Thrombocytopenia yog ib qho mob pathological uas cov platelets hauv cov ntshav qis qis. Raws li qhov tshwm sim, muaj teeb meem cuam tshuam nrog kev txo qis los ntshav hauv cov hlab ntsha me. Feem ntau cov teeb meem tau piav qhia yog kab mob ywj pheej, qee zaum nws tshwm sim raws li cov tsos mob.
Tus kab mob no tshwm sim hauv cov hnub nyoog preschool lossis tom qab plaub caug xyoo. Feem ntau hom yog hu ua idiopathic thrombocytopenia. Raws li txoj cai, cov poj niam raug kev txom nyem, yog tias peb tham txog cov txheeb cais ntawm txoj kev loj hlob ntawm tus kab mob. Ntawm cov menyuam yaus, thrombocytopenia raug kuaj pom hauv 50 tus neeg mob ib lab.
Ua rau kab mob
hom kab mob no yog tshwm sim los ntawm kev puas tsuaj ntawm platelets, uas tshwm sim feem ntau hauv tus po. Qee zaum cov txheej txheem zoo li no tshwm sim hauv daim siab, qog thiab cov hlab ntsha. Idiopathic thrombocytopenia tseem hu ua autoimmune. Yog li ntawd, tus naj npawb ntawm platelets hauv cov ntshav peripheral txo qis vim lawv qhov kev puas tsuaj ntau ntxiv. Yog vim li cas ua ntejtseem tsis tau raug ntsia. Cov kws kho mob hais tias tus kab mob no tuaj yeem kis tau ntawm qib caj ces. Kuj tseem paub txog yam uas tuaj yeem ua rau nws. Cov no muaj xws li hypothermia, txhaj tshuaj tiv thaiv, kis kab mob thiab kab mob, tshuaj, insolation ntau tshaj.
Ntawm cov platelets, zoo li ntawm txhua lub hlwb hauv lub cev, muaj cov tshuaj tiv thaiv. Cov no yog cov molecular complexes. Thaum cov khoom txawv teb chaws nkag mus rau hauv lub cev, lub cev tiv thaiv kab mob tam sim ntawd pib tsim cov tshuaj tiv thaiv. Lawv ua rau antigens. Cov txheej txheem no xaus nrog qhov tseeb tias lub xov tooj ntawm tes uas nyob tom kawg tau raug rhuav tshem.
Txhais tau
Thaum ib tug neeg tsim idiopathic thrombocytopenia (ICD-10: D69.3), tus poov tshuaj tiv thaiv rau cov platelets xav tau los ntawm lub cev. Raws li qhov tshwm sim ntawm qee cov txheej txheem, thaum lub cev nkag mus rau tus po, lawv raug puas tsuaj tam sim ntawd. Yog li ntawd, lub neej ntawm platelets ua luv luv los ntawm ob peb teev.
Vim muaj cov txheej txheem zoo sib xws hauv lub cev, lub siab pib tsim cov thrombopoietin hauv ntau ntau. Yog li ntawd, ntau platelets thiab megakaryocytes yog tsim nyob rau hauv cov pob txha pob txha. Txawm li cas los xij, vim yog kev puas tsuaj ntawm thawj zaug hauv lub cev, lub hlwb qaug zog tshwm sim, muaj kab mob xws li thrombocytopenia.
Nyob hauv cov poj niam cev xeeb tub, qhov teeb meem no tuaj yeem ua rau lub cev puas tsuaj txawm tias nyob hauv fetus.
Degrees of disease
Kev kho mob ntawm idiopathic thrombocytopenia nyob ntawm qhov degree thiab qhov hnyav ntawm tus kab mob. Cia peb saib ib leeg.
Thrombocytopenia tuaj yeem mob me, nruab nrab lossis hnyav.
- Lub ntsws yog nrog los ntawm qhov teeb meem uas qhov concentration ntawm platelets hauv ib microliter yog los ntawm 50 txog 150 txhiab. Qhov nyiaj no tso cai rau koj kom tswj tau qhov xwm txheej ntawm cov hlab ntsha, thiab tseem tiv thaiv kev tawm ntawm cov ntshav los ntawm cov channel. Raws li txoj cai, los ntshav tsis tshwm nyob rau theem no. Tsis tas yuav kho. Tus kws kho mob yuav tsum ua cov kev ntsuam xyuas thiab saib xyuas tus neeg mob, sim txheeb xyuas qhov ua rau txo qis ntawm lub cev.
- Nruab nrab yog tus cwj pwm los ntawm cov ntsiab lus ntawm 20 txog 50 txhiab hauv ib microliter. Teeb meem yuav tshwm sim nyob rau hauv daim ntawv ntawm hemorrhage nyob rau hauv lub qhov ncauj, los ntawm lub qhov ntswg, thiab hais txog. Qhov no tuaj yeem ua rau cov pos hniav tsis zoo. Nrog me bruises thiab raug mob, hemorrhages loj tshwm sim. Kev kho mob tsuas yog raug sau tseg yog tias muaj qee yam cuam tshuam rau kev loj hlob los ntshav.
- Kev mob hnyav yog tshwm sim los ntawm qhov concentration ntawm platelets hauv cov ntshav qis dua 20 txhiab ib microliter. Hemorrhages tas li tshwm sim hauv daim tawv nqaij, nrog rau lwm cov tsos mob ntawm hemorrhagic syndrome. Nyob rau tib lub sijhawm, txhua tus neeg mob zoo siab, kev tsis txaus siab tsuas yog cuam tshuam nrog kev kho kom zoo nkauj.
Problem Mechanism
Platelets ntawm lawv cov haujlwm muaj ib qho tseem ceeb tshaj plaws - nws yog kom tsis txhob los ntshav hauv lub cev. Yog li ntawd, yog tias lawv cov concentration txo qis, ces qhov teeb meem ntawm kev txwv cov ntshav yuav mob heev. Cov tsos mob ntawm idiopathic thrombocytopenia hauv cov menyuam yaus thiab cov neeg laus pib tshwm sim tsuas yog yog tias ib tus neeg muaj tsawg dua 50 txhiab platelets hauv ib microliter ntawm cov ntshav. Txawm li cas los, tag nrho cov manifestationQee tus neeg mob tsawg heev thiab tsis ua rau tsis xis nyob, yog li tus kab mob no suav tias yog qhov txaus ntshai. Ib qho ntawm qhov tshwm sim loj heev yog kev loj hlob ntawm cov ntshav liab loj thiab mob ntshav hauv hlwb.
Tus kab mob no tshwm sim tib yam hauv txhua kis. Ua ntej, tus naj npawb ntawm platelets hauv cov ntshav txo qis. Vim li no, teeb meem nrog kev noj haus ntawm cov hlab ntsha pib thiab, raws li, lawv ua nkig. Tom qab cov txheej txheem zoo li no, lawv raug rhuav tshem txawm tias nyob rau hauv kev cuam tshuam ntawm yam tsis muaj kev phom sij. Muab hais tias muaj ob peb platelets, tsis muaj platelet ntsaws rau hauv cov hlab ntsha. Yog li ntawd, nrog rau kev loj hlob ntawm idiopathic thrombocytopenia (ICD-10: D69.3), ntau cov ntshav mus rau hauv cov ntaub so ntswg.
Symptomatics
Cia peb saib cov tsos mob kom ntxaws ntxiv.
- Txhob los ntshav tom qab tshem cov hniav. Thaum tshem tawm cov hniav, cov hlab ntsha thiab cov hlab ntsha hauv cov pos hniav raug torn. Feem ntau, los ntshav nres hauv 5-20 feeb. Yog li ntawd, yog tias muaj teeb meem nrog cov ntsiab lus ntawm platelets hauv cov ntshav, nws yuav mus ntev.
- Hemorrhage rau ntawm daim tawv nqaij thiab mucous daim nyias nyias. Cov tsos mob no yog qhov tshwj xeeb tshaj plaws thiab suav tias yog qhov tseem ceeb. Tus neeg mob tsim cov pob liab me me, tshwj xeeb tshaj yog nyob rau hauv qhov chaw uas cov khaub ncaws nias. Lawv tshwm sim vim qhov tseeb tias daim tawv nqaij thiab cov mucous membranes saturated nrog ntshav. Tsis muaj qhov mob, qhov chaw tsis ploj yog tias koj nias rau lawv. Muaj petechiae thiab ecchymosis. Cov qub yog ib qho hemorrhages, thiab tom kawg yog cov pob loj. Kuj ua taumuaj liab thiab xiav smudges uas tig ntsuab thiab daj thaum lub sij hawm.
- Lub sijhawm ntev thiab hnyav. Raws li txoj cai, nyob rau hauv cov poj niam, kev coj khaub ncaws ntev li ntawm peb mus rau tsib hnub. Nyob rau hauv cov ntaub ntawv no, lub ntim ntawm secretions yog tsis ntau tshaj 150 ml, nrog rau cov txheej ntawm lub rejection nto. Ntawm cov nyiaj no, ntshav nyob ntawm 50 mus rau 80 ml. Yog tias thrombocytopenia tau pom, ces kev coj khaub ncaws ntau dua.
- Ntxhais ntswg ntswg. Lub qhov ntswg mucosa muaj ntau tus capillaries. Thaum cov concentration ntawm platelets txo, lawv ua nkig. Kev ua kom muaj zog yuav tsum tau sau tseg tias txham, mob khaub thuas, microtrauma, nrog rau lub cev txawv teb chaws. Cov ntshav yuav ci liab. Los ntshav hauv idiopathic thrombocytopenia tuaj yeem kav ntev li ob peb feeb, yog li tus neeg yuav txawm tsis nco qab.
- ntshav tso zis. Cov tsos mob no muaj nws lub npe - hematuria. Nws manifests nws tus kheej nyob rau hauv cov ntaub ntawv thaum ib tug neeg muaj ib tug hemorrhage nyob rau hauv lub zais zis. Cov zis tuaj yeem muaj xim sib txawv, nyob ntawm seb cov ntshav ntau npaum li cas. Qee lub sij hawm nws cov ntsiab lus me me uas nws tsuas tuaj yeem tshawb pom los ntawm kev tshawb fawb hauv chav kuaj.
- teeb meem ntawm cov pos hniav. Qee cov neeg mob yuav muaj ntshav thaum txhuam hniav. Kev txwv nws yog ib qho nyuaj txaus.
- Ntshav hauv plab hnyuv. Cov tsos mob no tshwm sim vim qhov tsis muaj zog ntawm cov hlab ntsha thiab thaum noj cov zaub mov hnyav, hnyav. Cov ntshav tuaj yeem dhau los ntawm lub cev nrog quav (stained liab) lossis ntuav. Cov tsos mob zaum kawg qhia tias ib tug neeg tau los ntshav hauv mucosaplab. Qee zaum qhov no tuaj yeem ua rau tib neeg ua neej nyob.
Cov tsos mob ntxiv yuav suav nrog cov uas tshwj xeeb rau tus kab mob ua rau muaj teeb meem platelet.
Kev tshuaj ntsuam qhov teeb meem
Feem ntau, qhov teeb meem ntawm kev txo cov platelets hauv cov ntshav tsis yog kev ywj pheej, tab sis yog cov tsos mob ntawm qee yam kab mob. Txhawm rau txhawm rau txheeb xyuas qhov ua tau raug thiab raug, yuav tsum tau kuaj xyuas kom raug. Tom qab ntawd kev kho mob ntawm idiopathic thrombocytopenia thiab purpura yuav ua tau zoo tshaj plaws. Xav txog txhua txoj kev kuaj mob.
Kev kuaj ntshav dav dav yog qhov yuav tsum tau ua. Ua tsaug rau nws, koj tuaj yeem paub seb cov ntshav muaj li cas, tus naj npawb ntawm lub cev, nrog rau qhov loj thiab cov duab ntawm txhua lub hlwb uas ua rau nws. Los ntawm kev txiav txim siab lub sij hawm los ntshav, koj tuaj yeem paub txog lub xeev ntawm platelets, uas yog lub luag haujlwm rau cov ntshav txhaws. Ib qho puncture ntawm cov pob txha liab yog noj. Nws yog ib qho tsim nyog yuav tsum tau soj ntsuam cov khoom siv nyob rau hauv lub tshuab microscope. Raws li txoj cai, lawv tus lej tsis pub tshaj 10-20 ml. Nws yuav tsum nco ntsoov tias thrombocytopenia hauv idiopathic purpura tshwm sim vim kev puas tsuaj ntawm lub cev, yog li kev ntsuam xyuas yuav ua tiav.
Ua tsaug rau txoj kev kuaj cov tshuaj tiv thaiv kab mob, nws tuaj yeem txheeb xyuas tias yog vim li cas platelets hauv cov ntshav tau deformed. Nco ntsoov ua txoj kev tshawb nrhiav caj ces. Nws yog ib qho tsim nyog kom nkag siab qhov ua rau ntawm qhov teeb meem. Tus kws kho mob kuj tuaj yeem xaj MRI thiab ultrasound. Thawj txoj kev tshawb fawb tso cai kom tau txais cov ntaub ntawv ntawm lub xeev ntawm txhua lub cev thiab cov hlab ntsha, thiab txoj kev thib obyuav pab txiav txim seb qhov loj ntawm tus po, daim siab, thiab nyob rau hauv lub xub ntiag ntawm cov qog yuav qhia lawv. Koj kuj yuav tsum tau txiav txim siab lub sijhawm ntawm cov ntshav txhaws. Qhov no yog lub sijhawm uas cov ntshav txhaws yuav pib tsim tom qab lub qhov txhab tshwm, cia cov ntshav tso tseg.
Deciphering indicators
Raws li tau hais los saum no, platelets raug rhuav tshem hauv tus po. Nrog kev pab los ntawm cov pob txha pob txha pob txha, qhov teeb meem no tuaj yeem txiav txim siab, vim tias nws yuav ua kom tag nrho thaum platelets tau tsim ntau ntau.
Thaum ua kev kuaj mob rau idiopathic thrombocytopenia, cov ntsuas hauv qab no raug coj mus rau hauv tus account: qhov loj me ntawm platelets hauv cov ntshav smear, muaj cov tshuaj tiv thaiv uas ua rau lub cev puas tsuaj. Thaum ua OAC, cov txiaj ntsig tau los uas tau piav qhia txog cov platelet tsawg. Tsis tas li ntawd, thaum kuaj pom qhov teeb meem zoo sib xws, xav tau kev tshawb fawb ntxiv. Lawv yuav tawm tsam lwm yam kab mob autoimmune.
Kuv puas xav tau pw hauv tsev kho mob?
Cov neeg mob uas muaj qhov mob me me ntawm idiopathic thrombocytopenia (ICD-10: code D69.3) tsis xav tau kev kho mob hauv tsev kho mob. Raws li txoj cai, tus kws kho mob tsuas yog saib lawv tus mob. Nws yog ib qho tsim nyog yuav tsum sab laj nrog ib tus kws kho mob hematologist ib ntus thiab ua qhov kev ntsuam xyuas dav dav. Tom qab ntawd koj tuaj yeem txheeb xyuas qhov ua rau txo qis ntawm cov platelets hauv cov ntshav.
Yog tus neeg mob tsis muaj hemorrhagic syndrome, tab sis raug kuaj pom qhov nruab nrabcov degree ntawm tus kab mob, ces tus kws kho mob sau ntawv kho mob nyob rau hauv tsev. Tus kws kho mob tshwj xeeb yuav tsum qhia tus neeg mob txog yam kab mob dab tsi, nws cuam tshuam dab tsi thiab yuav ua li cas los ntshav. Thaum cov kev kho mob tab tom ua, lawv yuav tsum txwv lawv lub cev ua si, so kom ntau ntxiv thiab noj tag nrho cov tshuaj uas tau muab los ntawm kws kho mob. Qee zaum qee tus kws kho mob kuaj pom tus lej 68.8 raws li idiopathic thrombocytopenia. Txawm li cas los xij, qhov no tsis raug, vim qhov no ICD-10 code yog tshwj xeeb rau cov teeb meem uas muaj lupus erythematosus inhibitors.
Lawv mus pw hauv tsev kho mob li cas?
Txhua tus neeg mob uas muaj tsawg dua 20,000 platelets ib microliter hauv lawv cov ntshav yuav tsum tau mus pw hauv tsev kho mob. Txwv tsis pub, lawv tus mob yuav hnyav zuj zus. Hauv tsev kho mob, lawv yuav tsum tau saib xyuas tag nrho.
Yog tias tus neeg mob muaj cov ntshav tsis tu ncua ntawm lub ntsej muag, qhov ntswg, qhov ncauj, tsis hais lub cev hauv cov ntshav, nws yuav tsum mus pw hauv tsev kho mob. Cov tsos mob zoo li no qhia tau tias tus kab mob no siab heev thiab yuav tsum tau kho tam sim ntawd.
Tshuaj rau thrombocytopenia
Tshuaj feem ntau yog siv thaum muaj kev tiv thaiv kab mob thrombocytopenia. Lub luag haujlwm ntawm tus kws kho mob thaum kho yog txhawm rau tshem tawm qhov liab thiab pob khaus, txhawm rau txheeb xyuas qhov ua rau ntawm qhov teeb meem. Tsis tas li, yog tias qhov teeb meem tsis muaj kev ywj pheej, tus kab mob tseem ceeb yuav tsum tau kho.
Kev piav qhia tshuaj
Cia peb saib cov tshuaj uas xav tau los kho qhov teeb meem.
- Immunoglobulin intravenously. Covcov tshuaj txo cov kev tsim cov tshuaj tiv thaiv, thaiv platelet antigens, uas tso cai rau cov tshuaj tiv thaiv kom tsis txhob txuas mus rau lawv ntxiv kev puas tsuaj, tua cov kab mob. Cov chav kawm ntawm kev kho mob ntawm idiopathic thrombocytopenia, cov laj thawj uas tau piav qhia saum toj no, nrog rau qhov kev kho no yog 5 hnub. Noj 400 mg rau 1 kg ib hnub twg.
- "Eltrombopag". Cov tshuaj no txo qhov kev pheej hmoo ntawm los ntshav. Nws yog ib qho hluavtaws hloov rau thrombopoietin. Vim li no, cov tshuaj txhim kho kev tsim cov platelets thiab megakaryocytes. Cov tshuaj yuav tsum tau muas nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj. Tsis pub ntau tshaj 50 mg tuaj yeem siv rau ib hnub. Yog tias tsis muaj txiaj ntsig zoo, cov koob tshuaj tuaj yeem nce mus rau 75 mg, tab sis koj yuav tsum sab laj nrog koj tus kws kho mob ib txwm.
nyiaj ntxiv
- "Txoj Kev". Cov cuab yeej txo cov fragility ntawm cov hlab ntsha, normalizes ntshav ncig thiab txhim kho cov tsim ntawm platelets ntawm qhov chaw ntawm kev raug mob. Cov tshuaj yuav tsum tau noj tom qab noj mov peb zaug ib hnub, 500 mg. Cov tshuaj no muaj ib tug xov tooj ntawm contraindications, nrog rau kev xeeb tub. Nrog idiopathic thrombocytopenia hauv cov poj niam cev xeeb tub, nws yog txwv tsis pub noj.
- "Prednisolone". Ua tsaug rau tus neeg sawv cev no, cov tshuaj tiv thaiv tsawg dua tsim nyob rau hauv tus po, lawv ua tsis tshua muaj zog thiab tsis khi rau cov antigens ntawm lub cev, kev pheej hmoo ntawm platelet kev puas tsuaj txo qis thiab lub zog ntawm tag nrho cov hlab ntsha nce. Thaum pib ntawm kev kho mob, koob tshuaj ib hnub yuav tsum tsis txhob ntau tshaj 40-60 mg, thaum lawv yuav tsum tau muab faib ua peb koob. Yog tias tsim nyog, nce koob tshuajrau 5mg. Kev kho mob nrog cov tshuaj no yog nqa tawm rau 1 lub hlis. Yog tias tus neeg mob muaj lub sijhawm tso cai, tom qab ntawd cov tshuaj raug tso tseg maj mam, qhov no tsis tuaj yeem ua sai sai. Koj yuav tsum txo qhov koob tshuaj 2.5 mg txhua lub lim tiam.
Results
Koj tau kawm tias nws yog dab tsi - idiopathic thrombocytopenia. Los ntawm kev nkag siab txog cov txheej txheem ntawm qhov teeb meem thiab nws cov laj thawj, muaj feem cuam tshuam, koj tuaj yeem zam qhov teeb meem yooj yim. Yog tias txawm tias cov tsos mob me me tshwm sim, koj yuav tsum sab laj nrog kws kho mob kom tshem tawm lawv raws sijhawm.
