Vim li cas cov ntshav hemoglobin txo qis: ua rau, tsos mob thiab kev kho mob

2024 Tus sau: Curtis Blomfield | [email protected]. Kawg hloov kho: 2024-01-02 05:49

Vim li cas hemoglobin hauv cov ntshav txo qis? kiv taub hau thiab teeb meem ntawm daim tawv nqaij thiab plaub hau yog ib co ntawm cov tsos mob.

Hemoglobin yog lub hauv paus tseem ceeb ntawm cov qe ntshav liab thiab ua kom cov pa oxygen ntawm lub ntsws mus rau tag nrho cov ntaub so ntswg ntawm lub cev, nrog rau kev thauj cov pa roj carbon dioxide mus rau qhov sib txawv. Tib neeg cov ntshav muaj kwv yees li 750 g ntawm hemoglobin. Nrog nws qhov tsis txaus, tag nrho cov hlwb ntawm lub cev tau txais oxygen tsawg. Cov khoom no muab cov txheej txheem ntawm kev ua pa ntawm tes, uas yog, tsim lub zog tsim nyog rau lub neej. Nrog rau qhov tsis muaj oxygen, kev ua haujlwm ntawm txhua lub hlwb, cov ntaub so ntswg thiab lub cev raug cuam tshuam. Cov ntaub so ntswg tshwj xeeb yog rhiab heev rau oxygen tshaib plab. Yog vim li cas hemoglobin hauv cov ntshav txo qis, thiab kiv taub hau thiab qaug zog thab cov neeg mob.

Erythrocytes yog tsim nyob rau hauv cov pob txha liab, qhov twg hemoglobin pib sau. Nws cov molecule muaj cov hlau atoms, thiab qee cov vitamins xav tau los tsim cov qe ntshav liab. Hlau deficiency ua rau me mehemoglobin, thiab tsis muaj cov vitamins (cyanocobalamin (B _{12) thiab folic acid), kev tsim cov qe ntshav liab yog cuam tshuam. Iron deficiency yog qhov ua rau muaj hemoglobin tsawg. Nws tuaj yeem tshwm sim los ntawm kev noj zaub mov tsis txaus. Tab sis muaj lwm yam laj thawj thiab. Hauv qee qhov xwm txheej, qhov tsis muaj hlau tsis txaus tshwm sim txawm tias muaj txaus los ntawm cov zaub mov. Cov khoom no, zoo li tag nrho lwm yam khoom, yog absorbed los ntawm cov zaub mov hauv cov hnyuv. Cov kab mob ntawm lub tuam tsev no yuav ua rau txo qis ntawm txhua yam khoom mus rau hauv cov ntshav, suav nrog hlau. Tom ntej no, txhua qhov xwm txheej yuav raug txiav txim siab ntau ntxiv, vim li cas hemoglobin hauv lub cev tuaj yeem txo qis.}

Kev faib cov ntshav ntshav

Tus mob ntawm lub cev tshwm sim los ntawm tsis txaus hemoglobin hauv cov ntshav yog hu ua anemia. Raws li WHO cov lus pom zoo, cov qauv hauv qab no rau ntshav ntshav tau txais:

• rau cov poj niam, qib hemoglobin ≦ 120 g / l (rau cov poj niam cev xeeb tub - tsawg dua 110 g / l);
• rau txiv neej Hb ≦ 130 g/l;
• rau menyuam Hb ≦ 110 g/l.

Nyob rau hauv Russia thiab CIS lub teb chaws, anemia yog cais raws li hemoglobin cov ntsiab lus nyob rau hauv ib tug erythrocyte (los ntawm cov xim index):

• hypochromic (CPU < 0, 8);
• normochromic (CPU 0.8 - 1.05);
• hyperchromic (CPU > 1, 05).

Kev faib tawm ntawm qhov kev faib tawm no tau piav qhia yooj yim. Koj tuaj yeem txiav txim siab CPU hauv ib lub tsev kho mob tsis tu ncua siv lub ntsuas hemoglobin portable rau ib feeb, thiab cov ntshav capillary (los ntawmntiv tes).

Hauv lwm lub tebchaws (thiab tsis ntev los no hauv peb lub tebchaws), kev faib tawm raws li kev ntsuas qhov ntim (qhov loj me) ntawm cov qe ntshav liab (MCV) kuj tau siv. Ob qhov kev faib tawm ntawm cov ntshav liab sib tshooj thiab tuaj yeem ua ke:

• microcytic (MCV < 80 fl) hypochromic;
• normocytic (MCV 80-100 fl) normochromic;
• macrocytic (MCV > 100 fl) hyperchromic.

MCV tam sim no suav nrog hauv cov npe CBC ib txwm muaj thiab tuaj yeem ntsuas hauv ib lub chaw kuaj mob nrog lub tshuab ntsuas automated.

YMicrocytic hypochromic anemias

Cov pab pawg neeg mob ntshav qab zib no yog txiav txim siab los ntawm ntau qhov ntsuas, qhov tseem ceeb ntawm qhov yog qhov ntim ntawm erythrocytes (MCV). Txhawm rau tsim kom muaj vim li cas cov ntshav hemoglobin txo qis nrog kev poob hauv MCV, nws yog ib qho tsim nyog los txiav txim siab cov ntsiab lus ntawm cov ntshav hlau.

Yog tias cov ntsiab lus hlau yog qhov qub lossis txawm tias nce siab, tus neeg mob raug xa mus rau kws kho mob hematologist. Yog tias cov hlau tsawg dua li qub, txhawm rau txhawm rau txhawm rau paub tias vim li cas hemoglobin tau poob qis, kev kuaj mob sib txawv ntawm cov hlau tsis muaj hlau tsis txaus thiab cov ntshav tsis txaus ntawm cov mob ntev yog ua tiav. Ua li no, txiav txim siab theem ntawm cov ntshav hloov pauv.

Iron deficiency anemia

Iron deficiency tau sau npe hauv 30% ntawm cov neeg hauv ntiaj teb thiab hauv 6% ntawm cov neeg nyob sab Europe. Yuav luag ib nrab ntawm cov neeg no muaj hlau deficiency anemia (IDA). Hom mob ntshav qab zib no yog qhov tshwm sim ntau tshaj plaws thiab suav txog 41.5% ntawm tag nrho cov xwm txheej no thoob ntiaj teb.cov ntaub ntawv, thiab raws li cov kws tshawb fawb Lavxias - 93%. Feem ntau, IDA tau sau npe rau cov poj niam, thiab yuav luag ib nrab ntawm cov neeg mob muaj hnub nyoog ntawm 15 thiab 30, nrog rau hnub nyoog cov kab mob tsawg dua.

Iron deficiency anemia yog ib qho mob uas tshwm sim los ntawm kev ua txhaum ntawm hemoglobin ntau lawm vim tsis muaj hlau, uas tsim tawm tsam keeb kwm ntawm ntau yam kev mob ntawm lub cev thiab kab mob.

IDA tau tshwm sim los ntawm ob pawg ntawm cov tsos mob: anemic thiab sideropenic.

Cov tsos mob tsis zoo:

• yoov ua ntej qhov muag, kiv taub hau, tinnitus, tsaus muag ntawm qhov muag thaum sawv ntxov, mob taub hau;
• qaug zog, qaug zog, tsis ua haujlwm, qaug zog;
• pallor ntawm daim tawv nqaij thiab mucous daim nyias nyias, palpitations, ua tsis taus pa ntawm exertion, throbbing nyob rau hauv caj dab thiab lub tuam tsev.

Sideropenic cov tsos mob:

• tawv nqaij qhuav, dull, phua xaus.
• Ntsiag ntawm taw, ntiv tes.
• Fragility, layering, waviness of rau tes, rau tes ua concave, zoo li ib rab diav.
• Dub hniav enamel, caries.
• Perversion ntawm saj thiab tsw. Feem ntau, cov neeg mob ua txhaum cov cim qhia ntawm cov hlau tsis muaj zog rau lawv cov quirks lossis tus cwj pwm zoo. Noj lub ntiaj teb, txiv qaub, chalk, nqaij nyoos, qos yaj ywm, pleev xim, lub siab xav noj ib yam dab tsi txias - dej khov los yog dej khov, kev hlub ntawm cov ntxhiab tsw ntawm kerosene, tso pa tawm, xab npum - yog cov tsos mob ntawm hemoglobin qis.
• Glossitis (mob tus nplaig), dysphagia (kev nqhis dej tsis zoo), angular stomatitis (tom, tawg ntawm lub qhov ncauj).
• Txuagkev txawj ntse.
• Tachycardia, diastolic myocardial dysfunction.
• Tsis muaj peev xwm tuav zis thaum luag lossis hnoos. Cov neeg mob nco txog cov tsos mob ntawm "ceg tsis xis nyob" - qhov yuav tsum tau txav ob txhais ceg vim qhov tshwm sim ntawm qhov tsis xis nyob, feem ntau thaum yav tsaus ntuj.

Cas of iron deficiency

ntshav poob. Feem ntau yog vim li cas vim li cas hemoglobin txo qis hauv cov poj niam yog suav tias yog lub caij nyoog ntev thiab hnyav hnyav. Nws yog qhov ua rau txo qis ntawm cov ntsiab lus hlau hauv cov ntshav ntawm cov poj niam hauv 30% ntawm tag nrho cov mob. Yog tias koj lub sijhawm ntev dua 5 hnub lossis ntau dua txhua 26 hnub, koj lub cev yuav poob ntau dua 60 ml ntawm cov ntshav hauv ib hlis. Muab rau hauv tus account qhov poob ntawm cov hlau nrog cov ntshav ntim thiab qhov nruab nrab ntawm cov kab no los ntawm cov khoom noj, hauv 10 xyoo lub cev yuav poob ib nrab ntawm tag nrho cov khoom siv hlau. Tias yog vim li cas cov ntshav hemoglobin txo qis hauv cov poj niam, feem ntau yog cov poj niam hluas - ua ntej cev xeeb tub.

5% ntawm cov hlau tsis tshua muaj vim yog pub dawb, 1% vim los ntshav, 1% vim poob hauv cov zis, xws li lub raum pob zeb.

Qhov laj thawj tseem ceeb vim li cas cov ntshav hemoglobin txo qis hauv cov txiv neej thiab poj niam yog los ntshav los ntawm txoj hnyuv. Xws li pathologies tshwm sim nrog ulcers, erosions, polyps, qog, hemorrhoids, noj tshuaj aspirin thiab lwm yam tshuaj uas tsis yog-steroidal anti-inflammatory siv tshuaj (ua kom cov ntshav permeability ntawm cov phab ntsa hauv cov hnyuv).

Congenital iron deficiency. Sau npe rau cov menyuam yug tshiab yog tias tsis muaj hlau los ntawm leej niam thaum lub sijhawmcev xeeb tub.

Malabsorption. Hauv 5% ntawm cov neeg mob, cov qib hlau tsis tshua muaj raug kaw vim intolerance rau gluten protein ntawm cereals. Tus kab mob no hu ua kab mob celiac, nws ua rau atrophy ntawm plab hnyuv mucosa thiab, vim li ntawd, rau malabsorption ntawm cov tshuaj, nrog rau cov hlau. Hauv tebchaws Russia, tus kab mob no feem ntau kuaj pom. Tsis tas li ntawd, tsis zoo saj nyiam ua rau malabsorption. Tshuaj yej, kas fes, khoom noj uas muaj calcium (cheese, cream, tsev cheese, walnuts) - qhov no yog qhov yuav txo tau hemoglobin.

Iron deficiency nyob rau hauv cov zaub mov nrog nruj kev noj haus los yog vegetarianism. Iron deficiency nyob rau hauv niam cov kua mis yog ib qho ua rau tsis muaj hemoglobin nyob rau hauv cov me nyuam mos.

Ntau cov hlau tau sau tseg thaum:

• hnub nyoog hloov pauv, feem ntau yog cov ntxhais;
• xeeb tub;
• lactation;
• poj niam premenopausal.

Cov qauv hauv qab no thiab qib qis kawg ntawm hemoglobin thaum cev xeeb tub raug saws:

• hauv I trimester: 112-160 110 g / l;
• 2nd peb lub hlis twg: 108-144 105g / l;
• hauv III trimester: 112-140 110 g / l.

Vim li cas hemoglobin txo cov poj niam thaum cev xeeb tub?

thawj qhov laj thawj yog qhov nce ntawm tag nrho cov ntshav ntim. Qhov no tshwm sim vim qhov nce hauv cov kua dej feem ntau ntawm cov ntshav, yog li qhov concentration ntawm tag nrho cov tshuaj ntshav txo. Qhov no yog physiological anemia.

Qhov thib ob yog vim li cas vim li cas hemoglobin txo qis thaum cev xeeb tub yog qhov nce ntxiv ntawm cov hlau. Nws yog qhov tsim nyog rau kev tsim cov hematopoieticCov txheej txheem ntawm tus me nyuam hauv plab, rau kev sib txuas ntawm nws cov hemoglobin, tsim ntawm lwm cov ntaub so ntswg ntawm tus me nyuam, nrog rau kev tsim cov placenta thiab kev loj hlob ntawm lub tsev menyuam. Kev noj ntau tshaj ntawm cov hlau tshwm sim ntawm 16-20 lub lis piam ntawm cev xeeb tub. Qhov no piav qhia vim li cas hemoglobin hauv cov poj niam cev xeeb tub yuav txo qis hauv lub peb hlis ntuj thib ob.

Ntxiv rau, ib tus yuav tsum tsis txhob suav nrog ntau yam kab mob pathological uas tuaj yeem ua rau muaj kev poob qis dua hauv cov ntsiab lus hemoglobin hauv cov ntshav ntawm leej niam lub siab.

Kev kho mob ntawm cov hlau deficiency anemia

Cov hauv paus ntsiab lus ntawm kev kho mob:

1. Koj tsis tuaj yeem kho tsis muaj hlau tsis txaus ntshav ntshav nrog kev noj haus. Yog tias kuaj tau, ces kev kho mob tsuas yog ua nrog kev npaj hlau. Tsis txhob cia siab rau cov khoom noj kom raug. Tsuas yog 2.5 mg ib hnub tuaj yeem nkag mus rau hauv lub cev los ntawm cov zaub mov, kaum zaus ntxiv nrog tshuaj. Nws yuav tsim nyog siv cov khoom uas muaj cov microelement tom qab nws cov ntsiab lus hauv cov ntshav yog qhov qub.
2. Yuav tsum siv tshuaj noj qhov ncauj.
3. Kev tswj hwm tshuaj Parenteral yog tshwj tseg rau cov mob hnyav ntawm ntshav ntshav, hlau malabsorption lossis intolerance rau cov tshuaj hauv qhov ncauj.
4. Kev kho mob tau zoo yog txiav txim siab los ntawm kev kho cov hemoglobin thiab qib hlau (tsis yog los ntawm cov tshuaj noj).
5. Rau kev kho mob ntawm cov hlau deficiency anemia, ferric hlau npaj tau siv. Tam sim no, kev npaj ntawm bi- thiab ferric hlau tau nthuav tawm hauv khw. Cov tom kawg yog ntau npaum li cas thiab muaj kev nyab xeeb dua.

Nyob rau hauv tus kab mob chronic

Qhov no yog hom ntshav qab zib thib ob uas tshwm sim tom qab tsis muaj hlau. Cov laj thawj feem ntau:

• mob raum mob;
• mob plawv tsis ua hauj lwm;
• kab mob siab;
• kab mob autoimmune;
• kab mob endocrine (hypothyroidism, ntshav qab zib mellitus, hyperparathyroidism);
• kab mob oncological.

Txhua yam ntawm cov kab mob saum toj no ua rau txo qis hauv lub neej ntawm erythrocytes, inhibition ntawm lawv cov synthesis thiab deposition ntawm hlau nyob rau hauv lub hlwb ntawm lub reticuloendothelial system. Qhov no piav qhia vim li cas cov ntsiab lus hemoglobin txo qis hauv cov kab mob ntev.

Yuav kho mob ntshav qab zib hauv cov kab mob ntev, nws yog qhov yuav tsum tau tshem tawm cov kab mob hauv qab. Cov tshuaj ntxiv hlau yuav tsis pab.

Normocytic anemia

Yog tias qhov txo qis hauv cov ntsiab lus hemoglobin pom hauv cov ntshav, thiab qhov ntim ntawm erythrocyte yog ib txwm, lawv hais txog cov ntshav tsis txaus. Yuav kom paub tias vim li cas vim li cas hemoglobin txo qis hauv qhov no, nws yog qhov yuav tsum tau txiav txim siab cov ntsiab lus ntawm reticulocytes. Cov no yog cov hlwb ua ntej ntawm cov qe ntshav liab, lawv yuav tsum loj hlob hauv cov pob txha liab, thiab tom qab ntawd hauv cov hlab ntsha mus rau hauv cov qe ntshav liab lawv tus kheej. Feem ntau, lawv muaj 1% ntawm tag nrho cov qe ntshav liab hauv lawv cov ntshav. Koj tuaj yeem suav lawv hauv smear hauv qab lub tshuab tsom. Cov qib siab ntawm reticulocytes hauv cov ntshav yog tshwm sim los ntawm kev tsim cov qe ntshav liab nyob rau hauv cov pob txha liab thiab qhia tias muaj ntshav qab zib lossis hemolytic anemia.

Posthemorrhagic anemia tuaj yeem tshwm sim los ntawm qhov mob los ntshav uas yuav tsum tau phaiskev cuam tshuam.

Hemolytic anemia yog ib yam kab mob ntawm lub cev tshwm sim los ntawm kev puas tsuaj ntau ntawm cov qe ntshav liab. Nws tuaj yeem ua tau los ntawm keeb kwm thiab tau txais, nyob rau hauv ib nrab ntawm cov neeg mob uas ua rau tsis muaj ntshav qab zib. Cov qe ntshav liab tuaj yeem raug rhuav tshem los ntawm cov hauv qab no:

• kev puas tsuaj rau erythrocyte daim nyias nyias (los ntawm lub plawv valve prostheses, lub plawv-lub ntsws tshuab);
• tshuaj puas rau cov qe ntshav liab (nug tom, lom nrog cov hlau lead, benzene, tshuaj tua kab);
• hypersensitivity rau tej yam tshuaj;
• kab mob parasitic (malaria).

Txoj kev kho kom tiav, nws yog ib qho tsim nyog yuav tsum tshem tawm qhov ua rau muaj ntshav liab. Ntxiv thiab, muab:

• vitamin B npaj _{12 thiab folic acid;}
• nyob rau hauv cov xwm txheej tshwj xeeb - kev hloov pauv ntawm "hloov" cov qe ntshav liab;
• glucocorticoid cov tshuaj hormones, txij li tus kab mob feem ntau nrog los ntawm kev nce qhov loj ntawm tus po thiab daim siab (qee zaum, lub poov xab raug tshem tawm);
• cytostatics hauv autoimmune etiology.

Hemolytic kab mob ntawm tus menyuam mos

HDN yog hais txog kev mob ntshav qab zib hauv lub cev.

Tsis txhob cuam tshuam HDN nrog lub cev nqaij daim tawv jaundice. Xws li jaundice tshwm sim nyob rau hauv feem ntau ntxov ntxov thiab ib nrab hnub tag nrho cov me nyuam mos uas tsis muaj pathology. Qhov tseeb yog hais tias nyob rau hauv cov ntshav ntawm tus me nyuam ua ntej yug me nyuam, tshwj xeeb fetal hemoglobin prevails, uas muaj peev xwm mus txuas oxygen. Thaum tus me nyuam nyob hauv plab, nws tau muab cov pa oxygen los ntawm leej niam cov ntshav, nws hloov tawm mus.tsis txaus. Hauv cov xwm txheej ntawm qhov tsis muaj oxygen, hemoglobin zoo tib yam yuav tsis tuaj yeem tiv nrog nws qhov kev xa mus rau txhua lub cell ntawm lub cev xeeb tub. Tom qab yug me nyuam, tus me nyuam pib ua pa ntawm nws tus kheej, muaj oxygen ntau dua, fetal hemoglobin twb tsis tsim nyog thiab hloov los ntawm "tus neeg laus". Tom qab yug menyuam, "cov menyuam yaus" hemoglobin pib maj mam tawg hauv lub txaj vascular nrog kev tsim cov khoom kawg - bilirubin, uas muaj xim liab-daj. Yog vim li cas tus me nyuam hemoglobin txo qis hauv thawj ob lub hlis ntawm lub neej los ntawm 200 mus rau 140 g / l. Feem ntau cov kab mob jaundice ploj mus ntawm nws tus kheej, qee zaum yuav tsum tau kho cov teeb. Muaj tsawg zaus, jaundice yog tshwm sim los ntawm cov kab mob pathological uas yuav tsum tau kuaj xyuas thiab kho.

Ib qho ntawm cov laj thawj no yog kab mob hemolytic ntawm tus menyuam mos, uas tshwm sim hauv 0.5% ntawm cov menyuam yaus. Nws tshwm sim vim qhov tsis sib haum xeeb ntawm cov ntshav ntawm leej niam thiab fetus. Qhov laj thawj tuaj yeem yog leej niam Rh tsis zoo thiab tus menyuam qhov zoo, lossis lawv hom ntshav sib txawv. Yog li ntawd, cov tshuaj tiv thaiv yog tsim nyob rau hauv cov poj niam lub cev uas rhuav tshem cov fetal qe ntshav liab. Txawm hais tias lub npe - "tus kab mob ntawm tus menyuam mos", tus kab mob tuaj yeem cuam tshuam rau tus menyuam hauv plab thiab txawm ua rau nws tuag. Kev puas tsuaj ntawm cov qe ntshav liab ua rau muaj kev mob ntshav qab zib hauv cov menyuam yug tshiab thiab, qee zaum, mob daj ntseg hnyav. Qhov no piav qhia vim li cas hemoglobin txo qis tom qab TTH.

YMacrocytic anemia

Nws yog tus cwj pwm los ntawm kev ua txhaum ntawm cov txheej txheem ntawm hematopoiesis thiab cov tsos ntawm lub txaj vascular ntawm cov hlwb loj hu ua macrocytes. NtawmKev kuaj pom ntawm cov hlwb hauv cov ntshav smear qhia tias B ₁₂-deficient, folate-deficient, lossis tshuaj-induced toxic anemia. Ntawm cov no, B₁₂-tsis muaj ntau dua, sau tseg feem ntau hauv cov neeg laus. Qhov tsis muaj cov vitamin no tshwm sim nrog cov neeg tsis noj nqaij nruj tshaj plaws, tom qab kev ua haujlwm ntawm lub plab, cov hnyuv me, nrog rau mob plab, helminthic ntxeem tau. Txhawm rau kho hom kab mob ntshav qab zib no, B_{12 tshuaj tau muab tshuaj ntawm ib koob ntawm 500-1000 g / hnub thiab kho cov kab mob uas ua rau cov vitamin deficiency.}

Folic deficiency anemia feem ntau tshwm sim hauv cov tub ntxhais hluas. Vitamin deficiency tuaj yeem yog vim kev noj zaub mov tsis txaus ntawm cov nroj tsuag, nrog rau kev mob ntawm cov hnyuv me los yog tshem tawm ib feem ntawm nws. Kev xav tau ntau ntxiv rau cov vitamin tshwm sim thaum cev xeeb tub. Rau kev kho mob, folic acid tau muab tshuaj ntawm 5-15 mg / hnub.