Anemia

Introduction The so-called anemia appearance is the performance of anemia in the human body, mainly observed by the naked eye, such as pale eyes, pale lips and nails, etc., severe anemia can also express skin sallow. Pale, prone to fatigue, irritability, weakness, shortness of breath, low blood pressure, and dizziness, oral pain, cracked nails, headache, and sudden preference for a particular preference for food or lack of appetite, etc. symptom.

Cause

Caused by anemia.

In coastal and plain areas, the hemoglobin of adult men is less than 12.5g/dl, and the hemoglobin of adult women is less than 11.0g/dl, which can be considered as anemia. Children under the age of 12 are about 15% lower than the normal value of hemoglobin in adult men, and there is no significant difference between boys and girls. Areas with high altitudes are generally higher.

The amount of red blood cells per cubic millimeter in the blood is 3.8-5.5 million in young children; 470-6.1 million in school-age children and 420-5.4 million in girls. Hemoglobin is shown by the number of grams of hemoglobin per 100 ml of blood, 9.5 to 14.5 g for 3 months; 10.5 to 14 g for 6 months to 6 years; l 1.0 to 16.0 g for 7 to 12 years, if Below the normal reference value, it can be considered as anemia.

From 8-9 months to 2 years old, anemia is prone to occur due to insufficient iron content in food. Because premature babies do not absorb enough iron from the mother and are more prone to anemia. Even if the child is normally born, after 8-9 months, if only breastfeeding is the mainstay, and no supplementary food such as fish and meat is added, iron deficiency is easy to occur.

Pale, prone to fatigue, irritability, weakness, shortness of breath, low blood pressure, and dizziness, oral pain, cracked nails, headache, and sudden preference for a particular preference for food or lack of appetite, etc. symptom.

an examination

Related inspection

Morphological examination of blood smear hemoglobin bone marrow cells

The most basic hematological examinations other than erythrocyte hemoglobin erythrocyte ratio should include:

1. Restricted red blood cell count correction reticulocyte count = patient's hematocrit / / L × reticulocyte (%).

2. Determination of MCV and MCHC.

3, peripheral blood smear observation of red blood cells with or without red blood cells such as spherical red blood cell target erythrocyte fission cells with or without red blood cell size uneven pigmentation and multi-staining red blood cell eosinophilic spot color Cabot's ball Hao week's body, etc. Changes in the number and morphology of white blood cells and platelets are associated with abnormal cells.

4, bone marrow puncture for bone marrow smear examination for diagnosis is not necessary when necessary for bone marrow biopsy bone marrow examination must include staining to confirm or exclude iron deficiency anemia and iron granulocyte anemia.

Urine routine fecal occult blood and parasitic egg blood urea nitrogen creatinine and lung X-ray examination can not be ignored.

Differential diagnosis

First, the identification of blood loss anemia

Acute blood loss anemia

The common feature of acute blood loss, especially the anemia caused by large blood loss, is that the mucosa is pale and pale, and even the conjunctiva is white like porcelain. The cardiopulmonary dysfunction is severe and the course is short. The bleeding is not only endless, but immediately worsens. The various components of the blood are progressively reduced in parallel.

trauma

The cause of trauma can be investigated. Sudden onset after trauma; visible trauma on the surface, bleeding site after debridement, bleeding stops after effective treatment; plasma and blood components are simultaneously reduced. Non-open trauma should pay attention to the local or subcutaneous or intramuscular wounds, or local puncture for diagnosis, or make inferences based on the rapid reduction of plasma and blood components in parallel.

Postpartum hemorrhage

Due to the cause of tearing of the birth canal during childbirth, etc., postpartum hemorrhage is not limited to anemia, and the bleeding site can be found by carefully examining the birth canal. Small blood vessels rupture, and more naturally stop bleeding.

Chronic blood loss anemia

The course of the disease is slow, the sales of sick animals, and the anemia gradually increase, affecting the growth and production performance of animals to varying degrees. The blood picture is small cell hypochromic anemia. The red blood cells become smaller, the size is uneven, and the central light-stained area is enlarged. Serum iron and extramedullary iron are reduced.

Ascariasis

The main symptoms are constipation and diarrhea alternately, losing weight and anemia, pale mucous membranes, rough hair, long course of disease, and multiple deaths. In the feces, the aphid eggs are detected, and sometimes the insects are discharged, and the insects such as the cockroaches are markedly effective.

Ruminant liver schistosomiasis

The ruminant is caused by infection with Fasciola hepatica or large trematode sac, which is mainly parasitic in the liver bile duct. The course of the disease is slow and long. The main symptom is that the mucous membrane gradually becomes pale, and the symptoms of early gastric retardation appear for a long time, and the body is highly thin, and the mandible, the chest and the lower abdomen are swollen. The eggs are detected in the feces, and the pathological examination can detect the worms in the liver.

Second, the identification of hemolytic anemia

Hemolytic anemia is short-lived or slow, and the onset is fast or slow; the body temperature is normal or elevated, the jaundice index is increased, the mucous membrane is pale yellow, and hemoglobinuria is often present; in hematological changes, the serum is golden yellow, jaundice The index increased, indirect bilirubin increased, thrombocytosis, peripheral blood showed proliferative activity, and a number of immature red blood cells such as reticulocytes appeared. There are many causes of hemolysis, and the following four types are more common.

1 Infectious hemolytic anemia disease

(1) Leptospirosis acute type of initial body temperature rise, conjunctival redness, shame and tears, after the body temperature decreased, the conjunctiva pale yellow staining, oral mucosa and skin necrosis, urine decreased, viscous yellow-red soybean oil-like, red blood cells decreased. Chronic type of anaerobic anemia, urine is yellow-brown, hemoglobinuria is excreted, and red blood cells are significantly reduced. Dark-field live or silver-plated staining is used to check blood (hot period), urine and cerebrospinal fluid (no heat period), and Leptospira can be detected.

(2) Piriformosis can be seen as pale yellow staining of the mucosa, and sometimes bleeding spots of different sizes appear on the mucosa. The blood is thin, red blood cells and hemoglobin are drastically reduced, and a lot of immature red blood cells such as nucleated red blood cells can be seen on the blood film, and pear-shaped worms can be detected in the red blood cells.

(3) Eperythrozoonosis This disease occurs in pigs, cattle, sheep, cats, etc., and does not occur often. The main symptoms are fever, jaundice and anemia. More secondary to other diseases, such as pigs often associated with Lectra. The disease is milder, no hemoglobinuria, acute cases can be detected on the blood smear during the fever period, indirect hemagglutination test can help diagnose.

2. Hemolytic toxic disease caused by hemolytic anemia

(1) A snake bite has a history of poisonous snake bites, and suddenly starts to fall after a bite. Common bite local swelling and severe pain, bleeding, purple, black edema, often necrosis, hematuria, hemoglobinuria, hemorrhage, hemorrhage, hemorrhage, hemorrhage, hemorrhage, hemorrhage, hemorrhage, hemorrhage

(2) The life history of castor bean poisoning in the case of ingestion of castor bean is more than a few hours after eating. The main symptoms are severe diarrhea, mixed blood in the feces, drooling, whole body tremor, often accompanied by hemoglobinuria, and more death. Castor can be detected in the stomach contents.

(3) Chronic copper poisoning has a long history of exposure to copper, and copper accumulation to a certain level causes a hemolytic crisis. The main symptoms are abdominal pain, diarrhea, vomiting, feces and vomit, brown or blue, pale yellow pigmentation of the conjunctiva, chest, abdominal cavity and pericardium can have a large amount of fluid, hemoglobinuria. The content of copper in blood and tissues is significantly increased. The blood copper level in the hemolytic crisis is 78.5-314umol (normally 4.8ppm), which is copper poisoning.

3 immune hemolytic anemia disease

(1) Newborn animal homologous immune hemolytic anemia, also known as neonatal animal erythrocyte solubilization, is an immune hemolytic disease of newborn animals, more common, horses, yaks and piglets also occur. There is a history of sudden onset within 8 to 48 hours after birth of colostrum. The sick animal spirit is extremely depressed, the undercover can not afford, the whole body muscle is soft, the heart rate and breathing are significantly increased, the first heart sound is enhanced, and the systolic heart murmur is often present. The mucous membrane quickly becomes Tibetan white, highly yellow stained, and hemoglobinuria The urine is soy or black, and there is no red blood cells in the urine. The plasma is golden yellow, red blood cells and hemoglobin are significantly reduced, the course of disease is extremely short, and the treatment is lost, and death occurs within a few hours.

(2) Incompatibility of blood infusions often starts after an incompatible blood transfusion. Appearance of anaphylactic shock and hemolytic anemia.

4 hemolytic diseases caused by physical factors

Yak paroxysmal hemoglobinuria, caused by excessive drinking water, hemolysis, a history of sudden onset of a large number of drinking cold water. The disease is difficult to breathe, the amount of urine is increased, hemoglobinuria is excreted, and the urine is dark red or even black and red. The blood changes with septicemia. Mild 1-2h can be self-healing, severe multiple secondary pulmonary edema and death.

Third, the identification of nutritional anemia diseases

Such diseases are mainly caused by insufficient hematopoietic substances such as iron, copper, cobalt, etc.; or chronic repeated blood loss, excessive loss of iron; or young animals grow too fast, iron and other hematopoietic substances need to increase and cause disease.

1 iron deficiency

There is a lack of iron in the life history, such as insufficient feeding iron. More piglets are more common, and piglets are more common. The main symptom is that the growth of the larvae is slow, the coat is rough, the skin is gradually thin, and the mucosa is pale. Often secondary to E. coli or streptococcal infection, concurrent with E. coli disease or streptococcal pericarditis. The hematological changes of iron deficiency anemia are small cell hypochromic anemia, red blood cell count and hemoglobin decrease; red blood cell like red blood cell diameter is small, and the size is uneven, the central light-stained area is enlarged, iron supplementation is one week, and peripheral blood is more obvious. Proliferative hematopoietic effect.

2 copper deficiency

Primary copper deficiency occurs regionally in areas lacking copper. The main symptoms are anemia and weight loss, pale conjunctiva, hair color change, cattle red hair and black hair into gray hair or brown hair, movement disorders, limb stiffness, joint swelling, easy to fracture. The blood and liver copper content is reduced, blood copper is less than 10.99u mol/L, and liver copper is less than 20ppm (dry weight), which can be diagnosed as copper deficiency.

3 cobalt deficiency

It occurs in cobalt-depleted areas such as the coast, lakeshores and sub-glaciers. More common in cattle and sheep, often in the group. The main symptoms are heterosexuality, weight loss, pale conjunctiva, diarrhea, and gradually weakening.

Fourth, the identification of aplastic anemia diseases

Common to all these diseases is that, in addition to acute radiation diseases, the general course of disease is prolonged and progressive, often accompanied by bleeding tendency and uncontrollable infection. Hematological changes are positive pigmented anemia, whole blood cells are reduced, while peripheral blood does not show bone marrow in the raw reaction, and reticulocytes are reduced. The fat droplets in the bone marrow fluid increased, and the three lines of the bone marrow cells were significantly reduced, and only the proportion of lymphocytes increased.

1 Tuberculosis: In addition to symptoms such as difficulty breathing, cough, bronchial pneumonia and swollen lymph nodes, the diseased animals gradually lose weight, and the bone marrow hematopoietic function is inhibited, presenting aplastic anemia.

2 Booger: The sick animal gradually loses weight, the bone marrow hematopoietic function is inhibited, and aplastic anemia occurs. According to the characteristic symptoms of various types of snot, the sinusin test and the positive complement reaction can be identified.

3 Arsenic poisoning: There is a life history of exposure to arsenic-containing pesticides (arsenic trichloride, etc.), often starting to eat arsenic-containing pesticides for several hours. The main symptoms are gastrointestinal symptoms and neurological symptoms of severe drama, such as severe diarrhea, or alternating diarrhea and constipation, chronic cases such as visual impairment and ataxia, and blood changes in aplastic anemia. The arsenic content of liver and kidney exceeds 10-15ppm for reference.

4 Mercury poisoning: Chronic mercury poisoning can inhibit bone marrow hematopoietic function and cause aplastic anemia. Have a life history of exposure to organic mercury pesticides. Gastrointestinal and neurological symptoms such as persistent diarrhea and ataxia appear. Kidney mercury is increased, and mercury treatment is effective. 5 Chloramphenicol poisoning has a long history of application of chloramphenicol, especially for overdose applications. The first is to inhibit erythropoiesis, and then other cell lines of the bone marrow are also inhibited, resulting in aplastic anemia.

6 Sulfonamide poisoning: causes aplastic anemia, which can be identified according to the history of long-term application of sulfa preparations.

A pediatric anemia

The amount of hemoglobin or red blood cells in the unit volume of blood is lower than the normal value called anemia. Anemia is a common symptom. The domestic diagnostic criteria for pediatric anemia are: newborns less than 145 g/l, 1 to 4 months less than 90 g/l, 4 to 6 months less than 100 g/l, 6 months to 6 years less than 110 g/l From 6 to 12 years old, it is less than 120 g / liter, and from 12 to 14 years old, it is basically adult standard. If the amount of hemoglobin in the blood is below this standard, it can be considered anemia!

It is worth noting that the oxygen in the plateau is thin, and for every 1000 meters above sea level, the hemoglobin should increase by 4%.

Nutritional iron deficiency anemia

Iron deficiency anemia is a hypopigmented small cell anemia caused by a decrease in hemoglobin synthesis caused by iron deficiency in the body. This kind of anemia spreads all over the world, with the highest incidence rate of infants and adolescents. It is one of the key pediatric diseases in China.

Pale, prone to fatigue, irritability, weakness, shortness of breath, low blood pressure, and dizziness, oral pain, cracked nails, headache, and sudden preference for a particular preference for food or lack of appetite, etc. symptom.

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