Ingxoxo yonyango lwesibini kunye neyesithathu
Nangona uninzi lwabantwana kunye nenani elincinci labantu abadala abane- immune thrombocytopenia (i-ITP) baya kuba nebala eliqhelekileyo leplatelet, ezinye ziza kuqhubeka zinexesha elingapheliyo. Ingcamango yokuba ne-ITP engapheliyo ingasalisa, ngoko makhe sihlolisise oko kuthetha ntoni apha.
Okokuqala, i-ITP ingabelana ngoku:
- Iiprayimari: I- ITP yeprayimari yenziwa ngenxa yokutshatyalaliswa kweplatelet. Kubantwana, uninzi lwamatyala yi-ITP ephambili.
- ISekondari: I-ITP yesibini inxulumene neminye imeko efana ne- lupus , i- HIV , i- hepatitis C , okanye i-leyemia ye-lymphocytic engapheliyo .
Nangona unyango lokulungisa ukuphuma kwegazi kwi-ITP eziziiprayimari nezesekondari zingafana, unyango lwe-ITP yesibini lujoliswe kwiimeko zonyango. Ulawulo olubhetele kwiimeko zonyango luya kuphucula i-thrombocytopenia.
I-ITP yeprayimari ngoko iyakwazi ukwahlukana kwakhona kwi:
- Ukufumanisa ngokutsha: Ukuxilonga kwiinyanga ezintathu.
- Ukuqhubeka: I- ITP eqhubekayo ngaphezu kweenyanga ezintathu.
- Isifo esingapheliyo: Ukuba iinyanga ezingapheliyo ezilishumi elinesibhozo, zibhalwe zingapheliyo.
- I-Refractory: Eli gama lisetyenziselwa ukuchaza i-ITP efuna unyango (isigulane sinempawu eziphazamisayo) esichasayo kwipilisi yokuqala (steroids, IVIG, WinRho) okanye i- splenectomy .
Nangona uninzi lwabantu abadala abanokuxilongwa nge-ITP eyintloko baya kuqhubeka nokuphuhlisa inkqubo engapheliyo, ininzi iya kugcina inani elizinzileyo, elincinci leplatelet (ngokuqhelekileyo lithetha ngaphezu kweeseli ezingama-20,000 ngamnye), apho ukuphuma kwegazi ngokukhawuleza kungenakwenzeka.
Ezi zi gulane zisenokufuna ezinye iikhosi ezongezelelweyo zonyango. Omnye umzekelo ugqirha, apho isibalo seplatelet sidla ngokukhawuleza ukuba siphephe ukukhupha igazi ngexesha le nkqubo.
Ukwelashwa kweSibini
Umngeni kukuba abo bagulane abaqhubeka bephuma ngaphandle kokunyanga okokuqala.
Kwiminyaka edlulileyo, i-splenectomy ithathwa njengento eyintloko yonyango lomgca wesibini. I-Splenectomy isebenza ngeendlela ezimbini. Okokuqala, isusa indawo ephambili yokutshatyalaliswa kweplatelet. Okwesibini, isusa ezinye i-lymphocytes ezivelisa i-anti-platelet antibodies zihlala kwipeni. Ukususwa kwala ma-lymphocytes kunokunyusa ubomi beeplatelets.
I-Splenectomy inomlando owaziwayo kunye neepesenti ezingama-85 zezigulane eziphendulayo, uninzi lwabantu ngokumalunga nokubala kweplatelet. Nangona le mpu melelo, i-splenectomy ayikho ngaphandle kwayo ingozi, ingakumbi ingozi yokuphila kwe-sepsis enkulu (intsholongwane ebangelwa yi-bacterial infection).
Ngenxa yale mngcipheko, abanye oogqirha babecinga i-rituximab unyango lwesibini. I-Rituximab yi-antibody eyazibandakanya kwi-B lymphocytes (enye yeeseli zegazi ezimhlophe ezenza izikhuhlane), ezibangela ukuba zitshabalalise. Nge-anti-platelet ye-anti-platelet yemveliso evela kwi-B lymphocyte, iiplatelets aziyi kubhujiswa. I-Rituximab inikwe ngokuqhelekileyo njenge-IV infusion nganye ngeveki ezine, kodwa ngezinye iiveki zingaphantsi kweeveki. Impendulo kwi-rituximab iyahluka ngakumbi kune-splenectomy, kunye nezinye izigulane ezineempendulo ezihlala njalo kodwa ezinye zibuyela kwakhona.
Ukwelashwa kweThathu
Ngethamsanqa, ngoku kukho iindlela zokwelapha zendlela yesithathu ezifumaneka kwi-ITP.
Kwiminyaka emininzi, kwakukholelwa ukuba kwi-ITP, iiplatelet zenziwe ngokuqhelekileyo emnxeni wethambo kodwa zatshatyalaliswa xa zikhutshwe kwi-circulation. Iingcali ngoku ziyaziwa ukuba umsebenzi weplatelet naye unzima. Olu lwazi lubangele ukuphuhliswa kwamachiza okuthiwa i-thrombopoietin (TPO) i-receptor agonists.
Okwangoku kukho ezimbini i-TPO receptor agonists efumaneka e-US, elthrombopag ne-romiplostim. I-Elthrombopag yonyango lomlomo elithathwe imihla ngemihla kwaye i-romiplostim inikwa kanye ngeveki nje nge-injection subcutaneous. Nangona i-elthrombopag ibonakala ngathi yonyango elula kuba ithathwa ngomlomo, akukho ukutya okuqukethe i-calcium kunokudliwa kwiiyure eziliqela ngaphambi nangemva kwesazi.
Xa i-dose yesondlo imisiwe, abadala bangafunda indlela yokuphatha i-romiplostim ekhaya.
I-TPO i-agonists i-receptor igonists iyalwa njengamachiza okugcina angapheliyo asetyenziswe ukugcina inani leplatelet eliphezulu ngokwaneleyo ukukhusela igazi. La mayeza angasetyenziswa kubantwana kunye nabantu abadala abane-ITP engapheliyo.
Njengoko unyango oluninzi lwezonyango, umyalelo wokuqala, wesibini, nowesithathu unyango unokuhluka ngokusekelwe kwiimpawu zesigulane ngasinye. Ukuba unemibuzo okanye uxhalaba malunga neyeza lakho, kufuneka uxoxe nabo nodokotela wakho.
Imithombo:
JB. I-ITP kubantwana: Ulawulo lweZifo eziPhezulu. Ku: U-UpToDate, i-Post TW (Ed), UpToDate, i-Waltham, MA.
UGeorge JN noArnold DM. I-ITP kwiBantu abadala: I-Second Line kunye neMilandiselo eLawulayo. Ku: U-UpToDate, i-Post TW (Ed), UpToDate, i-Waltham, MA.