Post-Hemorrhagic Anemia

1. Risk Factors

1.1. • Bleeding Disorders such as Hemophilia & Other genetic abnormalities • Vitamin deficiencies, Existing anemias • Von Willebrand's disease • Integumentary disorders • Endometrial shedding (normal and with abnormal uterine bleeding) • Autoimmune disorders attacking Red Blood Cells

2. Diagnostic Tests

2.1. • Blood pressure/Cardiovascular monitoring of Central Arterial and Venous Pressure • Hemoglobin and Hematocrit/On site Hematocrit spin in Emergency Department • Chemistry Panel • Urinalysis/Dipstick for blood • Exploratory laparoscopy • Diagnostic imaging

3. Treatments

3.1. • Stop Hemorrhage/reverse condition via surgery, compression, or cauterization • Fluid and electrolyte replacement • Blood administration/Whole, Plasma or Packed Red Blood Cells • Vasopressors • Compression device application • Hemodynamic monitoring • Assure erythropoiesis

4. Injury Factors

4.1. • hemolytic destruction of red blood cells • Trauma resulting in either obvious or occult vascular, skeletal or organ damage, leading to blood/volume loss • Burns; fire or chemical

5. References

5.1. Bougle, A., Harrois, A., & Duranteau, J. (2013, January 12, 2013). Resuscitative strategies in traumatic hemorrhagic shock. Annals of Intensive Care, 3(1). http://dx.doi.org/10.1186/2110-5820-3-1 McCance, K., & Huether, S. (2014). Alterations of erythrocyte function. In Pathophysiology (7th ed., p. 996). St. Louis, MO: Elsevier. McCance, K., & Huether, S. (2014). Shock, multiple organ dysfunction syndrome and burns in children. In Pathophysiology (7th ed., p. 1705). St. Louis, MO: Elsevier.

6. Pathophysiologic Etiology

6.1. • This Anemia is caused by acute blood loss (10-20% of total volume) resulting in a loss of circulating hemoglobin, resulting in the inability to carry the oxygen required to both central and peripheral structures to maintain normal metabolism and function (McCance & Huether, 2014, p. 996) • Blood loss may be due to sudden inability of vascular compartment to hold blood, hold blood pressure, or maintain osmolality sufficient to keep whole blood within vessel walls within normal pressure

7. Causative Factors

7.1. • Loss of Blood due to Surgery • Trauma: Motor vehicle accident, major laceration, fall, gunshot wound • Dysfunctional clotting; Disseminated intravascular coagulation, Hemophelia • Ulcers; erosion of visceral tissue into vascular compartment • Cancerous lesions of the Gastrointestinal tract • Complicating factors such as: Pernicious Anemia, Folate deficiency, Iron deficiency, Sideroblastic anemia, Aplastic anemia, Hemolytic anemia, Anemia of Chronic Disease

8. Common Findings

8.1. • Hypovolemic Shock • Cardiogenic shock (McCance & Huether, 2014, p. 1705) • Altered level of consciousness • Low or absent blood pressure/decreased cardiac output • Cardiac arrest • Low or Critical Hemoglobin & Hematocrit • Rapid heart rate • Shunting primarily, of blood from extremities to trunk & brain to maintain essential functions, resulting in cool blue hands and feet