Ukuqwalaselwa kwesizathu, ukuthintela, kunye nokonyango kwesi sifo
Izifo ze-Hemolytic zeNtsana (i-HDN) yimeko yebomvu yegazi ebomvu phakathi komama nosana lwakhe. Oku kwenzeka xa uhlobo lwegazi lomama nguRhabi kwaye umntwana usuRh positive. Ngexesha lokukhulelwa umama uvelisa iintsholongwane ezihlasela nokutshabalalisa iiseli ezibomvu zegazi, ezibangelwa i-anemia emntwaneni. Imeko efanayo ivela ngeeplatelet ezibizwa ngokuthi i- neonatal alloimmune thrombocytopenia .
Kutheni Kuthiwa Izifo Ze-Hemolytic?
Amaseli ethu abomvu aphethwe ngama-antigens, izinto ezenza ukuphendula komzimba. Ezinye ze-antigens zisinika uhlobo lwethu lwegazi (A, B, O, AB) kunye namanye amaqela ethu e-Rh (ayenayo, awananto). Iqela le-Rh libizwa ngokuba yi-D antigen. Abasetyhini abangama-Rh angenayo i-D antigen kwiiseli zabo ezibomvu zegazi. Ukuba umntwana ongakazalwa usuRh-positive (uzuze kwifa), unayo iD antigen. Xa amaseli omzimba omama abonakaliswa kwiiseli ze-fetus (ezinokuthi zenzeke ngexesha lokuhambisa, ukuphuma kumama ngexesha lokukhulelwa, ukukhulelwa komzimba kwangaphambili), isimiso somzimba sokukhusela umama sikwazi ukubona i-antigen "D" njengamazwe angaphandle.
Ukukhulelwa kokuqala kunye nosana olungamaRh aluchaphazelekayo njengoko i-antibodies eyenziwe ekuqaleni ayinakuwela i-placenta. Nangona kunjalo, ekukhulelweni kwangaphambili, ukuba amaseli omzimba omama adibane ne-D antigen kumaseli egazi, i-immune system ikhiqiza ngokukhawuleza i-anti-D antibodies ezingakwazi ukuwela i-placenta.
Ezi zinqamleza zidibanisa kwiiseli zegazi, ziphawula ngokutshabalalisa, zibangele i-anemia. Imeko efana nayo inokuvela xa kukho ukungabikho kokusetyenziswa kwegazi ekuthiwa yi-ABO engahambelaniyo.
Indlela iNtsana echaphazeleka ngayo
Njengoko kuthethwe ngentla, ukukhulelwa kokuqala kunye nosana olungamaRh, akukho ziingxaki.
Ukuba le nto ingaziwayo ekukhulelweni kokuqala (kwenzeka ngezinye iimeko xa ukukhulelwa kokuqala kubangela ukukhulelwa kwesisu) okanye ukuba amanyathelo okuthintela okufanelekileyo (aya kuxoxwa emva koko) ayithathiweyo, ukukhulelwa kwangaphambili kunokuchaphazeleka. Emva kokukhulelwa kokuqala okuchaphazelekayo, ubunzima besifo se-hemolytic yengane esandul 'ukuzalwa buba nzima ngokukhulelwa.
Iimpawu ziqulathwe ubunzima be-cell red breaking (ebizwa ngokuba yi-hemolysis). Ukuba kuphela kuthinteka ngomoya ophantsi, kunokubakho iingxaki ezincinci ezifana ne- anemia kunye ne-jaundice engafuneki unyango. Ukuba inani le-hemolysis libi kakhulu, uya kuba ne-jaundice ebalulekileyo (ephakamileyo ye-bilirubin) kungekudala emva kokuzalwa.
Ngelishwa, i-hemolysis ayigcini xa umntwana ezalwa njengama-antibodies amamazana ahlala eveki eziliqela. Ezi nqanaba ezigqithiseleyo ze-bilirubin zingabangela umonakalo kwengqondo. Kwezinye iimeko, i-anemia inzima kakhulu kwi-utero (ngaphambi kokuba kuzalwe) ukuba isibindi kunye ne-spleen yandisa ukwandisa imveliso yeeseli yegazi ebangela ukuhluleka kwesibindi. Isifo se-hemolytic sinokukhokelela kwi-hydrops fetalis kunye ne-edema jikelele (ukuvuvukala), izilwanyana ezijikelezayo kunye nokufa.
Indlela I-Hemolytic Disease Iphephelwa ngayo
Ewe. Namhlanje bonke abafazi abafumana unyango lwababelethi banomsebenzi wegazi olujoliswe ekunqumeni uhlobo lwayo lwegazi kunye neqela.
Ukuba u-Rh-negative, umsebenzi wegazi uthunyelwa ukuba aqinisekise ukuba sele sele ene-anti-D antibodies. Ukuba akanayo i-antibodies, uya kufumana iyeza elibizwa ngokuthi yiRhoGAM. I-RhoGAM okanye inxamnye no-D Ig isilini esinikwe kwiiveki ezingama-28, iziqephu zokuphuma kwamanzi (kubandakanywa ukulahleka kwamathambo emva kweveki ezingama-13 zesisu) kunye nokuziswa. I-RhoGAM ifana ne-antibody umama ayayiyenza kwi-D-antigen. Injongo yenzelwa iRhoGAM ukutshabalalisa nayiphi na iseli ebomvu yeeseli ekuhambeni komama ngaphambi kokuba akwazi ukuhlakulela izifo.
Ukuba i-anti-D antibodies i-anti-D ifunyenwe, i-RhoGAM ayinakunceda kodwa ukuhlolwa kwesongezelelo komntwana kuza kwenziwa njengoko kuchaziwe ngezantsi.
Izifo Ze-Hemolytic Zithathwa Njani?
Ukuba umama unqwenela ukuba ne-antibodies anti-D kunye noyise nguR Rh-positive, kukho ukubonakala kwesifo se-hemolytic yintsana. Kule meko, uvavanyo luyenziwa kwi-amniotic fluid okanye igazi ukusuka kwintambo yomgca ukucacisa uhlobo lwegazi kunye neqela le-baby. Ukuba umntwana ufunyaniswa ukuba yi-RH, akukho nonyango efunekayo.
Nangona kunjalo, ukuba umntwana usuRh-positive, ukukhulelwa kuya kujongwa ngokukhawuleza. I-Ultrasounds izakusetyenziswa ukuhlola ukukhulelwa kwe-anemia yesisu kunye nokucacisa isidingo sokumpontshelwa kwangaphakathi kwegazi (ukuxilongwa okunikezelwa kumntwana xa usesiswini). Igazi likaMama liya kuhlolwa ngenyameko ngexesha lokukhulelwa ukuqinisekisa ukuba luphi ulwaphulo-mthetho olwenzayo. Ukuba umntwana ufunyanwe unomdlavuza, ukunyelwa igazi kunokunikezelwa ngexesha lokukhulelwa ukukhusela iingxaki (ukuxilongwa kwe-intrauterine). Ukuba umntwana ufunyanwe kwaye unesigxina esipheleleyo, ukuhanjiswa kwangethuba kunokucetyiswa.
Emva kokuba umntwana ezalwe, umsebenzi wegazi uthunyelwa ukubeka iliso kwinqanaba le-anemia kunye ne-bilirubin. Ukuphazamiseka kwamaseli obomvu akumiseli ngokukhawuleza ukuba umntwana azalwe ukuze i-bilirubin ikwazi ukuphakama kumazinga anobungozi kwiintsuku ezimbalwa zokuqala. Amanqanaba e-bilirubin aphakamileyo (i-jaundice) ayaphathwa nge-phototherapy apho umntwana efakwe phantsi kwezibane eziluhlaza. Izibane zidiliza i-bilirubin evumela umzimba ukuba usilahle. Ukutshintshiswa kwakhona kusetyenziswa ukunyanga i-anemia. Ukuba i-anemia ne-jaundice inzima, umntwana uyaphathwa nge-transfusion exchange. Kulo hlobo lokumpontshelwa igazi, ixabiso elincinci legazi lisuswe kulutsha kwaye lithatyathwa yigazi egaziniweyo.
Emva kokukhutshwa esibhedlele, kubalulekile ukuba ulandelelwano olusondeleyo kunye nodokotela wezilwanyana okanye i-hematologist ukujonga i-anemia. Iintsholongwane ezibomvu zesibindi zegazi zingabangela ukutshabalalisa kwiiveki ezi-4-6 emva kokunikezelwa kunye nokongezwa okungezelelweyo.
Imithombo:
Nandyal RR. Izifo zeHemolytic zeNtsana. Umbhalo weHematology kunye neThromboembolic Disease. 2015.