Chronic posthemorrhagic anemia

It frequently develops after long, repeated slow blood loss, in the majority of cases at hemorrhages from gastrointestinal tract (ulcer, cancer, hemorrhoids), uterine bleedings, in hemophilia, hemorrhagic diathesis, in ankylospondylosis.

Clinical sign of anemia is pale skin and visceral organs. In some cases, the source of hemorrhage is inconsiderable, it is very difficult to reveal it. Severe iron-deficient anemia develops.

Anemias caused by disturbances of hemopoiesisoccur in those cases when the organism amount of a definite substance (e.g. iron, vitamin B₁₂) is insufficient. Therefore, these anemias are called deficiency anemias. Disturbances of hemopoiesis can occur in helminthic invasions, toxic effect on the organism, in hypoplasia of the bone marrow.

There are different types of iron deficiency anemia, their etiology is various, but the main pathogenetic factor is iron deficiency in the organism (sideropenia, hyposiderosis). All types of iron deficiency anemia may be divided into the following clinico-anatomical forms:

1. Iron deficiency anemia of early age.

2. Early and late chlorosis.

3. Symptomatic chloranemia which develops at different pathological conditions of gastrointestinal tract (achylic, agastric, anenteral etc.) in infections (tuberculosis).

4. Hypochromic anemia of pregnancy.

5. Posthemorrhagic anemia which indeed is iron deficiency anemia.

6. Chlorosis ( called so because of pale greenish color of skin in this disease).

There are two types of chlorosis: early and late. Early chlorosis occurs in women at the age of 15— 20, that is at the period of sexual maturation. Late chlorosis is observed in women aged 35—45, sometimes before climax.

Iron deficiency anemias are iron-insaturated (sideroachrestic) anemias in which erythrocytes contain small amount of iron due to the fact that iron is not used by the bone marrow for hemoglobin synthesis.

Anemias due to vitamin B₁₂ deficiency (pernicious anemias).Pathogenetic mechanisms of B₁₂ deficient anemia development are different, that is why there are different forms:

1. Pernicious anemia (Addison-Biermer) due to deficiency of gastromucoprotein in the gastric juice.

2. Pernicious anemia after stomach resection for cancer, polyposis.

3. Pernicious anemia in diseases of small intestine due to disturbed absorption of vitamin B₁₂.

4. Helminthic pernicious anemia.

5. Pernicious anemia of pregnancy due to fetal growth and increased consumption of vitamin B₁₂ and folic acid.

6. B₁₂ achrestic anemia due to disturbances of B₁₂ utilization in the bone marrow.

Classical form of B₁₂ deficiency anemia is Addison-Biermer malignant or pernicious anemia first described by Addison in 1855.