Wali olina okukozesa eddagala eriyitibwa Heparin? Oboolyawo oluvannyuma lw’okulongoosebwa, oba okuziyiza omusaayi okuzimba, omusawo ayinza okuba nga yakuwa eddagala lino. Kyokka wadde nga si ttono nnyo, heparin ono asobola okuleetera omubiri gwaffe okukola omusaayi omungi n’okukendeeza ku muwendo gw’obutoffaali obuyitibwa platelets. Ekyo kye tuyita `Heparin-Induced Thrombocytopenia` oba `(HIT)`. Tofaayo, kino kiyinza okuwulikika ng’ekizibu katono, naye ka twogere ku nsonga eno mu ngeri ennyangu.
Heparin kye ki? Lwaki HIT ebaawo?
Mu ngeri ennyangu, heparin ddagala
eriziyiza okuzimba omusaayi (ekigonza omusaayi). Kikozesebwa okuziyiza ebizimba by’omusaayi okutondebwa mu misuwa gyaffe. Abasawo bagiwandiika oluvannyuma lw’okulongoosebwa ennyo, oba okusaanuusa ekizimba ky’omusaayi ekyatondebwa edda. Wabula si bulijjo nnyo, heparin bw’eweebwa abantu abamu, esobola okuleeta obuzibu. Kino kye kiseera
abaserikale baffe abaserikale bwe beegatta mu nsobi ne heparin ne bakola platelets zaffe. Platelets kika kya butoffaali obuyamba okukomya omusaayi gwaffe. Kale, platelets bwe zikolebwa mu ngeri eno, mu kifo ky’okuyimiriza okuzimba omusaayi okukola,
zitandika okukola omusaayi mu ngeri eteetaagisa (thrombosis). Mu kiseera kye kimu, omuwendo gwa platelets nagwo gukendeera mangu (thrombocytopenia). Eno y’ensonga lwaki embeera eno oluusi eyitibwa `Heparin-Induced Thrombocytopenia and Thrombosis (HITT)`.
Teebereza, kyewuunyisa katono nti eddagala eriweebwa okuziyiza okuzimba omusaayi lyandiyongedde okuzimba omusaayi n’okukendeeza ku platelets, nedda? Naye kiyinza okubaawo.
Waliwo ebika bya HIT bibiri ebikulu.
Abasawo embeera eno eya `(HIT)` bagigabanya mu bika bibiri ebikulu: 1.
HIT I (Ekika 1): Mu mbeera eno, emiwendo gy’obutoffaali bwo (platelets) gikendeera katono mu nnaku ezisooka oluvannyuma lw’okutandika okukozesa heparin, naye ne gidda mu mbeera eya bulijjo mu nnaku ntono.
Eno si mbeera ya bulabe , era tewali bulabe bwa kuzimba musaayi, n’olwekyo tekyetaagisa bujjanjabi bwa njawulo. 2.
HIT II (Ekika 2): Kino kye kika kye twetaaga okweraliikirira. Mu mbeera eno, abaserikale baffe abaserikale bakola obutoffaali obuyitibwa platelets nga buddamu heparin. Kino kireetera obutoffaali bw’omusaayi okukendeera, era waliwo
akabi k’okuzimba omusaayi mu ngeri ey’amaanyi . Ebiseera ebisinga, bwe twogera ku `(HIT)`, tutera okutegeeza ekika kino eky'akabi ekiyitibwa `(HIT II)`.
Ani asinga okukulaakulanya HIT eno?
Omuntu yenna akozesa eddagala lya heparin, awatali kufaayo ku ddoozi oba ebbanga ly’amaze ng’akozesa, asobola okufuna embeera eno. Wabula kizuuliddwa nti
abakyala abasukka emyaka 40 batera okubufuna. Abasawo n’okutuusa kati tebamanyi bulungi lwaki abantu abamu balina embeera eno ku heparin ate abalala tebalina. No
Si mbeera ya bulijjo nnyo. Embeera eno eya ``(HIT)`` ebeerawo mu kibinja ky'abantu abatono, nga 5%, abamira heparin okumala ennaku ezisukka mu nnya. Bubonero ki obw’obulwadde bwa HIT? Tukitegeera tutya?
Bw’oba omira eddagala lya heparin, omusawo ajja kutera okukebera omuwendo gw’obutoffaali mu musaayi gwo naddala omuwendo gw’obutoffaali obuyitibwa platelets. Omuwendo gwa platelet omutono guyinza okuba akabonero akasooka akalaga nti alina HIT. Nga kitundu ku bantu abalina HIT bafuna okuzimba omusaayi omupya. Kino kiyinza okuba okuzimba emisuwa emiwanvu (DVT) mu kigere oba okuzimba amawuggwe (PE). Weetegereze obubonero buno: Okugatta ku ekyo, oyinza okulaba obulumi, okulumwa oba okusiiyibwa ku lususu mu kifo we baakubye empiso ya heparin. Ekisinga obukulu: Bw’oba omira eddagala lya heparin n’ofuna obubonero bwonna ku buno, genda mu ddwaaliro ery’amangu mu bwangu. Kino si kintu kya kulwawo.
HIT ebaawo ddi?
Ebiseera ebisinga, obubonero butandika mu nnaku ttaano okutuuka ku wiiki bbiri ng’omaze okutandika okukozesa heparin. Kyokka era zisobola okubaawo mu biseera ebirala:- HIT etandika amangu: Kino kiyinza okubaawo mu nnaku emu oba ssatu ng’omaze okutandika okukozesa heparin. Kino kitera okubaawo singa oba okozesezza heparin emabegako (ebiseera ebisinga mu myezi esatu). Olwo, omubiri gwo "gujjukira" heparin, ne gukola antibodies ezigiziyiza, era nga gwetegefu okukola amangu.
- Refractory HIT: Embeera eno esobola okumala wiiki eziwera nga heparin eyimiriziddwa.
- Okulwawo okutandika HIT: Kino kibaawo oluvannyuma lw’obujjanjabi bwa heparin okuyimirizibwa. Ebiseera ebisinga bubaawo nga wayise ennaku ttaano oba okusingawo ng’omaze okuyimiriza eddagala.
Kiki ddala ekivaako HIT eno?
`HIT` ebaawo ng’eddagala lya heparin lyesibye ku puloteyina eyitibwa `PF4` (Platelet Factor 4) mu platelets zaffe. Heparin eno ne `PF4` byegattira wamu ne bikola `Heparin-PF4 complex`. Bwe tulaba nti `Heparin-PF4 complex` mu mubiri gwaffe, abaserikale baffe abaserikale beeraliikirira ne batandika okukola obutoffaali obuziyiza endwadde. Antibodies zino zigenda ne zisiba ku `Heparin-PF4 complex` eyo. Wano byonna we bitandikira. Amangu ddala ng’obuziyiza buno bwesibye, amangu ago obusimu obuyitibwa platelets bukola ne butandika okukola okuzimba omusaayi. Mu ngeri eno, `PF4` endala efuluma okuva mu platelets ezikola okuzimba omusaayi. Olwo eyo eyaakatuuka `PF4` nayo yeekwata ku heparin, n'ekola `Heparin-PF4 complex` endala. Antibodies zikomawo ne ziddamu okugisiba, omusaayi omulala ne gukola... Kino kigenda mu maaso nga chain reaction. Olw’okuba omusaayi guno gwonna gukola okuzimba, obutoffaali obuyitibwa platelets mu mubiri buggwaawo mangu. N’ekyavaamu, omuwendo gw’obutoffaali obukola omusaayi gukendeera. Olw’okuba omusaayi guyitiridde okuzimba, omusaayi omunene oguyinza okutta obulamu buyinza okutondebwawo, ne guzibikira emisuwa n’emisuwa gyaffe. Biki ebiyinza okuvaako obulwadde bwa HIT?
Waliwo ebintu ebiwerako ebyongera ku bulabe bw’okulwala HIT:- Ekikula kyo: Abakyala batera okufuna HIT.
- Ekika kya heparin ekozesebwa: Okunoonyereza okumu kulaga nti akabi k’okulwala HIT kayinza okwawukana okusinziira ku kika kya heparin ky’omira. Ng’ekyokulabirako, waliwo obukakafu obumu obulaga nti okukozesa heparin etali ya bitundutundu mu kifo ky’okukozesa heparin ow’obuzito bwa molekyu entono kiyinza okukendeeza ku bulabe. Kyokka, kyetaagisa okunoonyereza okusingawo ku nsonga eno.
- Okumira heparin oluvannyuma lw’okulongoosebwa: Abantu abamira heparin okuziyiza okuzimba omusaayi oluvannyuma lw’okulongoosebwa batera okufuna HIT okusinga abo abamira okujjanjaba omusaayi ogubaddewo. Obulabe buno buba bungi nnyo naddala oluvannyuma lw’okulongoosebwa amagumba, okulongoosebwa omutima, n’okuyita ku mutima n’amawuggwe .
HIT ezuulibwa etya? (Okuzuula obulwadde)
Okukebera omusaayi okuwerako kuyinza okuyamba okuzuula oba olina HIT:- Emiwendo gy’obutoffaali obukola omusaayi: Kino kiyinza okukebera oba omuwendo gw’obutoffaali bw’omubiri gwo mutono (thrombocytopenia).
- Okukola omusaayi: Okukebera omusaayi kulaga oba omusaayi gwo guzimba.
- Emiwendo gy’obuziyiza bwa PF4: Omuwendo gw’obuziyiza bwa PF4 mu musaayi gwo gusobola okuzuula oba abaserikale b’omubiri bo bakola platelets. Okukebera kuno okw’obutoffaali obuziyiza endwadde kwe kukakasa okuzuula obulwadde bwa HIT.
Omusawo ayinza n’okulagira okukebera omusaayi (Ultrasound) okukebera oba omusaayi gukutte mu magulu (DVT). Okusinziira ku mbeera gy’olimu, bayinza n’okulagira okukeberebwa okukebera oba omusaayi guzimba mu bitundu ebirala, gamba ng’emikono gyo. Wabula olw’okuba ebyava mu kukeberebwa kuno okw’obutoffaali obuziyiza endwadde bitwala ekiseera okudda, abasawo tebalinda kudda nga tebannatandika kujjanjaba. Olw’okuba HIT mbeera eyinza okutta omuntu singa tegijjanjabwa, obujjanjabi busalibwawo okusinziira ku mikisa gy’olina okuba n’obulwadde bwa HIT. Kino "ekigezo kya 4Ts" kye ki?
Ekigezo kya `4Ts` nkola ya bubonero ebalirira emikisa gy'olina okuba ne `HIT`. Ewa amawulire g’olina okutandika okujjanjaba nga tolinze bivudde mu kukebera obutoffaali obuziyiza endwadde. Omusawo awa obubonero (okuva ku 0 okutuuka ku 2) ku nsonga zino ennya:- Thrombocytopenia (omuwendo gw’obutoffaali obutono): Omuwendo gw’obutoffaali obutono zo guli wansi gutya?
- Ebiseera (ekiseera ky’okola ku heparin): Ddi emiwendo gy’obutoffaali bwo (platelets) gyakka?
- Thrombosis (okuzimba omusaayi): Waliwo obubonero obulaga nti omusaayi guzimba?
- oEbirala ebivaako: Wandibaawo ensonga endala okuggyako heparin lwaki omuwendo gwa platelet zo omutono?
Obukodyo gye bukoma okuba obunene, n'omukisa gw'ofuna `HIT` gye gukoma okuba omunene. Bujjanjabi ki obuweebwa obulwadde bwa HIT?
Ekisooka mu bujjanjabi kwe kulekera awo okumira eddagala lya heparin mu bwangu. Olwo, ojja kukyusibwa odde ku ddagala eddala erikendeeza omusaayi. Omuwendo gwa platelet zo gulina okutandika okuddamu okweyongera mu nnaku ntono ng’omaze okuyimiriza heparin. Okutuusa olwo, omusawo ajja kukuwa eddagala eddala okuyamba okuziyiza okuzimba omusaayi. Waliwo eddagala eriwerako eriyinza okukozesebwa mu kifo kya heparin:- ``Ebiziyiza obutereevu thrombin'' (okugeza `argatroban', `bivalirudin')
- `Fondaparinux`
- `Direct oral anticoagulants` (eddagala eriziyiza okuzimba omusaayi eriyinza okumira butereevu mu kamwa)
Omuwendo gw’omusaayi gwo bwe gumala okudda mu mbeera eya bulijjo era ng’obulabe bw’okuzimba omusaayi olw’obulwadde bwa HIT buyise, omusawo ayinza okukukyusa n’akozesa eddagala eddala erigonza omusaayi, gamba nga warfarin. Tusobola okuziyiza HIT?
Mazima ddala tewali ky'oyinza kukola kuziyiza HIT. Kyokka, okubeera n’omusawo wo buli kiseera okulondoola emiwendo gy’obutoffaali bw’omusaayi (platelets) kiyinza okuyamba okukendeeza ku buzibu obuva ku heparin. Kiki ky'osuubira singa oba olina HIT?
Heparin-Induced Thrombocytopenia (HIT) mbeera ya maanyi era eyinza okutta omuntu singa tegijjanjabwa mangu. Okuzimba omusaayi omunene mu mikono n’amagulu kuyinza okwonoona ebitundu ebyo okumala ebbanga eddene. Okuzimba omusaayi okukosa ebitundu ebikulu kuyinza okutta omuntu. Ekirungi, olw’okumanya okweyongera ku HIT n’engeri z’obujjanjabi ennungi, emiwendo gy’abawona giteredde nnyo. Okuzuula amangu, nga tekunnaba kuzimba musaayi ogw’amaanyi, kikulu nnyo mu kuvaamu ebirungi.Omusawo bw’amala okulaba obubonero bwa HIT, gamba ng’omuwendo gw’obutoffaali obutono, asobola okukuwa obujjanjabi okukendeeza ku bulabe bw’okuzimba omusaayi mu ngeri ey’akabi. Nze nneerabirira ntya?
Ojja kwetaaga okulaba omusawo buli kiseera okulondoola emiwendo gy’obutoffaali obukola omusaayi n’okukakasa nti tofuna kuzimba musaayi. Okugatta ku ekyo, omusawo wo ajja kumanya ebizibu ebiyinza okuvaamu (nga okuvaamu omusaayi mu bantu abamu) ng’akyusa okuva ku heparin n’adda ku ddagala eppya eriziyiza okuzimba omusaayi. Mu kiseera kino, kikulu nnyo okumira eddagala lyo nga bwe likulagiddwa. Ne bw’oba tofunye musaayi, ojja kwetaaga okumira eddagala eriziyiza okuzimba omusaayi eritali lya heparin okumala waakiri omwezi mulamba. Bw’oba obadde n’omusaayi oguzimba, kiyinza okukwetaagisa okugumira okumala ebbanga eddene. Engeri esinga okwerabirira kwe kugamba omusawo yenna akujjanjaba mu biseera eby’omu maaso nti obadde n’ekizibu kino. Bwoba obadde ne `HIT`, tolina kuddamu kumira heparin.
Bw’olaba enkyukakyuka yonna mu mubiri gwo ng’omira eddagala lya heparin, genda mangu omusawo ow’amangu. Heparin-Induced Thrombocytopenia (HIT) mbeera etatera kulabika, naye akabonero konna akalaga nti omusaayi guzimba kazibu nnyo okubuusa amaaso. Awatali bujjanjabi, HIT eyinza okutta omuntu. Bw’ofuna obujjanjabi, emiwendo gy’obutoffaali bw’omusaayi (platelets) girina okudda mu mbeera eya bulijjo era n’obulabe bw’okuzimba omusaayi bulina okukendeera. Yogerako n’omusawo wo ku ddagala erisinga obulungi ly’oyinza okukozesa mu kifo ky’okukozesa heparin ng’ogenda mu maaso. Obubaka Obusembayo Okutwala Awaka
- Wadde nga heparin ddagala ddene eriziyiza omusaayi okuzimba, terutera kuleeta mbeera ya maanyi eyitibwa `Heparin-Induced Thrombocytopenia (HIT).`
- Ekibaawo mu mbeera eno nti mu kifo ky’okuziyiza omusaayi okuzimba, okutondebwa kw’omusaayi kweyongera ate omuwendo gw’obutoffaali obuyitibwa platelets ne gukendeera.
- Beera ku bunkenke okulaba obubonero ng’okuzimba mu magulu/emikono gyo, obulumi, okulumwa mu kifuba, n’okukaluubirirwa okussa. Bw’olaba bino, laba omusawo mu bwangu.
- Singa `HIT` ezuulibwa, ekintu ekisooka okukola kwe kuyimiriza heparin. Olwo ojja kwetaaga okukozesa eddagala eddala erigonza omusaayi.
- Bwoba obadde ne `HIT`, giwandiike mu biwandiiko byo byonna eby'obujjanjabi era obuulire omusawo yenna gw'olaba mu biseera eby'omu maaso. Tolina kuddamu kuweebwa ddagala lya heparin.
Nsuubira nti amawulire gano ga mugaso gy’oli. Sigala nga oli mulamu bulungi! Heparin, Thrombocytopenia, Okuzimba omusaayi, Platelets, Anticoagulant, HIT, Side effect, Okuzimba omusaayi, Platelets, Heparin, Ebizibu
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