Isifo se-Hemolytic sosana olusanda kuzalwa - izimbangela, izimpawu, amafomu

Ngokuvumelana nomsebenzi walo, Ibhodi Lokuhlela le-MedTvoiLokony lenza yonke imizamo yokuhlinzeka ngokuqukethwe kwezokwelapha okuthembekile okusekelwa ulwazi lwakamuva lwesayensi. Ifulegi elengeziwe elithi "Okuqukethwe Okuhloliwe" libonisa ukuthi i-athikili ibuyekezwe noma yabhalwa udokotela ngokuqondile. Lokhu kuqinisekisa okuyizinyathelo ezimbili: intatheli yezokwelapha kanye nodokotela basivumela ukuthi sinikeze okuqukethwe kwekhwalithi ephezulu ngokuhambisana nolwazi lwamanje lwezokwelapha.

Ukuzibophezela kwethu kule ndawo kuye kwathakaselwa, phakathi kokunye, yiNhlangano Yezintatheli Zezempilo, eyaklomelisa Ibhodi Lokuhlela le-MedTvoiLokony ngesihloko sokuhlonipha esithi Umfundisi Omkhulu.

Isifo se-neonatal haemolytic yisimo esibangelwa ukungahambisani (ukungqubuzana) ku-Rh factor noma amaqembu egazi angu-AB0 phakathi kukamama nombungu. Lesi sifo sibangela ukukhiqizwa kwamasosha omzimba egazini likamama, okuholela ekuqhekekeni kwamangqamuzana egazi abomvu osana nosana olusanda kuzalwa. Uhlobo oluyingozi kakhulu lwesifo se-hemolytic yi-jaundice.

Amagama ambalwa mayelana nesifo se-hemolytic sosana olusanda kuzalwa ...

Lesi sifo sihlobene nokungqubuzana kwe-serological, okungukuthi isimo lapho iqembu legazi likamama lihlukile eqenjini legazi lomntwana. Isifo se-haemolytic sidala ukukhiqizwa kwamasosha omzimba egazini likamama aphula amangqamuzana egazi abomvu osana nosana olusanda kuzalwa. Uhlobo oluyingozi kakhulu lwalesi sifo yi-jaundice enzima ye-neonatal, ebangelwa amazinga akhuphuka ngokushesha e-bilirubin egazini kanye nokuthuthukiswa kwe-anemia. Lapho izinga le-bilirubin lidlula umkhawulo othile, lingalimaza ubuchopho, olwaziwa ngokuthi i-jaundice yamasende esisekelo sobuchophookuphumela - uma ingane isinda - ukungathuthuki kahle kwengqondo. Njengamanje, ukungqubuzana kwe-serological akuyona inkinga enkulu njengasekhulwini lesi-XNUMX.

Izimbangela zesifo se-hemolytic sosana olusanda kuzalwa

Wonke umuntu uneqembu elithile legazi, futhi ngaphansi kwezimo ezijwayelekile umzimba onempilo awukhiqizi amasosha omzimba ngokumelene namaseli awo egazi. Iqembu legazi le-Rh + alikhiqizi amasosha omzimba ngokumelene nalesi sici, okungukuthi i-anti-Rh. Ngokufanayo, umzimba wesiguli oneqembu legazi A awukhiqizi ama-anti-A antibodies. Kodwa-ke, lo mthetho awusebenzi kwabesifazane abakhulelwe, ngakho-ke isifo se-hemolytic somntwana osanda kuzalwa sibangelwa ukungqubuzana phakathi kwegazi lomntwana kanye nama-antibodies akhiqizwa ngumama. Ukukubeka kalula: igazi likamama alizwani negazi lomntwana. Amasosha omzimba owesifazane okhulelwe angawela i-placenta (okwamanje noma okulandelayo) futhi ahlasele amangqamuzana egazi omntwana. Umphumela uba isifo se-haemolytic yengane.

Izimpawu nezinhlobo zesifo se-hemolytic yengane

Uhlobo olulula kakhulu lwesifo se-haemolytic ukubhujiswa ngokweqile kwamangqamuzana egazi omntwana. Ingane izalwa nayo i-anemiangokuvamile kuhambisane nobende olukhulisiwe nesibindi, kodwa lokhu akubeki usongo empilweni yakhe. Ngokuhamba kwesikhathi, isithombe segazi sithuthuka kakhulu futhi umntwana ukhula ngendlela efanele. Kodwa-ke, kufanele kugcizelelwe ukuthi kwezinye izimo i-anemia inzima futhi idinga ukwelashwa okukhethekile.

Olunye uhlobo lwesifo se-hemolytic kukhona i-jaundice enzima. Ingane yakho ibonakala iphile saka ngokuphelele, kodwa iqala ukuba ne-jaundice ngosuku lokuqala ngemva kokuzalwa. Kukhona ukwanda okusheshayo kwe-bilirubin, okubangela umbala ophuzi wesikhumba. I-jaundice iyingozi enkulu ngoba ukugxila kwayo ngaphezu kwezinga elithile kunomthelela onobuthi ebuchosheni bomntwana. Kungaholela ekulimaleni kwengqondo. Ezinganeni ezine-jaundice, ukuquleka kanye nokuqina kwemisipha ngokweqile kuyabonwa. Ngisho noma ingane isindisiwe, i-jaundice ingaba nemiphumela emibi kakhulu, isibonelo, ingane ingase ilahlekelwe ukuzwa, ihlushwe yisithuthwane futhi ibe nenkinga yokukhuluma nokugcina ibhalansi.

Uhlobo lokugcina nolubi kakhulu lwesifo se-hemolytic sosana olusanda kuzalwa lujwayelekile ukuvuvukala kwe-fetus. Njengomphumela wokubhujiswa kwamangqamuzana egazi omntwana ngama-antibodies kamama (esesesiteji sokuphila komntwana), ukujikeleza kwengane esanda kuzalwa kuyaphazamiseka futhi ukuvuthwa kwemikhumbi yayo kwanda. Kusho ukuthini? Uketshezi oluphuma emithanjeni yegazi lubalekela ezicutshini eziseduze, ngaleyo ndlela kubangele ukuba i-edema yangaphakathi yakheke ezithweni ezibalulekile, njenge-peritoneum noma i-pericardial sac ezungeze inhliziyo. Ngesikhathi esifanayo, ingane encane iba ne-anemia. Ngeshwa, ukuvuvukala kwe-fetus kubi kangangokuthi ngokuvamile kuholela ekufeni kwengane isesibelethweni noma ngemva nje kokuzalwa.

Ukuxilongwa kwesifo se-hemolytic sosana olusanda kuzalwa

Ngokuvamile, owesifazane okhulelwe uzohlolwa ukuze abone ukuba khona kwe-anti-RhD noma amanye amasosha omzimba ahlobene ngokulinganayo. Ngokuvamile, ku-trimester yokuqala yokukhulelwa, ukuhlolwa kwe-antiglobulin (ukuhlolwa kwe-Coombs) kwenziwa uma abazali bengane bengahambisani ne-RhD. Ngisho noma umphumela ungalungile, ukuhlolwa kuphindaphindiwe njalo ku-trimester nenyanga eyodwa ngaphambi kokubeletha. Ngokulandelayo, umphumela wokuhlolwa omuhle uyinkomba yokwelula ukuxilongwa kanye nokwenza izivivinyo zohlobo nesihloko samasosha omzimba. I-antibody titer ephansi (ngezansi kwe-16) idinga kuphela ukwelashwa okuvamile, okungukuthi ukuqapha kwanyanga zonke kwesihloko se-antibody. Ngakolunye uhlangothi, ukuhlonzwa kwe-antibody titer ephezulu (ngaphezulu kwama-32) kudinga ukwelashwa okuhlaselayo. Inkomba yalokhu futhi ukuhlonza ukunwetshwa komthambo wenkaba, i-hepatomegaly kanye ne-placenta ejiyile ku-ultrasound. Bese, i-aminopuncture kanye ne-cordocentesis (ukuthola isampula yegazi lengane ukuze lihlolwe) kuyenziwa. Lokhu kuhlola kuvumela ukuhlola ngokunembile ukuthi i-anemia yengane ithuthuke kangakanani, ukuhlola uhlobo lwegazi kanye nokuba khona kwama-antigen afanelekile kumaseli egazi. Imiphumela ejwayelekile idinga ukuhlolwa ukuthi kuphindwe ngemva kwamaviki ambalwa.

Ukwelashwa kuqalwa lapho i-anemia enzima itholakala. Ngaphezu kwalokho, kwenziwa indlela ye-PCR eqinisekisa ukuba khona kwe-D antigen. Ukuntuleka kwale antigen akuhlanganisi ukuvela kwesifo se-hemolytic ku-fetus.

Isifo se-Hemolytic sosana olusanda kuzalwa - ukwelashwa

Ukwelashwa kwezifo ikakhulukazi kuhilela ukumpontshelwa igazi elingaphandle kwe-intrauterine ngaphansi kokuqondisa kwe-ultrasound. Igazi linikezwa embhedeni we-vascular noma emgodini we-peritoneal we-fetus. Imijikelezo yokumpontshelwa okungu-3-4 iyadingeka ukuze kushintshwe ngokuphelele igazi. Ukwelashwa kufanele kuqhutshekwe kuze kube yilapho ingane isikwazi ukuphila ectopic. Ngaphezu kwalokho, odokotela batusa ukuqeda ukukhulelwa kuze kufike kumaviki angu-37. Ngemva kokuzalwa, umntwana osanda kuzalwa ngokuvamile udinga ukumpontshelwa i-albumin kanye ne-phototherapy, ezimweni ezinzima kakhulu, ukushintshwa noma ukumpontshelwa okuhambisanayo kuyenziwa. Ngaphezu kokwelashwa, ukuvimbela izifo nakho kubalulekile.

Isifo se-Hemolytic sosana olusanda kuzalwa - i-prophylaxis

I-Hemolytic disease prophylaxis ingase icace futhi ingaqondile. Okokuqala ukugwema ukuthintana negazi langaphandle kanye nokulandela imithetho yokumpontshelwa igazi okuhambisana neqembu ngemva kokuphambana. Okwesibili, futhi, kusekelwe ekusetshenzisweni kwe-anti-D immunoglobulin amahora angu-72 ngaphambi kokuvuza kwegazi okulindelekile, okungukuthi:

  1. ngesikhathi sokubeletha,
  2. uma kwenzeka uphuphunyelwa yisisu,
  3. uma kwenzeka ukopha ngesikhathi sokukhulelwa,
  4. ngenxa yezinqubo zokuhlasela ezenziwa ngesikhathi sokukhulelwa,
  5. ngesikhathi sokuhlinzwa kokukhulelwa kwe-ectopic.

Njenge-intra-pregnancy prophylaxis kwabesifazane abane-Rh negative abanemiphumela yokuhlolwa ye-antiglobulin engemihle, ukuphathwa kwe-anti-D immunoglobulins (evikini lama-28 lokukhulelwa) kusetshenziswa. Umthamo olandelayo wama-immunoglobulins unikezwa kuphela ngemva kokuzalwa komntwana. Le ndlela ivikela kuphela ukukhulelwa okukodwa, okuseduze kakhulu. Kwabesifazane abahlela izingane ezengeziwe, i-immunoprophylaxis iphinde isetshenziswe.

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