Èse dɔléle sia si me nètrɔna blɔ le vuvɔ me eye ɖeɖi tea ŋuwò ŋutɔ la ŋu nya kpɔa? (Agglutinin ƒe Dɔléle si nye Vuvɔ) .

Ðe nèsena le ɖokuiwò me ɣeaɖewoɣi be yeƒe asibidɛwo kple afɔbidɛwo le blɔ ne vuvɔ le wɔwɔm ŋutɔŋutɔa? Alo ɖe nèsena le ɖokuiwò me be ɖeɖi te ye ŋu le mɔ si mebɔ o nu eye yegbɔdzɔ le susu aɖeke manɔmeea? Ðewohĩ wò ŋutigbalẽ trɔ zu ɣie. Ne dzesi siawo le ŋuwò la, ate ŋu anye nɔnɔme si mebɔ o si gbɔ wòtso, gake enye nusi ŋu wòle be mí katã míanya. Egbea, míaƒo nu tso nɔnɔme sia si woyɔna be `Cold Agglutinin Disease (CAD),' si gɔmee nye "cold blood cell aggregation disease" le Sinhalagbe me ŋu.

Nukae nye `Agglutinin ƒe dɔléle (CAD)`? Mina míase egɔme bɔbɔe ŋutɔ.

Kpuie ko la, `Cold Agglutinin Disease (CAD)` nye ʋumenugbagbeviɣidɔ si mebɔ o si me míaƒe ŋutilã ƒe dɔlélenutsiŋutete – ɖoɖo si kpɔa mía ta tso dɔléle me abe asrafo siwo le míaƒe ŋutilã me ene – dzea mía ŋutɔwo ƒe ʋumenugbagbevi dzĩ siwo le lãmesẽ me dzi vodadatɔe .

Bu eŋu kpɔ, zi geɖe la, míaƒe dɔlélenutsiŋutete wɔa protein ƒomevi tɔxɛ aɖe si woyɔna be `antibodies` tsɔ tsrɔ̃a dɔlékui siwo gblẽa nu le ame ŋu siwo gena ɖe ŋutilã me. Gake le CAD ƒe nɔnɔme sia me la, míaƒe dɔlélenutsiŋutete wɔa `antibody` ƒomevi tɔxɛ aɖe si woyɔna be `autoantibody`, si woyɔna hã be `cold agglutinin`. Nu tɔxɛ si le esia ŋue nye be edzea ʋumenugbagbevi dzĩ siwo le lãmesẽ me le míaƒe ŋutilã me dzi hegblẽa wo.

Abe alesi nènyae ene la, ʋumenugbagbevi dzĩwo nye lãmenugbagbevi vevi aɖe ŋutɔ si tsɔa ɔksidzin yia míaƒe ŋutilã katã me. Oxygen sia kpena ɖe míaƒe lãmenugbagbeviwo ŋu wowɔa ŋusẽ si wohiã. Eyata ne ʋumenugbagbevi dzĩwo ƒe xexlẽme dzi ɖe kpɔtɔ, si fia be ʋusɔgbɔdɔ dzɔ la, míaƒe ŋutilã kpɔa vevesese ƒomevi vovovowo.

`Cold Agglutinin Disease` nye ʋusɔgbɔdɔ ƒe ƒuƒoƒo aɖe si woyɔna be `hemolytic anemia.` `Hemolytic anemia` nye ne míaƒe ƒumeŋuɖui gblẽa ʋumenugbagbevi dzĩwo kabakaba wu alesi wòate ŋu awɔ yeyewo. Ele abe gaze si me do le eye tsi dzea dodo gɔme ene.

Aleke gbegbee nɔnɔme sia bɔe be `Cold Agglutinin Disease`?

Le nyateƒe me la, esia nye nɔnɔme si mebɔ kura o . Ame siwo ade ɖeka le 100,000 ɖesiaɖe me koe wokpɔa dɔlélea le ƒe sia ƒe. Ebɔ ɖe nyɔnu siwo xɔ tso ƒe 40 va ɖo ƒe 80. Gake amesiwo ŋu wokpɔa dɔlélea le wue nye amesiwo le woƒe ƒe 60-awo ƒe domedome.

Aleke `Cold Agglutinin Disease` kpɔa ŋusẽ ɖe nye ŋutilã dzii?

Dɔléle sia ate ŋu ana ʋusɔgbɔdɔ ƒe dzesiwo nadze le ŋuwò. Ʋusɔgbɔdɔ nye ne ʋumenugbagbevi dzĩwo mesɔ gbɔ le ŋutilãa me o. Le nusi gbɔ wòtso nu la, nɔnɔme sia ate ŋu anɔ anyi didi alo anɔ anyi ɣeyiɣi kpui aɖe . Azɔ hã, ŋusẽ si wòakpɔ ɖe ŋutilãa dzi ate ŋu ato vovo tso esi nu mesẽ o dzi va ɖo esi nu sẽ dzi .

Le kpɔɖeŋu me, ne CAD mesẽ o la, dzesiawo ate ŋu adze blewu ŋutɔ. Ate ŋu axɔ ƒe geɖe hafi woate ŋu ade dzesi dɔlélea. Gake le nɔnɔme sesẽwo me la, CAD ate ŋu ahe dzidɔ sesẽ siwo ate ŋu ade ame ƒe agbe afɔku me gɔ̃ hã vɛ.Ate ŋu adzɔ be wòadzɔ.

Nya "vuvɔ" le dɔléle sia ƒe ŋkɔ me. Esi wòle alea ta la, wosea dzesi siawo vevie wu le teƒe siwo vuvɔ le wɔwɔm alo le ŋkeke siwo dzi vuvɔ wɔna le.

Nukae nye `Cold Agglutinin Disease` ƒe dzesiwo?

Zi geɖe la, CAD ƒe dzesiwo do ƒome kple ʋusɔgbɔdɔ kple ʋu ƒe sisi nyuie le ŋutilã bliboa me. Dzesi siawo dometɔ aɖewoe nye:

• Feeling very tired (Fatigue) : Menye ɖeɖiteameŋu ɖeɖeko o, ke boŋ agbemanɔamesi ƒe seselelãme.
• Gbɔdzɔgbɔdzɔ : Ŋutilã la gbɔdzɔna ale gbegbe be mete ŋu wɔa naneke o.
• Taɖuame : Seselelãme si nye be èle tsatsam.
• Fifia : Fifia dzodzro.
• Yagbɔgbɔ sesẽ (dyspnea) : Yagbɔgbɔ sesẽ ne wodze agbagba vie gɔ̃ hã.
• Dzi ƒe tsotso dzina ɖe edzi (tachycardia) : Dzi ƒe tsotso dzina ɖe edzi.
• Pallor : Ʋu meganɔa ŋutigbalẽa ŋu o eye wòzua ɣie.
• Asibidɛwo, afɔbidɛwo, kple towo trɔna blɔ ne vuvɔ le ŋuwò (Raynaud ƒe nudzɔdzɔ) : Ne èyi teƒe si fa miamiamia abe Nuwara Eliya ene, alo ne èka asi tsi fafɛ ŋu la, wò asibidɛwo, afɔbidɛwo, kple towo trɔna zua blɔ, ɣeaɖewoɣi ɣie. Esia ate ŋu akplɔ lãmetutudɔ hã ɖo.

Àte ŋu adze aɖuɖɔtoedɔ ƒe dzesiwo hã gɔme . Ne ʋumenugbagbevi dzĩwo tsrɔ̃ la, woɖea nu ɣi aɖe si woyɔna be bilirubin dona. Ne bilirubin sia ƒo ƒu ɖe ŋutilãa me la, jaundice dzɔna. Dzesi siwo dzena le jaundice ŋu dometɔ aɖewoe nye:

• Aɖuɖɔ si ƒe amadede nye aŋutiɖiɖi.
• To, ŋkuwo ƒe ɣiwo kple iriswo nye ɣie.

Nukae nye nusiwo hea `Cold Agglutinin Disease` vɛ?

Agglutinin Dɔléle si nye Cold Agglutinin Disease nye ʋusɔgbɔdɔ si dɔlékuiwutikewo tsɔna naa ʋusɔgbɔdɔ ƒomevi aɖe. Esia fia be mía ŋutɔwo ƒe dɔlélenutsiŋutete dzea mía ŋutɔwo ƒe lãmenugbagbeviwo dzi. Le CAD me la, vuvɔ ƒe nɔnɔmewo nana míaƒe dɔlélenutsiŋutete wɔa dɔ eye wòwɔa autoantibody si "dea dzesi" ʋumenugbagbevi dzĩwo be wòatsrɔ̃ wo. Ʋumenugbagbevi dzĩ siwo wode dzesii la léna ɖe wo nɔewo ŋu eye woƒoa ƒu ɖe wo nɔewo ŋu (agglutinate). Míaƒe dɔlélenutsiŋutete ƒe akpa bubu si woyɔna be macrophages ate ŋu alé lãmenugbagbevi siwo ƒo ƒu la bɔbɔe ahatsrɔ̃ wo.

Dɔ sia dzea egɔme ne yame ƒe dzoxɔxɔ ɖiɖi wu Celsius dzidzenu 3-4 (Fahrenheit dzidzenu 37-39). Bu eŋu kpɔ be míaƒe ŋutilã ƒe dzoxɔxɔ si sɔ la anɔ abe Celsius dzidzenu 37 ene. Kuxi sia dzea egɔme ne míeɖo dzoxɔxɔ si bɔbɔ wu ema kura me.

CAD gblẽa ɖoɖowɔɖi si sɔ na míaƒe ŋutilã be wòawɔ ʋumenugbagbevi dzĩ siwo le lãmesẽ me. Zi geɖe la, ʋumenugbagbevi dzĩ aɖe nɔa agbe abe ŋkeke 120 ene. Le ɣeyiɣi sia me la, míaƒe ƒumeŋuɖui ate ŋu awɔ ʋumenugbagbevi dzĩ yeyewo be woaxɔ ɖe esiwo kuna la teƒe. Gake le CAD me la, wogblẽa tsatsam sia me.

Numekulawo menya nusita tututu míaƒe dɔlélenutsiŋutete dzea lãmenugbagbevi siwo le lãmesẽ me dzi haɖe o.Ɣeaɖewoɣi la, atikewɔwɔ me nɔnɔme bubu si gbɔ wòtso ate ŋu ahe CAD vɛ. Woyɔa esia be `CAD evelia`. Ne womete ŋu ke ɖe kadodo ma tɔgbe aɖeke ŋu o, si fia be CAD doa ŋgɔ nusi gbɔ wòtso manɔmee la, woyɔnɛ be `primary CAD` alo `idiopathic CAD`.

Nɔnɔme bubu kawoe ateŋu ado ƒome kple `Cold Agglutinin Disease`?

Zi geɖe la, CAD evelia do ƒome kple dɔlékuiwo, dɔléle siwo dɔlélenutsiŋutete hena vɛ, kple ʋumenugbagbeviɣidɔ. Le kpɔɖeŋu me:

• `Mononucleosis si xɔa ame` (glandular fever) .
• Mycoplasma aklãdɔléle
• `Cytomegalovirus ƒe dɔlékui`
• Lupus ƒe dɔléle
• Lãmetsiŋusẽ ƒe ƒunukpeƒetetedɔ
• `Non-Hodgkin ƒe ʋumenugbagbeviɣidɔ`
• Ʋumenugbagbeviɣidɔ si nɔa anyi didi
• ``Waldenstrom ƒe ʋumenugbagbevi dzĩwo ƒe ʋumenugbagbeviɣidɔ''.

Ŋkɔ siawo adze na wò be woatɔtɔ vie, gake ŋkɔ siawo koŋ ɖɔktawo zãna, eyata anyo be nànya wo.

Aleke woawɔ anya `Cold Agglutinin Dɔléle`? (Dɔléle ƒe dzesi) .

Wò ɖɔkta abia nu tso wò dzesiwo ŋu eye wòato wò atikewɔwɔ ŋutinya me. Emegbe, woaɖe gbe be woawɔ ʋudodokpɔ tɔxɛ aɖewo atsɔ akpɔe ɖa be ʋusɔgbɔdɔ si me ʋu sina tona le lãme na wò le ŋuwò eye nenye be dɔlékuiwutike siwo do ƒome kple CAD le ŋuwò hã.

Ʋudodokpɔ be woatsɔ anya ʋusɔgbɔdɔ si me ʋu sina tonae nye:

• Ʋu ƒe xexlẽme bliboa (CBC) : Esia naa nyatakaka tsitotsito tso wò ʋumenugbagbevi dzĩwo ŋu. Ate ŋu alé ŋku ɖe ʋumenugbagbevi dzĩ agbɔsɔsɔme si le ŋuwò, woƒe lolome, kple wò ʋumenugbagbevi dzĩ ƒe agbɔsɔsɔ ŋu. Hemoglobin nye protein vevi aɖe ŋutɔ si kpena ɖe ʋumenugbagbevi dzĩwo ŋu be woatsɔ oxygen.
• `Reticulocyte count` : Esia dzidzea ʋumenugbagbevi dzĩ siwo metsi o (`reticulocytes`) agbɔsɔsɔme si le wò ŋutilã me. Ne dɔlélenutsiŋutete tsrɔ̃ ʋumenugbagbevi dzĩ siwo tsi la, ŋutilãa dzea agbagba be yeawɔ lãmenugbagbevi siawo siwo metsi o la geɖe wu be wòanye mɔ si dzi yeato aɖo eteƒe.
• Serum ƒe agbɔsɔsɔ dodokpɔ : `Lactate dehydrogenase (LDH)` kple `bilirubin` ƒe agbɔsɔsɔ si dzi ɖe edzi le ʋu me, kple `haptoglobin` ƒe agbɔsɔsɔ si dzi ɖe kpɔtɔ nye `hemolytic anemia` ƒe dzesiwo.

Emegbe be nànya ne CAD gbɔe wò ʋusɔgbɔdɔ tsona la, wò ɖɔkta akpɔe ɖa be dɔlékuiwutike siwo dzea ʋumenugbagbevi dzĩwo dzi la le eme hã. Dodokpɔ siwo wowɔna na esiae nye:

• Direct Coombs test (DAT) : Dodokpɔ sia léa ŋku ɖe autoantibodies siwo do ƒome kple CAD ƒe anyinɔnɔ ŋu hã. Le dodokpɔa me la, woɖea wò ʋumenugbagbevi dzĩwo ɖa tso wò ʋu susɔea gbɔ eye wotsɔa wo dana ɖe teƒe si wokpɔa wo dzi le. Emegbe wotsɔa egbɔkpɔnu tɔxɛ aɖe kpena ɖe eŋu. Ne ʋumenugbagbevi dzĩawo lé ɖe tsia ŋu eye woƒo ƒu ɖekae (agglutinate) la, dodokpɔa ɖee fia be dɔlékuiwutikea le eme.
• `Agglutinin ƒe agbɔsɔsɔme dodokpɔ fafɛ`: Dodokpɔ sia dzidzea `autoantibodies` siawo ƒe agbɔsɔsɔ, alo woƒe agbɔsɔsɔ, le wò ʋu me. `Autoantibodies` siawo ƒe agbɔsɔsɔ fũ nye CAD ƒe dzesi.

Ne wonya ɖo kpe wò dɔlélea dzi ko la, wò ɖɔkta hã akpɔe ɖa be wò CAD do ƒome kple nɔnɔme aɖe si le eme hã (`secondary CAD`).

Aleke wowɔa atike na `Cold Agglutinin Disease`?

Le alesi wò dzesiawo nu sẽe nu la, atikewɔwɔ ate ŋu anye tɔtrɔ le agbenɔnɔ me, atikewo zazã, kple ʋudodo ɣeaɖewoɣi le nɔnɔme kpatawo me .

• Agbenɔnɔ : Ne CAD le ŋuwò la, anɔ eme be wò ɖɔkta aɖo aɖaŋu na wò be nàƒo asa na vuvɔ . Esiae nye nu vevitɔ kekeake. Ele be nàwɔ nuwo abe awu siwo me dzo le dodo, aƒo asa na tsilele fafɛ, eye nàɖo seɖoƒe na wò mɔzɔzɔ yi teƒe siwo fa miamiamia.
• Atikewo : Atike si wozãna wu tsɔ daa CAD enye `Rituximab` . Esia wɔa dɔ to wò dɔlélenutsiŋutete ƒe nutsitsi be wòagawɔ `autoantibodies` siwo dzea wò ʋumenugbagbevi dzĩwo dzi o. Woda asi ɖe atike yeye aɖe si woyɔna be `Sutimlimab` hã dzi nyitsɔ laa. Esia wɔa dɔ to dɔlélenutsiŋutetea nu tsitsi tẽ be wòagadze wò ʋumenugbagbevi dzĩwo dzi o.
• Ʋudodo kple ʋumenugbagbeviɣidɔ : Ne wò CAD va le sesẽm ɖe edzi la, ahiã be wò ɖɔkta nado ʋu alo ʋumenugbagbeviɣidɔ na wò be wò nɔnɔmea nali ke. Plasma exchange wɔa dɔ to autoantibodies ƒe agbɔsɔsɔ si le wò ʋu me dzi ɖeɖe kpɔtɔ me.

Ne `secondary CAD` le ŋuwò la, wò ɖɔkta ada dɔléle si le ete hã.

Ðe woate ŋu axe mɔ ɖe CAD nua?

Nublanuitɔe la, Cold Agglutinin Dɔléle menye dɔléle si woate ŋu axe mɔ na o. Ke hã, àte ŋu aɖu dzesiawo dzi ahanɔ agbe nyui.

Ɣeyiɣi didi kae nàte ŋu anɔ agbe kple `Cold Agglutinin Disease`?

Zi geɖe la, amesiwo ŋu wokpɔ CAD le la nɔa agbe didi abe woƒe ƒemetɔ siwo si CAD mele o ene. Numekuku aɖe si wowɔ nyitsɔ laa ɖee fia be amesiwo ŋu wokpɔ dɔlélea le esime woxɔ ƒe 68 ate ŋu akpɔ mɔ be yewoanɔ agbe vaseɖe yewoƒe ƒe 80-awo me, le mamã dedie nu. Ema fia be ne wowɔ atike na wò nyuie hekpɔ egbɔ nyuie la, àte ŋu akpɔ mɔ be yeanɔ agbe nyui.

Nya kawoe wòle be mabia nye ɖɔkta?

Ne wokpɔe be CAD le ŋuwò la, anyo be nàbia nya siawo abe esiawo ene wò ɖɔkta:

• Ðe nye CAD do ƒome kple dɔléle aɖe si gbɔ wòtsoa?
• Dzesi kawoe akpe ɖe ŋunye manya ne nye nɔnɔmea le nyonyom ɖe edzi alo le gbegblẽm ɖe edzi?
• Ðe wòahiã be mayi edzi anɔ atikewo nom na dɔléle sia?
• Nukae nye yame ƒe nɔnɔme nyuitɔ kekeake si me amesi ŋu CAD le ate ŋu anɔ?
• Dzoxɔxɔ ƒe didime kawoe wòle be maƒo asa na be makpɔ nye dzesiwo gbɔ?

Wò nuteƒekpɔkpɔ le Cold Agglutinin Disease (CAD) ŋu nɔ te ɖe nenye be enye gbãtɔ (‘gbãtɔ’) alo evelia (‘secondary’) dzi. Alesi wò dzesiawo nu sẽe hã akpɔ ŋusẽ ɖe alesi nèhiã atikewɔwɔ vevie dzi. Ne wò ɖɔkta da dɔléle si gbɔ wòtso la, ate ŋu ada wò CAD. Ne CAD le ŋuwò ɣeyiɣi didi gɔ̃ hã la, àte ŋu aɖu wò ʋusɔgbɔdɔ ƒe dzesiwo dzi eye nànɔ lãmesẽ me ne èƒo asa na dzamezã kple wò atikewo nono abe alesi wogblɔe ene.

Nu vevitɔ kekeake siwo dzi wòle be míaɖo ŋkui tso nusiwo me míedzro me (Take-Home Message) .

• Cold Agglutinin Disease (CAD) nye dɔléle si mebɔ o si me mía ŋutɔwo ƒe dɔlélenutsiŋutete dzea míaƒe ʋumenugbagbevi dzĩwo dzi eye vuvɔ nana wògasẽna ɖe edzi.
• Dzesiawo ate ŋu anye ƒunukpeƒeveame, ɖeɖiteameŋu si gbɔ eme, ŋutigbalẽ ƒe ɣie, asibidɛwo ƒe blɔ le vuvɔ me, kple ɣeaɖewoɣi la, ʋuʋudedi .
• Esia ateŋu anye `gbãtɔ` (si metso o) alo `evelia` (si tso dɔléle bubu gbɔ).
• Ʋudodokpɔwo li woatsɔ anya dɔlélea.
• Atikewɔwɔ ate ŋu anye be woaƒo asa na dzamezã, atikewo zazã, kple ʋudodo ɣeaɖewoɣi.
• Togbɔ be womate ŋu axe mɔ ɖe esia nu o hã la, ne èkpɔ egbɔ nyuie la, àte ŋu anɔ agbe nyui.
• Ne dzesi siawo le ŋuwò la, mègahe ɖe megbe le atikewɔlawo ƒe aɖaŋuɖoɖo didi me o. Zi alesi nède dzesii kaba la, zi nenemae edada nɔa bɔbɔe wu.

Ðo ŋku edzi be nyatakaka nana koe nyati sia nye. Ne dzesi aɖewo le ŋuwò la, kpɔ egbɔ be yeyi ɖɔkta gbɔ hena aɖaŋuɖoɖo.

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