of the 10th revision, posthemorrhagic anemia belongs to the category "Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism." Subsection: "Anemias associated with nutrition. Iron deficiency anemia." The classification of diseases with codes is as follows:

Iron deficiency anemia secondary to blood loss (chronic) - code D50.0.
Acute posthemorrhagic anemia - code D62.
Congenital anemia due to fetal blood loss - code P61.3

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ICD-10 code

D62 Acute posthemorrhagic anemia

D50.0 Iron deficiency anemia secondary to blood loss chronic

Causes of posthemorrhagic anemia

The etiology of a lack of blood in the body can be:

Trauma, as a result of which there was a violation of the integrity of the vessels and, above all, of the large arteries.
Surgical intervention. Any surgical intervention is always a risk. Getting down to even a seemingly ordinary man in the street, the simplest operation, the surgeon is not able to foresee all its nuances and consequences.
Duodenal and gastric ulcer. These diseases are often accompanied by internal bleeding. And the complexity of their timely detection lies in the fact that bleeding occurs inside the body and externally it can be recognized by an amateur by some signs and call an ambulance in time. Otherwise, the delay can result in a lethal outcome for the patient.
Violation of hemostasis. This factor is designed to maintain the blood in a liquid state, being responsible for the blood coagulability index, which makes it possible to maintain the circulating blood volumes within the normal range and normalize the composition ("formula") of the blood.
Ectopic pregnancy. This pathology is accompanied in women by acute profuse bleeding, which leads to acute post-hemorrhagic anemia.
Pulmonary diseases. Such bleeding is manifested by a scarlet discharge of a liquid or clot-like consistency that occurs during coughing.

Pathogenesis

The pathogenesis, or the sequence of the emerging phenomena, is the phenomenon of vascular insufficiency, due to a sharp emptying of the bloodstream from the blood (plasma) of the vascular bed. These factors lead to a lack of red blood cells that carry oxygen, which, in turn, leads to a general oxygen starvation of the body. The body cannot replenish this loss on its own, due to the more active work of the heart.

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Symptoms of post-hemorrhagic anemia

Knowledge will not harm anyone. And in order to be able to recognize bleeding (especially if it is internal), it is necessary to know the symptoms of post-hemorrhagic anemia and its manifestations in order to provide first aid or call an ambulance on time.

With profuse blood loss, vascular manifestations come first: shortness of breath, palpitations (tachycardia), pressure indicators (both arterial and venous) fall.
The patient's skin and mucous membranes become pale.
The patient begins to feel darkening in the eyes, tinnitus and light dizziness.
A gag reflex may appear.
Acute dry mouth can be considered an acute sign of internal bleeding. The severity of the clinic is determined not only by the total amount of sweat, but also by the rate at which the victim loses blood.
The place of injury is also an important factor. So lesions of the gastrointestinal tract are accompanied by a sharp increase in body temperature.
Obvious manifestations of intoxication.
Increases its indicators and the level of residual nitrogen in the plasma (while the urea indicator remains normal).
Even with small volumes of internal bleeding, the patient feels compression of the organs.
Fecal discharge can also be an indicator of internal damage. Due to the withdrawn blood, they turn black.

Acute post-hemorrhagic anemia

If a person loses an eighth of the total volume of working blood due to trauma (the consequence of which is damage to a large artery), an operation being performed or an exacerbation of any disease, an acute form of post-hemorrhagic anemia occurs.

Doctors distinguish several stages in the development of an acute form of anemia:

Reflex-vascular stage. It is expressed by a sharp decrease in the value of blood pressure, blanching of the skin and mucous membranes, tachycardia. A sudden lack of oxygen to the organs leads to peripheral vascular spasms. To prevent a further drop in pressure, the body opens arterio-venular shunts, which lead to the withdrawal of plasma from the organs. This therapy itself works for an adequately compensatory return of blood fluid to the heart.
Hydraemic stage. After three to five hours, the basis for hydraemic compensation is created, due to the flow of fluid from the interstitial region into the blood vessels. In this case, irritation of certain receptors occurs, which are included in the work to maintain the volume of fluid circulating through the vessels. The increased synthesis of aldosterone blocks the excretion of sodium from the body, which stimulates water retention. However, this also leads to plasma dilution, and as a consequence, a decrease in the content of erythrocytes and hemoglobin. This stage of compensation can take place within two to three days.
Bone marrow stage - this stage occurs four to five days after the bleeding. Hypoxia progresses. The indicators of erythropoietin are growing. In the peripheral blood, the number of newly formed erythrocytes (reticulocytes) with a reduced hemoglobin amount increases. The characteristic of this stage becomes hypochromic. In addition, a sharp shortage of blood causes a decrease in iron in the blood.

Chronic post-hemorrhagic anemia

This type of anemia, chronic post-hemorrhagic anemia, occurs in a patient if he gradually, over a period of time, loses blood fractionally. This type of anemia can be observed in a number of diseases. For example, such as: bowel cancer, peptic ulcer of the duodenum or stomach, gingivitis, hemorrhoids, and many others. Frequent, but minor bleeding leads to a general depletion of the body. Iron deficiency occurs. In this regard, this pathology by etiology is referred to as post-hemorrhagic anemia; by pathogenesis, this pathological condition can be attributed to iron deficiency anemia.

Proceeding from this, the main goal of therapy for posthemorrhagic anemia, in any of its form, is to restore the full volume of blood plasma circulating in the vessels, as well as, as a consequence, to overcome iron deficiency and lack of erythropoiesis. But this is an "ambulance" for the body. After emergency resuscitation, you need to turn your attention to the root cause that prompted the bleeding. And easier - it is necessary to proceed to the treatment of the underlying disease.

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Posthemorrhagic iron deficiency anemia

Today, doctors state that post-hemorrhagic iron deficiency anemia is beginning to become widespread. In short, iron deficiency anemia is a condition of the body characterized by a pathological lack of iron ions. Moreover, the mass concentration of this element decreases everywhere: in the blood plasma, and in the bone marrow, and in the so-called storehouse, where the body accumulates everything it needs in reserve. As a result, a failure occurs in the system of heme synthesis, a deficiency in myoglobin and tissue enzyme is formed.

Modern statistical studies have voiced the figure of 50% - this is the number of the population that, in one form or another, suffer from anemia. Compounds in which metals are found in nature are poorly absorbed, or not absorbed at all by the human body. If the balance in the supply of iron to the body and its use is imbalanced, we get iron deficiency anemia.

Most often, in the adult population, iron deficiency is associated with acute or chronic blood loss. This diagnosis can occur, albeit quite rarely, with nosebleeds, dental aspects of blood loss, as well as with trauma ... Exceptional cases have been identified when a donor's anemia developed, who “often with bloodsuckers”. Moreover, oddly enough it sounds, such deviations are found in female donors.

In women, the causes of the disease can be both uterine bleeding and pregnancy itself, as well as painful, pathological disruptions in the menstrual cycle. Laboratory studies show that uterine fibroids can also lead to post-hemorrhagic anemia with iron deficiency, which contributes to the leaching of iron and the subsequent appearance of anemic symptoms.

The second place in terms of the incidence of diseases is occupied by blood loss in acute diseases of the gastrointestinal tract, which is rather problematic to diagnose in the early stages. Pulmonary hemorrhage is a rather rare manifestation of iron deficiency, as is blood loss from the urinary tract and kidneys.

Newborns and babies can suffer from iron deficiency due to abnormal placenta previa or damage during surgery (caesarean section). And also there are cases of intestinal bleeding, as a manifestation of an infectious disease.

The reason for the lack of iron for older children may be the scarcity of the diet. The kid simply does not get enough of the element along with the foods that he eats. Also, the cause of anemia can be a lack of iron in the mother during her pregnancy, as well as in premature babies or babies from twins, triplets ... cut the umbilical cord early.

You should not bypass the situation when (for example, with great physical exertion, pregnancy, etc.) the body's need for it sharply increases. Therefore, the likelihood of post-hemorrhagic iron deficiency anemia increases.

The lack of this element in the body causes significant harm to the human immune system. But, oddly enough it sounds, patients suffering from iron deficiency suffer less infectious diseases. It's simple. Iron is an excellent breeding ground for some bacteria. However, in light of other problems, the lack of iron in the human body cannot be ignored. It is not uncommon for changes in dietary habits to indicate a lack of iron in the blood. For example, there is a previously not observed craving for peppery or salty foods.

Doctors also identify the psychological aspect of iron deficiency. Often it occurs in people who do not care about their health, and, therefore, about themselves: diets, limited nutrition, physical inactivity, lack of fresh air, a minimum of positive emotions. All this does not contribute, but inhibits those metabolic processes that go on in the body. After conducting a study, scientists have established that deep depression, psychological trauma, is usually behind all this.

Today, medicine is equipped with a fairly large arsenal in the form of iron preparations: conferon, feramide, jectofer, sorbifer and many others. There are also liquid forms, for example, maltofer, the degree of absorption, which depends on the level of iron deficiency in the body. This drug is approved for use even for newborns (even premature babies).

Posthemorrhagic anemia in children

Posthemorrhagic anemia in children occurs quite often and happens, as in adults, both acute (quite common) and chronic (less common).

Newborns are quite vulnerable. They have post-hemorrhagic anemia quite often during birth trauma or may occur even with excessive blood sampling during laboratory tests. In older and middle-aged children, the main cause of anemia is often helminths, which, sticking to the wall of the gastrointestinal tract, injure the body and provoke microbleeding.

Symptoms on the basis of which parents should raise the alarm:

Same as for adults.
But the first manifestations are lethargy, a decrease in appetite, there is a suspension in growth, and the baby begins to gain weight worse.
One of the primary signs of the initial stage of the disease may be a change in the taste preferences of the baby, up to the fact that children tend to eat earth, chalk, clay ... This is the result of iron deficiency and a lack of mineral components in the baby's body. Sometimes these changes are not as drastic.
There is a change in behavior too. Babies become capricious and whiny, or, in contrast, apathetic.
There is also a manifestation according to external signs: fragility of hair and marigolds, peeling of the skin.
"Lacquered" smooth tongue.
In adolescent girls, menstrual irregularities are interrupted.
Quite often, against the background of post-hemorrhagic anemia, complications of an infectious nature are observed: otitis media, pneumonia ...

The first thing that needs to be done in a situation where a child is in a state of hemorrhagic shock is resuscitation measures to stop bleeding and anti-shock therapy. Blood-substituting drugs are injected by jet and drip. During this period, the baby's blood group and its Rh affiliation are established. Resuscitation is performed with fresh citrate blood. If this is not available, a direct transfusion from the donor is performed. Parallel to this, glycosides of the cardiovascular system are being supported and a diet rich in protein and vitamins is assigned.

Treatment of posthemorrhagic anemia in children is reduced to identifying and treating the root cause of bleeding, that is, the disease that caused blood loss.

Stages

Doctors also have a so-called working classification of the stages of severity of anemia, which is determined on the basis of laboratory tests:

with a hemoglobin content in the blood of more than 100 g / l and erythrocytes above 3 t / l - an easy stage.
with a hemoglobin content in the blood within 100 ÷ 66 g / l and erythrocytes above 3 ÷ 2 t / l - the middle stage.
with a hemoglobin content in the blood less than 66 g / l - a severe stage.

Mild posthemorrhagic anemia

Earlier detection of the disease allows you to put the child on his feet in a shorter period of time. With a mild stage of the disease, sometimes there are enough iron-containing preparations to replenish the lack of iron in the body. The course of treatment often lasts three months or more. In this case, temporary hospitalization of the patient is possible. This issue is decided by the doctor, based on the patient's condition.

Severe posthemorrhagic anemia

Severe posthemorrhagic anemia is an unconditional hospitalization.

Only in inpatient conditions can a patient receive qualified and full medical care and there is no need to hesitate with this. In this situation, "procrastination is like death."

Having received the patient at their disposal, the doctors, first of all, must do everything to stop the bleeding, while simultaneously trying to make up for the blood loss by any means. To obtain the maximum hemodynamic effect (removing the patient from shock, obtaining higher blood pressure, etc.), at least half a liter of polyglucin (artificial plasma substitute) is transfused. In acute traumatic form, this drug is administered primarily by jet, while the doctor is obliged to control the blood pressure figure. If the pressure was brought to values: systolic - 100 ÷ 110 mm, diastolic - 50 ÷ 60 mm, the dropper is transferred from the jet to the drip feed. The total dose of the injected solution can reach, if necessary, one and a half liters (maximum 2 ÷ 3 liters).

Only after stopping the bleeding and removing the main shock symptoms, the medical staff transgresses to a further, planned protocol for removing the patient from the anemic state.

Diagnostics of the post-hemorrhagic anemia

Modern medicine cannot be imagined without laboratories and modern medical equipment. But do not be highly professional specialists, no equipment will help. And in the case of the diagnosis of post-hemorrhagic anemia, the situation is as follows: the diagnosis of acute or chronic post-hemorrhagic anemia can be made on the basis of a combination of clinical, laboratory and anamnestic data. Baseline is clinical indicators.

Having an external source of bleeding, it is not difficult to make a clear diagnosis; it is more difficult to diagnose it with internal blood loss. The main thing is to accurately determine the place of expiration.

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Blood test for post-hemorrhagic anemia

The first thing that doctors need to do is to urgently do a detailed blood test so that they can assess the level of blood loss and, accordingly, the danger to the patient. During the first half hour with acute blood loss, the number of platelets increases sharply, which leads to a reduction in the time interval for blood clotting, which is quite important in case of blood loss. The level of erythrocytes and hemoglobin in plasma remains within the normal range for some time, although their total number (erythrocytes) decreases.

Two to three hours later, thrombocytosis in the blood is still observed, but the tests show the emerging neutrophilic leukocytosis. A high level of thrombocytosis and a small interval for which blood clotting is a criterion showing profuse blood loss. Further, there is a decrease in the number of red blood cells and the hemoglobin index. This is an indicator of the development of normochromic posthemorrhagic anemia.

After five to six days from the critical moment, there is an increase in the number of reticulocytes (the formation of young leukocytes). If during this period no repeated bleeding is observed, then after a couple of weeks, the composition of the peripheral blood is normalized, which is what the analyzes show. If post-hemorrhagic anemia was observed in severe form, then the recovery period will be longer.

Even in the case of a single acute bleeding, biochemical analysis shows a sharp drop in plasma iron levels. With small reserves of this element in the body itself, its quantitative recovery is rather slow. During this period, the active appearance of new erythrocytes in the red bone marrow is also visible.

Clinical analysis during the period of illness shows the presence of leukopenia with slight lymphocytosis. Due to the low level of iron, there is an increase in the ability to bind serum iron.

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Treatment of posthemorrhagic anemia

If a mild form of post-hemorrhagic anemia can be treated at home, then its acute manifestations must be stopped only in stationary conditions. The main goal of all the measures taken is to stop blood loss and restore the normative, in full, blood circulation.

The first stage of treatment is to stop bleeding. A drop in hemoglobin levels to 80 g / l and below (8 g%), plasma hematocrit - below 25%, and protein - less than 50 g / l (5 g%), is an indication for transfusion therapy. During this period, it is necessary to replenish at least a third and the content of erythrocytes. It is urgent to replenish the normal plasma volume. In this regard, the patient receives colloidal solutions of polyglucin or gelatinol by transfusion. If such solutions are not available, they can be replaced with 1000 ml of glucose (10%), and then 500 ml - 5% solution. Rheopolyglucin (and analogs) are not used in this situation, as they reduce the blood coagulation capacity, which can provoke repeated bleeding.

To restore the level of red blood cells, the patient receives red blood cells. In case of acute blood loss, when the number of platelets also falls, doctors resort to direct transfusion or to transfusion of blood taken immediately before the procedure.

Today, if the blood loss during the operation is less than 1 liter, the red blood cell mass and transfusion are not used. Full compensation for blood loss is not carried out either, since the danger lies in the possibility of disseminated intravascular coagulation syndrome, as well as immune conflict.

Most often, bivalent iron is used in medicine. Medicines based on it are taken by the patient as prescribed by the doctor, either 1 hour before eating, or 2 hours after eating. In the treatment of post-hemorrhagic anemia, the following iron-containing preparations are used:

Feramide is a drug based on a combination of nicotinamide and ferric chloride. Reception is carried out three times a day, 3-4 tablets. The disadvantage of this drug is the low iron content in the tablet. To obtain the maximum effect, along with the medicine, you need to take ascorbic acid.
Conferon is a complex content of sodium dioctyl sulfosuccinate with iron sulfate. Release form - capsules. This drug is well absorbed by the intestinal mucosa. Take it 3 times a day, 1 ÷ 2 capsules. Additional intake of ascorbic acid is not required.
Ferrocal. Composition - iron sulfate with calcium fructose diphosphate. It is prescribed after meals 1 ÷ 2 tablets three times a day.
Ferroplex is a combination of ferrous sulfate with ascorbic acid. Reception is 2 ÷ 3 tablets three times a day. Tolerance and absorption properties of the drug are excellent.
Ferrocerone. The basis of the preparation is the sodium salt of ortho-carboxybenzoylferrocene. The medicine is perfectly absorbed by the mucous membrane of the gastrointestinal tract. It is taken three times a day, 1 ÷ 2 tablets. Easy to carry. Together with this medicine, hydrochloric and ascorbic acids cannot be introduced into the body. It is strictly necessary to remove lemons and other sour foods from food.

Other drugs are also used.

Nutrition in the treatment of post-hemorrhagic anemia plays an important role. An anemic patient should include in his diet foods that contain a large amount of iron and protein. This is meat, and egg white, and fish, cottage cheese ... At the same time, remove fatty foods from your diet.

Prophylaxis

Prevention of post-hemorrhagic anemia must be started yet, no less, in the womb. If the mother of the unborn child suffers from iron deficiency, the newborn will be born with the same problem. Therefore, it is primarily necessary to eliminate this problem in a pregnant woman. Then, the already born child should receive natural, rational and natural feeding. It is essential that the baby is surrounded by a normal healthy environment. We also need constant monitoring by a pediatrician so as not to miss the development of rickets, infectious diseases and dystrophy.

A special risk group for iron deficiency can be attributed to children born to anemic mothers, premature babies and babies from multiple pregnancies, as well as babies taking artificial, irrational feeding, growing rapidly. The pediatrician usually ascribes iron supplements to such children, or milk formulas containing an increased percentage of this element.

For children of the first year of life, as a prophylaxis of post-hemorrhagic anemia, it is necessary to introduce vegetables and fruits, cereals and herbs, meat and fish, milk and cheeses into the diet. That is, to diversify food. To maintain the content of auxiliary elements (copper, manganese, cobalt, zinc) within the normal range, it is necessary to give the baby beets, yolk and fruits (apples, peaches, apricots). And also the child is obliged to receive the required amount of fresh air - walks in the fresh air are required. Protect children from contact with harmful chemicals, especially volatile substances. Medicines should be used only as directed by a doctor and under his supervision.

Prevention of anemia for an adult is akin to child's. These are the same foodstuffs rich in iron and trace elements, as well as an active correct lifestyle, fresh air.

In childhood, the use of iron preparations is prophylactic, not only prevents the development of iron deficiency in a child, but also reduces the incidence of his ARVI. With aggravated hereditary anemia, the medical prognosis directly depends on the frequency of crises and their severity.

In any situation, one should not give up and it is preferable to recognize any disease as soon as possible, at its earlier stages. Be more attentive to yourself and your loved ones. Preventive measures for post-hemorrhagic anemia are not as difficult as it might seem. Just live, eating well, actively spending your time in nature with family and friends, and this trouble will bypass you. But if the irreparable has already happened, and trouble has come to the house, do not panic, call the doctors and fight with them. After all, life is beautiful and worth the struggle.

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Posthemorrhagic anemia is a set of pathological changes that develop in the body due to the loss of a certain amount of blood: it contains iron, and with blood loss it becomes insufficient. It is divided into two types: acute and chronic.

ICD-10 code

Chronic posthemorrhagic anemia has the following ICD-10 code - D50.0, and acute - D62. These disorders are found under Nutritional Anemias. Iron-deficiency anemia".

Latin defines the word "anemia" as "bloodless", literally speaking. Also, the word can be translated as "anemia", which means a lack of hemoglobin. And "hemorrhagic" translates as "accompanied by bleeding", the prefix "post" means "after."

Information about what post-hemorrhagic anemia is will allow to detect its development in time and provide the necessary assistance.

Pathogenesis in posthemorrhagic anemia

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

The severity of posthemorrhagic anemia is determined by the content of hemoglobin and the severity of tissue hypoxia due to its deficiency, but the symptoms of anemia and its features are associated not only with this indicator, but also with others that decrease with blood loss:

Iron content;
Potassium;
Magnesium;
Copper.

Iron deficiency affects the circulatory system especially negatively, in which the production of new blood elements is difficult.

The minimum volume of blood that can be lost without the risk of developing serious disorders is 500 ml.

Donors donate blood without exceeding this amount. A healthy human body with sufficient body weight over time completely restores the lost elements.

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

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

What color can the venous blood be read?

Read the heart muscle consists

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

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

Formation of an arteriovenous shunt that prevents blood from reaching the capillaries

This system exists to support blood flow in the brain and heart, which allows them to continue to function even with severe blood loss.

The interstitial fluid quickly compensates for the lack of plasma (liquid part of the blood), but microcirculation disorders persist. If the blood pressure drops too much, the speed of blood flow in the small vessels will decrease, leading to thrombosis.

In the severe stage of post-hemorrhagic anemia, small blood clots form, which clog small vessels, which leads to a malfunction of the arterial glomeruli in the kidney tissue: they do not filter fluid properly, and the amount of urine excreted decreases, and harmful substances are retained in the body.

It also weakens blood circulation in the liver. If you do not start timely treatment of acute post-hemorrhagic anemia, this will lead to liver failure.

In post-hemorrhagic anemia, the liver suffers from a lack of blood

Oxygen deficiency in the tissues leads to the accumulation of under-oxidized elements that poison the brain.

Acidosis develops: a violation of the acid-base balance towards the predominance of an acidic environment. If post-hemorrhagic anemia is severe, the amount of alkali decreases, and the symptoms of acidosis increase.

With blood loss, the level of platelets decreases, but this does not significantly affect the coagulation processes: the content of other substances that affect coagulation reflexively increases.

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

Causes

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

Acute post-hemorrhagic anemia

This is a disorder that develops rapidly due to profuse blood loss. This is a dangerous condition that requires a quick start of treatment.

Causes of acute anemia:

Chronic post-hemorrhagic anemia

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

The causes of chronic anemia:

Also, hemorrhagic anemia develops due to vitamin C deficiency.

Views

Posthemorrhagic anemia is divided not only by the nature of the course (acute or chronic), but also by other criteria.

The severity of anemia is assessed by the amount of hemoglobin in the blood.

Depending on its content, anemia is divided into:

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

There are also certain pathologies included in the ICD:

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

Symptoms

Acute anemia

Symptoms in the acute form of post-hemorrhagic anemia grow very quickly and depend on the severity of blood loss.

Observed:

A decrease in blood pressure against a background of massive blood loss is called hemorrhagic shock. The intensity of the drop in blood pressure depends on the severity of blood loss.

The following symptoms are also present:

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

Symptoms of post-hemorrhagic anemia and hemorrhagic shock are joined by signs that are inherent in the disease that caused the blood loss:

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

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

Stages of acute posthemorrhagic syndrome

Acute post-hemorrhagic syndrome has three stages of development.

Name	Description
Reflex-vascular stage	The level of plasma and erythrocyte mass falls, compensatory processes are activated, the pressure drops, the heartbeat is rapid.
Hydremia stage	It develops several hours after blood loss and lasts from 2 to 3 days. The intercellular fluid restores the volume of fluid in the vessels. The content of red blood cells and hemoglobin decreases.
Bone marrow stage	It develops 4-5 days after blood loss due to oxygen deprivation. In the blood, the level of hematopoietin and reticulocytes, the precursor cells of erythrocytes, increases. The amount of iron in the plasma is reduced.

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

Signs of a chronic form

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

Observed:

People with post-hemorrhagic anemia have low immunity and often develop infectious diseases.

Diagnostics

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

Laboratory diagnostics of post-hemorrhagic anemia is carried out repeatedly, and the results vary depending on the stage and severity of the disorder.

Laboratory signs of acute anemia:

In the first two hours, the concentration of platelets rises, and erythrocytes and hemoglobin are kept at a normal level;
After 2-4 hours, the excess of platelets remains, neutrophilic granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, according to the color index, anemia is defined as normochromic (the value is normal);
After 5 days, there is an increase in reticulocytes, the level of iron is insufficient.

What tests do I need to take?

It is necessary to pass a general blood test, in case of chronic anemia, it reveals the content of elliptocytes, lymphocytes are increased in the peripheral blood, but reduced in the total cellular composition.

Deficiency of iron, calcium, copper is revealed. The manganese content is high.

In parallel, analyzes are carried out that allow you to determine the cause of bleeding: fecal examination for helminthiasis and occult blood, colonoscopy, urine analysis, bone marrow examination, ultrasound examination, esophagogastroduodenoscopy, electrocardiogram.

Who to contact?

Hematologist

Treatment

Acute hemorrhagic anemias in the first stage of treatment require elimination of the cause of blood loss and restoration of normal blood volume.

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

Artificial blood substitutes. They are poured in by drip or jet, depending on the patient's condition;
With the development of shock, the use of steroids (Prednisolone) is indicated;
Soda solution eliminates acidosis;
Anticoagulants are used to eliminate blood clots in small vessels.
If the blood loss exceeds a liter, a donor blood transfusion is required.

Treatment of chronic anemia, not aggravated by serious illnesses, takes place on an outpatient basis. Shown nutritional correction with the addition of foods that contain iron, vitamins B9, B12 and C.

In parallel, the treatment of the underlying disease, which caused pathological changes, is carried out.

Forecast

If, after extensive blood loss, the patient quickly arrived at the hospital and received the full range of medical procedures aimed at restoring blood levels and eliminating bleeding, then the prognosis is favorable, unless the blood loss is extremely pronounced.

The chronic type of pathology is successfully eliminated by curing the disease that caused it. The prognosis depends on the severity of concomitant diseases and the degree of neglect of anemia. The sooner the cause is identified and treatment is started, the greater the chances of a favorable outcome.

Video: Anemia. How is anemia treated?

As is already known, post-hemorrhagic anemia occurs in the human body due to blood loss. Moreover, it will not necessarily be abundant. It is important to understand that even minor bleeding, but occurring frequently, can become seriously dangerous for the patient.

Posthemorrhagic anemia: ICD-10 code

Distribution of diseases according to this classification (regarding the acute course of the disease) - D62. This classification also indicates that the cause of the disease is considered to be blood loss of any nature.

Posthemorrhagic anemia: severity

The severity of this type of anemia also depends on the hemoglobin value. The first degree of severity is characterized by a hemoglobin content of more than 100 grams per liter of blood and erythrocytes above 3 t / l. If the level of hemoglobin in the blood reaches 66 - 100 g / l and the number of erythrocytes is higher than 2 - 3 t / l, we can talk about the course of moderate severity of post-hemorrhagic anemia. Finally, we are talking about a severe stage of anemia in the event that hemoglobin falls below 66 g / l.

If a mild severity of this type of anemia is detected in time, the patient can still be really helped. In this case, the main goal of treatment is to replenish the iron stores in the body. Taking appropriate iron supplements can help. Only a doctor can prescribe such drugs in accordance with the tests submitted by the patient and his individual complaints. It is important that the preparation contains a component that promotes the complete absorption of iron. This component can be, for example, ascorbic acid. Sometimes inpatient treatment may be required.

With post-hemorrhagic anemia of moderate severity, post-hemorrhagic anemia requires appropriate medication. As for the severe degree, hospitalization of the patient is urgently indicated. Delay in this case can cost the patient his life.

Posthemorrhagic anemia: causes of the disease

Lack of blood in the body may be due to:

Violation of normal hemostasis. Hemostasis is designed to keep the blood in a liquid state, that is, as it should be normal. It is also responsible for normal blood clotting;
Diseases of the lungs. Such diseases can be judged by scarlet bleeding in the form of liquid or clots, which occurs when coughing;
Trauma, due to which the vascular integrity was violated, mainly in large arteries;
Ectopic pregnancy. With such a problem, severe internal bleeding is observed, which causes the development of acute post-hemorrhagic anemia;
Surgical intervention. Almost any operation is associated with blood loss. It is not always abundant, but this may be enough for the development of pathology;
Ulcers of the stomach and duodenum. With such diseases, internal bleeding is common. Such bleeding cannot always be recognized quickly. But if it is not done in time, it could be fatal.

Posthemorrhagic anemia: stages

There are two stages in the course of this pathology - acute and chronic. Acute begins due to rapid and massive blood loss. Such blood loss is often caused by trauma, internal and external bleeding, surgical intervention, during which the vessels are injured. The chronic stage of the course of the disease is characterized by moderate bleeding, which occurs quite often, for example, we are talking about hemorrhoids and peptic ulcer disease. The same goes for girls with menstrual abnormalities and uterine fibromatosis. The same goes for nosebleeds.

Pathogenesis of posthemorrhagic anemia

The key factors of this type of anemia are the phenomena of vascular insufficiency. At the same time, blood pressure decreases, blood supply to tissues and internal organs is disturbed, hypoxia and ischemia are observed, and a state of shock may become likely.

The first phase is called early reflex-vascular. It is also called latent anemia. At the same time, the indicators of hemoglobin and erythrocytes are still close to normal. The second phase is the hydraemic phase of compensation. It is characterized by the entry of tissue fluid into the bloodstream and the normalization of plasma volume. The decrease in the number of red blood cells begins quite abruptly. In the third phase, there is a strong decrease in the number of formed elements in the blood and the situation begins to get out of control.

Acute post-hemorrhagic anemia: ICD-10

What can be said about the stages of this kind of anemia? Chronic post-hemorrhagic anemia is something that is difficult to deal with, since the causes lie in some other disorders in the body. That is why we will focus on acute post-hemorrhagic anemia.

With acute blood loss, which means more than 1000 ml of blood, in a short period of time, the patient may experience collapse and shock.

Acute anemia: causes (post-hemorrhagic) - what are they? They are most often associated with injuries of an unforeseen nature.

If we talk about the symptoms of acute hemorrhagic anemia, they are represented by disorders of the gastrointestinal tract, dizziness, nausea. In addition, the patient may feel weak, his skin may turn pale and blood pressure may drop.

Treatment of posthemorrhagic anemia

Therapy for such a disease is carried out only in a hospital setting. The fact is that bleeding, especially massive, in other conditions, is not always possible to stop. Sometimes you need infusion-transfusion therapy and surgery.

After the bleeding stops, it is necessary to start taking iron-containing drugs, and only at the discretion of the doctor. In the severe stage, it will be necessary to administer the drugs intravenously; at the mild stage, it is enough to take the tablets inside. In some cases, combined treatment with both methods is indicated.