anemia
Introduction
Introduction to anemia In a certain volume of circulating blood, red blood cell count, hemoglobin volume and hematocrit are lower than the normal standard called anemia. Among them, hemoglobin is the most important, adult males are less than 120g / L (12.0g / dl), adult females are less than 110g / L (11.0 / dl), generally can be considered anemia. Anemia is one of the most common manifestations in the clinic. However, it is not an independent disease. It may be an important clinical manifestation of a basic or sometimes complex disease. Once anemia is found, the cause must be identified. basic knowledge Sickness ratio: 0.1% Susceptible people: more common in women and children Mode of infection: non-infectious Complications: malnutrition
Cause
Cause of anemia
Anemia caused by abnormal hematopoietic stem cells (25%):
(1) aplastic anemia (AA): AA is a bone marrow hematopoietic failure associated with primary and secondary hematopoietic stem cell damage. The pathogenesis of partial pancytopenia is related to the production of anti-myeloid autoantibodies by B cells, which in turn destroy or inhibit bone marrow hematopoietic cells.
(2) pure red cell anemia (PRCA): PRCA refers to the damage of bone marrow erythroid hematopoietic stem and progenitor cells, which in turn causes anemia. According to the cause, the disease can be divided into two categories: congenital and acquired. Congenital PRCA, the Diamond-Blackfan syndrome, is caused by heredity; acquired PRCA includes both primary and secondary. Some scholars have found that some patients with primary PRCA have their own EPO or young red blood cell antibodies in their serum. Secondary PRCA mainly has drug-related, infection-related types (bacteria and viruses, such as parvovirus B19, hepatitis virus, etc.), autoimmune disease-related types, lymphoproliferative disease-related types (such as thymoma, lymphoma, plasma). Cytopathic and lymphocytic leukemia, etc.) and acute aplastic crisis.
(3) congenital dyserythropoietic anemia (CDA): CDA is a kind of hereditary erythroid stem progenitor cells caused by abnormal clonal abnormalities, characterized by erythroid ineffective hematopoiesis and morphological abnormalities anemia. According to hereditary methods, the disease can be divided into autosomal concealed hereditary and dominant hereditary.
(4) Hematopoietic malignant clonal diseases: These diseases have abnormalities in hematopoietic stem and progenitor cells, including myelodysplastic syndromes and various hematopoietic neoplastic diseases such as leukemia. The former is due to pathological hematopoiesis, hyperproliferation, high apoptosis, and in situ hemolysis; the latter has tumoric hyperplasia, low apoptosis and poor differentiation, and hematopoietic regulation is also affected, thereby reducing normal mature red blood cells and causing anemia.
Anemia caused by abnormalities in hematopoietic microenvironment (15%):
The hematopoietic microenvironment includes bone marrow stroma, stromal cells and cytokines. (1) Anemia caused by damage of bone marrow stroma and stromal cells: bone marrow necrosis, myelofibrosis, myelosclerosis, marble disease, bone marrow metastasis of various extramedullary neoplastic diseases, and various infections or non-infectious osteomyelitis The hematopoietic microenvironment may be abnormal due to damage to the bone marrow stroma and stromal cells, which may affect blood cell formation.
(2) Anemia caused by abnormal levels of hematopoietic regulatory factors: stem cell factor (SCF), interleukin (IL), granule-mono-column colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G- CSF), erythropoietin (EPO), thrombopoietin (TPO), platelet growth factor (TGF), tumor necrosis factor (TNF) and interferon (IFN) all have positive and negative regulation of hematopoiesis. Insufficient EPO occurs in renal insufficiency, liver disease, and pituitary or hypothyroidism; neoplastic diseases or certain viral infections induce more hematopoietic negative regulators such as TNF, IFN, and inflammatory factors, which can cause chronic disease. Anemia of chronic disease (ACD).
Anemia caused by insufficient hematopoietic materials or utilization disorders (20%):
Hematopoietic raw materials are substances necessary for the proliferation, differentiation, and metabolism of hematopoietic cells, such as proteins, lipids, vitamins (folic acid, vitamin B12, etc.), and trace elements (iron, copper, zinc, etc.). Any deficiency or utilization of hematopoietic materials may result in reduced erythropoiesis. (1) Anemia caused by deficiency of folic acid or vitamin B12 or utilization disorder: megaloblastic anemia caused by absolute or relative deficiency or utilization of folic acid or vitamin B12 due to various physiological or pathological factors. (2) Iron deficiency and iron utilization of anemia: This is the most common anemia in the clinic. Iron deficiency and iron utilization disorders affect heme synthesis, and this type of anemia is called hemoglobin synthesis abnormal anemia. The erythrocyte morphology of this type of anemia is small, and the central light-stained area is enlarged, belonging to small cell hypochromic anemia.
Anemia has different classifications based on different clinical features. Such as: according to the progress rate of anemia, acute anemia, chronic anemia; according to the red blood cell morphology of large cell anemia, normal cell anemia and small cell hypochromic anemia; according to hemoglobin concentration of mild, moderate, severe and extremely severe anemia; Bone marrow erythroid hyperplasia is divided into proliferative anemia (such as hemolytic anemia, iron deficiency anemia, megaloblastic anemia, etc.) and hyperplastic anemia (such as aplastic anemia).
Clinically, the classification of pathogenesis and causes of anemia is often:
(a) erythropoiesis-reducing anemia
Abnormalities in hematopoietic cells, bone marrow hematopoietic microenvironment, and hematopoietic materials affect erythropoiesis, which can reduce erythropoiesis-deficient anemia.
(2) hemolytic anemia (HA), that is, red blood cells destroy excessive anemia
(3) Hemorrhagic anemia
According to the rate of blood loss, acute and chronic, chronic hemorrhagic anemia often combined with iron deficiency anemia. Can be divided into coagulopathy (such as idiopathic thrombocytopenic purpura, hemophilia and severe liver disease) and non-clotting diseases (such as trauma, tumors, tuberculosis, bronchiectasis, peptic ulcer, sputum and Two types of gynecological diseases, etc.).
Prevention
Anemia prevention
Usually eat more iron-rich foods, such as lean meat, pork liver, egg yolk and kelp, hairy vegetables, seaweed, fungus, fragrant beans and so on. Pay attention to the reasonable combination of diet, such as eating some fruits after a meal, the fruit is rich in vitamin C and fruit acid, which can promote the absorption of iron. Drinking strong tea after a meal is caused by the combination of iron and tannic acid in the tea to form a precipitate, which affects the absorption of iron. In addition, cooking food in a wok is good for preventing anemia. Folic acid and vitamin B12 are also essential for hematopoiesis. Fresh green vegetables, fruits, melons, beans and meat are rich in folic acid, meat and liver, kidney, heart and other internal organs, rich in vitamin B12, but after high temperature cooking, can make more than 50% The folic acid and 10-30% of the vitamin B12 were destroyed. Therefore, in life, we must pay attention to diet diversification, but also pay attention to cooking techniques, try to avoid overcooking food.
Complication
Anemia complications Complications malnutrition
1. Severe anemia can cause heart failure due to myocardial hypoxia. On the other hand, activation of myocardial energy source requires the action of Vit B12. If Vit B12 is deficient, it can affect the activation of ATP and aggravate myocardial disorders. Promote the occurrence of heart failure, so in patients with severe megaloblastic anemia, at the beginning of treatment, attention should be paid to the presence or absence of cardiovascular disease, in order to take necessary measures to prevent accidents.
2, bleeding: thrombocytopenia and the lack of other coagulation factors, this disease is also not uncommon for patients with cerebral hemorrhage or other parts of the bleeding.
3, gout: severe megaloblastic anemia can be seen in the blood marrow caused by ineffective hematopoietic destruction in the bone marrow, resulting in abnormal increase in serum uric acid value, causing gout attacks, but extremely rare.
4, mental abnormalities: severe megaloblastic anemia can not only occur peripheral neuritis, but also people with mental disorders, such as excitement, depression, and even sleepwalking, which may be related to abnormal brain and nerve tissue caused by Vit B12 deficiency related.
Symptom
Symptoms of anemia Common symptoms Tired nose color pale amenorrhea nausea, tinnitus, drowsiness, dizziness, dizziness, confusion, conjunctiva, shallow or pale
The presence or absence of anemia symptoms depends on the degree of anemia, the rate of anemia, the change in circulating blood volume, the age of the patient, and the compensatory capacity of the cardiovascular system. Anemia occurs slowly, and the body gradually adapts, even anemia. Heavier, can still maintain physiological function; on the contrary, if anemia occurs in a short period of time, even if the degree of anemia is not heavy, obvious symptoms can appear, old and frail or heart, lung function decline, the symptoms are more obvious.
The general symptoms of anemia, the signs are as follows:
First, weakness and weakness: fatigue, drowsiness, due to muscle hypoxia, is the most common and earliest symptoms.
Second, the skin, pale skin: skin, mucous membranes, conjunctiva and skin capillary distribution and systolic state and other factors, it is generally believed that the combined membrane, palm-sized fish and nail bed color is more reliable.
Third, the cardiovascular system: palpitations is one of the most prominent symptoms, there is tachycardia, in the apex or pulmonary valve area can hear soft systolic murmur, called anemia murmur, severe anemia can hear diastolic murmur, Severe anemia or existing coronary heart disease can cause angina, heart enlargement, and heart failure.
Fourth, the respiratory system:: shortness of breath or difficulty breathing, mostly due to hypoxia or hypercapnia in the respiratory center.
Fifth, the central nervous system: dizziness, headache, tinnitus, vertigo, inattention, drowsiness, etc. are common symptoms, syncope and even confusion can occur in severe anemia or sudden, especially in elderly patients.
Sixth, the digestive system: loss of appetite, abdominal flatulence, nausea, constipation, etc. are the most common symptoms.
VII. Reproductive system: There are often menstrual disorders in women, such as amenorrhea or menorrhagia, and both sexes are more common in both sexes.
Eight, urinary system: severe anemia may have mild proteinuria and reduced urine concentration.
Examine
Anemia check
In addition to red blood cells, hemoglobin, and red blood cell ratio, the most basic hematology should include:
(1) Net red blood cell count, corrected reticulocyte count = patient's hematocrit / 0.45 / L × reticulocyte (%).
(2) Determination of MCV and MCHC.
(3) Peripheral blood smear, observe whether red blood cells have abnormal red blood cells, such as spherical red blood cells, target red blood cells, fission cells, presence or absence of red blood cell size unevenness, low pigmentation and polychromatic red blood cells, eosinophilic spot color, Kabo The celestial sphere, the hobby body, the number and morphology of white blood cells and platelets, and the presence or absence of abnormal cells.
(D) bone marrow puncture for bone marrow smear examination, the diagnosis is indispensable, if necessary, bone marrow biopsy should be performed, bone marrow examination must include staining to confirm or exclude iron deficiency anemia and iron granulocyte anemia.
Urine routine, fecal occult blood and parasite eggs, blood urea nitrogen, serum creatinine and lung X-ray examination can not be ignored.
Diagnosis
Anemia diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
The indicators for identifying the nature of anemia are often used to calculate the mean red blood cell volume (MCV), mean red blood cell hemoglobin (MCH) and mean red blood cell hemoglobin concentration (MCHC) calculated from the number of red blood cells, hematocrit and hemoglobin.
Increased MCV, seen in aplastic anemia, decreased, found in iron deficiency anemia, increased, is an indication of hemolysis, decreased with small cell hyperplasia, iron deficiency anemia, decreased with large cell syndrome, For aplastic anemia.
Comprehensive changes in MCV, MCH, and MCHC can identify anemia as hypoxic small erythrocyte anemia and hyperchromic large cell anemia (MCV is increased, MCHC is higher than normal).
