| Object iveBy the design of case-control study in the same period, there is a preliminary study that concludes clinical characteristics of anemic hemorrhoids(moderate or above anemia caused by hemorrhoidal bleeding) in patients.MethodsThe synchronous observation in patients who were diagnosed hemorrhoidal bleeding and hospitalized in the colorectal department of Guangdong hospital of Traditional Chinese Medicine Hospital of Guangdong Province from March,2015 to February,2016. And these cases were divided into 2 groups according to the hemoglobin (Hb) concentration, one named "common group" [the adult male (female)Hb concentration approximately fluctuates from 120 (110) to 160(150)g/L],the other named "anemia group" (Hb≤90g/L). We used the clinic case-report form to get medical history, physical and laboratory examinations et al, and put them all in the data. The main outcome measures:(1) basic information:age, gender, job, diet custom, and the history of alcohol, tobacco, et al; (2)clinical features:course of the disease, action in chief, the number of times in recent lyear and days of this hematochezia-attack cycle, defecation times, hematochezia time and capacity et al;(3) physical examinations:the number and morphology of hemorrhoids, et al; (4) laboratory examinations:Routine blood, Anemia three, Blood coagulation; (5)the diagnosis, TCM syndrome types and periodization. It would have some outcomes by using Excel software and SPSS 17.0 software to provide statistical analysis of all the clinic observational indices.ResultsThis observational study finally collected 216 patients, among them 162 patients in the common group, and the rest in anemic group.(1) Basic information:there were no statistical differences between 2 groups in age, gender, job, the history of alcohol & tobacco, and common internal medicine diseases including hypertension and type 2 diabetes. Compared with the other group, the common group had a statistical difference in spicy food habit(P=0.035)(2)Clinical features:there were no statistically significant differences between 2 groups in course of the disease, action in chief, conservative treatments before attack cycle, seasons, the Bowel habits which including defecation positions & times, stool property, exacerbation days, the factor changes of the Bowel habits & hematochezia characteristics in exacerbation and hematochezia-attack cycle. Compared with the common group, the anemic one had statistical differences in the number of times in recent 1 year and days of this hematochezia-attack cycle, with or without exacerbation, the hematochezia characteristics which including the sequence of defecation & hematochezia, the time, the capacity and the way of hematochezia in both exacerbation and hematochezia-attack cycle (P<0.05).In the anemia group, days of hematochezia-attack cycle were longer(13.22 ±9.00 VS 7.50±6.10);the times in recent 1 year of this hematochezia-attack cycle were more (10.30±6.51 VS 5.02±3.48);the main sequence of defecation & hematochezia was defecation or hematochezia, the order was fair consistent concentration of the hematochezia time was from 1to 10mins (85.1% VS 36.4%), while the other was under lmin(63.6%); concentrations of hematochezia capacity were 2 types:10～50ml and 50～00ml (33.3%,33.3%), while the common one was highly concentrated in less than 10ml (91.4%); hematochezia description was given priority to blood squirting(53.7% VS7.4%), including this way still existing 25.9%. And exacerbation was also significantly existing in anemia group(P=0.000), during this time, the main sequence of defecation & hematochezia was hematochezia(73.9% VS 15.0%); concentration of the hematochezia time was from 1 to 10mins (69.5%), and ratio of above 10mins was also not so low(26.1%), while the other was all in under 5mins; concentrations of hematochezia capacity were 2types:50-100ml and above 100ml(39.1%,34.8%), while the common one was concentrated in less than 10ml and 10-50ml (45%,50%); hematochezia description was given priority to blood squirting(52.2% VS35.0%), and blood squirting with mixed blood clots also not few (30.4%)(3) Physical examinations (lithotomy position):The differences, of hyperemia, erosion, bleeding of haemorrhoids mucosa and haemorrhoids prolapse between the 2 groups, were existing statistical significance(P<0.05). Anemia group in hemorrhoids mucosa were mostly in 3,5,7,11 point congestion at the same time distribution, but the constituent ratio lower than normal group(75.93% VS 82.10%), the highest percentage of hyperemia was 3 point in primary hemorrhoid area. Anemia patients mostly had hemorrhoid mucosal erosions(75.93% VS 20.99%), mainly distributed in 7,11 points erosions at the same time and only 7 point erosion. Anemia group bleeding ratio is high (33.33% VS 3.7%), although the two groups in bleeding hemorrhoids mucosa are infrequent, and mainly distributed in 7 and 3 points, About 83.3% of the presence of haemorrhoids prolapse in patients with anemia,when received medical examinations. The number of hemorrhoids and presence of incarcerated hemorrhoid between the two groups had no differences in statistical significance.(4) Laboratory examinations:76.8% patients in anemia group were in the range of microcytic hypochromic anemia according to the red blood cell morphological classification, and 92.3% patients who tested Anemia three belonged to iron deficiency anemia, only one of them lacked of folic acid. There was no statistically significant differences between coagulation abnormality in both groups(P=0.3173).(5) The diagnosis, TCM syndrome types and periodization:Both groups were mixed hemorrhoid in diagnosis and staging in the vast majority of III period, there was no statistically significant difference; But on the TCM syndrome types, the difference was highly statistical significance(P=0.000), everyone in common group was the Dampness-heat diffusing downward Syndrome, and 81.5% of patients in anemia group were Qi Collapse and Spleen Deficiency Syndrome.ConclusionThe patients diagnosed as anemic haemorrhoids are not so rare in clinic work as reported abroad. The risk factors of this special haemorrhoid are not The history of alcohol & tobacco, common internal medicine diseases including hypertension and type 2 diabetes, and coagulation abnormality, those patients in symptoms generally have these features:much more bleeding time, more severe bleeding volume, and the main description of hemorrhoidal bleeding is to blood squirting, there is also an obvious exacerbation; In the physical examinations, these situation are more likely to take place:the erosion and bleeding of haemorrhoids mucosa in primary hemorrhoid area and the presence of haemorrhoids obvious prolapse. Most of the anemia classification belongs to microcytic hypochromic anemia, and iron deficiency anemia is most common. Qi Collapse and Spleen Deficiency is the major TCM syndrome type. The patients with such characteristics of hemorrhoid hemorrhage symptoms in clinical practice should be paid intense attention, timely diagnosis and treatments can effectively avoid missed diagnosis and misdiagnosis which lead to serious consequences. |
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