Ngaba wakha wasebenzisa iyeza elibizwa ngokuba yiHeparin? Mhlawumbi emva kotyando, okanye ukuthintela amahlwili egazi, ugqirha usenokuba ukunike eli yeza. Nangona kunjalo, nangona lingaqhelekanga, eli heparin linokubangela ukuba imizimba yethu yenze amahlwili egazi amaninzi kwaye linciphise inani leeplatelets. Yiloo nto siyibiza ngokuba yi 'Heparin-Induced Thrombocytopenia' okanye '(HIT)'. Ungakhathazeki, oku kusenokuvakala kuyinkimbinkimbi kancinci, kodwa masithethe ngayo ngokulula.
Yintoni i-heparin? Kutheni i-HIT isenzeka?
Ngamafutshane, i-heparin yi
-anticoagulant (i-blood thinner). Isetyenziselwa ukuthintela ukwakheka kwamahlwili egazi kwimithambo yethu yegazi. Oogqirha bayinika emva kotyando olukhulu, okanye ukunyibilikisa ihlwili legazi esele lenziwe. Nangona kunjalo, kunqabile kakhulu, xa i-heparin inikwa abanye abantu, inokubangela impendulo engalunganga. Kulapho
inkqubo yethu yomzimba idibana ngempazamo ne-heparin kwaye isebenze iiplatelets zethu. Iiplatelets luhlobo lweeseli ezinceda ekumiseni ukopha kwethu. Ngoko ke, xa iiplatelets zisebenza ngale ndlela, endaweni yokuthintela ukwakheka kwamahlwili egazi,
ziqala ukwenza amahlwili egazi ngokungeyomfuneko (thrombosis). Kwangaxeshanye, inani leeplatelets nalo liyehla ngokukhawuleza (thrombocytopenia). Yingakho le meko ngamanye amaxesha ibizwa ngokuba yi-'Heparin-Induced Thrombocytopenia and Thrombosis (HITT)'.
Khawucinge nje, kuyamangalisa ukuba iyeza elinikwa ukuthintela amahlwili egazi linganyusa ukwakheka kwamahlwili egazi kwaye linciphise iiplatelets, akunjalo? Kodwa kusenokwenzeka.
Kukho iintlobo ezimbini eziphambili zeHITs.
Oogqirha bahlula le meko `(HIT)` ibe ziintlobo ezimbini eziphambili: 1.
I-HIT I (Uhlobo 1): Kule meko, amanqanaba eeplatelet zakho ancipha kancinci kwiintsuku zokuqala ezimbalwa emva kokuqala i-heparin, kodwa abuyela kwisiqhelo kwiintsuku ezimbalwa.
Le ayisiyongxaki , kwaye akukho mngcipheko wokuqhekeka kwegazi, ngoko ke akukho nyango lukhethekileyo lufunekayo. 2.
I-HIT II (Uhlobo 2): Olu luhlobo ekufuneka siluxhalabele. Kule meko, inkqubo yethu yomzimba yokuzikhusela isebenza iiplatelet ngokuphendula kwi-heparin. Oku kubangela ukuba amanqanaba eeplatelet ehle, kwaye kukho
umngcipheko wokuqhekeka kwegazi okukhulu . Ngokwesiqhelo, xa sithetha nge-`(HIT)`, sidla ngokuthetha olu hlobo luyingozi olubizwa ngokuba yi-`(HIT II)`.
Ngubani onokuthi aphuhlise le HIT?
Nabani na osebenzisa i-heparin, nokuba ingakanani na idosi okanye ixesha lokusetyenziswa, unokufumana le meko. Nangona kunjalo, kufunyenwe ukuba
abafazi abangaphezu kweminyaka engama-40 banamathuba amancinci okuba nayo. Oogqirha abasazi ukuba kutheni abanye abantu benayo le mpendulo kwi-heparin kanti abanye abanayo. Oku
Asiyonto ixhaphakileyo le. Le meko ``(HIT)`` yenzeka kwiqela elincinci labantu, malunga ne-5%, abathatha i-heparin iintsuku ezingaphezu kwezine. Zithini iimpawu zeHIT? Siyibona njani?
Ukuba usebenzisa i-heparin, ugqirha wakho uhlala ejonga inani leeseli egazini lakho, ingakumbi inani lee-platelet. Ukubalwa kwee-platelet okuphantsi kunokuba luphawu lokuqala lwe-HIT. Malunga nesiqingatha sabantu abane-HIT baphuhlisa i-blood clot entsha. Oku kungaba yi-deep vein thrombosis (DVT) emlenzeni okanye i-pulmonary embolism (PE). Lumkela ezi mpawu: Ukongeza, ungabona iintlungu, isilonda, okanye irhashalala lolusu kwindawo yokufakwa inaliti ye-heparin. Okubaluleke kakhulu: Ukuba usela i-heparin kwaye ufumana naziphi na ezi mpawu, funa uncedo lwezonyango olungxamisekileyo ngoko nangoko. Asikuko ukulibazisa oku.
I-HIT yenzeka nini?
Amaxesha amaninzi, iimpawu ziqala kwiintsuku ezintlanu ukuya kwiiveki ezimbini emva kokuqala i-heparin. Nangona kunjalo, zinokuvela nangamanye amaxesha:- UKUHLASELA KWASEKUQALENI: Oku kunokwenzeka kwiintsuku enye ukuya kwezintathu emva kokuqala i-heparin. Oku kunokwenzeka ngakumbi ukuba ukhe wayisebenzisa i-heparin ngaphambili (ngesiqhelo kwiinyanga ezintathu). Emva koko, umzimba wakho "uyayikhumbula" i-heparin, wenze ii-antibodies ezichasene nayo, kwaye ulungele ukusabela ngokukhawuleza.
- UKUHLASELA OKUNGACHANANGA: Le meko inokuhlala iiveki emva kokuba i-heparin iyekiwe.
- Ukulibaziseka kokuqala UKUHLASELA: Oku kwenzeka emva kokuba unyango lwe-heparin luyekisiwe. Ngokwesiqhelo kwenzeka emva kweentsuku ezintlanu okanye ngaphezulu emva kokuyeka iyeza.
Yintoni kanye kanye ebangela oku KUHLAWULWA?
I-'HIT' yenzeka xa iyeza i-heparin libopha kwiproteni ebizwa ngokuba yi-'PF4' (iPlatelet Factor 4) kwiiplatelets zethu. Le heparin kunye ne-'PF4' zidityaniswe zenze i-'Heparin-PF4 complex'. Xa sibona ukuba i-'Heparin-PF4 complex' emzimbeni wethu, inkqubo yethu yomzimba iyakhathazeka ize iqale ukwenza ii-antibodies ezichasene nayo. Ezi antibodies ziyahamba zize zibophane kuloo 'Heparin-PF4 complex'. Kulapho konke kuqala khona. Kwangoko nje ezi antibodies zibophana, iiplatelets zivuselelwa ngoko nangoko kwaye ziqale ukwenza amahlwili egazi. Ngale ndlela, i-'PF4' engaphezulu ikhutshwa kwiiplatelets ezenza amahlwili egazi. Emva koko loo 'PF4' isandul' ukufika nayo ibophana kwi-heparin, yenze i-'Heparin-PF4 complex' engaphezulu. Ii-antibodies ziyabuya zibophane kuyo kwakhona, amahlwili egazi amaninzi ayakhiwa... Oku kuyaqhubeka njenge-chain reaction. Ngenxa yalo lonke olu hlobo lokwenza amahlwili egazi, iiplatelets emzimbeni ziyasetyenziswa ngokukhawuleza. Ngenxa yoko, inqanaba leplatelets liyehla. Ngenxa yokuqhekeka kwegazi okugqithisileyo, kunokubakho amahlwili egazi amakhulu, asongela ubomi, avale imithambo yethu kunye nemithambo yegazi. Ziziphi izinto ezibangela umngcipheko we-HIT?
Kukho izinto ezininzi ezonyusa umngcipheko wokufumana i-HIT:- Isini sakho: Abafazi banamathuba amaninzi okufumana i-HIT.
- Uhlobo lwe-heparin esetyenzisiweyo: Ezinye izifundo zibonisa ukuba umngcipheko we-HIT unokwahluka ngokuxhomekeke kuhlobo lwe-heparin oyithathayo. Umzekelo, kukho ubungqina bokuba ukusebenzisa i-heparin engaqhekezwanga endaweni ye-heparin enobunzima obuphantsi kunokunciphisa umngcipheko. Nangona kunjalo, kufuneka uphando oluthe kratya ngale nto.
- Ukusela i-heparin emva kotyando: Abantu abasebenzisa i-heparin ukuthintela ukuqhekeka kwegazi emva kotyando banamathuba amaninzi okufumana i-HIT kunabo bayithathayo ukunyanga ihlwili esele ikho. Le ngozi iphezulu kakhulu emva kotyando lwamathambo, utyando lwentliziyo, kunye ne-cardiopulmonary bypass .
Ifunyaniswa njani i-HIT? (Ukuxilongwa)
Uvavanyo lwegazi oluninzi lunokunceda ekuboneni ukuba une-HIT:- Amanqanaba eeplatelet: Oku kunokujonga ukuba inani leeplatelet zakho liphantsi na (thrombocytopenia).
- Ukwakheka kwamahlwili: Uvavanyo lwegazi lubonisa ukuba igazi lakho liyawawa na.
- Amanqanaba e-PF4 antibody: Ubungakanani bee-PF4 antibodies egazini lakho bunokumisela ukuba inkqubo yakho yomzimba iyasebenza na iiplatelets. Olu vavanyo lwe-antibody lulo oluqinisekisa ukuchongwa kwe-HIT.
Ugqirha wakho unokuyalela i-ultrasound ukujonga amahlwili egazi emilenzeni yakho (i-DVT). Ngokuxhomekeke kwimeko yakho, banokuyalela iimvavanyo ukujonga amahlwili egazi kwezinye iindawo, ezifana neengalo zakho. Nangona kunjalo, ngenxa yokuba iziphumo zolu vavanyo lwe-antibody zithatha ixesha ukubuya, oogqirha abalindi ukuba libuye ngaphambi kokuba baqale unyango. Ngenxa yokuba i-HIT yimeko enokuba yingozi ukuba ayinyangwa, unyango lumiselwa ngokusekelwe ekubeni unokuba ne-HIT kangakanani. Yintoni le "vavanyo lwe-4Ts"?
Uvavanyo lwe-`4Ts` luyinkqubo yokufumana amanqaku eqikelela ukuba unokuba `ne-HIT` kangakanani. Lubonelela ngolwazi olufunekayo ukuze uqale unyango ngaphandle kokulinda iziphumo zovavanyo lwe-antibody. Ugqirha unika amanqaku (ukusuka ku-0 ukuya ku-2) kwezi zinto zine:- I-Thrombocytopenia (ubuninzi beeplatelet): Ingakanani i-platelet yakho esezantsi?
- Ixesha (ixesha lokuphendula kwi-heparin): Amanqanaba akho eeplatelet ehle nini?
- I-Thrombosis (ihlwili legazi): Ngaba kukho iimpawu zehlwili legazi?
- Ezinye izizathu: Ngaba ikho enye into enokubangela ukuba inani lakho leeplatelet libe liphantsi ngaphandle kwe-heparin?
Okukhona amanqaku ephezulu, kokukhona amathuba okuba u-'HIT' aphezulu. Ziziphi iindlela zonyango ze-HIT?
Inyathelo lokuqala kunyango kukuyeka ukuthatha i-heparin ngoko nangoko. Emva koko, uza kutshintshelwa kwenye iyeza lokunciphisa igazi. Inani leeplatelet zakho kufuneka liqale ukunyuka kwakhona kwiintsuku ezimbalwa emva kokuyeka i-heparin. Kude kube ngoko, ugqirha wakho usenokukunika elinye iyeza ukunceda ukuthintela ukwakheka kwamahlwili egazi. Kukho amayeza aliqela angasetyenziswa endaweni ye-heparin:- ``Ii-thrombin inhibitors ezithe ngqo'' (umz. `argatroban', `bivalirudin')
- `Fondaparinux`
- `Amayeza okuthintela ukugabha kwegazi ngomlomo ngqo` (amayeza athintela ukugabha kwegazi anokuthathwa ngomlomo ngqo)
Nje ukuba amanqanaba akho eeplatelet abuyele kwisiqhelo kwaye umngcipheko wokuqhekeka kwegazi ngenxa yeHIT udlulile, ugqirha wakho unokukutshintshela kwenye iyeza lokunciphisa igazi, njenge-warfarin. Ngaba singayithintela i-HIT?
Akukho nto unokuyenza ukuthintela i-HIT. Nangona kunjalo, ukuba ugqirha wakho ajonge rhoqo amanqanaba eeplatelet zakho kunokunceda ukunciphisa umngcipheko weengxaki ezivela kwi-heparin. Yintoni onokuyilindela ukuba une-HIT?
I-Heparin-Induced Thrombocytopenia (HIT) yimeko embi kakhulu enokuba yingozi ukuba ayinyangwa ngokukhawuleza. Amahlwili egazi amakhulu ezingalweni nasemilenzeni anokubangela umonakalo wexesha elide kuloo malungu. Amahlwili egazi achaphazela amalungu amakhulu anokubulala. Ngethamsanqa, ngokwazi ngakumbi nge-HIT kunye neendlela zonyango ezingcono, amazinga okusinda aphucuke kakhulu. Ukufunyanwa kwangoko, ngaphambi kokuba amahlwili egazi akhule, kubalulekile kwisiphumo esihle.Xa ugqirha wakho ebona iimpawu zeHIT, ezifana nokubalwa kweeplatelet eziphantsi, unokukunika unyango lokunciphisa umngcipheko wokuqhekeka kwegazi okuyingozi. Ndingazinyamekela njani?
Kuya kufuneka ubone ugqirha wakho rhoqo ukuze ujonge amanqanaba eeplatelet zakho kwaye uqinisekise ukuba awuphuhli amahlwili egazi. Ukongeza, ugqirha wakho uya kwazi ngemiphumo emibi enokubakho (njengokopha kwabanye abantu) xa utshintsha ukusuka kwi-heparin ukuya kwi-anticoagulant entsha. Okwangoku, kubaluleke kakhulu ukusela amayeza akho njengoko kuyalelwe. Nokuba awuzange ube namahlwili egazi, kuya kufuneka uthathe i-non-heparin anticoagulant ubuncinane inyanga. Ukuba ube namahlwili egazi, kunokufuneka ulithathe ixesha elide. Eyona ndlela ilungileyo yokuzinyamekela kukuxelela nawuphi na ugqirha oza kunyanga kwixesha elizayo ukuba ukhe waba nale ngxaki. Ukuba ukhe waba ne-'HIT', akufuneki uphinde uthathe i-heparin.
Ukuba ubona naluphi na utshintsho emzimbeni wakho ngelixa usebenzisa i-heparin, funa uncedo lonyango olungxamisekileyo ngokukhawuleza. I-Heparin-Induced Thrombocytopenia (HIT) yimeko engaqhelekanga, kodwa naluphi na uphawu lwegazi eliqhekekileyo lubi kakhulu ukuba lungahoywa. Ngaphandle konyango, i-HIT inokubulala. Ngonyango, amanqanaba akho eeplatelet kufuneka abuyele kwisiqhelo kwaye umngcipheko wakho wegazi eliqhekekileyo kufuneka wehle. Thetha nogqirha wakho malunga namayeza angcono onokuwasebenzisa endaweni ye-heparin ukuya phambili. Umyalezo Wokugqibela Wokuya Ekhaya
- Nangona i-heparin iyeza elibalulekileyo elithintela ukuqhekeka kwegazi, ayinakubangela imeko enzima ebizwa ngokuba yi-'Heparin-Induced Thrombocytopenia (HIT).'
- Okwenzekayo kule meko kukuba endaweni yokuthintela amahlwili egazi, ukwakheka kwamahlwili egazi kuyanda kwaye inani leeplatelet liyancipha.
- Khangela iimpawu ezifana nokudumba kwemilenze/iingalo zakho, iintlungu, iintlungu zesifuba, kunye nobunzima bokuphefumla. Ukuba uzibona ezi zinto, bona ugqirha ngokukhawuleza.
- Ukuba i-'HIT' ifunyenwe, into yokuqala ekufuneka uyenze kukuyeka i-heparin. Emva koko kuya kufuneka usebenzise amanye amayeza okunciphisa igazi.
- Ukuba ukhe waba ne-'HIT', yibhale phantsi kuzo zonke iirekhodi zakho zonyango kwaye uxelele ugqirha oza kumbona kwixesha elizayo. Akufuneki uphinde unikwe i-heparin.
Ndiyathemba ukuba olu lwazi luluncedo kuwe. Hlala usempilweni! I-Heparin, i-Thrombocytopenia, amahlwili egazi, iiPlatelet, i-Anticoagulant, i-HIT, isiphumo esingesihle, amahlwili egazi, iiPlatelet, i-Heparin, imiphumo engentle
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