Txoj kab mob sib txawv hauv lub cev tiv thaiv kab mob tuaj yeem ua rau muaj teeb meem nyuaj. Yog li ntawd, lub cev yuav xav txog nws cov hlwb ua yeeb ncuab, thiab kuj tua lawv. autoimmune anemia yog suav hais tias yog ib yam kab mob tsawg uas cov tshuaj tiv thaiv tau tsim tawm tsam nws tus kheej cov qe ntshav liab. Qhov tshwm sim ntawm qhov tshwm sim no yog qhov hnyav, vim muaj kev cuam tshuam hauv kev ua haujlwm ntawm cov hlab ntsha hauv lub cev cuam tshuam rau kev ua haujlwm ntawm tag nrho cov kabmob.
Txoj kev xav
Autoimmune anemia yog ib yam kab mob uas tshwm sim los ntawm kev puas tsuaj loj ntawm cov qe ntshav liab noj qab haus huv vim muaj kev cuam tshuam ntawm cov tshuaj tiv thaiv rau lawv. Cov tshuaj tiv thaiv no yog tsim los ntawm lub cev. Qhov no manifests nws tus kheej nyob rau hauv daim ntawv ntawm daj ntseg ntawm daim tawv nqaij, lub siab loj thiab spleen, mob nyob rau hauv lub sab nraub qaum thiab plab mog, ua tsis taus pa luv thiab lwm yam tsos mob. Txhawm rau txheeb xyuas tus kab mob, yuav tsum muaj kev sim kuaj. Kev kho mob yuav tsum tau saib xyuas, tab sis qee zaum yuav tsum tau phais kom tshem tawm tus po.
Autoimmune anemia tsis tshua muaj. Kab mob notshwm nyob rau hauv 1 tus neeg ntawm 70-80 txhiab. Nws feem ntau pom muaj nyob rau hauv cov poj niam. Autoimmune anemia tshwm sim hauv cov menyuam yaus thiab cov neeg laus. Kev kuaj mob feem ntau yog yooj yim. Nrog kev pab los ntawm kev kuaj ntshav niaj hnub, cov kws kho mob tuaj yeem kuaj mob. Kev rov zoo tshwm sim tsis pub ntau tshaj 50% ntawm cov neeg mob. Tab sis thaum kho nrog glucocorticosteroids, kev txhim kho hauv kev noj qab haus huv tau pom hauv 85-90% ntawm cov neeg mob.
Code
Hauv ICD, autoimmune anemia yog coded D59. Tus kab mob ntawm hom no yog txuam nrog cov tsos ntawm cov tshuaj tiv thaiv rau lawv cov qe ntshav liab. Tus kab mob no kis tau thiab los ntawm noob neej. Kev puas tsuaj RBC tuaj yeem yog intracellular lossis intravascular.
Autoimmune hemolytic anemia (ICD-10 code saib saum toj no) yog ib qho mob uas yuav tsum tau txheeb xyuas sai li sai tau. Feem ntau muaj cov npe nyuaj ntawm tus kab mob. Autoimmune hemolytic anemia nrog tsis tiav tshav kub agglutins yog ib lo lus siv rau ib hom kab mob ntshav qab zib.
Yog vim li cas
Qhov no anemia yog idiopathic (primary) thiab symptomatic (secondary). Yog tias qhov ua rau kev puas tsuaj ntawm cov qe ntshav liab tuaj yeem txheeb xyuas tau, qhov no yog qhov mob ntshav qab zib theem nrab. Thaum tsis pom qhov tshwm sim ntawm etiological, ces qhov anemia yuav yog idiopathic.
Autoimmune hemolytic anemia tsim:
- los ntawm lymphoblastic leukemia;
- raug hluav taws xob;
- malignant qog;
- kab mob sib kis;
- kab mob yav dhau los;
- kab mob autoimmune tsis cuam tshuam txog kev puas tsuaj rau hematopoietic system;
- mob ntshav qab zib hom 1;
- tshuaj tua kab mob;
- immunodeficiency xeev.
Feem ntau yog cov thermal daim ntawv ntawm anemia, thaum ib puag ncig sab hauv ntawm lub cev muaj qhov kub thiab txias, thiab cov erythrocytes muaj cov chav kawm G immunoglobulins, Cheebtsam C3 thiab C4. Erythrocytes tsuas yog nyob rau hauv tus po los ntawm macrophages.
Tus kab mob khaub thuas tuaj yeem tshwm sim los ntawm qhov tsis paub tseeb. Nws kuj tshwm sim los ntawm kev kis kab mob, hypothermia, kab mob lymphoproliferative. Hauv qhov kawg, cov neeg muaj hnub nyoog 60 xyoo tau mob. Pathology nyob rau hauv lub cev, nyob rau hauv uas cov qe ntshav liab raug rhuav tshem, manifests nws tus kheej tom qab qhov kub thiab txias nyob rau hauv lub peripheral hlab ntsha poob mus rau 32 degrees. Cold autoagglutinins yog immunoglobulins M.
Hemolysis, uas pom nyob rau hauv tus po, feem ntau hnyav heev. Feem ntau tus neeg mob yuav cawm tsis tau. Cov kab mob los ntawm kev kis kab mob feem ntau yog mob. Yog tias qhov ua txhaum cai tshwm sim los ntawm qhov tsis paub qhov laj thawj, ces nws yuav mob ntev.
Tsis tshua muaj, paroxysmal txias anemia tshwm sim. Hemolysis tshwm sim los ntawm kev raug mob khaub thuas. Kev phom sij tshwm sim txawm tias thaum noj cov dej txias thiab ntxuav tes hauv dej txias. Feem ntau qhov no anemia tshwm nrog syphilis. Qhov hnyav ntawm tus kab mob no tuaj yeem sib txawv ntawm qhov xwm txheej. Qee lub sij hawm ib qho kev kho tsis tau zoo tshwm sim, ua rau tuag.
Symptoms
Autoimmune anemia nyob rau hauv cov menyuam yaus thiab cov neeg laus tshwm sim nws tus kheej nyob rau hauv daim ntawv ntawm 2 syndromes: anemic thiab hemolytic. Koj tuaj yeem txheeb xyuas thawj tus mob:
- ntawm daim tawv nqaij daj ntseg thiab cov mucous;
- bout kiv taub hau;
- nrawm xeev siab;
- mob siab;
- tsis muaj zog;
- kev nyuaj siab.
Kev kuaj pom tus kab mob autoimmune hemolytic anemia:
- rau lub teeb daj lossis xim daj tsaus;
- loj ntawm tus po;
- xim av;
- tshwm sim ntawm DIC.
Mob ntshav qab zib feem ntau tshwm sim thaum lub cev kis kab mob. Yog li ntawd, ntxiv rau cov tsos mob ntawm kev puas tsuaj ntawm cov qe ntshav liab, muaj cov tsos mob ntawm tus kab mob hauv qab.
Cold anemia muaj cov chav kawm ntev. Nyob rau ntawm qhov kub thiab txias, ntiv tes thiab ntiv taw, pob ntseg, lub ntsej muag tig daj ntseg. Kab mob thiab gangrene tuaj yeem tshwm sim. Cov neeg mob feem ntau muaj mob khaub thuas urticaria. Cov kab mob ntawm daim tawv nqaij nyob ntev.
Heat anemia is chronic. Pathology yog exacerbated nrog qhov kub thiab txias, uas feem ntau manifests nws tus kheej nyob rau hauv cov kab mob thiab kab mob. Cov tsos mob yog zis dub.
Mob ntshav qab zib tshwm sim nws tus kheej hauv daim ntawv ua npaws, ua daus no, mob taub hau, kiv taub hau. Kuj tseem muaj ua pa luv, mob hauv plab thiab sab nraub qaum. Cov tawv nqaij ua daj ntseg, tej zaum yuav daj, subcutaneous hemorrhages tshwm sim ntawm ob txhais ceg. Ntxiv rau tus po, qhov loj ntawm daim siab nce.
Nyob rau hauv ib tug mob ntev, ib tug neeg txoj kev noj qab haus huv yog txaus siab. Kev ua txhaum cai tuaj yeem txheeb xyuas tau los ntawm qhov nce ntawm qhov loj ntawm tus po thiab sib cuam tshuam jaundice. Tom qab bouts ntawm kev zam txim, exacerbations tshwm sim.
Diagnosis
Yuav kom kuaj tau qhov tseeb, koj tsuas yog xav taukev kuaj sab nraud ntawm tus neeg mob. Nws yog ib qho tsim nyog yuav tau ua qhov kev kuaj mob tag nrho ntawm autoimmune hemolytic anemia. Ntxiv rau kev sau cov anamnesis, koj yuav tsum pub ntshav. Nws txoj kev tsom xam pom tau tias muaj kev nce hauv ESR, reticulocytosis, normo- lossis hypochromic anemia, thiab kuaj pom qhov nce ntawm bilirubin hauv cov ntshav. Thiab qib ntawm hemoglobin thiab cov qe ntshav liab poob qis.
ntsuas zis yuav tsum. Nws nthuav tawm cov protein ntau, tshaj hemoglobin thiab urobilin. Tus neeg mob tseem raug xa mus rau ib qho ultrasound ntawm cov kab mob hauv nruab nrog cev nrog kev kawm txog lub siab thiab tus po. Yog hais tias cov ntaub ntawv tau txais tsis txaus, ces yuav tsum tau kuaj cov pob txha pob txha, uas nws puncture yog ua. Tom qab kuaj xyuas cov khoom, kuaj pom lub hlwb hyperplasia, uas yog ua los ntawm kev ua kom erythropoiesis.
Trepanobiopsy yog ib txheej txheem uas ua rau tib lub hom phiaj zoo li pob txha pob txha. Tab sis nws nyuaj dua rau cov neeg mob ua siab ntev, yog li nws siv tsawg dua.
Direct Coombs kuaj rau autoimmune anemia yuav zoo. Tab sis thaum koj tau txais cov txiaj ntsig tsis zoo, koj yuav tsum tsis txhob cais tus kab mob. Qhov no feem ntau tshwm sim thaum kho nrog cov tshuaj hormonal lossis nrog hemolysis hnyav. Enzyme immunoassay yuav pab txheeb xyuas cov chav kawm thiab hom immunoglobulins uas koom nrog cov tshuaj tiv thaiv autoimmune.
Txoj kev kho mob
Kev kho mob autoimmune anemia feem ntau yog ntev thiab tsis tas yuav ua rau rov qab zoo. Ua ntej koj yuav tsum txiav txim siab qhov laj thawj uas ua rau lub cev pib rhuav tshem nws cov qe ntshav liab. Yog etiologicalyam tau txiav txim siab, ces koj yuav tsum tshem tawm nws.
Yog tias qhov laj thawj tsis tsim, ces kev kho mob autoimmune hemolytic anemia yog ua los ntawm cov pab pawg ntawm glucocorticosteroids. Prednisolone feem ntau yog tshuaj. Yog hais tias tus kab mob no hnyav heev thiab qib hemoglobin poob mus rau 50 g / l, ces yuav tsum tau txhaj cov ntshav liab.
Autoimmune hemolytic anemia yog kho nrog ntshav detoxification kom tshem tawm cov khoom tawg ntawm cov qe ntshav liab thiab txhim kho kev noj qab haus huv. Plasmapheresis txo cov qib ntawm cov tshuaj tiv thaiv kab mob hauv cov hlab ntsha. Kev kho mob yuav tsum tau ua. Txhawm rau tiv thaiv kev txhim kho ntawm DIC, indirect anticoagulants raug tshuaj. Nws yuav ua tau los txhawb lub hematopoietic system los ntawm kev qhia cov vitamin B12 thiab folic acid.
Yog nws tig los kho tus kab mob no ces kev kho mob tag lawm. Yog tias tom qab qee lub sijhawm tus kab mob rov tshwm sim, kev phais yuav tsum tau tshem tawm tus po. Qhov no yuav pab tiv thaiv qhov tshwm sim ntawm hemolytic crises yav tom ntej, vim nws yog nyob rau hauv tus po uas cov qe ntshav liab sib sau. Cov txheej txheem feem ntau ua rau kom rov zoo dua. Cov txheej txheem kho mob qhia tias autoimmune hemolytic anemia tsis tshua kho nrog kev kho cov tshuaj tiv thaiv kab mob yog tias splenectomy tsis ua tiav.
Tshuaj siv tshuaj
Tshuaj siv tau los ua lub ntsiab lus lossis pab. Rau feem ntaumuaj txiaj ntsig suav nrog cov hauv qab no:
- "Prednisolone" yog cov tshuaj hormone glucocorticoid. Cov tshuaj inhibits kev tiv thaiv kab mob. Yog li, kev ua phem ntawm lub cev tiv thaiv kab mob rau cov qe ntshav liab txo qis. Ib hnub twg, 1 mg / kg yuav muab tso rau hauv txoj hlab ntshav, drip. Nrog hemolysis hnyav, koob tshuaj tau nce mus rau 15 mg / hnub. Thaum cov teeb meem hemolytic dhau lawm, koob tshuaj txo qis. Kev kho mob yog ua kom txog thaum normalization ntawm hemoglobin thiab erythrocytes. Tom qab ntawd cov koob tshuaj maj mam txo los ntawm 5 mg txhua 2-3 hnub kom txog rau thaum cov tshuaj tau txiav lawm.
- "Heparin" yog ib qho luv luv-acting anticoagulant. Cov tshuaj tau sau tseg los tiv thaiv DIC, qhov kev pheej hmoo ntawm kev nce ntxiv nrog kev txo qis ntawm cov qe ntshav liab ncig hauv cov ntshav. Txhua 6 teev, 2500-5000 IU yog txhaj subcutaneously nyob rau hauv kev tswj ntawm ib coagulogram.
- "Nadroparin" - cov tshuaj tiv thaiv kab mob ntev ntev. Cov lus qhia zoo ib yam li cov tshuaj Heparin. Subcutaneously txhaj 0.3 ml / hnub.
- "Pentoxifylline" yog cov tshuaj tiv thaiv kab mob, yog li nws yog siv los txo qhov kev pheej hmoo ntawm DIC. Lwm cov tshuaj suav hais tias yog peripheral vasodilator, uas txhim kho cov ntshav mus rau peripheral cov ntaub so ntswg thiab lub hlwb. Sab hauv, 400-600 mg / hnub yog noj hauv 2-3 koob tshuaj. Kev kho mob yuav tsum tau ua 1-3 lub hlis.
- Folic acid yog cov vitamin koom nrog ntau yam txheej txheem hauv lub cev, suav nrog kev tsim cov qe ntshav liab. Thawj koob tshuaj yog 1 mg ib hnub twg. Kev nce hauv koob tshuaj tau tso cai nrog cov txiaj ntsig kho tsis txaus. Qhov koob tshuaj ntau tshaj yog 5mg.
- Vitamin B12 - ib yam khoom koom nrogtsim ntawm ib tug paub tab erythrocyte. Nrog nws qhov tsis txaus, qhov loj ntawm erythrocyte nce, thiab nws cov khoom yas txo qis, uas txo lub sijhawm ntawm nws lub neej. 100-200 mcg yog noj hauv qhov ncauj lossis intramuscularly ib hnub.
- "Ranitidine" - H2-antihistamine uas txo cov tshuaj hydrochloric acid los ntawm lub plab. Cov kev ntsuas no yuav tsum tau them nyiaj rau cov kev mob tshwm sim ntawm prednisolone ntawm lub plab mucosa. Sab hauv noj 150 mg ob zaug ib hnub.
- Potassium chloride - ib qho tshuaj kho tau los them nyiaj rau qhov poob ntawm cov poov tshuaj ions hauv lub cev. Noj 1 g peb zaug ib hnub twg.
- "Cyclosporin A" - ib qho tshuaj tiv thaiv kab mob, uas tau noj nrog cov tshuaj tsis txaus ntawm glucocorticoids. 3 mg / kg intravenously, drip yog sau ib hnub.
- Azathioprine yog ib qho tshuaj tiv thaiv kab mob. Noj 100-200 mg ib hnub rau 2-3 lub lis piam.
- "Cyclophosphamide" yog ib qho tshuaj tiv thaiv kab mob. noj 100-200 mg ib hnub twg.
- Vincristine yog ib qho tshuaj tiv thaiv kab mob. 1-2 mg drip per week.
Txhua cov tshuaj muaj nws tus kheej cov lus qhia, contraindications, kev cai nkag, yog li koj yuav tsum xub nyeem cov lus qhia rau kev siv. Tag nrho cov kev kho mob uas tau hais hauv tsab xov xwm tuaj yeem siv tau yog tias lawv tau raug tshuaj los ntawm kws kho mob.
Kev tshem tawm ntawm tus po
Cov txheej txheem no suav hais tias yog yuam, nws tso cai rau koj kom tsis suav nrog intracellular hemolysis, txo qhov tshwm sim ntawm tus kab mob. Splenectomy - kev ua haujlwm kom tshem tawm tus po - yog ua nrog 1st exacerbation ntawm tus kab mob tom qab siv tshuaj kho. Kev ua haujlwm yuav tsis ua nrog contraindications los ntawm lwm yam kabmob thiab lub cev. Cov nyhuv ntawm cov txheej txheem yog qhov zoo heev thiab muab kev rov qab zoo, raws li ntau qhov chaw, hauv 74-85% ntawm cov neeg mob.
Splenectomy yog ua nyob rau hauv chav ua haujlwm hauv kev tso tshuaj loog. Tus neeg mob muab tso rau hauv lub supine txoj hauj lwm los yog pw ntawm sab xis. Tom qab tshem tawm ntawm tus po, yuav tsum tau kuaj xyuas ntawm lub plab kab noj hniav kom pom muaj tus po ntxiv. Thaum pom, lawv raug tshem tawm. Qhov kev tsis txaus ntseeg no tsis tshua pom, tab sis qhov tsis paub txog qhov tseeb ua rau kev kuaj mob tsis raug, vim tias tom qab tshem tawm yuav muaj kev tshem tawm tus kab mob. Kev txiav txim siab ua haujlwm yuav tsum yog tus kws kho mob. Tom qab ntawd, ua raws li txhua tus kws kho mob cov tshuaj yuav tsum tau ua, vim lawv yuav tso cai rau koj kom rov zoo sai.
Kev Tiv Thaiv
Raws li kev soj ntsuam cov lus qhia, autoimmune anemia tuaj yeem tiv thaiv. Qhov no yuav tsum muaj kev taw qhia ntawm kev siv zog los tiv thaiv tus neeg los ntawm cov kab mob txaus ntshai uas tuaj yeem ua rau muaj mob.
Yog tias tus kab mob tau tshwm sim lawm, nws yog qhov tsim nyog los txo qhov cuam tshuam rau lub cev ntawm cov xwm txheej uas tuaj yeem ua rau muaj qhov hnyav dua. Piv txwv li, nws yog ib qho tseem ceeb kom tsis txhob muaj qhov kub thiab txias. Tsis muaj txoj hauv kev los tiv thaiv idiopathic anemia vim nws tsis paub txog qhov ua rau.
Yog tias tsawg kawg ib zaug muaj autoimmune anemia, ces 2 xyoos tom ntej yuav tsum tau pub ntshav pub rau kev tshuaj ntsuam dav dav. Qhov no yuav tsum tau ua txhua 3 lub hlis. Tej yam tshwm sim ntawm tus kab mob yuav qhia tau hais tias ib tug kab mob loj hlob. Hauv qhov no, yuav tsum tau mus ntsib kws kho mob.
Huab cua
Dab tsi yog qhov tshwm sim rau autoimmune hemolytic anemia? Nws tag nrho nyob ntawm qhov degree ntawm tus kab mob. Idiopathic anemia yog qhov nyuaj rau kho. Kev rov zoo li qub tom qab kawm hormonal tuaj yeem ua tiav tsis pub ntau tshaj 10% ntawm cov neeg mob.
Tab sis tshem tawm tus po ua rau cov neeg rov qab los txog li 80%. Immunosuppressive therapy yog qhov nyuaj rau kev zam, qhov kev kho no tsis zoo cuam tshuam rau lub cev tiv thaiv kab mob thiab ua rau muaj teeb meem. Txoj kev vam meej ntawm txoj kev kho yog nyob ntawm qhov ua rau mob ntshav qab zib.
