Isifo se-hemolytic sengane esanda kuzalwa

Isifo se-hemolytic sengane esanda kuzalwa (i-HDN) ukuphazamiseka kwegazi embungwini noma usana olusanda kuzalwa. Kwezinye izinsana, kungabulala.

Imvamisa, amangqamuzana egazi abomvu (ama-RBC) ahlala cishe izinsuku eziyi-120 emzimbeni. Kulesi sifo, ama-RBCs egazini abhujiswa ngokushesha futhi ngenxa yalokho awahlali isikhathi eside.

Ngesikhathi sokukhulelwa, ama-RBC avela enganeni engakazalwa angawela egazini likamama nge-placenta. I-HDN yenzeka lapho amasosha omzimba omama ebona ama-RBC engane njengangaphandle. Ama-antibody abe esekhula ngokumelene nama-RBC engane. La ma-antibody ahlasela ama-RBC egazini lengane futhi abangele ukuthi aphuke kusenesikhathi.

I-HDN ingahle ikhule lapho umama nengane yakhe engakazalwa benezinhlobo ezahlukahlukene zegazi. Izinhlobo zisuselwa ezintweni ezincane (ama-antigen) ebusweni bamaseli egazi.

Kunezindlela ezingaphezu kweyodwa lapho uhlobo lwegazi lomntwana ongakazalwa lungase lungalingani nolomama.

• A, B, AB, no-O yizi-antigen noma izinhlobo ezine zegazi ezinkulu. Le yindlela ejwayelekile kakhulu yokungafani. Ezimweni eziningi, lokhu akunzima kakhulu.
• I-Rh isifushane nge-antigen "rhesus" noma uhlobo lwegazi. Abantu bahle noma babi ngale antigen. Uma umama engenayo i-Rh futhi ingane esesibelethweni inamaseli ane-Rh, amasosha omzimba akhe aya ku-Rh antigen angawela i-placenta futhi abangele i-anemia enamandla kakhulu enganeni. Kungavinjelwa ezimweni eziningi.
• Kunezinye izinhlobo, ezingavamile kakhulu, zokungafani phakathi kwama-antigen weqembu elincane legazi. Ezinye zazo zingadala nezinkinga ezinzima.

I-HDN ingabhubhisa amangqamuzana egazi omntwana osanda kuzalwa ngokushesha okukhulu, okungadala izimpawu ezifana nokuthi:

• I-Edema (ukuvuvukala ngaphansi kwesikhumba)
• I-jaundice esanda kuzalwa eyenzeka ngokushesha futhi inzima kakhulu kunokujwayelekile

Izimpawu ze-HDN zifaka:

• Ukushoda kwegazi noma ukubalwa kwegazi okuphansi
• Isibindi esikhulisiwe noma ubende
• Ama-Hydrops (uketshezi kuzo zonke izicubu zomzimba, kufaka phakathi ezikhaleni eziqukethe amaphaphu, inhliziyo, nezitho zesisu), okungaholela ekuhlulekeni kwenhliziyo noma ukwehluleka ukuphefumula kusuka kuketshezi oluningi

Yikuphi ukuhlolwa okwenziwayo okuncike ohlotsheni lokungahambisani kweqembu legazi nobukhulu bezimpawu, kepha kungafaka:

• Qedela ukubalwa kwegazi nokubala kwamaseli abomvu angavuthiwe (reticulocyte)
• Izinga leBilirubin
• Ukuthayipha kwegazi

Izinsana ezine-HDN zingalashwa nge:

• Ukondla kaningi nokuthola uketshezi oluthe xaxa.
• Ukwelashwa okulula (i-phototherapy) kusetshenziswa amalambu akhethekile aluhlaza okwesibhakabhaka ukuguqula i-bilirubin ibe yifomu okulula ukuthi umzimba wengane ususe.
• Ama-antibodies (i-intravenous immunoglobulin, noma i-IVIG) ukusiza ukuvikela amangqamuzana abomvu omntwana ekucekelweni phansi.
• Imithi yokwenyusa umfutho wegazi uma yehla kakhulu.
• Ezimweni ezinzima, ukumpontshelwa kokushintshaniswa kungadinga ukwenziwa. Lokhu kuhilela ukukhipha inani elikhulu legazi lengane, futhi ngaleyo ndlela i-bilirubin eyengeziwe namasosha omzimba. Kufakwa igazi lomnikeli omusha.
• Ukumpontshelwa okulula (ngaphandle kokushintshaniswa). Lokhu kungadinga ukuphindwa ngemuva kokuthi ingane ibuyele ekhaya ivela esibhedlela.

Ubukhulu balesi simo bungahluka. Ezinye izingane azinazo izimpawu. Kwezinye izimo, izinkinga ezinjenge-hydrops zingadala ukuthi ingane ife ngaphambi, noma ngemuva nje kokuzalwa. I-HDN enamandla ingelashwa ngaphambi kokuzalwa ngokumpontshelwa igazi ngaphakathi kwe-intrauterine.

Isimo esibi kakhulu salesi sifo, esibangelwa ukungahambelani kwe-Rh, singavinjelwa uma umama ehlolwa ngesikhathi sokukhulelwa. Uma kudingeka, unikezwa umuthi obizwa ngeRhoGAM ngezikhathi ezithile ngesikhathi sokukhulelwa nangemva kokukhulelwa kwakhe. Uma uke waba nengane enalesi sifo, khuluma nomhlinzeki wakho wezempilo uma uhlela ukuba nomunye umntwana.

Isifo se-hemolytic se-fetus nengane esanda kuzalwa (i-HDFN); I-Erythroblastosis fetalis; Ukushoda kwegazi - i-HDN; Ukungahambisani kwegazi - i-HDN; Ukungahambelani kwe-ABO - i-HDN; Ukungahambelani kwe-Rh - i-HDN

• Ukumpontshelwa isisu
• Amasosha omzimba

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UNiss O, Ware RE. Ukuphazamiseka kwegazi. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 124.

I-Simmons PM, uMagann EF. Ama-hydrops ama-immune kanye nama-non-immune immune. Ku: Martin RJ, Fanaroff AA, Walsh MC, ama-eds. Imithi kaFanaroff kanye ne-Neonatal-Perinatal Medicine: Izifo Zengane Nengane. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 23.