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Chronic posthemorrhagic anemia - Practical hematology of children's age

Table of contents
Practical hematology of children's age
Embryonal hemopoiesis
Morfofunktsionalny characteristic of cells of marrow and peripheral blood
Marrow parenchyma cells
Peripheral blood of children of different age
The system of a hemostasis is normal
Etiology and pathogeny of leukoses
Acute leukoses
Acute leukoses - a preleukosis
Possibilities of a predictive assessment of a course of an acute lymphoblastoid leukosis at children
General principles of treatment of an acute leukosis
Chemotherapeutic drugs
Treatment of an acute lymphoblastoid leukosis
Treatment of myeloid forms of an acute leukosis
Infectious complications and symptomatic therapy of an acute leukosis
Consolidation and maintenance therapy of an acute leukosis
Remission and recurrence of an acute leukosis
Inborn leukosis
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Hemorrhagic vasculitis (Shenleyn's illness — Genokh)
Mayokki's purpura
Ataxy teleangiectasia
Entsefalotrigeminalny angiomatosis
Kortiko-meningealny diffusion angiomatosis
Cerebroretinal angiomatosis
Hypertrophic gemangiektaziya
Multiple and huge hemangiomas
Elastic fibrodisplaziya
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Hereditary deficit of factors of VII, X, V and II
Deficit K-vitaminozavisimykh of factors of coagulation
Syndrome of the disseminated intravascular coagulation
Clinic and diagnosis of the IDCS
Treatment of the IDCS
Idiopathic Werlhof's disease
Clinic and diagnosis of an idiopathic Werlhof's disease
Treatment of an idiopathic Werlhof's disease
Isoimmune Werlhof's disease
Transimmune Werlhof's disease of newborns
Trombogemolitichesky Werlhof's disease (syndrome Moshkovich)
Hereditary Werlhof's diseases
The anemias connected with blood loss
Chronic posthemorrhagic anemia
Iron deficiency anemias
Clinic and diagnosis of an iron deficiency anemia
Treatment of iron deficiency anemias
Sideroakhrestichesky, sideroblastny anemias
Megaloblastny anemias
Foliyevodefitsitny anemia
Hereditary forms of megaloblastny anemias
Hereditary dizeritropoetichesky anemias
The anemias connected with oppression of proliferation of cells of marrow
Hereditary hypoplastic anemias
Hemolitic anemias
Hemolitic anemias - an ovalocytosis, a hereditary stomatocytosis
Acanthocytosis, piknotsitoz
The hereditary hemolitic anemias connected with disturbance of activity of enzymes of erythrocytes
The hereditary hemolitic anemias connected with disturbance of structure or synthesis of hemoglobin
The acquired immune hemolitic anemias
Isoimmune hemolitic anemias
Treatment of a hemolitic illness of newborns
Autoimmune hemolitic anemias
List of references

This state develops owing to is long the repeating small bleedings. Chronic posthemorrhagic anemia occurs at children rather seldom, more often it can be observed at adults — it is a basic reason of iron deficiency states. Chronic posthemorrhagic anemia in children can be caused by diseases of a digestive tract (polyposes of guts, a peptic ulcer of a stomach and duodenum, ulcer colitis, intestinal parasites, a gullet varicosity, etc.), and also hemorrhagic diathesis (idiopathic trombotsitopsnichesky purpura, hereditary trombotsitopatiya with frequent nasal bleedings, and in girls in the pubertal period — uterine, angiomatous, etc.).
This anemia is characterized by slow rate of development. It should be noted that children rather easily transfer chronic blood losses. The child's organism thanks to compensatory mechanisms adapts to chronic blood losses easier, than to acute in spite of the fact that the total quantity of the lost blood can be considerable big. Researches of cellular kinetics showed that at chronic posthemorrhagic anemia proliferative activity of erythron and an effective erythrocytopoiesis are reduced (S. V. Kanayev, 1969; S. I. Ryabova, 1971, 1973; G. D. Shostka, 1974). As a result of chronic blood losses the depot of iron is constantly exhausted and the sideropenia develops.
The clinical picture depends on severity of anemia. In mild cases anemia a long time can remain unnoticed. Many children feel well at the level of hemoglobin of 90 — 100 g/l. At heavy degree of anemia there are the general weakness, dizziness, a sonitus, physical and mental activity decreases, appetite worsens. Skin is pale, with a wax-like shade or porcelain and pale, mucous membranes of lips, conjunctivas anemic, scleras bluish. The person becomes bloated, on the lower extremities — pastosity, sometimes hypostases. Borders of heart are displaced to the left, over a top and the basis of heart systolic noise of anemic character, tachycardia, on jugular veins — "nun's murmur" is listened, arterial pressure decreases.
Much more often than at acute blood loss, changes of a muscle of heart are expressed. On an ECG — amplitude of teeth P and, signs of disturbance of food of a myocardium is reduced. At the long course of process some increase in a liver and disturbance of its functions is noted.
In peripheral blood — hypochromia anemia, a color indicator within 0,5 — 0,6, sometimes below. The microcythemia, an anisocytosis, a poikilocytosis are observed. Iron level in blood serum is reduced against the increased iron-binding ability of serum. The quantity of leukocytes is normal, but there is a leukopenia, sometimes define shift of a neutrophylic row to the left, a relative lymphocytosis. Treatment first of all is directed to elimination of a bleeding point and recovery of balance of iron. Appoint iron preparations, vitamins, the good nutrition enriched with proteins, the fruit, vegetables and other products containing iron in enough (see. Iron deficiency anemias). At heavy anemia, life-threatening the child, it is possible to resort to a transfusion of erythrocytes, a packed red cells or whole blood.

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