So wo mogya mu nkwammoaa resɛe ntɛmntɛm? Momma yɛnka hemolysis ho asɛm!

Ɛtɔ mmere bi a, wote nka sɛ woabrɛ na wo ho ayɛ wo yaw kɛkɛ? Anaasɛ ɛtɔ da bi a wote nka sɛ wo honam ani yɛ kɔkɔɔ kakra, na w’ani fitaa nso yɛ kɔkɔɔ? Eyi betumi ayɛ biribi a ɛfa wo mogya mu nkwammoaa kɔkɔɔ, nkwammoaa ahorow a ɛho hia sen biara wɔ wo mogya mu no mu biako ho. Ɛnnɛ yɛbɛka tebea bi a wɔfrɛ no hemolysis , a ɛyɛ bere a mogya mu nkwammoaa kɔkɔɔ no sɛe na ɛsɛe ntɛm ho asɛm. Mma ɛnhaw wo, ɛho hia sɛ wuhu eyi.

Dɛn ankasa ne hemolysis?

Sɛ yɛbɛka no tiawa a, mogya mu nkwammoaa kɔkɔɔ a ɛsɛe yɛn nipadua mu . Wunim, mogya mu nkwammoaa kɔkɔɔ yi te sɛ adwumayɛfo nketewa a wɔwɔ yɛn mogya mu. Wɔn na wogye mframa pa fi ahurututu mu bere a yɛhome no na wɔde kɔ nipadua no mu nkwammoaa ne ntini foforo biara mu. Ɛte sɛ nea wode gas cylinder reba fie. Enti, yɛn nipadua no de oxygen yi yɛ ahoɔden a ehia. Afei nso, mogya mu nkwammoaa kɔkɔɔ koro yi ara boa ma carbon dioxide a yɛmpɛ a ɛboaboa ano wɔ yɛn nipadua mu no san kɔ ahurututu mu na wɔhome.

Mpɛn pii no, yɛn nipadua kɔ so sɛe mogya mu nkwammoaa kɔkɔɔ dedaw anaa nea ɛyɛ mmerɛw na ɛde mogya mu nkwammoaa kɔkɔɔ foforo a ɛte apɔw si ananmu. Eyi te sɛ nea yɛayi dedaw afi hɔ na yɛayi foforo afi hɔ. Saa ɔsɛe ne nneɛma a wɔyɛ no kyinhyia yi nti na yɛwɔ mogya mu nkwammoaa kɔkɔɔ dodow a ɛfata wɔ yɛn nipadua mu bere nyinaa no.

Nanso, ɛtɔ mmere bi a mogya mu nkwammoaa kɔkɔɔ yi fi ase sɛe ntɛm, kyerɛ sɛ, ɛyɛ ntɛm dodo . Eyi betumi asi ansa na yɛn nipadua no anya bere ayɛ nkwammoaa foforo de ahyɛ ɔkwan a ɛda hɔ no mu ma. Wɔfrɛ mogya mu nkwammoaa kɔkɔɔ a wɔsɛe no ntɛmntɛm yi sɛ hemolysis. Sɛ mogya mu nkwammoaa kɔkɔɔ dodow a ɛwɔ nipadua no mu so tew kɛse esiane mogya a ɛtwetwe yi nti a, yɛfrɛ saa tebea no hemolytic anemia , anaa mogya a ɛtɔ kɔ nipadua no mu.

Dɛn nti na wɔsɛe mogya mu nkwammoaa kɔkɔɔ wɔ saa kwan yi so?

Mpɛn pii no mogya mu nkwammoaa kɔkɔɔ bi tra ase bɛyɛ nnafua 120. Wɔ saa bere yi awiei, sɛ saa nkwammoaa no nyin a, ɛma nsɛnkyerɛnne soronko bi ma. Saa nsɛnkyerɛnne yi ma akisikuru (a ɛwɔ yafunu no benkum so) a ɛwɔ yɛn nipadua mu no sɛe nkwammoaa dedaw yi wɔ nhyehyɛe kwan so. Sɛnea yeyi nneɛma dedaw a abubu fi yɛn fie hɔ no ara pɛ.

Wɔyɛ mogya mu nkwammoaa kɔkɔɔ foforo wɔ yɛn nnompe fã bi a ɛte sɛ sponge a wɔfrɛ no nnompe mu ntini mu . Afei mogya mu nkwammoaa kɔkɔɔ foforo a wɔayɛ wɔ nnompe mu ntini yi mu no fi adi kɔ mogya no mu.

Nanso, ɛtɔ mmere bi a, mogya mu nkwammoaa kɔkɔɔ bi nsɛso anaa nea ɛwom no mu sintɔ betumi ama ne nkwa nna ayɛ tiaa. Anaasɛ, nneɛma a efi akyi betumi asɛe mogya mu nkwammoaa kɔkɔɔ na awuwu ansa na nipadua no atumi ayɛ nkwammoaa foforo.

Dɛn ne mogya a wɔsɛe no titiriw?

Wobetumi akyekyɛ mogya a wɔsɛe no mu ayɛ no ahorow atitiriw abien. Saa din ahorow yi kyerɛ baabi a mogya mu nkwammoaa kɔkɔɔ no sɛe.

1. Extravascular hemolysis: Eyi ne bere a mogya mu nkwammoaa kɔkɔɔ sɛe wɔ yɛn mogya ntini ahorow akyi (i.e., ntini, ntini, ne ntini nketenkete). Mpɛn pii no, eyi si wɔ akyi berɛmo no mu . Bere a mogya fa ahurututu no mu no, mogya mu nkwammoaa fitaa soronko bi a wɔfrɛ no macrophages (eyinom te sɛ yɛn nipadua mu ahobammɔfo) hu mogya mu nkwammoaa kɔkɔɔ dedaw a asɛe na ɛsɛe no.

2. Intravascular hemolysis: Wɔ eyi mu no, mogya mu nkwammoaa kɔkɔɔ sɛe wɔ mogya ntini no mu. Sɛ wɔsɛe a, saa nkwammoaa no asinasin ne yɛn mogya tu fa nipadua no nyinaa mu.

Dɛn ne nneɛma a ɛma mogya tu?

Ɛnyɛ ade biako pɛ na ɛma mogya tu, na mmom nneɛma ahorow bi na ebetumi ama ayɛ saa. Momma yɛnhwɛ mu nkɔ akyiri kakra.

1. Mfomso ahorow a ɛwɔ mogya mu nkwammoaa kɔkɔɔ no ankasa mu

Ɛtɔ mmere bi a, sɛ biribi a ɛnteɛ anaa sintɔ bi wɔ mogya mu nkwammoaa kɔkɔɔ bi nsɛso anaa ne nhyehyɛe mu a, saa nkwammoaa no betumi asɛe ntɛm. Mpɛn pii no, nyarewa bi a wonya fi awo mu, anaasɛ wonya fi awo mu na ɛde sintɔ a ɛtete saa ba .

• Hemoglobin a entumi nnyina: Hemoglobin yɛ protein a ɛboa ma oxygen kɔ mogya mu nkwammoaa kɔkɔɔ mu. Tebea horow a ɛde saa tebea a entumi nnyina yi ba no bi ne sickle cell anemia (baabi a mogya mu nkwammoaa kɔkɔɔ no bɛyɛ sɛ sickle) ne thalassemia .
• Enzyme a enni nipadua mu: Saa tebea yi betumi aba nso bere a enzyme ahorow bi a ehia na ama mogya mu nkwammoaa kɔkɔɔ no ayɛ adwuma no nni hɔ no. Nhwɛso ahorow bi ne G6PD a enni nipadua no mu ne pyruvate kinase a enni nipadua no mu .
• Membrane defects: Tebea horow a sintɔ ahorow wɔ mogya mu nkwammoaa kɔkɔɔ a ɛkata akyi, nkwammoaa mu membrane no mu. Nhwɛso ahorow bi ne awosu mu spherocytosis ( nkwammoaa bɛyɛ kurukuruwa) ne awosu mu elliptocytosis (nkwaboaa bɛyɛ tenten).

2. Nyarewa a ɛfa nipadua no mu tumi a ɛko tia nyarewa ho

Ɛtɔ mmere bi a yɛn ankasa nipadua mu tumi a ɛko tia nyarewa (nhyehyɛe a ɛbɔ yɛn ho ban fi nyarewa ho) di mfomso fi ase tow hyɛ yɛn ankasa mogya mu nkwammoaa kɔkɔɔ so. Wɔfrɛ eyi autoimmune hemolytic anemia (AIHA) . Eyi yɛ tebea a ɛntaa nsi. Eyi ahorow nso wɔ hɔ:

• Atiridii agglutinin yare ( atiridii ho sɛnkyerɛnne no mu yɛ den bere a wɔde wɔn ho ahyɛ awɔw mu) .
• Aglutinin yare a ɛyɛ hyew

Tebea afoforo bi a ɛda adi a ebetumi de AIHA aba ne Mycoplasma pneumonia , lymphoma , mogya mu kokoram (eyinom yɛ kokoram ahorow), lupus, ne ntini mu yare (eyinom nso yɛ nyarewa a nipadua no tumi ko tia nyarewa).

Tebea afoforo a ɛnyɛ nipadua no mu tumi a ɛko tia nyarewa:

• Hemoglobinuria a ɛyɛ atiridiinini a ɛyɛ paroxysmal
• Hemoglobinuria a ɛba anadwo a ɛyɛ paroxysmal

3. Nyarewa a wɔde nyarewa ba

Nwansena, mmoawa, ne mmoawa bi a wɔhyɛn yɛn nipadua mu no tumi sɛe yɛn mogya mu nkwammoaa kɔkɔɔ no, na wɔsɛe no ansa na wɔatumi de asi ananmu. Eyi ho nhwɛso pa ne asramma . Ɔyare mmoawa a wɔde asramma ba no tow hyɛ mogya mu nkwammoaa kɔkɔɔ so tẽẽ.

Nneɛma afoforo a ɛde ɔyare mmoawa ba:

• Babesiosis a ɛma obi nya ɔyare
• Carrion yare no
• Rocky Mountain nyaa atiridiinini
• Haemophilus atiridiinini
• Nnipa a nipadua no tumi ko tia nyarewa (HIV) .

4. Nnuru bi

Nnuru bi a yɛnom nso betumi akanyan yɛn nipadua mu tumi a ɛko tia nyarewa no ma akɔtow ahyɛ mogya mu nkwammoaa kɔkɔɔ so na asɛe no ntɛmntɛm de, ɛwom sɛ ɛntaa nsi koraa de. Wɔfrɛ eyi sɛ nnuru a ɛma nipadua no tumi ko tia mogya a ɛma mogya tu (DIHA) . Eyi ho yɛ na koraa.

Nnuru bi a ebetumi ama mogya atu:

• Acetaminophen ( aduru a wɔfrɛ no paracetamol) .
• Nnuru bi a wɔde kum ɔyare mmoawa a wɔfrɛ no cephalosporin
• Clopidogrel a wɔde yɛ aduru
• Dapsone na ɔkyerɛwee
• Heparin a wɔde di dwuma
• Levodopa a wɔfrɛ no Levodopa
• Levofloxacin a wɔde di dwuma
• Methyldopa a wɔde yɛ aduru
• Nitrofurantoin a wɔde yɛ nnuru
• Pencillin a wɔde di dwuma
• Phenazopyridine a wɔde yɛ aduru
• Quinidine a wɔde ma
• Quinine a wɔde di dwuma
• Rifampin na ɔkyerɛwee
• Sulfonamide ahorow bi

Nea ɛho hia: Mma nnuru a wɔahyehyɛ yi nnyɛ wo hu. Saa nnuru yi ntaa mma mogya no ntumi nsɛe . Sɛ oduruyɛfo bi akyerɛw nnuru yi ama wo a, di wɔn akwankyerɛ akyi. Sɛ wowɔ nsɛmmisa bi a, wo ne wo duruyɛfo nkasa.

5. Nsɛnnennen a ɛba bere a wɔyem

Nsɛnnennen bi a ɛba wɔ nyinsɛn mu nso betumi ama mogya mu nkwammoaa kɔkɔɔ no asɛe ntɛmntɛm.

• HELLP yare a ɛma obi nya ɔyare no
• Preeclampsia a ɛma obi ho kyere no
• Eclampsia a ɛma obi ho yɛ hyew

Esiane sɛ eyinom yɛ tebea horow a emu yɛ den a ebetumi aba wɔ nyinsɛn mu nti, sɛ yare no ho sɛnkyerɛnne da adi a, ɛho hia sɛ wɔhwehwɛ aduruyɛfo afotu ntɛm ara.

6. Aduruyɛ ho nnwinnade ne ayaresa ahorow

Eyi nso ho yɛ na. Hemolysis betumi aba bere a wɔde nnuruyɛ mfiri bi ahyɛ nipadua no mu, anaasɛ bere a wɔreyɛ ayaresa ahorow bi, kosi sɛ nipadua no bɛsakra ne ho.

• Hemodialysis a wɔde ma ayarefo a wɔwɔ asaabo
• Afiri a wɔde twa koma ne ahurututu mu (a wɔde di dwuma wɔ oprehyɛn akɛse mu) .
• Koma mu valve a wɔde besi ananmu
• Mfiri afoforo a wɔde di dwuma wɔ tebea horow te sɛ koma a entumi nyɛ adwuma yiye mu, sɛ nhwɛso no , intra-aortic balloon pumps ne Impella mfiri .
• Mogya a wɔde ma (te sɛ bere a wɔde mogya a ɛne ne ho nhyia ama) .

7. Awuduru ne awuduru

Awuduru bi, sɛ wɔwe a, ebetumi asɛe mogya mu nkwammoaa kɔkɔɔ na ama mogya atu.

• Arsenic a wɔde yɛ nneɛma
• Kɔbere ( sɛ wɔnom boro so a) .
• Di kan
• Arsine ( mframa a awuduru wom) .
• Stibine ( mframa a awuduru wom) .
• Ɔwɔ awuduru

Bio nso, tebea biara a ɛma akyi berɛmo no yɛ adwuma boro so (hypersplenism) nso betumi ama mogya atɔ. Saa ara na mogya mmoroso a ɛkɔ soro dodo betumi ama mogya mu nkwammoaa kɔkɔɔ no mu apaapae bere a mogya fa mogya ntini no mu ntɛmntɛm dodo no.

Dɛn ne sɛnkyerɛnne ahorow a ɛkyerɛ sɛ mogya atu no?

Nsɛnkyerɛnne no gyina sɛnea wo mogya mu nkwammoaa kɔkɔɔ dodow sua so. Sɛ wo mogya mu nkwammoaa kɔkɔɔ dodow nkɔ fam dodo a, ebia worenhu yare no ho sɛnkyerɛnne biara. Mpɛn pii no, sɛnkyerɛnne ahorow no ba efisɛ nipadua no mu nkwammoaa ne ntini ahorow no nnya mframa pa a ɛdɔɔso esiane mogya mu nkwammoaa kɔkɔɔ dodow a ɛba fam nti.

Nsɛnkyerɛnne a ɛtaa ba:

• Ɔbrɛ
• Adwene a ɛyɛ basaa
• Wora a ɛyɛ mmerɛw
• Koma a ɛbɔ / tachycardia
• Ɔhome a ɛyɛ tiaa / ahome a ɛyɛ den
• Wora ne aniwa fitaa a ɛyɛ kɔkɔɔ (Jaundice) (Eyi fi bilirubin, ade bi a ɛba bere a mogya mu nkwammoaa kɔkɔɔ sɛe, a ɛboaboa ano wɔ mogya no mu) .
• Akisikuru a ayɛ kɛse / splenomegaly

Nsɛnkyerɛnne ahorow bi betumi ayɛ soronko a egyina tebea pɔtee a ɛde mogya a ɛtɔ gu nipadua no mu no so. Sɛ nhwɛso no, obi a ɔwɔ atiridiinini a wɔfrɛ no agglutinin yare no betumi anya mogya a ɛkɔ ne nsateaa ano ne ne nansoaa ano so tew, na ama wadan bruu na ayɛ mmerɛw (Raynaud adeyɛ) .

Nhwehwɛmu bɛn na wɔyɛ de hu sɛ ebia ɔhaw ahorow bi wɔ mogya a wɔsɛe no ho anaa?

Oduruyɛfo bi bɛfa wo mogya bi na wayɛ nhwehwɛmu mpɛn pii ahwɛ sɛ ebia mogya mu nkwammoaa kɔkɔɔ a ɛba fam no fi mogya a ɛtwetwe no anaa.

• Mogya dodow a edi mũ (CBC): Eyi betumi ama woahu nneɛma pii afa nkwammoaa ahorow a ɛwɔ wo mogya mu nyinaa ho, titiriw wo mogya mu nkwammoaa kɔkɔɔ no. Ebetumi ahwɛ nneɛma te sɛ wo hemoglobin dodow ne baabi a wo mogya mu nkwammoaa kɔkɔɔ no gye wɔ wo mogya mu (hematocrit).
• Reticulocyte dodow: Eyi yɛ CBC sɔhwɛ no fã. Reticulocytes yɛ mogya mu nkwammoaa kɔkɔɔ a wɔayɛ foforo a ennya nnyinii koraa. Sɛ hemolysis wɔ hɔ a, reticulocyte dodow betumi akɔ soro bere a nipadua no ma nkwammoaa foforo yɛ ntɛmntɛm de si nea asɛe no ananmu no.
• Mogya a wɔde gu nipadua no akyi: Saa nhwehwɛmu yi betumi ahwɛ sɛ ebia wo mogya mu nkwammoaa no nsusuwii ne ne kɛse a ɛnteɛ anaa. Nkwammoaa a wɔn nsusuwii nyɛ papa no taa sɛe ntɛmntɛm.
• Lactate dehydrogenase (LDH): LDH yɛ enzyme bi a ɛwɔ mogya mu nkwammoaa kɔkɔɔ mu. Sɛ mogya mu nkwammoaa kɔkɔɔ no mu paapae ntɛmntɛm sen sɛnea ɛte daa a, LDH dodow a ɛwɔ mogya no mu no betumi akɔ soro.
• Haptoglobin nhwehwɛmu: Haptoglobin yɛ protein a ɛne hemoglobin wɔ abusuabɔ. Sɛ mogya mu nkwammoaa kɔkɔɔ mu paapae (te sɛ nea ɛte wɔ hemolysis mu) a, hemoglobin pii fi mogya no mu. Afei haptoglobin dodow so tew.
• Bilirubin a wɔmfa nkabom: Wɔyɛ bilirubin bere a hemoglobin a ɛwɔ mogya mu nkwammoaa kɔkɔɔ mu no sɛe no. Bilirubin a ɛdɔɔso wɔ mogya mu no kyerɛ sɛ mogya mu nkwammoaa kɔkɔɔ dodow bi resɛe (eyi na ɛde jaundice ba).
• Direct Coombs test: Saa nhwehwɛmu yi tumi hu sɛ wowɔ antibodies a ɛbata wo mogya mu nkwammoaa kɔkɔɔ ho na ɛsɛe no ntɛmntɛm (eyi betumi aboa ma woahu tebea horow te sɛ AIHA).

Bio nso, oduruyɛfo betumi ayɛ nsu mu nhwehwɛmu de ahwɛ sɛ mogya ne bilirubin wɔ wo nsu mu, na ebetumi ayɛ tebea bi a wɔfrɛ no hemolytic anemia ho sɛnkyerɛnne.

Ɔkwan bɛn so na wɔsa hemolysis?

W’ayaresa no begyina nea ɛde wo mogya a ɛretu ne sɛnea wo sɛnkyerɛnne ahorow no mu yɛ den no so. Ebia ayaresa a wobetumi apaw bi ne vitamin, nnuru, oprehyɛn, ne mogya a wɔde ma.

Nea ɛho hia sen biara ne sɛ wo ne wo duruyɛfo bɛkasa afa ayaresa a eye ma wo ho, a egyina nea woahu so.

Yɛn nipadua rebɔ mmɔden bere nyinaa sɛ ɛbɛma mogya mu nkwammoaa kɔkɔɔ dodow a ɛfata akɔ so. Nanso, nyarewa, nyarewa a wonya fi awo mu, ne nkɛntɛnso a efi abɔnten betumi asɛe adeyɛ yi na ama mogya mu nkwammoaa kɔkɔɔ asɛe ntɛmntɛm dodo. Ne saa nti, mogya mu nkwammoaa kɔkɔɔ no so tew betumi aba, na ɛde mogya a ɛtɔ kɔ mogya mu aba.

Nanso, asɛmpa no ne sɛ wobetumi asa nneɛma a ɛma mogya tu no pii. Sɛ oduruyɛfo hu nea ɛde wo mogya a ɛretu no ba wie a, ɔbɛkyerɛw ayaresa ahorow a ɛbɛboa ma wo mogya mu nkwammoaa kɔkɔɔ dodow asan aba sɛnea na ɛte kan no.

Nneɛma a ɛho hia a ɛsɛ sɛ wokae (Take-Home Message) .

• Hemolysis yɛ mogya mu nkwammoaa kɔkɔɔ a wɔsɛe no ntɛm.
• Eyi betumi de sɛnkyerɛnne ahorow te sɛ ɔbrɛ kɛse, adwenemhaw, ne honam ani yɛ kɔkɔɔ (jaundice) aba .
• Nneɛma pii betumi de aba; mogya mu nkwammoaa kɔkɔɔ no ankasa mu sintɔ, nipadua no mu tumi a ɛko tia nyarewa, ɔyare mmoawa, nnuru bi, nsɛnnennen a ɛba bere a wɔyem, ne nea ɛkeka ho.
• Sɛ wowɔ saa sɛnkyerɛnne ahorow yi a, akyinnye biara nni ho sɛ hwehwɛ aduruyɛfo afotu .
• Mogya mu nhwehwɛmu betumi aboa ma wɔahu nea ɛde ba na ama wɔanya ayaresa a ɛfata.
• Wobetumi asa nneɛma pii a ɛde ba no ma mogya mu nkwammoaa kɔkɔɔ dodow asan aba. Enti ɛho hia sɛ woremmɔ hu na wohwehwɛ aduruyɛ mu akwankyerɛ a ɛfata.

Mewɔ anidaso sɛ wubehu sɛ mfaso wɔ saa nsɛm yi so. Kɔ so nya apɔwmuden!

` Hemolysis, mogya mu nkwammoaa kɔkɔɔ, mogya a ɛtɔ kɔ nipadua mu, akyi berɛmo, nnompe mu ntini, jaundice, mogya mu nhwehwɛmu