Post-hemorrhagic anemia – the complex of clinical and hematologic changes arising owing to sharp or chronic blood loss. Post-hemorrhagic anemia is characterized by pallor, short wind, darkening in eyes, dizziness, a hypothermia, arterial hypotonia; in hard cases - block, threadlike pulse, shock, consciousness loss. Post-hemorrhagic anemia is diagnosed according to a clinical picture and the general blood test; for establishment of a source of bleeding tool researches are conducted. At development of this state elimination of a source of blood loss, performing transfusion and symptomatic therapy is necessary.
Post-hemorrhagic anemia – the gipogemoglobinemiya which is developing owing to a hemorrhagic syndrome and followed by notable decrease in the volume of the circulating blood (VCB). Post-hemorrhagic anemia proceeds with an eritropeniya, but is frequent without reduction of concentration of hemoglobin (Hb). Normal the level of the general Hb and volume of the circulating erythrocytes of blood makes respectively: men have not lower than 130 g/l and 29-30 ml/kg of weight, women have not lower than 120 g/l and 22-23 ml/kg. Post-hemorrhagic anemia can complicate a current of the most various pathological states in surgery, hematology, gynecology, gastroenterology, cardiology, etc. Post-hemorrhagic anemia can have sharp or chronic character. The chronic form is option of iron deficiency anemia as the mechanism of development and symptoms of pathology are caused by the amplifying deficiency of iron.
Reasons of post-hemorrhagic anemia
The sharp or chronic loss of blood which arose owing to external or internal bleeding acts as an immediate cause of post-hemorrhagic anemia. Sharp post-hemorrhagic anemia arises at the bystry, massive blood losses caused by usually mechanical damage of walls of large blood vessels or cavities of heart at various injuries and surgeries, a rupture of walls of heart cameras in a heart attack zone, a rupture of aneurism of an aorta and branches of a pulmonary artery, a rupture of a spleen, a rupture of a fallopian pipe at extra-uterine pregnancy.
Sharp post-hemorrhagic anemia is characteristic of plentiful uterine bleedings (menoragiya, metroragiya), can accompany the course of stomach ulcer and a 12-perstny gut. Post-hemorrhagic anemia can be caused in newborns by placentary bleeding, a patrimonial trauma.
Chronic post-hemorrhagic anemia is caused by the long, often arising losses of small volumes of blood at gastrointestinal, gemorroidalny, renal, nasal bleedings, violations of mechanisms of fibrillation (the DVS-syndrome, hemophilia). Tumoral processes (stomach cancer, colon cancer) proceeding with destruction of fabrics and bodies carry out to development of internal bleeding and post-hemorrhagic anemia. Gipogemoglobinemiya can be connected with increase in permeability of walls of capillaries at leukoses, radiation sickness, infectious and septic processes, insufficiency of vitamin C.
Pathogenesis of post-hemorrhagic anemia
As major factors of development of post-hemorrhagic anemia the phenomena of vascular insufficiency, a gipovolemiya with reduction of total amount of plasma and the circulating uniform elements, in particular, of the erythrocytes which are carrying out oxygen transport act. This process is followed by a lowering of arterial pressure, a krovenapolneniye of internals and fabrics, a gipoksemiya, a hypoxia and ischemia, development of shock.
Degree of expressiveness of protective and adaptive reactions of an organism is defined by the volume, speed and a source of bleeding. In an early reflex and vascular phase of compensation of blood loss (the first days) thanks to excitement of simpatiko-adrenalovy system the vazokonstriktion and strengthening of resistance of peripheral vessels, stabilization of haemo dynamics due to centralization of blood circulation with prime blood supply of a brain and heart, reduction of return of blood to heart and warm emission is observed. Concentration of erythrocytes, Hb also gematokrit are still close to norm (the "latent" anemia).
The second gidremichesky phase of compensation (2-3 days) is followed by an autogemodilyution - receipt to the blood course of fabric liquid and completion of volume of plasma. Strengthening of secretion of catecholamines and an aldosteron adrenal glands, antidiuretic hormone – a hypothalamus promotes stability of level of electrolytes in blood plasma. There is a progressing decrease in indicators of erythrocytes and Hb (the general and in unit of volume), a gematokrita; value of a color indicator is normal (post-hemorrhagic normokhromny anemia).
In the third, marrowy phase of compensation (4-5 days) because of a lack of iron anemia becomes gipokhromny, formation of erythropoietin kidneys with activation of reticuloendothelial system, an eritropoez of marrow, the centers of ekstramedullyarny blood formation amplifies. In red marrow the giperplaziya of an eritroidny sprout and increase in total number of normotsit, in peripheral blood - substantial increase of quantity of young forms of erythrocytes (retikulotsit) and leukocytes is observed. The Hb levels, erythrocytes also gematokrit are lowered. Normalization of level of erythrocytes and Hb in the absence of further blood loss happens in 2-3 weeks. At massive or long blood loss post-hemorrhagic anemia gains hyporegenerative character, at exhaustion of adaptation systems of an organism shock develops.
Symptoms of post-hemorrhagic anemia
Clinical symptoms of post-hemorrhagic anemia are same regardless of the blood loss reason, are defined by its volume and duration.
In the first days after sharp blood loss at patients sharp weakness, a pale shade of skin and mucous, short wind, darkening and flashing of front sights in eyes, dizziness, noise in ears, drying in a mouth, decrease in body temperature (especially, extremities), cold sweat is noted. Pulse becomes frequent and weak, arterial hypotonia develops. The anemia of internals, fatty dystrophy of a myocardium, liver, TsNS and other bodies is a consequence of a hemorrhagic syndrome. Children, especially newborn and the 1st year of life, transfer blood loss much heavier, than adult patients.
Post-hemorrhagic anemia at massive and bystry blood loss is followed by the hemorrhagic collapse, sharp falling of arterial pressure, threadlike arrhythmic pulse, an adinamiya and block which is speeded up by superficial breath with possible development of vomiting, spasms, consciousness loss. If pressure falls to critical level, causing sharp violation of blood supply and a hypoxia of bodies and systems, death comes from paralysis of the respiratory center and cardiac arrest.
Slowly developing post-hemorrhagic anemia is characterized by less expressed manifestations as it manages to be compensated for the account of adaptable mechanisms partially.
Diagnosis of post-hemorrhagic anemia
Diagnosis of post-hemorrhagic anemia is carried out according to a clinical picture, laboratory and tool researches (the general and biochemical blood tests and urine, the ECG, BONDS diagnostics, a puncture of marrow, a trepanobiopsiya). At survey of the patient with sharp post-hemorrhagic anemia hypotonia, frequent breath, low arrhythmic pulse, tachycardia, a priglushennost of warm tones, small systolic noise on a heart top pays attention.
In blood - absolute decrease in eritrotsitarny weight; at the proceeding blood loss the progressing uniform fall of the contents of Hb and erythrocytes is observed. At moderate blood loss hematologic symptoms of post-hemorrhagic anemia it is found only for 2-4 days. Control of a diuresis, level of platelets, electrolytes and nitrogenous products in blood, HELL and OTsK is obligatory.
At sharp post-hemorrhagic anemia there is no need for a marrow research, it will be out at difficult diagnosed blood losses. In samples of a marrowy puncture symptoms of anemia are increase in activity of red marrow, in trepanobiopsiya medicines – replacement of fatty tissue of marrow with a red haematogenic brain.
At diagnosis of internal bleedings the syndrome of a sharp anemia and laboratory data is indicative. In a spleen, a liver, lymph nodes the centers of ekstramedullyarny blood formation indicating the raised load of haemo poetic system come to light; in blood - tranzitorny lowering of the level of iron, small increase in ALT.
For identification and elimination of a source of blood loss patients need consultations of the hematologist, surgeon, gynecologist, gastroenterologist and other experts; performing ultrasonography of abdominal organs and a small pelvis, FGDS and so forth the ECG at post-hemorrhagic anemia can show decrease in amplitude of the T-tooth in standard and chest assignment.
Treatment and forecast of post-hemorrhagic anemia
In treatment of post-hemorrhagic anemia establishment of a source of bleeding and its immediate elimination due to bandaging and an ushivaniye of vessels, a resection and an ushivaniye of the damaged bodies and fabrics, increase in coagulability of blood etc. is paramount.
For restoration of OTsK and decrease in extent of haemo dynamic violations on observation of a transfuziolog urgent transfusion of tinned blood, blood substitutes, plasma and plasma substitutes is carried out. At insignificant, but long bleeding the transfusion of whole blood or plasma is shown in small haemo static doses. At considerable loss of OTsK transfusions have to be carried out in the doses exceeding blood loss for 20-30%. Heavy post-hemorrhagic anemia is treated by transfusions of high doses of blood ("blood transplantation"). In the period of a collapse of a hemotransfusion supplement with hypertensive krovozameshchayushchy solutions.
After restoration of OTsK correction of qualitative composition of blood – completion of its components is carried out: erythrocytes, leukocytes, platelets. At big one-stage blood loss and the stopped bleeding massive doses of eritrotsitarny weight are necessary (> 500 ml). Efficiency of hemotransfusions judge on increase HELL, to hematologic shifts.
Introduction of proteinaceous and electrolytic solutions is also necessary (albumine, physical. solution, glucose), restoring water-salt balance. In treatment of post-hemorrhagic anemia iron medicines, group B vitamins are used. The symptomatic therapy directed to normalization of functional violations from cardiovascular and respiratory systems, a liver, kidneys, etc. is appointed.
The forecast of post-hemorrhagic anemia depends on duration and the volume of bleeding. Sharp loss 1/4 OTsK leads to sharp anemia and a condition of gipovolemichesky shock, and loss 1/2 OTsK is incompatible with life. Post-hemorrhagic anemia at slow loss even of considerable volumes of blood is not so dangerous as it can be compensated.