Zizindikiro, Chithandizo, ndi Kulimbana ndi Low Platelet Namba Pa Chemo
Thrombocytopenia (mtengo wochepa wa platelet mu magazi) umachitika ngati zotsatira za mankhwala a chemotherapy ndizovuta kuposa kale, komabe zingakhale zovuta kwambiri. Kodi muyenera kudziwa chiyani za zizindikiro za mapepala otsika ndi zomwe mungachite kuti muchepetse chiopsezo cha mankhwalawa ?
Mwachidule
Thrombocytopenia imatanthawuzidwa ngati kuchepa kwa chiwerengero cha mapiritsi m'magazi.
Mawerengedwe ochepa a mapuloteni amatha kutuluka magazi ndipo / kapena kufunika kuchepetsa chemotherapy. Thrombocytopenia kawirikawiri imadziwika kuti ndi mapiritsi osachepera 150,000 pa cubic millimeter ya magazi, ngakhale kuti magazi ochuluka samapezeka nthawi zambiri mpaka pansi pamtunda pansi pa 20,000 kapena 10,000. Izi zikuti, ndikofunika kudziwa kuti palibe mgwirizano woonekera pakati pa mlingo wamatope ndi chizolowezi chomwa magazi. Ngati muli ndi zizindikiro monga kupha magazi kapena kuvulaza, ndikofunika kuti dokotala wanu adziwe, mosasamala kanthu za mlingo wanu wa mapulogalamu.
Kudziwa
Dokotala wanu adzalangiza kuchuluka kwathunthu kwa magazi (CBC) musanayambe komanso pambuyo pa mankhwala a chemotherapy kuti muwone ngati muli ndi mlingo wochepa wa platelet. Kawirikawiri chiwerengero chokhala ndi mapiritsi (thrombocyte count) chimafotokozedwa kukhala ndi mapaleletiti 150,000 mpaka 400,000 pa miliki imodzi ya magazi. Mzere wapansi pansi pa 150,000 amaonedwa kuti ndi osalimba, kapena thrombocytopenia.
Nthawi zambiri mlingo wa mapalegalamu oposa 50,000 suli ndi vuto lalikulu.
Nthawi zina 10,000 mpaka 20,000 amachotsa magazi, koma nthawi zambiri amatha kuchepa kufika 10,000 kapena pang'ono asanayambe magazi.
Kawirikawiri, ziŵerengero zosakwana 10,000 zimaperekedwa (nthawi zambiri zimakhala ndi kuika magazi) koma ziŵerengero zosakwana 20,000 zingathenso kulandira, makamaka ngati zimakhala ndi malungo.
Kwa omwe amadwala mankhwala a chemotherapy, masitepe a 50,000 mpaka 100,000 angayambe kuchepetsa mankhwala a chemotherapy. Ndikofunika kuzindikira kuti aliyense ali wosiyana, ndipo mofanana ndi anthu awiri osiyana angakhale ovuta chifukwa chodera nkhawa ndi zina.
Mipata yamagazi imakhala pafupifupi masiku 8 mpaka 10 ndipo imabwereranso mwamsanga.
Zimayambitsa Pakati pa Chithandizo cha Khansa
Chifukwa chofala kwambiri cha thrombocytopenia mwa anthu omwe ali ndi khansa ndi kupweteka kwa mafupa okhudzana ndi mankhwala a chemotherapy. (Onaninso zina zomwe zimayambitsa pansipa.) Chemotherapy amawononga maselo mofulumira, monga mafupa omwe amakhala mapaleti. Kuwonjezera pa thrombocytopenia, kupweteka kwa mafupa kuchokera ku mankhwala a chemotherapy kungayambitse kuchepetsa maselo ofiira a magazi ( chemotherapy-induced anemia ) ndi mlingo wochepa wa mtundu woyera wa maselo oyera omwe amadziwika kuti neutrophils ( chemotherapy-yomwe imachititsa neutropenia ) yomwe imateteza matenda a bakiteriya .
Mankhwala ambiri a chemotherapy samakhudza mabala a platelet ku digiri yomwe ili yofunika kwambiri kuti ipeze chithandizo, koma mankhwala ena ndi ovuta kwambiri kusiyana ndi ena kuchepetsa chiwerengero. Mankhwala omwe amagwiritsidwa ntchito kwambiri ndi thrombocytopenia ndi awa:
- Mankhwala a Platinum monga Paraplatin (carboplatin) ndi Platinol (cisplatin)
- Gemzar (gemcitabine)
- Taxol (paclitaxel)
Thrombocytopenia yokhudzana ndi chemotherapy kawirikawiri ndi vuto lalifupi. Mabala a Platelet amayamba kugwedeza sabata imodzi pambuyo pa mankhwala a chemotherapy ndikufika pamunsi otsika (ndidir) patapita masiku 14 mutatha kulowetsedwa. Mipata imabwereranso kwa masiku osachepera 28 mpaka 35 akutsatira koma ikhoza kutenga masiku makumi asanu ndi limodzi (60) kuti ikafike pazitsamba zoyenera.
Zifukwa zina za Thrombocytopenia mwa Anthu omwe ali ndi khansa / Matenda osiyanasiyana
Palinso zifukwa zina zingapo kuti chiwerengero cha platelet chikhoza kuchepa kwa anthu omwe ali ndi khansa. Kuphatikiza pa kuponderezedwa kwa mafupa a mafupa monga taonera pamwambapa, izi zingaphatikizepo:
- Chitetezo cha Immune thrombocytopenia (ITP) - Kuteteza thupi kwa Immune thrombocytopenia kumachitika pamene thupi lanu limapanga ma antibodies motsutsana ndi mapepala anu. Izi zimafala kwambiri ndi khansa monga matenda a Hodgkin ndi matenda aakulu a khansa ya m'magazi
- Matenda, makamaka matenda opatsirana
- Mankhwala ena omwe angapangitse mapuloteni otsika monga antigenic anticomycin, ndi mankhwala oletsa tizilombo
- Matendawa amafalikira ku fupa la mafupa (makamaka ma lymphomas, khansa ya m'mawere, khansara yamapapo)
- Matenda a microbiopathy (vuto limene selo wamkati limakhala ndi mitsempha ya magazi limawonongeka lomwe nthawi zina limapezeka ndi mankhwala a chemotherapy monga Mitomycin C ndi gemcitabine.)
Zizindikiro
Zizindikiro zomwe mungapeze ndi thrombocytopenia zikuphatikizapo:
- Kulira kosavuta
- Kutsegula - Kuchotsa mphuno, pakamwa pako (makamaka ndi kusakaniza,) mimba (yakuda kapena wamagazi), kapena m'mimba (kusanza magazi kapena kapepala)
- Petechiae - Mawanga ofiira pa khungu lanu (lofala kwambiri pamapazi a m'munsi), zomwe sizikutembenuka zoyera mukamawakakamiza ndi zala zanu
- Matenda obiriwira a buluu (makutu) pa khungu lanu
- Kwa amayi, nthawi yomwe ndi yolemetsa kuposa yachibadwa
- Kuphweteka kumodzi ndi kumaliseche
- Kufooka
- Mutu
Kuchiza / Kuteteza
Ndikofunika kuyamba choyamba kudziwa chifukwa cha thrombocytopenia monga pangakhale zifukwa zosiyana siyana zapakiteriya yanu yomwe ili ndi njira zosiyanasiyana. Mwachitsanzo, ngati akugwirizana ndi mankhwala a chemotherapy, mankhwala angaphatikizepo kuchepetsa mankhwala a chemotherapy, koma ngati akugwirizana ndi zomwe zimayambitsa matenda, steroids ikhoza kukhala mbali ya mankhwala ovomerezeka.
Malinga ndi mlingo wa mapuloleteni anu, ndipo ngati muli ndi zizindikiro zilizonse kapena ayi, dokotala wanu angapangire chithandizo kuti awonjezere kuchuluka kwa mapulogalamu anu. Zosankha zikuphatikizapo:
- Kupatsirana kwa Platelet - Mankhwala a Platelet ndiwo njira yowonjezera yothetsera thrombocytopenia, makamaka yaifupi ya thrombocytopenia yokhudzana ndi mankhwala a chemotherapy. Kuwotcha kungagwiritsidwe ntchito monga mankhwala (kuonjezera mapulateletti mwa iwo omwe akuwuluka mwazidzidzidzi) kapena kuteteza (kwa omwe ali ndi chiwerengero chochepa kapena choyembekezeredwa cha mapiritsi koma osatuluka). Chowopsa kwambiri ndi zotsatira za chiwindi. Zotsatira zamtunduwu zingaphatikizepo kuchitidwa magazi kapena kutengeka kwa matenda monga chiwindi.
- Kuchepetsa mankhwala a chemotherapy - Kuchepetsa mankhwala a chemotherapy, kapena kusintha ma dolo nthawi zina kungakhale kofunikira.
- Mankhwala omwe amachititsa mapangidwe a mapuloleteni - Nthawi zina amagwiritsidwa ntchito pofuna kupangitsa mafupa kupanga mapulogalamu ambiri. Zotsatira zofala kwambiri ndi kusungira madzi (kutupa).
- Zilonda zam'chipatala - Zochitika zachipatala zikupitirira, kuyang'ana njira zina kuti athetse chiopsezo cha thrombocytopenia panthawi ya chemotherapy.
Kulimbana
Kuphatikiza pa mankhwala alionse omwe dokotala wanu akuwuzani, ngati muli pachiopsezo cha thrombocytopenia yesani ku:
- Pewani aspirin ndi mankhwala otsutsa-kutupa monga ibuprofen ndi naproxen. Funsani dokotala wanu za mankhwala enaake kapena mankhwala omwe mumatenga, chifukwa ena mwa iwo amatha kutuluka magazi.
- Pewani kumwa mowa chifukwa ichi chikhoza kuonjezera chiopsezo chokhala ndi magazi.
- Gwiritsani ntchito ubweya wotsitsi. Akatswiri ambiri amauza kuti musagwiritse ntchito mano a mano, koma izi sizinatsimikizidwe kuti zithandiza.
- Gwiritsani ntchito lumo lamagetsi kuti musapewe mabala.
- Limbani mphuno mwanu.
- Yesetsani kuti mukhale otetezedwa, ndipo ngati mutero, pewani kugwedeza kapena kugwiritsa ntchito mankhwala owonjezera. Mankhwala ena opweteka, komanso kusintha kwa zakudya, angayambitse kudzimbidwa, ndipo dokotala wanu angakulimbikitseni mankhwala ochepetsera mankhwala kapena mankhwala ena kwa inu pa mankhwala a chemotherapy kuti muteteze izi.
- Peŵani mikhalidwe yomwe mungadwale kapena kudzipweteka nokha. Samalirani kwambiri pamene mukugwiritsa ntchito lumo, mukuphika, ndi kugwiritsa ntchito zipangizo. Pewani masewera olimbirana.
Nthawi yoyenera Dokotala
Muyenera kulola dokotala wanu kudziwa ngati muli ndi zizindikiro za thrombocytopenia. Muitaneni mwamsanga ngati mwaika magazi omwe simungathe kuimitsa, kupweteka mutu, kusawona masomphenya kapena kufooka.
> Zotsatira:
> Estcourt, L., Stanworth, S., Doree, C., Hopewell, S., Trivella, M., ndi M. Murphy. Kuyerekeza kwa Platelet Zosiyanasiyana Zolemba Zomwe Zitsogolere Kulamulira kwa Prophylactic Platelet Transfusion Poletsa Kutsekemera kwa Anthu Amene Ali ndi Matenda a Haematological Myelosuppressive Chemotherapy kapena Kusuntha kwa Cell Shwi. Dongosolo la Cochrane la Zosintha Zogwirizana . 2015. 18 (11): CD010983.
> Kuter, D. Kusamalira Thrombocytopenia Yogwirizana ndi Khansa Chemotherapy. Oncology (Williston Park) . 2015. 29 (4): 282-94.
> Liebman, H. Thrombocytopenia omwe ali ndi odwala khansa. Thombosis Research . 2014. 133 Suppl 2: S63-9.