Posthemorrhagic anemia: treatment of acute and chronic forms. Posthemorrhagic anemia: treatment of acute and chronic forms. Acute posthemorrhagic anemia Posthemorrhagic anemia types pathogenesis manifestations

In the Basics Hemorrhagic anemia There may also be a combination of typical phenomena, for example, blood loss and iron deficiency.

Symptoms of hemorrhagic anemia

The clinical situation contains a set of syndromes. Thus, eunuchoidism of hemolysis is expressed in icteric coloring of the sclera and skin, darkening of urine, enlargement of the spleen and liver.

Anemia: signs and therapy

If erythropoiesis is unsuccessful, bone destruction is likely. “Weak eunuchoidism” is considered universal for anemia of various origins:

Weakness, drowsiness and asthenia. Another name for anemia, “tired blood” disease, is explained by these manifestations:

Decreased and pathological appetite.

Shortness of breath and arrhythmias.

Visual pathologies (“spots”), which are a consequence of hypotension.

Iron deficiency (sideropenia) is considered the most common factor hemorrhagic anemia. For this reason, general anemic hyperthyroidism is generally expanded by the properties of iron deficiency anemia and signs of sideropenia:

Epithelial syndrome. The skin tone changes: it can be green (pale sickness), the color of yellow wax, blue-violet. There are zones with hyperpigmentation or depigmentation near the mouth, and redness of the edge of the tongue can be seen. The skin is dried out, peeling (disease), subject to cracking; hair is pale, brittle, split. Spoon-shaped marigolds (koilonychia) indicate neglected anemia. Trophic lesions of the mucous layers are formed: cracks in the corners of the mouth (inflammation), inflammation, dysphagia, disease.

Perversion of taste, flair. Geophagy and pagophagia often appear.

The blue tone of the sclera, associated with dystrophic transformations of the cornea, can be seen in almost 90% of patients.

Muscle deficiency due to myoglobin deficiency. When this symptom appears, the activity of the sphincters is disrupted and incontinence is formed. Myocardial disease can cause prolonged heart failure.

Typical tooth decay: caries, enamel pathologies.

As is already known, posthemorrhagic anemia occurs in the human body due to blood loss. Moreover, it will not necessarily be abundant. It is important to understand that even minor bleeding, but occurring frequently, can become seriously dangerous for the patient.

Posthemorrhagic anemia: code according to ICD-10

Distribution of diseases according to this classification (regarding the acute course of the disease) – D62. This classification also indicates that the cause of the disease is considered to be blood loss of any nature.

Posthemorrhagic anemia: severity levels

The severity of this type of anemia also depends on the hemoglobin level. The first degree of severity is characterized by a hemoglobin content in the blood of more than 100 grams per liter of blood and red blood cells above 3 t/l. If the hemoglobin level in the blood reaches 66 - 100 g/l and the number of red blood cells is above 2 - 3 t/l, we can talk about the occurrence of moderate severity of posthemorrhagic anemia. Finally, we are talking about a severe stage of anemia if hemoglobin drops below 66 g/l.

If a mild degree of severity of this type of anemia is detected in time, the patient can still be helped. In this case, the main goal of treatment is to replenish iron reserves in the body. Taking appropriate iron supplements can help with this. Only a doctor can prescribe such drugs in accordance with the patient’s tests and his individual complaints. It is important that the preparation contains a component that promotes the complete absorption of iron. This component may be, for example, ascorbic acid. Sometimes hospital treatment may be required.

For posthemorrhagic anemia of moderate severity, posthemorrhagic anemia requires taking appropriate medications. As for the severe degree, hospitalization of the patient is urgently indicated. Delay in this case could cost the patient his life.

Posthemorrhagic anemia: causes of the disease

A lack of blood in the body can be caused by:

1. Violation of normal hemostasis. Hemostasis is designed to keep the blood in a liquid state, that is, as it should be normally. It is also responsible for normal blood clotting;
2. Lung diseases. Such diseases can be judged by scarlet bleeding in the form of liquid or clots that occurs when coughing;
3. Trauma due to which vascular integrity was compromised, mainly affecting large arteries;
4. Ectopic pregnancy. With this problem, severe internal bleeding is observed, which causes the development of acute posthemorrhagic anemia;
5. Surgical intervention. Almost any operation involves blood loss. It is not always abundant, but this may be enough for the development of pathology;
6. Stomach and duodenal ulcers. Internal bleeding is common with such diseases. Such bleeding cannot always be quickly recognized. But if this is not done on time, death is possible.

Posthemorrhagic anemia: stages

There are two stages of this pathology – acute and chronic. Acute begins due to rapid and massive blood loss. Such blood loss is often caused by injury, internal and external bleeding, and surgical intervention during which blood vessels are injured. The chronic stage of the disease is characterized by moderate bleeding, which occurs quite often, for example, we are talking about hemorrhoids and peptic ulcers. The same applies to girls with menstrual cycle abnormalities and uterine fibromatosis. The same goes for nosebleeds.

Pathogenesis of posthemorrhagic anemia

The key factors of this type of anemia are the phenomena of vascular insufficiency. At the same time, blood pressure decreases, blood supply to tissues and internal organs is disrupted, hypoxia and ischemia are observed, and a state of shock may become possible.

The first phase is called early reflex-vascular. It is also called hidden anemia. At the same time, hemoglobin and red blood cell levels are still close to normal. The second phase is the hydremic phase of compensation. It is characterized by the entry of tissue fluid into the bloodstream and the normalization of plasma volume. The decrease in the number of red blood cells begins quite sharply. In the third phase, there is a strong decrease in the amount of formed elements in the blood and the situation begins to get out of control.

Acute posthemorrhagic anemia: ICD-10

What can be said about the stages of this type of anemia? Chronic posthemorrhagic anemia is something that is difficult to combat, since the causes lie in some other disorders in the body. That is why we will talk about acute posthemorrhagic anemia.

With acute blood loss, by which we mean more than 1000 ml of blood, in a short period of time, the patient may experience collapse and shock.

Acute anemia: causes (post-hemorrhagic) - what are they? They are most often associated with unforeseen injuries.

If we talk about the symptoms of acute hemorrhagic anemia, they are represented by gastrointestinal disorders, dizziness, and nausea. In addition, the patient may feel weak, his skin may become pale and his blood pressure may drop.

Treatment of posthemorrhagic anemia

Therapy for this disease is carried out only in a hospital setting. The fact is that bleeding, especially massive bleeding under other conditions, cannot always be stopped. Sometimes infusion-transfusion therapy and surgical intervention are needed.

After bleeding has stopped, you should start taking iron supplements, and only at the discretion of your doctor. In the severe stage, it will be necessary to administer drugs intravenously; in the mild stage, taking tablets orally is sufficient. In some cases, combined treatment with both methods is indicated.

Posthemorrhagic anemia is a condition that develops as a result of sudden or prolonged blood loss. It is characterized by a decrease in the filling of the vascular bed, as a result of which the number of red blood cells and hemoglobin decreases, which leads to oxygen starvation, and in severe cases, death. Long-term disruption of hemodynamics causes not only a deterioration in well-being, but also degeneration of tissues and organs, provoking hematopoietic pathologies.

The direct cause of the condition is acute or chronic blood loss resulting from external or internal bleeding:

Due to pathologies and injuries accompanied by blood loss, its volume in the vascular bed decreases. There is a lack of cells containing hemoglobin. And since red blood cells are responsible for the delivery of oxygen, oxygen starvation occurs in the body.

The human body is able to restore up to 500 ml of blood without damage; the disease develops if blood loss exceeds this figure. The loss of half the volume of fluid in the vessels leads to inevitable death.

Main symptoms

Classification of anemia in case of blood loss is carried out according to the degree of development of the condition, distinguished:

1. Spicy. Massive blood loss occurs due to injuries and damage to large vessels, with internal bleeding.
2. Chronic. Secondary iron deficiency anemia (IDA) gradually develops as a result of diseases.
3. Congenital. When the fetus suffers due to blood loss.

Consequently, in patients with posthemorrhagic anemia, symptoms differ depending on the degree of development of the process and the severity of the condition.

Acute form

In acute pathology, the clinical picture progresses rapidly; vascular insufficiency is observed as a result of a sharp depletion of the riverbed. With the onset of blood loss, the following is noted:

• hypotension,
• dizziness and tinnitus,
• tachycardia and shortness of breath,
• pallor of the skin and mucous membranes,
• severe weakness and dry mouth,
• cold sweat,
• nausea.

If there is damage to the gastrointestinal tract, the stool becomes dark in color and the temperature may rise.

If blood loss is significant, hemorrhagic collapse develops. The pressure drops sharply to critical levels - thread-like pulse, shallow and rapid breathing. Muscle weakness is observed up to the cessation of motor activity, vomiting, convulsions and loss of consciousness are possible. Lack of blood supply causes oxygen starvation in organs and systems, death occurs due to respiratory and cardiac arrest.

Chronic form

If posthemorrhagic anemia develops slowly, the symptoms are not so pronounced, since adaptation mechanisms are activated. Signs of the chronic form resemble IDA, since minor bleeding leads to iron deficiency:

• dry skin and painful pallor,
• face is swollen
• hair loss and dullness,
• brittleness and thickening of the nail plate,
• increased fatigue and dizziness,
• heart rhythm disturbance,
• sweating

When the hemoglobin concentration drops to 70 g/l or lower, some patients experience low-grade fever. Patients complain of a feeling of numbness and changes in taste preferences. The severe stage is often accompanied by stomatitis and rapidly developing caries.

Diagnostic methods

When making a diagnosis of posthemorrhagic anemia, the basis of measures includes studying the patient’s medical history, a set of laboratory and instrumental studies. To identify the cause of anemia, you will need to consult a surgeon, hematologist, gastroenterologist or gynecologist. As a basic examination and to clarify the duration of blood loss, tests are carried out to determine the degree of anemia, a blood test is taken:

• General. Indicates a decrease in erythrocyte mass, their hemoglobin saturation, and platelet volume.
• Biochemical. The hemogram gives a detailed idea of ​​the blood elements, their morphology and ratio to the volume of fluid. The study determines an increase in manganese, the enzyme alanine aminotransferase, a decrease in calcium and copper.

Urinalysis gives an initial idea of ​​the state of the urinary system and the functioning of the body. To diagnose the site of internal bleeding, examination methods are used:

Bone marrow examination is carried out in complex cases when the cause of anemia cannot be identified by conventional methods. Puncture samples taken show the activity of the red brain, trephine biopsy reveals the replacement of hematopoietic cells with adipose tissue.

Treatment with drugs and folk remedies

For posthemorrhagic anemia, the main goals of treatment are to identify the source of blood loss and stop the bleeding. For external injuries, apply a tourniquet and bandage. If necessary, vessels and damaged tissues and organs are sutured and resection is performed.

In case of massive blood loss, measures are carried out in the hospital:

• To restore blood supply and hemodynamics, a transfusion of canned blood and plasma is performed. When hemoglobin is below 8%, plasma substitutes are used: “Hemodez”, “Polyglyukin” or “Reopoliglyukin”. The blood transfusion procedure is carried out promptly, since a quarter of the blood loss is fraught with the death of the patient. The volume of infused fluid in this case exceeds blood loss by a maximum of 30%.
• Transfusion of red blood cells is necessary to restore oxygen transport; with rapid loss, its amount can be half a liter.
• Shock is treated with Prednisolone.
• To restore the acid-base balance during treatment, electrolyte and protein compounds are administered intravenously: albumin, glucose, saline.
• Iron is replenished by such drugs as Ferroplex, Feramide, Conferon, Sorbifer Durules. They are taken orally or by injection.
• Microelements are prescribed: cobalt, copper and manganese, as they increase the absorption of iron.

For prolonged bleeding:

• In the case of severe chronic anemia, transfusion is carried out in a small volume.
• To eliminate the symptoms of functional disorders in the heart, liver, and kidneys, therapeutic measures are used.
• For better absorption of Fe, iron-containing products, vitamins C and B groups are prescribed.
• Sometimes surgery is recommended.

The regimen and duration of drug treatment are individual in each specific case. Restoration of the normal picture is observed after one and a half or two months, but the patient takes the medicine for up to six months.

Diet and traditional treatment

To restore the body after treatment of posthemorrhagic anemia and replenish hemoglobin, a specific diet is used. Its goal is to provide the body with vitamins and elements, so nutrition should be balanced and high in calories, but with a minimum amount of fat.

• The patient's diet requires the presence of foods containing iron, such as lean meat and liver.
• For enrichment with microelements, valuable amino acids and protein, fish, cottage cheese, and eggs are recommended.
• Suppliers of vitamins are vegetables and fruits, natural juices.

Loss of fluid is replenished by consuming water (at least 2 liters per day). To restore strength and support the body, you can also use folk recipes:

• Rose hips are brewed and drunk instead of tea; you can add strawberry leaves.
• When you lose strength, mix honey (200 ml), Cahors (300 ml) and aloe juice (150 ml). Take a spoon before meals.
• Mix 30 g of chicory juice in a glass of milk and drink it a day.
• Squeeze the juice from radishes, beets and carrots (1:1:1), pour into a dark glass container, cover with a lid and simmer in the oven for 3 hours. The liquid is drunk on a spoon before meals for a course of 3 months.

When blood loss occurs, the immune defense suffers and the body becomes susceptible to infection, so infusions or decoctions based on echinacea, ginseng, lemongrass or marshmallow will help to strengthen and restore the system.

Preventive measures will help prevent the development of posthemorrhagic anemia and its relapses:

• Patients with chronic diseases should monitor their condition, undergo regular examinations and take medications. When a specialist insists on surgery, there is no need to refuse: surgical treatment of the underlying disease will eliminate the cause of anemia.
• The diet of children and adults must include foods containing iron, vitamins and elements necessary for the body.
• It is important for pregnant women to register in time and detect anemia in order to prevent complications dangerous to the health of the mother and newborn.
• If a baby is diagnosed with a pathology, it is recommended not to stop breastfeeding. Each child is provided with a healthy environment and nutritious nutrition, rational complementary feeding. To normalize the condition, regular walks are important; medications are given only as prescribed by a doctor.
• To prevent dystrophy, rickets and infectious invasions in children, pediatrician supervision is necessary. Particular attention is paid to babies born to mothers with diagnosed anemia and who are bottle-fed. Also at risk are babies with multiple pregnancies, premature babies and those who quickly gain weight.
• To maintain health, every person needs to lead a correct lifestyle, move actively, and be in the fresh air.

V.V. Dolgov, S.A. Lugovskaya,
V.T.Morozova, M.E.Pochtar
Russian Medical Academy
postgraduate education

Posthemorrhagic anemia- a condition that develops as a result of loss of blood volume, as a result of which this type of anemia is called “Anemia due to blood loss.”

Acute posthemorrhagic anemia

Acute posthemorrhagic anemia is a condition that develops as a result of rapid loss of a significant volume of blood. Regardless of the pathogenesis of the disease, with anemia, oxidative processes in the body are disrupted and hypoxia occurs. The degree of anemia depends on the speed and amount of blood loss, the degree of adaptation of the body to new living conditions.

The cause of acute blood loss may be a violation of the integrity of the walls of the vessel due to its injury, damage by a pathological process in various diseases (stomach and intestinal ulcers, tumor, tuberculosis, pulmonary infarction, varicose veins of the legs, pathological childbirth), changes in capillary permeability (hemorrhagic diathesis) or a violation in the hemostatic system (hemophilia). The consequences of these changes, regardless of the reasons that caused them, are the same.

The leading symptoms of extensive bleeding are an acute deficit in circulating blood volume (CBV) and disruption of homeostasis. In response to the development of BCC deficiency, adaptation mechanisms are activated aimed at compensating for it.

At the first moment after blood loss, signs of collapse are observed: severe weakness, drop in blood pressure, pallor, dizziness, fainting, tachycardia, cold sweat, vomiting, cyanosis, convulsions. In the case of a favorable outcome, anemic symptoms themselves appear, caused by a decrease in the respiratory function of the blood and the development of oxygen starvation.

The body's normal response to blood loss is characterized by activation of hematopoiesis. In response to hypoxia, the synthesis and secretion of EPO by the kidneys increases, which leads to increased erythropoiesis and increased erythropoietic function of the bone marrow. The number of erythroblasts increases sharply. With large blood losses, the yellow bone marrow of the tubular bones can be temporarily replaced by active - red, and foci of extramedullary hematopoiesis appear.

Against the background of the main pathophysiological changes, several phases of the disease are distinguished.

Reflex phase accompanied by spasm of peripheral vessels, which leads to a decrease in the volume of the vascular bed. Initially, blood flow to the vessels of the skin, subcutaneous tissue and muscles decreases. Blood is redistributed among organs and systems - blood circulation is centralized, which helps compensate for the deficit of BCC. By turning off peripheral vessels from the blood circulation, blood flow in vital organs (brain and spinal cord, myocardium, adrenal glands) is maintained. The compensatory mechanism leading to vasospasm is based on the additional release of catecholamines by the adrenal glands, which have a pressor effect. With insufficient blood circulation in the kidneys, the secretion of renin by the cells of the juxtaglomerular apparatus (JGA) increases. Under the influence of renin, angiotensinogen is formed in the liver, which constricts blood vessels, stimulates the secretion of aldosterone by the adrenal glands, which activates sodium reabsorption in the proximal tubules of the kidneys. Water returns to the blood plasma after sodium. Sodium retention leads to increased reabsorption of water in the tubules and decreased urine formation. The secretion of aldosterone activates hyaluronidase, which causes depolymerization of hyaluronic acid, pores are formed in the basement membrane of the collecting ducts and water goes into the interstitial tissue of the medulla of the kidney. This is how water is retained in the body. A decrease in renal blood flow and its movement from the cortex to the medulla like a juxtaglomerular shunt occurs due to spasm of the glomerular vessels, which are excluded from the blood circulation. As a result of hormonal changes and a decrease in renal blood flow, filtration in the renal glomeruli stops and urine formation is disrupted. These changes lead to a sharp decrease in urine output with a subsequent drop in glomerular blood pressure (BP) below 40 mmHg. Art.

The reflex phase, according to various sources, lasts 8-12 hours and rarely more.

Laboratory indicators . A decrease in the total volume of the vascular bed leads to the fact that, despite the absolute decrease in the amount of red blood cells, the indicators of hemoglobin and red blood cells per unit volume of blood approach the original figures and do not reflect the degree of anemia, the hematocrit value does not change, while the bcc is sharply reduced. Immediately after blood loss, latent anemia occurs; the number of leukocytes rarely exceeds 9.0-10.0 x 10 9 /l. Leukopenia and neutropenia are more common. During the period of bleeding, due to the large consumption of platelets, which are mobilized to stop it, their content may decrease.

Compensation phase (hydremic) develops 2-3 hours after blood loss, characterized by the mobilization of interstitial fluid and its entry into the bloodstream. These changes do not immediately cause a “thinning” of the circulating blood. Immediately after blood loss, “hidden anemia” occurs. The posthemorrhagic period is accompanied by the release of red blood cells from the depot and an increase in the volume of blood volume, followed by a decrease in blood viscosity and an improvement in its rheology. This adaptive mechanism is referred to as the “autohemodilution reaction.” This creates conditions for the restoration of central and peripheral hemodynamics and microcirculation.

Hemodilution phase depending on the magnitude and duration of blood loss, it can last from several hours to several days. It is characterized by an increase in the permeability of the walls of blood vessels, which leads to the entry of tissue fluid into the bloodstream. The influx of tissue fluid restores bcc and promotes a simultaneous uniform decrease in the amount of hemoglobin and red blood cells per unit volume of blood.

The body tolerates blood loss of 10-15% of the bcc easily, up to 25% of the bcc with minor hemodynamic disturbances. When blood loss exceeds 25%, the patient’s own adaptation mechanisms fail. Loss of about 50% of circulating red blood cells is not fatal. At the same time, a decrease in the volume of circulating plasma by 30% is incompatible with life.

Prolonged spasm of peripheral vessels (insufficient autohemodilution) with large blood losses can lead to disruption of capillary blood flow.

When blood pressure drops below 80 mm Hg. Art. blood accumulates in the capillaries, the speed of its movement slows down, which leads to the formation of aggregates of red blood cells (sludge syndrome) and stasis. As a result of changes in capillary blood flow, microclots form, which leads to disruption of microcirculation, with the subsequent development of hemorrhagic shock and irreversible changes in organs.

Laboratory indicators . Anemia that develops 1-2 days after blood loss is normochromic in nature: the color index is close to 1.0. The saturation of erythrocytes with hemoglobin and its concentration in one erythrocyte depend on the availability of iron reserves in the body. An increase in the number of reticulocytes occurs already from the third day, as a consequence of the activation of bone marrow hematopoiesis, reaching a maximum on days 4-7. If the reticulocyte count does not decrease by the beginning of the second week, this may indicate ongoing bleeding. At the height of the hydremic stage, the macroerythrocyte shift in the blood reaches a maximum, but it is not pronounced, and the average diameter of erythrocytes does not exceed 7.4-7.6 microns.

The severity of anemia is diagnosed by indicators of hemoglobin, erythrocytes, reticulocytes, iron metabolism (serum iron concentration, CVSS, plasma ferritin, etc.).

The greatest changes in hematological parameters of peripheral blood are usually observed 4-5 days after blood loss. These changes are caused by active proliferation of bone marrow elements. The criterion for the activity of hematopoiesis (erythropoiesis) is an increase in the number of reticulocytes in the peripheral blood to 2-10% or more, polychromatophils. Reticulocytosis and polychromatophilia, as a rule, develop in parallel and indicate increased regeneration of erythrokaryocytes and their entry into the blood. The size of red blood cells increases slightly after bleeding (macrocytosis). Erythroblasts may appear. On days 5-8 after bleeding, moderate leukocytosis usually occurs (up to 12.0-20.0 x 10 9 / l) and other indicators of regeneration - band shift (less often to myelocytes). Persistent leukocytosis occurs in the presence of an associated infection. The platelet count increases to 300-500 x 10 9 /l. Sometimes thrombocytosis up to 1 million is observed for several days, indicating large blood loss.

With small blood losses, deposited iron enters the bone marrow, where it is used for the synthesis of hemoglobin. The degree of increase in serum iron depends on the level of reserve iron, erythropoiesis activity and plasma transferrin concentration. With a single acute blood loss, there is a transient decrease in the level of serum iron in plasma. With large blood losses, serum iron remains low. Deficiency of reserve iron is accompanied by sideropenia and the development of iron deficiency anemia. The degree of anemia is influenced by the volume and rate of blood loss, the time since bleeding, the iron reserve in the depot organs, the initial number of red blood cells and hemoglobin.

Tissue hypoxia, which develops during blood loss, leads to the accumulation of under-oxidized metabolic products in the body and to acidosis, which at first is compensated. The progression of the process is accompanied by the development of uncompensated acidosis with a decrease in blood pH to 7.2 and below. In the terminal stage, alkalosis joins acidosis. The carbon dioxide tension (pCO 2) decreases significantly as a result of hyperventilation of the lungs and the binding of plasma bicarbonates. The respiratory quotient increases. Hyperglycemia develops, the activity of the enzymes LDH and aspartate aminotransferase increases, which confirms damage to the liver and kidneys. In the serum, the concentration of sodium and calcium decreases, the content of potassium, magnesium, inorganic phosphorus and chlorine increases, the concentration of the latter depends on the degree of acidosis and may decrease with its decompensation.

In some diseases accompanied by large loss of fluid (diarrhea in ulcerative colitis, vomiting in gastric ulcer, etc.), a compensatory hydremic reaction may be absent.

Chronic posthemorrhagic anemia

Hypochromic-normocytic anemia, which occurs with prolonged moderate blood loss, for example, with chronic gastrointestinal bleeding (with stomach ulcers, duodenal ulcers, hemorrhoids, etc.), as well as with gynecological and urological diseases, will be described below in the section “Iron deficiency anemia".

BIBLIOGRAPHY [show]

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Source: V.V. Dolgov, S.A. Lugovskaya, V.T. Morozova, M.E. Pochtar. Laboratory diagnosis of anemia: A manual for doctors. - Tver: "Provincial Medicine", 2001

Posthemorrhagic anemia is a set of pathological changes that develop in the body due to the loss of a certain amount of blood: it contains iron, and with blood loss it becomes insufficient. It is divided into two types: acute and chronic.

ICD-10 code

Chronic posthemorrhagic anemia has the following ICD-10 code - D50.0, and acute - D62. These disorders are located in the section “Anemia associated with nutrition. Iron-deficiency anemia".

Latin defines the word anemia as “lack of blood,” literally speaking. The word can also be translated as “anaemia”, which means a lack of hemoglobin. And “hemorrhagic” is translated as “accompanied by bleeding,” the prefix “post” means “after.”

Information about what posthemorrhagic anemia is will allow you to detect its development in time and provide the necessary assistance.

Pathogenesis in posthemorrhagic anemia

Pathogenesis is a certain sequence of development of pathological changes, which makes it possible to judge the features of the occurrence of posthemorrhagic anemia.

The severity of posthemorrhagic anemia is determined by the hemoglobin content and the severity of tissue hypoxia due to its deficiency, but the symptoms of anemia and its features are associated not only with this indicator, but also with others that decrease with blood loss:

• Iron content;
• Potassium;
• Magnesium;
• Copper.

Iron deficiency has a particularly negative effect on the circulatory system, in which the production of new blood elements is difficult.

The minimum volume of blood that can be lost without the risk of developing serious disorders is 500 ml.

Donors donate blood without exceeding this amount. A healthy human body with sufficient body weight completely restores lost elements over time.

When there is not enough blood, small vessels constrict to compensate for the shortage and maintain blood pressure at a normal level.

Due to a lack of venous blood, the heart muscle begins to work more actively to maintain sufficient minute blood flow - the amount of blood that is ejected by the heart per minute.

What color of venous blood can you read?

Read what the heart muscle consists of

The functioning of the heart muscle is impaired due to mineral deficiency, the heart rate decreases, and the pulse weakens.

An arteriovenous shunt (fistula) occurs between the veins and arterioles, and blood flows through the anastomoses without touching the capillaries, which leads to impaired blood circulation in the skin, muscular system, and tissues.

This system exists to maintain blood flow to the brain and heart, allowing them to continue to function even in the face of severe blood loss.

Interstitial fluid quickly compensates for the lack of plasma (the liquid part of the blood), but microcirculation disturbances persist. If blood pressure drops significantly, the speed of blood flow in small vessels will decrease, leading to thrombosis.

In the severe stage of posthemorrhagic anemia, small blood clots form that clog small vessels, which leads to disruption of the functioning of the arterial glomeruli in the kidney tissue: they do not filter fluid properly, and the amount of urine excreted is reduced, and harmful substances are retained in the body.

Blood circulation in the liver also weakens. If acute posthemorrhagic anemia is not treated promptly, it will lead to liver failure.

Oxygen deficiency in tissues leads to the accumulation of under-oxidized elements that poison the brain.

Acidosis develops: a violation of the acid-base balance towards the predominance of an acidic environment. If posthemorrhagic anemia is severe, the amount of alkalis is reduced, and the symptoms of acidosis increase.

With blood loss, the level of platelets decreases, but this has little effect on the coagulation processes: the content of other substances that affect coagulation reflexively increases.

Over time, the clotting mechanisms return to normal, but there is a risk of developing thrombohemorrhagic syndrome.

Causes

The main factor influencing the development of posthemorrhagic anemia is blood loss, the causes of which can be different.

Acute posthemorrhagic anemia

This is a disorder that develops rapidly due to excessive blood loss. This is a dangerous condition that requires rapid initiation of treatment measures.

Causes of acute anemia:

Chronic posthemorrhagic anemia

A condition that develops with systematic blood loss over a long period of time. It can go unnoticed for a long time if the blood loss is mild.

Causes of chronic anemia:

Hemorrhagic anemia also develops due to vitamin C deficiency.

Kinds

Posthemorrhagic anemia is divided not only by the nature of its course (acute or chronic), but also by other criteria.

The severity of anemia is assessed by the amount of hemoglobin in the blood.

Depending on its content, anemia is divided into:

• Light. With mild anemia, hemoglobin begins to lack iron, its production is impaired, but the symptoms of anemia are practically absent. Hemoglobin does not fall below 90 g/l.
• Average. Symptoms with moderate severity are moderate, hemoglobin concentration is 70-90 g/l.
• Heavy. In severe cases, serious organ dysfunction is observed, heart failure develops, and the structure of hair, teeth, and nails changes. Hemoglobin content is 50-70 g/l.
• Extremely severe. If the hemoglobin level is below 50 g/l, there is a risk of life.

There are also certain pathologies included in the ICD:

• Congenital anemia in the newborn and fetus due to blood loss (code P61.3);
• Posthemorrhagic anemia of the chronic type, which is secondary iron deficiency (code D50.0).

Symptoms

Acute form of anemia

Symptoms in the acute form of posthemorrhagic anemia increase very quickly and depend on the severity of blood loss.

Observed:

A decrease in blood pressure due to massive blood loss is called hemorrhagic shock. The intensity of the fall in blood pressure depends on the severity of blood loss.

The following symptoms are also present:

• Tachycardia;
• The skin is cold and pale, with moderate and severe degrees it has a cyanotic (bluish) color;
• Impaired consciousness (stupor, coma, loss of consciousness);
• Weak pulse (if the stage is severe, it can only be felt on the main vessels);
• Reducing the amount of urine excreted.

The symptoms of posthemorrhagic anemia and hemorrhagic shock are joined by signs that are inherent to the disease that caused blood loss:

• With an ulcer, black or red stool is observed;
• Swelling in the impact area (if injured);
• When the arteries in the lungs rupture, there is a cough with bright scarlet blood;
• Intense bloody discharge from the genitals during uterine bleeding.

The source of bleeding is identified by indirect signs depending on the clinical picture.

Stages of acute posthemorrhagic syndrome

Acute posthemorrhagic syndrome has three stages of development.

The body fully recovers after blood loss after two to three or more months.

Signs of chronic form

Chronic bleeding gradually leads to posthemorrhagic anemia, which develops gradually, and its symptoms are closely related to the severity of hemoglobin deficiency.

Observed:

People with posthemorrhagic anemia have low immunity and often develop infectious diseases.

Diagnostics

In case of acute blood loss, the patient remains in hospital treatment so that risks can be assessed and timely assistance provided.

Laboratory diagnosis of posthemorrhagic anemia is carried out repeatedly, and the results vary depending on the stage and severity of the disorder.

Laboratory signs of acute anemia:

• In the first two hours, the concentration of platelets increases, and red blood cells and hemoglobin remain at normal levels;
• After 2-4 hours, the excess platelets remain, neutrophil granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, according to the color indicator, anemia is defined as normochromic (normal value);
• After 5 days, an increase in reticulocytes is noted, the iron level is insufficient.

What tests need to be taken?

It is necessary to take a general blood test; in case of chronic anemia, it reveals the content of elliptocytes; lymphocytes are increased in the peripheral blood, but reduced in the overall cellular composition.

A deficiency of iron, calcium, and copper is detected. Increased manganese content.

In parallel, tests are carried out to determine the cause of bleeding: stool examination for helminthiasis and occult blood, colonoscopy, urinalysis, bone marrow examination, ultrasound examination, esophagogastroduodenoscopy, electrocardiogram.

Who to contact?

Hematologist

Treatment

Acute hemorrhagic anemia at the first stage of treatment requires eliminating the cause of blood loss and restoring normal blood volume.

Surgeries are performed to suture wounds and blood vessels, and the following medications are prescribed:

• Artificial blood substitutes. They are infused by drop or stream, depending on the patient’s condition;
• When shock develops, the use of steroids (Prednisolone) is indicated;
• Soda solution eliminates acidosis;
• Anticoagulants are used to eliminate blood clots in small vessels.
• If blood loss exceeds a liter, a donor blood transfusion is necessary.

Treatment of chronic anemia not complicated by serious diseases is carried out on an outpatient basis. Nutrition correction with the addition of foods containing iron, vitamins B9, B12 and C is indicated.

In parallel, treatment is carried out for the underlying disease that caused the pathological changes.

Forecast

If, after extensive blood loss, the patient quickly arrived at the hospital and received the full range of treatment procedures aimed at restoring blood levels and eliminating bleeding, then the prognosis is favorable, except in cases where the blood loss is extremely severe.

A chronic type of pathology is successfully eliminated by curing the disease that caused it. The prognosis depends on the severity of concomitant diseases and the degree of neglect of anemia. The sooner the cause is identified and treatment is started, the greater the chances of a favorable outcome.

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