pale nose
Introduction
Introduction The pale color of the nose is one of the symptoms of anemia. Anemia refers to the amount of hemoglobin, red blood cell count, and hematocrit in a circulating blood per unit volume that is lower than the normal pathological state. The symptoms of anemia manifest themselves in various organ systems throughout the body. Attention should be paid to the onset of illness, the development process and its characteristic performance. Such as acute aplastic anemia often onset more acute, anemia aggravation, chronic aplastic anemia, iron deficiency anemia, chronic hemolytic anemia are often slow onset, course service. Acute hemolysis begins rapidly, chills are hot, muscles are sore, and can be accompanied by soy sauce. Juvenile cell anemia often has glossitis and burning. Anemia associated with heterophilic or difficulty in swallowing and post-sternal pain should be considered iron deficiency anemia.
Cause
Cause
According to the cause of the disease, anemia can be divided into three categories: hematopoietic, hemorrhagic and hemolyzed.
First, poor hematopoietic anemia (red blood cell production)
(1) Hemoglobin synthesis disorder
1. Iron deficiency anemia: insufficient iron intake, relatively increased iron requirement (pregnancy, child growth and development) iron absorption disorder (chronic gastrointestinal disease, postoperative gastrectomy), chronic blood loss.
2. Iron granulocyte anemia.
3. Vitamin B6 reactive anemia.
4. Ferritin deficiency anemia.
(2) Nuclear maturity disorder
1. Pernicious anemia.
2. Other causes of folic acid and or vitamin B12. Lack of megaloblastic cell anemia caused by the use of disorders: malnutrition (lack of food, improper feeding of infants and young children, long-term alcohol abuse, intractable anorexia), increased demand (pregnancy, lactation, child growth and development, mites) , hemolysis, infection, hyperthyroidism, etc., malabsorption (complete gastric or gastrectomy, chronic atrophic gastritis, gastric cancer, chronic liver disease, chronic enteritis, malabsorption syndrome, postoperative bowel resection, intestinal diverticulum Bacterial infection>, the effect of drugs on nucleic acid metabolism (such as antifolate, anticonvulsant, antituberculosis, oral contraceptive, neomycin, nitrite, etc.).
(3) Reduced bone marrow hematopoietic function
Stem cell defect
(1) Aplastic anemia.
(2) Congenital aplastic anemia.
(3) Pure red blood cell aplastic anemia.
(4) Myelodysplastic syndrome.
2. Bone marrow hematopoietic tissue is crowded by other cells: leukemia, malignant lymphoma, multiple myeloma, bone marrow metastasis, myelofibrosis, systemic mastocytosis, marble bone disease, etc.
3. Defects in erythropoiesis regulatory factors: renal anemia, endocrine glands (such as pituitary, thyroid) dysfunction, infectious anemia.
Second, blood loss anemia
(1) Acute blood loss anemia
Such as trauma caused by massive external bleeding or visceral rupture, ectopic pregnancy, gastrointestinal bleeding.
(2) Chronic blood loss anemia
Such as menorrhagia, hemorrhoids, hookworm disease, stomach cancer, peptic ulcer and so on.
Third, hemolytic anemia (red cell destruction)
(1) Red blood cell intrinsic defects
Congenital hereditary
(1) erythrocyte membrane abnormalities: hereditary spherocytosis, hereditary ellipsoidosis, hereditary orthostatic syndrome.
(2) erythrocyte enzyme abnormality: deficiency of enzyme in sugar anaerobic glycolysis (such as pyruvate kinase deficiency) lack of enzyme in hexose phosphate bypass (~glucose dehydrogenase deficiency, often due to broad bean, primary ammonia Oxidative drugs such as quinine or infection induce hemolysis; hemolytic anemia caused by lack of other related ingredients).
(3) abnormal globin chain: abnormality of peptide chain amount (Q thalassemia, B thalassemia), abnormal structure of peptide chain (polymeric hemoglobin disease, unstable hemoglobinopathy).
2. Acquired acquired
Paroxysmal nocturnal hemoglobinuria (PNH).
(two) red blood cell external factors
Immune
(1) Autoimmune: warm antibody type (acute idiopathic acquired hemolytic anemia, chronic idiopathic warm antibody immunological hemolytic anemia, symptomatic warm antibody immunological hemolytic anemia) cold antibody type (special Chronic cold agglutinin disease, paroxysmal cold hemoglobinuria, symptomatic cold agglutinin patients).
(2) Alloimmunity: neonatal hemolytic disease, ABO blood group incompatible hemolytic transfusion reaction, Rh blood group incompatibility hemolytic transfusion reaction.
(3) drug-induced hemolytic anemia: can be found in ammonia salicylic acid, isoniazid, rifampicin, quinidine, phenacetin, aminopyrine, sulfonamides, chlorpromazine, chlorsulfuron , insulin, penicillin, cephalosporin and the like.
2. Non-immune
(1) Mechanical factors (red blood cell debris syndrome): hemolytic anemia after microangiopathic hemolytic anemia and artificial heart valve replacement.
(2) Infectious hemolytic anemia: malaria, sepsis, and the like.
(3) hemolytic anemia caused by biological factors; snake venom, poisonous phlegm and so on.
(4) Hemolytic anemia caused by drugs and chemicals.
(5) hypersplenism.
(6) Disseminated intravascular coagulation (DIC)
(7) Ionizing radiation.
Examine
an examination
Related inspection
Skin color nasal examination
First, medical history
The exact medical history can provide important clues for the diagnosis of anemia, and should be comprehensive, detailed and focused.
1. Anemia performance: The symptoms of anemia are related to various organ systems throughout the body. Attention should be paid to the onset of illness, the development process and its characteristic performance. Such as acute aplastic anemia often onset more acute, anemia aggravation, chronic aplastic anemia, iron deficiency anemia, chronic hemolytic anemia are often slow onset, course service. Acute hemolysis begins rapidly, chills are hot, muscles are sore, and can be accompanied by soy sauce. Juvenile cell anemia often has glossitis and burning. Anemia associated with heterophilic or difficulty in swallowing and post-sternal pain should be considered iron deficiency anemia. Anemia associated with bleeding and fever or infection, more common in acute aplastic anemia, leukemia and malignant histiocytosis.
2. Pathogenic factors: There are many pathogenic factors for anemia. Pay attention to the bleeding, infection, nutrition, diet and medication. History of exposure to radiation and chemical poisons, pregnancy, childbirth and breastfeeding in women of childbearing age. Such as peptic ulcer, stomach cancer, sputum, menstruation and other bleeding is easily ignored. Some people should pay attention to hookworms, worms and other infections. Infants, growth and development, women of childbearing age and the elderly are prone to malnutrition. There may be malabsorption after gastrointestinal surgery. The lack of G6PD endemic areas should pay attention to the history of fresh broad beans and the application history of carbamide, sulfonamide and antipyretic analgesics. History of application of chloramphenicol and cytotoxic drugs. History of exposure to radiation and toxic chemicals.
3. Primary disease: Anemia is often a symptom or complication of certain diseases. It is necessary to pay attention to the presence or absence of chronic infections causing anemia, malignant tumors, chronic liver, kidney or endocrine diseases, autoimmune diseases, rheumatism and the like. Be alert to severe anemia that masks atypical primary disease performance.
4. Genetic factors: Many hemolytic anemias are congenital hereditary disorders. Should pay attention to the family history, whether the parents are married, whether they are ancestral, or have anemia or intermittent jaundice after birth or at an early age.
5. Treatment response: Those who have used anti-anemia drugs at the time of treatment should pay attention to their treatment response. Iron deficiency anemia on iron, nutritional megaloblastic anemia on vitamin B; folic acid treatment has a good effect. Malignant tumors, chronic liver and kidney and endocrine diseases or aplastic anemia are not effective.
Second, physical examination
(1) General conditions
The patient's development, nutrition, expression, blood pressure and body temperature can provide clues for the diagnosis of anemia. Such as childhood developmental delay is common in hereditary hemolytic anemia. Patients with malignant tumors are generally in poor condition and often present with cachexia. Dampness and edema in the sagging area suggest malnutrition anemia. Increased blood pressure with facial or peripheral edema is seen in kidney disease. Apathy, unresponsiveness, and facial edema suggest hypothyroidism. People with severe anemia may have low fever. High fever is often caused by primary disease or concurrent infection, and acute hemolysis can also be seen with high fever.
(2) Special signs
Can provide an important basis for the definition of anemia.
1. Skin, scleral material: nail and tongue skin, sclera jaundice is one of the important signs of hemolytic anemia, often in light lemon color, acute hemolysis can be deep, neonatal hemolytic anemia jaundice is serious, and there are nucleus The nervous system symptoms of jaundice. Skin stasis and plaque suggestive of leukemia, aplastic anemia or bleeding with thrombocytopenic purpura. Chronic hemolytic anemia such as hereditary spherocytosis, sickle cell anemia, etc. should be considered in the chronic or medial side of the lower extremity. Spider Confucianism and liver palm suggest liver disease. Flat or depressed nails are common in iron deficiency anemia. Tongue nipple atrophy, pale and smooth tongue is seen in nutritional anemia and megaloblastic anemia, iron deficiency anemia. The megaloblastic anemia may have a reddish tongue and is often accompanied by pain.
2. Face, bone: severe thalassemia due to bone marrow spasm and thickening of the skull, frontal bulge, nasal bridge collapse, special face of eyelid edema. Chest tenderness suggests leukemia or hemolytic anemia. Multiple bone myeloma, bone metastases, and leukemia should be considered in many parts of the ribs, spine, frontal bone and other bone pain and tenderness.
3. Lymph nodes, splenomegaly: anemia with obvious local or systemic lymphadenopathy often suggest malignant lymphoma, acute or chronic lymphocytic leukemia, malignant histiocytosis. With mild to moderate splenomegaly, hemolytic anemia, malignant lymphoma, cirrhosis, and parasitic infection should be considered. If the spleen is obviously swollen, it is often chronic myeloid leukemia and myelofibrosis. Chronic lymphocytic leukemia is often less common than chronic myeloid leukemia. There is no splenomegaly in the early stage, but there are also a few cases with significant splenomegaly as a unique manifestation. For some diseases, negative signs are also diagnostic. For example, an anemia patient has a complete blood cell reduction. If lymph nodes and splenomegaly are found, primary aplastic anemia is no longer considered.
(three) nervous system performance
The megaloblastic anemia caused by vitamin B1 deficiency may have peripheral neuritis and combined degeneration of the posterior and lateral cords of the spinal cord, and the sense of touch, position and tremor may be reduced or disappeared, and the movement is inconvenient.
Diagnosis
Differential diagnosis
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, reduced, seen in iron deficiency anemia. Increased, is the indication of hemolysis, decreased with small cell hyperplasia, is iron deficiency anemia; reduced with large cell hyperplasia, aplastic anemia. Comprehensive changes in MCV, MCH, and MCHC can identify anemia as hypoxic small erythrocyte anemia and hyperchromic large cell anemia (MCV increases, MCHC is higher than normal).
