Erythropenia is a decrease in the number of red blood cells in the blood. In most cases, it is combined with a decrease in hemoglobin levels, which in total causes the development of anemia. The cause of erythropenia is acute and chronic blood loss, malnutrition and absorption, cancer, some autoimmune, infectious, hereditary diseases, poisoning. Pathology is manifested by weakness, fainting, tachycardia, decreased immunity, bleeding. Erythropenia is detected as part of a clinical blood test. Treatment - diet correction, B vitamins, iron preparations, erythropoietin.
The norms of erythrocytes vary according to gender and age:
Red blood cells carry hemoglobin, which provides oxygen to the tissues. With a decrease in the number of red blood cells, oxygen starvation occurs. Clinical manifestations are determined by the severity of erythropenia, the rate of decrease in the level of erythrocytes and hemoglobin. In an acute course, symptoms quickly worsen over several hours. In a chronic process, the formation of a typical picture takes weeks or months, the body gradually adapts to changes in the composition of the blood.
Anemia that develops with erythropenia is manifested by constant fatigue, weakness, weakness, loss of strength, decreased exercise tolerance, and a decrease in muscle mass. The patient is concerned about tachycardia, headaches, dizziness, possible pre-syncope, fainting. Decreased sex drive. Skin and mucous membranes become pale, hair becomes dull, nails become brittle.
Against the background of secondary immunodeficiency, colds occur, fungal infections develop (stomatitis, thrush). There is poor healing of wounds, frequent suppuration. Caries progresses rapidly. Mucosal defects are formed in the oral cavity and rectum. Jams appear in the corners of the mouth. Nosebleeds, causeless bruising are possible.
They have a sharp character. The easiest to diagnose are external bleeding with incised and lacerated wounds with damage to an artery or vein. If the integrity of the artery is violated, the blood is bright red, pouring out in a fountain. The skin is pale, tachycardia and hypotension rapidly increase, loss of consciousness is possible. The defeat of large arterial trunks without the provision of emergency medical care is fraught with a fatal outcome.
When a vein is injured, the blood is dark, flows out in a trickle. Erythropenia increases slowly, the condition, as a rule, remains satisfactory. In victims with stab wounds, the severity of blood loss is not always obvious, because due to the narrow wound channel, the blood does not flow outward, but into the tissues and body cavities. Bleeding is accompanied by all fractures, including closed ones. The degree of erythropenia correlates with the severity of blood loss, which depends on the location of the fracture, the presence of concomitant damage to nearby vessels.
A significant danger is internal bleeding in the body cavity due to injuries such as:
May be acute or chronic. The first place in prevalence is occupied by bleeding from the gastrointestinal tract, mainly from the stomach and esophagus. Along with erythropenia and signs of anemia, they are manifested by chalk, vomiting of coffee grounds. Observed in the following pathologies:
erythropenia
Chronic bleeding in diseases of OGK is characterized by hemoptysis, an admixture of blood in the sputum. Acute bleeding is preceded by persistent dry and then wet cough, sometimes combined with a sensation of tickling, gurgling, burning in the chest. The causes of erythropenia are:
The number of heart diseases in which blood loss from the lungs and bronchi with the development of erythropenia can occur includes aortic aneurysm, mitral heart disease.
A pathological condition, accompanied by erythropenia, occurs with tumors, uterine fibroids, inflammatory processes, and disorders of the blood coagulation system. A serious danger is postpartum bleeding, which develops due to uterine hypotension against the background of a complicated course of pregnancy and childbirth, atrophy or hypertrophy of the endometrium after surgical interventions, and pathological processes in the uterus. Bleeding with uterine atony is especially difficult.
Pathological hemolysis is accompanied by massive destruction of red blood cells, the development of erythropenia, hemolytic anemia. Associated with the following conditions:
Erythropenia is formed due to the absence or change in the structure of the enzyme that provides the supply of erythrocytes with glucose, which leads to violations of the properties and premature destruction of red blood cells. The most common fermentopathies are considered to be insufficiency of pyruvate kinase, glucose-6-phosphate dehydrogenase. The phenomena of hemolytic anemia predominate.
Hereditary defects in the erythrocyte membrane cause a change in the shape and increased fragility of blood cells. Erythropenia is found against the background of hemolytic anemia, accompanied by yellowness of the skin, enlargement of the spleen. It is found in pathologies such as spherocytosis (Minkowski-Choffard disease), stomatocytosis, pyropycnocytosis. Another form of hereditary membranopathy is acanthocytosis, which develops with abetalipoproteinemia, some neurological diseases (McLeod's syndrome, chorea-acanthocytosis).
With this hereditary hemoglobinopathy, hemoglobin has an atypical crystalline structure, and red blood cells are sickle or crescent shaped. Sickle cell anemia can be asymptomatic, and when hypoxia occurs, it can manifest as fatigue, pallor, jaundice, and dizziness. In some cases, a severe course is possible with frequent hemolytic crises, the threat of sepsis.
Erythropenia occurs against the background of insufficient intake of folic acid and vitamin B12. With a deficiency of these compounds, megaloblasts accumulate in the blood - large precursor cells of erythrocytes with a short lifespan and a reduced ability to carry oxygen. As a result, patients develop pernicious anemia. Pathology is provoked by the following factors:
Erythropenia has the greatest clinical significance in acute leukemia with damage to bone marrow cells that are precursors of erythrocytes - erythromyelosis. The disorder is also seen in other acute and chronic leukemias. Anemia is combined with intoxication, hemorrhagic, hyperplastic syndromes, the severity of manifestations is determined by the form and variant of the course of the disease.
Erythropenia is detected in the final stages of all cancers, regardless of the location of the pathological process. It is considered as a kind of paraneoplastic syndrome. Occurs as a result of violations of appetite, exhaustion, gastrointestinal bleeding. The latter causes a high probability of severe anemia against the background of cancer of the stomach, large intestine. In addition, radiation therapy can become the cause of erythropenia.
The specialty of the doctor who establishes the causes of erythropenia is determined by the nature of the pathology. Patients with bleeding are examined by traumatologists, gastroenterologists, pulmonologists. Patients with anemia need the help of a hematologist. To determine the severity of erythropenia, to clarify the diagnosis, the following studies are prescribed:
Diagnosis of erythropenia
The wound should be closed with a pressure bandage, in case of arterial bleeding, a tourniquet should be applied to the thigh or shoulder. Fractures are fixed with a splint or improvised items (boards, thick cardboard). A patient with non-traumatic bleeding is provided with complete rest. When blood is released through the mouth, the patient is placed in a position that excludes aspiration. Isolation of blood from the mouth or anus, the occurrence of melena, vomiting of coffee grounds is the reason for the immediate call of the SMP team.
The tactics of conservative treatment is determined by the cause of erythropenia, the existing symptoms. Victims with fractures require immobilization using a plaster cast or skeletal traction. With gastric bleeding, an ice pack is placed on the stomach area, with pulmonary bleeding, tracheal aspiration is performed. Asphyxia is an indication for immediate intubation, removal of blood, and mechanical ventilation.
To correct hypovolemia in erythropenia caused by significant blood loss, infusions of rheopolyglucin, dextran, native plasma or gelatin solution are performed. Posthemorrhagic anemia is eliminated by transfusion of red blood cells. The volume of medical care is determined by the severity of erythropenia, the general condition of the patient, may include resuscitation, control of diuresis, vital signs.
Patients with erythropenia against the background of beriberi are prescribed a special diet, vitamin preparations. The main pathology that provoked the deficiency of vitamins is treated. Iron deficiency anemia due to bleeding is considered an indication for the use of iron supplements. In hemolytic anemia, the transfusion of erythrocyte mass is supplemented with glucocorticoids, iron-binding agents.
Treatment of erythropenia against the background of hemoblastosis involves the organization of aseptic conditions, mono- or polychemotherapy, blood transfusion therapy, irradiation of the spleen and lymph nodes. For malignant tumors of various localizations, chemotherapy and radiation therapy are prescribed.
Taking into account the causes of erythropenia, operations such as: