Ukumpontshelwa ngegazi ezininzi iinjongo zobomi kwezinye izigulane ezine-leukemia, i-lymphoma kunye ne-myeloma. Ukutshintshwa kusetshenziselwa ukuphucula ukubalwa kweeseli zegazi kunye nokuphatha iimpawu kunye neempawu ze- anemia - njengokukhathala , ukucinga ngentshukumo, ukuphefumula nokuphefumula . Nangona kunjalo, ukumpontshelwa igazi ngexesha elide kunokubangela ukuba insimbi ibe yindleko - imeko yokuba, ukuba ingaphathiswa, ingonakalisa intliziyo nesibindi.
Kwenzeka njani
Intsimbi inendima ebaluleke kakhulu emzimbeni wethu. Idlala inxaxheba kwiinkqubo ezininzi ze-biological, kubandakanywa ne-DNA xa iiseli zahlula, kunye nokuthuthwa kwe-oksijini kwimiphophu ukuya kwiiseli kunye nezicubu zethu. Intsimbi esiyifumanayo ngokutya kwethu ibophelela kwiprotheni ebizwa ngokuthi i-transferrin kwaye ijikeleze ngegazi leplasma.
Ngokona nxalenye ininzi, le ntsimbi isetyenziselwa ukudala i- hemoglobin, into elinezibomvu zegazi ezibomvu ezithwala umoya-mpilo esiwuphefumlayo kwiishukela zethu . I-Leftover isinyithi igcinwe kwisibindi, ukusetyenziswa kwangomso.
Umzimba womntu awunako ukukhipha ngenjongo okanye ukukhupha i-iron eyimfuneko, nangona enye insimbi ilahlekile kwiinkqubo eziqhelekileyo ezifana nokucinywa kweeseli zesikhumba. Xa isithuba esiphezulu sendawo yokugcinwa kwesinyithi sifikelelwe, isinyithi siqala ukwakha kwezinye iindawo zomzimba, okukhokelela kwisitrity overload.
Ukuxilongwa kwegazi okomvu obomvu kukhupha inani elikhulu lensimbi.
Abantu abanobuchopho, kuphela u- 1-2 mg wensimbi uguqulwa ngosuku oluthile - oko kukuthi, isinyithi esithathwayo ukusuka ekudleni kunye nokulahleka ngokutyhala kweeseli zesikhumba kunye neeseli zesisu, ngokomzekelo. Iyunithi enye yamaseli obomvu aphetheyo (PRBCs), nangona kunjalo, iqulethe malunga ne- 200-250mg . Uninzi lwamaxesha amaninzi, izigulane zifumana iiyunithi ezimbini ngalunye ixesha xa zitshintshiswa, ngoko ke enye ingama 500 mg ngosuku olunye.
I ziphumo
Xa isinyithi ikhusele amandla omzimba ukuba agcine ngokukhuselekileyo, kunokubangela ingozi ngeendlela ezininzi. Okokuqala, xa kukho enye insimbi emzimbeni kunokuba i-transfrinrin ukuba ibophe kuyo, ijikeleza ngokwayo njengensimbi engeyiyo-transferrin-iron bound (NTBI). Le ndlela yensimbi inobuthi kwiimzimba zethu, kwaye ibangela ukulimala kwiisisu kunye namalungu ethu kumgangatho weselula.
Ukongezelela, isinyithi esinyanisekileyo iqokelela entliziyweni, emaphaphu, ebuchosheni, kwiintlanzi ze-endocrine, isibindi kunye nangomnatha wethambo.
Ukungabonakali, oku kuqokelela kungakhokelela eku:
• Ukumelwa yintliziyo
• Ukungenzi lutho
• Isifo sikashukela
• I-cirrhosis yesibindi
• IArthritis
• I-Hypothyroidism (i-thyroid engekho phantsi)
• Ukukhula kakubi
• Ukungasebenzi kwe-Erectile
• Umhlaza
• Uxinzelelo
Olunye ubungqina lubonisa ukuba usulelo lwebhaktheriya lunokuba yimpembelelo yesitrityload over.
Ngubani Osemngciphekweni?
Abantu abasemngciphekweni wokunxiliswa kweensimbi ezithandwayo ngegazi banabo bafumene ukunyuswa kwamanzi amangqombela egazi abomvu. Abantu abadala abafumana rhoqo igazi bangengozi emva kweeyunithi ezingama-20 ze-PRBCs, okanye ukunyuswa kwegazi xa ufumana iiyunithi ezimbini ngelo xesha.
Izigulane ezinegazi kunye nomongo weengxaki zomhlaza, ezifana ne-leukemia kunye ne-lymphoma, ngokuqhelekileyo zifuna inani elikhulu lokumpontshelwa emva kwe-chemotherapy, emva kwe-radiotherapy kwisigxina se- pelvic, okanye ukulandelwa kwe-cell stem .
Izigulane ezine- myelodysplastic syndromes (MDS) zihlala zihlala ne- hemoglobin ehlala phantsi kwaye ezininzi zixhomekeke kwi-transfusion, zibeka emngciphekweni omkhulu wokutsalwa kwesimbi. I-MDS kunye ne-anemia ye-sideroblastic inokubangela ukuba izigulane zifumane ubuninzi beesinyithi ekudleni kwazo, okwenza ingxaki ibe yimbi ngakumbi.
Ukuxilongwa
Ukugqithiswa kweentsimbi kubakho ngexesha, kwaye izigulane aziyi kubonisa nayiphi na imiqondiso. Kungenzeka ukuba i-iron overload izakufunyanwa kwiziphumo zebhoratri ngaphambi kokuba umntu abe neempawu.
Uvavanyo oluqhelekileyo ukuvavanya i-iron saturation kuthiwa ngamanqanaba e-serum ferritin. Olu vavanyo lwegazi olunokuthi luyenziwe rhoqo rhoqo kubantu abasengozini enkulu.
Amazinga eSerum ferritin akhula njengoko inani le-NTBI landa kwigazi. Amanqanaba e-Ferritin angaphezu kwe-1,000 mcg / L abonisa ukugqithisa insimbi. Amadoda aphilileyo anesifo se-serum ferritin se-24-336 mcg / L kunye nabafazi abanempilo 12-307 mcg / L. Ezinye izifo kunye neemeko zinokubangela ukuba inani elikhulu le-ferritin likhutshwe ekusasazweni, nangona kunjalo, oko kungenza ukufundwa okuphakamileyo okuthembekile, ngoko ukuvavanywa rhoqo kusemgangathweni.
Oogqirha banokukhetha ukwenza i-biopsy yesibindi ukujonga ingcinezelo yensimbi. Nangona lo vavanyo lungafumana iziphumo ezichanekileyo ngakumbi kunezinga le-serum ferritin, lifuna inkqubo echanekileyo engakhokelela kwiinkathazo, ezifana nokusuleleka nokukhupha. Iziphumo ze-Biopsy ezingaphezu kwe-7 mg isinyithi nganye ngegrama yesibindi kubonisa ukuba insimbi ithwala umthwalo.
Uphononongo lokuphonononga lungaphinda lubonakalise iziphumo ezibonisa ukugqithiswa kwentsimbi. I-imagery resonance imagination (MRI) ingasetyenziselwa ukufumanisa ukuqokelela kwinyithi esibindi nasentliziyweni. I-MRI ingasetyenziselwa kunye ne-biopsy yesibindi ukuxilonga i-iron overload okanye ngokuzimela. Nangona kunjalo, ukugcinwa kwesebe akuqinisekanga ngokuchanekileyo nge-MRI kwezinye iziganeko, njengokuba i-deposit deposit yenzeka kwi-pancreas.
Unyango
Kukho iindlela ezimbini eziphambili ezenziwe ngongxowankulu: i-phlebotomy yokwelapha kunye nonyango lwe-chelation yonyango.
I-phlebotomy yokwelapha yindlela ekhawulezayo neyona ndlela iphumelelayo yokufumana amanqanaba esinyithi phantsi kwesigulane. Ngelishwa, ayikwazi ukusetyenziswa kwizigulane eziseleyo. Ngoko ke, ngokuqhelekileyo igcinelwe izigulane ezine-leukemia okanye i-lymphoma.
Ngethuba le-phlebotomy yonyango, umongikazi okanye ugqirha uza kufaka inaliti enkulu emthanjeni wakho , ngokuqhelekileyo kwisandla sakho. Emva koko baya kususa malunga ne-500 ml yegazi emzimbeni wakho malunga nemizuzu eyi-15-30. Ukuba uke wanikela ngegazi, ufumana ingcamango. Le mali iqulethe malunga ne-250 mg yesinyithi. Njengoko le ntsimbi isuswe ngegazi lakho, isibindi sakho sishiya ezinye izitolo zayo kwaye ekugqibeleni inani lokujikeleza insimbi linokubuyiselwa kwiindawo eziqhelekileyo. I-Phlebotomy inokwenziwa kanye okanye kabini ngeveki xa kuyimfuneko ukufikelela kwinjongo yamanqanaba e-serum ferritin ka-50-100mcg / L.
I-iron chelation yonyango isebenzisa imishanguzo ebophayo, okanye i-chelate, isinyithi kwaye iququzelele ukususwa kwayo emzimbeni. Injongo yale hlobo lonyango kukuba kususwe isinyithi esingaphezulu kwegazi kunye nezicubu zomzimba. Nangona le ngonyango isebenza kakuhle kwi-intsimbi yesinyithi kunye ne-fover deposit, ayifanelekanga ukususa iimbotyi zentsimbi entliziyweni.
Deferoxamine (Desferal), i-deferasirox (Exjade), kunye ne-deferiprone (i-Ferriprox) yile miyeza emithathu.
Imithi ye-Iron chelator iphumelele ekunciphiseni amanqanaba e-NTBI, kodwa ezi nqanaba zihlawule ngokukhawuleza ukuba unyango luyekile. Ngoko ke, la mayeza kufuneka athathwe ngokufanayo njengoko atyelwe ukuba asebenze ngokufanelekileyo. Oku kungenza ukuzibophezela okukhulu kwezinye izigulane. I-iron chelators ayinayo imiphumo emibi, kwaye ingozi kunye neenzuzo zentsimbi ye-chelation imfuneko yokunyaniseka.
Ukongezelela kwezi zonyango, umboneleli wakho wezempilo unokwenza iingcebiso ukunciphisa inani lentsimbi oyithathayo ngokutya kwakho. Nangona le nto ingumlinganiselo onokuqonda, ngeendlela ezimbalwa, iingeniso zokunciphisa isinyithi ekudleni ziphikisayo kuba le ndlela ixhamla kwi "bhokheni kwibhakethi", kwaye ekubeni unyango lwe-iron overload ezifana ne-phlebotomy lide kusebenza ngakumbi ekunciphiseni amanqanaba ensimbi.
Iingcebiso malunga nokuzinakekela
Ukuxilongwa kwegazi ngokuqhelekileyo kuyimfuneko ebalulekileyo kwaye isebenzayo ye-leukemia kunye nonyango lwe-lymphoma. I-anemia ingaba neyona nto inobungozi, nokuba yingozi, iziphumo emzimbeni wakho kunye nokugonywa kungenakukhutshwa.
Nangona kunjalo, kukho izinto onokuzenza ukuze uqinisekise ukuba amazinga ensimbi yakho ahlolwe kakuhle. Qinisekisa ukuba iqela lakho lokunakekelwa kwezempilo liyakwazi konke malunga nembali yakho yegazi lokudlulela. Unokufumana i-PRBC kwiminyaka edlulileyo kwimeko engahambelani ngokupheleleyo, kodwa ugqirha wakho kufuneka azi malunga naloo nto ngoku. Khumbula ukuba insimbi ayinayo indlela yokukhutshwa emzimbeni wakho, ngoko-ke ukumpontshelwa ngalunye ufumana ngexesha lakho lobomi kunakho ukufaka isandla kwi-iron overload namhlanje.
Kufuneka uzame ukugcina ithrekhi ye-transfusion nganye oyifumayo. Oku kusenokungabi lula, kwaye kunokubakho amaxesha ekunyango kwakho xa kubonakala ngathi konke okwenzayo kuthunyelwa igazi, kodwa kuya kubaluleka kamva.
Iqela lakho lononophelo lwezempilo kufuneka liqalise ukubeka esweni iinqanaba lakho le-serum ferritin xa sele ufumene iiyunithi ezingama-20 zegazi. Ukuba uhlala ufumana iiyunithi ezimbini ngelo xesha, oku kunokuphela kwegazi eli-10 kuphela. Ukuba abayikuyilawula ngokuzenzekelayo, kufuneka ucele.
Okukwintsusa
Izigulane ezithotyelwa igazi kwiindawo zabo zobomi zisengozini yokuphuhlisa intsimbi. Ngenxa yobume bezifo zabo, kunye neendlela ezisetyenziselwa ukuphatha, izigulane zegazi kunye nomdlavuza womongo zisoloko zixhomekeke kwi-transfusion-time depend. Ukuba angakhange axoxwe, ukugqithiswa kwesinyithi kunokukhokelela kumonakalo omkhulu womzimba kunye nokufa, kodwa unyango olusebenzayo lukhoyo.
Nangona kungenakwenzeka ukuphepha igazi, izigulana zinokukunceda ukuzikhusela ngokukhumbuza inani leeyunithi ezifumanayo kwaye zicela ukuhlolwa kwe-iron overload ukuba kuyimfuneko.
Ukuhlaziywa kweyoKwindla ka-2016, iTI.
Imithombo:
IBrittenham GM. Ulwaphulo lweCandelo loTywala lokuTyhulwa kweNsimbi. N Engl J Med . 2011; 364 (2): 146-156.
I-Zhang C. Imisebenzi ebalulekileyo yesinyithi-efuna iiprotheni kwi-DNA ukuphindaphinda, ukulungiswa nokulawula umjikelezo weseli. Iprotheni kunye neSeli . 2014; 5 (10): 750-760.
Geissler C, Singh M. Iron, inyama kunye neMpilo. Amanzi . 2011; 3 (3): 283-316.
I-Karimi M, i-Jamalian N, i-Rasekhi A, i-Kashef S. i-Magnetic imaging resonance (MRI) ukufunyanwa kwamalungu kwi-beta-thalassemia izigulane ezinkulu: i-fluid ezungeze ithambo le-scaphoid: i-novel findings, njengefuthe elibonakalayo le-hemochromatosis yesibini. J Pediatr Hematol Oncol . 2007; 29 (6): 393-8.
I-Antle, E. Ngubani ofuna i-Phlebotomy ye-Purebotomy? I-Clinical Journal ye-Oncology Nursing. Disemba 2010. 14: 694-696.
I-Ault, uP., Jones, K. Ukuqonda ukugqithisa kweHonga: Ukuhlola, ukubeka iliso nokunyamekela izigulane ezine-Transfusion ezixhomekeke ku-Anemias. I-Clinical Journal ye-Oncology Nursing. Oktobha, 2009; 13: 511-517.