That one can bleed to death after a traffic accident due to external injuries is of course familiar to everyone. But also small, repeatedly oozing internal bleeding can lead to significant losses in the long term and are usually not even noticed externally. Bleeding anemia is the associated disease characterized by anemia, weakness, pallor. Most often affected are women with heavy menstruation.
What is bleeding anemia?
Hemorrhagic anemia is an anemia that can be undoubtedly attributed to chronic blood loss through body surfaces. These blood losses may be visible externally, as in menstrual bleeding, but may also occur covertly through the mucous membranes, as in the case of easily bleeding gastric ulcers, colon cancer, or diverticular bleeding of the intestine. In the long run, they lead to a deficiency of iron and red blood cells and to the typical anemia symptoms of pallor, weakness and rapid fatigability.
Causes
One of the most common causes of bleeding anemia is the normal menstrual period in women. Although this is intended by nature and is in no way pathological, it can still lead to a relevant loss of iron, especially in small women, and cause the symptoms of anemia. Of course, the heavier the menstruation, the more severe the anemia. Furthermore, when anemia of unclear cause occurs, the very first thing a doctor thinks of is the possibility of colon cancer. Cancerous tumors can bleed easily, and due to the mixing with intestinal contents and the accumulation of intestinal secretions, such bleeding in the stool is usually not even noticeable. Also a permanent blood loss due to a repeatedly bleeding stomach ulcer or bleeding diverticula of the large intestine usually remains unnoticed and is only noticed when the anemia leads the affected person to the doctor or, even more frequently, accidentally catches the doctor’s eye in the course of taking blood from another cause. The intestine is the main site of blood loss, but blood can also be lost via the urinary tract in the case of chronic inflammation or tumor diseases (in this case, however, red urine is usually noticeable). With such permanent blood losses, blood production usually does not keep up and a deficiency of red blood cells develops. In addition, most bleeding anemias are also iron deficiency anemias. This means that it is not so much the lack of blood cells as the lack of iron, which is contained in the blood cells as an important oxygen transporter, that causes the anemia, if at the same time it is not sufficiently replenished by the diet.
Symptoms, complaints and signs
Anemia of bleeding is noticeable through a number of physical and mental symptoms. Initially, anemia leads to fatigue and listlessness. Accompanying this are mental deficits: There is a lack of concentration, a drop in performance and impaired consciousness. Bleeding anemia overloads the circulatory system, which can cause symptoms such as palpitations and dizziness. In extreme cases, circulatory collapse occurs. Shortness of breath and chest tightness may also occur. Some sufferers complain of balance disorders. Externally, anemia is manifested by pallor and sunken eye sockets. Fingernails are often brittle and have white spots. Also typical are torn and inflamed corners of the mouth, which usually hurt a lot, as well as brittle hair and dandruff. If iron deficiency occurs as a result of anemia, other symptoms may include diarrhea, constipation and flatulence. The teeth and oral cavity are also affected by pronounced anemia – root damage, bleeding gums and other symptoms may occur. Anemia has no clear symptoms. Nevertheless, it can be diagnosed on the basis of the external characteristics and the drop in performance. If medical clarification is not obtained, serious complaints may result from the above symptoms, usually leading to further complications.
Diagnosis and course
Symptoms of anemia are generally pallor, feeling of weakness, reduced performance, permanent fatigue or rapid fatigability. In addition, there may be palpitations or heart palpitations; a physician may also detect new heart murmurs when listening to the heart. The symptoms of bleeding anemia do not differ at all from those of other forms of anemia.Because these symptoms are all so nonspecific and difficult to grasp, they lead most people to the doctor only very late. Anemias are therefore often carried over for a long time, which can be fatal, especially in the case of an underlying tumor disease. A lowered hemoglobin value in a simple blood test indicates to the physician that anemia is present. Based on the size of the red blood cells seen under the microscope, one can also get an initial indication of what form of anemia might underlie the event. In bleeding anemia, the red blood cells are normal in size (after all, blood formation is not the problem), but are simply present in reduced numbers. In addition, an iron deficiency can usually be detected. In women, such latent anemia is often due to menstruation. However, major deviations from the normal value or “sudden” appearance in old age, when the affected person has never had anemia all her life, should still prompt further investigations. In older patients, the very first thing to do is to examine the stool for hidden blood and then often a colonoscopy to rule out cancer or diverticulosis. If nothing is found at the bottom, the search continues at the top: a gastroscopy provides information about possible blood loss due to the presence of gastric ulcers. Further special diagnostics may follow.
Complications
Bleeding anemia need not lead to immediate complications and limitations. However, they may become apparent over time if bleeding anemia is not properly treated. Sufferers often complain of severe fatigue, palpitations and dizziness. In addition, there are difficulties with concentration and problems with the circulation. In most cases, heavy physical work or sports can no longer be performed. Heart palpitations occur, even though the patient is not exerting himself particularly hard. In most cases, the affected person does not realize that he or she is suffering from bleeding anemia, which usually further aggravates the symptom. In this case, a tumor may also be the cause of the bleeding anemia. In most cases, bleeding anemia can be counteracted relatively well, so that no further symptoms occur. The blood loss can be compensated by iron supplements. However, it takes several weeks for the blood volume to return to normal. In the case of cancer, no prediction can be made; various complications can occur in this case. If bleeding anemia occurs after an accident, it must be treated by a doctor. Often, blood loss is not directly detected due to the shock, and in this case it represents a very dangerous condition.
When should you go to the doctor?
A physician should always be consulted for bleeding anemia. It is often necessary to give a blood transfusion in acute bleeding anemia to compensate for a high blood loss. If the anemia is chronic, it is imperative for the physician to determine the cause of the bleeding. Often this is then occult bleeding, that is, internal bleeding that goes unnoticed. Acute bleeding anemia, on the other hand, is quickly recognized because there is obvious blood loss. If the blood loss is very severe, it can lead to circulatory shock with life-threatening consequences. Therefore, emergency medical measures are often required here to avert a life-threatening situation. However, chronic bleeding anemias can also have serious consequences and therefore also require a visit to the doctor. Since the cause of the symptoms is often not immediately recognized here, a doctor’s consultation is all the more urgent. The doctor should be consulted in any case if such symptoms as chronic fatigue, pale skin, dizzy spells, circulatory problems or even impaired consciousness occur. These symptoms also occur in many other diseases in addition to bleeding anemia and should therefore already prompt the affected person to urgently consult a doctor, regardless of their cause. If, in addition, such symptoms as dry, itchy skin, torn corners of the mouth, aphthae, burning of the tongue, loss of appetite, brittle nails or diffuse hair loss occur, it is imperative that a doctor be consulted. This combination of symptoms is a strong indicator of chronic bleeding anemia for the physician.
Treatment and therapy
If no serious cause for the bleeding anemia is found, the problem can often be corrected with permanent iron supplementation.Through the daily supply in the form of tablets, blood formation is sustainably supported and ongoing losses, for example through menstruation, can be permanently compensated. The symptoms also improve after a few weeks. In the case of cancer, gastric ulcer or chronic inflammation, these must of course be treated.
Outlook and prognosis
Bleeding anemia refers to severe blood loss that can negatively affect a person’s well-being. Because bleeding anemia can occur in varying degrees of severity, it is very difficult to make an accurate prediction. If a person loses only a few milliliters of blood, it does not negatively affect well-being. Only when 30% of the total blood is lost do the first symptoms appear. The affected person becomes very pale within a very short time and a strong feeling of dizziness develops. If there is external bleeding, this must of course be stopped. If this succeeds without problems, the prospect of complete recovery and regeneration looks very good. If the bleeding cannot be stopped by the affected person, an appropriate doctor should be consulted as soon as possible. As soon as 50% of the blood is lost, there is an acute danger to life. Symptoms such as dizziness, nausea, vomiting or even fainting are imminent. In the worst case, vital organs can no longer be properly supplied with blood, so that high blood loss can lead to death. Early treatment by a specialist increases the prospect of a complete and rapid recovery.
Prevention
Because a variety of causes of bleeding anemia can be considered, it is difficult to take specific prophylactic measures. Healthy eating in moderation with adequate fiber is certainly good advice to prevent intestinal diseases and tumors, but of course never exclude sources of bleeding. Therefore, anyone who notices permanent fatigue and other signs of anemia in themselves should definitely see a doctor in time, as most causes of bleeding anemia can still be treated very effectively in early stages.
Follow-up
In most cases, no special aftercare is possible or necessary for bleeding anemia. The disease must be treated directly by a physician, otherwise other complications and, in the worst case, death of the affected person may occur. However, early diagnosis and treatment usually results in a positive course of the disease and not in a reduced life expectancy of the patient. As a rule, the affected person is dependent on taking iron supplements to alleviate the symptoms and to build up a normal amount of blood in the body again. Patients should therefore ensure that they take the medication regularly, and parents in particular should force their children to take it. Furthermore, a healthy lifestyle with a balanced diet also has a positive effect on the further course of the disease. In the case of bleeding anemia, unnecessary exertion and other strenuous activities should be avoided as far as possible. The affected person should rest and take care of his body. Likewise, sporting activities should be refrained from, as dizziness or loss of consciousness can often occur.
Here’s what you can do yourself
If bleeding anemia or the bleeding itself underlying the anemia does not require immediate medical treatment, there are definitely some means by which the affected person can help himself. First of all, it is important to combat the cause, i.e. to stop the internal or external bleeding. This can be done externally primarily by carefully closing the wound and sparing the affected area. If the bleeding anemia is caused by a (often chronic) bleeding inside the body, there are also methods to stop it. For example, in addition to medical medication, a bleeding peptic ulcer often requires a change in behavior, which includes abstaining from nicotine, alcohol, coffee, as well as highly spiced foods. Reducing stress levels can also help. In the case of bleeding from hemorrhoids, the patient can eliminate his or her discomfort and thus the cause of anemia by eating a high-fiber diet, drinking enough fluids, and using home remedies such as psyllium husks. Consistent drinking of water and tea is also important to compensate for a lack of fluid volume caused by blood loss in the body.For the improvement of blood values (especially ferritin and hemoglobin), an iron cure can be applied through dietary supplements or over-the-counter iron preparations. In this context, vegetarians can also find preparations on the market that are free of gelatine. The success of these measures should be checked by a regular blood count with the attending physician.
