Anemia due to hypothyroidism
Introduction
Introduction to anemia caused by hypothyroidism Anemia caused by hypothyroidism is more common in endocrine diseases, mainly because thyroxine partially affects iron absorption, lowering the metabolic rate of hematopoietic tissue, lowering the rate of iron renewal in plasma and red blood cells, and decreasing oxygen consumption in tissues, resulting in erythropoietin. Reduced secretion. basic knowledge The proportion of illness: 0.02%-0.05% Susceptible population: more common in infants, adolescents, pregnant and lactating women Mode of infection: non-infectious Complications: pleural effusion pericardial effusion
Cause
Causes of anemia caused by hypothyroidism
(1) Causes of the disease
Hypothyroidism causes patients to have mucinous edema or dysplasia, often associated with mild anemia, and there are two causes of hypothyroidism. One is primary hypothyroidism, mostly caused by chronic subacute thyroiditis. An autoimmune disease can cause thyroid body atrophy, fibrosis, loss of function, and second, post-treatment hypothyroidism, seen in drugs for hyperthyroidism, radionuclide therapy or surgical resection.
(two) pathogenesis
1. The reduction in thyroxine secretion can partially affect iron absorption.
2. The decrease of thyroxine leads to a decrease in the metabolic rate of hematopoietic tissue, a decrease in the rate of iron renewal in plasma and red blood cells, and a decrease in the oxygen consumption of tissue, which leads to a decrease in EPO secretion. In addition, thyroid hormone directly stimulates hematopoiesis, which may be regulated by regulation. The adrenergic nervous system is completed, and stimulation of adrenergic nerves in the presence of EPO can stimulate hematopoiesis in erythroid hematopoietic progenitor cells.
3. It has been reported that the hypothyroidism can increase the incidence of malignant anemia, and it is believed that the autoimmune function causes gastric mucosal atrophy and the lack of internal factors.
4. Autoimmune hemolytic anemia Autoimmune endocrine diseases often involve multiple endocrine glands and organs, such as the thyroid gland, adrenal gland, gastric parietal cells, parathyroid glands, and various anti-autoantibodies in the blood. A few people may resist themselves. Erythrocyte antibodies cause autoimmune hemolytic anemia.
Prevention
Anemia prevention caused by hypothyroidism
(1) Supply sufficient protein: The protein content per person per day is at least 20G, in order to maintain the human protein balance egg, amino acid is the basic component of protein, about 3% of protein is updated every day, the rate of small intestinal mucosal renewal is reduced when hypothyroidism Slow, the glands secreted by the digestive juice are affected, the enzyme activity is decreased, and the albumin is generally decreased. Therefore, essential amino acids should be added to supply sufficient protein to improve the condition.
(2) Correct anemia, supply rich vitamins: those with anemia should supplement the iron-rich diet, supplement vitamin B12, such as animal liver, if necessary, also supply folic acid, liver preparations.
(3) Fat-restricting and cholesterol-rich diets: Daily fat supply accounts for about 20% of total calories and limits cholesterol-rich diets. Because hypothyroidism patients often have hyperlipidemia, which is more obvious in primary hypothyroidism, it should limit the fat diet.
Complication
Anemia complications caused by hypothyroidism Complications, pleural effusion, pericardial effusion
Late stage can be combined with heart enlargement, pericardium, chest, and peritoneal effusion.
Symptom
Symptoms of anemia caused by hypothyroidism Common symptoms chills constipation dry skin expression pale face pale pale reaction slow giant tongue forgetful muscle pain goiter after childbirth
The clinical progress of this disease is slow, often masking the symptoms of hypothyroidism, gradually appearing fatigue, chills, myalgia, facial and limb edema, forgetfulness and mental retardation, slow response to external stimuli, generally constipation, sometimes even very Serious, physical examination with apathy, pale complexion, sparse hair, dry and rough skin, thickening of the nose and lips, may have giant tongue disease, non-recessed edema in the lower extremities, a history of hypothyroidism, combined with clinical manifestations, symptoms, laboratory tests, Not difficult to diagnose.
Examine
Examination of anemia caused by hypothyroidism
According to the surrounding red blood cell morphology, it can be divided into three types, each with its own laboratory examination features.
1. Peripheral blood: anemia is mostly mild to moderate, general hemoglobin is not lower than 80 ~ 90g / L, reticulocytes are reduced, blood smear abnormal red blood cells are rare, but about 20% of patients can see spinous red blood cells, white blood cells and platelets Generally normal or slightly reduced.
2. Antiglobulin test: A small number of patients with autoimmune hemolytic anemia can be positive for antiglobulin test.
3. Bone marrow: mild hyperplasia, iron dynamics showed a slight decrease in iron and red blood cell turnover rate, normal red blood cell survival time, and a slight decrease in hemoglobin A2 in red blood cells.
According to the symptoms and signs of the disease, you can choose ECG, B-ultrasound, X-ray, biochemical examination.
Diagnosis
Diagnosis and diagnosis of anemia caused by hypothyroidism
Should be differentiated from anemia caused by other diseases. Such as iron deficiency anemia, megaloblastic anemia. Iron deficiency anemia is mainly due to increased iron demand and insufficient iron intake: more common in infants, adolescents, pregnant and lactating women. Infants and young children need more iron. If they do not supplement foods with high iron content such as eggs and meat, they may cause iron deficiency. Young people are prone to iron deficiency due to partial eclipse. Women with increased menstruation, pregnancy or breastfeeding, increased iron content, if not supplemented with high-iron food, easy to cause IDA. Iron absorption disorder: common in the majority of gastric resection, gastric acid secretion is insufficient and food quickly enters the jejunum, bypassing the main absorption site of iron (duodenum), so that iron absorption is reduced. In addition, gastrointestinal dysfunction caused by a variety of reasons, such as long-term unexplained diarrhea, chronic enteritis, Crohn's disease, etc. can occur due to iron absorption disorder IDA. Iron is too much lost. According to various symptoms, signs, characteristics of the disease, etc. to identify.
