Ua hoʻohana paha ʻoe i kahi lāʻau lapaʻau i kapa ʻia ʻo Heparin? Malia paha ma hope o kahi ʻoki kino, a i ʻole e pale i nā ʻūpā koko, ua hāʻawi paha ke kauka iā ʻoe i kēia lāʻau lapaʻau. Eia naʻe, ʻoiai he mea kakaikahi loa, hiki i kēia heparin ke hana i ko mākou kino e hana i nā ʻūpā koko hou aʻe a hōʻemi i ka helu o nā platelets. ʻO ia ka mea a mākou e kapa nei ʻo 'Heparin-Induced Thrombocytopenia' a i ʻole '(HIT)`. Mai hopohopo, he mea paʻakikī paha kēia, akā e kamaʻilio maʻalahi kākou.
He aha ka heparin? No ke aha e hana ʻia ai ka HIT?
I ka ʻōlelo maʻalahi, he
anticoagulant (mea hoʻomaʻalili koko) ka heparin. Hoʻohana ʻia ia e pale i ke kūkulu ʻia ʻana o nā ʻōpū koko i loko o ko kākou mau kīʻaha koko. Ua kuhikuhi nā kauka iā ia ma hope o ke ʻoki kino nui, a i ʻole e hoʻoheheʻe i kahi ʻōpū koko i kūkulu mua ʻia. Eia naʻe, he mea kakaikahi loa, ke hāʻawi ʻia ka heparin i kekahi poʻe, hiki iā ia ke hana i kahi hopena maikaʻi ʻole. ʻO kēia ka manawa
e hui hewa ai kā mākou ʻōnaehana pale me ka heparin a hoʻāla i kā mākou mau platelets ponoʻī. ʻO nā platelets kahi ʻano cell e kōkua i ka hoʻōki ʻana i ko mākou kahe koko. No laila, ke hoʻāla ʻia nā platelets ma kēia ʻano, ma kahi o ka hoʻōki ʻana i nā ʻōpū koko mai ka hana ʻana,
hoʻomaka lākou e hana i nā ʻōpū koko me ke kumu ʻole (thrombosis). I ka manawa like, emi koke ka helu o nā platelets (thrombocytopenia). ʻO ia ke kumu i kapa ʻia ai kēia ʻano i kekahi manawa ʻo 'Heparin-Induced Thrombocytopenia and Thrombosis (HITT)'.
E noʻonoʻo, he mea kupanaha iki ka mea e hoʻonui ai kahi lāʻau i hāʻawi ʻia e pale i nā ʻaʻa koko i ka hoʻokumu ʻana o nā ʻaʻa koko a hoʻemi i nā platelets, ʻeā? Akā hiki ke hana ʻia.
ʻElua ʻano nui o nā HIT.
Ua hoʻokaʻawale nā kauka i kēia kūlana `(HIT)` i ʻelua ʻano nui: 1.
HIT I (ʻAno 1): I kēia hihia, emi iki kou pae platelet i nā lā mua ma hope o ka hoʻomaka ʻana o ka heparin, akā hoʻi lākou i ka maʻamau i loko o kekahi mau lā.
ʻAʻole kēia he kūlana weliweli , a ʻaʻohe pilikia o nā ʻūlū koko, no laila ʻaʻohe pono o kahi lāʻau kūikawā. 2.
HIT II (ʻAno 2): ʻO kēia ke ʻano e pono ai mākou e hopohopo. I kēia hihia, hoʻāla kā mākou ʻōnaehana pale i nā platelets i ka pane ʻana i ka heparin. Hoʻemi kēia i nā pae platelet, a aia
kahi pilikia o nā ʻūlū koko koʻikoʻi . ʻO ka maʻamau, ke kamaʻilio mākou e pili ana i ka `(HIT)`, manaʻo pinepine mākou i kēia ʻano weliweli i kapa ʻia ʻo `(HIT II)`.
ʻO wai ka mea i ʻoi aku ka paʻakikī ke hoʻomohala i kēia HIT?
ʻO kēlā me kēia mea e hoʻohana ana i ka heparin, me ka nānā ʻole i ka nui a i ʻole ka lōʻihi o ka hoʻohana ʻana, hiki ke loaʻa i kēia maʻi. Eia nō naʻe, ua ʻike ʻia he ʻoi aku ka nui o ka loaʻa ʻana o
nā wahine ma luna o 40 mau makahiki . ʻAʻole maopopo i nā kauka ke kumu o kēia hopena i kekahi poʻe i ka heparin a ʻo kekahi ʻaʻole. ʻO kēia
ʻAʻole ia he maʻi maʻamau loa. Loaʻa kēia maʻi "(HIT)" i kahi hui liʻiliʻi o ka poʻe, ma kahi o 5%, nāna e lawe i ka heparin no nā lā ʻehā a ʻoi. He aha nā hōʻailona o HIT? Pehea mākou e ʻike ai?
Inā ʻoe e lawe ana i ka heparin, e nānā pinepine kāu kauka i ka helu o nā cell i loko o kou koko, ʻoiai ka helu o nā platelets. ʻO ka helu platelet haʻahaʻa hiki ke lilo i hōʻailona mua o HIT. Ma kahi o ka hapalua o ka poʻe me HIT e hoʻomohala i kahi clot koko hou. Hiki i kēia ke lilo i deep vein thrombosis (DVT) ma ka wāwae a i ʻole ka pulmonary embolism (PE). E makaʻala i kēia mau hōʻailona: Eia kekahi, e ʻike paha ʻoe i ka ʻeha, kahi ʻeha, a i ʻole ka ʻulaʻula o ka ʻili ma kahi o ka inikini heparin. ʻO ka mea nui loa: Inā ʻoe e lawe ana i ka heparin a loaʻa iā ʻoe kekahi o kēia mau hōʻailona, e ʻimi koke i ke kōkua lapaʻau . ʻAʻole kēia he mea e hoʻopaneʻe ai.
Āhea ka manawa e hana ʻia ai ka HIT?
ʻO ka hapa pinepine, hoʻomaka nā hōʻailona i loko o ʻelima mau lā a ʻelua pule o ka hoʻomaka ʻana o ka heparin. Eia nō naʻe, hiki iā lākou ke loaʻa i nā manawa ʻē aʻe:- HIT hoʻomaka mua: Hiki ke hana i loko o hoʻokahi a ʻekolu mau lā o ka hoʻomaka ʻana o ka heparin. ʻOi aku ka maʻalahi o kēia inā ua hoʻohana mua ʻoe i ka heparin (ʻo ka maʻamau i loko o ʻekolu mahina). A laila, "hoʻomanaʻo" kou kino i ka heparin, e hana ana i nā antibodies e kūʻē iā ia, a ua mākaukau e pane koke.
- HIT paʻakikī: Hiki i kēia ʻano ke hoʻomau no nā pule ma hope o ka hoʻōki ʻana i ka heparin.
- HIT hoʻomaka lohi: Hana ʻia kēia ma hope o ka hoʻōki ʻia ʻana o ka lāʻau heparin. ʻO ka maʻamau, hana ʻia ia i ʻelima mau lā a ʻoi aku paha ma hope o ka hoʻōki ʻana i ka lāʻau.
He aha ke kumu maoli o kēia HIT?
ʻO ka `HIT` ke hoʻopaʻa ʻia ka lāʻau heparin i kahi protein i kapa ʻia ʻo `PF4` (Platelet Factor 4) i loko o kā mākou mau platelets. Hoʻohui kēia heparin a me `PF4` e hana i kahi `Heparin-PF4 complex`. Ke ʻike mākou i kēlā `Heparin-PF4 complex` i loko o ko mākou kino, hopohopo ko mākou ʻōnaehana pale a hoʻomaka e hana i nā antibodies e kūʻē iā ia. Hele kēia mau antibodies a hoʻopaʻa i kēlā `Heparin-PF4 complex`. Ma laila e hoʻomaka ai nā mea āpau. I ka wā e hoʻopaʻa ai kēia mau antibodies, hoʻāla koke ʻia nā platelets a hoʻomaka e hana i nā clots koko. Ma kēia ʻano, hoʻokuʻu ʻia ka nui o `PF4` mai nā platelets e hana i nā clots koko. A laila hoʻopaʻa pū kēlā `PF4` i ka heparin, e hana ana i ka `Heparin-PF4 complex` hou aʻe. Hoʻi mai nā antibodies a hoʻopaʻa hou iā ia, hana ʻia nā clots koko hou aʻe ... Hoʻomau kēia e like me ka hopena kaulahao. Ma muli o kēia hana clot koko a pau, hoʻohana koke ʻia nā platelets i loko o ke kino. ʻO ka hopena, emi ka pae platelet. Ma muli o kēia nui o ke koko e paʻa ana, hiki ke hana ʻia nā ʻōpū koko nui e hoʻoweliweli ana i ke ola, e ālai ana i ko kākou mau aa koko a me nā ʻaʻa. He aha nā kumu pilikia no ka HIT?
Aia kekahi mau kumu e hoʻonui ai i ka pilikia o ka hoʻomohala ʻana i ka HIT:- Kou kāne: ʻOi aku ka nui o ka pilikia o nā wāhine i ka HIT.
- Ke ʻano o ka heparin i hoʻohana ʻia: Hōʻike kekahi mau noiʻi e ʻokoʻa paha ka pilikia o ka HIT ma muli o ke ʻano o ka heparin āu e lawe ai. No ka laʻana, aia kekahi mau hōʻike e hiki ai i ka hoʻohana ʻana i ka heparin unfractionated ma kahi o ka heparin kaumaha-molecular haʻahaʻa ke hōʻemi i ka pilikia. Eia nō naʻe, pono ka noiʻi hou aku ma kēia.
- ʻO ka lawe ʻana i ka heparin ma hope o ke ʻoki kino: ʻOi aku ka nui o ka poʻe e lawe ana i ka heparin e pale i nā ʻūlū koko ma hope o ke ʻoki kino e loaʻa iā lākou ka HIT ma mua o ka poʻe e lawe ana ia mea e mālama i kahi ʻūlū koko. He kiʻekiʻe loa kēia pilikia ma hope o ke ʻoki kino orthopedic, ke ʻoki kino puʻuwai, a me ka cardiopulmonary bypass .
Pehea e ʻike ʻia ai ka HIT? (Diagnosis)
Hiki i kekahi mau hoʻāʻo koko ke kōkua i ka hoʻoholo inā loaʻa iā ʻoe ʻo HIT:- Nā pae platelet: Hiki i kēia ke nānā inā haʻahaʻa kāu helu platelet (thrombocytopenia).
- Ka hoʻokumu ʻana o ke koko: Hōʻike nā hoʻāʻo koko inā he ʻūlū kou koko.
- Nā pae antibody PF4: ʻO ka nui o nā antibody PF4 i loko o kou koko e hiki ke hoʻoholo inā e hoʻāla ana kāu ʻōnaehana pale i nā platelets. ʻO kēia hoʻāʻo antibody ka mea e hōʻoia i ka hōʻoia o HIT.
Hiki i kāu kauka ke kauoha i kahi ultrasound e nānā i nā ʻōpū koko i kou mau wāwae (DVT). Ma muli o kou kūlana, hiki iā lākou ke kauoha i nā hoʻokolohua e nānā i nā ʻōpū koko ma nā wahi ʻē aʻe, e like me kou mau lima. Eia nō naʻe, no ka mea, ua lōʻihi ka manawa e hoʻi mai ai nā hopena o kēia hoʻāʻo antibody, ʻaʻole kali nā kauka no ka hoʻi ʻana mai ma mua o ka hoʻomaka ʻana i ka lāʻau. No ka mea, he kūlana hiki ke make inā waiho ʻole ʻia, hoʻoholo ʻia ka lāʻau ma muli o ka nui o kou loaʻa ʻana o ka HIT. He aha kēia "hoʻāʻo 4T"?
ʻO ka hoʻāʻo `4Ts` he ʻōnaehana helu e kuhi ana i ka nui o kou loaʻa ʻana i ka `HIT`. Hāʻawi ia i ka ʻike e pono ai ʻoe e hoʻomaka i ka lāʻau lapaʻau me ka ʻole o ke kali ʻana i nā hopena o ka hoʻāʻo antibody. Hāʻawi ke kauka i kahi helu (mai 0 a 2) no kēia mau mea ʻehā:- Thrombocytopenia (helu platelet haʻahaʻa): Pehea ka haʻahaʻa o kāu helu platelet?
- Ka Manawa (ka manawa o ka pane ʻana i ka heparin): I ka manawa hea i hāʻule ai kou mau pae platelet?
- ʻO ka Thrombosis (ʻū koko): Aia kekahi mau hōʻailona o ke koko?
- Nā kumu ʻē aʻe: Aia paha kekahi kumu ʻē aʻe ma mua o ka heparin no kou helu platelet haʻahaʻa?
ʻO ke kiʻekiʻe o ka helu, ʻo ke kiʻekiʻe o ka manawa kūpono e loaʻa ai kahi `HIT`. He aha nā lāʻau lapaʻau no ka HIT?
ʻO ka hana mua i ka mālama ʻana, ʻo ia ke hoʻōki koke i ka lawe ʻana i ka heparin. A laila, e hoʻololi ʻia ʻoe i kahi lāʻau hoʻokahe koko ʻē aʻe. Pono e hoʻomaka hou ka helu o kāu platelet e piʻi i loko o kekahi mau lā ma hope o ka hoʻōki ʻana i ka heparin. A hiki i kēlā manawa, e kuhikuhi paha kāu kauka i kahi lāʻau ʻē aʻe e kōkua i ka pale ʻana i ka hoʻokumu ʻana o nā ʻōpū koko. Aia kekahi mau lāʻau lapaʻau e hiki ke hoʻohana ʻia ma kahi o ka heparin:- ``Nā mea hoʻopale thrombin pololei'' (e laʻa me `argatroban', `bivalirudin')
- ʻO Fondaparinux
- ʻO nā lāʻau anticoagulant waha pololei (nā lāʻau lapaʻau e pale ai i nā ʻōpū koko hiki ke lawe pololei ʻia ma ka waha)
Ke hoʻi hou kāu mau pae platelet i ka maʻamau a ua hala ka pilikia o ke koko ma muli o HIT, hiki i kāu kauka ke hoʻololi iā ʻoe i kahi lāʻau lapaʻau ʻē aʻe e hoʻokahe koko ai, e like me warfarin. Hiki iā kākou ke pale aku i ka HIT?
ʻAʻohe mea hiki iā ʻoe ke hana e pale aku ai i ka HIT. Eia nō naʻe, ʻo ka nānā mau ʻana o kāu kauka i kāu mau pae platelet hiki ke kōkua i ka hōʻemi ʻana i ka pilikia o nā pilikia mai ka heparin. He aha kāu e manaʻo ai inā loaʻa iā ʻoe ʻo HIT?
He maʻi koʻikoʻi ka Heparin-Induced Thrombocytopenia (HIT) hiki ke make inā ʻaʻole mālama koke ʻia. Hiki i nā ʻōpū koko nui ma nā lima a me nā wāwae ke hōʻeha lōʻihi i kēlā mau ʻōpū. Hiki ke make nā ʻōpū koko e hoʻopilikia i nā ʻōpū nui. ʻO ka mea pōmaikaʻi, me ka hoʻonui ʻia o ka ʻike o HIT a me nā koho lapaʻau maikaʻi aʻe, ua hoʻomaikaʻi nui ʻia nā helu ola. ʻO ka ʻike mua ʻana, ma mua o ka ulu ʻana o nā ʻōpū koko koʻikoʻi, ke kī i kahi hopena maikaʻi.Ke ʻike kāu kauka i nā hōʻailona o HIT, e like me ka helu platelet haʻahaʻa, hiki iā lākou ke kuhikuhi i ka lāʻau e hōʻemi i ka pilikia o nā ʻōpū koko weliweli. Pehea wau e mālama ai iaʻu iho?
Pono ʻoe e ʻike pinepine i kāu kauka e nānā i kāu mau pae platelet a e hōʻoia ʻaʻole ʻoe e ulu ana i nā clots koko. Eia kekahi, e ʻike kāu kauka i nā hopena ʻaoʻao hiki (e like me ke kahe ʻana o ke koko i kekahi poʻe) ke hoʻololi mai ka heparin i kahi anticoagulant hou. I kēia manawa, he mea nui loa ia e lawe i kāu lāʻau lapaʻau e like me ke kauoha. ʻOiai inā ʻaʻole ʻoe i loaʻa i kahi clot koko, pono ʻoe e lawe i kahi anticoagulant non-heparin no hoʻokahi mahina. Inā loaʻa iā ʻoe kahi clot koko, pono paha ʻoe e lawe iā ia no ka lōʻihi. ʻO ke ala maikaʻi loa e mālama ai iā ʻoe iho, ʻo ia ke haʻi aku i kekahi kauka e mālama iā ʻoe i ka wā e hiki mai ana ua loaʻa iā ʻoe kēia pilikia. Inā ua loaʻa iā ʻoe ka 'HIT', ʻaʻole pono ʻoe e lawe hou i ka heparin.
Inā ʻike ʻoe i kekahi mau loli i kou kino i ka wā e lawe ana i ka heparin, e ʻimi koke i ke kōkua lapaʻau. He maʻi laha ʻole ka Heparin-Induced Thrombocytopenia (HIT), akā he mea koʻikoʻi loa kēlā me kēia hōʻailona o kahi ʻōpū koko e hoʻowahāwahā ʻia. Me ka ʻole o ka lāʻau lapaʻau, hiki i ka HIT ke make. Me ka lāʻau lapaʻau, pono e hoʻi hou kāu mau pae platelet i ka maʻamau a pono e emi iho kou pilikia o nā ʻōpū koko. E kamaʻilio me kāu kauka e pili ana i ka lāʻau lapaʻau maikaʻi loa e hoʻohana ai ma kahi o ka heparin i ka wā e hiki mai ana. Leka Hoʻihoʻi Hope Loa
- ʻOiai he lāʻau lapaʻau koʻikoʻi ka heparin e pale ai i nā ʻūpā koko, ʻaʻole hiki iā ia ke hana i kahi maʻi koʻikoʻi i kapa ʻia ʻo 'Heparin-Induced Thrombocytopenia (HIT).'
- ʻO ka mea e hana ʻia ma kēia hihia, ma kahi o ke kāohi ʻana i nā ʻaʻa koko, hoʻonui ʻia ke kūkulu ʻia ʻana o nā ʻaʻa koko a emi iho ka helu o nā platelets.
- E makaʻala i nā hōʻailona e like me ka pehu ʻana i kou mau wāwae/lima, ka ʻeha, ka ʻeha o ka umauma, a me ka paʻakikī o ka hanu ʻana. Inā ʻike ʻoe i kēia mau mea, e ʻike koke i ke kauka.
- Inā ʻike ʻia ka `HIT`, ʻo ka mea mua e hana ai, ʻo ia ke hoʻōki i ka heparin. A laila pono ʻoe e hoʻohana i nā lāʻau lapaʻau hoʻokahe koko ʻē aʻe.
- Inā ua loaʻa iā ʻoe ka `HIT`, e kākau i loko o kāu mau moʻolelo lapaʻau a pau a haʻi i kekahi kauka āu e ʻike ai i ka wā e hiki mai ana. ʻAʻole pono e hāʻawi hou ʻia ʻoe i ka heparin.
Manaʻolana wau he mea pono kēia ʻike iā ʻoe. E noho olakino! Heparin, Thrombocytopenia, Nā ʻōpū koko, Platelets, Anticoagulant, HIT, ʻaoʻao hopena, Nā ʻōpū koko, Platelets, Heparin, Nā hopena ʻaoʻao
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