ʻAʻole kūlike ke ʻano koko o kāu pēpē i hānau ʻole ʻia me kāu? (Erythroblastosis Fetalis) E ʻike kākou i ke ʻano o kēia!

Inā he makuahine hānau ʻoe, ua makaʻu iki paha ʻoe i kou lohe ʻana i nā huaʻōlelo 'Erythroblastosis Fetalis'. A i ʻole ua haʻi aku paha kāu kauka iā ia i kekahi manawa i hala aku nei i kāna kamaʻilio ʻana e pili ana i kou ʻano koko. Hiki ke hopohopo iki ke lohe i kēia inoa. Akā, mai hopohopo, i kēia lā e kamaʻilio mākou e pili ana i ia mea ma ke ʻano maʻalahi e hiki ai iā ʻoe ke hoʻomaopopo. E nānā kākou i ke ʻano o ia mea, no ke aha e hana ʻia ai, a pehea e hiki ai iā mākou ke pale iā mākou iho mai kēia maʻi.

He aha ke ʻano o ka 'Erythroblastosis Fetalis'?

I ka ʻōlelo maʻalahi, he mea laha ʻole kēia, ʻo ia hoʻi, ʻaʻole loaʻa i nā kānaka a pau, kahi pilikia e hiki ke kū i ka wā hāpai. Hana ʻia kēia inā he kūlike ʻole ke ʻano koko ma waena ou a me kāu pēpē i hānau ʻole ʻia. ʻAʻole nā ​​ʻokoʻa koko āpau e hoʻoulu i nā pilikia. Eia nō naʻe, kiʻekiʻe loa kēia pilikia inā he 'Rh-negative' kou ʻano koko a he 'Rh-positive' ke ʻano koko o kāu pēpē.

E noʻonoʻo, inā ua hoʻopili ʻia ʻoe i kēia koko Rh-positive, i ka wā hāpai mua a i ʻole i ka wā o ke kahe koko, hiki i ka ʻōnaehana pale o kou kino (ka ʻōnaehana e pale ai iā mākou mai nā maʻi) ke hoʻomaka e hoʻouka i nā hunaola koko ʻulaʻula o ka pēpē. Me he mea lā e hoʻouka ana i kahi ʻenemi. Hiki i kēia ke kumu i ka emi ʻana o nā hunaola koko ʻulaʻula o ka pēpē. Kāhea mākou i kēia anemia. Inā lilo kēia anemia i mea koʻikoʻi, hiki ke hoʻoweliweli i ke ola o ka pēpē inā ʻaʻole mālama ʻia.

Akā, he nūhou maikaʻi! I kēia mau lā, hiki i nā hoʻokolohua maʻamau i ka wā hāpai ke hoʻoholo i kou ʻano koko. Inā he Rh-negative ʻoe, hiki i nā kauka ke kuhikuhi i ka lāʻau lapaʻau e pale aku i kēia pilikia.

Ua kapa ʻia kēia ʻano maʻi ʻo `(alloimmune hemolytic disease of the newborn - HDN)` a me `(hemolytic disease of the fetus and newborn - HFDN)`. Akā i ka wā e kamaʻilio ai mākou e pili ana i ia mea, e hoʻohana mākou i ka huaʻōlelo `(Erythroblastosis Fetalis)`.

He aha nā hōʻailona inā loaʻa kēia maʻi i ka pēpē?

Hiki i nā pēpē i hānau ʻia me kēia maʻi (Erythroblastosis Fetalis) ke hōʻike i nā hōʻailona o ka anemia. Loaʻa iki paha i kekahi mau pēpē, aʻo kekahi poʻe e loaʻa nui paha. Eia kekahi, hiki i ka pēpē ke loaʻa ka jaundice i loko o 24 mau hola o ka hānau ʻana. Eia kekahi o nā hōʻailona:

• Melemele o nā maka a me ka ʻili.
• Ka mae koke ʻana o ka ʻili.
• Ua manaʻo ka pēpē ua palaualelo loa a make ke ola (lethargy).
• Kuʻi wikiwiki ka puʻuwai (tachycardia).
• ʻAʻohe makemake i ka waiū.

I kekahi mau hihia koʻikoʻi, hiki i ka ʻōpū a i ʻole ka pēpē hānau hou ke loaʻa i kahi maʻi weliweli i ke ola i kapa ʻia ʻo "hydrops fetalis." ʻO kāna mau hōʻailona:

• Pehu kino.
• Ka hōʻiliʻili ʻana o ka wai i loko o ka ʻōpū o ke pēpē, a i ʻole ma waena o nā ʻāpana koʻikoʻi e like me ka puʻuwai a me nā māmā.

No ke aha lā kēia e hana nei? He aha nā kumu?

ʻO kēia kūlana, i kapa ʻia ʻo "Erythroblastosis Fetalis", ke kū mai nei no ka mea, e like me ka mea i ʻōlelo ʻia ma mua, hoʻouka ka ʻōnaehana pale o kou kino i nā hunaola koko ʻulaʻula o ka pēpē.

He mau māka kūikawā ko ko kākou mau hunaola koko ʻulaʻula ma luna o lākou. Kāhea mākou iā lākou he "antigens." E noʻonoʻo i kēia mau "antigens" me he mau lepili me nā inoa ma luna o lākou. Inā ʻike kāu ʻōnaehana pale i kēia lepili, ʻaʻole ia e hoʻouka i kēlā mau hunaola koko ʻulaʻula.

ʻO kēia ma muli o ka ʻokoʻa o nā ʻano koko o kāu pēpē a me kāu pēpē. Hoʻokaʻawale ʻia nā ʻano koko ma muli o nā "antigens" ma luna o ka ʻili o nā hunaola koko ʻulaʻula. ʻElua mau ʻano koko nui a mākou e kamaʻilio nei:

• Rh factor: ʻO ia hoʻi inā maikaʻi (+) a maikaʻi ʻole paha ke koko (-).
• Nā antigens ABO: ʻO ia hoʻi ke ʻano koko A, B, AB, a i ʻole O.

Inā hāpai ʻoe, ʻo kāu ʻōnaehana pale, inā ʻaʻole ia e ʻike i nā "antigens" ma nā ʻulaʻula koko o kāu pēpē, e hoʻomaka e hana i nā "antibodies" e kūʻē iā lākou. ʻO kēia mau "antibodies" ka mea e hoʻouka i kēlā mau ʻulaʻula koko. E like me ka wā e loaʻa ai i ko mākou kino kahi germ e hoʻoulu ai i ka maʻi, e hakakā ko mākou kino iā ia. Akā no kēia mea, pono ke koko o ka pēpē e hoʻopili me kou koko. ʻO ka hapa nui o ka manawa, hana ʻia kēia i ka wā e kokoke ana ka hānau ʻana o ka pēpē. Eia naʻe, i kekahi manawa hiki i ke koko ke hui pū me ia ma mua. Eia kekahi laʻana:

• Inā hana ʻia kahi hoʻopau ʻana.
• Inā nalowale ka hāpai ʻana i ka hapalua o ka manawa, ua kapa ʻia ia he "Miscarriage".
• I ke kūlana e like me ka hāpai ectopic (aia ka hāpai ma waho o ka ʻōpū, e like me loko o ka ʻōmole fallopian).
• I ka wā e hana ai i ka "(Amniocentesis)" (kahi hoʻāʻo i hana ʻia i ka wā hāpai).
• I ka wā e hana ai i ka `(Chorionic villus sampling)` (kekahi hoʻāʻo hāpai).

Ke hana kou kino i kēia mau `(antibodies)`, hoʻomanaʻo ia iā ia. Inā loaʻa hou kēlā `(antigen)` i nā hunaola koko ʻulaʻula o ka pēpē i ka wā hāpai aʻe, e hele kēia mau `(antibodies)` a luku i kēlā mau hunaola. Kāhea mākou i kēia luku ʻana i nā hunaola koko ʻulaʻula `(hemolysis)`.

Ke kumu nui: ka kūlike ʻole o Rh

ʻO ke kumu koʻikoʻi a kaulana loa o kēia ʻano, ʻo ia ka wā he Rh-negative ʻoe a he Rh-positive kāu pēpē. Ke hana ʻia kēia, hoʻouka kāu ʻōnaehana pale i nā hunaola koko ʻulaʻula Rh-positive o kāu pēpē. Ma kahi ʻāina e like me ʻAmelika, ma kahi o 15% o ka poʻe he koko Rh-negative. I ka hapanui o nā hihia, ʻo ka makuahine a me ka makuakāne, a me ke pēpē, he Rh-positive.

ʻO ka maʻamau, ʻaʻole kēia kūlike ʻole Rh e hoʻoulu i nā pilikia nui i ka wā hāpai mua. ʻOiai inā he Rh-negative ʻoe a he Rh-positive ka pēpē, he mea kakaikahi ka hui ʻana o kou koko me ke koko o ka pēpē i ka wā hāpai e hoʻoulu ai i kahi hopena koʻikoʻi (antibodies). Eia naʻe, i ka wā e hānau ai ke pēpē, e pane maoli nō kou koko me ke koko o ka pēpē. I kēlā manawa, inā ʻaʻole ʻoe i lawe i ka lāʻau lapaʻau e pale aku i kāu ʻōnaehana pale mai ka hoʻouka ʻana iā ia, hiki i kou kino ke hoʻomohala i nā antibodies e kūʻē i nā hunaola koko ʻulaʻula Rh-positive.

A laila inā hāpai hou ʻoe, a he ʻano koko Rh-positive ko kēlā pēpē, e hele aku kēlā mau antibodies i hana ʻia ma mua a hoʻouka i nā hunaola koko ʻulaʻula o kēlā pēpē. Maopopo iā ʻoe?

Nā ʻano kūlike ʻole ʻē aʻe o ke ʻano koko

I kekahi manawa, hiki i kāu ʻōnaehana pale ke hoʻouka i nā hunaola koko ʻulaʻula o kāu pēpē ʻoiai he kūlike ʻole me kahi antigen hunaola koko ʻulaʻula kakaʻikahi. Hana ʻia kēia inā loaʻa i kāu pēpē kēlā antigen kakaʻikahi a nalowale iā ʻoe. Hana ʻia kēia inā ua hōʻike ʻia ʻoe i kēlā antigen ma o ka hāpai ʻana ma mua a i ʻole ke kahe koko a ua hoʻomohala i nā antibodies iā ia. ʻO kekahi o kēia mau antigens:

• `(Kolton)`
• `(Duffy)`
• `(Diego)`
• `(ʻAe)`
• `(Gerbich)`
• `(H)`
• `(Kell)`
• `(Kidd)`
• `(Lutheran)`
• `(MNS)`
• `(P)`
• `(Xg)`

Hiki i nā hoʻokolohua koko i hana ʻia i ka wā mua o ka hāpai ʻana ke ʻike inā ʻoe e hana ana i nā antibodies e kūʻē i kēia mau ʻano koko ʻulaʻula kakaikahi.

Pehea ka maʻamau o kēia ʻano?

Ma ka honua holoʻokoʻa, ua hōʻike ʻia ma kahi o 276 o 100,000 mau hānau ola e loaʻa ana nā pilikia hāpai e pili ana i ka kūlike ʻole o ke ʻano koko Rh. Wahi a nā kānaka noiʻi, inā ʻaʻole mālama ʻia, aia he 50% ka manawa e make ai ka pēpē i hānau ʻole ʻia a loaʻa paha nā pilikia olakino koʻikoʻi.

Akā, mai hopohopo! Me ka hoʻāʻo ʻana i ke ʻano koko a me ka lāʻau lapaʻau e pono ai, hiki ke pale ʻia nā hopena ʻino loa. Ma kekahi mau wahi o ka honua kahi i loaʻa ai ka mālama ma mua o ka hāpai ʻana, aia wale nō ma kahi o 2.5 o 100,000 mau hānau ʻana i loaʻa nā pilikia ma muli o ka Rh incompatibility. He mea hopohopo nui kēia ma Sri Lanka.

Pehea ʻoe e ʻike ai i kēia?

ʻO ka maʻamau, ma nā keʻena antenatal, e nānā ʻia kou ʻano koko a me nā "antibodies". Inā hāpai ʻoe a he ʻano koko Rh-negative kou, e nānā kāu kauka no nā "antibodies" e kūʻē i ke koko Rh-positive. Inā ʻaʻohe ou "antibodies", e hāʻawi ʻia kāu ʻōnaehana pale i kahi lāʻau lapaʻau e pale aku iā lākou mai ka hoʻokumu ʻana.

Inā hōʻoia ka hoʻāʻo ʻana ua loaʻa iā ʻoe kēia mau antibodies, ʻo ia hoʻi inā he Rh-positive ka pēpē, aia kou ʻōnaehana pale i ka pilikia o ka hoʻouka ʻana i nā hunaola koko ʻulaʻula o ka pēpē. A laila e nānā kāu kauka i kāu mau pae antibody i kēlā me kēia mau pule. Inā kiʻekiʻe loa kāu mau pae antibody, hiki ke hana ʻia nā hoʻāʻo hou aʻe e ʻike inā he anemia kāu pēpē, a pono paha ʻoe e loaʻa nā hoʻoili koko i loko o ka ʻōpū. Inā pilikia kāu pēpē i ka hānau ʻia me ka anemia koʻikoʻi, hiki i kāu kauka ke hoʻoholo e hānau koke i ka pēpē.

Ma hope o ka hānau ʻana o ka pēpē, hiki i ke kauka ke hoʻoholo i ke ʻano koko o ka pēpē. Hiki i kēia ke kōkua i ka hoʻoholo ʻana inā he anemia o ka pēpē ma muli o ka kūlike ʻole o ke ʻano koko.

ʻO nā hoʻokolohua ʻē aʻe i hana ʻia:

• Helu Koko Piha (CBC): Hiki i kēia hoʻāʻo ke nānā i ka haʻahaʻa o nā hunaola koko ʻulaʻula o ka pēpē. ʻO ka haʻahaʻa o ka pae, ʻo ka ʻoi aku ka koʻikoʻi o ka anemia.
• ʻO ka Peripheral Blood Smear (PBS): Pili kēia i ka nānā ʻana i kahi hāpana koko ma lalo o kahi microscope. Hiki i kēia ke hāʻawi i kahi manaʻo inā paha ka emi ʻana ma muli o ka luku mua ʻana o nā hunaola koko ʻulaʻula (hemolysis).
• Hoʻāʻo Bilirubin:Ana kēia i nā pae bilirubin. ʻO Bilirubin kahi huahana o ka haki ʻana o nā hunaola koko ʻulaʻula. ʻO nā pae bilirubin kiʻekiʻe (hyperbilirubinemia) e hōʻike paha ua luku ʻia nā hunaola koko ʻulaʻula.
• Hoʻāʻo Antiglobulin Pololei (DAT): Hōʻike kēia hoʻāʻo inā aia nā antibodies ma ka ʻili o nā hunaola koko ʻulaʻula o ka pēpē. ʻO ke ʻano kēia, ke hoʻouka nei ka ʻōnaehana pale o ka makuahine i nā hunaola o ka pēpē.

He aha nā lāʻau lapaʻau?

Aia ka lāʻau lapaʻau i ka wā e hāpai ana ʻoe a i ʻole ua hānau wale ʻoe i kahi pēpē.

Lapaʻau i ka wā hāpai

Inā loaʻa iā ʻoe nā antibodies e hoʻoweliweli iā ʻoe no ka Erythroblastosis Fetalis, e nānā kāu kauka i kāu mau pae antibody i kēlā me kēia mau pule. Inā kiʻekiʻe kou mau pae antibody, pono paha ʻoe e loaʻa i nā scan ultrasound hou e ʻike ai inā he anemia kāu pēpē. Inā koʻikoʻi ka anemia, pono paha kāu pēpē i nā hoʻoili koko.

Ka mālama ʻana ma hope o ka hānau ʻana o ke pēpē

Hoʻōla nā kauka i nā pēpē hānau hou me ka "Erythroblastosis Fetalis" ma ka mālama ʻana i ka anemia a me ka "hyperbilirubinemia" (jaundice). Eia nā koho lapaʻau:

• Phototherapy: Hoʻohana kēia i ka mālamalama e mālama i ka hyperbilirubinemia. Hoʻololi kēia mālamalama i ka bilirubin i nā mea e maʻalahi ke hoʻokuʻu ʻia mai ke kino o ke pēpē.
• Hoʻoili koko: Ma hope o ka hānau ʻana o ka pēpē, pono paha i ka pēpē ke hoʻoili koko e hōʻoia i ka lawa ʻana o nā hunaola koko ʻulaʻula.
• Nā Mea Hoʻoulu Erythropoiesis (ESA): He koho paha kēia no ka mālama ʻana i ka anemia ʻaʻole i koʻikoʻi e pono ai ke hoʻoili koko. Pono paha e hāʻawi ʻia me nā mea hoʻohui hao e kōkua i ka pēpē e hana i nā hunaola koko ʻulaʻula olakino.

I nā hihia koʻikoʻi, pono paha i ka pēpē ke mālama kākoʻo, e like me ka ventilator a me nā wai IV.

He aha ka mea e hana ʻia i ka pēpē ma hope o kēia kūlana?

Aia nā hopena i ke koʻikoʻi o nā hōʻailona o kāu pēpē. Hiki i ka anemia koʻikoʻi a me ka hyperbilirubinemia ke make inā ʻaʻole mālama ʻia.

Eia nō naʻe, hiki i nā pēpē me ka Erythroblastosis Fetalis ke ola i ke kūlana inā mālama pono ʻia. Pono paha lākou i nā hoʻoili koko e hoʻopiha hou i ko lākou mau hunaola koko ʻulaʻula i ka wā hāpai a/a ma hope o ka hānau ʻana. Pono ke kauka e nānā iā lākou no kekahi mau mahina e hōʻoia ʻaʻohe pilikia.

ʻAʻole anei hiki ke pale ʻia kēia?

He mea hiki nō ia! Hiki ke pale ʻia ka Erythroblastosis Fetalis ma o ka hoʻāʻo ʻana i ke ʻano koko a me ka lāʻau pale i ka wā hāpai.Kūlana. Inā he Rh-negative ʻoe, hiki iā ʻoe ke lawe i ka Rh immune globulin (Rh immune globulin - RhIg a i ʻole RhoGAM®) e pale i kou kino mai ka hana ʻana i nā antibodies e kūʻē i ke koko Rh-positive. Pono ʻoe e lawe i kēia lāʻau lapaʻau i ka 28 pule o ka hāpai ʻana, i loko o 72 mau hola o ka pau ʻana o ka hāpai ʻana (ma hope o ka hānau ʻana, ka hāʻule ʻana o ka hāpai keiki), a inā he nui ke kahe koko i ka wā hāpai (ʻoiai i ka trimester mua).

Hana wale kēia inā ʻoe e lawe i kēia lāʻau lapaʻau ma mua o ka hōʻike ʻia ʻana o kou koko i ke koko Rh-positive. ʻO ia ke kumu e nānā nui ʻia ai i nā keʻena hāpai.

Nā mea e nīnau aku ai i kāu kauka

Inā he mau nīnau hou aku kāu e pili ana i kēia, mai makaʻu e nīnau i kāu kauka a kahu maʻi paha. Eia kekahi mau laʻana:

• He aha koʻu ʻano koko?
• Aia kekahi mau "antibodies" e pono iaʻu e hopohopo?
• Pono anei au e hopohopo no ka `(Erythroblastosis Fetalis)`?
• E pono anei iaʻu ka nānā hou ʻana a i ʻole nā ​​​​​​kikoʻī pinepine ʻana i ke keʻena lapaʻau?
• Pono anei iaʻu e lawe i ka Rh immune globulin (RhIg)?
• Āhea wau e hoʻonohonoho ai i kahi manawa a e ʻimi paha i ka mālama ulia pōpilikia?

He aha ka mea e hana ai inā he Rh-positive ka makuahine a he Rh-negative ka pēpē?

ʻAʻole kēia he mea maʻamau e hopohopo ai no ka kūlike ʻole o ke ʻano koko. ʻAʻohe o kahi fetus Rh-negative i ka Rh-antigen e hiki ai i ka ʻōnaehana pale o ka makuahine ke hoʻouka. Inā ʻaʻole he mau ʻano koko ʻē aʻe, ʻaʻole pono kēia he pilikia.

Nā mea nui e hoʻomanaʻo

He mea weliweli ka manaʻo e hiki i kāu ʻōnaehana pale ponoʻī ke hoʻouka i kāu pēpē i hānau ʻole ʻia. Akā ʻo ka nūhou maikaʻi, ʻaʻole maʻamau kēia mau pilikia koko weliweli. A, hana nā kauka i kā lākou mea maikaʻi loa e pale aku i kēia mau pilikia. He ʻāpana koi ʻia ka hoʻāʻo ʻana i ke ʻano koko o ka mālama ʻana i ka wā hāpai. Eia kekahi, ʻo ka nānā ʻana a me ka mālama ʻana i nā pilikia koko e hiki ke hoʻoweliweli i kāu pēpē he ʻāpana paʻa ia o ka mālama ʻana i ka wā hāpai. E noho pū ana kāu kauka me ʻoe i kēlā me kēia ʻanuʻu o ke ala e mālama iā ʻoe a me kāu pēpē i ka palekana. No laila, mai hopohopo pono ʻole, a e hahai pono i nā ʻōlelo a ke kauka. A laila hiki iā ʻoe a me kāu pēpē ke noho olakino!

ʻErythroblastosis Fetalis, Rh incompatibility, nā pilikia hāpai, ʻano koko o ka pēpē, ʻano koko o ka makuahine, anemia, jaundice, RhoGAM