home Auditorium 8 How dangerous are hemorrhages, how to diagnose and treat them? Hemorrhagic syndrome - types and causes. Symptoms and consequences of hemorrhagic syndrome in children and adults

How dangerous are hemorrhages, how to diagnose and treat them? Hemorrhagic syndrome - types and causes. Symptoms and consequences of hemorrhagic syndrome in children and adults

Hemorrhages are blood loss of varying severity that can occur in any part of the human body. The reason for this phenomenon may be various diseases. Most often, hemorrhages are characterized by the accumulation of blood inside the tissues, although blood loss also occurs external character(when blood comes out).

Definition of hemorrhage and the process of its development

Hemorrhage is bleeding or hemorrhage associated with damage to blood vessels or increased permeability of their walls. At the time of injury, blood flows through the gaps beyond the blood vessel. In the case of high permeability, blood from the vessels leaks through their walls.

Depending on the area in which the damage occurred, hemorrhages are conventionally divided into:

external (bleeding coming out of a person’s skin);
internal (blood loss formed during internal organs and tissues);
venous (moderate bleeding from an opening in the wall of a vessel, resulting from a violation of its integrity);
arterial (characterized by heavy blood loss caused by damage to the artery);
capillary (flow of blood from small vessels);
parenchymal (blood loss from tissues that form organs).

Hemorrhagic syndrome can be either temporary or chronic nature. Chronic hemorrhages usually occur after the age of 50, as blood vessels become weaker as the body ages.

Causes

There are three types of this pathological phenomenon, which are distinguished according to the reasons for their formation:

hemorrhage caused by a violation of the integrity of a blood vessel through mechanical damage;
hemorrhage, the formation of which is caused by a decrease in the thickness of the vessel walls;
hemorrhage caused by a breakdown in the wall of a vessel, caused by the negative effects of certain chemical substances or infections.

To the reasons that can cause rapid development hemorrhagic syndrome, should include:

Danger of pathology

The prognosis of the pathology directly depends on the affected area and the amount of bleeding. Although in most cases the consequences of minor injuries gradually disappear on their own, there are cases when the lesion suppurates, which subsequently requires surgical treatment.

The danger of hemorrhage is that blood loss can destroy tissue. This can also cause more serious consequences, for example, hemorrhage in the brain, lungs and heart.

Symptoms of various types of hemorrhages

The symptoms of hemorrhages largely depend on their location and type. That is why each type of pathology has its own clinical picture.

For internal bleeding

For internal bleeding, the symptoms directly depend on the damaged source (artery, vein, capillary). Since internal bleeding is quite difficult to detect, there are a number of basic symptoms by which it can still be identified. The main ones include the following:

apathetic or drowsy state;
unnatural skin color (appears pale);
(intense heartbeat - more than 90 beats per minute);
darkening of the eyes;
loss of orientation in space, dizziness;
fainting;
low blood pressure;
general malaise;
dehydration, thirst;
a sharp decrease in hemoglobin and red blood cells in the blood (determined clinically).

For parenchymal hemorrhage

Parenchymal bleeding in the early stages manifests itself in the following symptoms:

feeling of weakness, fatigue;
dryness in oral cavity, thirst;
chills, pale skin;
manifestation of threadlike pulse, decreased blood pressure;
bad feeling, .

External symptoms of hemorrhage

External signs of hemorrhage are visible quite clearly. As blood penetrates into the subcutaneous space, pockets of redness appear in certain areas of the body different sizes and forms. If the damage is large-scale, bluish hematomas are formed, the touch of which causes severe pain.

With hemorrhage in the eye area, redness of the sclera is observed. In addition, in this case, visual acuity decreases.

If a patient has gastric hemorrhage, then the predominant manifestations are the presence of blood in the stool and urine, and nausea.

Diagnosis of pathology

Recognizing hemorrhage (as well as identifying the location of the lesion and the cause of development) is not easy. For a complete examination, the following procedures are necessary:

Blood collection for general analysis. This procedure will help determine the number of leukocytes in the blood, which in turn will make it possible to check damaged tissue for the presence of inflammatory processes.
MRI. Manipulation will allow you to determine the location of damage to the vessel in any type of hemorrhage.
X-ray examination. This type diagnostics visualizes possible accumulation of blood in internal organs and tissues.

These procedures are sufficient to determine the type and cause of hemorrhage in each specific case.

First aid for hemorrhage

Since hemorrhage is characterized by bleeding from a damaged vessel wall, in case of minor blood loss, first of all it is necessary to apply something cold to the affected area. This will help reduce the rate of blood loss. Then, depending on the type of bleeding, further measures help until the bleeding stops completely.

Bleeding from a vein It is easy to determine by the color of the blood coming out: it is dark red. The bleeding intensity will be slow but continuous. The first thing to do in this case is to apply a tourniquet below the wound (10-15 cm) and a tight bandage. It is important to record the time the tourniquet is applied. For small wounds, you can get by with a bandage, since the veins have the ability to collapse on their own.

When arterial bleeding the blood is bright red and flows or gushes out like a fountain. With this type of bleeding, a tourniquet should be applied immediately. If the bleeding is not stopped within a minute, there is an increased chance fatal outcome due to heavy blood loss. In case of arterial bleeding, the tourniquet should be applied 10-15 cm above the affected area. A bandage must be applied to the wound. After 1-2 hours, the tourniquet is loosened for 3-5 minutes to allow blood to restore circulation in the extremities, since stagnant blood can accumulate toxic substances. In this case, there is a high probability of developing shock, which causes the death of the victim.

Capillary bleeding are not dangerous (with the exception of injuries to persons with poor clotting blood). In such cases, the affected area is treated and bandaged. To stop this type of bleeding, you can also use hemostatic drugs (Hemostop or Celox). These powdered products promote blood clotting.

Internal bleeding are among the most severe, so if they are detected, you should immediately go to the hospital or call emergency help. Before the doctors arrive, the patient should move as little as possible and be in a calm position.

Treatment of hemorrhage

The treatment process should begin after a complete examination of the patient. After determining the diagnosis, the doctor prescribes necessary measures, given that some forms of the disease are prone to complications.

Based on the patient's well-being, clinical form hemorrhages and the level of threat of complications, the doctor determines whether they are appropriate in a particular case medical supplies for the treatment of pathology. For example, for mild subcutaneous bleeding, drug treatment is practically not used. In case of formation of hemorrhage of the skin with a large affected area, the use of various ointments (troxevasin, heparin) is recommended. They should be applied to the affected areas.

In addition, the following drugs are used for hemorrhages:

normalizing blood pressure (Enap, Captopril);
increasing blood clotting (Piracetam);
anti-inflammatory with analgesic effect (Ortofen);
local action for resorption of accumulated blood (Indovazin, bodyagi ointment).

Systemic aseptic inflammation of the microvasculature with predominant damage to the skin, joints, gastrointestinal tract and renal glomeruli. Occurs with symptoms of hemorrhagic or urticarial rash, arthralgia, abdominal pain syndrome, hematuria and renal failure. Diagnosis is based on clinical symptoms, laboratory data (blood test, urine test, coagulogram), examination of the gastrointestinal tract and kidneys. The basis of treatment for vasculitis is therapy with anticoagulants and angioplatelet agents. IN severe cases extracorporeal hemocorrection, glucocorticoid therapy, anti-inflammatory, cytostatic treatment are used.

Complications

Kidney damage is the most persistent syndrome of hemorrhagic vasculitis; it can be complicated by malignant glomerulonephritis and chronic renal failure. In severe cases of allergic purpura, gastrointestinal bleeding accompanied by bloody vomiting and the presence of blood in the stool, pulmonary hemorrhage, hemorrhages in the substance of the brain (hemorrhagic stroke). Massive blood loss can lead to collapse and anemic coma. Complications abdominal syndrome are less common and are represented by intussusception, peritonitis, thrombosis of mesenteric vessels, necrosis of the small intestine. The highest frequency of deaths is recorded in the fulminant form of hepatitis B.

Diagnostics

Treatment

IN acute phase hemorrhagic vasculitis, patients must observe bed rest And hypoallergenic diet, limit fluid and salt intake, avoid taking antibiotics and other medications that may increase sensitization of the body. The main directions of therapy depend on the clinical manifestations, so it is advisable to consider them syndromously:

For any syndromes. The basis basic therapy for all forms of hepatitis B, the prescription of antiplatelet agents (dipyridamole, pentoxifylline) and fibrinolysis activators (nicotinic acid) is prescribed. Drugs of these groups prevent platelet aggregation, improve microcirculation and interstitial perfusion. Heparin and other anticoagulants are often included in the basic regimen.
For skin syndrome. Therapy involves the use of sulfasalazine and colchicine. The use of prednisolone is still controversial issue among doctors. It may be prescribed in severe cases of hepatitis B. In the absence of effect from corticosteroid therapy, cytostatics are used as reserve drugs.
For articular syndrome. Severe arthralgia is relieved by anti-inflammatory therapy (indomethacin, ibuprofen). Additionally, aminoquinoline derivatives (chloroquine) may be prescribed.
For renal syndrome. High doses of glucocorticoids and cytostatics are prescribed. It is possible to use ACE inhibitors, angiotensin II receptor antagonists, and introduce normal human immunoglobulin, carrying out electrophoresis with nicotinic acid and heparin to the kidney area. In terminal stage of chronic renal failure hemodialysis or kidney transplantation is required.
For abdominal syndrome. Intensive pain syndrome serves as an indication for intravenous administration prednisolone, rheopolyglucin, crystalloids. During development surgical complications(perforation, intussusception) surgical tactics are used.

The severe course of the disease is an indication for extracorporeal hemocorrection (hemosorption, immunosorption,). Many authors note the ineffectiveness antihistamines in the treatment of hepatitis B. However, their use may be justified in patients with a history of allergies. If the disease is associated with food allergies and the presence of abdominal syndrome, enterosorbents are additionally prescribed.

Forecast and prevention

Mild forms of hemorrhagic vasculitis are prone to spontaneous recovery after the first attack of the disease - their prognosis is favorable. In the fulminant form, death of patients can occur in the first few days from the onset of the disease. Most often this is associated with damage to the vessels of the central nervous system and the occurrence of intracerebral hemorrhage. Another cause of death may be severe renal syndrome, leading to the development of uremia. In order to prevent allergic vasculitis, it is recommended to sanitation of chronic infectious foci ENT organs, deworming for helminthic infestations, avoiding contact with known allergens and uncontrolled use of medications.

Hemorrhagic syndrome

Hemorrhagic syndrome, or a tendency to skin hemorrhage and bleeding of mucous membranes, occurs as a result of changes in one or more parts of hemostasis. It could be defeat vascular wall, violation of the structure, function and number of platelets, violation of coagulation hemostasis. When determining the causes of bleeding, it is necessary to take into account that some types of pathology are common, others are rare, and still others are extremely rare. From hereditary disorders hemostasis, the most common thrombocytopathies in therapeutic practice are hemophilia A, von Willebrand disease, hemophilia B, and vascular forms - telangiectasia. The most common causes of acquired forms of hemorrhagic syndrome are secondary thrombocytopenia and thrombocytopathies, DIC syndrome, deficiency of prothrombin complex factors and hemorrhagic vasculitis. Other forms are rare or very rare. It should be taken into account that in recent years, hemostasis disorders and, as a result, hemorrhagic syndrome are increasingly associated with the use of drugs that interfere with platelet aggregation (antiplatelet agents) and blood clotting (anticoagulants), as well as psychogenic forms - neurotic bleeding and Munchausen syndrome.

Clinical characteristics

There are 5 types of hemorrhagic syndrome.

Hematoma. Typical of hemophilia A and B, characterized by the occurrence of painful intense hemorrhages in soft fabrics and joints, the gradual development of dysfunction of the musculoskeletal system.

Petechial-spotted (bruised). Occurs with thrombocytopenia, thrombocytopathy, coagulation system disorders (hypo- and dysfibrinogenemia, hereditary deficiency of coagulation factors).

Mixed bruise-hematoma. Develops with severe deficiency of factors of the prothrombin complex and factor XIII, von Willebrand disease, disseminated intravascular coagulation syndrome, overdose of anticoagulants and thrombolytics, the appearance of immune inhibitors of factors VIII and IX in the blood and is characterized by a combination of petechial-spotted skin hemorrhages with individual large hematomas in the retroperitoneal space and intestinal wall . Unlike the hematoma type, hemorrhage into the joint cavity occurs extremely rarely. Bruises may be extensive and painful.

Vasculitic purpuric type. It is observed in infectious and immune vasculitis, easily transforms into DIC syndrome and is characterized by hemorrhage in the form of a rash or erythema on the inflammatory basis, possible association with nephritis and intestinal bleeding.

Angiomatous type. It develops in areas of telangiectasia, angiomas, arteriovenous shunts and is characterized by persistent local hemorrhages associated with areas of vascular pathology.

With a certain degree of probability, pathology of the vascular-platelet or coagulation component of hemostasis can be assumed based on the characteristics of hemorrhagic manifestations.

Signs of disturbance of vascular-platelet and coagulation hemostasis

Clinical sign	Changes in coagulation hemostasis	Changes in vascular platelet hemostasis
Petechiae	Rare	Characteristic
Dissecting hematomas	Characteristic	Rare
Superficial ecchymoses	Most often large single	Usually small multiple
HemartosisHemarthrosis	Characteristic	Rare
Delayed bleeding	Common	Rare
Bleeding from cuts and scrapes	Minimum	Long-term, often intense
Patient gender	80-90% in men	Slightly more common in women
Indication of family history	Often	Rarely

Initial stage differential diagnosis hemorrhagic syndrome is always a peripheral blood platelet count and simple coagulation tests.

Literature

"Guide internal medicine for the doctor general practice» ed. F. I. Komarov, 2007, ISBN 5-89481-367-0

Links and sources

Wikimedia Foundation. 2010.

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MYELODYSPLASTIC SYNDROME- honey Myelodysplastic syndrome (MDS) is a group of pathological conditions characterized by impaired hematopoiesis in all germs, manifested by pancytopenia. MDS often transforms into acute leukemia or aplastic anemia. Frequency. Increase … Directory of diseases

Hemorrhagic syndrome is a violation of the hemostatic system - one of the main biological processes in the body. The main functions of this system are to preserve blood in a liquid state and stop internal bleeding when the vascular walls are damaged. When the integrity of the vessel is compromised, blood penetrates beyond its boundaries, and a specific red and bluish coloration appears on the skin. In the photo below, a patient with hemorrhagic syndrome looks as if part of his body is covered with bruises and red spots. Of particular danger are hemorrhages of the mucous membranes and internal bleeding.

The disease develops at any age. According to statistics, women are more susceptible to it than men. In the pathological course of pregnancy it occurs in newborns.

Treatment of the syndrome involves A complex approach, which is based on therapeutic methods aimed at improving the blood clotting process. In some cases, when there is a risk of loss large quantity blood, it is important to provide immediate medical attention.

Reasons for the development of pathology

Hemorrhagic syndrome occurs due to disruption of complex hematopoietic processes.

In the presence of certain diseases, there is a high probability of formation of this syndrome. At risk are patients diagnosed with:

hepatitis - inflammatory processes in the liver;
cirrhosis of the liver, when the organ is not able to produce substances involved in the process of blood clotting;
oncological neoplasms;
infectious and viral diseases;
hemorrhoidal syndrome;
hemophilia - a condition of the body associated with a violation of the coagulation process (blood clotting);
vasculitis – inflammation of blood vessels of an immunopathological nature;
thrombocytopathy - with a sufficient platelet content, a violation of their functions is observed;
thrombocytopenia – while platelet functions are preserved, their number decreases.

IN medical practice There have been cases where changes in the process of blood clotting occur under the influence of certain medications.

Often, hemorrhagic syndrome develops in newborns. It usually appears a few days after the baby is born. Among the factors influencing its formation are:

long-term use expectant mother certain medications, the components of which are able to penetrate to the fetus through the placenta (anticonvulsants, antituberculosis drugs, antibiotics, anticoagulants, phenobarbital);
birth of a child before the due date;
fetal hypoxia;
the mother has diseases that are at risk.

The causes of hemorrhagic syndrome are also hereditary and associated with gene mutation.

Classification and main features

IN medical science There are two forms of the syndrome:

primary (congenital), due to a person’s genetic predisposition;
secondary (acquired), arising due to damage to blood vessels of various types.

Depending on what part of the body the lesion is located and what caused it, several types of the disease are distinguished. Each of them has characteristic symptoms and features of the therapeutic technique.

Type of hemorrhagic syndrome	Main features
Hematoma	A hemorrhagic disease in children, particularly infants, caused by genetic changes. Develops in hemophilia. Soft tissues are injured, causing painful sensations. The damaged area swells and a slight swelling appears. The skin becomes bruised due to heavy bleeding. Motor functions are gradually impaired
Microcirculatory-hematoma (mixed)	Due to small effusions of blood, petechiae - small red dots - appear on the skin and mucous membranes. This occurs with bruises, after an injection, or as a result of friction of a pathological area.
Petechial-spotted (bruised)	The main symptom is bruises appearing on the patient’s body. The skin acquires a bluish tint, and yellowness appears in places. Blood clotting is impaired.
Angiomatous	Bleeding from the nose that does not stop for a long time. Vomiting with blood. Small angiomas - small moles Red. Concomitant diseases of the gastrointestinal tract associated with damage to the stomach and liver.
Vasculitic purpuric	A bright red or bluish rash that primarily covers the lower extremities. The rash reaches a size of 4 mm, slightly rising above the surface of the skin.

Diagnostic tests

The main goal of diagnostics is to establish the cause of the disease, on the basis of which it is prescribed further treatment. If a person has an acute form of the syndrome, it is necessary to first stop the bleeding and stabilize the condition.

The main diagnostic method for suspected hemorrhagic bleeding is lab tests: a detailed blood test and urine test that allows you to see the whole picture. The platelet count in peripheral blood is important. Additional methods examinations include simple coagulation tests and sternal puncture.
When making a diagnosis, the duration of bleeding, as well as the nature of blood clotting, are taken into account.

Therapeutic measures

Treatment of hemorrhagic syndrome in adults depends on several factors:

causes of the disease;
stages of development;
the nature of the course and severity of the disease.

Urgent Care

In the acute form of hemorrhagic syndrome, it may be necessary urgent Care. It is important to stop the source of damage. For this purpose, the following therapeutic methods are used:

conservative hemostatic therapy;
cryotherapy;
laser barotherapy;
surgical intervention.

Drugs

When the first one is rendered health care and the bleeding is stopped, the patient is prescribed drugs that have a positive effect on the coagulation process. Modern pharmaceuticals have big amount medicines, improving blood clotting.

In cases of significant blood loss, it is necessary replacement treatment, involving the introduction of plasma. The use of heparin and prednisolone is possible.

If hemorrhagic syndrome occurs against the background of any diseases, treatment has characteristics. Therapeutic measures are aimed not only at stopping the pathological focus, but also at eliminating the concomitant illness.
For some diseases, it cannot be guaranteed that treatment will be highly effective. For example, with a congenital type of hemophilia, it is necessary to take hormonal drugs, the action of which is aimed at normalizing the blood circulation process. Patients must be under close medical supervision and follow all his recommendations.

Home Recipes

Facilities traditional medicine can't replace drug therapy. However, their use has a positive effect on the condition of the walls of blood vessels. Only an integrated approach that combines all types of therapy can have the desired effect. Useful for hemorrhagic syndrome are green varieties of apples, cherries, red grapes, raspberries, strawberries, currants, sea buckthorn, red pepper, rowan, rose hips, buckwheat, yarrow.

They have a whole complex of vitamins and nutrients, strengthening blood vessels and increasing blood clotting.

With all the effectiveness of medicines, as well as mixtures and decoctions prepared according to folk recipes, it is necessary to exclude those components that are allergens. Please read the instructions carefully for any contraindications and side effects. If the body is individually intolerant to the components of the drug, its use is excluded.

Hemorrhagic syndrome is a set of pathological conditions accompanied by a single clinical symptom complex, manifested in increased bleeding and characterized by the polyetiology of its occurrence. In terms of clinical and laboratory diagnostics and prognosis for the patient’s health, a fundamental difference is between chronic and acute form course of hemorrhagic syndrome. Clinical and laboratory manifestations of hemorrhagic syndrome can “start” at any age, from the neonatal period to the elderly age category.

Causes of hemorrhagic syndrome

All pathogenetic forms of hemorrhagic syndrome are usually divided into two large categories (primary or hereditary, and secondary or acquired) depending on the prevailing etiological factor that causes the development of pathological bleeding.

Hereditary forms of hemorrhagic syndrome can develop according to several pathogenetic mechanisms, however, all these conditions are characterized by the presence of genetic determination (the presence of a defective gene). Genetic determination can affect all parts of the coagulation system, that is, the development of hereditary hemorrhagic syndrome can be caused by pathology of platelet blood cells, coagulation factors or the vascular wall.

Secondary or acquired hemorrhagic syndrome most often develops as a result of pathological changes in the walls of blood vessels of various sizes resulting from inflammatory, mechanical, autoimmune or toxic effects. Secondary, as one of the etiopathogenetic variants of hemorrhagic syndrome, can be provoked by long-term use of certain medications pharmacological groups(for example, disaggregants), as well as as a result of dysmetabolic disorders in the body.

A reduced content of platelet blood cells also provokes the development of hemorrhagic syndrome and most often develops as a result of disruption of the processes of normal hematopoiesis in the red bone marrow or their increased destruction, which occurs with thrombocytopenic purpura and systemic purpura.

Coagulopathies in the form of hypocoagulation are manifested by the development of hemorrhagic syndrome and develop most often as congenital pathology ( , ). Pathogenetic mechanisms The development of this form of hemorrhagic syndrome is a significant decrease in the production of plasma factors and an increase in the activity of factors of the fibrinolytic system.

Primary vasopathies mainly provoke hemorrhagic syndrome in children during puberty and their development is based on a pathological increase in the permeability of the vessel wall and the formation of telangiectasia (limited dilations of the vascular wall).

It should be borne in mind that pathological bleeding can manifest itself not only on the skin, but also on the mucous membranes, and an example is the hemorrhagic syndrome of the uterus, observed in neoplasms of a benign and malignant nature.

Symptoms of hemorrhagic syndrome

The most common clinical variant of pathological bleeding is cutaneous hemorrhagic syndrome, which can vary significantly in intensity and morphological type of skin elements. Thus, the hematoma variant, which is observed in hemophilia and is manifested by the development of massive effusion and accumulation of blood in the intermuscular spaces and joint capsules, accompanied by severe pain, is the most severe in terms of patient tolerance. A pathognomonic symptom of the hematoma variant of hemorrhagic syndrome is a long-term significant limitation of the mobility of one or an entire group of joints.

The occurrence of hemorrhages occurs, as a rule, after any traumatic impact, and in severe forms of hemophilia, hematomas and hemarthrosis occur spontaneously against the background of complete well-being. The most pathognomonic sign of the hematoma variant of hemorrhagic syndrome is the appearance of signs of intra-articular hemorrhages, and large groups of joints of the upper and upper joints are more affected. lower limbs. Clinical criteria for hemarthrosis in hemorrhagic syndrome are sharp, intense pain, swelling of the periarticular soft tissues and the inability to perform habitual motor movements. In a situation where a large volume of fresh blood accumulates in the joint capsule, positive symptom fluctuations. The consequences of such changes in hemorrhagic syndrome of the hematoma type are the development of chronic infectious lesion synovial membranes and destruction cartilage tissue, which inevitably leads to the development of deforming arthrosis.

At pathological change The number or shape of platelet cells most often develops petechial-spotted hemorrhagic syndrome. With this pathological condition, the patient has a tendency to develop superficial intradermal hemorrhages even with minimal traumatic effects on the skin (for example, mechanical compression of the skin with a cuff when measuring blood pressure). Petechial intradermal hemorrhage, as a rule, is small in size, not exceeding three millimeters of intense red color, which does not disappear upon palpation. This variant of hemorrhagic syndrome is characterized by the appearance of hemorrhages in the mucous membranes various localizations, especially into the conjunctiva of the eye. With the petechial-spotted version of the hemorrhagic syndrome, observed with, there is a tendency to develop persistent nosebleeds, causing anemia in the body.

In the mixed bruise-hematoma variant, the patient experiences the development of both intradermal hemorrhages and intermuscular hematomas. The fundamental difference This form of hemorrhagic syndrome from the hematoma variant is the absence of intra-articular hemorrhages.

With, as a variant of hemorrhagic syndrome, the development of skin hemorrhages in the form of purpura is noted. Hemorrhagic elements of the rash form in inflammatory areas skin, therefore they always rise somewhat above the surface of the skin and have clearly defined pigmented contours. The fundamental difference between a hemorrhagic rash with vasculitis is the persistent pigmentation of the skin even after leveling acute manifestations hemorrhagic syndrome.

The most specific in terms of clinical manifestations is angiomatous hemorrhagic syndrome, the occurrence of which is due to anatomical changes in the vascular wall. This form of hemorrhagic syndrome is characterized by bleeding specific localization, for example from the nasal cavity with Randu-Osler syndrome. With the angiomatous variant of hemorrhagic syndrome, intradermal and subcutaneous hemorrhages are never observed.

Since acquired hemorrhagic syndrome develops against the background of any diseases and pathological conditions, the classic picture can be supplemented by nonspecific symptoms characteristic of the background pathology.

Qualitative diagnosis of hemorrhagic syndrome involves the assessment of clinical, laboratory and instrumental data. The fundamental element in conducting a diagnostic search is a thorough collection of anamnestic data and a careful examination of the patient to determine the location and nature of skin manifestations.

Hemorrhagic syndrome in newborns

It should be taken into account that after birth a child has imperfections in almost all organs and systems in the body, including the mechanisms of hematopoiesis. All newborn children have a tendency to increase the permeability of the vascular wall of the capillary network, as well as immaturity of processes and coagulation factors, which are exclusively functional in nature and do not provoke the development of classic hemorrhagic syndrome. In a situation where a child develops acute hemorrhagic syndrome in a short time after birth, one should first of all assume the genetic nature of this pathology. Indirect predisposing factors in the development of hemorrhagic syndrome are long-term use of salicylate drugs by the mother during pregnancy, intrauterine fetal hypoxia and prematurity.

IN last decade In neonatological practice, the prophylactic use of vitamin K in a minimum dosage of 1 mg is widely used, which can significantly reduce the incidence of hemorrhagic syndrome among children in the neonatal period. A noteworthy fact is that the clinical picture of hemorrhagic syndrome does not develop immediately after delivery, but after the seventh day, when the child has already been discharged from the maternity hospital, therefore the main task of the local pediatrician observing the child after birth is to adequately assess the severity of the child’s condition and promptly determine the cause of the occurrence. of this pathological condition.

Classic clinical criteria for the development of hemorrhagic syndrome in a newborn child are the appearance of blood in the stool or vaginal bleeding, prolonged healing umbilical wound and the release of blood from it, a change in the color of the urine, which becomes brown-red, and the release of fresh blood from the nasal passages.

IN long term(several weeks after birth) hemorrhagic syndrome can develop as a result of severe dysbiosis and manifest itself with symptoms of intracerebral hemorrhage, which has an extremely severe course.

Treatment of hemorrhagic syndrome

The volume and method of treatment for each form of hemorrhagic syndrome may differ significantly, therefore, when determining the tactics of patient management, the predetermining factor is pathogenetic variant the course of this pathology.

If we consider hemophilia, it should be borne in mind that the only pathogenetically substantiated method of treatment is transfusion of blood components, which is an option for replacement therapy. Due to the fact that most coagulation factors are very labile and do not retain their properties during blood conservation and the production of dry plasma, direct blood transfusion to the patient from a donor is a priority.

Factor VIII has a short elimination period, so an adequate replacement therapy regimen is transfusion of cryoprecipitate and plasma at least three times a day in a single calculated dose of 10 ml per 1 kg of recipient weight. It is unacceptable to mix antihemophilic drugs with any infusion solutions, and the drug must be administered exclusively intravenously, since drip infusion does not increase the level of factor VIII in the plasma.

If the patient has a combination of hemarthrosis with severe accumulation of blood in the intermuscular spaces, it is necessary to use more intensive care antihemophilic agents. In case of existing external bleeding, the use of local hemostatic drugs (Thromboplastin solution) is sufficient. The presence of signs of acute hemarthrosis is the basis for the use of puncture joint capsule and aspiration of blood followed by intra-articular administration of Hydrocortisone. During the period of remission, it is necessary to perform exercises physical therapy, the action of which is aimed at restoring the motor function of the joint and preventing the development of atrophic changes in the muscle mass. Surgical intervention is used only as a last resort in the formation of ankylosis and the extreme stage of osteoarthritis. In this situation, surgical procedures such as synovectomy and bone tissue distraction are used).

In case of hemorrhagic syndrome occurring as a coagulopathy, fundamental method therapy is parenteral administration of Vikasol in daily dose 30 mg. In a situation where hemorrhagic syndrome develops against the background long-term use anticoagulants of indirect action in high dosage, a prerequisite is their cancellation. For severe coagulopathy, it is used replacement therapy fresh frozen plasma intravenously in a stream at a calculated dose of 20 ml per 1 kg of patient weight with Somatotropic hormone at a dose of 4 IU per day, the effect of which is aimed at improving the synthesis of coagulation factors.

DIC syndrome is the most severe and difficult to eliminate form of hemorrhagic syndrome and the mortality rate is acute period DIC syndrome accounts for more than 60%. The drug of choice for hemorrhagic syndrome caused by DIC is Heparin in the hypercoagulation stage at an initial dose of 10,000 units and subsequent transition to subcutaneous administration at a single dose of 5,000 units. In case of massive hemorrhage observed in the hypocoagulation stage, patients are advised to administer high doses Kontrikala intravenously drips up to 10,000 units.

For thrombocytopenic purpura, it is pathogenetically justified to prescribe glucocorticosteroid drugs, as well as surgical intervention in the form of splenectomy. In the complete absence of a positive effect from the treatment used, it is necessary to prescribe cytostatic drugs immunosuppressive effect. The daily dose of Prednisolone is about 60 mg, and if the hemorrhagic syndrome continues in the form of new ones, the dose of Prednisolone should be doubled. The duration of corticosteroid therapy directly depends on the rate of relief of clinical manifestations of hemorrhagic syndrome and the degree of normalization of the number of platelet blood cells. In a situation where a decrease in the dosage of Prednisolone provokes the development of a relapse of hemorrhagic syndrome, it is necessary to increase the dose of the drug again.

The adequate dose of immunosuppressants is 5 mg per 1 kg of patient weight (Ciclosporin A). Absolute indication for the use of drugs in this group is the ongoing course of hemorrhagic syndrome and progressive thrombocytopenia even after splenectomy.

For hemorrhagic telangiectasia, as one of the variants of hemorrhagic syndrome, the use of general therapeutic measures does not have a positive effect. However, the use of Estrogen or Testosterone in some situations reduces bleeding. Recently, surgical and laser correction of this pathology, with good long-term results and a low relapse rate.

Because various options hemorrhagic syndrome is accompanied by the development of anemia of the body to varying degrees; in most cases, patients suffering from increased bleeding should be additionally prescribed iron-containing drugs (Tardiferon in a daily dose of 600 mg).

Prevention of hemorrhagic syndrome

As a priority and most effective methods To prevent the development of hemorrhagic syndrome among newborn children, routine subcutaneous administration of vitamin K to all premature infants should be considered, as well as early breastfeeding.

In a relationship preventive measures aimed at preventing the development of hemophilia, as the most severe form of hemorrhagic syndrome, medical and genetic counseling should be considered, which makes it possible to most accurately determine the degree of risk of having a child with signs of hemophilia. People suffering from hemorrhagic syndrome should inform all treating specialists about the presence of this pathology, since even a banal tooth extraction in this category of patients must be accompanied by preliminary drug preparation.

With regard to the prevention of the development of repeated episodes of hemorrhagic syndrome, especially the hematoma variant, good positive effect have special exercises physical therapy, provided they are performed regularly. In addition, during the period of remission, patients suffering from hemorrhagic syndrome are advised to use absorbable physiotherapeutic manipulations (magnetic therapy, electrophoresis).

Hemorrhagic syndrome - which doctor will help? If you have or suspect the development of hemorrhagic syndrome, you should immediately seek advice from doctors such as a hematologist or transfusiologist.