Kodi munayamba mwagwiritsapo ntchito mankhwala otchedwa Heparin? Mwina mutachitidwa opaleshoni, kapena kuti magazi asaundane, dokotala akhoza kukupatsani mankhwala awa. Komabe, ngakhale kuti ndi osowa kwambiri, heparin iyi ingayambitse thupi lathu kupanga magazi ambiri oundana ndikuchepetsa kuchuluka kwa ma platelet. Ndicho chimene timachitcha `Heparin-Induced Thrombocytopenia` kapena `(HIT)`. Musadandaule, izi zingamveke zovuta pang'ono, koma tiyeni tikambirane mwachidule.
Kodi heparin ndi chiyani? Nchifukwa chiyani HIT imachitika?
Mwachidule, heparin ndi
mankhwala oletsa magazi kuundana (ochepetsa magazi). Amagwiritsidwa ntchito poletsa magazi kuundana m'mitsempha yathu yamagazi. Madokotala amatipatsa mankhwalawo pambuyo pa opaleshoni yayikulu, kapena kusungunula magazi kuundana omwe adapangidwa kale. Komabe, nthawi zambiri, heparin ikaperekedwa kwa anthu ena, ingayambitse vuto. Apa ndi pamene
chitetezo chathu cha mthupi chimalumikizana molakwika ndi heparin ndikuyambitsa ma platelet athu. Ma platelet ndi mtundu wa selo lomwe limathandiza kuletsa kutuluka kwa magazi. Chifukwa chake, ma platelet akayambitsidwa mwanjira iyi, m'malo moletsa magazi kuundana,
amayamba kupanga magazi kuundana mosafunikira (thrombosis). Nthawi yomweyo, chiwerengero cha ma platelet chimachepanso mwachangu (thrombocytopenia). Ichi ndichifukwa chake vutoli nthawi zina limatchedwa `Heparin-Induced Thrombocytopenia and Thrombosis (HITT)`.
Tangoganizirani, n’zodabwitsa pang’ono kuti mankhwala operekedwa kuti aletse magazi kuundana angawonjezere kupanga magazi kuundana ndi kuchepetsa ma platelet, sichoncho? Koma zingatheke.
Pali mitundu iwiri ikuluikulu ya ma HIT.
Madokotala amagawa vutoli la `(HIT)` m'mitundu iwiri ikuluikulu: 1.
HIT I (Mtundu 1): Pankhaniyi, kuchuluka kwa ma platelet anu kumachepa pang'ono m'masiku oyamba mutayamba heparin, koma amabwerera mwakale mkati mwa masiku ochepa.
Imeneyi si vuto loopsa , ndipo palibe chiopsezo cha magazi kuundana, kotero palibe chithandizo chapadera chomwe chikufunika. 2.
HIT II (Mtundu 2): Imeneyi ndi mtundu womwe tiyenera kuda nkhawa nawo. Pankhaniyi, chitetezo chathu cha mthupi chimayambitsa ma platelet poyankha heparin. Izi zimapangitsa kuti kuchuluka kwa ma platelet kuchepe, ndipo pali
chiopsezo cha magazi kuundana kwambiri . Nthawi zambiri, tikamalankhula za `(HIT)`, nthawi zambiri timatanthauza mtundu woopsa uwu wotchedwa `(HIT II)`.
Ndani amene ali ndi mwayi waukulu wopeza HIT iyi?
Aliyense amene amagwiritsa ntchito heparin, mosasamala kanthu za mlingo kapena nthawi yomwe akugwiritsa ntchito, akhoza kukhala ndi vutoli. Komabe, zapezeka kuti
akazi azaka zopitilira 40 ali ndi mwayi wokulirapo wopeza vutoli. Madokotala sakudziwabe chifukwa chake anthu ena ali ndi vutoli ndi heparin ndipo ena sadziwa. Izi
Si vuto lofala kwambiri. Vuto la ``(HIT)`` limeneli limapezeka mwa anthu ochepa, pafupifupi 5%, omwe amamwa heparin kwa masiku opitilira anayi. Kodi zizindikiro za HIT ndi ziti? Kodi timazizindikira bwanji?
Ngati mukumwa heparin, dokotala wanu nthawi zambiri amafufuza kuchuluka kwa maselo m'magazi mwanu, makamaka kuchuluka kwa ma platelet. Kuchuluka kochepa kwa ma platelet kungakhale chizindikiro choyambirira cha HIT. Pafupifupi theka la anthu omwe ali ndi HIT amapanga magazi atsopano. Izi zitha kukhala deep vein thrombosis (DVT) mwendo kapena pulmonary embolism (PE). Samalani zizindikiro izi: Kuphatikiza apo, mungazindikire kupweteka, zilonda, kapena ziphuphu pakhungu pamalo omwe munabayira jakisoni wa heparin. Chofunika kwambiri: Ngati mukumwa heparin ndipo mukukumana ndi zizindikiro izi, pitani kuchipatala mwamsanga. Izi sizinthu zochedwetsa.
Kodi HIT imachitika liti?
Kawirikawiri, zizindikiro zimayamba mkati mwa masiku asanu mpaka milungu iwiri mutayamba kugwiritsa ntchito heparin. Komabe, zimathanso kuchitika nthawi zina:- KUYAMBIRA KOYAMBA: Izi zitha kuchitika mkati mwa tsiku limodzi kapena atatu mutayamba kugwiritsa ntchito heparin. Izi zitha kuchitika ngati mudagwiritsapo ntchito heparin kale (nthawi zambiri mkati mwa miyezi itatu). Kenako, thupi lanu "limakumbukira" heparin, ndikupanga ma antibodies motsutsana nayo, ndipo limakhala lokonzeka kuchitapo kanthu mwachangu.
- Kupweteka kwa mankhwala: Matendawa amatha kupitirira kwa milungu ingapo heparin itasiya kugwiritsidwa ntchito.
- Kuchedwa kuyamba kwa mankhwala: Izi zimachitika munthu atasiya kumwa mankhwala a heparin. Nthawi zambiri zimachitika masiku asanu kapena kuposerapo munthu atasiya kumwa mankhwalawo.
Kodi n’chiyani kwenikweni chimayambitsa kumenyedwa kumeneku?
`HIT` imachitika pamene mankhwala a heparin amalumikizana ndi puloteni yotchedwa `PF4` (Platelet Factor 4) m'ma platelet athu. Heparin iyi ndi `PF4` zimaphatikizana kupanga `Heparin-PF4 complex`. Tikawona kuti `Heparin-PF4 complex` m'thupi mwathu, chitetezo chathu cha mthupi chimada nkhawa ndikuyamba kupanga ma antibodies motsutsana nayo. Ma antibodies amenewa amapita ndi kumangirira ku `Heparin-PF4 complex` imeneyo. Apa ndi pomwe zonse zimayambira. Ma antibodies awa akangomanga, ma platelet amayamba kugwira ntchito nthawi yomweyo ndikuyamba kupanga magazi kuundana. Mwanjira imeneyi, `PF4` yambiri imatulutsidwa kuchokera ku ma platelet omwe amapanga magazi kuundana. Kenako `PF4` yatsopanoyo imalumikizananso ndi heparin, ndikupanga `Heparin-PF4 complex` yambiri. Ma antibodies amabwerera ndi kumangiriranso, magazi kuundana ambiri amapangidwa... Izi zimapitirira ngati chain reaction. Chifukwa cha zonsezi zopanga magazi kuundana, ma platelet m'thupi amagwiritsidwa ntchito mwachangu. Zotsatira zake, kuchuluka kwa ma platelet kumachepa. Chifukwa cha magazi ambiri oundana amenewa, magazi oundana akuluakulu omwe angawononge moyo angapangidwe, zomwe zingatseke mitsempha ndi mitsempha yathu. Kodi ndi zinthu ziti zomwe zimayambitsa HIT?
Pali zinthu zingapo zomwe zimawonjezera chiopsezo cha matenda a HIT:- Jenda lanu: Akazi ali ndi mwayi waukulu wogwidwa ndi HIV.
- Mtundu wa heparin womwe umagwiritsidwa ntchito: Kafukufuku wina akusonyeza kuti chiopsezo cha HIT chingasiyane kutengera mtundu wa heparin womwe mumamwa. Mwachitsanzo, pali umboni wina wosonyeza kuti kugwiritsa ntchito heparin yopanda magawo m'malo mwa heparin yolemera pang'ono kungachepetse chiopsezocho. Komabe, kafukufuku wowonjezereka akufunika pankhaniyi.
- Kumwa heparin atachitidwa opaleshoni: Anthu omwe amamwa heparin kuti apewe magazi kuundana atachitidwa opaleshoni amakhala ndi mwayi waukulu wopeza matenda a HIT kuposa omwe amamwa kuti athetse magazi kuundana omwe alipo kale. Chiwopsezochi chimakhala chachikulu makamaka pambuyo pa opaleshoni ya mafupa, opaleshoni ya mtima, ndi cardiopulmonary bypass .
Kodi matenda a HIT amawapeza bwanji? (Kuzindikira)
Mayeso angapo a magazi angathandize kudziwa ngati muli ndi HIT:- Kuchuluka kwa ma platelet: Izi zitha kuwona ngati kuchuluka kwa ma platelet anu kuli kotsika (thrombocytopenia).
- Kupangika kwa magazi oundana: Kuyezetsa magazi kumasonyeza ngati magazi anu amaundana.
- Kuchuluka kwa ma antibodies a PF4 m'magazi anu kungathe kudziwa ngati chitetezo chanu cha mthupi chikugwira ntchito ndi ma platelet. Kuyesa kwa ma antibodies kumeneku ndiko kumatsimikizira kupezeka kwa matenda a HIT.
Dokotala wanu angafunenso kuyitanitsa ultrasound kuti aone ngati magazi anu ali ndi magazi oundana m'miyendo yanu (DVT). Kutengera ndi momwe mulili, angafunenso kuyitanitsa mayeso kuti aone ngati magazi ali ndi magazi oundana m'malo ena, monga m'manja mwanu. Komabe, chifukwa zotsatira za mayeso a antibody awa zimatenga nthawi kuti zibwerere, madokotala sayembekezera kuti abwererenso asanayambe kulandira chithandizo. Chifukwa chakuti HIT ndi vuto lomwe lingathe kupha ngati silinalandire chithandizo, chithandizo chimatsimikiziridwa kutengera momwe mungakhalire ndi HIT. Kodi "mayeso a 4Ts" awa ndi otani?
Mayeso a `4Ts` ndi njira yowerengera kuchuluka kwa mwayi womwe ungakhale nawo `HIT`. Imapereka chidziwitso chomwe mukufuna kuti muyambe kulandira chithandizo popanda kudikira zotsatira za mayeso a antibody. Dokotala amapereka zigoli (kuyambira 0 mpaka 2) pazinthu zinayi izi:- Thrombocytopenia (kuchuluka kwa ma platelet m'magazi): Kodi kuchuluka kwa ma platelet m'magazi anu ndi kotsika bwanji?
- Nthawi (nthawi yochitira heparin): Kodi kuchuluka kwa ma platelet m'magazi anu kunatsika liti?
- Kutsekeka kwa magazi (thrombosis): Kodi pali zizindikiro za magazi kuundana?
- Zina mwa zifukwa: Kodi pangakhale chifukwa china kupatula heparin chomwe chimapangitsa kuti magazi anu akhale ochepa m'magazi?
Zigoli zikakwera, mwayi wanu woti mugonjetsedwe umawonjezeka. Kodi mankhwala a HIT ndi ati?
Gawo loyamba la chithandizo ndi kusiya kumwa heparin nthawi yomweyo. Kenako, mudzasinthidwa kupita ku mankhwala ena ochepetsa magazi. Kuchuluka kwa ma platelet anu kuyenera kuyamba kukweranso patatha masiku ochepa mutasiya kugwiritsa ntchito heparin. Mpaka nthawi imeneyo, dokotala wanu mwina adzakupatsani mankhwala ena kuti athandize kupewa magazi kuundana. Pali mankhwala angapo omwe angagwiritsidwe ntchito m'malo mwa heparin:- "Zoletsa thrombin mwachindunji" (monga `argatroban', `bivalirudin')
- `Fondaparinux`
- `Ma anticoagulants omwa mwachindunji` (mankhwala omwe amaletsa magazi kuundana omwe angatengedwe mwachindunji ndi pakamwa)
Mukangobwerera ku mlingo wa ma platelet anu ndipo chiopsezo cha magazi kuundana chifukwa cha HIT chatha, dokotala wanu angakusinthireni ku mankhwala ena ochepetsa magazi, monga warfarin. Kodi tingapewe kugwidwa ndi matenda a HIT?
Palibe chomwe mungachite kuti mupewe HIT. Komabe, dokotala wanu nthawi zonse aziyang'anira kuchuluka kwa ma platelet m'magazi anu kungathandize kuchepetsa chiopsezo cha mavuto omwe amabwera chifukwa cha heparin. Kodi mungayembekezere chiyani ngati muli ndi HIT?
Matenda a Heparin-Induced Thrombocytopenia (HIT) ndi matenda oopsa omwe amatha kupha ngati sachiritsidwa mwachangu. Magazi ambiri m'manja ndi miyendo angayambitse kuwonongeka kwa ziwalozo kwa nthawi yayitali. Magazi ambiri omwe amakhudza ziwalo zazikulu amatha kupha. Mwamwayi, chifukwa cha kudziwa bwino za HIT ndi njira zabwino zochiritsira, kuchuluka kwa anthu opulumuka kwawonjezeka kwambiri. Kuzindikira msanga, magazi asanayambe kuundana kwambiri, ndikofunikira kwambiri kuti munthu apeze zotsatira zabwino.Dokotala wanu akangoona zizindikiro za HIT, monga kuchuluka kwa ma platelet ochepa, amatha kukupatsani chithandizo chochepetsa chiopsezo cha magazi kuundana. Kodi ndimadzisamalira bwanji?
Muyenera kuonana ndi dokotala wanu nthawi zonse kuti muwone kuchuluka kwa ma platelet anu ndikuwonetsetsa kuti magazi anu sakuundana. Kuphatikiza apo, dokotala wanu adzadziwa zotsatirapo zake (monga kutuluka magazi mwa anthu ena) mukasintha kuchoka pa heparin kupita ku anticoagulant yatsopano. Pakadali pano, ndikofunikira kwambiri kumwa mankhwala anu monga momwe mwalangizidwira. Ngakhale mutakhala kuti simunaundane magazi, muyenera kumwa anticoagulant yopanda heparin kwa mwezi umodzi kapena kuposerapo. Ngati mwakhala ndi magazi oundana, mungafunike kumwa kwa nthawi yayitali. Njira yabwino yodzisamalira ndi kuuza dokotala aliyense amene adzakuthandizeni mtsogolo kuti mwakhala ndi vuto ili. Ngati mwakhala ndi `HIT`, simuyenera kumwa heparin kachiwiri.
Ngati muwona kusintha kulikonse m'thupi lanu mukumwa heparin, funani thandizo lachipatala mwamsanga. Heparin-Induced Thrombocytopenia (HIT) ndi vuto losowa kwambiri, koma chizindikiro chilichonse cha magazi kuundana chimakhala chachikulu kwambiri moti sichinganyalanyazidwe. Popanda chithandizo, HIT ikhoza kupha. Ndi chithandizo, kuchuluka kwa ma platelet anu kuyenera kubwerera mwakale ndipo chiopsezo chanu cha magazi kuundana chiyenera kuchepa. Lankhulani ndi dokotala wanu za mankhwala abwino kwambiri oti mugwiritse ntchito m'malo mwa heparin mtsogolo. Uthenga Womaliza Wopita Nawo Kunyumba
- Ngakhale heparin ndi mankhwala ofunikira omwe amaletsa magazi kuundana, nthawi zambiri sangayambitse matenda oopsa otchedwa `Heparin-Induced Thrombocytopenia (HIT).`
- Chomwe chimachitika pankhaniyi ndichakuti m'malo moletsa magazi kuundana, magazi kuundana amawonjezeka ndipo chiwerengero cha ma platelet chimachepa.
- Yang'anirani zizindikiro monga kutupa m'miyendo/m'manja mwanu, kupweteka, kupweteka pachifuwa, komanso kupuma movutikira. Ngati muzindikira izi, pitani kwa dokotala nthawi yomweyo.
- Ngati `HIT` yapezeka, choyamba kuchita ndikusiya kugwiritsa ntchito heparin. Kenako muyenera kugwiritsa ntchito mankhwala ena ochepetsa magazi.
- Ngati mwakhalapo ndi `HIT`, lembani m'mabuku anu onse azachipatala ndipo muuzeni dokotala aliyense amene mudzamuone mtsogolo. Simuyenera kupatsidwanso heparin.
Ndikukhulupirira kuti izi zikuthandizani. Khalani athanzi! Heparin, Thrombocytopenia, Magazi amaundana, Mapulateleti, Anticoagulant, HIT, Zotsatira zoyipa, Magazi amaundana, Mapulateleti, Heparin, Zotsatira zoyipa
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