Hemolytic anemia caused by arsine
Introduction
Introduction to hemolytic anemia caused by arsine Arsine is a colorless gas and is a very strong hemolytic poison. Arsenic hydrogen is produced when the arsenic-containing metal is contacted with sulfuric acid or hydrochloric acid, and arsine is produced when the arsenic-containing metal slag encounters humid air or water in industrial production (there is no direct use in the industry and belongs to an exhaust gas). basic knowledge The proportion of sickness: 0.00001% Susceptible people: no special people Mode of infection: non-infectious Complications: kidney damage
Cause
Causes of hemolytic anemia caused by arsine
Cause:
Absorbed into the human body by the respiratory tract, 95% to 99% of the arsine entering the blood is combined with hemoglobin in the red blood cells in a non-volatile form to cause hemolysis. Currently, in vivo or in vitro, it has been observed that sulfhydryl groups protect red blood cells from arsenic. Hydrogen hemolysis may also cause hydrogen peroxide generated by arsenic oxidation to bind to the sulfhydryl group of the erythrocyte membrane to damage the erythrocyte membrane, and form an arsenic-Hb complex and an arsenic oxide after hemolysis, and distribute the whole body with the blood flow. Renal function is not compromised and is eventually excreted by the kidneys.
Prevention
Prevention of hemolytic anemia caused by arsine
The main focus of prevention of hemolytic anemia caused by arsine is to improve the working and living environment and reduce environmental pollution and arsenic exposure. In the event of an emergency, all contacts should be quickly removed from the scene. Prevention of arsine poisoning is mainly to strengthen protective facilities to prevent arsenic-containing slag from coming into contact with humid air or water. If there is moisture in the slag, it should be evacuated to the personnel.
Complication
Complications of hemolytic anemia caused by arsine Complications kidney damage
Hemolytic anemia caused by arsine is associated with kidney damage.
The kidney is located in the retroperitoneum and is located deep. It is usually not easily damaged, but it is often open injury due to stab and gunshot wounds. It can also cause renal parenchymal damage due to direct impact of the waist or upper abdomen, or intense oscillation, called closed injury. Due to the rich blood supply of the kidney, once the injury is likely to cause bleeding and extravasation of urine into the tissue, shock and infection occur. Kidney damage is more common in men aged 20-40. It accounts for 3% of hospitalized trauma patients, accounting for 8-10% of abdominal injuries. 6-14% of abdominal puncture injuries can damage the kidneys.
Symptom
Symptoms of hemolytic anemia caused by arsine common symptoms brown urine mild poisoning abdominal pain cold war without urine
The clinical manifestations of acute severe poisoning are divided into 4 phases:
1. Prodromal period: within 3 to 7 hours of inhalation of poison, a large amount of hemolysis in the blood vessels causes low back pain, abdominal pain, chills, vomiting, and then there is brown urine (hemoglobinuria), which is generally only a few hours.
2. Hemoglobinemia: Anemia caused by massive hemolysis and jaundice can lose 50% of the original red blood cells within 12 to 24 hours. After 1 to 2 days, there is obvious jaundice, liver, spleen, and tenderness.
3. Acute renal failure period: arsenic oxide formed after hemolysis, hemoglobin tube type and broken red blood cells block the renal tubules, causing oliguria or even no urine. In addition, anemia after hemolysis causes renal ischemia, hypoxia, and further Aggravate kidney damage.
4. Recovery period: mild poisoning can be clinically free of acute renal failure. In addition, arsine itself has direct damage to liver, kidney and heart. The foreign literature reports that the mortality rate is about 22.5%. If a small amount of arsine is inhaled, Anemia, jaundice and polyneuritis and skin lesions can also occur over a long period of time.
Examine
Examination of hemolytic anemia caused by arsine
Red blood cell debris can be seen in peripheral blood samples, and there are obvious red blood cells of different sizes and deformities. The red blood cell denatured globin bodies (Heinz bodies) can be seen to increase, but the osmotic fragility is normal and the urinary arsenic concentration is increased.
According to the condition, clinical manifestations, symptoms, signs, choose to do ECG, X-ray, biochemistry, hematuria routine.
Diagnosis
Diagnosis and diagnosis of hemolytic anemia caused by arsine
Identification of hemolytic anemia caused by arsine:
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, according to 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.
1. Anemia caused by abnormal hematopoietic stem cells
(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.
2. The hematopoietic microenvironment caused by abnormalities in 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. Tumor diseases or certain viral infections may induce more hematopoietic negative regulators such as TNF, IFN, and inflammatory factors, which may cause chronic disease. Anemia of chronic disease (ACD).
3. Anemia of hematopoietic raw materials or utilization of anemia. Hematopoietic raw materials refer to substances necessary for the proliferation, differentiation and metabolism of hematopoietic cells, such as proteins, lipids, vitamins (folic acid, vitamin B12, etc.), trace elements (iron, copper, zinc). and many more. 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.
(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.).
