Hemolytic anemia due to copper poisoning
Introduction
Introduction to hemolytic anemia caused by copper poisoning Copper is a heavy metal, and industrial contact with copper itself does not cause acute or chronic poisoning. However, copper compounds such as copper sulfate, copper acetate, copper chloride, etc. are more toxic than copper itself, which can cause poisoning. Clinically, acute copper poisoning accompanied by hemolysis is common in the following situations: 1. Copper sulfate treatment Poisoning caused by mistakes such as copper sulphate as an emetic agent for rescue patients (usually vomiting dose of 500mg), if the dose is greater than 1 ~ 2g, it will cause copper poisoning. Another example is that the skin is burned by yellow phosphorus. The treatment is often debrided with 5% copper sulfate. If it is applied to the wound for a long time or a large area, it can be absorbed by the skin and poisoned. 2. Poisoning caused by excessive intake of copper sulphate (mistaken or attempted suicide) or copper acetate (stored in copper with copper-green enamel). 3. Accidents: According to the relevant data, the hemodialysis is too alkaline, so that the copper on the dialysis machine dissolves and causes poisoning. 4. Hepatolenticular degeneration is a representative disease of hemolysis caused by inorganic copper in human diseases. Intravascular hemolysis can occur in patients. Due to congenital enzyme deficiency, abnormal copper metabolism in the liver, excessive copper deposition in tissues can also cause damage to liver, kidney, brain and other tissues. Individual patients in the early stage of the disease (children or adolescents) have not been diagnosed, acute hemolytic anemia can occur due to a large amount of inorganic copper into the blood, becoming the first symptom of the disease. basic knowledge The proportion of illness: common in the copper ore metallurgical industry, the incidence rate is about 0.02% - 0.04% Susceptible people: no specific population Mode of infection: non-infectious Complications: jaundice
Cause
Causes of hemolytic anemia caused by copper poisoning
Cause:
Copper is one of the essential trace elements in life. Lack and excess are harmful to the body. Copper absorbed by normal people from the intestine is loosely bound to albumin in the serum and enters the liver. Most of the copper is re-conducted with 2 globulin. The formation of ceruloplasmin (called indirect reaction copper), a part of copper is excreted by the bile duct, a small amount of copper is excreted in the urine, only a small part remains in the blood circulation (called direct reaction copper), when the intake of copper exceeds The liver's processing capacity, copper (direct reaction copper) is released into the blood, it is known that the main reduction in red blood cells is completed in the pentose phosphate bypass process, the pentose metabolism pathway provides reduced glutathione (GSH) and Reduced coenzyme 2 (NADPH), which protects erythrocyte thiol and hemoglobin from oxidative damage. It is believed that copper can bind to the thiol group of erythrocyte membrane to reduce GSH in erythrocytes, and copper is considered to seriously inhibit 6-phosphate glucose dehydrogenase. (G6PD) activity, G-6-PD is a key enzyme in the pentose metabolism pathway. Oxygen free radicals can damage hemoglobin and erythrocyte membrane due to the reduction of antioxidants in red blood cells, making red blood cells Deformability decreases, the membrane permeability, thereby shortening the life of the erythrocytes.
Prevention
Prevention of hemolytic anemia caused by copper poisoning
Avoid or reduce exposure to copper sulfide, copper sulfate, and hepatolenticular degeneration should be treated early.
Complication
Complications of hemolytic anemia caused by copper poisoning Complications
In severe cases, jaundice, liver and kidney dysfunction, and liver and kidney failure may occur.
Astragalus, also known as yellow gallbladder, commonly known as yellow disease, is a symptom and sign of yellowing of the skin, mucous membranes and sclera due to elevated serum bilirubin. Some liver and gallbladder diseases and blood diseases often cause symptoms of jaundice. Usually, when the blood bilirubin concentration is higher than 2-3mg/dL (34-51), these parts will have a color that can be discerned by the naked eye.
Symptom
Symptoms of hemolytic anemia caused by copper poisoning Common symptoms Urine red sauce or soy sauce color skin is pale yellow or deep golden yellow sclera yellow stain congenital copper metabolism disorder
Mainly manifested as yellow lesions of the skin sclera, soothing urine and other hemolytic symptoms and anemia.
The cause of anemia, the degree of decline in blood oxygen carrying capacity, the degree of decline in blood volume, the rate of anemia and the compensatory and tolerable capacity of blood, circulation, and respiratory systems all affect the clinical manifestations of anemia.
Nervous system
Dizziness, tinnitus, headache, insomnia, multiple dreams, memory loss, inattention, etc., are common symptoms caused by anemia and hypoxia leading to nerve tissue damage. When children have anemia, they can cry, worry, and even affect mental development.
2. Skin mucosa
Pale is the main manifestation of skin and mucous membranes in anemia. When anemia occurs, the body can redistribute effective blood volume through neurohumoral regulation. Compared with secondary organs such as skin and mucous membranes, blood supply is reduced. In addition, due to the decrease of red blood cells and hemoglobin content per unit volume of blood, skin and mucous membranes become lighter. Roughness, lack of luster and even ulceration are another manifestation of skin and mucous membranes in anemia, and may also be related to the primary disease of anemia. Hemolytic anemia, especially extravascular hemolytic anemia, can cause yellowing of skin and mucous membranes.
3. respiratory circulatory system
In anemia, more 2,3-diphosphoglycerate (2,3-DPG) is synthesized in the red blood cells to reduce the affinity of hemoglobin for oxygen, so that the oxygen dissociation curve shifts to the right and the tissue acquires more oxygen. Shortness of breath or difficulty breathing, mostly due to hypoxia or hypercapnia in the respiratory center. Therefore, mild anemia has no obvious performance, and only after the activity, the breathing is accelerated and deepened, and the heart rate is increased and the heart rate is accelerated. The heavier the anemia, the greater the amount of activity, the more obvious the symptoms. In severe anemia, even in a calm state, there may be shortness of breath or even sitting breathing. Long-term anemia, overworked heart and insufficient oxygen supply can lead to anemia heart disease. At this time, not only heart rate changes, but also arrhythmia and cardiac insufficiency.
4. Digestive system
In anemia, the secretion of digestive glands is reduced or even the glands are atrophied, which leads to digestive function reduction, indigestion, abdominal fullness, loss of appetite, changes in stool and traits. Long-term chronic hemolysis can be combined with biliary stones and splenomegaly. Iron deficiency anemia can have a foreign body sensation or heterosexuality. Juvenile cell anemia or pernicious anemia can cause glossitis, tongue atrophy, beef tongue, mirror tongue and so on.
5. Urogenital endocrine system
Extravascular hemolysis occurs without bilirubin, high urinary tracturia; hemoglobinuria and hemosiderin in the blood vessels, and even hemoglobin can block renal tubules, causing oliguria, anuria, acute renal failure . Long-term anemia affects the secretion of testosterone and weakens the characteristics of men; for women, it affects the secretion of female hormones and causes menstrual abnormalities, such as amenorrhea or menorrhagia. Both sexes are more common in both sexes. Long-term anemia affects the function of various endocrine glands and the secretion of erythropoietin.
Examine
Examination of hemolytic anemia caused by copper poisoning
1. Peripheral blood: Hemoglobin and red blood cells decrease, reticulocytes increase, white blood cells and platelets are normal.
2. Serum haptoglobin decreased, blood bilirubin increased, and plasma free hemoglobin increased.
3. Urine check: hemoglobinuria, hemosiderin urine.
4. When oral copper salt is acutely poisoned, serum copper, ceruloplasmin and urinary copper are higher than normal, while serum ceruloplasmin is decreased in patients with hepatolenticular degeneration, serum copper oxidase is decreased, and direct reaction of copper and urinary copper Increased (normal reference value: serum copper 0.015 ~ 0.034mmol / L; ceruloplasmin 280 ~ 560mg / L; urine copper 0.24 ~ 0.48mol / 24h).
According to the condition, clinical manifestations and symptoms and signs, choose ECG, B-ultrasound, X-ray, liver and kidney function and bone wear, biochemical examination.
Diagnosis
Diagnosis and diagnosis of hemolytic anemia caused by copper poisoning
Comprehensive analysis of the history, physical examination and laboratory results of anemia patients can determine the etiology or pathogenesis of anemia, thereby making anemia diagnosis. In recent years, due to weight loss caused by nutritional disorders, another group of people with severe anemia. Many patients have anemia of unknown cause, but they can't find any cause in the hematology department. They have been treated as iron deficiency anemia. In response, a new study published in the latest issue of the British Journal of Colorectal Disease found that such unexplained iron deficiency anemia is likely to be an early symptom of colorectal cancer. Dr. S. Dameri, a professor at Durham University in the United Kingdom, and colleagues studied at least 628,000 patients over the age of 40. Participants were screened for iron deficiency anemia and found that one third of patients with iron deficiency anemia later developed colon cancer.
