Chronic posthemorrhagic anemia: causes, symptoms, diagnosis, treatment

Chronic posthemorrhagic anemia develops as a result of prolonged recurrence of neonatal bleeding and is the main cause of iron deficiency conditions.

[1], [2], [3]

Causes of chronic posthemorrhagic anemia

Causes of repeated small hemorrhage can be the following pathological conditions:

1. Diseases of the gastrointestinal tract: erosive and ulcerative lesions of the gastrointestinal tract, polyposis, diaphragmatic hernia, duplicate mucosa, diverticulosis and others.
2. Helminthiases: trichocephalosis, ankylostomiasis, ascaridosis.
3. Tumors (including glomus).
4. Kidney diseases: chronic glomerulonephritis, urolithiasis.
5. Diseases of the lung: Syndrome Celena - Gellerstedt (hemosiderosis of the lungs).
6. Diseases of the liver: cirrhosis with the development of portal hypertension syndrome, hepatic insufficiency.
7. Uterine blood loss: menorrhagia of various genesis, dysfunctional uterine bleeding, endometriosis, uterine myoma and others.
8. Pathology of the hemostatic system: hereditary and acquired thrombocytopathy, coagulopathy, vasopathy.
9. Iatrogenic hemorrhage: frequent blood fetuses for research, blood loss during extracorporeal methods of treatment (hemodialysis, plasmapheresis).

In newborns of the first week of life, the most frequent cause of chronic posthemorrhagic anemia is fetomaterin transfusions. Fetomaternal transfusions are diagnosed in about 50% of pregnant women, but significant volumes of fetal blood loss (> 30 ml) are found in 1% of cases. Fetomaterin transfusions are considered the only cause of true iron deficiency anemia in newborns. The diagnosis is based on the detection of fetal erythrocytes in the mother's bloodstream and the detection of an elevated level of fetal hemoglobin in her blood. For diagnosis, the Kleinhauer-Betke test is used, based on the phenomenon of leaching of HbA from erythrocytes in citrate-phosphate buffer. After appropriate treatment of the mother's peripheral blood smear, erythrocytes with HbF (red blood cells of the fetus) are visible as bright red, while erythrocytes with HbA (that is, maternal) are like pale cellular shadows.

The cause of the development of chronic posthemorrhagic anemia in newborns can be postpartum haemorrhages, repeated blood sampling for laboratory tests. Postpartum hemorrhages in internal organs and the brain develop due to obstetric birth trauma and disorders in the hemostatic system (hereditary and acquired coagulopathies, thrombocytopenia, DIC syndrome), as well as against perinatal pathology (asphyxia, intrauterine and acquired infections).

Chronic posthemorrhagic anemia is characterized by slow development. Children relatively easily suffer chronic blood loss. The child's organism thanks to compensatory mechanisms is more easily adapted to chronic blood loss than to acute blood, despite the fact that the total amount of lost blood can be significantly greater.

In the study of erythron kinetics, it was established that in the case of chronic posthemorrhagic anemia, erythron proliferative activity decreases, ineffective erythropoiesis increases, and the life span of erythrocytes shortens. Compensation of anemia (taking into account the transition to a lower level of peripheral blood) is achieved by expanding the base of hematopoiesis. As a result of chronic blood loss, the iron depot is constantly depleted and sideropenia develops. Due to iron deficiency, various hypovitaminoses develop (B, C, A); the exchange of microelements is disrupted (in the erythrocytes the concentration of copper decreases, the level of nickel, vanadium, manganese, zinc increases).

[4], [5], [6], [7]

Symptoms of chronic posthemorrhagic anemia

Depends on the severity of anemia. At a hemoglobin level of 90-100 g / l, children feel satisfactory and anemia can go unnoticed for a long time.

The clinic of chronic posthemorrhagic anemia is equivalent to the clinic of iron deficiency anemia. Children complain of weakness, dizziness, noise in the ears, impaired appetite, reduced tolerance to physical activity. Skin pale with a waxy shade or porcelain-pale. Mucous pale. Typical dryness and roughness of the skin, seizures, smoothed papillae of the tongue, softness and increased fragility of nails and hair. Possible puffiness of the face, pastosity of the shins. Some patients have subfebrile condition. The boundaries of the heart are shifted to the left, the systolic murmur, the tachycardia, on the jugular veins - "the noise of the top" is heard. Blood pressure can decrease moderately.

Clinic of chronic posthemorrhagic anemia in newborns: pallor of the skin and mucous membranes, moderate tachycardia with tender systolic murmur on the apex of the heart, tachypnea. The liver and spleen can be enlarged by developing foci of extramedullary hematopoiesis in them. In this case, if posthemorrhagic anemia is caused by hemorrhage to the abdominal organs (adrenal glands, liver, spleen), the clinical picture can be, as it were, two-stage - moderately pronounced signs of anemia are replaced on the 3-5th day of life due to a sharp increase in hematoma and organ rupture, the development of the post-hemorrhagic shock clinic and the clinic of obstruction or adrenal insufficiency.

Diagnosis of chronic posthemorrhagic anemia

In clinical blood analysis, hypochromic normo- or moderately hyperregenerative anemia. There is microcytosis, anisocytosis, poikilocytosis. Characterized by leukopenia with relative lymphocytosis.

The level of iron in the blood serum is reduced, the total and latent iron binding capacity of the serum is increased, the transferrin saturation ratio is lowered.

On the ECG - the amplitude of the P and T waves is reduced, signs of a disturbance in myocardial nutrition.

Having diagnosed chronic posthemorrhagic anemia, it is very important to find out its cause. The direction and nature of the surveys are determined individually, taking into account clinical and anamnestic data. In all patients, regardless of the history and clinical picture, it is necessary five times to examine the feces for eggs of helminths.

[8], [9]

Treatment of chronic posthemorrhagic anemia

The treatment is primarily aimed at eliminating the source of bleeding and restoring the balance of iron.

The patient's diet is enriched with foods containing high amounts of iron, vegetables, fruits. The amount of protein in the diet is increased by 0.5-1 g / kg of the patient's weight in comparison with the age norm.

In chronic posthemorrhagic anemia, indications for hemotransfusions are established based on the general condition of the patient and clinical symptoms: resistance to iron therapy, pronounced anemia progression (Hb <70 g / l, Ht <0.35 l / l), cardiopulmonary insufficiency with symptoms of hypoxia, lack of compensatory and regulatory mechanisms. Newborns with chronic posthemorrhagic anemia of transfusion of erythrocyte mass (10-15 ml / kg) are shown at the level of Hb <100 g / l at the 1st week of life and below 81-90 g / l in the future.

Prescribe treatment with iron, vitamin therapy.

Forecast

In chronic posthemorrhagic anemia, the prognosis depends on the ability to treat the underlying disease, the timeliness of iron prescription, the rationality of the regimen, and the diet.

[10], [11], [12]