Wo ba a ɔhyɛ yafunu mu no mogya ne wo de nhyia? (Erythroblastosis Fetalis) Momma yɛnhwehwɛ nea eyi yɛ ankasa!

Sɛ woyɛ ɛna a wobɛyɛ ɛna a, ebia wosuro kakra bere a wotee nsɛmfua ‘Erythroblastosis Fetalis’ no. Anaasɛ ebia wo duruyɛfo kaa ho asɛm bere tiaa bi a atwam ni bere a na ɔreka wo mogya su ho asɛm no. Ebetumi ayɛ hu kakra sɛ wobɛte saa din yi. Nanso mma ɛnhaw wo, ɛnnɛ yɛbɛka ho asɛm wɔ ɔkwan a ɛnyɛ den so a wobɛtumi ate aseɛ. Ma yɛnhwɛ nea ɛyɛ, nea enti a ɛba, ne sɛnea yebetumi abɔ yɛn ho ban afi tebea yi ho.

Dɛn ne ‘Erythroblastosis Fetalis’?

Sɛ yɛbɛka no tiawa a, eyi yɛ ɔhaw a ɛntaa nsi, a ɛkyerɛ sɛ ɛnyɛ obiara na onya bi, a ebetumi aba bere a wɔyem. Sɛ mogya bi nhyia wɔ wo ne wo ba a ɔhyɛ yafunu mu no ntam a, eyi ba. Ɛnyɛ mogya mu nsonsonoe nyinaa na ɛde ɔhaw ba. Nanso, asiane yi yɛ kɛse titiriw sɛ wo mogya yɛ `Rh-negative` na wo ba no mogya yɛ `Rh-positive` a.

Fa no sɛ, sɛ wohyiaa mogya a Rh wom yi, wɔ nyinsɛn bi a atwam mu anaasɛ bere a wɔde mogya rema wo no a, wo nipadua mu tumi a ɛko tia nyarewa (nhyehyɛe a ɛbɔ yɛn ho ban fi nyarewa ho) betumi afi ase akɔtow ahyɛ akokoaa no mogya mu nkwammoaa kɔkɔɔ no so. Te sɛ nea ɔreto ahyɛ ɔtamfo bi so. Eyi betumi ama akokoaa no mogya mu nkwammoaa kɔkɔɔ no akɔ fam wɔ ɔkwan a ɛyɛ hu so. Yɛfrɛ eyi mogya a ɛtɔ kɔ nipadua mu. Sɛ mogya a ɛtɔ kɔ nipadua mu yi mu yɛ den a, sɛ wɔansa akokoaa no nkwa a, ebetumi de ne nkwa ato asiane mu.

Nanso asɛmpa bi wɔ hɔ! Nna yi, nhwehwɛmu a wɔyɛ daa wɔ nyinsɛn no mfiase betumi ahu wo mogya mu. Sɛ wowɔ Rh-negative a, nnuruyɛfo betumi akyerɛw nnuru ama wo de asiw ɔhaw yi ano.

Wɔsan frɛ saa tebea yi `(alloimmune hemolytic disease of the newborn - HDN)` ne `(hemolytic yare a ɛwɔ akokoaa ne abofra a wɔawo no foforo mu - HFDN)`. Nanso sɛ yɛka ho asɛm a, yɛde asɛmfua `(Erythroblastosis Fetalis)` bedi dwuma.

Sɛ akokoaa no wɔ saa tebea yi a, dɛn ne sɛnkyerɛnne ahorow no?

Nkokoaa a wɔwo wɔn a wɔwɔ saa tebea yi (Erythroblastosis Fetalis) no betumi ada mogya a ɛtɔ kɔ wɔn mu ho sɛnkyerɛnne adi. Ebia nkokoaa binom benya bi brɛoo, bere a afoforo nso betumi anya bi a emu yɛ den. Afei nso, akokoaa no betumi anya jaundice wɔ nnɔnhwerew 24 akyi wɔ awo akyi. Nsɛnkyerɛnne no bi ni:

• Aniwa ne honam ani a ɛyɛ kɔkɔɔ.
• Wora a ɛyɛ fitaa mpofirim .
• Akokoaa no te nka sɛ wayɛ mmerɛw kɛse na onni nkwa (ɔbrɛ).
• Koma no bɔ ntɛmntɛm (tachycardia).
• Nufusu ho akɔnnɔ a wonni.

Wɔ tebea horow bi a emu yɛ den mu no, akokoaa anaa abofra a wɔawo no foforo betumi anya tebea bi a ɛde ne nkwa to asiane mu a wɔfrɛ no ``hydrops fetalis.'' Ne sɛnkyerɛnne ahorow no bi ne:

• Nipadua a ɛho ahonhon.
• Nsu a ɛboaboa ano wɔ akokoaa no yafunu mu, anaa akwaa a ɛho hia te sɛ koma ne ahurututu ntam.

Dɛn nti na eyi rekɔ so? Dɛn ne nea enti a ɛte saa?

Saa tebea yi a wɔfrɛ no ``Erythroblastosis Fetalis'' no ba efisɛ, sɛnea yɛadi kan aka no, wo nipadua mu ahoɔden a ɛko tia nyarewa no tow hyɛ akokoaa no mogya mu nkwammoaa kɔkɔɔ so.

Yɛn mogya mu nkwammoaa kɔkɔɔ no wɔ agyiraehyɛde soronko bi wɔ so. Yɛfrɛ wɔn ``antigens.'' Susuw saa ``antigens'' yi ho sɛ nkyerɛwde a wɔakyerɛw din wɔ so. Sɛ wo nipadua mu tumi a ɛko tia nyarewa no hu saa nkyerɛwde yi a, ɛrentow nhyɛ saa mogya mu nkwammoaa kɔkɔɔ no so.

Eyi te saa esiane nsonsonoe a ɛwɔ wo ne wo ba no mogya mu nti. Wɔkyekyɛ mogya ahorow mu gyina ``antigens`` a ɛwɔ mogya mu nkwammoaa kɔkɔɔ no ani so. Mogya ahorow atitiriw abien na yɛreka ho asɛm:

• Rh factor: Eyi kyerɛ sɛ mogya no yɛ papa (+) anaasɛ bɔne (-).
• ABO antigens: Eyi kyerɛ mogya mu su A, B, AB, anaa O.

Sɛ wonyinsɛn a, wo nipadua mu ahoɔden a ɛko tia nyarewa no, sɛ enhu ``antigens`` a ɛwɔ wo ba mogya mu nkwammoaa kɔkɔɔ no so a, befi ase ayɛ ``antigens`` atia wɔn. Saa ``antibodies`` yi na ɛtow hyɛ saa mogya mu nkwammoaa kɔkɔɔ no so. Te sɛ bere a yɛn nipadua nya ɔyare mmoawa bi a ɛde yare ba no, yɛn nipadua no ko tia. Nanso sɛ eyi bɛba a, ɛsɛ sɛ akokoaa no mogya ne wo mogya di nkitaho. Mpɛn pii no, eyi ba bere a wɔrebɛwo akokoaa no. Nanso, ɛtɔ mmere bi a mogya no tumi frafra mu ansa. Nhwɛsoɔ:

• Sɛ nyinsɛn a wotu gu a.
• Sɛ nyinsɛn no yera fã a, wɔfrɛ no ``Miscarriage``.
• Wɔ tebea te sɛ nyinsɛn a ɛwɔ awotwaa no akyi (nyinsɛn no wɔ awotwaa no akyi, te sɛ nea ɛwɔ awotwaa mu).
• Sɛ wɔreyɛ ``(Amniocentesis)`` (sɔhwɛ a wɔyɛ wɔ nyinsɛn mu).
• Sɛ woreyɛ `(Chorionic villus sampling)` (nyinsɛn mu nhwehwɛmu foforo).

Sɛ wo nipadua no yɛ saa `(antibodies)` yi wie a, ɛkae. Sɛ akokoaa no mogya mu nkwammoaa kɔkɔɔ no nya saa `(antigen)` no bio wɔ nyinsɛn a edi hɔ no mu a, saa `(antibody)` yi bɛkɔ akɔsɛe saa nkwammoaa no. Yɛfrɛ mogya mu nkwammoaa kɔkɔɔ a wɔsɛe no yi `(hemolysis)`.

Ade titiriw a ɛde ba: Rh a ɛne ne ho nhyia

Nea ɛde tebea yi ba a emu yɛ den na wonim no yiye ne bere a wowɔ Rh-negative na wo ba no wɔ Rh-positive. Sɛ eyi ba a, wo nipadua mu tumi a ɛko tia nyarewa no tow hyɛ wo ba no mogya mu nkwammoaa kɔkɔɔ a ɛwɔ Rh no so. Wɔ ɔman te sɛ Amerika mu no, nnipa bɛyɛ 15% na wɔwɔ mogya a Rh-negative. Mpɛn pii no, ɛna no ne agya no nyinaa, ne akokoaa no nyinaa wɔ Rh.

Mpɛn pii no, saa Rh a ɛne ne ho nhyia yi mfa ɔhaw kɛse biara mma wɔ nyinsɛn a edi kan no mu. Sɛ mpo woyɛ Rh-negative na akokoaa no wɔ Rh-positive a, ɛntaa mma sɛ wo mogya bɛfra akokoaa no mogya mu bere a wonyinsɛn no ma ɛde adeyɛ a emu yɛ den aba (antibodies). Nanso, sɛ wɔwo akokoaa no pɛ a, akyinnye biara nni ho sɛ wo mogya ne akokoaa no mogya bɛyɛ adwuma. Saa bere no, sɛ woannom nnuru a ɛbɛma wo nipadua no mu tumi a ɛko tia nyarewa no antow ahyɛ so a, ebia wo nipadua no benya nnuru a ɛko tia mogya mu nkwammoaa kɔkɔɔ a ɛwɔ Rh no.

Afei sɛ wunyinsɛn bio, na saa akokoaa no nso wɔ mogya a ɛwɔ Rh a, saa nnuru a ɛko tia nyarewa a wɔadi kan ayɛ no bɛkɔ akɔtow ahyɛ saa akokoaa no mogya mu nkwammoaa kɔkɔɔ no so. So wote ase?

Mogya mu nneɛma afoforo a ɛntaa nsi

Ɛtɔ mmere bi a, wo nipadua mu tumi a ɛko tia nyarewa no tumi tow hyɛ wo ba no mogya mu nkwammoaa kɔkɔɔ no so ɛmfa ho sɛ ɛne mogya mu nkwammoaa kɔkɔɔ antigen a wɔntaa nhyia no nhyia de. Sɛ wo ba no wɔ saa antigen a ɛntaa nsi no na wohwere no a, eyi ba. Eyi ba sɛ woanya saa antigen no denam nyinsɛn anaa mogya a wode ma wo kan no so na woanya nnuru a ɛko tia nyarewa no a. Saa antigen ahorow yi bi ne:

• `(Colton)`
• `(Duffy)`
• `(Diego)`
• `(Ee)`
• `(Gerbich)`
• `(H)`
• `(Kell)`
• `(Abofra)`
• `(Lutheran)`
• `(MNS)`
• `(P)`
• `(Xg)`

Mogya mu nhwehwɛmu a wɔyɛ wɔ nyinsɛn no mfiase no betumi ahu sɛ ebia woreyɛ nnuru a ɛko tia mogya mu nkwammoaa kɔkɔɔ ahorow a wɔntaa nhu yi anaa.

Saa tebea yi abu so dɛn?

Wɔ wiase nyinaa no, wɔbɔ amanneɛ sɛ mmofra a wɔawo wɔn a wɔte ase 100,000 biara mu bɛyɛ 276 wɔ nyinsɛn mu nsɛnnennen a ɛfa Rh mogya a ɛne ne ho nhyia ho. Sɛnea nhwehwɛmufo kyerɛ no, sɛ wɔansa no yare a, ɛyɛ 50% sɛ akokoaa a ɔhyɛ yafunu mu no bewu anaasɛ obenya akwahosan ho haw a emu yɛ den.

Nanso mma ɛnhaw wo! Sɛ wɔyɛ mogya mu nhwehwɛmu na wɔnom nnuru a ɛho hia a, wobetumi asiw nea enye koraa a ebefi mu aba no ano. Wɔ wiase mmeae bi a wobetumi ahwɛ wɔn ansa na wɔawo no, awo 100,000 biara mu bɛyɛ 2.5 pɛ na wɔwɔ ɔhaw ahorow esiane Rh a ɛne ne ho nhyia nti. Eyi yɛ ade titiriw a ɛhaw adwene wɔ Sri Lanka nso.

Wobɛyɛ dɛn ahu eyi?

Mpɛn pii no, wɔ ayaresabea ahorow a wɔhwɛ awo ansa na wɔawo no, wɔhwɛ wo mogya ne ``antibody'' biara. Sɛ wonyinsɛn na wowɔ mogya a Rh-negative a, wo duruyɛfoɔ bɛhwɛ sɛ ``antibodies'' a ɛko tia mogya a Rh-positive. Sɛ wo nni saa ``antibody'' no a, wɔbɛma wo nipadua mu ahoɔden a ɛko tia nyarewa no aduru bi a ɛbɛma wɔagyae.

Sɛ nhwehwɛmu no si so dua sɛ wowɔ saa nnuru a ɛko tia nyarewa yi a, ɛkyerɛ sɛ sɛ akokoaa no wɔ Rh a, wo nipadua mu tumi a ɛko tia nyarewa no wɔ asiane mu sɛ ɛbɛtow ahyɛ akokoaa no mogya mu nkwammoaa kɔkɔɔ no so. Afei wo duruyɛfo bɛhwɛ sɛnea wo nipadua mu nkwammoaa a ɛko tia nyarewa no te adapɛn kakraa biara. Sɛ wo nipadua mu nkwammoaa a ɛko tia nyarewa no dɔɔso wɔ ɔkwan a ɛyɛ hu so a, wobetumi ayɛ nhwehwɛmu foforo ahwɛ sɛ mogya atɔ wo ba no anaa, na ebia ebehia sɛ wɔma wo mogya wɔ awotwaa no mu. Sɛ wo ba no wɔ asiane mu sɛ wɔbɛwo no a mogya atɔ no kɛse a, ebia wo duruyɛfo besi gyinae sɛ ɔbɛwo akokoaa no ntɛm.

Sɛ wɔwo akokoaa no wie a, oduruyɛfo no betumi ahu akokoaa no mogya. Eyi betumi aboa ma wɔahu sɛ ebia akokoaa no mogya a ɛtɔ kɔ nipadua no mu no fi mogya bi a ɛne ne ho nhyia anaa.

Sɔhwɛ afoforo a wɔyɛ ne:

• Mogya Dodow a Edi Mu (CBC): Saa nhwehwɛmu yi betumi ahwɛ sɛnea akokoaa no mogya mu nkwammoaa kɔkɔɔ no sua. Dodow a dodow no sua no, dodow no ara na mogya a ɛtɔ kɔ nipadua no mu no mu yɛ den.
• Peripheral Blood Smear (PBS): Nea ɛka eyi ho ne sɛ wɔde afiri a wɔde hwɛ nneɛma nketenkete bɛhwehwɛ mogya bi mu. Eyi betumi ama wɔanya adwene sɛ ebia mogya mu nkwammoaa kɔkɔɔ a wɔsɛe no ntɛm (hemolysis) na ɛso tew no.
• Bilirubin nhwehwɛmu:Eyi kyerɛ bilirubin dodow. Bilirubin yɛ ade a efi mogya mu nkwammoaa kɔkɔɔ a ɛpaapae mu ba. Ebia bilirubin dodow a ɛkɔ soro (hyperbilirubinemia) bɛkyerɛ sɛ mogya mu nkwammoaa kɔkɔɔ resɛe.
• Direct Antiglobulin Test (DAT): Saa sɔhwɛ yi kyerɛ sɛ ebia nnuru a ɛko tia nyarewa wɔ akokoaa no mogya mu nkwammoaa kɔkɔɔ no ani anaa. Eyi kyerɛ sɛ ɛna no nipadua mu ahoɔden a ɛko tia nyarewa no reto ahyɛ akokoaa no nkwammoaa so.

Dɛn ne ayaresa ahorow no?

Ayaresa no gyina sɛ ebia woanyinsɛn anaasɛ woawo akokoaa nkyɛe so.

Ayaresa a wɔde ma bere a wɔyem

Sɛ wowɔ nnuru a ɛko tia nyarewa a ɛde wo to asiane mu ma Erythroblastosis Fetalis a, wo duruyɛfo bɛhwɛ wo nipadua mu nkwammoaa a ɛko tia nyarewa no dodow adapɛn kakraa biara. Sɛ wo nipadua mu nkwammoaa a ɛko tia nyarewa no dɔɔso a, ebia ebehia sɛ woyɛ ultrasound scan foforo na ama woahu sɛ mogya atɔ wo ba no anaa. Sɛ mogya a ɛtɔ kɔ nipadua no mu no mu yɛ den a, ebia ebehia sɛ wɔma wo ba no mogya.

Ayaresa a wɔde ma bere a wɔawo akokoaa no akyi

Nnuruyɛfo sa mmofra a wɔawo wɔn foforo a wɔwɔ ``Erythroblastosis Fetalis'' denam mogya a ɛtɔ kɔ nipadua mu ne ``hyperbilirubinemia'' (jaundice) a wɔsa so. Ayaresa a wobetumi apaw ne:

• Phototherapy: Eyi de hann di dwuma de sa hyperbilirubinemia. Saa hann yi dan bilirubin ma ɛbɛyɛ nneɛma a ɛnyɛ den sɛ wobeyi afi akokoaa no nipadua mu.
• Mogya a wɔde ma: Sɛ wɔwo akokoaa no wie a, ebia ebehia sɛ wɔma akokoaa no mogya na ama wahwɛ ahu sɛ ɔwɔ mogya mu nkwammoaa kɔkɔɔ a ɛdɔɔso.
• Erythropoiesis Stimulating Agents (ESA): Eyinom betumi ayɛ ɔkwan a wɔbɛfa so asa mogya a ɛtɔ kɔ nipadua mu a ɛnyɛ den sɛnea ɛbɛyɛ a ebehia sɛ wɔde mogya ma no. Ebia ɛho behia sɛ wɔde ka dade a wɔde ma ho na aboa akokoaa no ma wanya mogya mu nkwammoaa kɔkɔɔ a ɛte apɔw.

Wɔ tebea horow a emu yɛ den mu no, ebia obehia ɔhwɛ a ɛboa akokoaa no, te sɛ mframa a wɔde ma ne nsu a wɔde fa IV mu.

Dɛn na ɛto akokoaa no wɔ tebea yi akyi?

Nea ebefi mu aba no gyina sɛnea wo ba no yare no ho sɛnkyerɛnne no mu yɛ den no so. Sɛ wɔansa mogya a ɛtɔ kɔ nipadua mu a emu yɛ den ne bilirubinemia a ɛboro so a, ebetumi akum obi.

Nanso, nkokoaa a wɔwɔ Erythroblastosis Fetalis no betumi atra ase wɔ tebea no mu sɛ wɔsa wɔn yare yiye a. Ebia ebehia sɛ wɔma wɔn mogya na ama wɔn mogya mu nkwammoaa kɔkɔɔ no ayɛ ma wɔ nyinsɛn mu ne/anaasɛ awo akyi. Ɛho behia sɛ oduruyɛfo no hwɛ wɔn so asram pii na ama wɔahwɛ ahu sɛ ɔhaw biara nni ho.

So wontumi nsiw eyi ano?

Akyinnye biara nni ho sɛ ebetumi aba! Erythroblastosis Fetalis yɛ nea wotumi siw ano kɛse denam mogya mu nhwehwɛmu ne nnuru a wɔde siw ano bere a wɔyem no so.Tebea. Sɛ woyɛ Rh-negative a, wobɛtumi anom Rh immune globulin (Rh immune globulin - RhIg anaa RhoGAM®) na amma wo nipadua no annyɛ antibodies atia Rh-positive mogya. Ɛsɛ sɛ wonom saa aduru yi wɔ nyinsɛn no adapɛn 28 mu, wɔ nnɔnhwerew 72 akyi wɔ nyinsɛn no awiei (awo akyi, nyinsɛn no atu), ne sɛ mogya tu wo kɛse wɔ nyinsɛn no mu (wɔ bosome abiɛsa a edi kan mpo mu).

Sɛ wonom saa aduru yi ansa na wo mogya akɔ mogya a Rh wom mu nkutoo a, eyi yɛ adwuma. Ɛno nti na wɔhwɛ no titiriw wɔ nyinsɛn ayaresabea ahorow mu no.

Nneɛma a ɛsɛ sɛ wubisa wo duruyɛfo

Sɛ wowɔ nsɛmmisa foforo bi fa eyi ho a, nsuro sɛ wubebisa wo duruyɛfo anaa ɔyarehwɛfo. Nhwɛso ahorow bi ni:

• Me mogya yɛ dɛn?
• So ``antibody'' bi wɔ hɔ a ɛsɛ sɛ mehaw me ho?
• So ɛsɛ sɛ mehaw me ho wɔ `(Erythroblastosis Fetalis)` ho?
• So ɛho behia sɛ wɔhwɛ me so bio anaasɛ mɛtaa akɔ ayaresabea?
• So ɛho behia sɛ menom Rh immune globulin (RhIg)?
• Bere bɛn na ɛsɛ sɛ meyɛ nhyehyɛe anaasɛ mehwehwɛ ɔhwɛ a egye ntɛmpɛ?

Sɛ ɛna no wɔ Rh-positive na akokoaa no wɔ Rh-negative a, dɛn na ɛba?

Mpɛn pii no, eyi nyɛ mogya a ɛne ne ho nhyia a ɛsɛ sɛ ɛhaw yɛn ho. Akokoaa a onni Rh nni Rh-antigen a ɛna no nipadua mu ahoɔden a ɛko tia nyarewa no tumi tow hyɛ so no. Gye sɛ mogya mu nneɛma afoforo a wɔntaa nhyia wɔ hɔ a, ɛnsɛ sɛ eyi yɛ ɔhaw.

Nneɛma a ɛho hia sen biara a ɛsɛ sɛ yɛma ɛtra yɛn adwenem

Adwene a ɛne sɛ w’ankasa nipadua mu ahoɔden a ɛko tia nyarewa betumi atow ahyɛ wo ba a ɔhyɛ yafunu mu no so no yɛ hu. Nanso asɛmpa no ne sɛ mogya a ɛnhyia a asiane wom yi ntaa mma. Na, nnuruyɛfo yɛ nea wobetumi biara de siw ɔhaw ahorow yi ano. Mogya mu nhwehwɛmu yɛ ɔhwɛ ansa na wɔawo no fã a ɛyɛ ahyɛde. Afei nso, mogya mu nneɛma a ɛne ne ho nhyia a ebetumi de asiane aba wo ba no so a wobɛhwɛ na wɔasa no yɛ ɔhwɛ ansa na wɔawo no fã a wɔahyɛ da ayɛ. Wo duruyɛfo bɛka wo ho wɔ anammɔn biara a wobɛtu na ama wo ne wo ba no akɔ so ayɛ dwoodwoo. Enti, mma wo ho mmɔ hu a ɛho nhia, na di oduruyɛfo no akwankyerɛ akyi yiye. Afei wo ne wo ba no nyinaa betumi anya apɔwmuden!

` Erythroblastosis Fetalis, Rh a ɛnhyia, nyinsɛn mu nsɛnnennen, akokoaa mogya, ɛna mogya, mogya a ɛtɔ kɔ nipadua mu, jaundice, RhoGAM