Posthemorrhagic anemia

Posthemorrhagic anemia is a deficiency of iron-containing elements in human blood plasma. Anemia caused by 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 as a result of sudden, abundant 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: "Anemias 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 hemorrhage - code P61.3

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Causes posthemorrhagic anemia

The etiology of the occurrence of blood deficiency in the body can be:

• An injury resulting in damage to the integrity of blood vessels, especially large arteries.
• Surgical intervention. Any surgical intervention is always a risk. When starting even a seemingly simple operation for an ordinary person, 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 bleeding occurs inside the body and externally it can be recognized by an amateur by some signs and an ambulance can be called in time. Otherwise, delay can result in a fatal outcome for the patient.
• Violation of hemostasis. This factor is designed to maintain blood in a liquid state, responsible for the blood coagulability index, which makes it possible to maintain the volume of circulating blood within normal limits and normalize the composition ("formula") of the blood.
• Ectopic pregnancy. This pathology is accompanied by acute profuse bleeding in women, which leads to acute posthemorrhagic anemia.
• Lung diseases. This type of bleeding is manifested by scarlet discharge of liquid or clotted consistency that occurs during coughing.

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Pathogenesis

Pathogenesis, or the sequence of emerging phenomena, are the phenomena of vascular insufficiency, due to the abrupt emptying of the blood (plasma) of the vascular bed. These factors lead to a shortage 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 more active work of the heart.

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Symptoms posthemorrhagic anemia

Knowledge will not 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 profuse blood loss, vascular manifestations come to the fore: shortness of breath, rapid heartbeat (tachycardia), and falling blood pressure (both arterial and venous).
• The patient's skin and mucous membranes become pale.
• The patient begins to feel darkening in the eyes, ringing in the ears and slight dizziness.
• A gag reflex may occur.
• A sharp dry mouth can be considered an acute sign of internal bleeding. The severity of the clinic is determined not only by the total volume of sweat, but also by the speed at which the victim loses blood.
• The location of the injury is also an important factor. Thus, damage to the gastrointestinal tract is accompanied by a sharp increase in body temperature.
• Obvious signs of intoxication.
• Increases its indicators and the level of residual nitrogen in plasma (while the urea indicator remains normal).
• Even with small amounts of internal bleeding, the patient feels pressure on the organs.
• Fecal discharge can also be an indicator of internal damage. Due to the blood that is excreted, it is colored black.

Acute posthemorrhagic anemia

If a person loses an eighth of the total volume of working blood due to an injury (which results in damage to a large artery), an operation, or an exacerbation of any disease, 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 the value of arterial pressure, paleness of the skin and mucous membrane, tachycardia. A sudden lack of oxygen supplied to the organs leads to spasms of peripheral vessels. In order to prevent a further drop in pressure, the body opens arteriole-venular shunts, leading to the removal of plasma from the organs. Such self-therapy works on an adequately compensatory return of blood fluid to the heart.
2. Hydremic stage. After three to five hours, a basis for hydremic compensation is created, caused by the flow of fluid from the interstitial area into the blood vessels. At the same time, certain receptors are irritated, which are included in the work of maintaining the volume of fluid circulating in the vessels. Increased synthesis of aldosterone puts a barrier in the excretion 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 erythrocytes and hemoglobin. This compensation stage can last for two to three days.
3. Bone marrow stage – this stage occurs four to five days after bleeding. Hypoxia progresses. Erythropoietin levels increase. The number of newly formed erythrocytes (reticulocytes) with a reduced hemoglobin level increases in the peripheral blood. The characteristic of this stage becomes hypochromic. In addition, a sharp lack of blood causes a decrease in iron in the blood.

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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 small portions. This type of anemia can be observed in a number of diseases. For example, such as: bowel cancer, ulcerative disease 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 is classified as posthemorrhagic anemia by etiology, and by pathogenesis, this pathological condition can be classified as iron deficiency anemia.

Medicine also classifies ankylostomal anemia, which manifests itself as a result of invasion (penetration) of protozoa of the class of nematodes into the patient's body, into this category. These parasites attach themselves to the intestinal walls, injuring them, which causes bleeding, or suck the blood from their host, which is food for them.

Based on this, the main goal of therapy for posthemorrhagic anemia, in any form, is to fully restore the blood plasma circulating in the vessels, and, as a consequence, to overcome iron deficiency and erythropoiesis deficiency. But this is "first aid" for the body. After emergency resuscitation, it is necessary to pay attention to the root cause that prompted the bleeding. Or, more simply, it is necessary to begin treating the underlying disease.

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Posthemorrhagic iron deficiency anemia

Today, doctors state that posthemorrhagic iron deficiency anemia is becoming quite widespread. In short, iron deficiency anemia is a condition of the body characterized by a pathological deficiency 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 reserve, where the body accumulates everything necessary in reserve. As a result, a failure occurs in the heme synthesis system, a deficiency in myoglobin and tissue enzymes is formed.

Modern statistical studies 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 are found 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, iron deficiency in adults 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 "began donating blood frequently." Moreover, as strange as it may sound, such deviations occur in female donors.

In women, the causes of the disease may be uterine bleeding, pregnancy itself, and painful, pathological disruptions in the menstrual cycle. Laboratory studies show that posthemorrhagic anemia with iron deficiency can also be caused by uterine fibroids, which contribute to the leaching of iron and the subsequent appearance of anemic symptoms.

The second most common disease is blood loss due to acute gastrointestinal diseases, which are quite difficult to diagnose at early stages. Pulmonary hemorrhages are a fairly rare manifestation of iron deficiency, as is blood loss from the urinary tract and kidneys.

Newborns and infants may suffer from iron deficiency due to abnormal placenta presentation or damage to the placenta during surgery (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 can also be the meagerness of the diet. The baby simply does not receive a sufficient amount of the element together with the products that he eats. Also, the cause of anemia can be a lack of iron in the mother during her pregnancy, as well as in premature babies or children from twins, triplets... Quite rarely, but the cause of this disease can also be a mistake of the obstetrician, who, without waiting for the pulsation to stop, cut the umbilical cord too early.

It is also worth considering the situation when (for example, during heavy physical exertion, pregnancy, etc.) the body's need for it increases sharply. Therefore, the likelihood of posthemorrhagic iron deficiency anemia increases.

Deficiency of this element in the body causes significant harm to the human immune system. But, strange as it may sound, patients suffering from iron deficiency are less likely to suffer 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 iron deficiency in the blood is indicated by changed eating habits. For example, a previously unnoticed craving for spicy or salty foods appears.

Doctors also highlight the psychological aspect of iron deficiency. It often occurs in people who don't 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 to, but rather inhibits the metabolic processes that occur in the body. Having conducted a study, scientists have established that, as a rule, deep depression and psychological trauma are behind all this.

Today, medicine is equipped with a fairly large arsenal of iron preparations: conferon, feramide, zhektofer, sorbifer and many 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) children.

Posthemorrhagic anemia in children

Posthemorrhagic anemia in children occurs quite often and, as in adults, can be acute (quite common) and chronic (less common).

Newborns are quite vulnerable. They often develop posthemorrhagic anemia due to birth trauma or may even develop due to excessive blood sampling during laboratory tests. In older and middle-aged children, the main cause of anemia is often helminths, which, by attaching themselves to the wall of the gastrointestinal tract, injure the body and provoke microbleeding.

The first signs of bleeding in infants can be noticed within half an hour after the onset. In older children, they appear the next day or a little later (this does not apply to acute spontaneous bleeding). Chronic manifestations of the disease occur in children of any age much less often. These are, as a rule: ulcerative diseases of the gastrointestinal tract, varicose veins, urolithiasis, polyps, parasitic invasion, nephritis, hemorrhagic diathesis, congenital or acquired thrombosis.

Symptoms that should raise alarm in parents:

• The same as in adults.
• But the first symptoms are lethargy, loss of appetite, growth retardation, and the baby begins to gain weight less well.
• One of the primary signs of the initial stage of the disease may be a change in the baby's taste preferences, to the point that children strive to eat earth, chalk, clay... This is the result of iron deficiency and a lack of mineral components in the baby's body. Sometimes these changes are not so radical.
• There is also a change in behavior. Babies become capricious and whiny, or, on the contrary, apathetic.
• There are also manifestations by external signs: brittle hair and nails, peeling skin.
• "Varnished" smooth tongue.
• In teenage girls, menstrual cycle irregularities.
• Quite often, complications of an infectious nature are observed against the background of posthemorrhagic anemia: otitis, pneumonia...

The first thing that needs to be done in a situation where a child is in a state of hemorrhagic shock is resuscitation measures to stop bleeding and anti-shock therapy. Blood substitutes are administered by jet and drip. During this period, the baby's blood type and Rh factor are determined. Resuscitation is carried out with fresh citrated blood. If there is none, a direct transfusion from a donor is carried out. In parallel with this, support for the cardiovascular system with glycosides is carried out and a diet rich in protein and vitamins is prescribed.

Treatment of posthemorrhagic anemia in children comes down to identifying and treating the underlying cause of bleeding, that is, the disease that caused the blood loss.

Stages

Doctors also have a so-called working classification of 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 the red blood cells are higher than 3 t/l – mild stage.
• with hemoglobin content in the blood within 100÷66 g/l and erythrocytes above 3÷2 t/l – average stage.
• if the hemoglobin content in the blood is less than 66 g/l – severe stage.

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Posthemorrhagic anemia of mild degree

Early detection of the disease allows the child to get back on his feet in a shorter period of time. At a mild stage of the disease, iron-containing drugs are sometimes enough to replenish the lack of iron in the body. The course of treatment often lasts three months or more. 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 hospital conditions can a patient receive qualified and full medical care, and there is no point in delaying this. In this situation, "delay is like death."

Having received the patient, the doctors, first of all, must do everything to stop the bleeding, while trying to replenish the blood loss by any means. To obtain the maximum hemodynamic effect (bringing the patient out of shock, obtaining higher blood pressure readings, etc.), they transfuse at least half a liter of polyglucin (artificial plasma substitute). In the acute traumatic form, this drug is administered primarily by jet stream, while the doctor is obliged to monitor the blood pressure figure. If the pressure was brought to the 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 the bleeding has stopped and the main shock symptoms have been relieved, the medical staff proceeds to the further, planned protocol for bringing the patient out of the anemic state.

Diagnostics posthemorrhagic anemia

It is impossible to imagine modern medicine without laboratories and modern medical equipment. But without highly professional specialists, no equipment will help. And in the case of diagnostics of 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. The basic ones are clinical indicators.

But in the process of treatment, for a more accurate diagnosis and identification of the causes of the disease, the doctor sometimes needs to resort to additional scientific indicators:

• Analysis of feces to detect hidden blood.
• Checking stool for helminths or other parasites.
• Determination of the acidity level of gastric juice pH.
• Conducting a scientific study to identify hidden bleeding by introducing the isotope 59 Fe into the body. Working with feces.
• A set of gynecological measures.
• Ultrasound examination, X-ray diagnostic measures to identify ulcerative manifestations or erosions in the gastrointestinal tract, tumors, varicose veins of the esophagus and other diseases that can cause internal bleeding.
• Proctological area. Detection or exclusion of hemorrhoids, ulcerative colitis or rectal cancer.

Having an external source of bleeding, it is not difficult to make a clear diagnosis, it is more difficult to diagnose it with internal bleeding. The main thing is to accurately determine the place of bleeding.

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Blood test for posthemorrhagic anemia

The first thing that doctors need to do is to urgently perform a comprehensive 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 time period during which blood clotting occurs, which is quite important in case of blood loss. The level of red blood cells and hemoglobin in the plasma remains within the normal range for some time, although their total number (red blood cells) decreases.

After two to three hours, thrombocytosis in the blood is still observed, but the tests show the appearance of neutrophilic leukocytosis. A high level of thrombocytosis and a short period during which the blood clots is a criterion showing abundant blood loss. Next comes a decrease in the number of erythrocytes and the hemoglobin index. 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 (new leukocytes are formed). If no repeated bleeding is observed during this period, then after a couple of weeks, the composition of the peripheral blood normalizes, which is what the tests show. If posthemorrhagic anemia was observed in a severe form, then the recovery period will be longer.

Even in the case of a single acute hemorrhage, biochemical analysis shows a sharp drop in the iron level in the plasma. With small reserves of this element in the body itself, its quantitative restoration is quite slow. During this period, the active appearance of new erythrocytes in the red bone marrow is also visible.

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

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Treatment posthemorrhagic anemia

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

The first stage of treatment is to stop bleeding. A drop in hemoglobin to 80 g/l and below (8 g%), plasma hematocrit below 25%, and protein below 50 g/l (5 g%) are indications for transfusion therapy. During this period, it is necessary to replenish at least a third of the red blood cell count. It is necessary to urgently replenish the plasma volume. In this regard, the patient receives colloidal solutions of polyglucin or gelatinol by transfusion. If such solutions are unavailable, they can be replaced with 1000 ml of glucose (10%), and then 500 ml of a 5% solution. Rheopolyglucin (and analogues) are not used in this situation, as they reduce the coagulability of the blood, which can provoke repeated bleeding.

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

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

Ferrum-containing preparations are used both in the form of injections and tablets, but necessarily in combination with ascorbic acid. The patient's body must also receive such microelements as copper, cobalt, manganese - they provoke higher rates of iron biosynthesis in the body, positively affecting the hemoglobin level.

Most often, divalent iron is 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. The following iron-containing drugs are used in the treatment of posthemorrhagic anemia:

• Feramide is a drug based on a compound of nicotinamide and iron chloride. It is taken three times a day, 3-4 tablets. The disadvantage of this drug is the small iron content in the tablet. To achieve the maximum effect, ascorbic acid should be taken with the drug.
• Conferon is a complex of sodium dioctyl sulfosuccinate and 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 iron sulfate and ascorbic acid. The dose is 2-3 tablets three times a day. The drug is highly tolerable and absorbable.
• Ferroceron. The basis of the drug is sodium salt of ortho-carboxybenzoylferrocene. The medicine is perfectly absorbed by the mucous membrane of the gastrointestinal tract. Take 1-2 tablets three times a day. Easily tolerated. Hydrochloric and ascorbic acids should not be introduced into the body together with this medicine. It is absolutely necessary to remove lemons and other sour foods from the diet.

Other drugs are also used.

Nutrition plays an important role in the treatment of posthemorrhagic anemia. A patient with anemia should include in their diet foods containing a large amount of iron and protein substances. This includes meat, egg whites, fish, cottage cheese... At the same time, remove fatty foods from their diet.

Prevention

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

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

For children of the first year of life, as a preventive measure against posthemorrhagic anemia, it is necessary to introduce vegetables and fruits, cereals and greens, meat and fish, milk and cheeses into the diet. That is, to diversify the diet. To maintain the content of auxiliary elements (copper, manganese, cobalt, zinc) within the normal range, it is necessary to give the baby beets, yolks and fruits (apples, peaches, apricots). And the child must also receive the necessary amount of fresh air - walks in the fresh air are mandatory. Protect children from contact with harmful chemicals, especially volatile substances. Use medications 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 an active healthy lifestyle and fresh air.

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Forecast

In most cases, doctors give a positive prognosis for posthemorrhagic anemia, with a few exceptions when the patient has lost too much blood and doctors are unable to stop and restore its circulation. In other cases, preventive measures and timely emergency care give the patient every chance of recovery.

In childhood, the use of iron preparations prophylactically not only prevents the development of iron deficiency in the child, but also reduces the percentage of his/her incidence of ARVI. In case of aggravated hereditary anemia, the doctor's prognosis directly depends on the frequency of the crises and their severity.

In any situation, you can't 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 measures for posthemorrhagic anemia are not as difficult as it may seem. Just live, eat well, actively spend your time outdoors with your family and friends, and this trouble will pass you by. But if the irreparable has happened and trouble has come to the house, do not panic, call the doctors and fight with them. After all, life is beautiful and worth this fight.

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