Kukambirana za mankhwala achiwiri ndi achitatu
Ngakhale kuti ambiri mwa ana ndi achikulire ochepa omwe ali ndi thrombocytopenia (ITP) omwe ali ndi chitetezo cha m'thupi (ITP) amatha kukhala ndi chiwerengero chokhala ndi mapiritsi achilendo, ena amatha kukhala ndi moyo wosatha. Lingaliro lokhala ndi nthawi yaitali la ITP lingakhale loopsya, kotero tiyeni tiwone zomwe zikutanthauza apa.
Choyamba, ITP ikhoza kugawidwa monga:
- Choyambirira: Pulogalamu yayikulu ya ITP imachokera ku kuwonongeka kwa mbale. Kwa ana, ambiri mwa iwo ndi ofunika kwambiri ITP.
- Sekondale: Sekondale ITP ikugwirizana ndi matenda ena monga lupus , HIV , hepatitis C , kapena chronic lymphocytic leukemia .
Ngakhale mankhwala oletsa kutaya mwazi kwa ITP yapachimake ndi yachiwiri angakhale ofanana, chithandizo chachiwiri cha ITP chimayang'ana pa chithandizo chamankhwala. Kulimbana bwinoko ndi vuto lachidwidwe la matenda lingathe kusintha thrombocytopenia.
Pulogalamu yayikulu ya ITP ikhozanso kupatulidwa kukhala:
- Zotsatira zatsopano: Kudziwa kwa miyezi itatu.
- Kulimbikira: ITP yomwe imapitirira miyezi itatu.
- Zopweteka: Ngati zakhala zotsatila miyezi khumi ndi iwiri, izo zikutchedwa zachilendo.
- Kutsutsa: Mawuwa amagwiritsidwa ntchito pofotokozera ITP yomwe imafuna chithandizo (wodwala ali ndi zizindikiro za magazi) zomwe zimatsutsa mankhwala oyamba (steroids, IVIG, WinRho) kapena splenectomy .
Ngakhale kuti anthu ambiri achikulire omwe ali ndi chidziwitso chachikulu cha ITP adzapitirizabe kukhala ndi moyo wosatha, ambiri amakhalabe ndi malo okwanira, omwe amatanthauza maselo oposa 20,000 pa microliters).
Odwalawa mwina nthawi zina amafuna nthawi zina mankhwala. Chitsanzo chimodzi ndi opaleshoni, momwe chiwerengero cha platelet kawirikawiri chimafunika kuti chikhale chokwanira kuti magazi asatuluke panthawiyi.
Njira Zachiwiri Zothandizira
Vuto ndilo kwa odwala omwe akupitirizabe kuika magazi ngakhale kuti akudwala mankhwala oyamba.
Zaka zapitazi, splenectomy inkaonedwa ngati yofunika kwambiri pa mankhwala achiwiri. Splenectomy imagwira ntchito ziwiri. Choyamba, icho chichotsa malo oyambirira a chiwonongeko cha platelet. Chachiwiri, amachotsa ma lymphocytes ena omwe amachititsa anti-platelet antibodies amakhala mu nthata. Kuchotsa ma lymphocyteswa kungapangitse moyo wa mapepalawo kukhala moyo.
Splenectomy ili ndi mbiri yodziwika bwino yoposa oposa 85 peresenti ya odwala akuyankha, ambiri ndi normalization ya platelet chiwerengero. Ngakhale kupambana kumeneku, splenectomy sizowopsa, makamaka kuika moyo wako pachiswe (matenda oopsa a bakiteriya).
Chifukwa cha zoopsazi, madokotala ena amaganiza kuti mankhwalawa ndi othandizira. Rituximab ndi anti-antibody yomwe imadziphatika ku ma lymphocyte B (imodzi mwa maselo oyera a magazi omwe amapanga antibodies), kuwapangitsa kuti awonongeke. Ndi mankhwala ochepa omwe amatsutsana ndi apuloleti ochokera ku ma lymphocyte B, mapaleti sangathe kuwonongedwa. Rituximab imaperekedwa ngati IV kulowetsedwa kamodzi pamlungu kwa milungu inayi, koma nthawi zina amatha kupatula milungu ingapo. Yankho la rituximab liri losiyana kwambiri ndi splenectomy, ndi odwala ena omwe ali ndi mayankho osatha koma ena akubwereranso.
Chithandizo Chachitatu
Mwamwayi, tsopano pali mankhwala achidule omwe alipo a ITP.
Kwa zaka zambiri, amakhulupirira kuti mu ITP, mapuloletiti amapangidwa kawirikawiri m'mafupa koma anawonongedwa akawamasulidwa. Akatswiri omwe tsopano amadziwika kuti ntchito yamapulaneti ndi ofunika. Kudziwa kumeneku kunachititsa kuti pakhale chithandizo cha mankhwala omwe amatchedwa agromboists a thrombopoietin (TPO).
Pakali pano pali agonist awiri a TPO omwe amapezeka ku US, elthrombopag ndi romiplostim. Elthrombopag ndi mankhwala am'thupi omwe amatengedwa tsiku ndi tsiku ndipo romiplostim amaperekedwa kamodzi pamlungu ngati jekeseni ya subcutaneous. Ngakhale kuti elthrombopag ingawoneke ngati yophweka chifukwa imatengedwa pakamwa, palibe zakudya zomwe zili ndi calcium zingadye kwa maola angapo isanafike komanso pambuyo pake.
Mukamaliza mlingo wokonza, akuluakulu angaphunzire momwe angagwiritsire ntchito romiplostim kunyumba.
Odwala agonist a TPO amaonedwa kuti ndi mankhwala osamalidwa osamalidwa bwino omwe amatha kusunga mapulogalamu apamwamba kuti athetse magazi. Mankhwalawa angagwiritsidwe ntchito kwa ana ndi akulu omwe ali ndi ITP yosatha.
Mofanana ndi mankhwala ambiri amachiritso, dongosolo la mankhwala oyamba, lachiwiri, ndi lachitatu lingasinthe malinga ndi zizindikiro za odwala. Ngati muli ndi mafunso kapena nkhawa zokhudza mankhwala anu, muyenera kukambirana nawo ndi dokotala wanu.
Zotsatira:
Kassel JB. ITP mwa Ana: Kusamalira Matenda Odwala. Mu: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.
George JN ndi Arnold DM. ITP mwa Achikulire: Njira Yachiwiri ndi Zotsatira Zothandizira. Mu: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.