Ingxoxo yomuthi wesibili nowesithathu
Nakuba iningi lezingane kanye nenani elincane labantu abadala abane- thrombocytopenia ye-immune (i-ITP) lizoba nezibalo ezijwayelekile zeplatelet, ezinye zizoqhubeka zinezimo ezingapheli. Umqondo wokuba ne-ITP ongapheli ungase uphazamise, ngakho ake sihlole ukuthi kusho ukuthini lapha.
Okokuqala, i-ITP ingahlukaniswa ngokuthi:
- Okuyinhloko: I- ITP eyinhloko ingenxa yokubhujiswa kweplatelet ngokuzenzakalelayo. Ezinganeni, iningi lamacala yi-ITP eyinhloko.
- Secondary: I-ITP yesibili ihlotshaniswa nesinye isimo njenge- lupus , i- HIV , i- hepatitis C , noma i-lymphocytic leukemia engavamile .
Nakuba ukwelapha ukuxazulula ukuphuma kwegazi kwe-ITP eyinhloko neyesibili kungaba okufanayo, ukwelashwa kwe-ITP yesibili kugxile esimweni esibucayi sezokwelapha. Ukulawulwa okungcono kwesimo sezokwelapha esingaphansi kungathuthukisa i-thrombocytopenia.
I-ITP eyinhloko ingabe isabelana ngokunye:
- Ukutholwa okusha: Ukuxilongwa ezinyangeni ezintathu.
- Ukuphikelela: i- ITP ephikelela isikhathi esingaphezu kwezinyanga ezintathu.
- Okungapheliyo: Uma kuqhubeka isikhathi esingaphezu kwezinyanga eziyishumi nambili, kubhalwe ukuthi singapheli.
- I-Refractory: Leli gama lisetshenziselwa ukuchaza i-ITP edinga ukwelashwa (isiguli sinamaphilisi aphuza igazi) okuphikisana nomuthi wokuqala we-line (steroids, IVIG, WinRho) noma i- splenectomy .
Naphezu kokuthi iningi labantu abadala ababhekene ne-ITP eyinhloko bazoqhubeka nokuthuthukisa inkambo engapheli, iningi lizogcina isibalo esiphezulu, esiphephile seplatelet (ngokuvamile esho amangqamuzana angaphezu kuka-20,000 ngamamitha-microliters ngamunye), lapho ukuphuma ngokwegazi kungenangqondo.
Lezi ziguli zingase zidinge ngezikhathi ezithile izifundo zokwelashwa. Isibonelo esisodwa ukuhlinzwa, lapho inani leplatelet livame ukuphakama ukuvimbela ukuphuma kwegazi ngesikhathi senqubo.
Ukwelapha okwesibili
Inselele yilabo abagulayo abaqhubeka nokugcoba naphezu kokunakekelwa kwemithi yokuqala.
Eminyakeni edlule, i-splenectomy ibhekwa njengesiqalo esincane semithi yokwelashwa kwesibili. I-Splenectomy isebenza ngezindlela ezimbili. Okokuqala, isusa isisekelo esiyinhloko sokubhujiswa kweplatelet. Okwesibili, isusa ezinye i-lymphocytes ezikhiqiza ama-anti-platelet antibodies zihlala ngepeni. Ukususwa kwalezi zymphocytes kungandisa izinga lokuphila kwamaplatelets.
I-Splenectomy inomlando owaziwa ngamaphesenti angaba ngu-85 weziguli ezithathayo, iningi elinokujwayelekile kwezibalo zeplatelet. Naphezu kwalesi silinganiso sokuphumelela, i-splenectomy ayinayo izingozi zayo, ikakhulukazi ingozi yokuphila kwe-sepsis eyingozi (ukutheleleka okukhulu kwebhaktheriya).
Ngenxa yalezi zingozi, abanye odokotela bacabanga ukuthi i-rituximab yedijithali yokwelashwa kwesibili. I-Rituximab i-antibody eyazihlanganisa ne-B lymphocytes (enye yamangqamuzana egazi omhlophe enza ama-antibodies), okwenza kubhujiswe. Ngomuthi omncane we-anti-platelet wokukhiqizwa kwama-b lymphocytes, amaplatelet ngeke abhujiswe. I-Rituximab ivame ukunikezwa njenge-IV ukumnika kanye masonto onke amaviki amane, kepha ngezinye izikhathi kungenziwa amasonto ambalwa. Ukusabela ku-rituximab kuyahluka kakhulu kune-splenectomy, kanti ezinye iziguli zinezimpendulo ezihlala njalo kodwa ezinye zibuyela emuva.
Ukwelashwa Kwesithathu
Ngenhlanhla, manje kunemithi yokwelapha yesithathu etholakalayo ye-ITP.
Kwase kuyiminyaka eminingi bekholelwa ukuthi ku-ITP, amaplatelete ayevame ukukhishwa emnothweni wamathambo kodwa wabhujiswa lapho ekhishwa ekuqhumeni. Ochwepheshe manje abaziwa ukuthi umsebenzi weplatelet uphinde uphazamisekile. Lolu lwazi luholele ekuthuthukiseni imithi ebizwa ngokuthi i-thrombopoietin (TPO) i-agonist receptor.
Njengamanje kunama-agonist amabili we-TPO receptor atholakala e-US, elthrombopag ne-romiplostim. I-Elthrombopag imithi yomlomo ethathwe nsuku zonke futhi i-romiplostim inikezwa kanye ngeviki njenge-injection encane. Nakuba i-elthrombopag ingase ibonakale iyindlela yokwelapha elula ngoba ithathwe ngomlomo, akukho ukudla okuqukethe i-calcium kungadliwa amahora ambalwa ngaphambi nangemva kwenzalo.
Uma isisindo sokunakekelwa sinqunywa, abantu abadala bangafunda ukuphatha i-romiplostim ekhaya.
Ama-agonist we-TPO abamukela imithi abhekwa njengamaphilisi okugcina angasetshenziswa njalo ukugcina inani leplatelet eliphakeme ngokwanele ukuvimbela ukuphuma kwegazi. Le mithi ingasetshenziswa kokubili izingane kanye nabantu abadala abane-ITP engapheli.
Njengezokwelapha eziningi zokwelashwa, ukuhlelwa kokuphathwa kokwelashwa kokuqala, kwesibili, nokwesithathu kungahlukahluka ngokusekelwe kwezici zesiguli ngasinye. Uma unemibuzo noma ukukhathazeka mayelana nokwelapha kwakho, kufanele uxoxe nabo nodokotela wakho.
Imithombo:
Bussel JB. ITP kwabantwana: Ukuphathwa kwezifo ezigulayo. Ku: Phezulu, I-post TW (Ed), UpToDate, Waltham, MA.
UGeorge JN no-Arnold DM. I-ITP kubantu abadala: I-Second Line kanye Nezokwelapha Eziqhubekayo. Ku: Phezulu, I-post TW (Ed), UpToDate, Waltham, MA.