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December 26, 2016 00:02

Symptomatic anemia

anemia development opportunities in a number of pathological conditions, it would seem unrelated to the hematopoietic system.Diagnostic difficulties tend to arise when the underlying disease is well known and prevalent syndrome is not anemic in the clinical picture.Meaning of symptomatic (secondary) anemia due to their relative frequency in pediatrics and possible resistance to therapy.The most common symptomatic anemia seen in chronic infections, systemic connective tissue diseases, liver disease, endocrine disease, chronic renal failure, tumors.

anemia in chronic inflammatory processes, infections

most frequently encountered in chronic inflammatory processes, protozoal infections, HIV infection.It is found that for any chronic infection, continuing more than 1 month, Hb is observed to decrease 110-90 g / L.

The origin of anemia are important several factors:

  1. blockade transfer of iron from reticuloendothelial cells in the bone marrow erythroblasts;Increased iron
  2. costs synthesis enzymes and ir
    on, respectively, reduced iron for hemoglobin synthesis walking;
  3. shortening lifespan of red blood cells due to increased activity of cells of the reticuloendothelial system;Violation
  4. allocation erythropoietin response to anemia in chronic inflammation and, consequently, reduced erythropoiesis;
  5. Reduced iron absorption at a fever.

Depending on the duration of chronic inflammation, detect normochromic normocytic anemia, rarely hypochromic normocytic anemia and very high duration of the disease - hypochromic microcytic anemia.Morphological signs of anemia are nonspecific.The blood smear detect Anisocytosis.Biochemically reveal a decrease in serum iron and serum iron binding capacity at normal or elevated iron content in the bone marrow and the reticuloendothelial system.The differential diagnosis from true iron deficiency anemia helps ferritin levels: the secondary hypochromic anemia ferritin levels normal or elevated (ferritin - a protein of the acute phase of inflammation), in true iron deficiency ferritin is low.

Treatment is aimed at relief of the underlying disease.Iron supplements administered to patients with low serum iron.For the treatment use vitamins (especially B).In patients with AIDS having tsizky erythropoietin level, its introduction in high doses can correct the anemia.

Acute infections, especially viral, can cause selective transient or transient erythroblastopenia bone marrow aplasia.Parvovirus B19 is the cause aregeneratornyh crises in patients with hemolytic anemia.

Anemia of systemic connective tissue diseases

According to the literature, anemia occurs in about 40% of patients with systemic lupus erythematosus and rheumatoid arthritis.The primary cause of anemia is considered to be lack of a compensatory response of the bone marrow due to impaired secretion of erythropoietin.Additional factors are the development of anemia of iron deficiency, caused by the constant hidden bleeding through the bowel in patients receiving NSAIDs and the depletion of reserves of folate (folic acid requirement for enhanced due to the proliferation of cells).Patients with systemic lupus erythematosus, moreover, may be autoimmune hemolytic anemia, and anemia due to renal failure.

Anemia often normochromic normocytic, hypochromic microcytic sometimes.There is a correlation between the concentration of hemoglobin and erythrocyte sedimentation rate - the higher ESR, the lower the level of hemoglobin.Serum iron low iron binding capacity is also low.

iron therapy in active phase may be effective in children younger than 3 years old, as they often have pre-existing iron deficiency, as well as in patients with very low levels of serum iron and a low coefficient of transferrin saturation with iron.Reduction of disease activity influenced by nosotropic therapy leads to rapid rise in serum iron and increased iron transport into the bone marrow.Patients can be assigned to erythropoietin therapy, but patients require high doses of erythropoietin, and even at the highest dose observed varying degrees of response.It is found that the higher basal levels of erythropoietin circulating in the plasma of the patient, the less the efficiency of therapy with erythropoietin.

secondary autoimmune hemolytic anemia in patients with connective tissue diseases often docked in the treatment of the underlying disease.The first step in treatment is a corticosteroid therapy and splenectomy, if necessary.When said resistance to hemolysis added tsntostatiki therapies (cyclophosphamide, azathioprine), cyclosporin A, high doses of intravenous immunoglobulin.For rapid decline in antibody titer can be used plasmapheresis.

anemia in diseases of the liver

In cirrhosis of the liver in patients with portal hypertension anemia due to iron deficiency due to blood loss from recurrent esophageal varices and gastric and hypersplenism.Cirrhosis may be accompanied by "shporokletochnoy anemia" fragmentation of red blood cells.Hypoproteinemia exacerbates anemia due to an increase in plasma volume.

In Wilson's disease can be a chronic hemolytic anemia as a result of accumulation of copper in red blood cells.

When viral hepatitis may develop aplastic anemia.

In some patients with possible folate deficiency.The level of vitamin B12 in severe liver disease is pathologically increased, since vitamin "comes out" of hepatocytes.

Treatment of symptomatic anemia, and depends on the underlying mechanism of its development - the replenishment of iron deficiency, folate, etc .;.surgical treatment of the syndrome of portal hypertension.

Anemia of endocrine pathology

Anemia is often diagnosed with hypothyroidism (congenital Mr. acquired), due to decreased production of erythropoietin.Most anemia normochromic normocytic may be hypochromic due to iron deficiency due to a violation of his absorption in hypothyroidism, or hyperchromic macrocytic because of deficiency of vitamin B12, which develops as a result of the damaging effect of antibodies directed against cells not only the thyroid gland, but also gastric parietal cellswhich leads to a deficiency of vitamin B12.Thyroxine replacement therapy leads to improvement and gradual normalization of hematological parameters, on the testimony prescribe iron supplements and vitamin B12 anemia

development possible with hyperthyroidism, chronic adrenal insufficiency, gipopitui-tarizme.

anemia in chronic renal failure

Chronic renal failure (CRF) - a syndrome caused by the irreversible loss of nephrons due to primary or secondary kidney disease.

With mass loss of nephrons occurs progressive loss of renal function, including decreased production of erythropoietin.Development of anemia in patients with chronic renal failure mainly due to a decrease in erythropoietin synthesis.It is found that the ability to decrease renal erythropoietin formulation coincides generally with the advent azotemia anemia develops at the level of creatinine 0,18-0,45 mmol / l and the severity correlates with the severity of azotemia.With the progression of renal complications of uremia and join the program hemodialysis (blood loss, hemolysis, violation of balance of iron, calcium, phosphorus, the effect of uremic toxins, etc.), Which complicates and individualizes the pathogenesis of anemia in chronic renal failure and its severity worsens.

usually normochromic normocytic anemia;hemoglobin level can be reduced to 50-80 g / l;with the appearance of iron deficiency - hypochromic mnkrotsitarnaya.

Treatment is carried out with recombinant human eritropoetnnom (Epokrin, Recormon), which is administered in the presence of anemia as a patient, is not yet in need of hemodialysis, and at the later stages of chronic renal failure.If necessary, administered iron supplements, folic acid, ascorbic acid, B-vitamins (B1, B6, B12), anabolic steroids.Blood transfusion is carried out mainly for emergency progressive correction of severe anemia (decreased hemoglobin level below 60 g / l), for example, massive bleeding.The effect of blood transfusion is only temporary, is necessary to further conservative therapy.

Anemia in cancer

are the following reasons for the development of anemia in malignant diseases:

  1. Hemorrhagic status
  2. deficient state
  3. Dizeritropoeticheskie anemia
    • anemia similar to that observed in chronic inflammation;
    • sideroblastic anemia
    • erythroid hypoplasia
  4. Gemodnlyutsiya
  5. Hemolysis
  6. Leykoeritroblastnaya anemia and bone marrow infiltration
  7. treatment with cytostatics.

patients with lymphoma or Hodgkin's disease is described refractory hypochromic anemia, which is characterized by biochemical and morphological signs of iron deficiency, but not untreatable iron preparations.It is found that of the reticuloendothelial system, involved in the pathological process, iron is not transferred into the plasma.

tumor metastasis in the bone marrow - often metastasizes to the bone marrow neuroblastoma, retinoblastoma and less rhabdomyosarcoma, lymphosarcoma.In 5% of patients with Hodgkin's disease reveal infiltration in the bone marrow.Bone marrow infiltration can be assumed when leykoeritroblastnoy anemia, which is characterized by the presence of mielotsitovi nucleated erythroid cells reticulocytosis, and in late stage - thrombocytopenia and neutropenia, ie, pancytopenia.Leykoeritroblastnaya blood picture due to the fact that the bone marrow infiltration occurs extramedullary erythropoiesis, resulting in peripheral blood ejected earlier myeloid and erythroid cells.Although anemia is usually available, it may be absent in early stage.

Treatment of anemia, in addition to the temporary effect of transfusion, a little success, if you are unable to stop the main process.Perhaps the use of erythropoietin.

Preterm infants with anemia during the severity of clinical and hematological changes should occur a doctor at least 1 time per week to control blood count every 10-14 days during treatment with iron preparations.When treatment failure and in cases of severe anemia hospitalization to determine refractory to drug treatment and iron.