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Anemia. Hemorrhagic syndrome

Anemia (anemia) is a condition characterized by a decrease in the number of erythrocytes (the norm in men is 4–5.1x10.12 / l, in women it is 3.9–4.7 × 10.12 / l) and a decrease in the hemoglobin content per unit blood volume (the norm men 130-160 g / l, for women - 120-140 g / l).

At the same time, qualitative changes of erythrocytes, their size, shape and color are often detected. Hemodilution should be distinguished from true anemia, that is, blood thinning due to abundant influx.

tissue fluid, observed6 for example, in patients during the period of convergence of edema, after surgery using cardiopulmonary bypass.

At the same time, true anemia can be masked by thickening of the blood with abundant fluid loss (abundant vomiting, profuse diarrhea, heavy sweat). A characteristic feature of true anemia is either an absolute decrease in the mass of erythrocyte-erythrone or functional insufficiency of erythron due to a decrease in the hemoglobin content in a single erythrocyte.

With anemia in the body, oxidative processes are disturbed and hypoxia develops. Moreover, the clinician often observes the discrepancy between the severity of anemia and the patient's condition. The most important role in eliminating anemia and restoring the normal composition of the blood belongs to the bone marrow, its erythropoietic function.

The state of blood formation in anemias can be divided into 4 types: regenerative normoblastic, hyporegenerative, normoblastic, megaloblastic, and regenerative (aplastic).

Regenerative normoblastic when there is an accelerated rate of maturation of erythrocytes, an increase in the content of erythronormoblasts, reticulocytes in the bone marrow, where their number is higher than in peripheral blood. Anemia is usually normochromic. Often

such a state of hemopase is characteristic of blood loss.

When hyporegenerative normoblasticheskom type imet place slowed down the rate of maturation of red blood cells. Hypochromic anemia and a decrease in the number of reticulocytes are observed in peripheral blood. This type of hematopoiesis is typical for iron deficiency.

The megaloblastic type is characterized by the transfer of blood formation to the embryonic type. The presence of megalocytes in the bone marrow causes a delay in the maturation of normal red blood cells. In the peripheral blood, megalocytic hyperchromic anemia is noted with an increased number of reticulocytes and the presence of such pathological elements as basophilic

red blood cells, Jolly calf and Cabot rings.

With the regenerative, aplastic (hypoplastic) type, the poverty of the bone marrow is determined by the nucleated cells of the leuko- and erythropoiesis, the picture of the fatty replacement of the bone marrow is growing. Peripheral blood is marked by pronounced pancytopenia.

Etiology and pathogenesis.
Anemia occurs either when the loss of red blood cells in the blood due to blood loss or hemorrhage at a given time interval exceeds the maximum capacity for bone regeneration.

brain, or due to insufficient erythropoietic function of the bone marrow, which depends both on the deficiency of substances necessary for normal blood formation (iron, vitamin B12, folic acid) - the so-called deficient anemia, and on the non-assimilation (non-use) of these substances by the bone marrow (so-called achrestic anemia).

Essentially, the classification of anemias is based on their division into 3 large groups, as suggested by MPKonchalovsky, and later modified by IA Kassirsky and GAAlekseev.

1. Anemia due to blood loss (post-hemorrhagic)

a) acute post-hemorrhagic (normochromic) anemia

b) chronic (hypochromic) post-hemorrhagic anemia

11. Anemias due to impaired blood formation

A) Iron deficiency anemia

1. Exogenous (alimentary) iron deficiency

2. Exogenous iron deficiency due to increased demands of the body

3. Resorption of iron deficiency in pathological conditions of the gastrointestinal tract, "surgical" iron deficiency anemia

B) Iron-refractory (sideroahresticheskie) anemia

a) hereditary

b) acquired

C) B-12 folic deficiency anemias

1. Exogenous vitamin B-12-folic acid deficiency

2. Endogenous vitamin B-12-folic acid deficiency due to impaired assimilation of dietary vitamin B-12 due to loss of gastromucoprotein secretion

3. Violation of the assimilation of vitamin B-12-folic acid in the intestine

4. Increased consumption of vitamin B-12-folic acid

D) B-12-folic-achrestic anemias due to impaired assimilation of vitamin B-12-folic acid by the bone marrow

D) Dizerythropoietic anemia due to ineffective


E) Aplastic (hypoplastic) anemia

G) Metaplastic anemia due to bone replacement


111. Anemias due to increased blood destruction (hemolytic)

A) Anemia caused by exo-erythrocyte factors

B) Anemia due to endo-erythrocyte factors

1. Erythrocytopathy

2. Erythrocytosis

3. Hemoglobinopathy
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Anemia. Hemorrhagic syndrome

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