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Heparin ni iki? Kuki HIT iba?
Muri make, heparin ni umuti ugabanya amaraso. Ukoreshwa mu gukumira kuzura kw'amaraso mu mitsi yacu. Abaganga bayitanga nyuma yo kubagwa cyane, cyangwa mu gushonga amaraso yamaze gushonga. Ariko, ni gake cyane, iyo heparin ihawe abantu bamwe, ishobora gutera ingaruka mbi. Aha niho ubudahangarwa bw'umubiri bwacu bwivanga na heparin bugakoresha platelets zacu bwite. Platelets ni ubwoko bw'uturemangingo dufasha guhagarika kuva kwacu. Rero, iyo platelets zikozwe muri ubu buryo, aho guhagarika kuzura kw'amaraso, zitangira gukora kuzura kw'amaraso bitari ngombwa (thrombosis). Muri icyo gihe, umubare wa platelets nawo ugabanuka vuba (thrombocytopenia). Niyo mpamvu iyi ndwara rimwe na rimwe yitwa Heparin-Induced Thrombocytopenia and Thrombosis (HITT).Tekereza gato, biratangaje ko umuti utangwa kugira ngo urinde kubyimba kw'amaraso wakongera ukwirema kw'amaraso no kugabanya platelets, si byo se? Ariko birashoboka.
Hari ubwoko bubiri bw'ingenzi bwa HITs.
Abaganga bagabanya ubu bwoko bwa (HIT) mo ubwoko bubiri bw'ingenzi: 1. HIT I (Ubwoko bwa 1): Muri iki gihe, urugero rwa platelet yawe rugabanuka gato mu minsi mike ya mbere nyuma yo gutangira heparin, ariko rusubira ku buryo busanzwe mu minsi mike. Ubu si ikibazo giteje akaga , kandi nta ngaruka zo kubumba amaraso, bityo nta buvuzi bwihariye bukenewe. 2. HIT II (Ubwoko bwa 2): Ubu ni bwo bwoko tugomba kwitaho. Muri iki gihe, ubudahangarwa bwacu bw'umubiri bukoresha platelet mu gusubiza heparin. Ibi bituma urugero rwa platelet rugabanuka, kandi hari n'ingaruka zo kubumba amaraso cyane . Ubusanzwe, iyo tuvuze (HIT), akenshi tuba dushaka kuvuga ubwoko buteje akaga bwitwa (HIT II).
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Umuntu wese ukoresha heparin, uko ingano cyangwa igihe akoresha, ashobora kuyirwara. Ariko, byagaragaye ko abagore barengeje imyaka 40 bafite amahirwe make yo kuyirwara. Abaganga ntibaramenya neza impamvu bamwe bagira iyi ndwara kuri heparin abandi ntibayirwara. IbiNtabwo ari indwara ikunze kugaragara cyane. Iyi ndwara ya (HIT) igaragara mu itsinda rito ry'abantu, bagera kuri 5%, bafata heparin mu gihe kirenga iminsi ine.Ni ibihe bimenyetso bya HIT? Twabimenya dute?
Niba ufata heparin, muganga wawe akunze gusuzuma umubare w'uturemangingo mu maraso yawe, cyane cyane umubare w'udupira. Umubare muto w'udupira dushobora kuba ikimenyetso cya mbere cya HIT. Hafi kimwe cya kabiri cy'abantu bafite HIT bagira amaraso mashya. Ibi bishobora kuba indwara yo mu mitsi itemba cyane (DVT) mu kaguru cyangwa indwara yo mu bihaha (PE). Itondere ibi bimenyetso:- Ububabare, kubyimba, gutukura, cyangwa ububabare mu kuboko cyangwa ku kuguru.
- Ububabare butunguranye kandi bukomeye mu gituza (nk'indwara y'umutima).
- Umuvuduko ukabije w'amaraso ( hypertension ).
- Kuzunguza , gucika intege, kumva umeze nk'uzuzuzuzu.
- Ukwiyongera k'umuvuduko w'umutima ( tachycardia ).
- Inkorora n'ibicurane .
- Kugorwa no guhumeka .
- Kubira ibyuya byinshi.
- Umuriro n'ubukonje.
Icy'ingenzi kurushaho: Niba ufata heparin kandi ukabona kimwe muri ibi bimenyetso, hita ushakisha abaganga bihutirwa . Ibi si ibintu byo gutinza.
HIT ibaho ryari?
Akenshi, ibimenyetso bitangira mu minsi itanu kugeza ku byumweru bibiri uhereye igihe umuntu atangiye gukoresha heparin. Ariko, bishobora no kugaragara mu bindi bihe:- IGITERANYO CY'IMVURA: Ibi bishobora kubaho mu minsi umwe cyangwa itatu uhereye igihe watangiye gukoresha heparin. Ibi birashoboka cyane niba warigeze gukoresha heparin mbere (ubusanzwe mu mezi atatu). Hanyuma, umubiri wawe "wibuka" heparin, ugakora ubudahangarwa bwayo, kandi ukaba witeguye kugira icyo ukora vuba.
- IGITERO CY'IMITERERE: Iyi ndwara ishobora kumara ibyumweru byinshi nyuma y'uko heparin ihagaritswe.
- Gutinda gutangira gukubita: Ibi bibaho nyuma yo guhagarika imiti ya heparin. Akenshi bibaho nyuma y'iminsi itanu cyangwa irenga nyuma yo guhagarika imiti.
Ni iki gitera iyi GAHUNDA mu by'ukuri?
HIT ibaho iyo umuti wa heparin wihambiriye kuri poroteyine yitwa PF4 (Platelet Factor 4) muri platelets zacu. Iyi heparin na PF4 bihurira hamwe bigakora Heparin-PF4 complex. Iyo tubonye ko Heparin-PF4 complex mu mubiri wacu, ubudahangarwa bwacu bw'umubiri burahangayika bugatangira gukora antibody zo kuyirwanya. Izi antibody zijya zihambirira kuri iyo Heparin-PF4 complex. Aho niho byose bitangirira. Iyo izi antibody zihambiriye, platelets zihita zikora zigatangira gukora clotting y'amaraso. Muri ubu buryo, PF4 nyinshi zisohoka muri platelets zikora clotting y'amaraso. Hanyuma iyo PF4 nshya ihageze nayo ihambirira kuri heparin, ikora Heparin-PF4 complex nyinshi. Antibody zigaruka zikongera kuzihambiriraho, clotting y'amaraso irakora... Ibi bikomeza nk'uruhererekane rw'imitsi. Kubera ubu buryo bwose bwo gukora clotting y'amaraso, platelets mu mubiri zikoreshwa vuba. Ingaruka ni uko urugero rwa platelets rugabanuka. Kubera uku kubumba amaraso menshi, amaraso menshi ashobora kugabanuka mu buryo bukabije, bigatuma imitsi n'imitsi bifunga imitsi yacu.Ni ibihe bintu bishobora gutera HIT?
Hari ibintu byinshi byongera ibyago byo kurwara HIT:- Igitsina cyawe: Abagore bafite amahirwe menshi yo gukubitwa.
- Ubwoko bwa heparin ikoreshwa: Ubushakashatsi bumwe na bumwe bugaragaza ko ibyago byo kurwara HIT bishobora gutandukana bitewe n'ubwoko bwa heparin ufata. Urugero, hari ibimenyetso bimwe na bimwe bigaragaza ko gukoresha heparin idacitse aho gukoresha heparin ifite uburemere buke bishobora kugabanya ibyago. Ariko, hakenewe ubushakashatsi bwinshi kuri ibi.
- Gufata heparin nyuma yo kubagwa: Abantu bafata heparin kugira ngo birinde kubyimba kw'amaraso nyuma yo kubagwa bafite amahirwe menshi yo kurwara HIT kurusha abayifata kugira ngo bavure ikibyimba gisanzwe. Ibi byago biri hejuru cyane cyane nyuma yo kubagwa amagufwa, kubagwa umutima, no gufunga umutima n'imitsi .
Ni gute umuntu apimwa indwara ya HIT? (Isuzuma)
Gupima amaraso menshi bishobora gufasha kumenya niba ufite uburwayi bwa HIT:- Urugero rw'imitsi yo mu maraso: Ibi bishobora kugenzura niba umubare w'imitsi yo mu maraso yawe uri hasi (thrombocytopenia).
- Kurema kw'ibibyimba: Ibipimo by'amaraso bigaragaza niba amaraso yawe yapfunditse.
- Igipimo cy'uturemangingo tw'umubiri twa PF4: Ingano y'uturemangingo tw'umubiri twa PF4 mu maraso yawe ishobora kugaragaza niba ubudahangarwa bw'umubiri bwawe burimo gukora plaquettes. Iki kizamini cy'uturemangingo ni cyo cyemeza ko umuntu yanduye HIT.
Iki "kizamini cya 4Ts" ni iki?
Ikizamini cya 4Ts ni uburyo bwo gupima amanota bupima amahirwe yo kuba wagira HIT. Butanga amakuru ukeneye kugira ngo utangire kuvurwa utiriwe utegereza ibisubizo by'ikizamini cy'umubiri. Muganga atanga amanota (kuva kuri 0 kugeza kuri 2) kuri ibi bintu bine:- Thrombocytopenia (umubare muto wa platelets): Umubare wa platelets zawe ni muto gute?
- Igihe cyo gusubiza heparin): Ni ryari urugero rw'imitsi yawe yagabanutse?
- Thrombosis (amaraso apfunditse): Ese hari ibimenyetso by'uko amaraso yapfunditse?
- Izindi mpamvu: Ese hari indi mpamvu idafite heparin ituma umubare wa platelet muke ugabanuka?
Ni ubuhe buryo bwo kuvura HIT?
Intambwe ya mbere mu kuvura ni ukureka gufata heparin ako kanya. Hanyuma, uzahindurirwa undi muti wo kugabanya amaraso. Umubare wa platelets zawe ugomba kongera kwiyongera mu minsi mike nyuma yo guhagarika heparin. Kugeza icyo gihe, muganga wawe ashobora kukwandikira undi muti wo gufasha gukumira kubyimba kw'amaraso. Hari imiti myinshi ishobora gukoreshwa aho gukoresha heparin:- "Imiti igabanya ubukana bwa thrombin" (urugero: argatroban, bivalirudin)
- Fondaparinux
- Imiti igabanya amaraso mu kanwa (imiti irinda kubyimba kw'amaraso ishobora gufatwa mu kanwa)
Ese dushobora gukumira indwara ya HIT?
Nta kintu na kimwe ushobora gukora kugira ngo wirinde HIT. Ariko, kuba muganga wawe akurikirana buri gihe urugero rw'imitsi yawe ya platelet bishobora kugabanya ibyago byo kugira ingaruka mbi zikomoka kuri heparin.Ni iki wakwitega niba ufite HIT?
Thrombocytopenia iterwa na heparin (HIT) ni indwara ikomeye ishobora kwica iyo idavuwe vuba. Kuziba kw'amaraso menshi mu maboko no ku maguru bishobora kwangiza iyo ngingo z'umubiri igihe kirekire. Kuziba kw'amaraso ku ngingo z'ingenzi bishobora kwica. Ku bw'amahirwe, hamwe no kumenya byinshi kuri HIT no kuvura neza, umubare w'abazima wariyongereye cyane. Kumenya hakiri kare mbere yuko amaraso aziba cyane, ni ingenzi ku musaruro mwiza.Iyo umuganga wawe abonye ibimenyetso bya HIT, nko kuba hari platelet nke, ashobora kuguha imiti kugira ngo agabanye ibyago byo kubyimba kw'amaraso.Nitwara nte?
Uzakenera kujya kwa muganga wawe buri gihe kugira ngo akurikirane urugero rw'imitsi yawe ya platelet kandi arebe neza ko utarimo kubyimba kw'amaraso. Byongeye kandi, muganga wawe azaba azi ingaruka mbi zishobora kubaho (nko kuva amaraso kuri bamwe) mu gihe uhindura kuva kuri heparin ujya kuri anticoagulant nshya. Hagati aho, ni ngombwa cyane gufata imiti yawe uko byategetswe. Nubwo waba utarabyimba amaraso, uzakenera gufata anticoagulant itari heparin nibura ukwezi. Niba wabyimbaga amaraso, ushobora kubimara igihe kirekire.Uburyo bwiza bwo kwiyitaho ni ukubwira umuganga wese uzaguvura mu gihe kizaza ko wagize iki kibazo. Niba waragize "HIT", ntugomba kongera gufata heparin.Niba ubonye impinduka mu mubiri wawe mugihe ufata heparin, shaka ubufasha bwihutirwa bwa muganga. Heparin-Induced Thrombocytopenia (HIT) ni indwara idakunze kugaragara, ariko ikimenyetso cyose cy'amaraso afite ikibazo gikomeye cyane ku buryo udashobora kwirengagiza. Iyo utavuwe, HIT ishobora kwica. Iyo uvuwe, urugero rwa platelet yawe rugomba gusubira ku rugero rusanzwe kandi ibyago byo kubyimba kw'amaraso bigomba kugabanuka. Vugana na muganga wawe ku muti mwiza wo gukoresha aho gukoresha heparin mu gihe kiri imbere.
Ubutumwa bwa nyuma bwo kujyana mu rugo
- Nubwo heparin ari umuti w'ingenzi urinda kubyimba kw'amaraso, ntabwo ishobora gutera indwara ikomeye yitwa Heparin-Induced Thrombocytopenia (HIT).
- Ikibaho muri iki kibazo ni uko aho gukumira kubyimba kw'amaraso, kubyimba kw'amaraso kuriyongera kandi umubare wa platelets ukagabanuka.
- Itondere ibimenyetso nko kubyimba amaguru/amaboko, ububabare, ububabare mu gituza, no guhumeka bigoranye. Nubibona, hita ugana muganga.
- Iyo hagaragaye ko hari "HIT", ikintu cya mbere ugomba gukora ni uguhagarika heparin. Hanyuma uzakenera gukoresha indi miti igabanya amaraso.
- Niba warigeze kugira "HIT", andika mu nyandiko zawe zose z'ubuvuzi kandi ubwire umuganga uwo ari we wese uzabona mu gihe kizaza. Ntugomba kongera guhabwa heparin ukundi.
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