Ukubuka konke
I-neonatal alloimmune thrombocytopenia (i-NAIT) yisimo esingavamile sokungafani kwamaplatelet phakathi komama nosana lwakhe. Ngesikhathi sokukhulelwa, umama ukhiqiza imishanguzo ehlasela nokubhubhisa amaplatelet okuholela ku- thrombocytopenia eqinile (isibalo esiphansi se-platelet) nokuphuma e-fetus. Kufana neHemolytic Disease of the Newborn, isifo sezinqamuzana zegazi elibomvu.
I-NAIT akufanele ididaniswe ne-neonatal autoimmune thrombocytopenia. I-thrombocytopenia ye-autoimmune i-neonatal ivela kumama abanomzimba we-immune thrombocytopenia (i-ITP) noma i-lupus. Unina unama-antibodies eplatelet ekusakazeni kwakhe okuhlasela ama-platelets akhe. Lezi zinselo zomzimba zidluliselwa emlonyeni we-fetus nge-placenta okuholela ekubhujisweni kwamaplatelets akhe kanye.
Izimpawu
Izimpawu zincike ekubaleni kweplatelet. Ngokuvamile ekukhulelweni kokuqala, azikho izinkinga kuze kube yilapho umntwana ezalwa. Phakathi nesonto lokuqala, i-thrombocytopenia iyaqhubeka. Njengoba i-plateslet yehla, ukunyakaza okunyukayo, i-petechiae (amachashazi amancane abomvu esikhumbeni), noma ukuphaphaza kungabonakala.
Inkinga enkulu kakhulu ye-NAIT iphuma echosheni ebizwa ngokuthi i-intracranial hemorrhage (ICH). Lokhu kwenzeka ngo-10 - 20% wezinsana. Izinsana ezinenani eliphansi kakhulu leplatelet zihlolwe i-ICH nge-cranial ultrasounds.
Ekukhulelweni okuzayo, i-thrombocytopenia ingaba nzima futhi i-ICH ingenzeka ngaphambi kokuzalwa (ngenkathi isisu).
Kungani Lokhu Kusenzeka?
Ama-platelet ethu agcwele ama-antigens, izinto ezenza ukuba kube nokuphendula kwamagciwane. E-NAIT, usana luzuza i-antigen eplatelet evela kubababa ongenakho umama.
Isivikelo somzimba samasosha omama siyabona le antigen ngokuthi "angaphandle" futhi ihlakulela ama-antibodies ngokumelene nayo. Lezi zinselo zomzimba zidluliselwa kusuka kumama ukuya emathunjini nge-placenta lapho zifaka khona kuma-platelet, zibeka uphawu lokubhujiswa. Ngokungafani nezifo ze-Hemolytic of the Newborn, lokhu kungenzeka ngokukhulelwa kokuqala.
Utholakala kanjani?
Kukhona uhlu olude lwezizathu ezikhona ze-thrombocytopenia enganeni esanda kuzalwa. Eziningi zazo zibangelwa izifo ezifana ne- CMV yokuzalwa, i-rubella yokuzalwa, noma i-sepsis (ukutheleleka okukhulu kwe-bacterial). Kulezi zimo ngokuvamile, ingane igula kakhulu. I-NAIT kufanele icatshangelwe ensaneni ebonakala kahle ene-thrombocytopenia enamandla (inani leplatelet elingaphansi kwama-50,000 amaseli nge-microliter ngayinye).
E-NAIT usana luthola ukwelashwa ngaphambi kokuxilongwa njengoba kuqinisekisa ukuthi ukuxilongwa kuthatha amasonto ambalwa. Ukuqinisekisa i-NAIT kudinga ukuhlolwa kwegazi kwabazali, hhayi usana. Umama uzoba nesamba sejwayelekile seplatelet njengoba ama-antibodies awahlaseli amaplatelets akhe. Igazi lithunyelwa ebhodini elikhethekile lokuhlola ukuthi umama nobaba baye baphazamisa ama-antigens aseplatelet futhi uma umama enza ama-antibodies ku-antigen platelet etholakala kubaba. Uma i-NAIT icatshangwa, uma kubaluleke kakhulu ukuqinisekisa ukuxilongwa ngokuthi ukukhulelwa esikhathini esizayo kungathinteka kakhudlwana nge-thrombocytopenia eyingozi nakakhulu ukubola kwesisu (ngaphambi kokubeletha).
Lokhu kuthathwa kanjani?
Izinsana ezithintekayo zingase zingadingi ukwelashwa. Ezinganeni ezithintekile kakhulu, umgomo wokwelapha ukuvimbela noma ukuyeka ukuphuma kwegazi okusebenzayo, ikakhulukazi ebuchosheni.
- Ukumpontshelwa kweplatelet: Ngenxa yokuthi amaplatelet omama akanayo i-antigen ephulukisayo ngakho-ke angeke abhujiswe, ngokufanele, amaplatelet ahanjiswe usana angaphuma kumama noma kumnikezi ofana nomama. Le nqubo ingathatha isikhathi eside futhi ingabi njalo ngaso sonke isikhathi ekuphileni kwangempela. Uma i-thrombocytopenia inzima kakhulu (<20,000 amaseli ngayinye nge-microliter) noma ukuphuma kwegazi kwenzeka, ukuphasiswa kweplatelet kuvela ohlelweni lomnikelo wokuzithandela lunikezwa. Lezi zivame ukuphathwa ngesikhathi esifanayo njenge-immune globulin engena emzimbeni ukuze ikhulise ukuphila kwama platelet.
- I-immune globulin (i-IVIG) engenakuthinta: I-IVIG ingafakwa enganeni ukuze iphazamise isimiso somzimba sokuzivikela. I-IVIG iqukethe ama-antibodies amaningi avela kubanikeli abaningi. Lezi zinselo zamagciwane ziqede isimiso somzimba sokuzivikela komzimba futhi sinciphisa ukubhujiswa kwamaplatelet, afana nokuphathwa kwe-ITP. Lokhu kusetshenziselwa ngokubambisana nokupompela kweplatelet.
- Ukweluleka: Abazali abanezingane ezine-NAIT kufanele banikwe iseluleko ngengozi yalokhu okwenzeka ekukhulelweni okuzayo. Njengoba kunikezwe lo mngcipheko, ukukhulelwa esikhathini esizayo kufanele kuhlolwe yi-obstetrician esengozini enkulu. I-IVIG ingase ihanjiswe kumama ngenkathi ukukhulelwa noma ukumpontshelwa kweplatelet kunganikezwa kumntwana okhulayo ukuvimbela ukuphuma okukhulu kwegazi. Isigaba se-Caesarea sinconywa ukudiliva ukuvimbela ukuphuma kwegazi.
> Inkomba
> Karen S. Fernandez noPedro de Alarcon. I-Neonatal Thrombocytopenia. I-NeoReviews. 2013.