Anemia - it is a symptom of clinical and hematological type, resulting from sudden or gradual decrease in the level of hemoglobin in the normal or the decline in the absolute number of erythrocyte blood cells.This symptom combines a whole group of pathological states of similar clinical and morphological manifestations and distinct etiopathogenesis of their development.
human hematopoietic system operates in such a way that the body is constantly the process of both education and destruction of blood cells of different orders.When violations in the formation of blood cells red blood cell number or increased destruction of the conditions for the development of anemia of various origins.
cause of anemia
Formation of anemia can be triggered as a single or group of etiological factors, depending on which to distinguish between these etiopathogenetical forms of anemia, such as alimentarnozavisimye, posthemorrhagic (triggered by acute or chronic flow of blood loss) and Megaloblastic
Before you consider pathogenetic mechanisms of anemia should be explored modern scheme of hematopoiesis and kroverazrusheniya derived from a healthy person under normal conditions.Thus, according to the modern differentiation of blood cells, which are produced by the bone marrow and undergo different stages of maturation, decided to allocate seven types of cell substrate.The first type is represented by stem cell myelopoiesis and lymphopoiesis.The second type - a blood progenitor cells from which cells are formed in the future гранулоцитарно-мегакариоцитарно-эритроцитарно-макрофагальногоdirection and precursor B and T lymphocytes.The third type is represented by more differentiated classes of blood cells, characterized by varying degrees of speed and gemoglobinizatsii.Maturation and differentiation of these three classes of blood cells is performed humoral regulation mechanisms, in particular erythropoietin.The fourth, fifth and sixth class is represented actively dividing and maturing polychromatic normocytes, and the seventh is a type of mature red blood cells.
Any chronic or acute anemia is secondary, that is a consequence of the existing body of any pathology (intoxication, neoplastic lesion, vitamin deficiency diseases, endocrine, gastrointestinal, gynecological, and others).
as the main etiopathogenetic manifistatorov anemia can be a loss of blood, inadequate maintenance of the human body substances necessary for the implementation of processes kroveobrazovaniya, toxic effects on bone marrow, the violation of humoral regulation of erythropoiesis, which is observed in hypothyroidism, gipoadrenalizme, hypopituitarism, hypogonadism, tumor lesion structuresbone marrow, increasing the activity of processes of destruction of red blood cell blood cells.
Symptoms and signs of anemia
Erythrocyte blood cells are the main "transporters" gases, namely oxygen and carbon dioxide due to the presence of hemoglobin in their composition.Therefore, even a minimal deficit of blood cells such as red blood cell and hemoglobin, respectively, and provokes the development of hypoxic damage sensitive to oxygen deficiency structure of the human body, as well as excessive accumulation of oxidized materials that violate the normal functioning of organs.The severity of the clinical manifestations of hypoxia associated with anemia depends on the magnitude and rate of decrease of red blood cells and the body's compensatory abilities.
primarily suffering with anemia structures of the central nervous system, namely the cortex.Manifestations of anemia on the impact on the brain is a headache diffuse nature of low intensity, reduced cognitive ability, constant sleepiness, and at the same time a violation of the deep night's sleep, a violation of coordination abilities and a constant feeling of tinnitus.
severe anemia of any etiopathogenetic form appears rough neurological symptoms and especially the development of human consciousness varying degrees of intensity (from fainting to anemic coma).
As regards the impact of anemia on hypoxic myocardium there is a progressive development of degenerative changes, manifested as a feeling of disruption of the heart, progressive shortness of breath, tendency to lower blood pressure, non-specific pain in the projection of his heart.
Chronic anemia in progressive course accompanied by the development of cardiosclerosis, provoking violations of the contractile capacity of the myocardium, causing the formation of a typical clinical symptom of severe circulatory failure stage.
An objective examination of a patient suffering from anemia is noteworthy not only blanching of the skin, but also a change of heart auscultation.Thus, the decrease in hematocrit and a decrease in blood viscosity is accompanied by an acceleration promote blood vessel having reflected in auscultation systolic murmur at all points of auscultation of the heart.Above the surface of the neck veins, as well as the projection of the femoral triangle is often possible to hear the so-called "noise-top."
hypoxic damage with anemia affects all organs and tissues of the human body, including muscle tissue, so patients with this disorder often complain of progression of muscle weakness, which has no connection with physical activity.Excessive accumulation of incompletely oxidized substances in the body triggers inflammation, and therefore, a patient with prolonged duration of anemia may be a chronic fever subfebrile type.
When evaluating a particular clinical symptom observed in the patient, it should be noted that the various forms of anemia etiopathogenetical may be accompanied by the development of specific clinical manifestations characteristic solely for this pathology.
severity of anemia
Considering anemia in terms of impact on the health of the patient, it is necessary to comprehensively assess not only the laboratory but also clinical parameters available to the patient.Determining the severity of anemia, according to the identified violations of the analysis of blood and other data types instrumental studies at any etiopathogenetic form of the disease it is included in the screening and diagnostic algorithm is used to determine further treatment strategy.
To distinguish anemia severity hematologists use classification, the basic criteria which are available clinical symptoms, according to which are five degrees of severity: latent stage (completely absent clinical manifestations, and diagnosis is based solely on laboratory data), moderately severe stage (validanemic and sideropenic symptom) expressed stage of anemia (significant clinical manifestations of hypoxic organ damage and disorders of the central hemodynamics type), precoma and coma.
In assessing laboratory parameters characteristic of anemia, it should be noted that in order to establish the degree of gravity is not enough of any one criterion, but only a set of pathognomonic signs of anemia to evaluate the patient's condition.
For example, in one degree of iron deficiency anemia there is a decrease in the concentration of hemosiderin macrophage cells of the bone marrow, as well as a decrease of iron absorption in the small intestine.2 degree of anemia characterized by an increase in erythrocyte protoporphyrin concentration of cells, decline ferritin decline sideroblasts, lowering saturability erythrocytes hemoglobin, as well as changes in the morphology of erythrocyte cell type hypochromia and macrocytosis.For Grade 3 is characterized by progressive deterioration of not only the laboratory values, but also the development of pathognomonic clinical symptoms of anemia.
types of anemia
Hematologists in their practice using division of anemia on etiopathogenetic basis, under which allocated anemia caused by deficiency of some factors involved in hematopoiesis, mielotoksicskie forms of anemia, and anemia caused by increased activity of the process of destruction of red blood cellblood cells.
Acute hemorrhagic anemia is often triggered by blood loss in the amount of not less than 500 ml and develops at different traumatic impact on vessels large and small caliber, which is the case in wounds, surgical interventions and chronic diseases of internal organs, accompanied by damaging effect on the vascular wall.Clinical manifestations haemorrhagic anemia include not only the symptoms of anemia, but hemodynamic disorders caused by rapid decrease in blood volume.Pathognomonic sign of acute post-hemorrhagic anemia is a serious medical condition when the orthostatic test.Severe anemia is characterized by the rapid development of renal failure.Diagnosis of anemia in existing outdoor signs hemorrhage usually not cause any difficulties, and internal bleeding is based on the instrumental examination methods.
The most common form of anemia is etiopathogenetic iron that occurs in various pathological conditions (blood loss, impaired iron absorption process in the small intestine, increased consumption of iron, iron fixing macrophages).In the process of iron absorption, negatively affected by various pathological changes in the mucous membrane of the gastrointestinal tract, observed in inflammatory diseases, atrophic character.Iron deficiency anemia during pregnancy is developed for other reasons, namely as a result of increased consumption of iron and processes of redistribution of endogenous iron.This etiopathogenesis of anemia is also observed in the presence of a person of any chronic foci of infection (tuberculosis, syphilis) and connective tissue diseases.Alimentary iron deficiency anemia in infants developing non-compliance with the rules of breastfeeding, as well as the transfer of the child to the type of artificial feeding.
Iron deficiency anemia refers to those forms of the disease, the severity of the clinical manifestations of which depends on the degree of anemia body.All displays available in a patient suffering from iron deficiency anemia can be attributed either to the so-called "anemic" or "sideropenic" complex of symptoms.In addition, the patient may experience symptoms that are not related to anemia caused by manifestations of the main pathology background.Regarding clinical sign of iron deficiency anemia should be noted that most of them have a high specificity and there are other forms of this pathology.When connecting the patient expressed sideropenia addition of non-specific symptoms of anemia occur trophic disorders of the skin and appendages in the form of excessive dryness, peeling, brittle nail plates, hair loss, the appearance of Zayed.A characteristic feature of anemia is a sharp decrease in appetite until its complete absence, as well as the distortion of taste preferences.
Depending on the peculiarities of iron deficiency anemia type, split some classic choices.Thus, in adolescence often debuts early chlorosis, the occurrence of which is due to the aggregate impact of the causes of inadequate intake of iron from food, increase the rate of iron in the period of intensive growth and puberty, increased synthesis of myoglobin and heavy menstrual bleeding.The most frequent variants of iron deficiency anemia is a type of chronic posthemorrhagic that there is greater among the female half of the population and is caused by frequent and heavy uterine bleeding and stomach.Also in the risk of developing iron deficiency include pregnant women, and pathogenesis of its development largely due to higher spending endogenous iron.
megaloblastic type of anemia caused by lack of pathogenesis of vitamin B12 group, which is a violation of the result of the synthesis of RNA and DNA of bone marrow cells and the transition to a type of megaloblastic hematopoiesis.Megaloblastic All forms of anemia, in turn, are divided on the etiopathogenetic basis for additional options.Risk of developing anemia megaloblastic forms are persons older age group with a history of stomach or intestinal disease atrophic character.The peculiarity of clinical symptoms of megaloblastic anemia that distinguishes it from other forms of etiopathogenetic this pathology is the presence of signs of lesions of the central nervous system structures.The initial neurological manifestations is a progressive weakness, followed by developing of peripheral skin sensitivity, coordination disorders.In some situations, megaloblastic anemia accompanied by the development of hepatosplenomegaly and toxic damage of the myocardium of the heart.Severe megaloblastic anemia characterized by more severe neurological symptoms in the form of disorders of consciousness, neurohumoral regulation of the functioning of internal organs and psycho-emotional disorders.
Hemolytic anemia forms differ in the mechanism of occurrence, but for all of them characterized by a common pathogenesis and the development of clinical symptoms.Hemolytic anemia often occur when the changes themselves available erythrocyte blood cells or by the impact of external factors on the toxic nature of the red blood cells (hemolytic anemia exo-erythrocytic).Hereditary hemolytic anemia develop as a result of endogenous disease erythrocyte blood cells, while for acquired forms of this disease is characterized by exo-erythrocytic development mechanism.The classic version
flow hemolytic anemia involves the development of the patient's anemia, jaundice and splenomegaly.In some situations, hemolytic anemia may be asymptomatic, but in most cases the patient develops clinical symptoms krizovoe bright character.Manifestations of jaundice is a diffuse change in color of the skin of varying severity.In the long hemolytic anemia patient palpable dramatically enlarged spleen and liver, as well as diagnosed by calculi in the bile ducts and gall bladder.
aplastic anemia refers to the most unfavorable in relation to forecasts, to life and a form of recovery of the patient with high levels of mortality in the youngest age category exceeds the figure of 75%.Aplastic anemia can develop both as deterministic hereditary diseases and under the influence of external etiological factors in the form of ionizing radiation, toxic chemicals, the body of infection.Pathogenetic mechanisms of bone marrow hypoplasia with red sprout inhibition of hematopoiesis is currently not well understood, which leads to the impossibility of etiopathogenetic treatment and the use of primary prevention of this disease blood.
In terms of clinical manifestations hypoplastic anemia should be noted that in this pathology noted the diversity of symptoms, all of which can be attributed to one of three major syndromes: anemic, hemorrhagic and septic necrotic.