Mhedziso yechinokonzera, kudzivirira, uye kurapwa kwechirwere ichi
Hemolytic Disease yeChechecheche (HDN) ndiyo mamiriro ekutsvaira kwemasero eropa pakati peamai nemwana wavo. Izvi zvinoitika apo ropa reamai vari R Rh negative uye mwana ndiye Rh positive. Munguva yehutumbi amai vanoita zvirwere zvinorwisa uye zvinoparadza masero matsvuku eropa, zvichiita kuti anemia mu fetus. Mamiriro akafanana anowanikwa nemaplatelets anonzi neonatal alloimmune thrombocytopenia .
Nei Hemolytic Disease Ichiitika?
Masero edu matsvuku eropa akaputirwa nemaantijeni, zvinhu zvinokonzera mhinduro dzomuviri. Mamwe aya antigens anotipa ropa redu (A, B, O, AB) uye vamwe vedu Rh boka (positive, negative). Rhi boka rinonziwo D antigen. Vakadzi vane Rh nhengo havana d antigen pamasero avo matsvuku. Kana mwana wavo asati aberekwa ari Rh-positive (nhaka kubva kuna baba), iye ane D antigen aripo. Apo maamai masimba emuviri anowanikwa mumasero eropa e fetus (anogona kuitika panguva yekubereka, kubuda ropa panguva yekuzvitakura, kupererwa kwepakutanga), chirwere chekuzvidzivirira pamuviri chinoziva kuti D antigen se "kune dzimwe nyika" uye inovandudza zvirwere zvinopesana navo.
Mimba yekutanga neR Rh-positive mwana haibatanidzwi sezvo ma antibodies akaumbwa pakutanga haagoni kuyambuka placenta. Zvisinei, munguva dzekuita pamuviri, kana maamai masimba ezvirwere zvemumunze achibatana neD antigen pamasero eropa, utachiona hunokurumidza kurwisa zvirwere zveAn anti-D zvinogona kuyambuka placenta.
Izvi zvinopesana nemasero eropa, zvichivaita kuti zviparadzwe, zvichikonzera kupererwa kwemvura. Chimwe chiitiko chinogona kuitika kana pane zvisina kufanira muropa rekuti ABO kusagadzikana.
Mucheche Mwana Anobata Sei
Sezvakakurukurwa pamusoro apa, pamuviri wekutanga neR Rh-positive mwana, hapana matambudziko.
Kana izvi zvisingazivikanwi hazvizivikanwi mukudzivirira kwekutanga (kunowanzoitika dzimwe nguva kana kutanga kuberekwa kunobatsira pakuparara kwepamuviri) kana kana zviito zvakadzivirira zvekudzivirira (izvo zvichataurwa gare gare) hazvina kutorwa, kutora pamuviri munguva yemberi kunogona kukanganiswa. Mushure mokutanga kutakurwa kwepamuviri, kuoma kwehemolytic chirwere chechechecheche kunotambudza nemubereki mumwe nomumwe.
Zviratidzo zvinoratidzirwa nekuoma kweiyo tsvuku yeropa kuputsika (inonzi hemolysis). Kana zvinyoro zvichitambudza, pangava nematambudziko mashoma akadai seanemia ane simba uye / kana jaundice isingadi kurapwa. Kana huwandu hwe hemolysis hwakanyanya, iye / iye achava nejerice yakakura (yakakwirira bilirubin) nguva pfupi mushure mekuberekwa.
Zvinosuruvarisa, hemolysis hairegi kana mwana aberekwa semadzimai emadzimai aripo kwemavhiki mashoma. Izvo zviyero zvakanyanya zvebilirubin zvinogona kukanganisa uropi. Mune zvimwe zviitiko, chirwere chekushaya ropa chinonyanyisa mutero (tisati taberekwa) kuti chiropa uye spleen zvinowedzera kuwedzerwa tsvuku dzeropa rekushandisa rinotungamirira kuchiropa kusakundikana. Hemolytic chirwere chinogonawo kutungamirira kuma hydrops fetisti nema generalized edema (kupfugama), mvura inopoteredza nhengo, uye kunyange rufu.
Hemolytic Disease Inodziviswa sei
Ehe. Mazuva ano vakadzi vose vanotora rubatsiro rwekusununguka vane basa reropa rakaswededzwa kuti vasarudze ropa rake nerudzi.
Kana iye ari Rh-negative, basa reropa rinotumirwa kuti aone kana iye atove ane anti-D maviri. Kana iye asina kutora zvirwere, anogamuchira mushonga unonzi RhoGAM. RhoGAM kana anti-D Ig inopihwa yakapiwa pamasvondo makumi maviri nemana, zvikamu zvekubuda ropa (kusanganisira kuora mwoyo mushure memasvondo gumi nemasere) uye panguva yekuberekwa. IRoGAM yakafanana nea antibody iyo amai vaizoita kune D-antigen. Chinangwa ndechokuti RhoGAM iparadze chero masero matsvuku eropa mumusasa wemama asati aita zvirwere.
Kana anti-D antibodies inowanikwa, RhoGAM haingabatsiri asi kuwedzera kuongororwa kwe fetus kuchaitwa sezvinotsanangurwa pasi apa.
Hemolytic Matambudziko Anoitwa Sei?
Kana amai vakatsunga kuva nevarwere-anti-D uye baba ndivo Rh-positive, pane mukana wehemolytic zvirwere zvechechecheche. Mumamiriro ezvinhu aya, kuedzwa kunoitwa pamusana wemamniotic fluid kana ropa kubva mundilical cord kuti uone rudzi rweropa uye boka recheche. Kana mwana akawanikwa ari Rh-negative, hapanazve kurapwa kunodiwa.
Zvisinei, kana mwana ari Rh-positive, pamuviri uchatariswa zvikuru. Ultrasounds ichashandiswa kuongororwa ne fetal anemia uye kugona kudikanwa kweropa re intrauterine (kuwedzerwa kupiwa kumucheche achiri muchibereko). Ropa raamai richaongororwa mushure mekuita pamuviri kuti vaone kuti yakawanda sei inoratidzira. Kana mwana akawanikwa aine hotera, kuwedzerwa ropa kunogona kupiwa panguva yekuzvitakura kunodzivirira matambudziko (intrauterine transfusions). Kana mwana akawanikwa ari ane chirwere uye ane nguva yakazara, nguva yekutanga inogona kukurudzirwa.
Mushure mokunge mwana aberekwa, basa reropa rinotumirwa kuti riongorore reanemia uye bilirubin mazinga. Kuparara kwemasero matsvuku eropa hakuregi pakarepo mwana paanoberekwa saka bilirubin inogona kukwira kumatambudziko ane ngozi mumazuva maviri ekutanga. Iyo yakakwirira yebilirubin mazinga (jaundice) inobatwa nephototherapy apo mwana akaiswa pasi pezviedza zvebhuruu. Mwenje inovhuna bilirubin ichibvumira muviri kuti uibvise. Kufurirwa kunoshandiswawo kurapa chirwere chekushaya ropa. Kana chirwere chinopera simba uye jaundice chakanyanya, mwana anorapwa nekuwedzerwa ropa. Mune rudzi urwu rwekuwedzerwa, ropa shoma rinodzingwa kubva kumwana uye rinotsiviwa neropa reropa.
Kana uchinge wabviswa kuchipatara, zvinokosha kuti uve nehutano hwepedyo nechiremba wevana kana hematologist kuti uone kuti ane chirwere chekushaya ropa. Madzimai matsvuku emasero emasero emuviri anogona kukonzera kuparadzwa kwemavhiki mana kusvika kwemaviri mushure mokuberekwa uye kuwedzera kuwedzerwa kunogona kudiwa.
Sources:
Nandyal RR. Hemolytic Disease yeMucheche. Nyaya yeHematology uye Thromboembolic Disease. 2015.