Wake wadinga ukusebenzisa umuthi obizwa ngokuthi i-Heparin? Mhlawumbe ngemva kokuhlinzwa, noma ukuvimbela amahlule egazi, udokotela kungenzeka ukuthi ukunike lo muthi. Kodwa-ke, nakuba kungavamile kakhulu, le heparin ingabangela ukuthi imizimba yethu yakhe amahlule egazi amaningi futhi inciphise inani lama-platelet. Yilokho esikubiza ngokuthi 'i-Heparin-Induced Thrombocytopenia' noma '(HIT)'. Ungakhathazeki, lokhu kungase kuzwakale kuyinkimbinkimbi kancane, kodwa ake sixoxe ngakho kalula.
Kuyini i-heparin? Kungani kwenzeka i-HIT?
Kalula nje, i-heparin iyi
-anticoagulant (i-blood thinner). Isetshenziselwa ukuvimbela ukwakheka kwamahlule egazi emithanjeni yethu yegazi. Odokotela bayinikeza ngemva kokuhlinzwa okukhulu, noma ukuncibilikisa ihlule legazi eselivele lakhekile. Kodwa-ke, akuvamile kakhulu, lapho i-heparin inikezwa abanye abantu, ingabangela ukusabela okungekuhle. Yilapho
isimiso sethu somzimba sokuzivikela sihlangana ngephutha ne-heparin futhi sisebenze ama-platelet ethu. Ama-platelet awuhlobo lweseli olusiza ekumiseni ukopha kwethu. Ngakho-ke, lapho ama-platelet esebenza ngale ndlela, esikhundleni sokuvimbela ukwakheka kwamahlule egazi,
aqala ukwakha amahlule egazi ngokungadingekile (thrombosis). Ngesikhathi esifanayo, inani lama-platelet nalo lehla ngokushesha (thrombocytopenia). Yingakho lesi simo ngezinye izikhathi sibizwa ngokuthi 'i-Heparin-Induced Thrombocytopenia and Thrombosis (HITT)'.
Cabanga nje, kuyamangaza ukuthi umuthi onikezwa ukuvimbela amahlule egazi ungandisa ukwakheka kwamahlule egazi futhi wehlise ama-platelet, akunjalo? Kodwa kungenzeka.
Kunezinhlobo ezimbili eziyinhloko zama-HIT.
Odokotela bahlukanisa lesi simo se-`(HIT)` ngezinhlobo ezimbili eziyinhloko: 1.
I-HIT I (Uhlobo 1): Kulesi simo, amazinga e-platelet akho ehla kancane ezinsukwini ezimbalwa zokuqala ngemuva kokuqala i-heparin, kodwa abuyela esimweni esijwayelekile ezinsukwini ezimbalwa.
Lesi akusona isimo esiyingozi , futhi akukho bungozi bokuqhekeka kwegazi, ngakho-ke akukho ukwelashwa okukhethekile okudingekayo. 2.
I-HIT II (Uhlobo 2): Lolu uhlobo okudingeka sikhathazeke ngalo. Kulesi simo, amasosha ethu omzimba asebenza ama-platelet ekuphenduleni i-heparin. Lokhu kubangela ukuthi amazinga e-platelet ehle, futhi kukhona
ingozi yokuqhekeka kwegazi okukhulu . Ngokuvamile, uma sikhuluma nge-`(HIT)`, sivame ukusho lolu hlobo oluyingozi olubizwa nge-`(HIT II)`.
Ubani onamathuba amaningi okuthuthukisa le HIT?
Noma ubani osebenzisa i-heparin, kungakhathaliseki ukuthi ingakanani idosi noma isikhathi sokusetshenziswa, angahlakulela lesi simo. Kodwa-ke, kutholakale ukuthi
abesifazane abangaphezu kweminyaka engu-40 banamathuba amancane okuba nayo. Odokotela abasazi kahle ukuthi kungani abanye abantu besabela ngale ndlela ku-heparin kanti abanye abanayo. Lokhu
Akuyona into evamile kakhulu. Lesi simo "(HIT)" senzeka eqenjini elincane labantu, cishe abangu-5%, abathatha i-heparin izinsuku ezingaphezu kwezine. Ziyini izimpawu ze-HIT? Siyibona kanjani?
Uma uthatha i-heparin, udokotela wakho uvame ukuhlola inani lamaseli egazini lakho, ikakhulukazi inani lama-platelet. Inani eliphansi lama-platelet lingaba uphawu lokuqala lwe-HIT. Cishe ingxenye yabantu abane-HIT iba ne-blood clot entsha. Lokhu kungaba yi-deep vein thrombosis (DVT) emlenzeni noma i-pulmonary embolism (PE). Qaphela lezi zimpawu: Ngaphezu kwalokho, ungase uqaphele ubuhlungu, isilonda, noma ukuqubuka kwesikhumba endaweni yomjovo we-heparin. Okubaluleke kakhulu: Uma uphuza i-heparin futhi uhlangabezana nanoma yiziphi zalezi zimpawu, funa usizo lwezokwelapha oluphuthumayo ngokushesha. Lokhu akuyona into yokulibazisa.
I-HIT yenzeka nini?
Izimpawu zivame ukuqala zingakapheli izinsuku ezinhlanu kuya emavikini amabili okuqala i-heparin. Kodwa-ke, zingavela nangezinye izikhathi:- UKUHAMBA KOKUQALA: Lokhu kungenzeka zingakapheli izinsuku ezintathu kusukela uqale i-heparin. Lokhu kungenzeka kakhulu uma uke wasebenzisa i-heparin ngaphambili (ngokuvamile zingakapheli izinyanga ezintathu). Ngemuva kwalokho, umzimba wakho "uyakhumbula" i-heparin, wenze ama-antibodies ngokumelene nayo futhi ulungele ukusabela ngokushesha.
- UKUSHAYA OKUNGAPHANDLE: Lesi simo singaqhubeka amasonto amaningi ngemva kokumiswa kwe-heparin.
- Ukuqala kokubambezeleka UKUSHAYA: Lokhu kwenzeka ngemva kokumiswa kokwelashwa nge-heparin. Ngokuvamile kwenzeka ezinsukwini ezinhlanu noma ngaphezulu ngemva kokuyeka umuthi.
Yini ngempela ebangela lokhu KUSHAYA?
I-'HIT' yenzeka lapho umuthi i-heparin ubopha iphrotheni ebizwa ngokuthi i-'PF4' (i-Platelet Factor 4) kuma-platelet ethu. Le heparin kanye ne-'PF4' kuhlangana ukwakha i-'Heparin-PF4 complex'. Uma sibona ukuthi i-'Heparin-PF4 complex' emzimbeni wethu, amasosha omzimba wethu ayakhathazeka bese eqala ukwenza ama-antibodies ngokumelene nayo. La ma-antibodies ayahamba futhi abopha kuleyo 'Heparin-PF4 complex'. Yilapho konke kuqala khona. Lapho nje la ma-antibodies ebopha, ama-platelet asebenza ngokushesha futhi aqale ukwenza ama-blood clots. Ngale ndlela, i-'PF4' eyengeziwe ikhishwa kuma-platelet enza ama-blood clots. Khona-ke leyo 'PF4' esanda kufika ibopha ne-heparin, yakha i-'Heparin-PF4 complex' eyengeziwe. Ama-antibodies ayabuya futhi abopha kuyo futhi, kwakheka ama-blood clots amaningi... Lokhu kuyaqhubeka njengokusabela kwe-chain. Ngenxa yakho konke lokhu kwenza ama-blood clot, ama-platelet emzimbeni asetshenziswa ngokushesha. Ngenxa yalokho, izinga lama-platelet liyehla. Ngenxa yalokhu kugoba kwegazi ngokweqile, kungakheka amahlule amakhulu, asongela ukuphila, avimbe imithambo yethu nemithambo yegazi. Yiziphi izinto ezibangela ingozi ye-HIT?
Kunezici eziningana ezandisa ingozi yokuthola i-HIT:- Ubulili bakho: Abesifazane banamathuba amaningi okuthola i-HIT.
- Uhlobo lwe-heparin olusetshenziswayo: Ezinye izifundo ziphakamisa ukuthi ingozi ye-HIT ingahluka kuye ngohlobo lwe-heparin oyithathayo. Isibonelo, kunobufakazi bokuthi ukusebenzisa i-heparin engaxutshiwe esikhundleni se-heparin enesisindo esincane sama-molecule kunganciphisa ingozi. Kodwa-ke, kudingeka ucwaningo olwengeziwe ngalokhu.
- Ukuthatha i-heparin ngemva kokuhlinzwa: Abantu abathatha i-heparin ukuvimbela ukujiya kwegazi ngemva kokuhlinzwa banamathuba amaningi okuthola i-HIT kunalabo abayithatha ukuze baphathe i-clot ekhona. Le ngozi iphezulu kakhulu ngemva kokuhlinzwa kwamathambo, ukuhlinzwa kwenhliziyo, kanye ne-cardiopulmonary bypass .
Ihlolwa kanjani i-HIT? (Ukuxilongwa)
Ukuhlolwa kwegazi okuningana kungasiza ekunqumeni ukuthi une-HIT:- Amazinga e-platelet: Lokhu kungahlola ukuthi inani lama-platelet akho liphansi yini (i-thrombocytopenia).
- Ukwakheka kwamahlule: Ukuhlolwa kwegazi kukhombisa ukuthi igazi lakho liyawavala yini.
- Amazinga e-antibody e-PF4: Inani lama-antibodies e-PF4 egazini lakho linganquma ukuthi amasosha omzimba wakho asebenza yini ama-platelet. Lokhu kuhlolwa kwama-antibody yikona okuqinisekisa ukutholakala kwe-HIT.
Udokotela wakho angase futhi akucele ukuthi kwenziwe i-ultrasound ukuhlola amahlule egazi emilenzeni yakho (i-DVT). Kuye ngesimo sakho, angase akucele ukuthi kwenziwe izivivinyo zokuhlola amahlule egazi kwezinye izindawo, njengezingalo zakho. Kodwa-ke, ngenxa yokuthi imiphumela yalolu vivinyo lwe-antibody ithatha isikhathi ukuthi ibuye, odokotela abalindi ukuthi ibuye ngaphambi kokuqala ukwelashwa. Ngenxa yokuthi i-HIT yisimo esingaba yingozi uma singalashwa, ukwelashwa kunqunywa ngokusekelwe ekutheni kungenzeka kangakanani ukuthi ube ne-HIT. Kuyini lokhu "kuhlolwa kwe-4Ts"?
Ukuhlolwa kwe-`4Ts` kuyisistimu yokulinganisa eqagela ukuthi kungenzeka kangakanani ukuthi ube ne-`HIT`. Kuhlinzeka ngolwazi oludingayo ukuze uqale ukwelashwa ngaphandle kokulinda imiphumela yokuhlolwa kwe-antibody. Udokotela unikeza amaphuzu (kusukela ku-0 kuya ku-2) kulezi zici ezine:- I-Thrombocytopenia (inani eliphansi lama-platelet): Liphansi kangakanani inani lama-platelet akho?
- Isikhathi (isikhathi sokusabela ku-heparin): Amazinga akho e-platelet ehle nini?
- I-Thrombosis (ihlule legazi): Ingabe zikhona izimpawu zokuqhekeka kwegazi?
- Ezinye izimbangela: Ingabe kukhona esinye isizathu ngaphandle kwe-heparin sokubalwa kwama-platelet akho aphansi?
Uma amaphuzu aphezulu, amathuba okuba `ushaye` aphezulu. Yiziphi izindlela zokwelapha i-HIT?
Isinyathelo sokuqala sokwelashwa ukuyeka ukuthatha i-heparin ngokushesha. Ngemuva kwalokho, uzoshintshelwa komunye umuthi wokunciphisa igazi. Inani lama-platelet akho kufanele liqale ukwanda futhi ezinsukwini ezimbalwa ngemva kokuyeka i-heparin. Kuze kube yileso sikhathi, udokotela wakho cishe uzokunikeza omunye umuthi ukusiza ukuvimbela ukwakheka kwamahlule egazi. Kunemithi eminingana engasetshenziswa esikhundleni se-heparin:- ``Izithibi ze-thrombin eziqondile'' (isib. `argatroban', `bivalirudin')
- `Fondaparinux`
- `Ama-anticoagulant omlomo aqondile` (imithi evimbela ukuqhekeka kwegazi engathathwa ngomlomo ngqo)
Uma amazinga akho e-platelet esebuyele esimweni esijwayelekile futhi ingozi yokuqhekeka kwegazi ngenxa ye-HIT isidlulile, udokotela wakho angase akushintshele komunye umuthi wokunciphisa igazi, njenge-warfarin. Singakwazi yini ukuvimbela i-HIT?
Akukho lutho ongakwenza ukuvimbela i-HIT. Kodwa-ke, ukuba nodokotela wakho aqaphe njalo amazinga e-platelet akho kungasiza ekunciphiseni ingozi yezinkinga ezivela ku-heparin. Yini ongayilindela uma une-HIT?
I-Heparin-Induced Thrombocytopenia (HIT) yisimo esibi kakhulu esingaba yingozi uma singelashwa ngokushesha. Amahlule amakhulu egazi ezingalweni nasemilenzeni angabangela umonakalo wesikhathi eside kulezo zitho. Amahlule egazi athinta izitho ezinkulu angabulala. Ngenhlanhla, ngokuqwashisa okwengeziwe nge-HIT kanye nezinketho zokwelapha ezingcono, amazinga okusinda athuthuke kakhulu. Ukutholwa kusenesikhathi, ngaphambi kokuba amahlule amakhulu egazi akhule, kuyisihluthulelo somphumela omuhle.Uma udokotela wakho ebona izimpawu ze-HIT, njengokubalwa kwama-platelet aphansi, angakunikeza ukwelashwa ukuze kuncishiswe ingozi yokuqhekeka kwegazi okuyingozi. Ngizinakekela kanjani?
Kuzodingeka ubonane nodokotela wakho njalo ukuze uqaphe amazinga e-platelet yakho futhi uqinisekise ukuthi awukhiqizi amahlule egazi. Ngaphezu kwalokho, udokotela wakho uzokwazi ngemiphumela emibi engaba khona (njengokopha kwabanye abantu) uma ushintsha kusuka ku-heparin uye ku-anticoagulant entsha. Okwamanje, kubaluleke kakhulu ukuthatha imithi yakho njengoba uyalelwe. Ngisho noma ungazange ube namahlule egazi, kuzodingeka uthathe i-non-heparin anticoagulant okungenani inyanga. Uma uke waba namahlule egazi, kungadingeka ukuthi uwathathe isikhathi eside. Indlela engcono kakhulu yokuzinakekela ukutshela noma yimuphi udokotela okwelaphayo esikhathini esizayo ukuthi uke waba nale nkinga. Uma uke waba ne-'HIT', akufanele uphinde uthathe i-heparin.
Uma ubona noma yiziphi izinguquko emzimbeni wakho ngenkathi uthatha i-heparin, funa usizo lwezokwelapha oluphuthumayo ngokushesha. I-Heparin-Induced Thrombocytopenia (HIT) iyisimo esingavamile, kodwa noma yiluphi uphawu lwe-blood clot lubi kakhulu ukuba lunganakwa. Ngaphandle kokwelashwa, i-HIT ingaba yingozi. Ngokwelashwa, amazinga akho e-platelet kufanele abuyele esimweni esijwayelekile futhi ingozi yakho ye-blood clot kufanele yehle. Khuluma nodokotela wakho ngemithi engcono kakhulu ongayisebenzisa esikhundleni se-heparin esikhathini esizayo. Umyalezo Wokugcina Wokuya Nasekhaya
- Nakuba i-heparin iwumuthi obalulekile ovimbela ukuqhekeka kwegazi, ayivamile ukubangela isimo esibi esibizwa ngokuthi 'i-Heparin-Induced Thrombocytopenia (HIT).'
- Okwenzekayo kulesi simo ukuthi esikhundleni sokuvimbela amahlule egazi, ukwakheka kwamahlule egazi kuyanda futhi inani lama-platelet liyancipha.
- Qaphela izimpawu ezifana nokuvuvukala emilenzeni/ezingalweni zakho, ubuhlungu, ubuhlungu besifuba, kanye nobunzima bokuphefumula. Uma ubona lokhu, bona udokotela ngokushesha.
- Uma kutholakala ukuthi une-'HIT', into yokuqala okufanele uyenze ukuyeka i-heparin. Ngemuva kwalokho kuzodingeka usebenzise eminye imithi yokunciphisa igazi.
- Uma uke waba ne-'HIT', yibhale phansi kuwo wonke amarekhodi akho ezokwelapha bese utshela noma yimuphi udokotela ozombona esikhathini esizayo. Akufanele uphinde unikezwe i-heparin.
Ngiyethemba ukuthi lolu lwazi luwusizo kuwe. Hlala uphilile! I-Heparin, i-Thrombocytopenia, Amahlule egazi, Ama-Platelet, i-Anticoagulant, i-HIT, Umphumela Ongemuhle, Amahlule egazi, Ama-Platelet, i-Heparin, Imiphumela Engemuhle
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