Acute posthemorrhagic anemia in children

Acute posthemorrhagic anemia is a condition that develops as a result of a single massive blood loss.

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Reasons

The causes of acute posthemorrhagic anemia in children in the neonatal period may be fetomaternal transfusions (spontaneous, caused by external rotation of the fetus behind the head, traumatic amniocentesis), intraplacental, retroplacental, intertwin bleeding.

Causes of acute posthemorrhagic anemia in children

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Symptoms

Minor blood loss in older children does not cause pronounced clinical symptoms and is tolerated relatively well. Significant blood loss is tolerated worse by children than by adults. Newborns tolerate rapid blood loss especially poorly. A loss of 10-15% of the circulating blood volume (CBV) in a newborn causes symptoms of shock, whereas in adults a loss of 10% of the CBV is compensated for independently, without pronounced clinical disorders. In older children, a loss of 30-40% of the CBV leads to shock. A sudden loss of 50% of the CBV is incompatible with life. At the same time, if the bleeding is relatively slow, a child can tolerate a loss of 50% of the CBV or even more.

The clinical picture of acute posthemorrhagic anemia consists of two syndromes - collapse and anemic, caused by a sharp decrease in the BCC. Signs of the collapse syndrome prevail over the anemic one. There are clear relationships between the degree of hypovolemia and the stage of hemodynamic impairment. Centralization of blood circulation occurs with a BCC deficit equal to 25% of the age norm (15 ml/kg), the transitional stage - at 35% (20-25 ml/kg), and decentralization - at 45% (27-30 ml/kg). Signs of hemodynamic decompensation: tachycardia, arterial hypotension, pale skin and mucous membranes, sticky sweat, clouded consciousness.

Symptoms of acute posthemorrhagic anemia in children

Diagnostics

The diagnosis of acute posthemorrhagic anemia and hemorrhagic shock is established based on a combination of anamnestic, clinical and laboratory data. Of primary importance are clinical data, pulse rate, arterial pressure, and diuresis.

The hematological picture of acute posthemorrhagic anemia depends on the period of blood loss. In the early period of blood loss (reflex vascular phase of compensation), due to the entry of deposited blood into the vascular bed and a decrease in its volume as a result of reflex narrowing of a significant portion of the capillaries, the quantitative indicators of erythrocytes and hemoglobin in a unit of blood volume are at a relatively normal level and do not reflect true anemia.

Diagnosis of acute posthemorrhagic anemia in children

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Treatment

Treatment of a patient with acute blood loss depends on the clinical picture and volume of blood loss. All children with clinical or anamnestic data suggesting blood loss of more than 10% of the BCC are subject to hospitalization.

How is acute posthemorrhagic anemia treated in children?

The circulating blood volume and hemodynamic parameters should be assessed immediately. It is extremely important to repeatedly and accurately determine the main parameters of central hemodynamics (heart rate, blood pressure, and their orthostatic changes). A sudden increase in heart rate may be the only sign of recurrent bleeding (especially in acute gastrointestinal bleeding). Orthostatic hypotension (a decrease in systolic blood pressure > 10 mm Hg and an increase in heart rate > 20 bpm when moving to a vertical position) indicate moderate blood loss (10-20% of the CBV). Arterial hypotension in the supine position indicates significant blood loss (> 20% of the CBV).

Forecast

The prognosis for acute blood loss depends on the underlying disease that caused the bleeding, the magnitude and speed of blood loss, and the age and individual characteristics of the child’s body.

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