High hematocrit

Introduction Hematocrit helps to understand the increase and decrease of red blood cells. When the absolute value of red blood cells is increased due to various reasons, the hematocrit will also increase accordingly. High hematocrit is found in patients who have been examined for blood after shock. There are many reasons for shock, and there are many ways to classify it. From the clinical point of view, according to its etiology and pathophysiological characteristics, shock can be divided into: 1 cardiogenic shock. 2 hypovolemic shock. 3 septic shock. 4 anaphylactic shock. 5 neurogenic shock. 6 Others have endocrine insufficiency (adrenal insufficiency, hypothyroidism, etc.) and endocrine hyperactivity (such as thyroid crisis, hyperparathyroidism, carcinoid and primary aldosteronism, etc.) shock.

Cause

There are many reasons for shock, and there are many ways to classify it. From the clinical point of view, according to its etiology and pathophysiological characteristics, shock can be divided into: 1 cardiogenic shock. 2 hypovolemic shock. 3 septic shock. 4 anaphylactic shock. 5 neurogenic shock. 6 Others have endocrine insufficiency (adrenal insufficiency, hypothyroidism, etc.) and endocrine hyperactivity (such as thyroid crisis, hyperparathyroidism, carcinoid and primary aldosteronism, etc.) shock.

The above types of shock can exist alone or in combination (ie, complex shock), which is more common in the advanced stage of the disease, and the condition is often complicated and serious.

(a) cardiogenic shock cardiogenic shock narrowly refers to the serious stage of acute myocardial infarction pump failure (see acute myocardial infarction). In acute myocardial infarction, clinical manifestations such as hypotension, hypoperfusion, renal blood flow reduction, central nervous system loss and other important organs microcirculation failure, but also drugs (such as analgesics, vasodilators) The diagnosis of cardiogenic shock can be considered in the hypotension caused by decreased blood volume caused by loss of body fluids or loss of fluid. In general, cardiogenic shock also includes acute myocarditis, massive pulmonary infarction, papillary or chordae rupture, leaflet perforation, severe aortic valve or pulmonary stenosis with mild or moderate tachycardia, acute pericardial tamponade, tension Sexual pneumothorax, atrial myxoma, severe mitral or tricuspid stenosis with mild or moderate tachycardia, sustained tachycardia, and other shocks.

(B) hypovolemic shock (hypovolemic shock) is a large amount of blood loss (internal or external bleeding) in the body or blood vessels, such as vomiting, diarrhea, intestinal obstruction, gastrointestinal fistula, diabetes acid Shock, etc.), loss of plasma (such as extensive burns, peritonitis, trauma and inflammation) and other reasons caused by a sudden decrease in blood volume caused by shock. It is characterized by decreased venous pressure, increased peripheral vascular resistance, and tachycardia. Hemorrhagic shock, traumatic shock, and burn shock are all hypovolemic shocks (see "Upper gastrointestinal bleeding").

(3) Septic shock Septic shock, also known as toxic shock, is characterized by insufficient perfusion of tissue. Usually caused by infection with Gram-negative bacilli. Insufficient circulatory function is due to increased peripheral vascular resistance, blood stasis in the microcirculation, decreased cardiac output and hypoxia (a small number of vascular resistance is reduced, small movements, venous short circuit is open, cardiac output is not reduced) Even increased, but the microcirculation perfusion is reduced). The cause is mainly found in Gram-negative bacilli infection (such as sepsis, peritonitis, necrotizing cholangitis, etc.), toxic bacillary dysentery, toxic pneumonia, fulminant epidemic cerebrospinal meningitis, epidemic hemorrhagic fever, etc. Shock is not directly caused by bacteria Invaded by blood flow, but related to the release of bacterial endotoxin and its cell wall lipopolysaccharide into the blood. It is particularly prone to occur in frail, elderly, malnourished, diabetic, malignant, and long-term use of hormones, immunosuppressive drugs, and antimetabolites. (See "Infectious Shock").

(4) Anaphylactic shock Anaphylactic shock is a rare type of shock in which the body develops an allergic reaction to certain biological products, drugs or animal and plant allergens. The allergen and antibody act on the sensitized cells, and the latter release serotonin, histamine, bradykinin and the like to cause peripheral vasodilation, enlargement of the capillary bed, plasma oozing, and relatively insufficient blood volume. In addition, there is often throat edema, dyspnea caused by bronchospasm, which increases the pressure in the thoracic cavity, thus reducing the amount of blood returning to the heart and reducing the amount of cardiac output (see "Allergic shock").

(5) Neurogenic shock Neurogenic shock is a severe disorder of arterial resistance regulation, loss of vascular tone, causing vasodilation, resulting in decreased peripheral vascular resistance and shock caused by reduced circulating blood volume. Shock, which is caused solely by neurological factors, is rare, and can be found in trauma, severe pain, cerebrospinal injury, drug anesthesia, intravenous barbiturates, ganglion blockers or other antihypertensive drugs, and trauma. Clinically, septic shock, cardiogenic shock, hypovolemic shock, and anaphylactic shock are more common.

an examination

Related inspection

Hematocrit (PCV)

As a clinical syndrome, the diagnosis of shock is often based on the clinical manifestations of hypotension, microcirculatory perfusion, and sympathetic compensatory hyperactivity.

Diagnostic conditions: 1 There is a cause of shock. 2 consciousness is abnormal. 3 pulse faster than 100 times / min, fine or can not be touched. 4 limbs wet and cold, sternum skin pressure positive (after refilling time is more than 2 seconds), skin pattern, pale mucous membrane or blemishes, urine volume less than 30ml / h or no urine. 5 systolic pressure is less than 10.64 kPa (80 mmHg). 6 pulse pressure is less than 2.66 kPa (20 mmHg). 7 The original systolic blood pressure of the original hypertension decreased by more than 30%. A diagnosis can be established if one of 1, 2, 3, 4, and 5, 6, or 7 is met.

(1) Early shock: The patient is conscious, but irritated and anxious or excited. The complexion and pale skin. The lips and nail bed are slightly blueish. Cold sweat, cold limbs. Can have nausea and vomiting. The heart beats faster and the pulse is still strong. Systolic blood pressure can be low or close to normal, but also due to increased secretion of catecholamines, but unstable, diastolic blood pressure is increased, so the pulse pressure is reduced. The amount of urine is also reduced.

(b) Mid-shock: Clinical manifestations vary with the degree of shock. In the case of moderate shock, in addition to the above performance, the mind is still clear, but weak, indifferent, unresponsive, and confused. The pulse speed is fine, the pressure is slightly heavier, the systolic pressure drops below 10.6 kPa (80 mmHg), the pulse pressure is less than 2.7 kPa (20 mmHg), the superficial vein is collapsed, thirst, and the urine volume is reduced to less than 20 ml per hour. In severe shock, shortness of breath can lead to coma, systolic blood pressure below 8kPa (60mmHg), and even no measurement, no urine.

(C) late stage of shock: diffuse intravascular coagulation and extensive cardiac organic damage occurred during this period. The former causes bleeding, may have skin, mucous membranes and internal organs bleeding, gastrointestinal bleeding and hematuria are more common, adrenal hemorrhage can lead to acute adrenal insufficiency, pancreatic hemorrhage can lead to acute pancreatitis. Heart failure, acute respiratory failure, acute renal failure, brain dysfunction, and acute liver failure can occur.

Differential diagnosis

1, erythrocytosis: erythrocytosis refers to the number of red blood cells per unit volume of blood is higher than the normal limit. It is generally believed that adult male erythrocytes >6 million/mm3 and adult females >5.5 million/mm3 are erythrocytosis. Increased relative is seen in blood concentration; absolute increase is seen in high altitude life, fetal and neonatal, severe physical labor, severe heart and lung disease, and polycythemia vera.

2, erythrocytosis - high viscosity: erythrocytosis - high viscosity syndrome is a more common disease in the neonatal period, due to increased red blood cells, blood viscous, slow blood flow, easy to cause poor perfusion and lack of tissue Oxygen and damage to the heart, brain, kidney and other organs can partially affect the long-term prognosis of the nervous system.

3, red blood cell syndrome: hemophagocytic syndrome (HPS) also known as hemophagocytic lymphohistiocytosis, also known as hemophagocytic reticulosis (hemophagocytic reticulosis), first in 1979 by Risdall et al report. It is a multi-organ, multi-system involving, and progressively aggravated macrophage proliferative disease with immune disorders, representing a group of diseases with different pathogens, characterized by fever, hepatosplenomegaly, and complete blood cell reduction.

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