Acute posthemorrhagic anemia in children
Last reviewed: 23.04.2024
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Causes
The causes of acute posthemorrhagic anemia in children during the newborn period can be fetomaterin transfusions (spontaneous, caused by an external turn of the fetus by the head, traumatic amniocentesis), intraplacental, retroplacental, interbreeding bleedings.
Symptoms
Small blood loss in older children does not cause severe clinical symptoms and is relatively well tolerated. Significant loss of blood by children is tolerated worse than adults. Newborns are particularly poor in tolerating rapid blood loss. The loss of 10-15% of the circulating blood volume (BCC) in a newborn causes shock symptoms, whereas in adults the loss of 10% of BCC is compensated for independently, without significant clinical disorders. In older children, the shock is caused by a loss of 30-40% of BCC. The sudden loss of 50 % of bcc is incompatible with life. At the same time, if the bleeding occurs relatively slowly, the child is able to suffer a loss of 50% of the BCC and even more.
The clinical picture of acute posthemorrhagic anemia consists of two syndromes - collaptoid and anemic, caused by a sharp decrease in BCC. Symptoms of a collapoid syndrome predominate over anemic. Between the degree of hypovolemia and the stage of hemodynamic disorders, there are clear relationships. Blood circulation centralization occurs with a BCC deficiency 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 decompensation of hemodynamics: tachycardia, arterial hypotension, pallor of the skin and mucous membranes, sticky sweat, clouded consciousness.
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Diagnostics
Diagnosis of acute posthemorrhagic anemia and hemorrhagic shock is established on the basis of a set of anamnestic, clinical and laboratory data. The main importance is the clinical data, heart rate, blood pressure, diuresis.
The hematological picture of acute posthemorrhagic anemia depends on the period of hemorrhage. In the early period of blood loss (reflex vascular phase of compensation) due to the receipt of deposited blood in the vascular bed and the decrease in its volume as a result of reflex narrowing of a significant part of the capillaries, the quantitative parameters of erythrocytes and hemoglobin per unit volume of blood are at a relatively normal level and do not reflect true anemization.
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 the amount of blood loss. All children who are clinically or anamnestic data are expected to be hospitalized for blood loss of more than 10% of BCC.
What is the treatment for acute posthemorrhagic anemia in children?
The volume of circulating blood and the parameters of hemodynamics should be evaluated immediately. It is extremely important to repeatedly and accurately determine the main indicators of central hemodynamics (heart rate, blood pressure and their orthostatic changes). A sudden increase in heart rate may be the only sign of recurrence of bleeding (especially with acute gastrointestinal bleeding). Orthostatic hypotension (a decrease in systolic blood pressure> 10 mm Hg and an increase in heart rate> 20 bpm when passing to the vertical position) indicate moderate blood loss (10-20% BCC). Arterial hypotension in the supine position indicates a large blood loss (> 20% BCC).
Forecast
The prognosis for acute blood loss depends on the underlying disease, on the basis of which bleeding has occurred, massive and rapid blood loss, age and individual characteristics of the child's body.
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