Post-hemorrhagic anemia

Posthemorrhagic anemia is the lack of iron-containing elements in human blood plasma. Anemia, which arose as a result of blood loss, is one of the most frequent anemias. Physicians 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 due to a sudden, abundant blood loss.

Dangerous to human life, the minimum amount of blood loss in an adult is 500 ml.

According to the International Classification of Diseases of the 10th revision, post-hemorrhagic anemia belongs to the category "Diseases of the blood, blood-forming organs and certain disorders involving the immune mechanism". Subsection: "Anemias associated with diet., Iron deficiency anemia." The classification of diseases with codes is as follows:

• Iron deficiency anemia secondary due to loss of blood (chronic) - code D50.0.
• Acute posthemorrhagic anemia - code D62. 
• Congenital anemia due to fetal blood loss - code P61.3

[1], [2], [3], [4], [5], [6], [7]

Causes of the posthemorrhagic anemia

The etiology of the lack of blood in the body can be: 

• Trauma, which resulted in a violation of the integrity of the vessels and primarily large arteries. 
• Surgical intervention. Any surgical intervention is always a risk. Coming to even a seemingly ordinary inhabitant, the simplest operation, the surgeon is not able to foresee all of 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 the bleeding occurs inside the body and externally it can be recognized by the dilettante on certain grounds and in time to call an ambulance. Otherwise, delay may result in a lethal outcome. 
• Violation of hemostasis. This factor is designed to maintain blood in a liquid state, answering for the index of blood coagulability, which makes it possible to maintain circulating blood volumes within the limits of normal and normalizing the composition ("formula") of the blood. 
• Ectopic pregnancy. This pathology is accompanied in women by acute heavy bleeding, which leads to acute posthemorrhagic anemia. 
• Pulmonary diseases. Such bleeding is manifested by secretions of a scarlet color of a liquid or bunchy consistency arising during a cough.

[8], [9]

Pathogenesis

Pathogenesis, or a sequence of emerging phenomena, is the phenomenon of vascular insufficiency, due to the sudden emptying of the bloodstream (plasma) of the vascular bed. These factors lead to a lack of erythrocytes, which carry oxygen, which, in turn, leads to a general oxygen starvation of the body. Independently this loss, due to more active work of the heart, the body can not make up for.

[10], [11], [12],

Symptoms of the 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 to call an ambulance on time. 

• With abundant blood loss, vascular manifestations come to the fore: dyspnea, heart palpitations (tachycardia), pressure indices (both arterial and venous) drop. 
• The skin and mucous membranes become pale. 
• The patient begins to feel a darkening in the eyes, a noise in the ears and a slight dizziness. 
• A vomitive reflex may appear. 
• Sharp dryness in the mouth can be considered an acute sign of internal bleeding. The severity of the clinic is determined not only by the general volumes of sweat, but also by the speed with which the victim loses blood. 
• An important factor is the place of injury. So the lesions of the gastrointestinal tract is accompanied by a sharp increase in body temperature. 
• Explicit manifestations of intoxication. 
• Increases its indices and the level of residual nitrogen in the plasma (while the urea index remains normal). 
• Even with small amounts of internal bleeding, the patient feels squeezing organs. 
• Indicator of internal damage can become and feces. Thanks to the withdrawn blood, they are painted black.

Acute posthemorrhagic anemia

If a person loses due to trauma (which results in damage to a large artery), an operation or an exacerbation of any disease, an eighth of the total volume of working blood, an acute form of posthemorrhagic anemia sets in .

Physicians differ in several stages of development of acute forms of anemia: 

1. Reflex-vascular stage. It is expressed by a sharp decrease in the value of blood pressure, blanching of the skin and mucous membrane, tachycardia. Sudden shortage of oxygen coming to the organs leads to spasms of peripheral vessels. To prevent further drop in pressure, the body opens arteriolo-venular shunts, which lead to the removal of plasma from the organs. This self-therapy works on an adequately compensating return of the blood fluid to the heart. 
2. Hydromechanical stage. After a lapse of three to five hours, a base is created for hydromic compensation, due to the flow of fluid from the interstitial region to the blood vessels. This causes irritation of certain receptors, which are included in the work to maintain the volume of fluid circulating through the vessels. The enhanced synthesis of aldosterone puts a barrier in excretion from the body of sodium, which stimulates water retention. However, this leads to a dilution of plasma, and as a consequence, a decrease in the content of red blood cells and hemoglobin. This stage of compensation can take place within two to three days. 
3. Bone marrow stage - this stage occurs four to five days after the bleeding. Progression of hypoxia. The indicators of erythropoietin increase. In the peripheral blood, the number of newly formed erythrocytes (reticulocytes) increases, with a reduced amount of hemoglobin. The characteristic of this stage becomes hypochromic. In addition, a sharp lack of blood causes a decrease in iron in the blood.

[13]

Chronic posthemorrhagic anemia

This type of anemia, chronic posthemorrhagic anemia, occurs in the patient, if he gradually, for some time, fractional blood loss. This kind of anemia can be observed in a number of diseases. For example, such as: intestinal cancer, duodenal ulcers or stomach ulcers, gingivitis, hemorrhoids, and many others. Frequent, but minor bleeding leads to a general exhaustion of the body. There is iron deficiency. In this regard, this pathology of etiology is attributed to posthemorrhagic anemia, pathogenesis, this pathological condition can be attributed to iron deficiency anemia.

To this category, medicine also includes ankylostomna anemia, which manifests itself as a result of the invasion (penetration) of the simplest class of nematodes into the patient's body. These parasites stick to the walls of the intestine, injuring it, causing bleeding, or sucking blood from their host, which is their food.

Proceeding from this, the main goal of therapy for posthemorrhagic anemia, in any form, is the restoration of the full volume of blood plasma circulating in the vessels, as well as, as a consequence, the overcoming of iron deficiency and the lack of erythropoiesis. But this is an "ambulance" for the body. After an emergency resuscitation, it is necessary to pay attention to the underlying cause that caused bleeding. And it is easier - it is necessary to transgress the treatment of the underlying disease.

[14], [15], [16], [17]

Posthemorrhagic iron deficiency anemia

To date, doctors have ascertained that post-hemorrhagic iron-deficiency anemia is beginning to take on a fairly wide spread. In short, iron deficiency anemia is a condition of the body that is characterized by a pathological shortage of iron ions. Moreover, the mass concentration of this element is reduced everywhere: in the blood plasma, in the bone marrow, and in the so-called storage room, where the body accumulates all the necessary supplies. As a result, a failure occurs in the gemma synthesis system, a deficiency in myoglobin and tissue enzyme is formed.

Modern statistical studies sound a figure of 50% - this is the number of people who suffer from anemia in one form or another. Compounds in which metals are found in nature are poorly absorbed, or not at all absorbed by the human body. If the balance in the intake of iron in the body and its use is disturbed, we get an iron deficiency anemia.

Most often in the adult population, iron deficiency can be associated with acute arisen or chronic blood loss. This diagnosis can occur, although rarely enough, with nasal bleeding, dental aspects of blood loss, as well as trauma ... There are also exceptional cases when zheozodefitsitnaya anemia developed in a donor who "became involved with blood loss". And, strange as it may sound, such deviations are found in female donors.

In women, the causes of the disease can serve as uterine bleeding, as well as pregnancy itself, as well as painful, pathological malfunctions in the menstrual cycle. Laboratory studies show that uterine fibroids may contribute to posthemorrhagic anemia with iron deficiency, which contributes to iron leaching and the subsequent appearance of anemic symptoms.

Second place in the frequency of diseases occupy blood loss in acute diseases of the gastrointestinal tract, which is diagnosed at early stages is problematic enough. Pulmonary bleeding is a rare enough manifestation of iron deficiency, as well as blood loss from the urinary tract and kidneys.

Newborns and infants may suffer from iron deficiency due to abnormal presentation of the placenta, or if it is damaged during surgical intervention (caesarean section). And also there are cases of intestinal bleeding, as manifestations of an infectious disease.

The reason for the lack of iron for older children may be the scarcity of the diet. The kid just does not get enough of the element along with the foods that he feeds on. Also, the cause of anemia may be a lack of iron in the mother during her pregnancy, as well as in premature babies or children from twins, triplets ... Rarely enough, the cause of this ailment may be the obstetrician's mistake, which, without waiting for the rupture to stop cut the umbilical cord early.

You should not bypass the situation, when (for example, with high physical exertion, pregnancy, etc.), the body's need for it sharply increases. Therefore, the probability of posthemorrhagic iron deficiency anemia increases.

The lack of this element in the body causes significant damage to the human immune system. But, strange as it may sound, patients suffering from iron deficiency suffer less infectious diseases. It's simple. Iron is an excellent nutrient medium for some bacteria. However, in the light of other problems, it is impossible to ignore the lack of iron in the human body. It is not uncommon for a shortage of iron in the blood to indicate a changed predilection in the diet. For example, there appears to be no previously observed craving for peppery or salty products.

Physicians also highlight the psychological aspect of iron deficiency. Often it occurs in people who do not care about their health, and, consequently, to themselves: diets, limited nutrition, lack of exercise, lack of fresh air, a minimum of positive emotions. All this does not contribute, but depresses those metabolic processes that go in the body. After the study, the scientists found that behind all this, as a rule, there is a deep depression, a psychological trauma.

To date, medicine is supplied with a fairly large arsenal in the form of iron preparations: conferon, feramide, gum, sorbite and quite a few others. There are also liquid forms, for example, maltofer, the degree of absorption, which depends on the level of iron deficiency in the body. This drug is approved for use even for newborns (even premature babies).

Posthemorrhagic anemia in children

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

Newborns are fairly vulnerable. They posthemorrhagic anemia often occurs with birth trauma or may occur even with excessive blood sampling during laboratory tests. In children of the senior and middle age, the main cause of anemia, often, are helminths, which, adhering to the wall of the gastrointestinal tract, injure the body and provoke microvulation.

The first signs of bleeding in infants can be noticed after half an hour after the beginning. In children of an older age, they manifest themselves on the next day or a little later (this does not apply to acute spontaneous bleeding). Chronic manifestation of the disease occurs in children of any age is much rarer. This, as a rule: gastrointestinal ulcer, varicose veins, urolithiasis, polyps, parasite infestation, nephritis, hemorrhagic diathesis, congenital or acquired thrombosis.

Symptoms on the basis of which parents should raise the alarm:

• Same as with adults. 
• But the first manifestations are lethargy, a decrease in appetite, there is a suspension in growth, and the baby begins to gain less weight. 
• One of the primary signs of the initial stage of the disease may be a change in the taste preferences of crumbs, up to the point that children tend to eat land, chalk, clay ... This is the result of iron deficiency and the lack of mineral constituents in the baby's body. Sometimes these changes are not so radical. 
• There is a change in behavior. Kids become capricious and whiny, or in contrast - apathetic. 
• There is also a manifestation according to external signs: brittle hair and marigold, skin peeling. 
• "Lacquered" smooth tongue. 
• In adolescent girls, interruptions in the menstrual cycle. 
• Quite often against the background of posthemorrhagic anemia, there are complications of an infectious nature: otitis media, pneumonia ...

The first thing to do in a situation where a child is in a state of hemorrhagic shock is resuscitation to stop bleeding and anti-shock therapy. Jet and drip are injected with blood substitutes. During this period, the baby's blood type and its Rh component are established. Resuscitation with fresh blood is carried out. If not available, direct transfusion from the donor is carried out. In parallel with this, glycosides are supported by the cardiovascular system and a diet rich in protein and vitamins is attributed.

Treatment of posthemorrhagic anemia in children is reduced in the identification and treatment of the underlying cause of bleeding, that is, the disease that caused the loss of blood.

Stages

Physicians also have a so-called, working classification of the stages of severity of anemia, which is determined on the basis of laboratory studies:

• with a hemoglobin content in the blood of more than 100 g / l and erythrocytes above 3 t / l - a mild stage.
• with a hemoglobin content in the blood in the range of 100 ÷ 66 g / l and erythrocytes above 3 ÷ 2 t / l - the middle stage.
• when the hemoglobin content in the blood is less than 66 g / l - a heavy stage.

[18]

Posthemorrhagic anemia of mild

An earlier detection of the disease makes it possible to put the baby on its feet in a shorter period of time. With an easy stage of the disease, iron-containing drugs are sometimes enough to fill 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 question is decided by the doctor, based on the patient's condition.

Posthemorrhagic anemia of severe severity

Posthemorrhagic anemia of a severe degree is unconditional hospitalization.

Only in inpatient settings can the patient receive qualified and full-scale medical care and do not hesitate to do this. In this situation, "the delay in the death is similar."

Having the patient at his disposal, physicians, first of all, should do everything to stop bleeding, while trying to fill up blood loss by any means. To obtain the maximum hemodynamic effect (excretion of the patient from the shock state, obtaining higher values of arterial pressure, etc.), transfusion is carried out not less than half a liter of polyglucin (artificial plasma substitute). In acute traumatic form this drug is injected primarily with a jet, while the doctor is required to control the figure of blood pressure. If the pressure could be brought to the values: systolic - 100 ÷ 110 mm, diastolic - 50 ÷ 60 mm, the dropper is transferred from the jet to the drip feed. The total dose of the injected solution can reach, if necessary, one and a half liters (maximum 2 ÷ 3 liters).

Only after stopping bleeding and removing the main shock symptom, the medical staff transgresses to a further, planned protocol for the patient's withdrawal from an anemic condition.

Diagnostics of the posthemorrhagic anemia

The present medicine can not be imagined without laboratories and modern medical equipment. But do not be highly professional specialists, no hardware will help. And in the case of diagnosing posthemorrhagic anemia, the situation is as follows: a diagnosis of acute or chronic posthemorrhagic anemia can be made on the basis of a combination of clinical, laboratory and anamnestic data. Basic - this is clinical indicators.

But in the process of treatment, for a more accurate diagnosis and detection of the causes of the disease, the doctor may need to resort to additional scientific indicators: 

• Analysis of feces to reveal hidden blood in them. 
• Checking feces for the detection of helminths or other parasites. 
• Determination of acidity level of gastric juice pH. 
• Conducting a scientific search for the detection of latent bleeding by introducing into the body the isotope 59 Fe. Working with feces. 
• Complex of gynecological measures. 
• Ultrasound examination, X-ray diagnostic measures to detect ulceration or erosions in the gastrointestinal tract, tumors, varicose veins of the esophagus and other diseases that can cause internal bleeding. 
• Proctologic area. Detection or elimination of hemorrhoids, ulcerative colitis or colorectal cancer.

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

[19], [20], [21], [22], [23]

Blood test for posthemorrhagic anemia

The first thing that physicians need to do is urgently to do a detailed blood test so that the level of blood loss and, consequently, the danger to the patient can be estimated. During the first half hour with acute blood loss, the number of platelets sharply increases, which leads to a shortening of the time interval for which blood clotting takes place, which is quite relevant in case of blood loss. The level of erythrocytes and hemoglobin in the plasma still remains within normal limits for some time, although their total number (erythrocytes) decreases.

After two to three hours, thrombocytosis is still present in the blood, but tests show the appearance of neutrophilic leukocytosis. A large level of thrombocytosis and a small gap for which the blood is folded is a criterion showing abundant blood loss. Then there is 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, there is an increase in the number of reticulocytes (the formation of young leukocytes). If there is no repeated bleeding during this period, then in a couple of weeks, the composition of the peripheral blood is normalized, which shows the analyzes. If posthemorrhagic anemia was observed in severe form, then the recovery period will be longer.

Even in the case of a single multiple acute bleeding biochemical analysis shows a sharp drop in the level of iron in the plasma. With a small amount of this element in the body, its quantitative recovery is rather slow. In this period, there is an active appearance of new red blood cells in the red bone marrow.

Clinical analysis during the period of illness shows the presence of leukopenia with a slight lymphocytosis. In connection with low iron levels, there is an increase in the ability to bind serum iron.

[24], [25], [26],

Treatment of the posthemorrhagic anemia

If the mild form of posthemorrhagic anemia can be treated at home, acute manifestations of it should be managed only under steady-state conditions. The main goal of all activities is to stop blood loss and restore the normative, in full, circulation of blood.

The first stage of treatment is the stop of bleeding. The drop in hemoglobin level to 80 g / l and below (8 g%), hematocrit of plasma - below 25%, and protein - less than 50 g / l (5 g%), is an indication for transfusion therapy. In this period, it is necessary to fill at least a third and the content of red blood cells. It is necessary to urgently fill the norm of the plasma volume. In this regard, the patient receives colloidal solutions of polyglucin or gelatin by transfusion. If such solutions are not available, they can replace 1000 ml of glucose (10%), and then 500 ml - 5% solution. Reopoliglyukin (and analogues) in this situation do not apply, as lower blood coagulation, which can provoke repeated bleeding.

To restore the level of erythrocytes, the patient receives an erythrocyte mass. In acute blood loss, when the number of platelets falls, physicians resort to direct transfusion or blood transfusion directly taken before the procedure.

To date, if blood loss during surgery is less than 1 L, red blood cell and transfusion is not used. There is no complete recovery of blood loss, since the danger consists in the possibility of a syndrome of disseminated intravascular coagulation, as well as an immune conflict.

Ferrux-containing preparations are used both in the form of injections, and tableted, but without fail in combination with ascorbic acid. The organism of the patient should also receive such microelements as copper, cobalt, manganese - they provoke higher rates of biosynthesis in the body of iron, positively affecting the level of hemoglobin.

Most often in medicine use iron bivalent. Medicines based on it are taken by the patient as prescribed by the doctor, either 1 hour before the meal or 2 hours after eating. In the treatment of posthemorrhagic anemia, iron-containing preparations are used:

• Feramid is a drug that is based on the combination of nicotinamide and ferric chloride. Reception is carried out three times a day for 3 ÷ 4 tablets. The disadvantage of this drug is a small amount of iron in the tablet. To get the maximum effect, together with the medicine you need to take and ascorbic acid.
• Conferon is the complex sodium content of dioctyl sulfosuccinate with iron sulfate. Form release - capsules. This drug is well absorbed by the intestinal mucosa. Take it 3 times a day for 1 ÷ 2 capsules. Additional intake of ascorbic acid is not required.
• Ferrocal. The composition is iron sulfate with calcium fructosodiphosphate. It is attributed after eating 1 to 2 tablets three times a day.
• Ferroplex is a combination of ferrous sulfate and ascorbic acid. Admission is 2 to 3 pills three times a day. The tolerability and absorbed properties of the drug are excellent.
• Ferrocerone. The base of the preparation is the sodium salt of ortho-carboxybenzoylferrocene. The medicine is perfectly absorbed by the mucosa of the gastrointestinal tract. It is taken three times a day for 1 ÷ 2 tablets. Easy to carry. Together with this medicine it is impossible to inject hydrochloric and ascorbic acids into the body. Categorically it is necessary to remove from the food lemons and other acidic food.

Apply, as well as other drugs.

Nutrition in the treatment of posthemorrhagic anemia plays an important role. A patient with anemia should include in his diet products containing a large amount of iron and protein substances. This and meat, and egg white, and fish, cottage cheese ... In doing so, remove from their food fatty foods.

Prevention

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

In a special group of risk for iron deficiency can be attributed to children born to an anemic mummy, premature babies and toddlers from multiple pregnancies, as well as infants taking artificial, irrational feeding, rapidly growing. Such pediatrician pediatrician usually ascribes iron preparations, or milk mixtures containing an increased percentage of this element.

For children of the first year of life, as prevention of posthemorrhagic anemia, it is necessary to introduce vegetables and fruits, cereals and greens, meat and fish, milk and cheeses into food. That is, to diversify the food. To maintain the content of auxiliary elements (copper, manganese, cobalt, zinc) within the limits of the norm, it is necessary to give the baby beets, yolks and fruits (apples, peaches, apricots). And as the child is obliged to receive and necessary quantity of fresh air - walks on fresh air are obligatory. Protect children from contact with harmful chemical, especially volatile, substances. Medicinal products should be used only according to the doctor's prescription and under his supervision.

Prevention of anemia for an adult is akin to a child. These are the same foods rich in iron and trace elements, as well as an active right lifestyle, fresh air.

[27], [28], [29], [30]

Forecast

In most cases, the prognosis of posthemorrhagic anemia is positive, with a small exception, when the patient has lost too much blood and can not stop and restore the circulation of the medicine to the physicians. In other cases, preventive actions and timely ambulance give every chance to the patient for recovery.

In childhood, the use of iron preparations is prophylactic, not only prevents the development of iron deficiency in a child, but also reduces the incidence of its acute respiratory viral infection. When weighed down with hereditary anemia, the medical prognosis directly depends on the frequency of the crises and their severity.

In any situation, one should not give up the hand and any disease should be recognized as soon as possible, in its earlier stages. Be more attentive to yourself and your loved ones. Preventive measures for posthemorrhagic anemia are not as complex as it may seem. Just live, fully eating, actively spending time in nature with family and friends, and this trouble will bypass you. But if the irreparable has happened, and the trouble has come to the house, do not panic, call the doctors and fight along with them. After all, life is beautiful and worth the fight.

[31], [32], [33], [34], [35]