acute hemorrhagic anemia
Introduction
Introduction to acute blood loss anemia Acute hemorrhagic anemia is caused by rupture of blood vessels caused by trauma or disease, or a large amount of blood is lost in a short period of time due to coagulation or hemostasis. It not only affects blood volume but also causes anemia after acute blood loss. The initial storage of iron does not decrease. basic knowledge The proportion of illness: the incidence rate is about 1-4/100000, mostly in a car accident or a bruise Susceptible people: no special people Mode of infection: non-infectious Complications: Hemorrhagic shock
Cause
Cause of acute hemorrhagic anemia
Cause
1. Various traumas and bleeding during surgery;
2. Esophageal or gastric fundus rupture, stomach or duodenal ulcer and other diseases caused by gastrointestinal bleeding;
3. All kinds of obstetrics and gynecology bleeding during ectopic pregnancy, placenta previa or delivery;
4. The internal organs, especially the rupture of organs such as the spleen and liver;
5. A large number of lung or bronchial hemoptysis
6. Inflammation, tumors, etc., causing sudden major bleeding caused by erosion of the vessel wall;
7. Various diseases with defective hemostatic mechanism, especially hemophilia, von Willebrand disease, and bleeding in platelet dysfunction.
pathology
The main pathophysiological changes in acute massive blood loss are a sudden decrease in blood volume and a decrease in arterial blood pressure. The early compensation mechanism is through the adjustment of cardiovascular dynamics and the stimulation of adrenal energy, which accelerates heart rate, increases cardiac output, redistributes circulating blood volume, and contracts blood vessels, muscles and spleen, kidney and gastrointestinal tract to ensure Important organ tissues and blood supply to hypoxic-sensitive organs such as heart, lung, liver, and brain tissue. The main clinical manifestation of this period is insufficient blood volume. Since red blood cells and plasma are lost in proportion, the hemoglobin and red blood cell ratios can be determined to be still in the normal range. After 2-3 days, the recovery of blood volume mainly depends on water, electrolytes and albumin mobilized from the outside of the blood vessels into the blood, so that the plasma volume is expanded, the blood is diluted, the viscosity is reduced, the blood flow is accelerated, and the tissue is more oxygen-sucking. However, on the other hand, hemoglobin concentration and red blood cell ratio are continuously decreasing, and anemia occurs. Acute blood loss causes tissue hypoxia, which can stimulate the kidney to produce erythropoietin and promote the proliferation of bone marrow erythrocytes. After 5 days of acute blood loss, the proliferation of young red blood cells reaches a peak. The compensatory ability of bone marrow depends on the hematopoietic function of bone marrow, the reaction of erythropoietin and iron. Whether the supply is abundant.
Prevention
Acute hemorrhagic anemia prevention
To avoid trauma, patients with coagulopathy should be given active treatment early.
Complication
Acute hemorrhagic anemia complications Complications, hemorrhagic shock
The main complication is hemorrhagic shock.
Symptom
Symptoms of acute hemorrhagic anemia Common symptoms Pale pale hypotension, dehydration, pulse, rapid conscious loss, tachycardia, internal hemorrhagic shock
The clinical manifestations of acute blood loss depend on the amount and speed of blood loss, as well as the patient's original health status and age. Most healthy young people can tolerate blood loss of 500-1000 ml (equivalent to 10% to 20% of blood volume), rarely causing symptoms. There is no anemia, but about 5% of people have symptoms due to "vascular vagal nerve reaction". The short-term blood loss is 1000-1500ml (20%-30% of total blood volume), such as healthy young people's mental state is stable. After a quiet rest, taking the supine position may not cause symptoms, but after the activity, cardiovascular symptoms and orthostatic hypotension may occur, such as blood loss of 1500-2000 ml (30% to 40% of total blood volume), even under supine rest. Can also have obvious symptoms: cold hands and feet, pale, thirsty, less urinary pulse, rapid pulse, lower blood pressure, transient loss of consciousness, blood loss more than 2000 ~ 2500ml (40% ~ 50% of total blood volume), can appear Severe hemorrhagic shock, such as improper treatment can lead to death, the original chronic disease, infection, malnutrition, loss of water or the original anemia, elderly patients, even if the amount of blood loss is less than the above, can also lead to shock or death.
Examine
Examination of acute hemorrhagic anemia
Laboratory inspection
1. In the early stage of acute blood loss in peripheral blood, only the blood volume is drastically reduced, and hemoglobin and hematocrit can still be in the normal range. At this time, the latter cannot be used to estimate the blood loss, and then the blood is diluted with hemoglobin and blood cell ratio. Rongcai gradually decreased, 2 to 3 days after hemorrhage is most significant, anemia is normal cells and normal pigmented anemia, reticulocytes began to rise within 2 to 3 days after acute blood loss, peaked at 6 to 11 days, but generally will not exceed 15% to 30%, white blood cells can also increase rapidly (10 ~ 20) × 10 9 / L, up to 35 × 10 9 / L, mainly neutrophils, nuclear left shift, and even the emergence of young cells Platelets begin to rise, up to 1000 × 10 9 /L, white blood cells and platelets return to normal in 3 to 5 days, white blood cells, platelets and reticulocytes continue to rise, the possibility of potential bleeding must be ruled out.
2. Bone marrow like bone marrow can be hyperplasia, mainly young red blood cell hyperplasia, showing normal young red blood cell type, about 10 to 14 days after the bleeding stops, the young red blood cell hyperplasia disappears.
3. Free bilirubin and serum lactate dehydrogenase increased, combined with globin decreased and increased erythrocyte erythrocyte count.
Auxiliary inspection
According to clinical manifestations, symptoms, signs, choose X-ray, CT, MRI, B-ultrasound, electrocardiogram, biochemical examination.
Diagnosis
Diagnosis and diagnosis of acute hemorrhagic anemia
1. Diagnostic criteria
There is no uniform standard for the diagnosis of anemia after acute blood loss. The clinical diagnosis mainly depends on the history of acute blood loss and the evidence of anemia occurring within a certain period of time after blood loss. It is recommended that the following points should be met before diagnosis.
(1) There is a clear history of acute blood loss and clinical manifestations.
(2) Anemia occurs in a short period of time after acute blood loss.
(3) To meet the diagnostic criteria for anemia.
(4) If the patient has anemia caused by other reasons, a large amount of blood loss in a short period of time leads to a 20 g/L decrease in the basic level to diagnose anemia after acute blood loss.
(5) After 2 to 3 days of acute blood loss, the anemia is no longer aggravated and may even recover on its own.
2. Diagnostic steps
Diagnosis is generally based on whether there is a recent anemia, whether there is a recent blood loss or blood loss, according to the steps.
There are many interfering factors in the diagnosis of anemia after acute blood loss. The development of anemia needs to go through several days, while the bone marrow hyperplasia will appear later. The blood volume in the early stage decreases blood concentration. The blood volume is diluted during the treatment process, and the blood volume is supplemented. At the same time, the severity of anemia is alleviated. For anemia after acute blood loss, the diagnostic value of blood examination is limited. Sudden, unexplained anemia needs to be suspected of potential bleeding. Evidence of hematopoietic hyperplasia such as reticulocyte increase and excessive red blood cell destruction cannot be found. The evidence is even more highly skeptical, and the final diagnosis needs to find the bleeding site.
Bleeding can be confirmed from the analysis of medical history, physical examination, and imaging examination. The obvious anemia caused by massive external hemorrhage is usually easy to identify. The bleeding in the digestive tract or female birth canal also has obvious symptoms and signs. Internal bleeding such as aneurysm rupture has no obvious external manifestation, but Sudden shock, hypotension, tachycardia should be suspected of internal bleeding, retroperitoneal, intracorporeal, intracapsular hemorrhage diagnosis is more difficult, B-ultrasound is clear to help with bleeding and bleeding sites.
Differential diagnosis
Anemia after acute blood loss has a clear history of blood loss and anemia evidence is generally no difficulty in diagnosis, but sometimes blood loss time, the site is not very sure or there are other factors mixed, it is difficult to determine whether it is anemia after acute blood loss or whether it is only anemia after acute blood loss It is necessary to pay attention to the identification of the anemia described below.
1. Acute hemolysis anemia After hemorrhagic hyperemia, hematopoietic hyperplasia, such as reticulocyte increased, is easily confused with acute hemolytic anemia, but the former has no evidence of red blood cell destruction such as elevated bilirubin, and a small part of acute blood loss is located in the body cavity or interstitial space. Blood loss is accompanied by red blood cell destruction, and jaundice can also occur, but the degree of red blood cell count and hemoglobin decrease is not parallel with the depth of jaundice, and jaundice is generally lighter than hemolysis, and there is no hemoglobinuria, which can be associated with acute hemolytic anemia. Identification.
2. Anemia with acute infection After acute blood loss, anemia can sometimes be caused by absorption of heat by hemorrhage and moderate fever. If the total number of white blood cells is increased, it needs to be differentiated from acute infection. The signs of anemia are gradually obvious and the lack of infection can be used as identification. in accordance with.
