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.
Chronic posthemorrhagic anemia has the following ICD-10 code – D50.0, and acute – D62. These disorders are found under Nutritional Anemias. Iron-deficiency anemia”.
Latin defines the word “anemia” as “bloodless”, literally speaking. Also, the word can be translated as “anemia”, which means a lack of hemoglobin. And “hemorrhagic” is translated as “accompanied by bleeding”, the prefix “post” means “after.”
Information about what post-hemorrhagic anemia is will allow 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 post-hemorrhagic anemia.
The severity of post-hemorrhagic anemia is determined by the content of hemoglobin 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, which decrease with blood loss:
- Iron content,
Iron deficiency affects the circulatory system especially negatively, 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, over time, completely restores the lost elements.
When there is not enough blood, the small blood vessels constrict to compensate for the shortage and keep blood pressure at a normal level.
Due to the lack of venous blood, the heart muscle begins to work more actively to maintain sufficient minute blood flow – the amount of blood that is thrown out by the heart per minute.
The functioning of the heart muscle is disrupted due to a deficiency of minerals, the heart rate decreases, the pulse weakens.
An arteriovenous shunt (fistula) arises between the veins and arterioles, and the blood flow goes through the anastomoses without touching the capillaries, which leads to impaired blood circulation in the skin, muscular system, and tissues.
Formation of an arteriovenous shunt, which prevents blood from reaching the capillaries
This system exists to support blood flow in the brain and heart, which allows them to continue to function even with severe blood loss.
Interstitial fluid quickly compensates for the lack of plasma (liquid part of blood), but microcirculation disorders persist. If the blood pressure drops too much, the speed of blood flow in the small vessels will decrease, leading to thrombosis.
In the severe stage of post-hemorrhagic anemia, small blood clots form, which 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 decreases, and harmful substances are retained in the body.
It also weakens blood circulation in the liver. If you do not start timely treatment of acute post-hemorrhagic anemia, it will lead to liver failure.
With post-hemorrhagic anemia, the liver suffers from a lack of blood
Oxygen deficiency in the tissues leads to the accumulation of under-oxidized elements, which poison the brain.
Acidosis develops: a violation of the acid-base balance towards the predominance of an acidic environment. If post-hemorrhagic anemia is severe, the amount of alkali decreases, and the symptoms of acidosis increase.
With blood loss, the platelet level decreases, but this does not significantly affect the coagulation processes: the content of other substances that affect coagulation reflexively increases.
Over time, the coagulation mechanisms return to normal, but there is a risk of developing thrombohemorrhagic syndrome.
The main factor influencing the development of post-hemorrhagic anemia is blood loss, the causes of which can be different.
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Acute posthemorrhagic anemia
This is a disorder that develops rapidly due to profuse blood loss. This is a dangerous condition that requires a quick start of treatment.
Causes of acute anemia:
- Mechanical damage to blood vessels. Occurs due to a variety of injuries and errors during surgery.
- Rupture of an aneurysm on the wall of a large vessel, which includes the aorta, peripheral vessels, pulmonary arteries.
- Complications of an ectopic pregnancy. If a pathological pregnancy was detected with a delay, the walls in the area where the fetus develops break through, and intense bleeding begins.
- Spleen ruptured due to trauma.
- Intense bleeding in the uterus during pathological pregnancies or due to menstrual irregularities. In the second case, chronic anemia develops more often.
- Peptic ulcer diseases. An ulcer of the duodenum or stomach is aggravated by profuse bleeding. With latent bleeding, a chronic type of anemia is observed.
- Severe coagulation disorders. A low level of elements that control the process of clotting, and excessive intake of anticoagulants lead to acute bleeding in the digestive tract.
Chronic posthemorrhagic anemia
A condition that develops with systematic blood loss over a long time. It can go unnoticed for a long time if blood loss is mild.
The causes of chronic anemia:
- Moderate coagulation disorders. Failures of mild and moderate severity in the processes of coagulation lead to periodic minor bleeding (nasal, renal, gastrointestinal tract). Also, hemorrhage (hemorrhage) occurs under the influence of other factors: ulcers, inflammatory processes.
- Hemophilia. It is a hereditary clotting disorder that increases the risk of bleeding even with minor injuries. It is capable of provoking both acute and chronic post-hemorrhagic anemias.
- Thrombohemorrhagic syndrome. With this pathology, violations of the coagulation processes are observed. The disease develops against the background of severe traumatic injuries, shock conditions, septic lesions.
- Malignant neoplasms of the stomach or intestines. If the tumor affects organs and tissues, it leads to bleeding of varying intensity.
- Leukemia. With leukemia, all processes of hematopoiesis are disrupted.
- Sepsis. With septic lesions, posthemorrhagic anemia develops due to the consequences of hemolysis, intoxication, and metabolic disorders.
- Hemorrhoids. Hemorrhoidal anemia develops due to systematic bleeding in this disease, it can be both acute and chronic, depending on the severity of the pathology.
- Helminthiasis. The intestinal parasite violates the integrity of the walls, which leads to systematic bleeding. In adults, this disease is rarely detected.
Also, hemorrhagic anemia develops due to vitamin C deficiency.
Posthemorrhagic anemia is divided not only by the nature of the 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:
- Easy. With a mild severity of 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 moderately expressed, the hemoglobin concentration is 70-90 g/l.
- Heavy. With a severe degree, serious violations of the functioning of organs are observed, heart failure develops, the structure of hair, teeth, nails changes. The hemoglobin content is 50-70 g/l.
- Extremely severe degree. If the hemoglobin level is below 50 g/l, there is a risk to life.
There are also certain pathologies included in the ICD:
- Congenital anemia in newborn and fetus due to blood loss (code P61.3),
- Chronic posthemorrhagic anemia, which is secondary iron deficiency (code D50.0).
Symptoms in the acute form of post-hemorrhagic anemia grow very quickly and depend on the severity of blood loss.
- Pallor of the skin,
- Cyanotic lips
- Great weakness
- Increased sweating
- Nausea, vomiting is also possible,
- The surface of the tongue is devoid of moisture,
- Frequent heartbeat, extrasystolic activity may occur,
- Weakened, difficult to palpate pulse,
- When listening to noticeable muffling of heart tones,
- Lowered blood pressure
- Breathing is weak, shortness of breath is present,
- Body temperature does not exceed 36 degrees.
A decrease in blood pressure against a background of massive blood loss is called hemorrhagic shock. The intensity of the drop in blood pressure depends on the severity of blood loss.
The following symptoms are also present:
- The skin is cold and pale, with a moderate to severe degree it has a cyanotic (bluish) color,
- Impaired consciousness (stupor, coma, loss of consciousness),
- Weak pulse (if the stage is severe, it can be felt only on the main vessels),
- Reducing the amount of urine excreted
Symptoms of post-hemorrhagic anemia and hemorrhagic shock are accompanied by signs that are inherent in the disease that caused the blood loss:
- With an ulcer, black or red stools are observed,
- Swelling in the impact area (if injured)
- When the arteries rupture in the lungs, there is a cough with blood of bright scarlet color,
- Intense bloody discharge from the genitals with uterine bleeding.
The source of bleeding is revealed by indirect signs, depending on the clinical picture.
Stages of acute post-hemorrhagic syndrome
Acute post-hemorrhagic syndrome has three stages of development.
|Reflex-vascular stage||The level of plasma and erythrocyte mass falls, compensatory processes are activated, the pressure falls, the heartbeat is rapid.|
|Hydremia stage||It develops a few hours after blood loss and lasts from 2 to 3 days. The intercellular fluid restores the volume of fluid in the vessels. The content of red blood cells and hemoglobin decreases.|
|Bone marrow stage||It develops 4-5 days after blood loss due to oxygen deprivation. In the blood, the level of hematopoietin and reticulocytes – precursor cells of erythrocytes – increases. The amount of iron in the plasma is reduced.|
The body fully recovers after blood loss after two to three months or more.
Signs of a chronic form
Chronic bleeding gradually leads to post-hemorrhagic anemia, which develops gradually, and its symptoms are closely related to the severity of hemoglobin deficiency.
- Pallor and dry skin
- Swelling of the face
- Impaired perception of taste and smell, change in taste preferences,
- Weakness and increased hair loss
- Fragility and smoothness of the nail plates,
- Excessive sweating
- Rapid heartbeat
- Feeling of weakness, severe fatigue,
- Subfebrile body temperature (37-37,5),
People with post-hemorrhagic anemia have low immunity and often develop infectious diseases.
In case of acute blood loss, the patient remains in hospital so that the risks can be assessed and timely assistance provided.
Laboratory diagnostics of post-hemorrhagic 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 erythrocytes and hemoglobin are kept at a normal level,
- After 2-4 hours, the excess of platelets remains, neutrophilic granulocytes grow in the blood, the concentration of red blood cells and hemoglobin decreases, according to the color index, anemia is defined as normochromic (the value is normal),
- After 5 days, there is an increase in reticulocytes, the level of iron is insufficient.
What tests should be taken?
It is necessary to pass a general blood test, in chronic anemia, it reveals the content of elliptocytes, lymphocytes are increased in the peripheral blood, but reduced in the total cellular composition.
Deficiency of iron, calcium, copper is revealed. The manganese content is high.
At the same time, tests are carried out to determine the cause of bleeding: feces examination for helminthiasis and occult blood, colonoscopy, urinalysis, bone marrow examination, ultrasound examination, esophagogastroduodenoscopy, electrocardiogram.
Who can I contact?
Acute hemorrhagic anemias in the first stage of treatment require elimination of the cause of blood loss and restoration of normal blood volume.
Operations are performed to suture wounds, blood vessels, and the following medications are prescribed:
- Artificial blood substitutes. They are poured in by drip or jet, depending on the patient’s condition,
- With the development of shock, 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, donor blood transfusion is required.
Treatment of chronic anemia, not aggravated by serious diseases, takes place on an outpatient basis. Shown is nutritional correction with the addition of foods that contain iron, vitamins B9, B12 and C.
In parallel, the underlying disease is being treated, which caused pathological changes.
If, after extensive blood loss, the patient quickly arrived at the hospital and received the full range of medical procedures aimed at restoring blood levels and eliminating bleeding, then the prognosis is favorable, unless the blood loss is extremely pronounced.
The chronic type of pathology is successfully eliminated when the disease that caused it is cured. 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.