Microangiolytic anemia

Introduction Acute microvascular hemolytic anemia is more common in the clinical manifestations of hemolytic uremic syndrome. It is characterized by microvascular hemolytic anemia, acute renal insufficiency and thrombocytopenia. Found in children, it is one of the main causes of acute renal failure in infancy. The cause of hemolytic uremic syndrome (HUS) is unknown, and may be related to infections, genetic factors, certain chemicals, certain drugs, and other factors. Rural areas are more common in cities. In the late spring and early summer, the peak is mostly sporadic cases.

Cause

Causes of microvascular hemolytic anemia:

The cause of hemolytic uremic syndrome (HUS) is unknown, and may be related to infections, genetic factors, certain chemicals, certain drugs, and other factors. Rural areas are more common in cities. In the late spring and early summer, the peak is mostly sporadic cases. This disease is more common in children and is one of the main causes of acute renal failure in infancy. Its clinical features are microvascular hemolytic anemia, acute renal insufficiency and thrombocytopenia. If you can make timely diagnosis and correct treatment, some patients can pass the critical period and avoid death. Adults have a poor prognosis, often with chronic renal failure, requiring long-term dialysis to maintain life or perform kidney transplantation.

The disease is more common in infants and young children. The cause is unknown, some children have fever or viral disease before onset, so it may be related to infection or immune complex mediated. Clinical manifestations similar to TPP, with fever, thrombocytopenia, microvascular hemolytic anemia, hypertension and acute renal failure, neurological symptoms are not common. However, microvascular hemolytic and capillary damage are mainly localized in the kidney and can be regarded as a focal type of TPP. Without effective treatment, acute renal failure can be treated with dialysis, and some cases can be spontaneously relieved. Clinical manifestations of blood uremia syndrome.

an examination

Related inspection

Fluid lactic acid dehydrogenase kidney CT examination kidney MRI examination kidney ultrasound examination serous effusion protein

Clinical manifestations of microvascular hemolytic anemia:

1. Predecessor performance: diarrhea, abdominal pain, vomiting and loss of appetite for several days;

2. Acute microvascular hemolytic anemia;

3. Diffuse intravascular coagulation, showing a wide range of bleeding tendency;

4. Acute renal failure, showing oliguria and no urine;

5. Others: such as circulatory system performance (hypertension, arrhythmia, heart failure), nervous system (sleepiness, convulsions, coma).

Diagnosis of microvascular hemolytic anemia:

1. Evidence of hemolytic anemia: severe anemia occurs in a short period of time, reticulocyte red blood cells 3%-5%, lactate dehydrogenase increased;

2. Evidence of thrombocytopenia: multiple parts of the body bleeding, platelet count more than <50 × 10 9 power / L;

3. Progressive renal dysfunction: oliguria, anuria, blood urea nitrogen, elevated serum creatinine;

4. Coagulation abnormality: prolonged clotting time, increased fibrin degradation products;

5. Renal biopsy: renal microvascular embolism.

Differential diagnosis

Differential diagnosis of microvascular hemolytic anemia:

1. Acute disseminated myelitis: The disease occurs mostly in young adults, and most of them have symptoms or vaccination history for several days or 1 to 2 weeks before the disease. Cold, overwork, trauma, etc. are often the cause of the disease. The onset is urgent, the first symptoms are mostly numbness and weakness of the lower extremities, the corresponding parts of the lesions are painful, and the lesions have a sense of banding, which often reaches a peak within 2 to 3 days. Clinically, the main features of limb paralysis, sensory loss and sphincter disorders are below the level of lesions. The acute phase can manifest as spinal shock. There are many autonomic dysfunctions below the damage plane. The disease can enter the recovery period after 3 to 4 weeks, and most of them recover after 3 to 6 months after the onset. A few cases have different degrees of sequelae, but most of them are not accompanied by spastic paralysis, involuntary movement, and mental retardation. Seizures.

2. Optic neuromyelitis: The age of onset of the disease is between 20 and 40 years old. It is rare in 10 years old and is a subtype of multiple sclerosis. Acute or subacute onset. First of all, the symptoms are mostly back pain or shoulder pain, followed by partial or complete spinal cord transverse damage, and can show visual acuity such as decreased vision before or after the symptoms of transverse spinal cord injury, but the condition is often relieved. Recurrence, but also other multifocal signs, such as nystagmus, diplopia, ataxia and so on.

3. Myasthenia gravis: The disease is more common than 20 to 60 years old, and children are less common. Insidious onset, the first symptoms are mostly different degrees of weakness of the extraocular muscles, including ptosis, limited eye movement and diplopia, other skeletal muscles can also be affected, such as masticatory muscles, throat muscles, facial muscles, sternocleidomastoid Muscle, trapezius and limb muscles can affect daily activities, and severe cases are forced to stay in bed. The above symptoms are usually aggravated after the activity, and can be relieved to varying degrees after rest, and have the characteristics of being light and heavy. Some cases have thymic hypertrophy or thymoma. Some merge with other autoimmune diseases such as hyperthyroidism.

4. Periodic paralysis: The disease is characterized by recurrent skeletal muscle flaccid paralysis, more than adolescent onset, and the onset is gradually reduced after middle age, and the incidence of infants and young children is extremely rare. Can be induced by factors such as overwork, full meal, cold, anxiety. Generally, more than the rest after a meal break or strenuous exercise, the onset of the disease, mostly from the lower limbs, and then the extension of the upper limbs, bilateral symmetry, with a proximal end heavier. The attack usually lasts for 6 to 24 hours, and the elderly can reach more than one week. Irregular recurrent episodes, most of which have changes in blood potassium (increased or decreased), some cases of heart rhythm disorder, blood pressure rises. Intermittent muscle strength during the interval. According to the seizure process, clinical signs, laboratory tests and family history, it is not difficult to identify this disease.

5. Progressive muscular dystrophy: The disease is a group of genetic diseases that originate in the muscles, mostly family history. The clinical features are characterized by symmetrical muscle weakness and muscle atrophy that slowly progress progressively. Individual types may have myocardial involvement. Different types often present with different ages of onset, clinical features, and diseased muscle distribution. But in general it is more common in children and adolescents. It can be seen that the "winged shoulders", "free shoulders", "calf muscle pseudo-hypertrophy", "Gowers" sign and other characteristic performance. With the progressive symptoms, age of onset, clinical features and family history can be identified with the disease.

6. Acute epidural abscess: the disease is caused by purulent lesions in other parts of the body, such as skin edema, tonsil purulent lesions, or infections of adjacent tissues, such as acne, sputum or perirenal abscess, pathogens Abscesses are formed by the spread of blood or tissue into the epidural adipose tissue. Most of the onset occurs several days or weeks after the primary infection, and sometimes the primary lesion is often overlooked. The first symptom is severe pain in the back or both lower extremities. Within a few days, there are obvious strong items, headache, fever, general weakness, and severe tenderness and sputum pain in the corresponding parts of the lesion. If you do not treat it in time, you can quickly have lower limb paralysis. Laboratory examination showed a slight increase in cerebrospinal fluid leukocytes and a marked increase in protein content, spinal obstruction, and increased peripheral white blood cells. CT and MRI are also helpful for identification.

7. Guillain-Barré syndrome: There are symptoms of upper respiratory tract or digestive tract infection 1 to 4 weeks before onset, and a small number of patients have a history of immunization. Most of the symmetry weakness of the limbs is the first symptom, which can develop from the distal end to the proximal end or vice versa, or the distal and proximal ends are involved at the same time, and can affect the trunk. In severe cases, the respiratory muscles may be involved and respiratory paralysis occurs, and the sputum is flaccid. In severe cases, muscle atrophy may occur at the distal end of the limb, which may be accompanied by paresthesia of the distal extremity and a glove-like, sock-like sensation. The lesions are more extensive, and cranial nerve damage is more common in adults with bilateral sputum, and more common in children with medullary paralysis. There may also be eye movements, paralysis of the sublingual and trigeminal nerves. There may be symptoms of autonomic nerve damage such as sweat, skin flushing, swelling of hands and feet, and nutritional disorders. The symptoms progressed rapidly, and about half of the cases peaked within a week. The longest is up to 8 weeks, and usually begins to recover after symptoms stabilize for 1 to 4 weeks. Cerebrospinal fluid examination revealed protein-cell separation. The prognosis is generally better.

8. Small chorea: Most of the disease is slow, except for a few cases of sudden onset of illness due to mental stimulation. The age of onset is mostly between 5 and 15 years old. Both mental stimulation and pregnancy can be an inducement. Clinically, it is characterized by irregular, non-repetitive, unpredictable, sudden and sudden dance-like involuntary movements. The face, upper limbs, and trunk can appear, but the lower extremities move less. The involuntary movements of the face and torso are bilateral. Involuntary movements are exacerbated during emotional stress and disappear during sleep. Casual exercise presents ataxia, often accompanied by mental symptoms such as emotional instability, distraction, and impermanence. In severe cases, there may be illusions, even arrogance and mania. There are many similarities between the disease and the cerebral palsy in the clinical manifestations, but the disease often shows various rheumatic fever manifestations before, during or after the disease. Can be identified.

9. Subacute combined degeneration of the spinal cord: a neurodegenerative disease caused by a deficiency of vitamin Blz. More than the middle age. A subacute or chronic course. Clinically, deep sensory loss, sensory ataxia, and spastic paralysis are the main manifestations. Often accompanied by peripheral sensory disturbances. Most patients have signs of fatigue, fatigue, glossitis, and diarrhea before the onset of neurological symptoms. The earliest neurological symptoms are mostly sensory abnormalities at the extremities of the extremities, such as tingling, numbness and burning sensation, etc., mostly persistent and symmetrical. Often from the toe, the upper limbs are gradually involved, and the distal extremities of the limbs and the sock-like feelings may be reduced. As the disease progresses, the lower limbs become weak and stiff, and the walking is unstable, such as stepping on cotton. If the cone beam damage is serious, the muscle tension of the lower limbs is increased. If the posterior or (and) peripheral nerve degeneration is heavy, the muscle tension is reduced, the tendon reflex is weakened, the pyramidal tract sign and pathological reflex are positive, and the bladder sphincter is often accompanied. . Also often accompanied by irritability, lethargy, suspicious, emotional instability and other mental symptoms, or the emergence of mental decline or even dementia, serum vitamin B12 decreased. The Schilling trial found a deficiency in vitamin B12 absorption.

10. Multiple neuropathy: The clinical manifestations of this disease are characterized by limb-symmetric peripheral sensory disturbance, lower motor neuron spasm, and autonomic neurological disorder. Due to different causes, the onset may be acute, subacute, chronic, recurrent, and the degree of impairment of various functions is also different. The end of the limb presents a glove-like, sock-like depth and sensation. Symmetrical lower motor neuron spasm occurs at the distal end of the limb, and the distal end is heavier than the proximal end, and may be accompanied by muscle atrophy and reduced tendon reflex. Some patients also have various manifestations of autonomic nerve involvement such as cold distal limbs, dry skin, desquamation, and sweating. Patients have significant diabetes, poisoning, taking furan drugs and isoniazid, uremia, pregnancy, postoperative surgery, chronic gastrointestinal diseases, malignant tumors, connective tissue diseases and vaccination history. According to its medical history and typical clinical manifestations, it is not difficult to identify this disease.

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