Uhlolo lokujonga
I-neonatal alloimmune thrombocytopenia (NAIT) yimeko engavumelekanga yeplatelet ngokungafaniyo phakathi komama kunye nosana lwakhe. Ngexesha lokukhulelwa, umama uvelisa iintsholongwane ezihlasela kwaye zichithe iiplatelet ezibangelwa i- thrombocytopenia enzima (inani eliphantsi leplatelet) kunye nokuphuma kumntwana. Ifana ne-Hemolytic Disease yeNtsana, isifo seeseli ezibomvu zegazi.
I-NAIT akufanele idideke ne-neonatal autoimmune thrombocytopenia. I-neonatal autoimmune thrombocytopenia ivela koomama abane- immune thrombocytopenia (ITP) okanye i-lupus. Unina unama-platelet antibodies ekujikelezeni kwakhe ahlasela zakhe iiplatelet. Ezi zithintelo zithintela kwi-fetus nge-placenta ezibangele ukutshatyalaliswa kweeplatelets kunye nazo.
Iimpawu
Iimpawu zixhomekeke kwi-platelet count. Ngokuqhelekileyo ekukhulelweni kokuqala, akukho ziingxaki de kube usana luzalwa. Ngeveki yokuqala, i-thrombocytopenia ibuhlungu. Njengoko iiplatelets zehla, ukunyuka kwenyuka, i-petechiae (amancinci amancinci ebomvu), okanye ukuphuma kwegazi kunokuphawulwa.
Ingxaki enkulu kakhulu ye-NAIT iphuma kumbongo obizwa ngokuba yi-intracranial hemorrhage (ICH). Oku kwenzeka kwi-10 - 20% yabantwana. Iintsana ezinenani eliphantsi kakhulu leplatelet zihlolwe i-ICH kunye ne-cranial ultrasounds.
Kwixesha elizayo lokukhulelwa, i-thrombocytopenia ingaba nzima kakhulu kwaye i-CH iyakwenzeka ngaphambi kokuzalwa (ngexesha lobunzima).
Kutheni Oku kwenzeka?
Iiplatelet zethu ziboshwe ngama-antigens, izinto ezenza ukuphendula kwamagciwane. Kwi-NAIT, umntwana usufumana i-antigen eplatelet evela kubaba ongenalo unina.
Isistim e-immune sokubeleka siyabona ukuba le antigen "njengangaphandle" kwaye ivelisa amanqamana nawo. Ezi zithintelo ezivela kumama ukuya emntwaneni nge-placenta apho zifakela kwiiplatelet, ziphawulwe ngokutshabalalisa. Ngokungafani ne-Hemolytic Disease yeNtsana, le nto inokuvela ngokukhulelwa kokuqala.
Kuchongwa njani?
Kukho uluhlu olude lwezizathu ezinokwenzeka ze-thrombocytopenia kwintsana. Uninzi lwezi zibangelwa izifo ezinjenge- CMV yokuzalwa, i-rubella yokuzalwa, okanye i-sepsis (intsholongwane enobungozi obukhulu). Kwiimeko eziqhelekileyo, umntwana usagula. I-NAIT ifanele ithathelwe ingqalelo kwintsana ebonakala kakuhle ene-thrombocytopenia enzima (inani leplatelet lingaphantsi kwama-50,000 amaseli nganye nge-microliter).
Kwi-NAIT usana lufumana unyango ngaphambi kokuxilongwa njengoko kuqinisekiswa ukuba ukuxilongwa kuthatha iiveki ezimbalwa. Ukuqinisekisa i-NAIT idinga ukuhlolwa kwegazi kubazali, kungekhona intsana. Unina uya kuba nebala eliqhelekileyo leplatelet njengoko i-antibodies ayihlaseli iiplatelets zayo. Igazi lithunyelwa kwi-lab ekhethekileyo ukuvavanya ukuba unina nobawo bachithe i-antigen antigens kunye nokuba umama wenza i-antibodies kwi-antigen eplatelet efunyenwe nguyise. Ukuba i-NAIT iyakrokrelwa, ukuba kubaluleke kakhulu ukuqinisekisa ukuxilongwa ukukhulelwa kwangaphambili kunokuchaphazeleka kakhulu kwi-thrombocytopenia enamandla kunye nokunyuka kwe-intrrhage e-utero (ngaphambi kokuzalwa).
Oku kulandelwa njani?
Iintsana ezichaphazelekayo zingenakufuna unyango. Kwiintsana ezithintekayo kakhulu, injongo yonyango kukukhusela okanye ukuyeka ukuphuma kwegazi, ingakumbi kwingqondo.
- Ukuxilongwa kweplateslet: Ngenxa yokuba iiplatelets zomama zingenayo i-antigen ephosakeleyo kwaye ngoko ayiyi kutshabalaliswa, ngokuqinisekileyo, iiplatelets ezixonywe kumntwana zivela kumama okanye kumxhasi ofana nomama. Le nkqubo inokuthabatha ixesha elide kwaye ayisoloko isetyenziswa ngobomi bokwenene. Ukuba i-thrombocytopenia inzima (<20,000 amaseli nganye nge-microliter) okanye ukuphuma kwegazi, kwenzeka ukuba uphephelo lweplatelet luvela kwinkqubo yokunikela ngevolontiya. Ezi zinto zihlala zilawulwa ngexesha elifanayo kunye ne-immune globulin ekhuselweyo yokunyusa ubomi beeplatelet.
- I-immune globulin (IVIG): I-IVIG ingeniswa kwiintsana ukuphazamisa isistim somzimba. I-IVIG iqulethwe ngamanzi amaninzi amaninzi evela kubaxhasi abaninzi. Ezi zikhusela zikhusela umzimba womzimba kwaye zinciphisa ukutshatyalaliswa kweeplatelet, ezifana nokuphathwa kwe-ITP. Oku kusetyenziswa ngokudibanisa ne-platelet transfusion.
- Ukucebisa: Abazali abanomntwana onama-NAIT kufuneka banikwe icebo malunga nomngcipheko wale nto eyenzekayo xa bekhulelwe. Ngenxa yokuba le mngcipheko, ukukhulelwa kwexesha elizayo kufuneka kuhlolwe ngumgqirha omkhulu wengozi. I-IVIG inokulawulwa kumama ngexesha lokukhulelwa okanye ukumpontshelwa kweplatelet inokunikezwa kumntwana okhulayo ukukhusela ukuphuma kwegazi. Icandelo le-Caesarea linconywa ukuhambisa ukukhusela igazi.
> Imbekiselo
> UKaren S. Fernandez noPedro de Alarcon. Neonatal Thrombocytopenia. NeoReviews. 2013.