Contents
Dangane da manufarta, Hukumar Edita ta MedTvoiLokony tana yin kowane ƙoƙari don samar da ingantaccen abun ciki na likita wanda ke da goyan bayan sabon ilimin kimiyya. Ƙarin tuta “Abin da aka Duba” yana nuna cewa likita ne ya duba labarin ko kuma ya rubuta kai tsaye. Wannan tabbacin mataki biyu: ɗan jarida na likita da likita ya ba mu damar samar da mafi kyawun abun ciki daidai da ilimin likita na yanzu.
An yaba da sadaukarwarmu a wannan yanki, da dai sauransu, ta Ƙungiyar 'Yan Jarida don Lafiya, wadda ta ba Hukumar Edita ta MedTvoiLokony lambar girmamawa ta Babban Malami.
Ciwon haemolytic na jarirai yanayi ne da ke haifar da rashin daidaituwa (rikici) a cikin Rh factor ko rukunin jini na AB0 tsakanin uwa da tayin. Ciwon yana haifar da samar da kwayoyin rigakafi a cikin jinin uwa, wanda hakan kan haifar da rugujewar jajayen kwayoyin halittar dan tayi da jarirai. Mafi hatsari nau'i na cutar hemolytic shine jaundice.
Kalmomi kaɗan game da cutar hemolytic na jariri…
Ciwon yana da alaƙa da rikicin serological, watau yanayin da rukunin jinin mahaifiyar ya bambanta da rukunin jinin yaro. Ciwon haemolytic yana haifar da samar da kwayoyin rigakafi a cikin jinin uwa wanda ke karya jajayen kwayoyin halitta na tayin da jarirai. Mafi hatsarin nau'in cutar shine jaundice na jarirai mai tsanani, wanda ke haifar da karuwar bilirubin a cikin jini da kuma ci gaban anemia. Lokacin da matakin bilirubin ya wuce wani kofa, zai iya lalata kwakwalwa, wanda aka sani da suna jaundice na tes na gindin kwakwalwawanda ke haifar da - idan yaron ya tsira - rashin ci gaba na psychophysical. A halin yanzu, rikicin serological ba shine babban matsala ba kamar na karni na XNUMX.
Abubuwan da ke haifar da cutar hemolytic na jariri
Kowane mutum yana da takamaiman rukunin jini, kuma a ƙarƙashin yanayin al'ada lafiyayyen jiki ba ya samar da ƙwayoyin rigakafi ga ƙwayoyin jininsa. Rukunin jini na Rh + ba ya samar da ƙwayoyin rigakafi akan wannan sinadari, watau anti-Rh. Hakazalika, jikin majiyyaci tare da rukunin jini A baya samar da ƙwayoyin rigakafin A. Duk da haka, wannan doka ba ta shafi mata masu juna biyu ba, don haka ciwon hemolytic na jarirai yana faruwa ne ta hanyar rikici tsakanin jinin jariri da kwayoyin rigakafi da uwa ta samar. Don sanya shi a sauƙaƙe: jinin mahaifiyar yana da rashin lafiyar jinin jariri. Maganin rigakafi na mace mai ciki na iya ketare mahaifa (a cikin halin yanzu ko na gaba) kuma su kai hari kan kwayoyin jinin jariri. Sakamakon haka shine cutar haemolytic na yaro.
Alamomi da siffofin cutar hemolytic na yaro
Mafi ƙanƙanta nau'in cutar haemolytic shine lalatar ƙwayoyin jinin jariri fiye da kima. An haifi yaro da shi anemiayawanci yana tare da kara girma da kuma hanta, amma wannan ba ya haifar da barazana ga rayuwarsa. Bayan lokaci, hoton jini yana inganta sosai kuma jaririn yana tasowa yadda ya kamata. Duk da haka, ya kamata a jaddada cewa a wasu lokuta anemia yana da tsanani kuma yana buƙatar magani na musamman.
Wani nau'i na cutar hemolytic akwai jaundice mai tsanani. Yaran ku yana da cikakkiyar lafiya, amma ya fara samun jaundice a rana ta farko bayan haihuwa. Ana samun karuwa sosai a cikin bilirubin, wanda ke da alhakin launin rawaya na fata. Jaundice babban haɗari ne saboda yawan maida hankalinsa fiye da wani matakin yana da tasiri mai guba akan kwakwalwar jariri. Har ma yana iya haifar da lalacewar kwakwalwa. A cikin yara masu jaundice, ana lura da tashin hankali da tashin hankali na tsoka. Ko da yaro ya sami ceto, jaundice na iya haifar da mummunan sakamako, misali, yaro na iya rasa jinsa, fama da farfadiya har ma da wahalar magana da kiyaye daidaito.
Na ƙarshe kuma mafi tsanani nau'i na cutar hemolytic na jarirai an haɗa shi gabaɗaya kumburin tayi. Sakamakon lalatar da kwayoyin jinin jariri ta hanyar rigakafi na uwa (har yanzu a matakin rayuwar tayin), yaduwar jini na jarirai yana damuwa kuma yana karuwa da karfin tasoshin. Me ake nufi? Ruwan da ke fitowa daga magudanar jini yakan tsere zuwa kyallen da ke kusa da shi, ta haka ne ke haifar da edema na ciki a cikin muhimman gabobin jiki, irin su peritoneum ko jakar pericardial da ke kewaye da zuciya. A lokaci guda, yaron yana tasowa anemia. Abin takaici, kumburin tayi yana da tsanani sosai wanda yakan haifar da mutuwar tayin yayin da yake cikin ciki ko bayan haihuwa.
Binciken cututtukan haemolytic na jarirai
Yawanci, mace mai ciki za ta yi gwajin gwaje-gwaje don gano kasancewar anti-RhD ko wasu ƙwayoyin rigakafi masu dacewa daidai. Yawancin lokaci, a farkon watanni uku na ciki, ana yin gwajin antiglobulin (gwajin Coombs) idan iyayen yaron ba su dace da RhD ba. Ko da sakamakon ba shi da kyau, ana maimaita gwajin kowane watanni uku da wata daya kafin haihuwa. Bi da bi, tabbatacce sakamakon gwajin nuni ne don tsawaita ganewar asali da yin gwaje-gwaje na nau'i da titer na rigakafi. Ƙananan titer antibody (ƙasa da 16) yana buƙatar magani na mazan jiya kawai, watau sa ido na kowane wata na titer antibody. A gefe guda, ganewar asali na babban titers antibody (sama da 32) yana buƙatar ƙarin magani mai lalacewa. Alamar hakan kuma ita ce gano dilatation na jijiyar cibiya, hepatomegaly da kauri mai kauri akan duban dan tayi. Sannan, ana yin aminopuncture da cordocentesis (samun samfurin jinin tayi don gwaji). Waɗannan gwaje-gwajen suna ba da damar tantance daidai yadda ci gaban anemia tayi, don tantance nau'in jini da kasancewar antigens masu dacewa akan ƙwayoyin jini. Sakamakon daidaitacce yana buƙatar maimaita gwajin bayan ƴan makonni.
Ana fara magani lokacin da aka sami anemia mai tsanani. Bugu da ƙari, ana yin hanyar PCR wanda ke tabbatar da kasancewar D antigen. Rashin wannan antigen ya keɓance faruwar cutar haemolytic na tayin.
Hemolytic cuta na jariri - magani
Maganin cututtuka ya ƙunshi ƙarin ƙarin jini na intrauterine a ƙarƙashin jagorancin duban dan tayi. Ana ba da jinin a cikin gadon jijiyoyin jini ko cikin rami na ɗan tayin. Ana buƙatar hawan jini 3-4 don cikakken musayar jini. Ya kamata a ci gaba da maganin har sai tayin ya sami damar rayuwa ta ectopic. Bugu da kari, likitoci sun ba da shawarar kawo karshen ciki zuwa matsakaicin makonni 37. Bayan haihuwa, jaririn yakan buƙaci ƙarin albumin da phototherapy, a cikin mafi tsanani lokuta, maye gurbin ko ƙarin ƙarin ƙarin. Baya ga magani, rigakafin cututtuka yana da mahimmanci.
Hemolytic cuta na jariri - prophylaxis
Maganin cutar haemolytic na iya zama na musamman kuma ba na musamman ba. Na farko shi ne kauce wa cudanya da jinin kasashen waje da kuma bin ka'idojin da suka dace na karin jini na rukuni bayan an daidaita su. Na biyu, bi da bi, ya dogara ne akan aikace-aikacen anti-D immunoglobulin sa'o'i 72 kafin jinin da ake tsammanin ya yi, wato:
- a lokacin haihuwa,
- a yanayin zubar da ciki,
- idan akwai zubar jini a lokacin daukar ciki,
- a sakamakon hanyoyin da za a bi da su a lokacin daukar ciki.
- a lokacin tiyatar ciki na ectopic.
Kamar yadda rigakafin ciki-ciki a cikin mata marasa kyau na Rh tare da sakamakon gwajin antiglobulin mara kyau, ana amfani da gudanarwar anti-D immunoglobulins (a sati na 28 na ciki). Ana ba da kashi na gaba na immunoglobulin ne kawai bayan an haifi jariri. Wannan hanyar tana tabbatar da ciki ɗaya kawai, mafi kusa. A cikin matan da ke shirin ma fiye da yara, ana amfani da immunoprophylaxis sau ɗaya.