PubMed · 5122450
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1971. [Ferrum Klinge].. https://pubmed.ncbi.nlm.nih.gov/5122450/
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Inherent in any decision to treat a patient for anemia is an appreciation of the underlying cause of a decrease in the oxygen-carrying capacity of blood. Equally important is an understanding of how this acute or chronic decrease in oxygen delivery affects individual patients. Anemia generally results from blood loss, decreased red blood cell (RBC) production, poor RBC maturation, or increased RBC destruction. This article reviews the pathophysiology of anemia, with specific emphasis on its physiologic consequences in the surgical patient, and provides a contemporary definition of anemia for use in that context. Taking a broader, more functional view of anemia paves the way for understanding and appreciating the newer techniques of RBC conservation and transfusion avoidance, as well as of pharmacologic methods available to counter this disorder.
Although the safety of allogeneic blood transfusion has increased dramatically in recent decades, some risks remain. Contamination with infectious agents-including viruses, bacteria, spirochetes, and parasites-is still possible, although recent advances in blood screening and testing have decreased the risk. The principal noninfectious complication of blood transfusion is immunomodulation. Clinical manifestations of transfusion-related immunomodulatory activity include hemolytic and allergic reactions, graft-versus-host disease, the possible decreased survival in patients with cancer, as well as increased susceptibility to postoperative infection, activation of latent infection, improvement in organ allograft survival, decreased frequency of spontaneous abortion, and moderation of immune inflammatory disease. The cause of transfusion-related immunosuppression is not yet known, but possible contributing factors are the development of a suppressor cell network, formation of anti-idiotype antibodies, clonal deletion, macrophage paralysis, up-regulation of cells with latent infections, cytokine infusion, and contamination by infectious and noninfectious agents.
Crohn Disease (CD) is a chronic granulomatous inflammatory disorder of not well known etiology. It may affect the whole digestive tract, segmentally, from the mouth to the anus although the rectum is usually not involved. Digestive symptoms of CD depend on the location and extension of the disease, its fistulating or stenosing evolution as well as the presence of local or systemic complications. 40% of the patients affected with CD have simultaneous terminal ileal and colonic involvement, 30% have terminal ileitis and 25% have granulomatous colitis. Isolated esophageal, gastroduodenal and perianal affection reach no more than 5% of the patients. We describe a case of a patient affected with CD with isolated jejunal involvement who was admitted to the hospital because of iron deficiency anemia and bowel subocclusion as an atypical clinical manifestation of the disease. After surgical resection of the affected segment of the bowel, the patient became asymptomatic up to now.