Symptoms of acute posthemorrhagic anemia in children

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.

Symptoms of acute posthemorrhagic anemia consist 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.

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

Symptoms of acute posthemorrhagic anemia in newborns

The clinical picture of acute posthemorrhagic anemia in newborns has its own characteristics. Pallor of the skin and mucous membranes, adynamia, muscle hypotension, weak cry, shortness of breath, moaning breath, apnea attacks, tachycardia, often systolic murmur, westernization of the anterior abdominal wall (associated with spasm of blood vessels of the abdominal cavity organs).

Clinical data in some newborns do not match the severity of anemia. In case of acute blood loss, there may be signs of hypovolemia (tachycardia, tachypnea, threadlike pulse, arterial hypotension, lethargy, white spot symptom more than 3 s) with normal color of the skin. Pallor can appear delayed - in a few hours or on the 2-3rd day. If pallor is noted, an important sign of anemia is the lack of its dynamics against the background of oxygen therapy.

In post-hemorrhagic shock, clinical manifestations can develop in the immediate future after blood loss: tachycardia (over 160 beats / min), tachypnea, apnea attacks, severe arterial hypotension (in a full-term newborn systolic pressure below 50 mm Hg, and in premature infants less than 45 mmHg, in children with very low birth weights below 35-40 mm Hg), which may be characterized by the absence of a palpable pulse in the radial and cubital arteries, oliguria or anuria, lethargy or coma. The development of this clinic stage II of the shock can be remote from the moment of bleeding for 6-12 hours and even 24-72 hours.

The absence of hepatosplenomegaly, edema, icterism helps in differential diagnosis with hemolytic disease of newborns.

Clinical signs of stages of hemodynamic disorders in shock

Stage

• Centralization of blood circulation
• Transitional
• Decentralization of blood circulation
• Terminal

[6], [7], [8], [9], [10], [11]

Clinical characteristics of the stages of shock

Psychomotor agitation or depression. Systolic BP within the age limit or + 20%. Decrease in pulse pressure. The pulse is tense, tachycardia up to 150% of the norm, sometimes a bradycardia. Dyspnea. Skin covers pale, cold, "marbling", cyanotic shade of mucous membranes, nail lodges.

The child is inhibited. Systolic blood pressure is reduced, but no more than up to 60% of the age norm. Pulse of weak filling, frequency more than 150% of impacts from age norm. Dyspnea. Sharply expressed pallor of the skin, distinct acrocyanosis. Oliguria. The child is inhibited. Systolic blood pressure is below 60% of the age norm, diastolic blood pressure is not determined. Pulse is threadlike, tachycardia more than 150% of the norm. The skin is pale-cyanotic. Breathing is frequent, superficial. Central venous pressure is higher or lower than normal, depending on the degree of heart failure. Increased tissue bleeding. Anuria. Clinic of agonizing state.

[12], [13]