Anemia and alcohol. Folk recipes for curing "alcoholic" numbness of hands and feet. Pressure pills and alcohol - compatibility

Laboratory analysis of blood and urine is one of the main methods for diagnosing diseases. General clinical, biochemical and other tests allow you to determine the degree of violation metabolic processes in the body, the presence of inflammatory, infectious diseases. Analyzes for hemoglobin, cholesterol, for the content of potassium, calcium, magnesium are used in diagnostics cardiovascular disease. Antibody tests play an important role in determining infectious, allergic, and oncological diseases. Alcohol affects the functioning of all organs. After its use, there is a change in the consistency and composition of the blood.

One of the main conditions for passing tests and obtaining reliable results on hemoglobin, platelets, cholesterol and other indicators is to refrain from drinking alcohol. How much time should elapse between drinking alcohol and the test procedure (1 or 3 days), the patient must clarify in advance.

The effect of alcohol on test results

To establish diagnoses of various diseases and monitor the condition of patients after surgery, it is necessary to donate blood for the following studies:

• General analysis for hemoglobin (iron), erythrocyte content and ESR (erythrocyte sedimentation rate), leukocytes, platelets. Thanks to such analyzes, it is possible to establish the presence of anemia and the risk of thrombosis, the development of purulent processes;
• A biochemical study is especially important for studying the functioning of organs (liver, kidneys, pancreas), as it shows how much protein, fat, sugar, cholesterol, uric acid, and various enzymes are in the tissues after food enters the stomach. In addition, with the help of this study, it is possible to establish the content of iron, calcium, phosphorus and other elements necessary for the functioning of all body systems;
• Immunological research can be used to determine the nature of infectious diseases, to establish the nature viral infection, the degree of weakening of the immune system (immunodeficiency). Diagnosis is established by testing for antibodies to various infections(among them: hepatitis, syphilis, rubella, measles, herpes and others);
• Tests for allergic reactions;
• Research on hormones (for diagnosing diseases of the endocrine, reproductive system, fetal developmental disorders during pregnancy) and others.

In addition to these analyses, great importance has a urine test. For example, by the content of protein and leukocytes, one can assess the state of the kidneys, by the content of bilirubin, conclusions are drawn about the work of the liver and pancreas. Detection of sugar content during examination of urine indicates the presence of diabetes mellitus. If you drink alcohol before taking the test, your glucose level will inevitably rise. The load on the liver disrupts it normal functioning. In this case, a urine test can show the presence of protein.

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How alcohol affects the complete blood count

Ethyl alcohol, which is part of alcoholic beverages, dissolves the fatty membrane of erythrocytes, disrupts their structure. Red blood cells stick together, blood clotting increases, due to this it thickens, and the risk of blood clots increases. As a result of the action of alcohol, the level of red blood cells decreases markedly, hemoglobin falls. An increase in viscosity, a decrease in the level of hemoglobin and erythrocytes may indicate the development of megaloblastic anemia (a deadly disease). A change in the rate of erythrocytes also affects other indicators, can distort data on blood composition and make it difficult to diagnose diseases, prescribe treatment after examination. Since alcohol is a toxic substance, the results general research blood and urine, carried out in a state of hangover, you can make an incorrect conclusion about poisoning, if you do not know about true reason violations.

The effect of alcohol on blood biochemical parameters

This study is affected by alcohol intake the most. First of all, the glucose content changes. Alcohol inhibits the formation of glucose in the liver, so its level is significantly reduced. It can be dangerous for a person. Drinking alcohol for people with diabetes is not recommended. At healthy person after a temporary decrease in glucose levels, the diagnosis of diabetes mellitus will be incorrectly diagnosed.

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Under the influence of alcohol, the content of lactic acid increases. This usually happens with heart failure and other circulatory disorders, as well as with large blood loss. You can mistakenly assume the presence of internal bleeding.

Alcohol affects uric acid levels. By this indicator, you can detect the accumulation of nitrogen, which happens with the development of gout, arthritis and other joint lesions.

Alcohol intake causes an increase in fat content, which may indicate the development of diseases such as atherosclerosis in the body, ischemic disease hearts, viral diseases liver, kidney failure, blockage of brain vessels, thyroid disease.

How alcohol affects immunoassay data (ELISA)

If you drink alcohol before the examination, the mode of operation of all organs changes. Alcohol acts on the production of hormones, changing their ratio. This can lead to false positive or false negative diagnostic results. serious illnesses liver, kidneys, thyroid gland and other organs. Ethyl alcohol reduces the production of antibodies in the body. The ELISA method is based on diagnosing diseases and assessing defensive forces organism by the presence or absence of antibodies a certain kind. Distorted results after drinking alcohol and testing for markers can lead to incorrect conclusions, will not allow diagnosing such serious illness like hepatitis (A,B,C,D), malignant tumors, gene abnormalities, allergies.

When a person has to visit a doctor and take tests for red blood cells, hemoglobin, infectious or oncological markers, then you should not drink alcoholic beverages at least 2 days before the examination. Alcohol distorts test results so much that experts will not be able to recognize the true picture of serious (sometimes fatal) diseases. For blood and urine tests, the time is usually set in advance, so a person should ask the doctor about the rules for donating, and also clarify after what time you can donate various analyzes if drinking alcohol. If, nevertheless, on the eve of the tests, the patient drank alcohol, then this must be reported. The timing of the survey will be changed.

Alcohol with anemia is not contraindicated. Some doctors, on the contrary, advise people suffering from this disease, drink weak alcoholic beverages, but within the normal range.

Some diseases absolutely exclude the use of wine, beer, vodka and other strong drinks. Alcohol with anemia is not under the ban, as it accelerates the absorption of iron into the blood, which contributes to recovery.

Anemia and alcohol are quite compatible. That's how they think modern doctors. Anemia is accompanied chronic fatigue, weakness. A person constantly experiences a slight malaise and the reason for this is a lack of oxygen in the body and insufficient intake of iron. It is iron that is part of hemoglobin, which is involved in the processes of tissue respiration.

Patients with anemia suffer from shortness of breath, dizziness. The skin becomes very pale. At proper nutrition a person receives enough iron and this disease does not develop. But sometimes even the use of a sufficient amount of this component cannot save from the onset of anemia. The reasons for the development of the disease include:

Lack of production of hydrochloric acid in the stomach;

Taking medications;

Diseases of the gastrointestinal tract;

Refusal of meat products;

Large blood loss;

Increased need for iron.

Pregnant women and athletes need much more of some mineral compounds than ordinary people, so they develop anemia quite often.

It is known that iron is better absorbed in the presence of vitamin C, which is found in large quantities in citrus fruits, herbs, and sesame. To improve the composition of the blood, doctors advise more often to include cereals boiled in water in the diet. It is best to eat them with boiled beef. There is a lot of iron in buckwheat.

As for alcohol, it improves the absorption of iron. Therefore, with anemia, weak alcoholic beverages may even be useful. Preference should be given to dry or semi-sweet wine, but not to beer or vodka.

Many people are interested in whether anemia can develop from alcoholism. Experts assure that the craving for strong drinks can only become indirect cause the development of the disease, as it worsens blood clotting and leads to other serious consequences.

If you drink a little wine a day, you can significantly increase the iron content in the blood. But at the same time, you need to eat right.

The rate of drinking alcohol for women is 200 milliliters of dry wine per day, and for men - 400 milliliters. In other words, the fairer sex can afford 1 glass of wine per day, and men - 2 glasses. It is better to give preference to red varieties of wine drinks, as they contain the most substances that accelerate the absorption of iron.

It is impossible to abuse alcohol, as this can lead to alcoholism, disrupt metabolism. Also, do not forget about a special diet. Some foods interfere with iron absorption. These include cottage cheese, milk, yogurt, eggs. It's about not about strict prohibition on such food, but about the restriction in its use. Polyphenols, oxalates also reduce the absorption of iron. There are a lot of polyphenols in tea, coffee, and oxalates are present in cabbage, nuts, and strawberries.

To get rid of anemia, you need to additionally take iron-containing vitamin-mineral complexes. While taking the drugs, you can drink alcohol, but within acceptable limits. Do not forget that this norm was calculated solely to solve the problem of iron deficiency in the body. In some cases, the dosage may be even less. At certain diseases It is necessary to completely exclude the use of alcoholic beverages.

Anemia due to alcoholism is very difficult to treat. In this case, it is required additional reception drugs, but this will not be enough if a person is not able to give up addiction.

At chronic alcoholism occurring in a severe form, may develop different kinds anemia due to damage to some organs and systems, as well as folic acid deficiency. The most common in this case is megaloblastic anemia, which accompanies iron deficiency.

Alcohol with anemia can be consumed, but in a very limited quantities. If the dosage is exceeded, the disease may be more severe. Alcoholism also leads to other serious violations, the consequences of which can be unpredictable.

Anemia is not one of the most striking manifestations of alcoholism. However, its adverse effect on the prognosis of visceral alcoholism is undeniable. Anemia-induced tissue hypoxia is additional factor worsening the course of alcoholic liver disease, myopathy, heart damage, nephropathy, encephalopathy. Anemia is one of the reasons severe course infectious diseases in chronic alcoholism. Anemia is likely to be associated with hemochromatosis, a common complication of alcoholism.

Alcoholism is characterized various forms anemia. Their identification, which is often difficult, has importance for early diagnosis of chronic alcoholism. Thus, an increase in the volume of erythrocytes - macrocytosis - is one of the most characteristic and early signs of chronic alcohol abuse, due to the toxic effect of acetaldehyde, folic acid deficiency and hyperlipidemia.

At acute intoxication alcohol in the bone marrow shows signs of damage to the erythrocyte germ - a decrease in cellularity, vacuolization of the cytoplasm and the nucleus of normoblasts and megaloblasts. These changes disappear 3-4 days after withdrawal. At the same time, the normalization of erythropoiesis is accompanied by reticulocytosis, which is especially pronounced during the 2nd week after the alcoholic excess.

At chronic abuse alcohol, a more severe lesion is observed with the development of various anemias - hypochromic, sideroblastic, megaloblastic, hemolytic (Table 10).

Iron deficiency anemia more typical for alcoholic lesions of the gastrointestinal tract, hemolytic anemia - for alcoholic liver disease, megaloblastic anemia occurs in all forms of visceral alcoholism and in neuroalcoholism.

• Iron-deficiency anemia [show]

  This type of anemia occurs in 20-25% of patients suffering from alcoholism.

  Pathogenesis. Iron deficiency, often observed in alcoholism, develops with damage to the gastrointestinal tract (alcoholic erosive gastritis, esophagitis, peptic ulcer), cirrhosis of the liver (bleeding from varicose veins of the esophagus, stomach, rectum), less often - with indurative pancreatitis with malabsorption syndrome. Alcoholic disorders of hemostasis contribute to increased bleeding - thrombocytopenia with hypocoagulation. It should be emphasized that in alcoholism, as a rule, iron absorption in the gastrointestinal tract is increased, therefore, when bleeding stops, the iron depot in the body of an alcoholic can spontaneously recover very quickly.

  Clinic. With a long course of anemia, along with general anemic (weakness, dizziness, tachycardia, shortness of breath, etc.), sideropenic symptoms are detected - skin lesions (dryness, cracks, angular stomatitis), nails (brittleness, thinning, koilonychia), hair, taste perversion, glossitis, dysphagia, sharp muscle weakness. Of the laboratory signs, hypochromia (color index 0.5-0.6), microcytosis, anisocytosis, poikilocytosis are characteristic with a normal or moderately increased number of reticulocytes. Serum iron is significantly reduced, latent and total iron-binding capacity is increased. In the bone marrow there are moderate hyperplasia erythrocyte germ, a decrease in the number of sideroblasts.

  Diagnostics. An important place in the diagnosis is the identification of the source of blood loss using a complex of radiological and endoscopic methods, repeated examination of feces for occult blood. With the introduction of autologous erythrocytes labeled with radioactive chromium, hidden (occult) bleeding from the gastrointestinal tract can be detected, and with the help of an oral test radioactive iron- to establish the fact of violation of its absorption in pancreatitis. Differential Diagnosis carried out with anemic syndrome with systemic diseases connective tissue(rheumatoid arthritis) and chronic infections(subacute bacterial endocarditis, tuberculosis), which are especially prone to patients with alcoholism. For such secondary hypochromic anemia normocytosis is more characteristic, in contrast to alcoholic anemia, the level of free serum transferrin is normal, iron is moderately reduced, treatment with iron preparations is ineffective. It is extremely important to distinguish between iron deficiency and sideroblastic anemia, the latter is also manifested by microcytosis, hypochromia, but is characterized by a high content of serum iron, bone marrow sideroblastosis, and resistance to treatment with iron preparations.

  Treatment consists in stopping bleeding, strict abstinence, prescribing iron supplements in combination with vitamins C and B 6, a diet containing iron-rich foods (meat, liver, eggs, legumes). Since with alcoholism an overdose of iron can develop especially easily with an oversaturation of the body (danger of hemochromatosis, hemolysis), it is more appropriate oral administration iron preparations under the control of its level in the blood. At chronic pancreatitis it is necessary to combine oral intake of iron with pancreatic enzymes; in case of impaired absorption of iron, it is necessary to parenteral administration. An early sign the effectiveness of treatment, preceding the increase in hemoglobin (Hb), is a reticulocyte crisis.

• Sideroblastic anemia [show]

  This type of anemia often (in 30% of cases) complicates alcoholism.

  Pathogenesis. main reason sideroblastic anemia in alcoholism - a deficiency of folic acid and vitamin B 6 in combination with the antifolic and antipyridoxal effects of alcohol on the bone marrow. The absolute and relative deficiency of these vitamins leads to disruption of the synthesis of protoporphyrin and heme, as a result of which the utilization of iron by the bone marrow decreases. Additional source The formation of iron is the accelerated destruction of red blood cells in the bone marrow, spleen, and peripheral blood. Unutilized excess iron accumulates in the cells of the bone marrow - between the cristae of mitochondria (annular sideroblasts), in the liver, pancreas, and myocardium.

  Clinic. Characterized by hypochromia (decrease in color index), microcytosis (often combined with macrocytosis), aniso- and poikilocytosis without reticulocytosis. Serum iron is elevated, less often normal with high transferrin saturation (low iron-binding capacity). In the bone marrow, the number of sideroblasts (especially ring-shaped) is significantly increased, and a megaloblastic type of hematopoiesis is often found. The fact of excess iron content in the body can be proved using a desferal test - after intramuscular injection 500 mg of Desferal sharply (5-10 times higher than normal) increases the daily excretion of iron in the urine.

  Diagnostics. With sideroblastic anemia, a differential diagnosis should be made with hemochromatosis, chronic lead intoxication, hereditary sideroblastic anemia. Hemochromatosis is characterized by a characteristic symptom complex (skin pigmentation, diabetes mellitus, mycardiodystrophy, pigmentary cirrhosis), a persistent sharp increase in serum iron, and anemia is not typical for it. Often there are difficulties in distinguishing from chronic lead intoxication, since general symptoms plumbism ( intestinal colic, encephalopathy) are often absent, and a number of symptoms are also characteristic of alcoholism (polyneuritis, hyperuricemia with arthritis, kidney damage, hypertension). Moreover, lead intoxication, in addition to industrial factors, can develop from drinking homemade wine. To hallmarks anemia with lead intoxication include severe hypochromia with basophilic granularity and significant reticulocytosis, high serum iron, sharp increase urinary excretion of δ-aminolevulinic acid and coproporphyrins. Sideroblastic anemia may be a manifestation of lymphogranulomatosis, diffuse myeloma, prostate cancer, rheumatoid arthritis, long-term use drugs that disrupt the metabolism of vitamin B 6 (isoniazid, cycloserine, levomycetin, antitumor cytostatics). Differential diagnostic value have abstinence ( quick effect with reticulocyte crisis in alcoholic anemia), trial treatment with vitamin B 6 (effective only for hereditary sideroblastic anemia), desferal test, detection of lead in urine after the administration of complexone.

  Treatment. After 3-4 days of complete abstinence, reticulocytosis develops, the number of sideroblasts in the bone marrow decreases sharply. To eliminate beriberi, apply folic acid and vitamin B 6 , as well as an appropriate diet enriched with these vitamins. The appointment of iron preparations is contraindicated.

• Megaloblastic anemia [show]

  This type of anemia is found in 40% of patients with alcoholism.

  Pathogenesis. It is associated, as a rule, with a deficiency of folic acid and the antifolic effect of alcohol. In the development of beriberi, not only a decrease in the intake of folate from food (unbalanced nutrition with advanced alcoholism) plays a role, but also a decrease in vitamin depot in the liver (with hepatitis, cirrhosis), an increased need for folic acid in alcoholism due to compensatory activation of erythropoiesis in response for hemolysis, iron loss. In addition, in conditions of even minimal folic acid deficiency, continued alcohol abuse leads to a decrease in the absorption of the vitamin in the gastrointestinal tract, thereby exacerbating beriberi.

  The antifolic effect of alcohol is to neutralize therapeutic doses vitamin by reducing its binding to plasma carrier proteins and inhibiting the action of folate on the synthesis of nucleic acids in the bone marrow (inhibition of the enzyme tetrahydrofolateformylase). Folic acid deficiency leads to the formation of a megaloblastic type of hematopoiesis with the development of macrocytic anemia. Much less frequently, macrocytic anemia in alcoholism is caused by vitamin B12 deficiency (with pancreatitis with malabsorption syndrome).

  Clinic. With alcoholism, bright typical clinical manifestations megaloblastic anemia (Hunter's glossitis, episodes of fever, funicular myelosis). In the foreground is a nonspecific anemic syndrome, therefore, a particularly important place is occupied by laboratory diagnostics, revealing an increase in the average volume of erythrocytes (macrocytosis), hyperchromia (color index> 1), a moderate increase in indirect blood bilirubin. Reticulocytosis is absent, serum iron levels are normal or moderately elevated. Less commonly, in advanced cases, leukopenia with hypersegmented neutrophils and basophilic granularity of erythrocytes (Jolly bodies, Kebot rings) is detected. Sternal puncture reveals a pattern of megaloblastic hematopoiesis.

  Difficulties in diagnosing megaloblastic anemia in alcoholism are associated with moderate severity of anemia, its frequent subclinical course, frequent combination with iron deficiency, when microcytosis, characteristic of iron deficiency anemia masks folic acid deficiency (macrocytosis). Wherein sternal puncture not of decisive importance early stage folic acid deficiency anemia in the presence of macrocytosis, the normoblastic type of hematopoiesis is preserved.

  The leading role in the diagnosis of megaloblastic anemia in alcoholism is played by the determination of the volume of red blood cells, in controversial cases (with a combination of macro- and microcytosis) - after trial treatment with iron preparations - the concentration of folic acid and vitamin B 12 in the blood serum, the detection of megaloblasts and hypersegmented neutrophils. Important diagnostic criterion is the development of a reticulocyte crisis on the 5-6th day of treatment with folic acid.

  Diagnostics. Other causes of megaloblastic anemia should be excluded: Addison-Birmer disease (pernicious anemia), diseases leading to malabsorption of folate and vitamin B12 from gastrointestinal tract, cancer stomach, chronic enteritis, sprue (tropical and non-tropical), malignant lymphomas, intestinal tuberculosis, helminthic invasions(diphyllobothriasis), diseases of the operated stomach and intestines. Megaloblastic anemia can be caused by an increased need for vitamin B 12 in solid cancers, hemoblastosis, prolonged hemolysis, the use of drugs that interfere with the absorption of vitamins in the gastrointestinal tract (neomycin, barbiturates, phenytoin, colchicine) or inhibit the metabolism of folate in the bone marrow (cytostatics, procarbazide, triamterene ).

  Treatment lies primarily in complete cessation drinking alcohol. After 2-4 months of complete abstinence, blood hemoglobin normalizes, macrocytosis disappears. Folic acid is used orally or parenterally at a dose of 2-5 mg / day in combination with vitamin B 12 (100 mcg every other day) under the control of the functional state of the kidneys and liver. In alcoholic disease with severe involvement of the liver, kidneys, nephro- and hepatotoxic effects of folic acid are possible, so its doses should be reduced. B 12 -deficiency megaloblastic anemia in alcoholism requires treatment with high doses of vitamin B 12 (500 mcg parenterally daily for 3-4 weeks), followed by a transition to maintenance doses, as well as the appointment of pancreatic enzymes that improve the absorption of the vitamin in the gastrointestinal tract.

• Hemolytic anemia [show]

  Hemolysis often complicates visceral alcoholism. In this case, intracellular hemolysis develops more often.

  Pathogenesis. Hemolytic anemia due to erythrocyte membranopathies complicate alcoholic liver disease. Characteristic for alcoholic cirrhosis in the liver, an increase in the content of serum lipids with a violation of the strength of the bond between cholesterol and lipoproteins leads to the accumulation of cholesterol and phospholipids in the erythrocyte membrane. This especially increases the content of cholesterol in the membrane (the ratio of cholesterol / phospholipids is more than 1 at a rate of 0.95).

  Violation of the properties of the erythrocyte membrane leads to an increase in the surface area and average volume of erythrocytes and is one of the causes of macrocytosis. The erythrocytes become target-like ( flat cells with a dark spot in the center and a ring of enlightenment surrounding it) or transform into stomatocytes (cells with a mouth-shaped strip of enlightenment in the center). In decompensated cirrhosis, when the accumulation of lipids in the membrane is most pronounced (cholesterol/phospholipids ratio 1.4-1.6), the membrane contours are deformed, forming process erythrocytes. The cause of hemolysis of target-shaped, process erythrocytes and stomatocytes is associated with a deterioration in their rheological properties. The permeability and density of membranes decrease, their microviscosity and cell area/volume ratio increase, and osmotic resistance increases. The spleen plays an important role in the mechanisms of hemolysis (often intracellular).

  Hemolytic anemia from non-erythrocytic causes complicates (in the form of severe hemolytic crises) peculiar to alcoholism disorders of lipid and electrolyte metabolism. Their pathogenesis is realized by the influence of plasma damaging factors on the erythrocyte. There is a characteristic association of episodes of hemolysis with severe hypertriglyceridemia accompanying a rare variant of alcoholic fatty hepatosis(Zieve's syndrome). Loss of phosphate and magnesium in the urine often complicates alcoholism. A sharp drop in the level of inorganic phosphate in the blood serum (below 3 mg%) leads to a 3-5-fold decrease in the content of ATP and 2,3-diphosphoglycerate in erythrocytes, disrupts glycolysis, which causes massive hemolysis. Other mechanisms for the development of hemolysis in alcoholism are also possible - due to immunological disorders, mechanical destruction of erythrocytes with rapidly increasing portal hypertension. More often observed intracellular hemolysis, accompanied by an increase indirect bilirubin(hemolytic jaundice). Massive intravascular hemolysis, manifested by hemoglobinuria, may be complicated by anuria.

  Clinic. The dependence of the severity of hemolysis on the severity of liver damage is characteristic. At chronic hepatitis and compensated cirrhosis, anemia, reticulocytosis and hyperbilirubinemia (due to the indirect fraction) are moderate. The hematocrit was not drastically reduced. Enlarged target erythrocytes and stomatocytes are revealed. Osmotic resistance is increased. Serum iron normal or moderately elevated. Significant hyperplasia of the erythrocyte germ is observed in the bone marrow. After 4-6 weeks of abstinence, stomatocytes and target cells are not detected, Hb normalizes. With decompensated cirrhosis, as a rule, more severe hemolytic anemia is detected with a progressive drop in Hb and hematocrit, reticulocytosis, hemolytic progressive jaundice, and splenomegaly. Processed erythrocytes are found in peripheral blood. Remission of anemia, as a rule, is not observed.

  With Zieve's syndrome, a rare variant of alcoholic hepatosis that accompanies an intense alcoholic excess, there is a sudden onset and rapid progression of anemia and hemolytic jaundice, fever is often detected. In the peripheral blood, there is a decrease in Hb and hematocrit, reticulocytosis, microspherocytosis, often in combination with macrocytosis. Characterized by hepatomegaly without enlargement of the spleen, severe hyperlipidemia: sharp rise levels of triglycerides, total lipids, phospholipids, cholesterol. Hemoglobinuria is rare. Liver biopsy reveals diffuse steatosis, usually without evidence of cirrhosis.

  Hemolysis in hypophosphatemia develops against the background of common manifestations of dyselectrolytemia - increased muscle excitability, mental retardation, anorexia, ECG changes. Anemia grows rapidly, accompanied by jaundice, rarely hemoglobinuria. A drop in hematocrit, reticulocytosis, thrombocytopenia, microspherocytosis are detected. Serum inorganic phosphates are sharply reduced.

  Diagnostics. Alcoholic hemolytic anemia due to erythrocyte membranopathies, accompanied by hepatolienal syndrome and characterized by a chronic persistent or slowly progressive course, intracellular hemolysis (with jaundice), must be distinguished from hereditary hemolytic anemia(Minkowski-Choffard disease), diffuse liver diseases non-alcoholic etiology (viral cirrhosis, chronic active hepatitis), hemoglobinopathies. The size and morphological features of erythrocytes, their osmotic resistance, iron saturation and the concentration of the latter in blood serum are of differential diagnostic value (Table 11). To establish the etiology of the disease, it is often necessary to resort to liver biopsy and laparoscopy. The diagnosis of hemoglobinopathies, thalassemia is confirmed by an electrophoretic study of Hb, the study of its properties (thermal lability, methemoglobin formation).

  Table 11. Differential diagnosis of hemolytic anemia in alcoholism
  Clinical and laboratory signs	Alcoholism	Minkowski-Shoffard disease	β-Thalassemia (heterozygous)	Hemoglobinosis S
  RBC size
  Color indicator	≥ 1	≥ 1	< 1	≤ 1
  Osmotic resistance
  Reticulocytes	h,
  blood iron	h,	H	, H	H
  Morphology of erythrocytes	Targeting, stomatocytosis, process cells	microspherocytosis	Targeting, sideroblastosis, basophilic granularity	Sickle, targeting
  Splenomegaly	±	++	+	++
  Liver enlargement	++	±, lithiasis	±	±
  Note: [+] - present, [++] - very characteristic, [±] - may be present, but not in all cases, H - norm, - increase, - decrease.

  Differential diagnosis is especially important in hemolytic crisis. Massive hemolysis (more often intravascular, complicated by acute renal failure) manifests erythrocyte enzymopathies (glucose-6-phosphate dehydrogenase deficiency), hemolytic-uremic syndrome, immune hemolytic anemia, malignant form tropical malaria, sepsis (usually anaerobic), poisoning with hemolytic poisons. When questioning the patient, attention should be paid to epidemiological anamnesis, heredity, taking drugs that provoke hemolysis in erythrocyte enzymopathies (quinidine, sulfonamides, analgesics, vitamins K, 4-aminoquinoline drugs, furadonin, chlorpromazine, PAS, chloramphenicol), contact with hemolytic poisons (arsenic hydrogen, aniline, sodium bichromate, acetic essence, etc.). For differential diagnosis it is important to assess the morphological and cytochemical features of erythrocytes, search for malarial plasmodium, immunological examination (Coombs test, detection of cold antibodies), laboratory diagnosis of DIC (erythrocyte fragmentation phenomenon, progressive decrease in fibrinogen and platelet levels, prolongation of thrombin and prothrombin time), detection of hypophosphatemia , hypertriglyceridemia.

  Treatment. With membranopathies and Zieve's syndrome, the treatment of anemia consists in withdrawal, improvement of liver function, and reduction of hyperlipidemia. With hypophosphatemic hemolysis, intravenous administration of phosphates gives a quick effect. With the addition of hemoglobinuric nephrosis, acute renal failure is treated.

With alcoholism, leukopenia is more often observed due to granulocytes. At the same time, dystrophic changes in the form of vacuolization of the cytoplasm are found in the bone marrow precursors of the latter. The reason for the inhibition of the granulocytic germ is associated not only with the direct toxic effect of alcohol, but also with a deficiency of folic acid, vitamin B 12. A decrease in the number of lymphocytes and plasma cells in alcoholism, as a rule, is not observed. Accession bacterial infection in alcoholism often exacerbates neutropenia. At the same time, it should be emphasized that in order to attack an acute alcoholic hepatitis and lobar pneumonia, characteristic of alcoholics, is characterized by neutrophilic leukocytosis, sometimes extremely pronounced - with the development of a leukemoid reaction.

If lymphocytosis (or monocytosis) is detected, the addition of tuberculosis infection, syphilis should first of all be excluded. Eosinophilia is also not characteristic of alcoholism.

To common reasons sudden death in alcoholism include cerebral hemorrhage, profuse bleeding from the gastrointestinal tract, often fatal thromboembolism. These severe complications are based on alcoholism-induced disturbances in the hemostasis system that develop against the background of alcoholic damage to the gastrointestinal tract, liver (with portal hypertension), blood vessels, and endogenous beriberi.

Alcohol has a direct toxic effect on the coagulation system and platelets. In addition, the progression of alcoholic liver disease leads to a deficiency of coagulation factors, most of which are synthesized in the liver, to a decrease in the absorption of vitamin K from the gastrointestinal tract, additional destruction of platelets in the spleen (with hypersplenism), and folic acid deficiency. In severe liver damage, the synthesis of endogenous anticoagulants (antithrombin-III, plasminogen) decreases, which can lead to spontaneous thrombosis, embolism and contribute to DIC.

In acute alcoholic excess, 1/3 of patients have moderate thrombocytopenia with shortened life expectancy and impaired aggregating ability. A decrease in the activity of platelet monoamine oxidase is characteristic. The duration of bleeding moderately increases, although severe bleeding is not typical, the risk of bleeding (hemorrhage) with alcohol excess is increased. It is especially high in patients with ulcers associated with alcoholism, hypertension, injuries and surgical interventions treatment with anticoagulants. On the 3-4th day of abstinence, the number of platelets begins to rise, reaching an excess of the maximum (reactive thrombocytosis) on the 10-14th day. In this regard, in the first 2-3 weeks of withdrawal, the risk of thromboembolic complications increases.

Hemostasis disorders are more pronounced in alcoholism, when a deficiency of vitamin K and folic acid (megaloblastic anemia) is added. At the same time, hemorrhagic manifestations are especially frequent and varied (petechiae, bleeding of mucous membranes, bleeding from the gastrointestinal tract). Therefore, in order to normalize hemostasis and platelet count, in addition to abstinence, it is necessary to prescribe folic acid and vitamin K parenterally.

The most severe disorders in the coagulation system are characteristic of acute alcoholic hepatitis and alcoholic cirrhosis of the liver. Significant thrombocytopenia, a decrease in most coagulation factors (especially fibrinogen) against the background of portal hypertension lead to severe bleeding.

To reduce hypocoagulation, vitamin K, folic acid, transfusions of platelet mass, cryoprecipitate (fibrinogen), dry and fresh frozen plasma are used. The prognosis is unfavorable, since even a small blood loss in decompensated cirrhosis easily leads to hepatic coma, HRS.

Recurrent thrombosis is more typical for the combination of alcoholic liver disease with chronic alcoholic pancreatitis, often observed when alcoholic cirrhosis of the liver transforms into cirrhosis-cancer. With cirrhosis-cancer, significant thrombocytosis is often found.

Alcoholic disease: Damage to internal organs in alcoholism / Kol. authors: Trayanova T. G., Nikolaev A. Yu., Vinogradova L. G., Zharkov O. B., Lukomskaya M. I., Moiseev V. S. / Ed. V. S. Moiseeva: Proc. allowance, - M .: Publishing House of UDN, 1990.- 129 p., ill.

ISBN 5-209-00253-5

The problems of alcoholic disease-pathology, which received in recent times widespread in many countries and ranked third among the causes of death and disability after cardiovascular and oncological diseases. The main issues of pathogenesis, clinic and diagnosis of the most common lesions of the internal organs of alcoholic etiology are covered. Special attention is given to methods of identifying persons who abuse alcohol.

Vinogradova L. G.

List of abbreviations [show]

Alcoholism is a disease that requires the intervention of doctors and the participation of the patient's relatives, since in addition to medications, antidepressants are required to eliminate the cause of addiction to alcohol. The causes of anemia in alcoholism are diverse and require mandatory elimination. If a person abuses alcohol and alcoholic beverages, does not cope with the disease on his own, he should know what anemia is in alcoholism.

Often the development of many diseases is associated with human behavior and in the wrong way his life. So, one of these reasons rests on the regular use of alcohol, and over time, this phenomenon becomes chronic, as a result of which it is difficult for a person to cope with this problem. In such cases, the relatives of the patient come to the rescue, since he himself is not able to consult a doctor and engage in treatment. Often, the main treatment is accompanied by a parallel visit to a psychotherapist in order to eliminate the psychological problems that cause a person to become addicted to alcohol.

In addition to the fact that alcoholism lowers a person’s status, worsens his quality of life, causes family strife and even divorce, it has been proven that regular alcohol consumption leads to the development of anemia, and 12 deficiency in this case is a sign of damage to the hematopoietic function.

Any disease makes itself felt by a number of symptoms that increase with a protracted nature. A patient with anemia cannot but experience the signs inherent in this type of disease.

So,
B12 deficiency anemia
must be accompanied by:

Increased weakness;

Decreased performance;

Attacks of dizziness;

shortness of breath;

palpitations;

Burning, and sometimes pain in the tongue;

Pain in the legs, aggravated by walking;

Staggering when walking.

Often severe anemia affects and nervous system, contributing to the violation of sensitivity, muscle atrophy, the development of polyneuritis and other phenomena. Diagnosis does not require a serious examination, as the results of the analysis are enough. For anemia, some important indicators blood is noticeably distorted, which is an indication for the diagnosis.

At the same time, all the efforts of the doctor are aimed at identifying the cause
anemia in alcoholism.

It is known
what b12 deficiency anemia
due to:

food deficiency;

Chronic stomach and intestinal
bleeding;

liver dysfunction;

Hemolysis of erythrocytes;

Hypersplenism due to portal
hypertension;

The direct toxic effect of ethanol on
erythropoiesis and folate metabolism;

Impaired heme synthesis.

Iron deficiency anemia is indicated by a decrease in the blood level of such an indicator as the level of vitamins B12. In addition, a urine test is performed, in which methylmalonic acid is detected, elevated level which speaks of tissue or cellular B12 deficiency.

In addition to these tests, the patient undergoes other types of examination in order to identify the presence of concomitant diseases provoked by alcoholism. If any are found, a complex treatment is prescribed, consisting not only of taking iron-containing drugs, but also of means aimed at eliminating the existing symptoms. Parallel to complex treatment the patient is assigned the help of a psychotherapist, since it is often quite difficult to achieve the expected effect.

During the entire treatment process, the patient regularly takes tests in order to control and correct the level of iron in the blood. In addition to taking iron-containing products, the doctor strongly recommends enriching your food ration natural foods rich in iron. These are: buckwheat grain, red meat, legumes, beef liver, Red beetroot. In addition to these products, it is recommended to use fresh juices from fruits and vegetables, which contain a large number of various vitamin and minerals. As for drinks like strong coffee and tea, they must be excluded from the diet, as they have a diuretic effect and contribute to the leaching of not only vitamins, but also iron from the body.

As medical practice shows, B12 deficiency anemia is subject to long treatment, since until the patient stops drinking alcohol and alcoholic beverages, it is impossible to compensate for iron deficiency in the body. Each patient with alcoholism should be aware of the indisputable fact that anemia, with its prolonged course, can cause the development of other, more serious diseases. Often, a neglected (chronic) form of anemia can no longer be treated, as a result of which the doctor is unable to help the patient. That's why timely appeal to a specialist, as well as compliance with a number of preventive measures will get rid of the development of not only anemia, but also other health problems. It should also be recalled that no disease should be treated independently, without the participation of an experienced and qualified specialist, since an incorrectly selected method of treatment can only aggravate the patient's condition.

The occurrence of anemia is quite easy to determine by general fatigue, severe fatigue and constant headaches. Anemia and alcohol are incompatible things, and evidence will be presented below to clearly illustrate this statement.

Consequences of drinking alcohol during anemia treatment

During the treatment of anemia, it is better to completely eliminate alcohol from your daily diet. The fact is that drinks containing ethylated benzene negatively affect the functioning of the whole organism, but they especially affect the liver. Alcohol interferes with the normal absorption of trace elements, including iron, along the way negative impact and on the liver.

With anemia, the body experiences a sharp shortage of hemoglobin, its level drops sharply and is fully restored only after the end of treatment. Having a negative impact on liver function, alcohol destroys hemoglobin molecules, synthesizing bilirubin instead. As a result, a person begins to feel even worse, and against the background of anemia, liver failure also develops.

Especially dangerous is the use of alcohol during the development of iron deficiency anemia. A constant influx of ethylated benzene makes it impossible to quickly absorb iron and produce hemoglobin, and as a result, a person may develop jaundice. When drinking alcoholic beverages, special diets and the medicines prescribed by the doctor are ineffective, and iron deficiency anemia continues to develop. Against the background of the development of the disease, blood flow to the internal organs decreases, which worsens the functioning of the kidneys and heart.

Few patients know that anemia due to alcohol begins to develop even more rapidly. With proper treatment, doctors manage to get rid of the signs of the disease in 1-2 weeks. However, even minimal amount alcohol makes its own adjustments to the recovery process. Gradually, the patient's blood clotting process is disrupted, which endangers not only his recovery, but also human life.

Useful properties of alcohol in anemia

When talking about the relationship between anemia and alcohol, many people forget that sometimes alcohol-containing drinks can be beneficial to health. So, for example, with iron deficiency anemia, experts may recommend taking grape wines before meals in small quantities (no more than 30 ml.). A small amount of wine before each meal increases appetite and also affects the improvement of gastric acid production.

However, experts recommend consuming good, natural wines with a minimum content of preservatives. The use of surrogates is unlikely to have any positive influence on the body and on the treatment of anemia.

Alcohol and anemia are incompatible things, but this is far from the only limitation that a person will have to endure after making a diagnosis. So, for example, a person should refrain from eating too fatty foods (lard, poultry), as well as a variety of sweets that are poorly digested (cakes, pastries). Many experts recommend avoiding marinades because they stimulate the destruction of red blood cells and affect the functioning of the pancreas.

Usually, a person's diet during the treatment of anemia consists of pork and chicken meat, fruits and vegetables, various cereals. Despite the fact that the list of allowed foods is quite large, a person needs to eat in a balanced way. In the process of treatment and recovery, it is better to exclude alcohol from the daily diet. Anemia is a serious and insidious disease, so it can easily return, especially if a person returns to normal after a diet. wrong diet and abuse of bad habits.