Ðe wòva hiã be nàzã atike aɖe si woyɔna be Heparin kpɔa? Ðewohĩ le dɔwɔwɔ nɛ vɔ megbe, alo be wòaxe mɔ ɖe ʋu ƒe sisi nu la, ɖɔkta aɖe ate ŋu ana atike sia wò. Gake togbɔ be mebɔ kura o hã la, heparin sia ate ŋu ana míaƒe ŋutilã nawɔ ʋu geɖe wu eye wòaɖe ʋumenugbagbevi dzĩwo ƒe xexlẽme dzi akpɔtɔ. Emae nye nusi míeyɔna be `Heparin-Induced Thrombocytopenia` alo `(HIT)`. Mègatsi dzi o, esia aɖi nya sesẽ vie, gake mina míaƒo nu tso eŋu bɔbɔe.
Nukae nye heparin? Nukatae HIT dzɔna?
Kpuie ko la, heparin nye
ʋumenugbagbeviɣitike (ʋu si nana ʋu mekɔna o). Wozãnɛ tsɔ xea mɔ na ʋu ƒe sisi le míaƒe ʋukawo me. Ðɔktawo ŋlɔnɛ nɛ le amekoko gã aɖe megbe, alo be woatsɔ alɔ ʋuka aɖe si do xoxo. Gake ƒã ŋutɔ be ne wona heparin ame aɖewo la, ate ŋu ana woawɔ nuvevi ame. Esiae nye esime míaƒe
dɔlélenutsiŋutete wɔ ɖeka kple heparin vodadatɔe eye wòna mía ŋutɔwo ƒe ʋumenugbagbevi dzĩwo wɔa dɔ. Ʋumenugbagbevi dzĩwo nye lãmenugbagbevi ƒomevi aɖe si kpena ɖe mía ŋu míedzudzɔa ʋu si dona le mía me. Eyata ne ʋumenugbagbevi dzĩwo le dɔ wɔm alea la, le esi teƒe be woaxe mɔ na ʋu ƒe sisi la,
wodzea ʋu ƒe sisi gɔme madzemadzee (thrombosis). Le ɣeyiɣi ma ke me la, ʋumenugbagbevi dzĩwo ƒe xexlẽme hã dzi ɖena kpɔtɔna kabakaba (thrombocytopenia). Esia tae woyɔa nɔnɔme sia ɣeaɖewoɣi be `Heparin-Induced Thrombocytopenia and Thrombosis (HITT)`.
Bu eŋu kpɔ, ewɔ nuku vie be atike si wona be woatsɔ axe mɔ ɖe ʋu ƒe sisi nu ana ʋu ƒe sisi nadzi ɖe edzi eye wòaɖe ʋumenugbagbevi dzĩwo dzi akpɔtɔ, alo? Gake ate ŋu adzɔ.
HIT ƒomevi vevi eve li.
Ðɔktawo ma `(HIT)` nɔnɔme sia ɖe hatsotso vevi eve me: 1.
HIT I (Ƒomevi 1): Le go sia me la, wò ʋumenugbagbeviɣidɔ dzi ɖena kpɔtɔna vie le ŋkeke ʋee gbãtɔ siwo me nèdze heparin zazã gɔme vɔ megbe, gake egatrɔna yia nɔnɔme si sɔ me le ŋkeke ʋee aɖewo megbe.
Esia menye nɔnɔme si me afɔku le o , eye ʋu ƒe sisi ƒe afɔku aɖeke hã mele eme o, eyata mehiã be woawɔ atike tɔxɛ aɖeke nɛ o. 2.
HIT II (Ƒomevi 2): Esiae nye ƒomevi si ŋu wòle be míatsi dzi ɖo. Le go sia me la, míaƒe dɔlélenutsiŋutete naa ʋumenugbagbevi dzĩwo wɔa dɔ le heparin zazã me. Esia nana ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ dzi ɖena kpɔtɔna, eye
ʋu ƒe sisi vevie ate ŋu anɔ eme . Zi geɖe la, ne míele nu ƒom tso `(HIT)` ŋu la, zi geɖe la, míefiaa afɔku ƒomevi sia si woyɔna be `(HIT II)`.
Amekae ate ŋu axɔ HIT sia wu?
Amesiame si zãa heparin, eɖanye agbɔsɔsɔme ka kee wozãe alo ɣeyiɣi didi kae wòxɔ o, ate ŋu axɔ nɔnɔme sia. Gake wokpɔe be
nyɔnu siwo xɔ wu ƒe 40 la ate ŋu axɔe vie. Ðɔktawo menya nusita tututu ame aɖewo wɔa nu ɖe heparin ŋu alea eye ame bubuwo ya mewɔa esia o haɖe o. Nu sia
Menye nɔnɔme si bɔ ŋutɔe wònye o. ``(HIT)`` nɔnɔme sia dzɔna le amewo ƒe ƒuƒoƒo sue aɖe me, abe 5% ene, siwo noa heparin wu ŋkeke ene. Nukawoe nye HIT ƒe dzesiwo? Aleke míewɔna dea dzesii?
Ne èle heparin nom la, zi geɖe la, wò ɖɔkta alé ŋku ɖe lãmenugbagbevi siwo le wò ʋu me ƒe xexlẽme ŋu, vevietɔ ʋumenugbagbevi dzĩwo ƒe xexlẽme. Ʋumenugbagbeviɣidɔ ƒe agbɔsɔsɔ si bɔbɔ ate ŋu anye HIT ƒe dzesi gbãtɔ. Ame siwo ŋu HIT le ƒe afã lɔƒo va xɔa ʋu yeye. Esia ate ŋu anye ʋuka me ʋu ƒe sisi goglo (DVT) le afɔ me alo aklã me ʋu ƒe sisi (PE). Kpɔ dzesi siawo ɖa: Tsɔ kpe ɖe eŋu la, àte ŋu ade dzesi vevesese, abi, alo ŋutigbalẽ ƒe ʋuʋu le afisi wodo heparin le. Vevietɔ wu: Ne èle heparin zãm eye nèkpɔ dzesi siawo dometɔ aɖe la, yi atikewɔƒe kpata enumake. Esia menye nusi woahe ɖe megbe o.
Ɣekaɣie HIT dzɔna?
Zi geɖe la, dzesiawo dzea egɔme le ŋkeke atɔ̃ va ɖo kwasiɖa eve me tso esime wodze heparin zazã gɔme. Gake woate ŋu adzɔ le ɣeyiɣi bubuwo hã me:- HIT si dzea egɔme kaba: Esia ate ŋu adzɔ le ŋkeke ɖeka va ɖo etɔ̃ me tso esime wodze heparin zazã gɔme. Esia ate ŋu adzɔ ne èzã heparin kpɔ (zi geɖe le ɣleti etɔ̃ me). Emegbe, wò ŋutilã "ɖoa ŋku" heparin dzi, wɔa dɔlékuiwutikewo ɖe eŋu, eye wòle klalo be yeawɔ nu kaba.
- Refractory HIT: Nɔnɔme sia ate ŋu anɔ anyi kwasiɖa geɖe ne wodzudzɔ heparin zazã vɔ megbe.
- HIT si dzea egɔme megbe: Esia dzɔna ne wodzudzɔ heparin zazã vɔ megbe. Zi geɖe la, edzɔna le ŋkeke atɔ̃ alo esi wu nenema le atikeawo dzudzɔ megbe.
Nuka tututue hea HIT sia vɛ?
`HIT` dzɔna ne atike si nye heparin bla ɖe protein si woyɔna be `PF4` (Platelet Factor 4) ŋu le míaƒe ʋumenugbagbeviɣiwo me. Heparin sia kple `PF4` ƒoa ƒu wɔa `Heparin-PF4 complex`. Ne míekpɔ `Heparin-PF4 complex` ma le míaƒe ŋutilã me la, míaƒe dɔlélenutsiŋutete tsia dzi eye wòdzea dɔlékuiwutikewo wɔwɔ gɔme ɖe eŋu. Dɔlékuiwutike siawo yia eye woblana ɖe `Heparin-PF4 complex` ma ŋu. Afi mae nusianu dzea egɔme tsoe. Ne dɔlékuiwutike siawo nya bla ɖe wo nɔewo ŋu ko la, ʋumenugbagbevi dzĩawo wɔa dɔ enumake eye wodzea ʋu ƒe sisi gɔme. To mɔ sia dzi la, `PF4` geɖe dona tso ʋumenugbagbevi dzĩ siwo wɔa ʋu ƒe sisi me. Emegbe `PF4` yeye ma hã blana ɖe heparin ŋu, eye wòwɔa `Heparin-PF4 complex` geɖe wu. Dɔlékuiwutikewo trɔna gbɔna eye wogablana ɖe eŋu ake, ʋu ƒe sisi geɖe wu dzɔna... Esia yia edzi abe kɔsɔkɔsɔ ƒe dɔwɔwɔ ene. Le ʋu ƒe sisi alea katã ta la, ʋumenugbagbevi dzĩ siwo le ŋutilãa me la vɔna kabakaba. Esia wɔnɛ be ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ dzi ɖena kpɔtɔna. Le ʋu ƒe sisi fũ alea ta la, ʋu gã siwo ate ŋu ade míaƒe agbe afɔku me ate ŋu adzɔ, si axe mɔ na míaƒe ʋukawo kple ʋukawo. Nukawoe nye afɔku siwo le HIT xɔxɔ me?
Nu geɖe li siwo nana afɔku si le HIT xɔxɔ me dzina ɖe edzi:- Wò ŋutsu alo nyɔnu nyenye: Nyɔnuwo ate ŋu axɔ HIT wu.
- Heparin ƒomevi si wozãna: Numekuku aɖewo ɖee fia be afɔku si le HIT me ate ŋu ato vovo le heparin ƒomevi si nèno nu. Le kpɔɖeŋu me, kpeɖodzi aɖewo li be heparin si womeɖe ɖe akpa vovovowo me o zazã ɖe heparin si ƒe molecule ƒe kpekpeme mede o teƒe ate ŋu aɖe afɔkua dzi akpɔtɔ. Ke hã, numekuku geɖe hiã le esia ŋu.
- Heparin nono le amekoko megbe: Ame siwo noa heparin be wòaxe mɔ na ʋu ƒe sisi le amekoko megbe la ate ŋu axɔ HIT wu amesiwo noae tsɔ daa ʋu ƒe sisi si li xoxo. Afɔku sia lolo ŋutɔ le ƒumeŋutinunya, dzidɔ, kple dzitodzito me dɔwɔwɔ vɔ megbe .
Aleke wowɔa dea dzesi HIT? (Dɔléle ƒe dzesi) .
Ʋudodokpɔ geɖe ate ŋu akpe ɖe ŋuwò nànya ne HIT le ŋuwò:- Ʋumenugbagbeviɣidɔ: Esia ate ŋu akpɔe ɖa be wò ʋumenugbagbevi dzĩwo ƒe xexlẽme le sue hã (thrombocytopenia).
- Ʋu ƒe sisi: Ʋudodokpɔwo ɖenɛ fiana ne wò ʋu le ƒoƒom.
- PF4 dɔlékuiwutike ƒe agbɔsɔsɔ: PF4 dɔlékuiwutike agbɔsɔsɔme si le wò ʋu me ate ŋu anya ne wò dɔlélenutsiŋutete le ʋumenugbagbevi dzĩwo wɔm dɔ. Dɔlékuiwutikewo dodokpɔ siae ɖo kpe HIT ƒe dzesi dzi.
Wò ɖɔkta ate ŋu abia hã be woawɔ ultrasound atsɔ akpɔe ɖa be ʋu le dodom le wò afɔwo me hã (DVT). Le wò nɔnɔmea nu la, woate ŋu aɖe gbe hã be woawɔ dodokpɔwo atsɔ akpɔe ɖa be ʋu le ƒoƒom le teƒe bubuwo abe wò abɔwo ene hã. Gake esi wònye be dɔlékuiwutikewo dodokpɔ sia me tsonu xɔa ɣeyiɣi aɖe hafi ɖɔktawo gatrɔna gbɔna ta la, ɖɔktawo melalana be wòagatrɔ ava hafi dzea atikewɔwɔ gɔme o. Esi wònye be HIT nye dɔléle si ate ŋu awu ame ne womewɔ atike nɛ o ta la, wonɔa te ɖe alesi wòanya wɔ be HIT nadze dziwò dzi ɖoa atikewɔwɔ nɛ. Nukae nye "4Ts dodokpɔ" sia?
`4Ts dodokpɔ` nye dzesidede ƒe ɖoɖo si bua alesi wòanya wɔ be `HIT` nanɔ ŋuwò. Enaa nyatakaka siwo nèhiã be nàdze atikewɔwɔ gɔme evɔ màlala dɔlékuiwutikewo dodokpɔa me tsonu o. Ðɔktaa naa dzesi (tso 0 va ɖo 2) le nu ene siawo ta:- Thrombocytopenia (ʋumenugbagbeviɣidɔ si mebɔ o): Aleke gbegbee wò ʋumenugbagbeviɣidɔ le ʋɛe?
- Ɣeyiɣi (ɣeyiɣi si nèwɔa nu ɖe heparin ŋu): Ɣekaɣie wò ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ ɖiɖi?
- Thrombosis (ʋu ƒe sisi): Ðe ʋu ƒe sisi ƒe dzesiwo lia?
- oNu bubu siwo gbɔ wòtsona: Ðe susu bubu aɖe ate ŋu anɔ anyi tsɔ wu heparin si tae ʋumenugbagbevi dzĩwo ƒe xexlẽme dzi ɖe kpɔtɔa?
Zi alesi dzesia loloe la, zi nenemae mɔnukpɔkpɔ asu asiwò be nàxɔ `HIT`. Nukawoe nye HIT ƒe atikewo?
Afɔɖeɖe gbãtɔ si woawɔ le atikewɔwɔ me enye be woadzudzɔ heparin nono enumake. Emegbe, woatrɔ wò ɖe atike bubu si nana ʋu mekɔna o ŋu. Ele be wò ʋumenugbagbevi dzĩwo ƒe xexlẽme nagadze dzidziɖedzi gɔme le ŋkeke ʋɛ aɖewo megbe le heparin zazã dzudzɔ vɔ megbe. Hafi ɣemaɣi naɖo la, anɔ eme be wò ɖɔkta aŋlɔ atike bubu na wò be wòakpe ɖe ŋuwò nàxe mɔ ɖe ʋu ƒe sisi nu. Atike vovovowo li siwo woate ŋu azã ɖe heparin teƒe:- ``Trombin mɔxenu tẽ'' (le kpɔɖeŋu me, `argatroban', `bivalirudin') .
- `Fondaparinux ƒe nusrɔ̃ƒe`
- `Direct oral anticoagulants` (atike siwo xea mɔ na ʋu ƒe sisi si woate ŋu ano tẽ to nu me)
Ne wò ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ gaɖo eƒe nɔnɔme nyuitɔ me eye afɔku si le ʋu ƒe sisi le HIT ta nu va yi ko la, wò ɖɔkta ate ŋu atrɔ wò ɖe atike bubu si nana ʋu mekɔna o, abe warfarin ene, ŋu. Ðe míate ŋu axe mɔ ɖe HIT nua?
Le nyateƒe me la, naneke meli nàte ŋu awɔ atsɔ axe mɔ ɖe HIT nu o. Gake ne èna wò ɖɔkta lé ŋku ɖe wò ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ ŋu edziedzi la, ate ŋu akpe ɖe ŋuwò nàɖe kuxi siwo heparin ado tso eme la dzi akpɔtɔ. Nukae nàkpɔ mɔ na ne HIT le ŋuwò?
Heparin-Induced Thrombocytopenia (HIT) nye dɔléle sesẽ aɖe si ate ŋu awu ame ne womedae kaba o. Ʋu gã siwo le abɔwo kple afɔwo me ate ŋu agblẽ nu le ŋutinu mawo ŋu ɣeyiɣi didi. Ʋu ƒe sisi si gblẽa nu le ŋutinu veviwo ŋu ate ŋu awu ame. Dzɔgbenyuietɔe la, esi amewo va nya nu tso HIT ŋu geɖe wu eye atikewɔmɔnu siwo nyo wu ta la, agbetsitsi ƒe agbɔsɔsɔ dzi ɖe edzi ŋutɔ. De dzesii kaba, hafi ʋu ƒe sisi sesẽwo nadze egɔme, nye nu vevi aɖe si ana nu nyui aɖe nado tso eme.Ne wò ɖɔkta nya kpɔ HIT ƒe dzesiwo, abe ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ si bɔbɔ ene ko la, ate ŋu aŋlɔ atike na wò be wòaɖe ʋu ƒe sisi si me afɔku le dzi akpɔtɔ. Aleke malé be na ɖokuinye?
Ahiã be nàyi ɖɔkta gbɔ edziedzi be nàlé ŋku ɖe wò ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ ŋu ahakpɔ egbɔ be ʋu megale ʋu ƒe sisi o. Tsɔ kpe ɖe eŋu la, wò ɖɔkta anya nugbegblẽ le ame ŋu siwo ate ŋu ado tso eme (abe ʋu si le dodom le ame aɖewo ŋu ene) ne èle tɔtrɔm tso heparin dzi yi ʋumenugbagbeviɣitike yeye dzi. Le ɣeyiɣi sia me la, ele vevie ŋutɔ be nàno wò atikeawo abe alesi woŋlɔe ene. Ne ʋu me mekɔ na wò o hã la, ahiã be nàno ʋumenugbagbeviɣitike si menye heparin o ɣleti ɖeka ya teti. Ne ʋu ƒo ɖe dziwò kpɔ la, ahiã be nànoe ɣeyiɣi didi wu. Mɔ nyuitɔ si dzi nàto alé be na ɖokuiwòe nye be nàgblɔ na ɖɔkta ɖesiaɖe si awɔ atike na wò le etsɔme be kuxi sia do mo ɖa na wò. Ne `HIT` nɔ ŋuwò kpɔ la, mele be nàgano heparin gbeɖe o.
Ne ède dzesi tɔtrɔ aɖewo le wò ŋutilã me esime nèle heparin nom la, yi atikewɔƒe kpata enumake. Heparin-Induced Thrombocytopenia (HIT) nye dɔléle si mebɔ o, gake ʋu ƒe sisi ƒe dzesi ɖesiaɖe nu sẽ akpa be woaŋe aɖaba aƒu edzi. Ne womewɔ atike na HIT o la, ate ŋu awu ame. Ne wowɔ atike na wò la, ele be wò ʋumenugbagbevi dzĩwo ƒe agbɔsɔsɔ natrɔ ava nɔ abe alesi wònɔ ene eye ʋu ƒe sisi ƒe afɔkua dzi naɖe akpɔtɔ. Ƒo nu kple wò ɖɔkta tso atike nyuitɔ si nàzã ɖe heparin teƒe ŋu le yiyi me. Gbedasi Mamlɛtɔ si Wotsɔ Yi Aƒeme
- Togbɔ be heparin nye atike vevi aɖe si xea mɔ na ʋu ƒe sisi hã la, ƒã hafi ate ŋu ahe nɔnɔme sesẽ aɖe si woyɔna be `Heparin-Induced Thrombocytopenia (HIT).` vɛ
- Nusi dzɔna le go sia mee nye be le esi teƒe be woaxe mɔ ɖe ʋu ƒe sisi nu la, ʋu ƒe sisi dzina ɖe edzi eye ʋumenugbagbevi dzĩwo ƒe xexlẽme dzi ɖena kpɔtɔna.
- Nya nyuie le dzesiwo abe wò afɔ/abɔwo ƒe vuvu, vevesese, akɔtave, kple gbɔgbɔ sesẽ ŋu. Ne ède dzesi esiawo la, yi ɖɔkta gbɔ enumake.
- Ne wokpɔ `HIT` la, nu gbãtɔ si woawɔe nye be woadzudzɔ heparin zazã. Ekema ahiã be nàzã atike bubu siwo nana ʋu mekɔna o.
- Ne `HIT` dze dziwò kpɔ la, ŋlɔe ɖe wò atikewɔwɔ ŋuti nuŋlɔɖiwo katã me eye nàgblɔe na ɖɔkta ɖesiaɖe si nàkpɔ le etsɔme. Mele be woagatsɔ heparin ana wò gbeɖe o.
Mele mɔ kpɔm be nyatakaka sia aɖe vi na wò. Nɔ lãmesẽ me! Heparin, Thrombocytopenia, Ʋu ƒe sisi, Ʋumenugbagbeviɣidɔ, Anticoagulant, HIT, Nusiwo dona tso eme, Ʋu ƒe sisi, Ʋumenugbagbeviɣidɔ, Heparin, Nusiwo dona tso eme
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