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The intestine, the organ of absorption of blood-forming factors (vitamin B12, folic acid and iron), plays an independent role in blood formation. We are referring to the synthesis of a number of “growth factors”, vitamins by intestinal microorganisms, of which the most important in the physiology of the blood system are folic acid and vitamin B12.

Impaired intestinal absorption in relation to vitamin B12, folic acid, gland, and impaired biosynthesis of folic acid lead to the development of anemia. The best known are pernicious-anemic conditions that occur with prolonged enteritis, pellagra, and especially with sprue (the so-called pernicious sprue anemia). Pernicious-like (or spruob-like) anemias often arise in connection with organic lesions of the intestines (poses, malignant tumors and hyperplastic-blastomic processes - reticulosarcomatosis, lymphogranulomatosis), with diverticula, strictures and large resections of fine lymphoma; as well as in connection with the operation of ileoectomy. The pathogenesis of B12 -deficiency anemia in the latter cases is associated with loss of function of the intestinal acceptor protein.

Pathogenesis. Causes of macrocytic and megalocytic, resp. pernicious, anemia that occurs with various anatomical and functional lesions of the small intestine, are more complex than agastral anemia. There is no doubt that the origin of these forms of anemia, which we combine under the common name of anenteral anemia, plays a role in the absorption of both iron and anti-anemic factors in the affected intestine - vitamin B12, folic acid. Dysbacteriosis also matters, as a result of which, on the one hand, folic acid biosynthesis processes are disrupted by lactic acid bacteria, and on the other hand, the flora (E. coli) multiplying in the small intestine competes with the macroorganism regarding the use of dietary vitamin.

It should be noted that, in contrast to the pure form of B12 monoavitaminosis, which develops with the loss of gastric (more precisely, fundic) secretion and realizes a picture of typical pernicious anemia, lesions of the small intestine, accompanied by general (protein, mineral and multivitamin) deficiency, lead to the development of mixed, B12 (folic) -zhelezdepletsnoy anemia.

The real possibility of the development of macrocytic anemia, resp.
pernitsiozopodobny type depending on the impaired resorption function of the small intestine is confirmed by observations of persons who underwent partial bowel resection for various reasons.

So, Wintrobe describes the development of sprue-type diarrhea and macrocytic anemia in a patient who, 5 years before, 317 cm of small intestines had been removed.

We (1954) observed a 33-year-old patient who, 10 years after resection of the small intestine (275 cm), made in connection with a gunshot wound to the abdominal cavity (in 1944), developed a typical pernicio-anemic coma (hemoglobin 18 units, erythrocytes 840,000 ), from which it was removed by transfusions of the erythrocyte mass and the introduction of vitamin B12.

Less typical are anenteral iron deficiency anemia, occurring in the form of chlorosis, with a low color index, low content of iron, plasma, but with macrocytosis of erythrocytes.

Treatment. Therapy of anenteral anemia is carried out according to the general rules of iron-vitamin (B12-folic) deficiency anemia treatment. Given the violation of intestinal absorption, all antianemic drugs should be prescribed parenterally. Repeated whole blood transfusions are shown. Due to a violation of the general, mainly protein, nutrition, patients are shown a diet rich in proteins and vitamins.
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    THYROORTHEUS ANEMIA Thyroid stimulation anemia is anemia that develops on the basis of hypothyroidism. Experimental work confirms the important role of thyroid hormone - thyroxin - in stimulating normal blood formation. Animals deprived of the thyroid gland, quickly anemiziruyutsya, the introduction of the same thyroid drugs to thyroidectomized animals cures them from the effects of thyroid-induced
    In contrast to the actual agastric anemia associated with partial or complete anatomical removal of the stomach, we distinguish anemia that develops in conditions of functional agastria, when the anatomically preserved stomach partially or completely turns off from the physiological process of digestion and, in particular, loses the ability to assimilate the external antianemic factor - Vitamin B12.
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