Puffiness in case of anemia
Anemia (anemia) - clinical-hematologicala syndrome characterized by a decrease in the number of erythrocytes and hemoglobin per unit volume of blood. Various pathological processes lead to anemia; so all anemia is considered secondary and treated as one of the symptoms of the underlying disease. But along with common for all anemia symptoms, each of them has its own specific features, which are the essence, distinctive features and peculiarities of certain anemias.
Anemia is divided into three main groups: anemia due to impaired blood flow, anemia due to excessive blood loss and anemia due to blood loss.
Anemia due to impaired blood formation. Iron deficiency anemia is the most common of all kinds of anemia, and their occurrence is associated with various causes: repeated blood loss, inadequate iron absorption (in diseases of the gastrointestinal tract), iron deficiency in food, increased iron intake (for example, in pregnancy) e.
Deficiency of iron causes disturbances not only withthe side of the bone marrow and in general the entire blood system, but also from many organs and systems, in particular the gastrointestinal tract. The lack of iron in the body leads to qualitative changes in the bone marrow: the formation of red blood cells (erythropoiesis) is largely ineffective, i.e., there is a significant death of young erythrocytes during their maturation (differentiation). Ineffective erythropoiesis with iron deficiency can reach 40-50%, while in a healthy person it does not exceed 10-20%.
Daily need for iron, necessary forhematopoiesis, is provided at the expense of iron, which is released when aging aging erythrocytes are destroyed. The missing amount of iron is replenished by food iron, which is absorbed from the gastrointestinal tract, mainly from the mucosa of the small intestine.
A fairly common form of anemia is Bi2(folic-deficiency anemia, the occurrence of which is associated with a lack of intake of vitamin Bi2 - an anti-anemic factor into the body.As a result of vitamin B2 deficiency, there are disturbances in the maturation of erythrocytes in the bone marrow and insufficient saturation of erythrocytes by hemoglobin involved in the delivery of oxygen from the lungs to the body tissues. Therefore, in peripheral blood in this disease there is not only a decrease in the content of red blood cells, but also a functional insufficiency of the available ones.
Clinical manifestations of this type of anemiadepend on the degree and speed of anemization of the organism. Patients are concerned about weakness, fatigue, dizziness, tinnitus, palpitations, dyspnea (especially with physical exertion), pain in the heart area. The appearance of these patients is characteristic: skin is pale, with iron deficiency anemia - with alabaster or greenish tinge. There is a slight swelling of the lower extremities. With a lack of iron, trophic disorders of skin and mucous membranes appear in the form of swelling of the skin and mucous membranes, increased brittleness and distortion of the nails. Hair loses its shine, splits and falls out. When the mucous membranes of the nasopharynx and esophagus are affected, dysphagia syndrome (swallowing disorder) is observed. Spasms of the esophagus are noted.
The epithelium of the tongue changes and leads to atrophy of the taste buds of the tongue. The tongue becomes smooth, waxy, shiny.
Against the background of atrophy of the tongue of the patients, burning, pain in the tongue, often occurring spontaneously and after eating, are often disturbed; there are cracks in the corners of the mouth (seizures), inflammatory phenomena of the oral cavity (stomatitis).
In iron deficiency anemia occursperversion of taste: there is a desire to eat earth, chalk, clay; there is a predilection for some sharp smells. When there is a lack of vitamins Bi2 and folic acid in the body, which is most often associated with gastritis with low acidity or complete absence of hydrochloric acid secretion, the tongue is distinguished by the smoothness of the papillae and bright red coloration.
Often these patients are concerned about various disorders of the gastrointestinal tract in the form of aching pain in the epigastric region, and also from the intestine.
With Bi2 (folic) anemia, there is a pronouncedneurological symptoms associated with spinal cord injury: in patients there are various sensitivity disorders, limb anemia, crawling sensation, muscle weakness, muscle atrophy. Sometimes there are mental disorders: nonsense, hallucinations. When the disease worsens, the subfebrile body temperature is noted. With iron deficiency anemia, there are sometimes imperative urges for urination, inability to keep urine from coughing and laughing, and girls have symptoms of urinary incontinence during sleep.
Anemia due to excessive blood loss. Anemia due to excessive blood loss, or hemolytic anemia, is basically the result of increased disintegration of red blood cells and a shortening of their life span. In normal life expectancy of red blood cells is 100-120 days, with hemolytic anemia it is shortened to 2-4 days.
Intracellular decay of erythrocytes occurs inspecific cells of various organs and tissues, but mainly in the spleen. Intravascular decay of erythrocytes takes place at thinning and brittleness of their shell.
Distinguish between hereditary and acquired hemolytic anemia. Hereditary hemolytic anemia arethe result of genetic defects in erythrocytes, which become functionally inferior and unstable. To hereditary hemolytic anemias include hereditary microspherocytosis (Minkowski-Schoffar's disease). At the heart of Minkowski-Schoffar's disease is a genetic defect in the protein of the erythrocyte membrane. This defect leads to an excessive intake of sodium and water ions in the erythrocyte, which, therefore, acquires a peculiar spherical shape. Such erythrocytes are called spherocytes. Because of their shape, the spherocytes hardly pass through the spinal sinuses, where the place of the surface separates from them with the formation of microspherocytes (hence the name of the disease is microspherocytosis). These erythrocytes are unstable and quickly destroyed in the spleen.
Another form of hereditary anemia is associated withdeficiency of one of the important enzymes - glucose-6-phosphate dehydrogenase, which strengthens the erythrocyte membrane. As a result, erythrocytes become unstable to the effects of a number of damaging factors (cold, drugs, certain foods, etc.).
Acquired hemolytic anemia is associated with the influence of various factors that cause erythrocyte destruction (temperature factors, toxic substances, the formation of antibodies, etc.).
In a large number of cases of hemolyticAnemia is detected in childhood or adulthood. Children have anemia often found when they are examined for their relatives' illness. Jaundice is one of the main clinical symptoms caused by increased erythrocyte decay and the formation of bilirubin. In the urine, bilirubin is not found, since free bilirubin formed through the kidneys does not pass through it. The feces are intensely colored in a dark brown color because of the high content of stercobilin in it. This group of patients has a tendency to stone formation, so they may have attacks of cholelithiasis. Often there is an increase in the spleen, with a prolonged course of hemolytic anemia, the liver can also increase. Children have signs of slowing growth, disfigurement of the facial skeleton (in the form of a tower skull, saddle nose, improperly located teeth, narrow eye sockets).
Individuals of middle and old age often suffertrophic ulcers of the lower leg. Hemolytic crises often occur during the course of the disease; at the same time, the temperature associated with mass decay of erythrocytes increases, jaundice increases, abdominal pain and vomiting are noted. More often crises arise against a background of hypothermia, infections, pregnancy, reception of various medicinal preparations (analgin, sulfonamides, vitamin K, etc.).
Anemia due to blood loss. Anemias due to blood loss, or posthemorrhagic anemia, are acute and chronic.
The point of posthemorrhagic anemia develops inthe result of various acute injuries, accompanied by damage to large and small vessels, or are the result of bleeding from the internal organs (nasal, pulmonary, uterine, gastrointestinal, hemorrhoidal, etc.). Patients complain of dizziness, weakness, tinnitus, increased thirst. The skin and visible mucous membranes become pale, the skin becomes covered with a sticky sweat. Palpitation and rapid breathing are noted. Depending on the localization of bleeding, there may be both bloody vomit (with bleeding from the upper sections of the digestive tract) and vomiting of gastric contents of the color of the coffee grounds (due to the transformation of the hemoglobin of blood to hemosiderin).
With pulmonary hemorrhage, a cough withsputum stained with blood, or just scarlet blood. With bleeding from the gastrointestinal tract, the stool becomes black; if bleeding from the rectum or hemorrhoidal veins, then in the excrements mark the admixture of blood or simply blood. Uterine bleeding gives smearing discharge from the vagina. An important diagnostic value is the study of blood. Usually, changes in blood occur 1-2 days after blood loss. In the 1st day, the red blood counts do not decrease due to the reflex reduction of the vascular bed and the flow of blood from the depot. Later, after 2 days, the tissue fluid passes into the bloodstream and the volume of blood is restored; During this period, anemia is noted in the blood, ie, a decrease in the hemoglobin of the blood. Complete recovery of blood occurs after 2-3 weeks.
Prognosis for acute posthemorrhagic anemia depends on the volume of lost blood and speedbleeding. If half the blood volume is lost, then there is a fatal outcome. With rapid stopping of bleeding and loss of less than half of the circulating blood, the outlook is favorable. When providing emergency care should be guided by the recommendations described in the section "Emergency care."
Chronic posthemorrhagic anemia develops more often as a result of repeatedblood loss. Repeated, even minor blood loss in the same diseases that can cause acute blood loss, in conditions of insufficient bone marrow function entail chronic anemia. Important factors are factors contributing to the reduction of iron stores in the body, which is observed with reduced secretory and acid-forming functions of the stomach, the presence of worms and inflammation of the intestine.
Patients complain of a pronounced general weakness,dizziness, increased fatigue, dyspnea, tinnitus. Their skin is waxy, the face is puffy; marked swelling and swelling of the legs. The blood picture is characterized by a low color index and a number of other changes. The prognosis for the elimination of the source of bleeding is favorable.
Treatment of anemia depending on severitycondition, results of laboratory blood tests, diseases that caused anemia, and a number of other indicators are carried out in a hospital or in outpatient settings. It should be borne in mind that as a result of rapid fatigue, general weakness, nervous disorders, patients are usually irritable, quick-tempered, easily excitable. Therefore, the environment surrounding the patient at home should be as calm as possible, not disturbing the patient with noise, vanity, negative emotions. The regimen recommended by the attending physician must be carried out rigorously.
The fundamental non-pharmacological factor intherapeutic activities are therapeutic nutrition. Patients are recommended diet number 11. The food ration of patients must contain high-calorie foods, mainly protein (meat, insects, poultry, fish, etc.). This is due to the fact that the main products containing easily digestible iron are meat and liver. Patients suffering from iron deficiency anemia should be aware that the iron contained in the liver is as well absorbed from the roast or boiled product as from raw or semi-raw; so you should not eat thermally poorly processed liver, as well as meat, and other foods that have iron.
In addition to protein foods in the foodthe ration in sufficient quantity should be vegetables, fruits, berries, fruit and vegetable juices as the main suppliers of vitamins. At home, you can easily prepare vitamin drinks and use them successfully in the treatment of anemia. The following prescriptions are recommended: 1) 20 g of crushed rose hips are covered in a thermos bottle, pour 1 liter of boiling water and leave overnight; Drink 0: 5 cup 3 times a day for an hour before a meal; 2) a tablespoon of rowan fruit to brew like tea in a glass of boiling water; take 0.5 glasses 2-3 times a day; 3) dried fruits of black currant and dogrose in equal proportions brew with boiling water at the rate of 1 tablespoon of the mixture for 2 cups of boiling water; insist for an hour, strain through gauze, add sugar to taste and take 0.5 cup 3 times a day; 4) to compile the collection: the root of carrots (dried) - 30 g, rose hips - 30, fruit of black currant or mountain ash - 10, nettle leaf - 30 g; 2-4 teaspoons of the collection pour 2 cups of boiling water and keep in a warm place (or in a thermos) for an hour, strain and drink 0.5 cup 3-4 times a day.
Great therapeutic potential for anemic patientsis incorporated in medicinal herbs such as nettle, buckwheat, dandelion, yarrow and many others. etc. Properly prepared infusions of medicinal plant collections with regular application favorably affect many kinds of metabolism in the body, stimulate the production of hydrochloric acid by the stomach, improve the assimilation of iron from food and normalize the formation of functionally active red blood cells - red blood cells in the bone marrow. When anemia is used the following fees:
1) 3 tablespoons of a mixture of nettle leaf, flowering tops of buckwheat and a sheet of spray (all components equally) brewed with 2 cups of boiling water,
for 3 hours and drain; drink a day in 3-4 hours20 minutes before meals; course of treatment - 6-8 weeks; 2) 2 tablespoons mixture of nettle leaf and birch leaf in equal proportions brew 1.5 cups of boiling water, insist an hour, strain, add 0.5 cups of beet juice; Drink a day in 3-4 hours for 20 minutes before a meal; course of treatment - 8 weeks; 3) 1 tablespoon of a mixture of nettle leaf, yarrow flowers and dandelion root (all components equally) brew 1.5 cups of boiling water, insist 3 hours and strain; Drink a day in 3-4 hours for 20 minutes before a meal; course of treatment - 8 weeks.
Dried fruits strawberries (and even better fresh) -an excellent remedy for anemia: they contain up to 10% sugar, organic acids, tannic and pectinic substances, up to 12% essential oil, phytoncides, carotene, a large amount of vitamin C, phosphoric acid, potassium, sodium, calcium, copper, aluminum, chromium In a word, this is a real storehouse of vitamins and trace elements, and it is not without reason that there is a saying: "In a house where you eat blueberries and strawberries, the doctor has nothing to do".
However, it should be borne in mind that ythe majority of patients with anemia, especially in cases when anemia is combined with chronic diseases of the gastrointestinal tract, especially with atrophic gastritis, severe suppression of production of hydrochloric acid by the stomach, absorption of food iron is significantly limited. Therefore, to refuse from drug therapy in favor of exclusively therapeutic nutrition is strictly not recommended. The main method of treatment of patients with iron deficiency anemia is the use of salt preparations of iron, since its absorption is many times higher.
In addition to the prescribed course of treatment for anemiapatients in the subsequent stages of dispensary-dynamic observation in the program of secondary prevention of the disease should undergo sufficiently long courses of anti-relapse therapy. It is carried out, as a rule, in the winter-spring period (February-March) for 1.5-2.0 months and includes iron preparations, vitamins Bi and Vb. During all periods of home treatment and prevention activities, dietary nutrition should provide for a sufficient number of vegetables, fruits, berries, and vitamin drinks. Dietary restrictions are not required.
There is a clear distinction between treatment andprevention of anemia does not exist: therapy of the disease includes many preventive measures, without which it is impossible to achieve the desired result of treatment. At the same time, a complex of preventive measures without courses of anti-relapse therapy and regular intake of certain medications does not have an effect. Therefore, both during an exacerbation of anemia and special treatment in this regard, it is necessary to know the risk factors of the disease, i.e., the causes and conditions that lead to the onset and progression of the disease, so as to exclude them and, if possible, stop the damaging effect on the body.
If as a result of examination of the patientfound that the main cause of the development of anemia is the alimentary factor (eating disorder), then the patient interested in his recovery needs to rethink the nature and diet of his diet. To prevent recurrence and progression of anemia in the first 2-3 months after the end of inpatient or outpatient treatment, diet No. 11 should be followed, followed by a transition to diet 15 lasting 3-4 months. Nutrition of patients even in conditions of their well-being and with satisfactory blood test results should be characterized by sufficient (not less than 100-120 g) content in the diet of animal protein and vitamins. In planning the menu, you should use data on the content of basic chemical components and vitamins in food, and when cooking, follow recommendations for the most rational cooking of foods in order to maximize the preservation of important nutrients.
In patients who developed anemia as aconsequently small in volume, but prolonged bleeding (gastric ulcer or duodenal ulcer, erosive gastritis, chronic hemorrhoids, fissures of the rectum, ulcerative colitis, nasal bleeding, prolonged menstruation et al.), the disease can steadily progressing, if not conduct persistent treatment described diseases. These patients should be under constant dispensary dynamic supervision of the corresponding medical specialists, follow recommendations for the prevention of diagnosed diseases. Anemia during or main disease caused anemia, can exacerbate existing in the body foci of chronic infection (chronic tonsillitis, cholecystitis, carious teeth, dental granuloma, chronic adnexitis, pyelonephritis, urinary tract infection another and t. P.). It should therefore be strongly perform treatment prescription (sanitation) of these diseases: tonsillectomies, teeth or extraction treatment, granuloma complex therapy of other diseases, implementing the activities of their secondary prevention. Finally, the detection of intestinal worms will require very persistent measures to expel these parasites. Recommendations Helminthology must be accurately (up to thoroughness) are made, and give only unfavorable self opposite to the desired effect.
It must be remembered that in patients with anemiaprogression of the disease can occur as a result of exposure to organisms of various occupational hazards (sources of radioactive radiation, corrosive liquids, dust of chemicals, microwave field, rocket fuel components, leaded benzene, etc.). In order to avoid accidents when working with occupational hazards and the occurrence of irreparable consequences as a result of this, including the progression of anemia, it is necessary to comply with all prescribed safety measures, be able to carry out emergency measures in cases of poisoning and in other emergency cases (see section "Urgent help "). The development of hypoplastic anemia associated with harmful factors in the professional activity of patients is a direct indication for changing the nature of the patient's activity and transferring it to work where there are no occupational hazards.
The use of alcohol with anemic patients contributes to a more severe course of the disease. rapid progression of pathologicalprocess, joining the syndrome of impaired blood clotting, which threatens not only the cure, but the very life of the patient. In this regard, alcoholic beverages, especially strong, and especially surrogates of alcohol are contraindicated in patients with anemia. However, on the recommendation of the doctor, patients with iron deficiency anemia and gastritis with reduced or zero acidity can be recommended a small dose of natural dry grape wine (30 ml before each meal) to improve appetite and increase gastric acidity.
An important preventive agent for anemiais a sanatorium treatment (a list of sanatoriums and resorts shown for referring patients with anemia of various origins, see the section "Indications and contraindications for the treatment of patients in health resorts and sanatoriums"). It should only be noted that patients with anemia do not tolerate a high-altitude and hot climate, and for this reason, treatment in plains resorts, especially in the middle of the coastal, plains and forest regions is most preferable for this contingent.
Visits to resorts are useful at all seasons, except for summer. Dispensary dynamic monitoring of patients with anemia is performed by the district therapist or the doctor of the hematology center.
With a favorable course of the diseasePeriodicity of the control medical examinations should be 1 time in 3 months. Consultations of the hematologist are carried out once a year. At least 1 time in 6 months patients should take a clinical blood test.
Clinical analysis of blood with examinationreticulocytes and platelets once a year, as well as the determination of serum iron and urinalysis are prescribed once a year. According to the indications (according to the prescription of the attending physician), patients with anemia are undergoing X-rays of the stomach, fibrogastroscopy, irrigoscopy, sigmoidoscopy, some special blood tests (osmotic resistance of erythrocytes, Coombs test, etc.) and urine (study of free hemoglobin, etc.).
In cases of progressive anemia, frequentrelapse of the disease visit to a sick doctor should be much more often for careful monitoring of the condition of patients by a specialist, prompt correction of treatment, timely, including preventive, hospitalization. Failure to comply with these conditions and the requirements of dispensary dynamic observation in anemia can lead to serious consequences, cause complications, and cause an unfavorable prognosis of the disease.