Diagnosis of acute posthemorrhagic anemia in children

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. This is also due to the fact that there is a parallel loss of both shaped elements and blood plasma. Early signs of hemorrhage are leukocytosis with neutrophilia and left shift and thrombocytosis, which are noted already in the first hours after the blood loss. Severe anemia after blood loss is not immediately apparent, but after 1-3 days, when the so-called hydromic phase of compensation occurs, characterized by the entry of a tissue fluid into the circulatory system. In this phase, the number of erythrocytes and hemoglobin progressively decreases, the true degree of anemia is detected without reducing the color index, that is, the anemia is of normochromic nature and is normocytic. After 4-5 days after hemorrhage, the medullary phase of compensation begins. It is characterized by the presence in the peripheral blood of a large number of reticulocytes, and in young children, normocytes may appear. It has been established that in the acute posthemorrhagic anemia, the proliferative activity of the bone marrow significantly increases - effective erythropoiesis increases approximately 2-fold compared with the norm. These changes are explained by the increased production of erythropoietins in response to hypoxia. Simultaneously with high reticulocytosis in peripheral blood, young cells of the granulocyte series are detected, there is a shift to the left, sometimes to metamyelocytes and myelocytes against the background of leukocytosis. The recovery of the mass of erythrocytes occurs within 1-2 months, depending on the volume of blood loss. At the same time, the reserve stock of the body's iron is spent, which is restored after a few months. This can lead to the development of latent or apparent iron deficiency, in which in the peripheral blood may be noted microcytosis, red blood cell hypochromia.

In neonates, a comprehensive clinical and laboratory assessment of the severity of anemia is important. In newborns of the first week of life, the criteria for anemia are: the Hb level is below 145 g / l, the number of red blood cells is less than 4.5 x 10 ¹² / l, Ht is less than 40%. For the diagnosis of anemia, the same indices are used in the second week of life, at the 3rd week and later anemia is diagnosed with a hemoglobin level <120 g / l, the number of red blood cells is less than 4 x 10 ² / l. If a history of a newborn has risk factors for the development of posthemorrhagic anemia, a complete clinical blood test is necessary at birth and then the level of hemoglobin and hematocrit should be determined in the first day of life every 3 hours after. In the analysis of peripheral blood, the level of hemoglobin and the number of erythrocytes may initially be even normal, but after a few hours as a result of hemodynamics decrease. Anemia is normochromic, there may be thrombocytosis, leukocytosis with a shift to the left. In post-hemorrhagic shock, the BCC is always below 50 ml / kg of body weight, and the central venous pressure (CVP) is below 4 cm of water. Art. (0.392 kPa) up to negative values.

[1], [2], [3], [4], [5], [6]