Kluiber R M, Wolff B G
Department of Surgery, Milwaukee Medical Clinic SC, Wisconsin.
Dis Colon Rectum. 1994 Oct;37(10):1006-7. doi: 10.1007/BF02049313.
Hemorrhoidal bleeding and anemia are two common entities. The purpose of this article is to review the incidence of hemorrhoidal bleeding that causes anemia in a stable population, to describe patients who have hemorrhoidal bleeding that caused anemia, and to define observations regarding the recovery of their anemia.
This was a retrospective chart review of patients seen at the Mayo Clinic and Olmsted Community Hospital in Rochester, Minnesota, from 1976 through 1990.
Incidence of hemorrhoidal bleeding that caused anemia was found to be 0.5 patients per 100,000 population per year in Olmsted County from 1976 to 1990. The mean age of 43 patients studied was 50 (range, 25-72) years. Twenty-seven patients were male, and 16 were female. Ninety-three percent of these patients had grade 2 or 3 internal hemorrhoidal disease. Six had impaired coagulation. The mean hemoglobin concentration before treatment was 9.4 g/dl (+/- 0.97 SD). Of note was the description of hemorrhoidal bleeding that included blood squirting or clots passing in 84 percent of patients for whom a description was available. It was found that recovery from anemia after definitive treatment with hemorrhoidectomy was rapid, with a mean hemoglobin concentration of 12.3 g/dl after two months, and by six months, the mean hemoglobin concentration was 14.1 g/dl.
It is imperative to evaluate other causes of anemia when presented with hemorrhoidal bleeding with anemia. If no other sources are identified, treatment of the hemorrhoid should be undertaken, and a rapid return of hemoglobin concentration can be expected within two months, and all patients should have a normal hemoglobin by six months. Failure to recover hemoglobin concentration should prompt further or repeated evaluation for other causes of bleeding.
痔出血和贫血是两种常见情况。本文旨在回顾稳定人群中导致贫血的痔出血发生率，描述因痔出血导致贫血的患者，并明确有关其贫血恢复情况的观察结果。
这是一项对1976年至1990年在明尼苏达州罗切斯特市梅奥诊所和奥尔姆斯特德社区医院就诊患者的回顾性病历研究。
1976年至1990年，奥尔姆斯特德县因痔出血导致贫血的发生率为每年每10万人中有0.5例患者。所研究的43例患者的平均年龄为50岁（范围25 - 72岁）。男性27例，女性16例。这些患者中有93%患有2级或3级内痔疾病。6例患者凝血功能受损。治疗前的平均血红蛋白浓度为9.4 g/dl（±0.97标准差）。值得注意的是，在有描述的患者中，84%的痔出血描述包括喷射状出血或排出血块。结果发现，痔切除术后确定性治疗后贫血恢复迅速，两个月后的平均血红蛋白浓度为12.3 g/dl，到六个月时，平均血红蛋白浓度为14.1 g/dl。
出现痔出血伴贫血时，必须评估贫血的其他原因。如果未发现其他出血源，应进行痔的治疗，预计两个月内血红蛋白浓度会迅速恢复，六个月时所有患者的血红蛋白应恢复正常。血红蛋白浓度未能恢复应促使进一步或重复评估其他出血原因。
