What Is Chronic Anemia?

Signs of chronic anemia

Chronic anemia

Anemia associated with chronic infections, inflammations, and neoplastic diseases is often called chronic anemia (ACD) and is one of the most common clinical syndromes. The disease is characterized by increased production of cytokines (such as tumor necrosis factor, interleukin-1, and interferon) that mediate immune or inflammatory responses. The entire process of ACD evolution is related to cytokines, including shortened life span of red blood cells, slow response to erythropoietin (EPO), impaired colony formation of red blood cell lines, and impaired iron mobilization in the reticuloendothelial system.

Signs of chronic anemia

(1) Anemia due to chronic infection: Any infection or inflammation that lasts more than 1-2 months is often accompanied by mild to moderate anemia. The clinical manifestations of anemia are often obscured by the symptoms of the primary disease. Anemia is generally not serious, mostly positive cell positive pigment type, but in severe anemia can become a member of the small cell low pigment type. If there is no effect of the primary disease, bone marrow is basically normal, and free protoporphyrin in the bone marrow smear increases. The above characteristics can be distinguished from iron deficiency anemia.

(2) Anemia caused by malignant tumors: In addition to the symptoms caused by the primary disease, the common condition is progressive anemia, with varying degrees of severity. Laboratory tests are similar to anemia caused by chronic infection. If the bone marrow is infiltrated by tumors, cancer cells can be seen in the bone marrow, neutrophils and platelets can be reduced; embolism, bleeding, and shock that cannot be explained by the primary disease can occur when DIC occurs, and jaundice can occur if hemolytic anemia is associated.

(3) Renal anemia: In addition to the general symptoms and signs of anemia, the clinical manifestations include the symptoms and signs of renal failure. The laboratory examination was positive cell angiochromic anemia, reticulocyte was not high, red blood cells and platelets were generally normal. Bone marrow looks normal. As renal failure progresses and urinary nitrogen levels rise, bone marrow can be hypoproliferative, and the maturation of young red blood cells is significantly inhibited.

(4) Hepatic anemia: The type of anemia is mainly normal cells or mildly large cells. Polychromatic nuclear reticulocytes may increase slightly. Bone marrow cells often show hyperplasia, which is mainly large cells-juvenile red blood cell hyperplasia.

Treatment of chronic anemia

In terms of treatment, the main treatment is the primary disease. With the remission of the principle, the anemia can be corrected. For the endocrine gland function, the anemia can be corrected after the lack of hormones. If accompanied by folic acid or vitamin B12 and iron deficiency , Giving supplements is effective. In addition to chronic renal failure complicated by anemia, in order to temporarily correct anemia. Patients with nephrotic anemia can be treated with erythropoietin (EPO), which has a significant effect. The effect is related to the dose and the time of administration. EPO is anaemic to other chronic diseases, but the rate of correction of anemia is slower than that of non-elderly patients, and the maintenance dose is larger. Adverse reactions are mainly increased blood pressure, the initial dose can be 100U / kg each time, 3 / week, the course of treatment is not shorter than 8 weeks. During the treatment, the dose should be adjusted in time according to the efficacy and adverse reactions, and the blood pressure should be closely observed and treated accordingly. Because elderly people are prone to iron deficiency, iron deficiency should be prevented in time to ensure the efficacy. It has been reported that EPO still has immunoregulatory functions and can increase IgG and IgA in patients. After EPO treatment, patients' quality of life improved, and the incidence of upper respiratory tract infections decreased.

Sometimes the reason why chronic anemia is difficult to treat is related to the above-mentioned diseases, but it is not noticed during pregnancy. Therefore, first find out the cause by asking the medical history and careful inspection and analysis. Only by eliminating the cause and then giving iron treatment can it work. . The anemia caused by the chronic infection is difficult to treat because it cannot be corrected with iron, folic acid, vitamin B12 or other known hemoglobin substances. Nevertheless, prevention with iron and folic acid to compensate for the deficiency caused by pregnancy is still appropriate.

From the perspective of perinatal health care, early treatment of certain chronic infections is found early in pregnancy, and early treatment with iron, folic acid and vitamin B12 will give better results.

It has been reported abroad that in women with acute pyelonephritis accompanied by fever and bacteriuria, the cause of anemia appears to be increased destruction of red blood cells and impaired manufacturing, and observation of impaired red blood cell manufacturing may continue for several weeks. We also think that this kind of urinary infection affects the production of red blood cells on the one hand and the lifespan of red blood cells on the other hand. As mentioned above, it also affects the reuse of iron after the destruction of red blood cells. Therefore, the effect of iron supplementation alone is not good. Anti-infection treatment must be first , And then add iron to work.

Principles of blood transfusion for chronic anemia

1. Patients with chronic anemia do not need to be treated urgently. They should actively seek out the cause. The treatment of the cause is more important than blood transfusion.

2. Anemia in chronic anemia patients occurs slowly, and most patients have been able to tolerate a reduction in Hb through compensation. The level of Hb and HCT is not the best indicator for deciding whether to transfusion, but it should be based on symptoms; those who have no obvious symptoms of anemia may not be transfused temporarily.

3. Chronic anemia does not have a problem of insufficient blood volume, and those who have an indication for blood transfusion can only transfuse red blood cells, without the need for transfusion of whole blood.

Considerations for chronic anemia

Treatment for different causes, patients with simple anemia, pay attention to observe the presence of anemia heart disease, heart failure; those with pancytopenia, should also pay attention to prevent infection and severe bleeding. Reduce activity and prohibit strenuous activity.

Patients can be transferred to the hospital if the diagnosis cannot be clearly confirmed after examination, or if the diagnosis is clear but no further treatment is available. For those with severe anemia accompanied by cardiac insufficiency or severe platelet reduction, they should run smoothly during transport and give oxygen if necessary. Bring the diagnosis and preliminary treatment data to the superior hospital for reference.