Hemolytic chirwere chemwana achangoberekwa - zvinokonzera, zviratidzo, mafomu

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Chirwere cheneonatal haemolytic chirwere chinokonzerwa nekusawirirana (kupesana) muRh factor kana AB0 mapoka eropa pakati paamai ne fetus. Chirwere ichi chinokonzeresa kugadzirwa kwemasoja ekudzivirira chirwere muropa raamai, izvo zvinozoita kuti masero matsvuku eropa emwana achangozvarwa uye achangozvarwa aparare. Chirwere chinotyisa chehemolytic chirwere chejaundice.

Mazwi mashoma nezve chirwere chehemolytic chemucheche ...

Chirwere chacho chakabatana nekurwisana kweserological, kureva mamiriro ezvinhu umo boka reropa raamai rakasiyana neboka reropa remwana. Chirwere cheHemolytic chinokonzera kugadzirwa kwemasoja ekudzivirira chirwere muropa raamai ayo anoputsa masero matsvuku eropa remwana achangoberekwa. Chirwere chinotyisa zvikuru chechirwere chakanyanya neonatal jaundice, inokonzerwa nekuwedzera nokukurumidza kwehuwandu hwebilirubin muropa uye kukura kwekushaya ropa. Kana iyo bilirubin level ikadarika imwe chikumbaridzo, inogona kukuvadza uropi, inozivikanwa se jaundice yemachende epasi pehuropiizvo zvinoguma - kana mwana akapona - psychophysical underdevelopment. Parizvino, kunetsana kweserological harisi dambudziko rakakura sezana ramakore rechiXNUMX.

Zvikonzero zvechirwere chehemolytic chemwana achangoberekwa

Wese munhu ane rimwe boka reropa, uye pasi pemamiriro akajairika muviri une hutano hauburitse masoja ekudzivirira eropa kurwisa masero eropa. Boka reRh + ropa hariburitse masoja ekudzivirira chirwere ichi, kureva anti-Rh. Saizvozvo, mutumbi wemurwere ane boka reropa A hauburitse maanti-A antibodies. Zvisinei, mutemo uyu haushandisi kuvakadzi vane pamuviri, saka chirwere chehemolytic checheche chinokonzerwa nekukakavadzana pakati peropa remwana uye ma antibodies anogadzirwa naamai. Kutaura zviri nyore: ropa raamai harina kupindirana neropa remwana. Masoja ekudzivirira chirwere emukadzi ane pamuviri anogona kuyambuka rukuvhute (pamuviri pazvino kana kuti inotevera) orwisa masero eropa emwana. Mugumisiro wacho ipapo hemolytic chirwere chemwana.

Zviratidzo uye mafomu emwana ane hemolytic chirwere

Chirwere chakapfava chehemolytic kuparadzwa kwakanyanya kwemasero eropa emwana. Mwana anozvarwa aine anemiakazhinji inoperekedzwa nespleen yakawedzera uye chiropa, asi izvi hazvikonzeri njodzi kuhupenyu hwake. Nokufamba kwenguva, mufananidzo weropa unovandudza zvakanyanya uye mwana anokura zvakanaka. Zvisinei, zvinofanira kusimbiswa kuti mune dzimwe nguva anemia yakaoma uye inoda kurapwa kwenyanzvi.

Chimwe chimiro chehemolytic chirwere kune jaundice yakaoma. Mwana wako anoita seane hutano hwakakwana, asi anotanga kuita jaundice pazuva rekutanga mushure mekuzvarwa. Kune kuwedzera kwakakurumidza kwebilirubin, iyo inokonzera ruvara rweyero yeganda. Jaundice injodzi huru nekuti kudzika kwayo kupfuura imwe nhanho ine chepfu muuropi hwemwana. Inogona kutotungamirira kukukuvadzwa kweuropi. Muvana vane jaundice, kugumburwa uye kunyanya kunetseka kwemhasuru kunoonekwa. Kunyange kana mwana akaponeswa, jaundice inogona kuva nemigumisiro yakakomba, somuenzaniso, mwana angarasikirwa nekunzwa kwake, kutambura nepfari uye kunyange kunetseka kutaura nekuchengetedza kuenzanisa.

Chimiro chekupedzisira uye chakakomba chechirwere chehemolytic checheche achangoberekwa chinowanikwa fetal kuzvimba. Somugumisiro wekuparadzwa kwemasero eropa emwana nema antibodies aamai (achiri padanho rehupenyu hwe fetus), kupararira kwechecheche kunovhiringidzika uye kupera kwemidziyo yayo kunowedzera. Zvinorevei? Mvura inobva mumitsipa yeropa inopukunyuka ichienda kune matishu ari pedyo, nokudaro zvichiita kuti edema yomukati iumbe munhengo dzakakosha, dzakadai se peritoneum kana kuti pericardial sac inopoteredza mwoyo. Panguva imwecheteyo, mucheche anotanga anemia. Nehurombo, kuzvimba kwe "fetus" kwakakomba zvekuti kazhinji kunotungamira kufa kwe "fetus" ichiri mudumbu kana mushure mekuzvarwa.

Diagnostics yehemolytic chirwere chemwana achangozvarwa

Kazhinji, mukadzi ane pamuviri anozoongororwa bvunzo kuti aone kuvepo kweanti-RhD kana mamwe masoja ekudzivirira chirwere akaenzana. Kazhinji, muchikamu chekutanga chekuzvitakura, antiglobulin test (Coombs test) inoitwa kana vabereki vemwana vari RhD isingaenderani. Kunyangwe kana mhedzisiro isiriyo, bvunzo inodzokororwa yega yega trimester uye mwedzi umwe usati wasununguka. Nekudaro, mhedzisiro yebvunzo yakanaka chiratidzo chekuwedzera kuongororwa uye kuita bvunzo dzemhando uye titer yemasoja ekudzivirira chirwere. Low antibody titer (pasi pegumi nematanhatu) inoda kurapwa kwechinyakare, kureva kutariswa kwemwedzi nemwedzi kwemasoja ekudzivirira chirwere. Kune rimwe divi, kuongororwa kweakakwira antibody titers (anopfuura makumi matatu nemaviri) kunoda kurapwa kwakanyanya. Chiratidzo cheizvi zvakare kuzivikanwa kweiyo umbilical vein dilatation, hepatomegaly uye gobvu placenta paultrasound. Zvadaro, aminopuncture uye cordocentesis (kuwana sampuli yeropa re fetal yekuongororwa) inoitwa. Miedzo iyi inobvumira kunyatsoongorora kuti fetal anemia yakakura sei, kuongorora rudzi rweropa uye kuvapo kwemaantigen akakodzera pamasero eropa. Mibairo yakajairwa inoda kuti bvunzo idzokororwe mushure memavhiki mashoma.

Kurapa kunotanga apo anemia yakakomba inowanikwa. Uyezve, nzira yePCR inoitwa inosimbisa kuvepo kweD antigen. Kushaikwa kweantigen iyi hakusanganisire kuitika kwechirwere chehemolytic che fetus.

Hemolytic chirwere checheche - kurapwa

Kurapa kwezvirwere kunonyanya kusanganisa kuisirwa ropa kwekunze kweropa pasi pekutungamira kwe ultrasound. Ropa rinopihwa muvascular bed kana mu peritoneal cavity yefetus. 3-4 transfusion cycles inodiwa pakuchinjana kweropa kwakakwana. Kurapa kunofanira kuenderera mberi kusvikira fetus inokwanisa ectopic life. Mukuwedzera, vanachiremba vanokurudzira kupedza pamuviri kusvika kumavhiki e37. Mushure mokuberekwa, mwana achangoberekwa kazhinji anoda kuisirwa albumin uye phototherapy, mumatambudziko akaoma zvikuru, kutsiva kana kuwedzerwa kuwedzerwa kunoitwa. Mukuwedzera pakurapwa, kudzivirira zvirwere kunokoshawo.

Hemolytic chirwere chemwana achangoberekwa - prophylaxis

Haemolytic chirwere prophylaxis inogona kunge yakananga uye isiri-yakananga. Yokutanga ndeyekudzivisa kusangana neropa rekunze uye kutevera mitemo yeboka rinoenderana nekuwedzerwa ropa mushure mekubatana. Yechipiri, zvakare, inobva pakushandiswa kwe-anti-D immunoglobulin maawa 72 isati yatarisirwa kubuda kweropa, kureva:

  1. panguva yekusununguka,
  2. kana mimba yabva,
  3. kana kubuda ropa panguva yekuzvitakura,
  4. semugumisiro we invasive maitiro akaitwa panguva yekuzvitakura,
  5. panguva ectopic pamuviri kuvhiyiwa.

Sezvo intra-pregnancy prophylaxis muRh negative vakadzi vane negative antiglobulin test results, kutungamirirwa kwe-anti-D immunoglobulins (pavhiki ye28 yekuzvitakura) inoshandiswa. Mushonga unotevera wema immunoglobulins unopiwa chete kana mwana azvarwa. Iyi nzira inongochengetedza imwe chete, yepedyo pamuviri. Muvakadzi vari kuronga kunyange vana vakawanda, immunoprophylaxis inoshandiswa zvakare.

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