Acute hemorrhagic anemia. Posthemorrhagic anemia. Prognosis of acute posthemorrhagic anemia

Iron deficiency types of anemia account for almost 80% of all cases of this disease. These include posthemorrhagic anemia, which is considered one of the most frequently diagnosed. This disease occurs due to severe blood loss. This disease can have either an acute form or develop into a difficult-to-diagnose chronic form. In the first case, posthemorrhagic develops due to sudden heavy blood loss. The chronic form appears with frequent but small internal bleeding.

Hemorrhagic anemia

This disease develops rapidly and poses a real danger to human life. Hemorrhagic anemia acute form may result in death. Therefore, when such a problem occurs, the patient should urgently seek medical help. A one-time loss of 500 ml of blood is considered critical. The chronic form of the disease can significantly worsen a person’s quality of life. Constant, but not heavy bleeding also often indicates the development of various cardiological, gynecological and gastroenterological problems.

Symptoms of diseases

Signs of chronic and acute forms of the disease can vary greatly. With regular, but not heavy bleeding, the patient develops faint severe symptoms. He may complain about:

• pale skin;
• fatigue;
• loss of performance;
• dizziness;
• darkening of the eyes;
• decrease in body temperature.

Acute posthemorrhagic anemia causes more obvious symptoms. It is important to know how to identify excessive internal blood loss in order to immediately call medical care. In this condition, the patient experiences:

A sign of internal bleeding is dry mouth. The person may also experience nausea, vomiting, and confusion. The problem can also be indicated feces. When internal bleeding occurs, they turn black. Against the background of general intoxication of the body, the patient’s body temperature may increase. The patient also complains of a feeling of compression of the internal organs. The greater the blood loss, the more clearly the above symptoms appear.

Lit.: Big medical encyclopedia 1956

The appearance of this disease is always associated with a lack of blood in the body. Acute posthemorrhagic anemia occurs most often due to injuries, during which damage to blood vessels and large arteries occurs. In addition, the disease can appear when:

• surgical interventions;
• rupture of the fallopian tube during ectopic pregnancy;
• stomach ulcer and duodenum;
• severe lung diseases;
• violation of hemostasis.

An acute form of anemia occurs with massive blood loss, which can be caused by damage to the walls of the heart chambers during a heart attack. The disease also often develops when an aortic aneurysm ruptures. This disease can also appear in infants. Their problem is associated with birth injuries, as well as placental bleeding.

The chronic form of hemorrhagic anemia manifests itself with the loss of small volumes of blood associated with various gastrointestinal, renal, hemorrhoidal and nasal injuries. The problem can occur with uterine bleeding, gingivitis, hemorrhoids and intestinal tumors.

In women, this disease can occur with very heavy menstruation and dysmenorrhea. Sometimes this disease is diagnosed in pregnant women. Their anemia may be associated with serious pathologies. For example, the problem may occur when:

• umbilical cord rupture;
• placental abruption;
• choriangioma;
• hematoma of the placenta.

If a person experiences symptoms of acute posthemorrhagic anemia, then emergency medical assistance must be urgently called. The faster the resuscitation team arrives, the higher the likelihood successful treatment. Doctors such as:

A patient who experiences signs of chronic anemia should seek help from these specialists. He may also need to undergo consultations with a hematologist, gastroenterologist, gynecologist, or proctologist. At the first appointment, the doctor must carefully listen to all the patient’s complaints. The doctor will definitely examine the patient and also ask him a few clarifying questions:

1. When did you first notice symptoms of the disease?
2. Have there been similar problems in the past?
3. Are you worried about chronic diseases?
4. Are there any other health complaints?
5. Are you taking any medications?

The survey allows the specialist to draw up a complete clinical picture of the disease. It also helps to find the true root cause of the development of posthemorrhagic anemia. The doctor must refer the patient for examination to confirm the diagnosis. The patient will have to undergo general and biochemical blood tests, which will determine the lack of hemoglobin. Ultrasound, ECG, radiography and FGS are performed to determine the cause of internal bleeding.

Features of treatment

Therapy may vary significantly depending on what form of anemia the patient has. If a person is diagnosed with acute hemorrhagic anemia, he is urgently hospitalized. All efforts of doctors will be aimed at immediately eliminating bleeding. To do this they can:

• carry out dressing;
• perform suturing of blood vessels;
• increase blood clotting;
• carry out resection and suturing of damaged organs.

In the future, hemorrhagic anemia may not require any treatment, since the body will begin to actively restore the lost amount of blood. This is performed by activating blood depots, which are located in the liver, lungs, and spleen.

If the patient has lost a lot of blood, then he needs an urgent transfusion. In severe conditions, the patient may also be given:

• blood replacement solutions;
• B vitamins;
• electrolyte solutions;
• iron supplements.

The prognosis for this disease depends on how quickly the person received qualified medical care. With prolonged and heavy bleeding, acute posthemorrhagic anemia can provoke hypovolemic shock, after which the patient can fall into a coma.

Treatment of posthemorrhagic anemia

Therapy for chronic anemia also begins with finding and eliminating the cause of bleeding. Having eliminated this problem, doctors prescribe medication to the patient. It consists of taking one of the following medications.

Posthemorrhagic anemia is caused by a single factor - blood loss. It occurs more often than others, as it accompanies injuries, chronic diseases, complicated by bleeding. Treatment of this pathology is impossible without replacing lost formed elements (erythrocytes, all types of leukocytes, platelets), plasma with protein and microelements.

Changes in the body during blood loss

It is customary to measure the severity of anemia by a decrease in hemoglobin levels and the resulting hypoxia (oxygen deficiency) of tissues.

But the clinical course and symptoms of posthemorrhagic anemia are largely due to a lack of iron, copper, magnesium, potassium, loss of protective functions (decreased immunity), and increased sensitivity to any allergens.

The critical volume of blood loss is 500 ml. This maximum amount vital substances that healthy body able to gradually recover without treatment on its own. It is allowed to be donated to donors if necessary.

Small arteries are the first to react to the reduced volume of circulating blood; they spasm in agreement with the sympathetic department of the autonomic system. nervous system. This is a reflexive reaction aimed at supporting blood pressure at the proper level. However, peripheral resistance increases significantly. Due to the drop in inflow venous blood the heart begins to contract more frequently, trying to maintain the required minute volume.

The loss of essential microelements affects myocardial function, contraction speed and strength decrease. An ECG at this time can reveal signs of hypoxia and impaired conductivity.

Shunts open between small arteries and veins, and blood rushes through the anastomoses, bypassing the capillary network. The blood supply to the skin, muscles, and kidney tissue immediately deteriorates. This mechanism allows you to protect the local blood supply to the heart and brain even with a loss of 10% of the circulating blood volume.

Plasma deficiency is restored quite quickly due to interstitial fluid. The main irreparable disorders remain at the level of microcirculation. A significant decrease in blood pressure contributes to a slowdown in blood flow in the capillaries, thrombosis and complete closure.

In the severe stage of hemorrhagic changes, microthrombi block the arterial glomeruli in the renal tissue, reduce the filtration of fluid through them, this sharply reduces urine output. At the same time, blood flow in the liver decreases. Long-term irreversible acute posthemorrhagic anemia can lead to liver failure.

As a result of general hypoxia, under-oxidized substances accumulate in tissues, which act as poisons on brain cells and cause a shift towards acidosis (acidification by wastes). With severe anemia, alkaline reserves are reduced, and the state of metabolic acidosis cannot be compensated.

Despite the decrease in the number of platelets, blood clotting is accelerated due to a reflex increase in the concentration of certain factors

This condition lasts for several days. Then the overall coagulability is normalized. Thrombohemorrhagic syndrome may occur due to the growth of procoagulant substances.

Pathological changes require urgent corrective measures and elimination of the causes that caused them.

Types of posthemorrhagic anemia

The clinical classification distinguishes 2 forms of anemia associated with blood loss:

• acute posthemorrhagic anemia - occurs against the background of rapid massive blood loss due to injuries, external and internal bleeding, during surgery for injury of large vessels;
• chronic - accompanies diseases with frequent moderate bleeding (hemorrhoids, peptic ulcer), typical for girls and women with menstrual irregularities, uterine fibromatosis, and is less often accompanied by nosebleeds.

According to the severity of clinical manifestations, it is customary to take into account the hemoglobin content in the blood and distinguish:

1. mild if hemoglobin is above 90 g/l;
2. average degree with a hemoglobin level from 70 to 90 g/l;
3. severe - hemoglobin level from 50 to 70 g/l;
4. extremely severe - the amount of hemoglobin is below 50 g/l.

According to ICD-10 ( International classification diseases), acute posthemorrhagic anemia is classified in the group “Aplastic and other” with code D62.

As separate conditions associated with the established cause of blood loss, the following are distinguished:

• congenital anemia in the fetus due to blood loss with code P61.3;
• chronic posthemorrhagic anemia as secondary iron deficiency with code D50.0.

Learn more about the causes of acute and chronic blood loss

Most common reasons anemia are:

• injuries with damage to large arterial vessels;
• unforeseen complication of surgical interventions;
• pathology of obstetrics and gynecology ( uterine bleeding with ovarian dysfunction, uterine tumors, ectopic pregnancy, complications during difficult childbirth);
• peptic ulcer of the stomach and duodenum;
• liver cirrhosis with portal hypertension and bleeding from the esophageal veins;
• chronic lung pathology (tuberculosis, bronchiectasis);
• chronic hemorrhoids.

Bleeding from an ulcer depends on its location; the internal curvature of the stomach is more traumatized by food

Signs of acute posthemorrhagic anemia appear immediately against the background of massive bleeding and after stopping:

• the patient has pale skin color, blue lips;
• covered with sticky cold sweat;
• complains of severe weakness, dizziness;
• possible fainting states;
• nausea, occasional vomiting;
• dry tongue;
• rapid heartbeat, extrasystoles;
• weak thready pulse;
• Heart sounds are muffled on auscultation;
• blood pressure is reduced;
• breathing is shallow, rapid;
• body temperature below 36 degrees.

Patients complain of a lack of fresh air and have difficulty withstanding the heat.

At different types bleeding can be detected:

• loose bloody stool (from a stomach ulcer);
• bloody sputum with bright scarlet blood released in a stream when coughing (from pulmonary arteries);
• increasing swelling at the site of a bruise or fracture (internal hematoma);
• discharge from the uterus in women.

Internal bleeding is difficult to diagnose. Doctors are based on general condition patient.

Stages of acute anemia

The clinical picture of acute posthemorrhagic anemia goes through 3 stages:

1. Vascular reflex- is determined by the inclusion of compensatory self-defense mechanisms, the opening of arteriovenous anastomoses. There is a drop in blood pressure, pale skin, tachycardia, and shortness of breath.
2. Hydremia stage - begins after 3–5 hours. Liquid enters the plasma from the intercellular spaces and “floods” the vascular bed. Lasts 2–3 days. The number of red blood cells and hemoglobin in the blood decreases.
3. Stage of bone marrow changes- begins on the 4th – 5th day after injury. Caused by the development and progression of hypoxia. Blood erythropoietin and reticulocyte levels increase. By their nature, new red blood cells are defined as hypochromic. The leukocyte formula shifts to the left. Plasma iron levels drop.

For treatment and full recovery indicators will take at least two months.

During menopause, uterine bleeding accompanies hormonal changes

Signs and course of the chronic form

Chronic posthemorrhagic anemia develops after several months or years. Since the basis pathological changes is the loss of iron, this form rightly refers to iron deficiency states. The symptoms are no different from those of iron deficiency in the diet:

• skin is pale, dry;
• face is swollen;
• changed taste sensations and attitude to smells;
• hair is dull and falls out rapidly;
• nails are brittle, flattened;
• increased sweating;
• complaints of fatigue, headaches, nausea;
• frequent dizziness;
• heartbeat;
• body temperature is slightly above 37 degrees.

Diagnostic methods

Diagnostics aims not only to identify the type of anemia, but also to establish the presence of a bleeding organ or tissue when chronic process. Therefore, detailed blood tests and additional investigations are equally important.

What does a blood test show?

In case of acute blood loss, the patient must be taken to a hospital, where it is possible to assess the degree of danger of blood loss to a person’s life. Changes in general analysis may indicate the duration of bleeding:

• in the first hour - the number of platelets, the level of red blood cells and hemoglobin increases within normal limits;
• after 2–3 hours - with preserved thrombocytosis, neutrophilia appears, blood clotting is sufficient, the number of erythrocytes and hemoglobin decreases, anemia is assessed as normochromic;
• after 5 days - the number of reticulocytes increases, low iron content in plasma is determined.

In case of chronic bleeding, oval red blood cells, leukopenia with lymphocytosis are detected in the blood smear. Biochemical tests show a loss of not only iron, but also copper, calcium, and an increase in manganese.

Additional data

To find the site of bleeding, be sure to carry out:

• stool analysis for occult blood and helminths;
• fibrogastroscopy is necessary to exclude gastric bleeding from an ulcer or a disintegrating tumor;
• colonoscopy - examination of the lower intestines;
• sigmoidoscopy - to visually confirm the integrity of the internal hemorrhoids;
• Women must be consulted by a gynecologist.

Ultrasound and Doppler studies allow us to specify the cause of blood loss.

Treatment

Treatment of the acute form is carried out in a hospital against the background or immediately after treatment. emergency care and stopping bleeding.

To replenish the volume of circulating blood, artificial blood substitutes (Polyglukin, Gelatinol) are transfused; in severe cases, they are injected in a stream. When blood pressure rises to 100/60 mm Hg. Art. continue drip transfusion.

An intravenous catheter allows long-term transfusion of fluids from medicines

If the patient is in shock, large doses of prednisolone are administered.

Tissue acidosis is relieved soda solution. Despite the blood loss, Heparin is prescribed to relieve thrombosis at the capillary level. The patient is connected to humidified oxygen into the breathing tubes.

The issue of replacement transfusion of donor blood or red blood cells is decided individually. If the surgical blood loss is less than 1000 ml, then transfusion is considered contraindicated. The procedure can cause complications such as intravascular coagulation syndrome or immune conflict.

Chronic posthemorrhagic anemia can be treated on an outpatient basis in the absence or exacerbation of the underlying disease. If the cause of blood loss is determined, elective surgery may be required.

The patient's diet must include foods with high content iron, vitamins C, B 12, folic acid.

When treating children, it is imperative to provide the necessary nutrition (complementary feeding from 6 months of age). If a child plays sports, the need for iron increases.

Immunity support is required during the recovery period. People with posthemorrhagic anemia are susceptible to infection by various microorganisms. For this purpose, you need a complex of vitamins with microelements, long-term use of immunostimulants (aloe extract, ginseng root, lemongrass).

Forecast

Quick delivery to the hospital and initiation of hemostatic measures contribute to the successful recovery of the patient. If there is large blood loss from large arteries and there is no help, the patient dies.

Chronic posthemorrhagic anemia can be cured only by eliminating the cause. The patient needs to monitor for signs of exacerbation, start preventive treatment in a timely manner, and not delay the possibility of surgery if doctors offer it.

The success of treating complications after blood loss depends on the timeliness of seeking medical help.

Etiology

Acute posthemorrhagic anemia characterized by rapid loss of hemoglobin and red blood cells in the blood and appears as a result of bleeding.

Anemia is based on a decrease in the mass of circulating red blood cells, leading to impaired oxygenation of body tissues.

Pathogenesis

Hypovolemia is accompanied by stimulation of the sympathetic-adrenal system. Redistribution reactions develop at the level of the capillary network, as a result of which phenomena of intravascular aggregation of blood cells occur. Disruption of capillary blood flow leads to the development of hypoxia of tissues and organs, the filling of under-oxidized and pathological metabolic products and intoxication, venous return decreases, which leads to a decrease in cardiac output. Decompensation of microcirculation occurs, caused by a combination of vascular spasm with aggregation of red blood cells, which creates conditions for the formation of blood clots. From the moment signs of erythrocyte aggregation form, shock becomes irreversible.

Clinic of acute posthemorrhagic anemia

The clinical picture depends on the amount of blood lost, the duration of bleeding and the source of blood loss.

Acute phase - after blood loss, the leading clinical manifestations are hemodynamic disorders (decreased blood pressure, tachycardia, pallor of the skin, loss of coordination, the development of shock, loss of consciousness)

Reflex-vascular phase, after blood loss, there is a compensatory flow of blood deposited in the muscles, liver, spleen into the bloodstream

Hydraemic phase of compensation, which lasts 1-2 days after bleeding, while anemia is detected in blood tests

Bone marrow stage of blood loss compensation, 4-5 days after blood loss develops reticulocyte crisis, which is characterized by: reticulocytosis, leukocytosis.

After day 7, the blood loss recovery phase begins, if bleeding does not recur, then after 2-3 weeks the red blood is completely restored, and there are no signs of iron deficiency anemia.

Diagnosis of posthemorrhagic anemia

Blood test: decrease in NV, number of red blood cells, it is normochromic, normocytic, regenerative - reticulocytes more than 1%

Treatment of acute posthemorrhagic anemia:

Treatment of acute posthemorrhagic anemia begins with stopping bleeding and anti-shock measures. In order to improve capillary blood flow, the bcc in the body should be replenished; influence the physical and chemical properties of blood. In case of severe blood loss, saline solutions are transfused to maintain the electrolyte balance of the body. The prognosis depends on the rate of blood loss - a rapid loss of up to 25% of the total blood volume can lead to the development of shock, and a slow blood loss even within 75% of the total body weight can end favorably!

IRON-DEFICIENCY ANEMIA

IDA is a clinical and hematological syndrome, which is based on a violation of hemoglobin synthesis, due to iron deficiency in the body or due to a negative balance of this microelement for a long time.

There are three stages in the development of iron deficiency:

Pre-latent iron deficiency or decreased iron stores.

Latent iron deficiency is characterized by depletion of iron in the depot, but the concentration of HB in peripheral blood remains above the lower limit of normal. Clinical symptoms at this stage are little expressed, manifested by a decrease in tolerance to physical activity.

Iron deficiency anemia develops when the concentration of HB drops below physiological values.

Etiological factors of IDA

IDA is the most common anemia; it occurs in 10-30% of the adult population of Ukraine. The reasons for the development of this pathology are: malnutrition, diseases of the digestive tract, accompanied by chronic blood loss and impaired iron absorption (hemorrhoids and rectal fissures, gastritis, gastric ulcer, etc.) Diseases of the genitourinary system, complicated by micro- and macrohematuria (chronic glomerulus - and pyelonephritis, polyposis Bladder etc.) Increased need for iron: pregnancy, lactation, uncontrolled donation, frequent inflammation.

Pathogenesis of IDA

Iron is a very important trace element in the human body; it takes part in oxygen transport, redox and immunobiological reactions. Insufficient amount of iron for the body is replenished with food. For normal absorption of dietary iron, free hydrochloric acid is necessary in the stomach, which converts it into an oxidized form, the latter in the small intestine binds to the protein apoferetin, forming ferretin, which is absorbed into the blood.

Iron, which appears during the destruction of red blood cells in the spleen (from heme), is included in the composition of feretin and hemosiderin (reserve iron) and also partially enters the bone marrow and is used by erythroblasts.

Iron contained in the body can be divided into functional (as part of hemoglobin, myoglobin, enzymes and coenzymes), transport (transferin), deposited (ferritin, hemosiderin) and iron, which forms a free pool. Of the iron contained in the body (3-4.5 mg), only 1 mg is involved in exchange with the external environment: excreted in feces, lost during hair loss and cell destruction.

The daily iron requirement of an adult in a state of physiological equilibrium is (1 - 1.5) mg, for women during menstruation - (2.5 - 3.3) mg.

Clinical picture of IDA

Except ANEMIC SYNDROME IDA is also typical SIDEROPENIC SYNDROME, which is associated with a violation of the trophism of epithelial cells as a result of a decrease in the activity of iron-containing enzymes - cytochromes. It manifests itself changes in the skin and its appendages– the skin becomes dry, sluggish, turgor decreases, nails become brittle, hair loss appears, the perception of smells and taste changes – an addiction to the smell of gasoline, chalk, acetone, etc. arises. Changes in mucous membranes gastrointestinal tract cheilitis, angular stomatitis, tendency to periodantosis, dysphagia (Plumer-Vinson syndrome), atrophic gastritis. Happening atrophy of the mucous membranes of the eyes in the form of dryness eyeball, “blue sclera symptom”, changes in the mucous membranes of the upper and lower respiratory tract, Atrophic rhinitis, pharyngitis, and bronchitis develop. The muscular system is affected - growth and physical development are delayed, muscle weakness, weakening of the muscular apparatus of the sphincters - imperative urge to urinate, nocturnal anuresis, etc.

Diagnosticsiron deficiency anemia

General blood analysis– decrease in NV, number of red blood cells, hypochromia, anisocyto-, poikilocytosis, microcytosis.

Blood chemistry

Decreased iron content in blood serum

Increase in the total iron-binding capacity of blood serum

Decrease in ferritin and transferrin levels

Treatment of iron deficiency anemia: identification and elimination of the cause of the development of IDA; correction of iron deficiency by prescribing iron-containing preparations for internal use.

Principles of treatment with iron supplements:

Dietary iron does not correct iron deficiency.

Preference is given to drugs containing ferrous iron.

Avoid taking foods that reduce iron absorption (calcium supplements, cottage cheese, milk, tannin in tea).

The simultaneous administration of B vitamins and folic acid is not advisable unless there is concomitant anemia.

Treatment for 12 months after normalization of HB levels in maintenance doses to replenish iron reserves;

Parenteral iron supplements are prescribed only in cases of malabsorption due to intestinal pathology, exacerbation of peptic ulcer disease, intolerance to oral iron supplements, and the need to quickly saturate the body with iron.

Megaloblastic anemias

(due to deficiency of vitamin B12 and folic acid)

B12-(folate)-deficiency anemia is a group of anemias in which there is a violation of DNA and RNA synthesis, which leads to impaired hematopoiesis, the appearance of megaloblasts in the bone marrow, and the destruction of erythrokaryocytes in the bone marrow.

Etiology of B12 and folic anemias

Vitamin B12 deficiency can develop due to malabsorption. This is due to a decrease in the secretion of the internal factor of Castle (patients after gastrectomy, type A gastritis).

Damage to the small intestine (celiac disease, blind loop syndrome, multiple diverticulosis, small intestine).

With competitive absorption of large amounts of vitamin B12 in the intestines (diphyllobothriasis).

Sometimes, but not often, exogenous vitamin B12 deficiency can occur (vitamin deficiency in foods or prolonged heat treatment of foods).

The causes of folate deficiency anemia are most often associated with the use of folic acid antagonists (methotrxate, acyclovir, triamterene), chronic alcoholism, malnutrition, and diseases of the small intestine.

Pathogenesis

Vitamin B12 deficiency leads to a lack of the coenzyme methylcobolamine, which in turn affects DNA synthesis, hematopoiesis is disrupted, and atrophy of the mucous membranes of the gastrointestinal tract occurs. With this anemia, the activity of the coenzyme deoxyadenosylcobolamine decreases, which leads to impaired fatty acid metabolism, accumulation of methyl malonate and propionate, which causes damage to the nervous system and the development of funcular myelosis.

Folic acid deficiency leads to ineffective hematopoiesis with a shortened life expectancy of not only red blood cells, but also other nucleated cells (hemolysis and cytolysis of granulocytes, platelets), a decrease in the number of red blood cells and, to a lesser extent, hemoglobin, leukopenia, neutropenia, thrombocytopenia, as well as changes in the functioning of some organs and systems of the body.

ClinicB12 and folate deficiency anemia

In B12 and folate deficiency anemia, damage occurs nervous system, funicular myelosis develops (demyelization of nerve endings) - parasthesia appears, the sensitivity of the limbs is impaired, and spastic spinal paralysis appears.

Changes in Gastrointestinal tract manifest themselves in the form of dyspeptic syndrome (diarrhea, bloating, rumbling, nausea, loss of appetite), the mucous membranes are affected - a burning sensation of the tongue, the mucous membrane of the mouth and rectum, a “varnished” tongue with areas of inflammation - Hunter’s glossitis, loss of taste occurs

Mental disorders– hallucinations, depressive syndrome, unsteady gait, impaired tactile and temperature sensitivity, Skin changes– pale skin with a lemon-yellow tint (moderate anemia), subecteric sclera

Possible moderate hepatosplenomegaly – liver enlargement and

spleen

DiagnosticsB12 deficiency anemia

Blood analysis: decrease in the amount of hemoglobin and red blood cells, macrocytic, hyperchromic anemia, basophilic punctuation of red blood cells is detected, which is more characteristic of B12 anemia (Jolly bodies, Cabot rings);

Bone marrow: erythroid hyperplasia with characteristic megaloblastic type of hematopoiesis in the bone marrow (“blue bone marrow”);

Treatment

Important in the treatment of these anemias is elimination of the etiological factor and therapeutic nutrition: a sufficient amount of meat, liver, milk, cheese, eggs.

TreatmentB12 deficiency anemia:

Vit preparations At 12 for parenteral administration

cyanocobalamin, hydroxycobalamin

Course treatment: 400-500 mcg/day. IM during the first two weeks; then 400-500 mcg after 1-2 days until red blood counts normalize.

If there are signs of funicular myelosis, a course of treatment of 1000 mcg/day. until all neurological symptoms disappear.

Treatmentfole deficiency anemia

Folic acid is prescribed at a dose of 3-5 mg/day until clinical remission is achieved. Pregnant women are prescribed a prophylactic dose of 1 mg/day. An indicator of effectiveness is a reticulocyte crisis on days 6-7 from the start of treatment and the presence of a normoblastic type of hematopoiesis, with the gradual onset of complete clinical and hematological remission.

HEMOLYTIC ANEMIA

Hemolytic anemia- a group of anemias, which is characterized by a decrease in the average life expectancy of red blood cells, which is due to their increased destruction and accumulation of red blood cell breakdown products - bilirubin - in the blood and the appearance of hemosiderin in the urine.

Etiology of hemolytic anemias –

Hereditary hemolytic anemias may be associated with a violation of the structure of the erythrocyte membrane; caused by impaired activity of erythrocyte enzymes, impaired structure or synthesis of hemoglobin.

Pathogenesis

The normal lifespan of red blood cells is 100-120 days. It is important to say that anemia develops if the compensatory capabilities of erythropoiesis lag behind the rate of destruction of red blood cells.

With hemolytic anemia, the lifespan of red blood cells can be reduced to 12 days. This increases the activity of free bilirubin, which has a toxic effect on body tissues, and hemosiderin, which can be deposited during internal organs and lead to hemosiderosis. At the same time, the amount of urobilin in the urine and stercobilin in the feces increases. With hemolytic anemia, a tendency to form stones in the gall bladder often develops due to the increased content of bilirubin in the bile.

Clinic

Hemolysis is characterized by a triad : jaundice, splenomegaly, anemia of varying severity. The severity of jaundice depends on the degree of destruction of red blood cells on the one hand and on the functional ability of the liver to bind bilirubin because Jaundice appears against the background of anemia, then the skin becomes lemon yellow. With hemolytic anemia, cholelithiasis can develop and, as complications, cholestatic hepatitis and cirrhosis of the liver.

The appearance of hemolytic anemia leads to impaired physical and mental development.

Hereditary anemia, in particular microspherocytosis, can be manifested by hypoplastic crises: a drop in hemoglobin levels, an increase in the concentration of indirect bilirubin, reticulocytosis, increased jaundice, fever, abdominal pain, and weakness.

Diagnosis of anemia

Blood analysis: decrease in NV, number of red blood cells, normochromic anemia, reticulocytosis, number of leukocytes and platelets does not change, leukocytosis is possible only after a crisis. The osmotic resistance of red blood cells may be reduced (hereditary ovalocytosis).

To exclude hereditary hemolytic anemia, it is necessary to identify the morphology of erythrocytes (spherocytosis, ovalocytosis, elliptocytosis).

Carrying out a genetic analysis - all anemias associated with a defect in protein membranes are inherited by the dominant type, and enzymopathies by the recessive type.

Biochemical analysis blood: increased amount of bilirubin due to indirect, increased amount of iron. Urobilin is detected in urine, stercobilin is detected in feces.

In autoimmune hemolytic anemia, a positive Coombs test is detected, and antibodies to red blood cells are detected.

Bone marrow: hyperplasia of the red bone marrow due to erythrokaryocytes.

Treatment

Treatment of hemolytic anemia depends on the pathogenesis of the disease.

For autoimmune hemolytic anemia Pathogenetic therapy is prescribed - corticosteriids; if they are ineffective, patients can receive cytostatic drugs such as cyclophosphamide or azathioprine. Treatment is usually carried out in combination with prednisolone. Persons with G-6-FDG deficiency should be prohibited from taking “oxidative” medications (sulfonamides, antimalarials, sulfones, analgesics, chemicals, nitrofurans).

Red blood cell transfusions are prescribed only in cases of severe enzyme deficiency. Measures are needed to improve diuresis in hemoglobinuria. Splenectomy is performed only for strict indications:

Severe course of the disease with functional impairment;

If cholecystectomy is necessary, splenectomy must be performed simultaneously.

Due to increased destruction of red blood cells, folic acid must be included in therapy.

(HYPO)-APLASTIC ANEMIA

Aplastic anemia is characterized by profound inhibition of bone marrow hematopoiesis and pancytopenia, which causes the main manifestations of the disease.

According to the etiological factor, they distinguish:

Acquired forms (exposure to chemical and physical agents, medications, toxins, viruses).

Idiopathic forms.

Hereditary forms (Fanconi anemia, hereditary deficiency of pancreatic hormones, hereditary dyskeratosis)

Clinichypo-aplastic anemia

For aplastic anemia with damage to three layers of hematopoiesis, the following syndromes are characteristic: anemic, hemorrhagic, immunodeficiency and febrile.

Hemorrhagic syndrome due to inhibition of the platelet layer, manifests itself in the form of rashes of the petichial-spot type, hemorrhages throughout the body, bleeding from the nose, uterus, gastrointestinal and others. Immunodeficiency syndrome manifests itself due to inhibition of leukocyte activity and a decrease in the body's immune resistance. This is manifested by frequent colds: sore throats, bronchitis, pneumonia. Feverish syndrome is characterized by an increase in temperature to subfebrile levels, weakness, and chills.

Diagnosis of hypo-aplastic anemia

General blood analysis- normochromic anemia, moderate anisocytosis and poikilocytosis, reduced reticulocyte count, leukocytopenia, thrombopenia

Biochemical analysis blood: serum iron concentration is increased. Determination of the renal complex, bilirubin and its fractions (hemolytic and anemia associated with impaired regulation of erythropoiesis). Immune disorders: autoantibodies to blood and bone marrow cells, auto- and allosensitization in 35% of patients, inhibition of the phagocytic reaction of neutrophils.

Bone marrow: inhibition of hematopoietic germs, hypocellularity with relative lymphocytosis in the classic type of acquired aplastic anemia.

Treatment:

Regimen: abolition of all medications to which there is individual hypersensitivity.

Drug treatment:

1. Hemostatic therapy: corticosteroids - prednisolone 60-80 mg, dexamethasone, polcortalone.

2. Anabolic steroids (especially after splenectomy): retabolil, nerobolil, methandrostenolone.

3. Replacement therapy:

transfusion of washed red blood cells (for severe anemia);

platelet transfusion (for hemorrhages).

4. Antilymphocyte globulin (rabbit and goat - intravenously 120-160 mg 10-15 times).

5. Antibiotic therapy for infectious complications.

Surgical treatment: bone marrow transplant, removal of an organ that produces antibodies - splenectomy

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

Posthemorrhagic anemia of a chronic nature occurs after small, but for some time, frequent bleeding. The acute form of this disease occurs due to sudden, heavy blood loss.

The minimum volume of blood loss in an adult that is dangerous to human life is 500 ml.

According to the International Classification of Diseases, 10th revision, posthemorrhagic anemia belongs to the category “Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism.” Subsection: "Anemia 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

, , , , , , ,

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 resulting in a violation of the integrity of blood vessels, especially large arteries.
• Surgical intervention. Any surgical intervention is always a risk. Getting down to even the seemingly ordinary man in the street, simplest operation, the surgeon is not able to foresee all its nuances and consequences.
• Ulcer of the duodenum and stomach. These diseases are often accompanied by internal bleeding. And the difficulty of their timely detection is that the bleeding occurs inside the body and externally it can be recognized by an amateur by certain signs and an ambulance can be called in time. Otherwise, delay may result in death for the patient.
• Impaired hemostasis. This factor is designed to maintain blood in a liquid state, being responsible for the blood clotting rate, which makes it possible to maintain circulating blood volumes within normal limits and normalize the composition (“formula”) of blood.
• Ectopic pregnancy. This pathology is accompanied in women by acute heavy bleeding, which leads to acute posthemorrhagic anemia.
• Pulmonary diseases. This bleeding is manifested by scarlet discharge with a liquid or clot-like consistency that occurs during coughing.

Pathogenesis

Pathogenesis, or the sequence of occurring phenomena, constitutes the phenomena of vascular insufficiency, due to a sudden emptying of blood (plasma) from the vascular bed. These factors lead to a lack of red blood cells that carry oxygen, which, in turn, leads to general oxygen starvation of the body. The body will not be able to compensate for this loss on its own due to the more active work of the heart.

, , , , ,

Symptoms of posthemorrhagic anemia

Knowledge won't hurt anyone. And in order to be able to recognize bleeding (especially if it is internal), it is necessary to know the symptoms of posthemorrhagic anemia and its manifestations in order to provide first aid or call an ambulance in time.

• With heavy blood loss, vascular manifestations come first: shortness of breath, rapid heartbeat (tachycardia), and decreased blood pressure (both arterial and venous).
• The patient's skin and mucous membranes become pale.
• The patient begins to feel darkening in the eyes, tinnitus and slight dizziness.
• A gag reflex may appear.
• An acute sign internal bleeding can be considered severe dry mouth. The severity of the clinic is determined not only by the total volume of sweat, but also by the rate at which the victim loses blood.
• The location of the injury is also an important factor. So defeat gastrointestinal tract accompanied by a sharp increase in body temperature.
• Obvious manifestations of intoxication.
• The level of residual nitrogen in the plasma also increases its performance (while the urea level remains normal).
• Even with small amounts of internal bleeding, the patient feels compression of the organs.
• indicator internal damage There may also be fecal discharge. Due to the excreted blood, they turn black.

Acute posthemorrhagic anemia

If a person loses, as a result of injury (the consequence of which is damage to a large artery), an operation being performed or an exacerbation of any disease, an eighth of the total volume of working blood, an acute form of posthemorrhagic anemia occurs.

Doctors distinguish several stages of development of acute anemia:

1. Reflex-vascular stage. It is expressed by a sharp decrease in blood pressure, pallor of the skin and mucous membranes, and tachycardia. A sudden lack of oxygen reaching the organs leads to spasms of peripheral blood vessels. To prevent a further drop in pressure, the body opens arteriole-venular shunts, leading to the removal of plasma from the organs. This therapy itself works to adequately compensate the return of blood fluid to the heart.
2. Hydremic stage. After three to five hours, the basis for hydremic compensation is created, caused by the flow of fluid from the interstitial area into blood vessels. In this case, certain receptors are irritated, which are involved in maintaining the volume of fluid circulating through the vessels. Increased synthesis of aldosterone blocks the removal 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 red blood cells and hemoglobin. This stage of compensation can take place within two to three days.
3. Bone marrow stage - this stage occurs four to five days from the moment of bleeding. Hypoxia progresses. Erythropoietin levels are increasing. In the peripheral blood, the number of newly formed red blood cells (reticulocytes), which have a reduced amount of hemoglobin, increases. The characteristic of this stage becomes hypochromic. In addition, a sharp lack of blood causes a decrease in iron in the blood.

Chronic posthemorrhagic anemia

This type of anemia, chronic posthemorrhagic anemia, occurs in a patient if he gradually, over a period of time, loses blood in fractions. This type of anemia can occur in a number of diseases. For example, such as: intestinal cancer, peptic ulcer of the duodenum or stomach, gingivitis, hemorrhoids, and many others. Frequent but minor bleeding leads to general exhaustion of the body. Iron deficiency occurs. In this regard, this pathology, according to its etiology, is classified as posthemorrhagic anemia; according to its pathogenesis, this pathological condition can be attributed to iron deficiency anemia.

Based on this, the main goal of therapy for posthemorrhagic anemia, in any of its forms, is to restore the full volume of blood plasma circulating in the vessels, and, as a consequence, to overcome iron deficiency and lack of erythropoiesis. But this " ambulance"for the body. After emergency resuscitation, it is necessary to turn your attention to the root cause that caused the bleeding. And it’s simpler - you need to start treating the underlying disease.

, , , , ,

Posthemorrhagic iron deficiency anemia

Today, doctors state that posthemorrhagic Iron-deficiency anemia is beginning to become quite 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, in the bone marrow, and in the so-called storage room, where the body accumulates everything it needs in reserve. As a result, a failure occurs in the heme synthesis system, resulting in a deficiency of myoglobin and tissue enzyme.

Modern statistical research They voice the figure of 50% - this is the number of the population that suffers from anemia in one form or another. Compounds in which metals occur in nature are poorly absorbed or not absorbed at all by the human body. When the balance in the intake of iron into the body and its use is disturbed, 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, although quite rarely, with nosebleeds, dental aspects of blood loss, as well as with trauma... Exceptional cases have also been identified when iron deficiency anemia developed in a donor who “frequently gave blood.” Moreover, strange as it may sound, 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 menstrual cycle. Laboratory studies show that uterine fibroids can also lead to posthemorrhagic anemia with iron deficiency, which contributes to the leaching of iron and the subsequent appearance of anemic symptoms.

The second place in the frequency of diseases is occupied by blood loss during acute diseases gastrointestinal tract, which are diagnosed on early stages quite problematic. Pulmonary hemorrhage is a fairly rare manifestation of iron deficiency, as is blood loss from urinary tract and kidneys.

Newborns and infants may suffer from iron deficiency due to improper placenta previa, or if it is damaged during surgical intervention (caesarean section). There are also cases of intestinal bleeding as a manifestation of an infectious disease.

The reason for the lack of iron in older children may also be a poor diet. The baby simply does not receive enough of the element from the foods he eats. Anemia can also be caused by a lack of iron in the mother during her pregnancy, as well as in premature babies or babies of twins and triplets... Quite rarely, but the cause of this disease can also be the mistake of the obstetrician, who, without waiting for the pulsation to stop, cut the umbilical cord early.

You should not ignore the situation when (for example, with large physical activity, pregnancy, etc.) the body’s need for it increases sharply. Therefore, the likelihood of posthemorrhagic iron deficiency anemia increases.

The lack of this element in the body causes significant harm immune system person. But, strange as it may sound, patients suffering from iron deficiency suffer less from infectious diseases. It's simple. Iron is an excellent nutrient medium for some bacteria. However, in light of other problems, iron deficiency in the human body cannot be ignored. There are often cases when a lack of iron in the blood is indicated by changed eating habits. For example, a previously unobserved craving for peppery or salty foods appears.

Doctors highlight and psychological aspect iron deficiency. It often occurs in people who do not care about their health, and, consequently, about themselves: diets, limited nutrition, physical inactivity, lack of fresh air, a minimum of positive emotions. All this does not contribute, but depresses those metabolic processes that go through the body. After conducting a study, scientists found that behind all this, as a rule, is deep depression, psychological trauma.

Today, medicine is equipped with a fairly large arsenal in the form of iron preparations: conferon, feramide, jectofer, sorbifer and quite a lot of others. There are also liquid forms, for example, maltofer, the degree of absorption of 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, like in adults, can be acute (quite common) or chronic (less common).

Newborns are quite vulnerable. In them, posthemorrhagic anemia occurs quite often when birth injuries or may even occur if blood is drawn excessively during laboratory research. In older and middle-aged children, the main cause of anemia is often helminths, which, by sticking to the wall of the gastrointestinal tract, injure the body and provoke microbleeding.

Symptoms for which parents should raise the alarm:

• The same as for adults.
• But the first manifestations are lethargy, loss of appetite, growth cessation occurs, and the baby begins to gain weight worse.
• One of the primary signs initial stage disease may be a change taste preferences crumbs, to the point that children tend to eat soil, chalk, clay... This is the result of iron deficiency and lack of mineral components in the baby’s body. Sometimes these changes are not so radical.
• There is also a change in behavior. Kids become capricious and whiny, or, in contrast, apathetic.
• There is also a manifestation of external signs: brittle hair and nails, peeling skin.
• “Vacquered” smooth tongue.
• In teenage girls, interruptions in the menstrual cycle.
• Quite often, against the background of posthemorrhagic anemia, complications of an infectious nature are observed: otitis media, pneumonia...

The first thing to do in a situation where a child is in a state of hemorrhagic shock– these are resuscitation measures to stop bleeding and anti-shock therapy. Blood substitutes are administered by stream and drip. During this period, the baby’s blood type and Rhesus status are determined. Resuscitation is carried out with freshly citrated blood. If one is not available, a direct transfusion from the donor is performed. In parallel with this, glycoside support for cardio vascular system and a diet rich in protein and vitamins is attributed.

Treatment of posthemorrhagic anemia in children involves 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 anemia severity, which is determined on the basis of laboratory tests:

• when the hemoglobin content in the blood is more than 100 g/l and erythrocytes are above 3 t/l - a mild stage.
• when the hemoglobin content in the blood is within 100÷66 g/l and erythrocytes above 3÷2 t/l - the middle stage.
• when the hemoglobin content in the blood is less than 66 g/l – a severe stage.

Mild posthemorrhagic anemia

More early detection illness allows the child to get back on his feet in a shorter period of time. At mild stage Diseases sometimes require iron-containing medications to replenish the lack of iron in the body. The course of treatment often lasts three months or more. IN 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 the patient can receive qualified and full medical care and there is no point in delaying it. In this situation, “delay is like death.”

Having received the patient at their disposal, doctors, first of all, must do everything to stop the bleeding, while at the same time trying to compensate for blood loss by any means. To obtain the maximum hemodynamic effect (removing the patient from state of shock, obtaining higher blood pressure, etc.), a transfusion of at least half a liter of polyglucin (an artificial plasma substitute) is performed. In the acute traumatic form, this drug is administered initially as a bolus, and the doctor is required to monitor the blood pressure. If the pressure was brought to the following values: systolic - 100÷110 mm, diastolic - 50÷60 mm, the dropper is switched from jet to drip feed. The total dose of the administered solution can reach, if necessary, one and a half liters (maximum 2÷3 l).

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

Diagnosis of posthemorrhagic anemia

Modern medicine cannot be imagined without laboratories and modern medical equipment. But without highly professional specialists, no equipment will help. And in the case of diagnosing posthemorrhagic anemia, the situation is as follows: the diagnosis of acute or chronic posthemorrhagic anemia can be made based on a combination of clinical, laboratory and anamnestic data. Basic are 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 location of the outflow.

, , , , , , , ,

Blood test for posthemorrhagic anemia

The first thing doctors need to do is 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 of acute blood loss, the number of platelets increases sharply, which leads to a reduction in the period of time during which blood clotting occurs, which is quite important in case of blood loss. The level of red blood cells and hemoglobin in plasma remains within normal limits for some time, although their total number (red blood cells) decreases.

After two to three hours, thrombocytosis in the blood is still observed, but tests show the appearance of neutrophilic leukocytosis. A high level of thrombocytosis and a short period during which the blood clots are a criterion indicating heavy blood loss. Next comes a decrease in the number of red blood cells and hemoglobin. This is an indicator of the development of normochromic posthemorrhagic anemia.

After five to six days from the critical moment, the number of reticulocytes increases (the formation of young leukocytes). If no repeated bleeding is observed during this period, then after a couple of weeks, the composition of the peripheral blood returns to normal, as tests show. If posthemorrhagic anemia was observed in severe form, then 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 restoration is quite slow. During this period, the active appearance of new red blood cells in the red bone marrow is also visible.

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

, , , , ,

Treatment of posthemorrhagic anemia

If light form While posthemorrhagic anemia can be treated at home, its acute manifestations must be stopped only in a hospital setting. The main goal of all measures taken is to stop blood loss and restore normal, full blood circulation.

The first stage of treatment is to stop the bleeding. A drop in hemoglobin level 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 the content of red blood cells by at least a third. There is an urgent need to replenish 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 of a 5% solution. Reopolyglucin (and analogues) are not used in this situation, as they reduce blood clotting ability, which can provoke re-bleeding.

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

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

Divalent iron is most often 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 posthemorrhagic anemia, the following iron-containing drugs are used:

• Feramide is a drug based on a compound of nicotinamide and ferric chloride. The dose is taken three times a day, 3÷4 tablets. The disadvantage of this drug is the low iron content in the tablet. To get the maximum effect, you need to take ascorbic acid along with the medicine.
• Conferon – 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. Prescribed after meals, 1÷2 tablets three times a day.
• Ferroplex is a combination of ferrous sulfate and ascorbic acid. The dose is 2÷3 tablets three times a day. The tolerability and absorption properties of the drug are excellent.
• Ferroceron. The basis of the drug - sodium salt ortho-carboxybenzoylferrocene. The medicine is well absorbed by the gastrointestinal mucosa. Take 1÷2 tablets three times a day. Easy to carry. Along with this medicine, hydrochloric and ascorbic acid. It is absolutely necessary to remove lemons and other acidic foods from food.

Other drugs are also used.

Nutrition plays an important role in the treatment of posthemorrhagic anemia. An anemic patient should include in his diet foods containing a large number of iron and proteins. This includes meat, egg whites, fish, cottage cheese... At the same time, remove fatty foods from your diet.

Prevention

Prevention of posthemorrhagic anemia must begin, no less, in the womb. If the mother of the unborn child suffers from iron deficiency, the newborn will be born already having the same problem. Therefore, it is necessary to first eliminate this problem in a pregnant woman. Then, the already born child should receive natural, rational and natural feeding. It is necessary that the baby is surrounded by a normal healthy environment. Constant monitoring by a pediatrician is also needed so as not to miss the development of rickets, infectious diseases and dystrophy.

A special risk group for iron deficiency includes children born from an anemic mother, premature babies and babies from multiple pregnancies, as well as infants receiving artificial, irrational feeding and growing rapidly. For such children, the pediatrician usually prescribes iron supplements or infant formula containing a higher percentage of this element.

For children in the first year of life, as a preventive measure for posthemorrhagic anemia, it is necessary to include vegetables and fruits, cereals and herbs, meat and fish, milk and cheeses in their diet. That is, diversify your diet. To maintain the content of auxiliary elements (copper, manganese, cobalt, zinc) within normal limits, it is necessary to give the baby beets, yolks and fruits (apples, peaches, apricots). And the child is also obliged to receive the necessary amount of fresh air - walks on fresh air required. Protect children from contact with harmful chemicals, especially volatile ones. Medicines Use only as prescribed by a doctor and under his supervision.

Prevention of anemia for an adult is similar to that for children. These are the same foods rich in iron and microelements, as well as active correct image life, fresh air.

IN childhood The use of iron supplements prophylactically 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 must 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 actions with posthemorrhagic anemia are not as complicated as it might seem. Just live, eat well, actively spend your time in nature with your family and friends, and this trouble will bypass you. But if something irreparable has happened and trouble has come to your home, don’t panic, call the doctors and fight with them. After all, life is beautiful and worth this struggle.

[48 ], , , , , ,

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

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

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

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

Main symptoms

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

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

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

Acute form

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

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

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

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

Chronic form

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

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

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

Diagnostic methods

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

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

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

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

Treatment with drugs and folk remedies

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

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

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

For prolonged bleeding:

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

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

Diet and traditional treatment

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

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

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

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

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

Help prevent the development of posthemorrhagic anemia and its relapses preventive measures:

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