- Who is sick more often?
- What can cause hyperchromia?
- Mechanisms of hematopoietic damage
- Clinical manifestations
- Blood picture
- Hyperchromic anemia in myelodysplastic syndrome
- What is written in the diagnosis?
- Treatment of
- The course of hyperchromic anemia
With a norm of 0.8-1.15, hyperchromic anemia exceeds the upper limit. This indicates that the main "culprit" of anemia development in this case is not hemoglobin and its components. Hooding varies due to other pathogenetic factors.
Which kinds of anemia do not affect hemoglobin?
Such a condition as hyperchromia is found in three cases of anemia:
- B12 - deficiency anemia;
- is folic acid-deficient;
- myelodysplastic syndrome.
Who is sick more often?
Hyperchromic anemia is more common among the elderly: by age 75, 4% of people in this age group have anemia. Among young people, only 0.1%( 1 per 1000 people surveyed) with symptoms of megaloblastic anemia are detected.
Basically, these are manifestations of vitamin B12 deficiency, as folate deficiency anemia is rarely detected.
What can cause hyperchromia?
The causes of the decrease in vitamin B12 concentration in the body are associated with various factors.
Insufficient intake of food - restriction of meat, vegetables and fruits in the course of hunger, different diets, vegetarianism, lack of financial opportunity to eat rationally.
Disturbance of assimilation in various gastrointestinal diseases:
- development of atrophic gastritis in the elderly is associated with impaired production of gastromukoprotein( an internal factor of Kastla) necessary for the absorption of vitamin from food, this kind of anemia is called pernicious;
- diseases affecting the small and large intestine( enterocolitis, chronic dysentery, condition after resection of part of the intestine) disrupt the suction function of the wall;
- infectious and intestinal worm infection, in which food vitamins serve as a food for pathological pathogens, parasites.
Folate deficiency arises rarely, because they are consumed by the body in very small quantities, the stock lasts for a long time.
The main cause of folic acid deficiency anemia are:
- alcoholism with hepatic cell damage;
- inflammatory liver disease( hepatitis);
- pregnancy and the period of breastfeeding without adequate compensation for the mother's nutrition.
Mechanisms of hematopoietic damage
Vitamin B12 and folate( folic acid salts) have an important function in the synthesis of cell DNA: they are essential enzymes, without which the biochemical process stops. It is impossible to accumulate a sufficient amount in the liver. The body needs constant replenishment of necessary components.
Pathology develops gradually when all stocks are exhausted. In the process of hematopoiesis, the division of erythroblast cells is disturbed. They turn into megaloblasts. A similar kind of erythrocyte sprout was in a person in the state of an embryo.
Clinical manifestations of
Symptoms of hyperchromic anemia are characterized by a small number of patient complaints, despite pallor and tired appearance. Anemia can be diagnosed when treated for heart pain or when examining the stomach.
It is not typical for this form to lose weight of the patient, on the contrary, the patients are inclined to fullness.
All symptoms are divided into 3 groups.
Manifestations of anemia:
- patient pays attention to weakness;
- frequent dizziness with tinnitus;
- there is an unmotivated shortness of breath with palpitations;
- at rest sudden anginal pain in the heart is possible;
- skin color acquires a pale yellow hue, become icteric sclera;
- with auscultation, the doctor can listen to a characteristic systolic noise in the upper region, and in advanced cases, a systolodiastolic.
Light jaundice sclera indicates anemia
The manifestations of the digestive system damage include:
- change in taste sensations, aversion to some products;
- decreased appetite;
- burning in tongue;
- persistent heaviness and feeling of overflow in the area of the stomach;
- unstable stool with frequent diarrhea;
- examination of the doctor reveals a characteristic "raspberry tongue" with thick folds, enlarged liver.
The defeat of the nervous system is expressed in the numbness of the skin zones, impaired sensitivity on the hands and feet, chilliness of the limbs, muscle weakness and convulsions in them.
Folic deficiency status does not cause neurological manifestations and symptoms from the gastrointestinal tract. The patient notes usual for all anemia manifestations.
In the peripheral blood it is found:
- a sharp decrease in the number of normal red blood cells;
- mild leukopenia and thrombocytopenia;
- in the blood smear there are various erythrocytes( megalocytes, megaloblasts) changed in structure, size and shape, in which an experienced laboratory assistant finds typical Jolly nuclear bodies and rings( due to the near-wall location of the nucleus).
The language differs not only in raspberry tint, but also in the smoothness of the pattern, edema of
Hyperchromic anemia in myelodysplastic syndrome
Myelodysplasia syndrome is isolated due to characteristic hyperchromic changes in the blood after the application of chemotherapy, radiation exposure to bone marrow in the treatment of tumors, leukemias.
In this case, there is a toxic effect on the process of hematopoiesis in the brain cells. Against the background of severe symptoms of the underlying disease, the patient appears:
- increased fatigue;
- sharp dizziness and tachycardia at the slightest load.
The diagnosis is based on a typical blood picture.
What is written in the diagnosis?
The doctor formulates the diagnosis, placing on the first place the underlying disease that caused anemia. A specific type of anemia is indicated as a concomitant pathology or complication. An example of an entry in an outpatient card: "Alcoholic cirrhosis of the liver. B12 and folic deficiency anemia of moderate severity ".
. Light forms are well compensated by changing food, by introducing into the daily diet products rich in essential vitamins( meat, especially liver products, fish, cheese, vegetables and fruits).Nutrition is especially important in pregnancy, breast-feeding.
Cyanocobalamin is used in intramuscular injections, and Folic acid in tablets.
Standard treatment regimen:
- Within 1-1,5 months, the patient is given maximum doses.
- Then another 2 months - maintenance therapy in the form of one injection per week.
- In the subsequent two-month period, the maintenance dose is administered 2 times a month.
The indicator of effectiveness is the appearance in the blood test of reticulocytosis, a week after the initiation of therapy, improvement of the patient's well-being. The longest are neurological disorders.
There is an important feature in therapy: if after a week of treatment with synthetic vitamins there is no improvement, this indicates an incorrect diagnosis.
In severe hyperchromic anemia, it is rare to transfuse the erythrocyte mass.
The lack of response to vitamin B12 therapy also serves as a differential sign between anemia of folic acid deficiency and B12 deficiency anemia.
With the confirmation of myelodysplastic syndrome, the patient does not have to expect fast results. Moreover, there is a danger of the disease passing into acute leukemia. For therapy, it is necessary to replace the transfusion of erythrocyte and platelet mass, introduce immunoglobulin, drugs that stimulate differentiated cell division.
In the diet of elderly people must necessarily be vegetable dishes, fruits, lean meat
The course of hyperchromic anemia
Timely treatment allows you to prevent possible severe consequences in the form of coma. The patient, observing the regimen of taking medications, gradually under the supervision of the doctor is getting full recovery. In rare cases, with a deficiency of folic acid, it must be taken continuously throughout life.
The methods of therapy of myelodysplastic syndrome are conducted by courses, do not have a lasting effect. They help extend the period of remission and life to the patient. In such cases, complete recovery can only be achieved by bone marrow transplantation.
The dispensary observation is carried out by the district therapist quarterly with the control analysis of a blood, once a year the consultation of the neurologist is necessary. There may be a referral and a control check in the hematological center.
Prevention of relapse is to observe the right diet, getting rid of the factors contributing to anemia. Given the high prevalence among older people, attention should be paid to the problem of the rational nutrition of older people.