I-Anisocytosis: incazelo, izimpawu kanye nokwelashwa

I-Anisocytosis igama elisetshenziswe ku i-hematology lapho kunokukhulu okungajwayelekile phakathi kwamangqamuzana egazi olayini weseli ofanayo njenge:

• amangqamuzana abomvu egazi, ebizwa nangokuthi amaseli abomvu egazi noma ama-erythrocyte;
• amaplatelets egazi, ebizwa nangokuthi ama-thrombocyte.

Kungenzeka ukuhlukanisa ama-anisocytoses amaningi ngokuya ngomugqa weseli othintekayo:

• i-erythrocyte anisocytosis lapho ukungajwayelekile kuthinta ama-erythrocyte (amaseli abomvu egazi);
• iplatelet anisocytosis, kwesinye isikhathi ibizwa ngokuthi i-thrombocytic anisocytosis, lapho ukungajwayelekile kuthinta ama-thrombocyte (amaplatelets egazi).

Ngokuya ngohlobo lokungajwayelekile okutholakele, i-anisocytosis kwesinye isikhathi ichazwa njenge:

• ukulele, evame ukufushaniswa njenge-microcytosis, lapho amangqamuzana egazi mancane ngokungajwayelekile;
• i-aniso-macrocytosis, evame ukufushaniswa njenge-macrocytosis, lapho amangqamuzana egazi emakhulu ngokungajwayelekile.

I-Anisocytosis ukungajwayelekile kwegazi okukhonjwe ngesikhathi se- i-hemogram, ebizwa nangokuthi i-Blood Count ne-Formula (NFS). Kwenziwa ngokuthatha isampula yegazi eliyingozi, lokhu kuhlolwa kunikela ngemininingwane eminingi kumaseli egazi.

Phakathi kwamanani atholakala ngesikhathi sokubalwa kwegazi, inkomba yokusabalalisa amaseli abomvu (i-RDI) ibizwa nangokuthi inkomba ye-anisocytosis. Ukwenza kube nokwenzeka ukuhlola ukwehluka ngosayizi wamaseli abomvu egazini, le nkomba yenza kube lula ukukhomba i-erythrocyte anisocytosis. Kubhekwa njengokujwayelekile uma kuphakathi kuka-11 no-15%.

Ngokuvamile, i-anisocytosis igama elisetshenziswa odokotela ukubhekisa ku-erythrocyte anisocytosis. Ngokuphathelene namaseli abomvu egazi, lokhu kungavamile kwegazi ngokuvamile kubangelwa i-anemia, ukwehla okungavamile ezingeni lamaseli abomvu egazi noma i-hemoglobin egazini. Lokhu kushoda kungadala izingqinamba ngoba amaseli abomvu egazi ngamaseli abalulekile ekusatshalalisweni komoya-mpilo emzimbeni. Yethule kumaseli abomvu egazi, i-hemoglobin yiprotheni ekwazi ukubopha ama-molecule e-oxygen (O2) ayidedele kumaseli.

Kungenzeka ukuhlukanisa izinhlobo eziningana ze-anemia ezibangela i-erythrocyte anisocytosis, kufaka phakathi:

• theukushoda kwe-iron anemia, kubangelwa ukuntuleka kwensimbi, okubhekwa njenge-microcytic anemia ngoba kungaholela ku-anisocytosis ngokwakhiwa kwamangqamuzana egazi abomvu amancane;
• i-vitamin deficiency anemia, okuvame kakhulu ukuthi kube i-vitamin B12 anemias yokushoda ne-vitamin B9 anemia, okuthathwa njenge-macrocytic anemias ngoba kungadala i-aniso-macrocytosis ngokukhiqizwa kwamangqamuzana egazi abomvu amakhulu akhubazekile.
• thei-hemolytic anemia, ebonakaliswa ukubhujiswa ngaphambi kwesikhathi kwamangqamuzana abomvu egazi, angadalwa ukungajwayelekile kofuzo noma izifo.

I-Platelet anisocytosis nayo inemvelaphi yezifo. I-Platelet anisocytosis ikakhulukazi ingabangelwa yi-myelodysplastic syndromes (MDS), eyakha iqoqo lezifo ngenxa yokungasebenzi kahle komnkantsha wamathambo.

Izimbangela Eziqondile ze-anisocytosis

Ngokwemvelo

Akubona ngaso sonke isikhathi ukuba khona kwe-anisocytosis kubonisa noma iyiphi i-pathology. Isibonelo, ezinganeni ezisanda kuzalwa, i-macrocytosis ye-physiological iyabonakala. Lokhu kungenxa yokuvuthwa kancane kancane komnkantsha kanye nezinqubo ze-mitosis kumaseli we-hematopoietic stem. Ngenyanga yesibili yokuphila, i-anisocytosis iyazixazulula ngokwayo.

iron ukuntula

Isizathu esivame kakhulu se-pathological ye-anisocytosis ukuntuleka kwensimbi. Ngokuntuleka kwe-iron emzimbeni, kukhona ukwephulwa kokuvuthwa kwama-erythrocyte, ukwakheka kolwelwesi lwamangqamuzana awo, nokwakheka kwe-hemoglobin. Ngenxa yalokho, ubukhulu bamangqamuzana abomvu egazi buyancipha (microcytosis). Ngokushoda okukhulu kwe-iron, inani eliphelele le-hemoglobin egazini liyehla, futhi i-anemia yokuntuleka kwe-iron (IDA) iyakhula.

Kanye ne-anisocytosis, i-hypochromia ivame ukwenzeka, okungukuthi, ukugcwala kwe-hemoglobin ye-erythrocyte encishisiwe. I-Anisocytosis, kanye nezinye izinguquko kuzinkomba ze-erythrocyte (MCV, MCH, MCHC), kungase kwandulele ukuthuthukiswa kwe-IDA, kulokho okubizwa ngokuthi ukuntuleka kwensimbi ecashile.

Futhi, i-anisocytosis ingase iqhubeke ekuqaleni kwe-iron supplementation yokwelapha i-anemia yokuntuleka kwensimbi. Ngaphezu kwalokho, inomlingiswa othize - kunenombolo enkulu yakho kokubili ama-microcyte nama-macrocyte egazini, yingakho i-histogram yokusatshalaliswa kwama-erythrocytes inokubonakala kokubonakala kweziqongo ezimbili.

Izimbangela zokuntuleka kwe-iron:

• I-Alimentary factor.
• Ubuntwana, ubusha, ukukhulelwa (izikhathi zokwanda kwesidingo sensimbi).
• Ukuya esikhathini eside ngokweqile.
• Ukulahleka kwegazi okungapheli: isilonda se-peptic sesisu noma i-duodenum, ama-hemorrhoids, i-hemorrhagic diathesis.
• Isimo ngemva kokususwa kwesisu noma amathumbu.
• Ukuphazamiseka kofuzo kwe-iron metabolism: i-atransferrinemia yofuzo.

Ukusampula kwegazi ukuze kwenziwe ucwaningo

I-Vitamin B12 kanye nokuntuleka kwe-folic acid

Enye imbangela ye-anisocytosis, okungukuthi i-macrocytosis, ukuntula kwe-B12 nge-folic acid, kanye nokuntuleka kwamavithamini okuhlangene kuvame ukubonwa. Lokhu kungenxa yokusabela kwabo okwenzeka eduze kwe-metabolic. Ukuntuleka kwe-B12 kuvimbela ukuguqulwa kwe-folic acid ibe ifomu elisebenzayo, le-coenzyme. Lesi simo se-biochemical sibizwa ngokuthi i-folate trap.

Ukuntuleka kwala mavithamini kuholela ekwephuleni izisekelo ze-purine ne-pyrimidine (izingxenye eziyinhloko ze-DNA), ezithinta ngokuyinhloko umsebenzi womnkantsha wamathambo, njengesitho esinomsebenzi ophezulu kakhulu wokwanda kwamangqamuzana. Kuvela uhlobo lwe-megaloblastic lwe-hematopoiesis - amangqamuzana angavuthiwe ngokugcwele anezici ze-nucleus yeseli, ukugcwala okukhulayo kwe-hemoglobin kanye nobukhulu obukhulayo bungena egazini le-peripheral, okungukuthi i-anemia i-macrocytic ne-hyperchromic ngokwemvelo.

Izimbangela eziyinhloko zokuntuleka kwe-B12:

• Ukudla okuqinile kanye nokukhishwa kwemikhiqizo yezilwane.
• i-atrophic gastritis.
• I-Autoimmune gastritis.
• Ukususwa kwesisu.
• Ukushoda kwefa le-intrinsic factor Castle.
• I-Malabsorption : isifo se-celiac, isifo samathumbu esivuthayo.
• Ukuhlasela kwezikelemu: i-diphyllobothriasis.
• Isici sofuzo se-transcobalamin.

Kodwa-ke, ukuntuleka kwe-folate okuhlukile kungenzeka. Ezimweni ezinjalo, ukuguqulwa kwe-pathological kuphela egazini kungase kube i-anisocytosis (macrocytosis). Lokhu kutholakala ikakhulukazi ekudakweni, njengoba i-ethyl alcohol ibambezela ukumuncwa kwe-folate emgudwini wamathumbu. Futhi, ukuntuleka kwe-folic acid kanye ne-macrocytosis elandelayo kwenzeka ezigulini ezithatha izinto zokuvimbela inzalo ngomlomo isikhathi eside, kwabesifazane abakhulelwe.

Thalassemia

Kwezinye izimo, i-anisocytosis (microcytosis), kanye ne-hypochromia, kungase kube izimpawu ze-thalassemia, iqembu lezifo elibonakala ngokungavamile kofuzo ekuhlanganisweni kwamaketanga e-globin. Ngokuya ngokuguqulwa kofuzo oluthile, kukhona ukushoda kwamanye amaketango e-globin kanye nokudlulela kwamanye (amaketanga e-alpha, e-beta noma e-gamma). Ngenxa yokuba khona kwama-molecule e-hemoglobin anesici, amangqamuzana abomvu egazi ayancipha ngosayizi (microcytosis), futhi ulwelwesi lwawo lusengozini yokubhujiswa (i-hemolysis).

I-Hereditary microspherocytosis

Esifweni saseMinkowski-Choffard, ngenxa yokuguqulwa kofuzo oluhlanganisa ukwakheka kwamaprotheni esakhiwo solwelwesi lwe-erythrocyte, ukuqina kodonga lwamangqamuzana awo kuyanda kumangqamuzana egazi abomvu, futhi amanzi anqwabelana kuwo. Ama-erythrocyte ayancipha ngosayizi futhi abe yindilinga (microspherocytes). I-Anisocytosis kulesi sifo ivame ukuhlanganiswa ne-poikilocytosis.

I-Sideroblastic anemia

Akuvamile kakhulu, i-anisocytosis ingase ibe ngenxa yokuba khona kwe-sideroblastic anemia, isimo se-pathological lapho ukusetshenziswa kwe-iron kungasebenzi khona, kuyilapho okuqukethwe kwe-iron emzimbeni kungase kube okujwayelekile noma ngisho nokuphakama. Izinkinga ze-sideroblastic anemia:

• I-Myelodysplastic syndrome (isizathu esivame kakhulu).
• Ukuthatha imithi ephazamisa i-metabolism ye-vitamin B6.
• Ukudakwa komthofu okungapheli.
• Ukuguqulwa kofuzo lwe-ALAS2.

Diagnostics

Ukutholwa kwesiphetho esithi "anisocytosis" ngendlela yokuhlolwa kwegazi kudinga isikhalazo udokotela ojwayelekile ukuze kutholakale imbangela yalesi simo. Ngesikhathi sokuqokwa, udokotela uqoqa umlando oningiliziwe, wembula ukutholakala kwezikhalazo ezinezici ze-anemia (ubuthakathaka obujwayelekile, isiyezi, ukuwohloka kokuhlushwa, njll.). Icacisa ukuthi isiguli sithatha noma yimiphi imithi ngokuqhubekayo.

Ngesikhathi sokuhlolwa okuhlosiwe, ukunakwa kudonswa ebukhoneni bezimpawu zomtholampilo ze-anemic syndrome: umbala obomvu wesikhumba nolwelwesi lwamafinyila, umfutho wegazi ophansi, ukushaya kwenhliziyo okwandisiwe, njll. Nge-hemolytic anemia yofuzo, ukuba khona kwezimpawu zokuguquka kwethambo. Uhlaka lwamathambo luyisici.

Izifundo ezengeziwe zihleliwe:

• Ukuhlaziywa kwegazi okujwayelekile. Ku-KLA, inkomba ye-hematological analyzer, ebonisa ukuba khona kwe-anisocytosis, i-RDW. Nokho, kungase kube phezulu ngephutha ngenxa yokuba khona kwama-agglutinins abandayo. Ngakho-ke, ukuhlolwa kwe-microscopic ye-blood smear kuyimpoqo. Futhi, i-microscopy ingathola izimpawu zokushoda kwe-B12 (imizimba ye-Jolly, izindandatho ze-Kebot, i-hypersegmentation ye-neutrophils) nokunye okufakiwe kwe-pathological (i-basophilic granularity, imizimba ye-Pappenheimer).
• Amakhemikhali egazi. Ekuhlolweni kwegazi le-biochemical, izinga le-serum iron, i-ferritin, ne-transferrin liyahlolwa. Izimpawu ze-hemolysis zingase futhi ziphawulwe - ukwanda kokuhlushwa kwe-lactate dehydrogenase ne-bilirubin engaqondile.
• Ucwaningo lwe-Immunological. Uma kusolakala ukuthi kunesilonda esizimelayo sepheshana lamathumbu, kwenziwa ukuhlolwa kwamasosha omzimba kumaseli e-parietal esiswini, amasosha omzimba ku-transglutaminase, ne-gliadin.
• Ukutholwa kwe-hemoglobin engavamile. Ekuxilongweni kwe-thalassemia, i-hemoglobin electrophoresis kufilimu ye-cellulose acetate noma i-chromatography yoketshezi esebenza kahle iyenziwa.
• Ukuxilongwa kwe-microspherocytosis. Ukuqinisekisa noma ukukhipha i-microspherocytosis yofuzo, ukumelana kwe-osmotic kwama-erythrocyte kanye nokuhlolwa kwe-EMA kwenziwa kusetshenziswa udayi we-fluorescent eosin-5-maleimide.
• ucwaningo lwe-parasitological. Uma kusolwa i-diphyllobothriasis, i-microscopy yokulungiswa kwe-fecal yendabuko inqunyelwe ukucinga amaqanda e-tapeworm ebanzi.

Kwesinye isikhathi kuyadingeka ukwenza ukuxilongwa okuhlukile phakathi kwe-IDA ne-thalassemia encane. Lokhu kungenziwa kakade ngokuhlolwa kwegazi okujwayelekile. Kulokhu, inkomba ye-Mentzer ibalwa. Isilinganiso se-MCV nenani lamaseli abomvu egazi angaphezu kuka-13 sivamile ku-IDA, ngaphansi kuka-13 - ku-thalassemia.

Ukuhlola i-blood smear

Izimpawu ze-anisocytosis yilezo ze-anemia. Yize kunezinhlobo ezahlukahlukene nemvelaphi yokushoda kwegazi, izimpawu ezimbalwa zezici zibonakala njalo:

• umuzwa wokukhathala okuvamile;
• ukuphelelwa umoya
• ukushaya kwenhliziyo;
• ubuthakathaka nesiyezi;
• i-pallor;
• ikhanda.

Ukwelashwa kwe-anisocytosis kuncike embangela yokungajwayelekile. Uma kwenzeka kushoda i-iron anemia noma i-vitamin deficiency anemia, ukwesekwa kokudla okunempilo ngokwesibonelo kunganconywa ukwelapha i-anisocytosis.