Konke Odinga Ukukwazi Nge-Tumor Lysis Syndrome

-Delile

• Iyini i-tumor lysis syndrome?
• Ziyini izimpawu?
• Kungani kwenzeka?
• Ingabe zikhona izinto eziyingozi?
• Kutholakala kanjani?
• Ilashwa kanjani?
• Ingabe kungavikeleka?
• Uyini umbono?

Iyini i-tumor lysis syndrome?

Inhloso yokwelashwa komdlavuza ukubhubhisa izicubu. Lapho izimila ezinomdlavuza ziphuka ngokushesha okukhulu, izinso zakho kufanele zisebenze kanzima ukukhipha zonke izinto ezazikulezo zimila. Uma zingakwazi ukuqhubeka, ungasungula into ebizwa nge-tumor lysis syndrome (TLS).

Lesi sifo sivame kakhulu kubantu abanomdlavuza ohlobene negazi, kufaka phakathi ama-leukemias nama-lymphomas. Ngokuvamile kwenzeka kungakapheli amahora ambalwa kuya ezinsukwini ezimbalwa ngemuva kokwelashwa kokuqala ngamakhemikhali.

I-TLS ayivamile, kepha ingasheshe isongele impilo. Kubalulekile ukwazi ukuthi ungayibona kanjani ukuze ukwazi ukuthola ukwelashwa ngokushesha.

Ziyini izimpawu?

I-TLS inyusa inani lezinto eziningana egazini lakho, ezingadala uhla lwezimpawu.

Lezi zinto zifaka:

• Potassium. Izinga eliphakeme le-potassium lingaholela ekuguqulweni kwemizwa nasezinkinga zenhliziyo.
• Uric acid. I-uric acid eyeqile (hyperuricemia) ingadala amatshe ezinso nomonakalo wezinso. Ungakha futhi i-uric acid deposits emajoyintini akho, okudala isimo esibuhlungu esifana ne-gout.
• I-Phosphate. Ukwakhiwa kwe-phosphate kungaholela ekuhlulekeni kwezinso.
• I-calcium. I-phosphate eningi kakhulu ingadala nokuthi amazinga e-calcium ehle, okungenzeka kuholele ekuhlulekeni kwezinso okunamandla.

Ngenkathi izimpawu ze-TLS zivame ukuba mnene ekuqaleni, njengoba izinto zakha egazini lakho, ungahle uzwe:

• ukungahlaliseki, ukucasuka
• ubuthakathaka, ukukhathala
• ukuba ndikindiki, ukuhayiza
• isicanucanu, ukuhlanza
• isifo sohudo
• ukuqunjelwa kwemisipha
• ubuhlungu obuhlangene
• ukuncipha kokuchama, umchamo onamafu

Uma ishiywe ingalashwa, i-TLS ekugcineni ingaholela ezimpawu ezinzima kakhulu, kufaka phakathi:

• ukulahleka kokulawulwa kwemisipha
• i-arrhythmia yenhliziyo
• isithuthwane
• ukusangana, ubumbano

Kungani kwenzeka?

Ngenkathi i-TLS kwesinye isikhathi izenzela yodwa ngaphambi kokwelashwa komdlavuza, lokhu akuvamile. Ezimweni eziningi, kwenzeka ngemuva nje kokuba i-chemotherapy iqale.

I-Chemotherapy ibandakanya imishanguzo eyenzelwe ukuhlasela izicubu. Njengoba izimila ziwohloka, zikhiphela okuqukethwe yizo emseleni wegazi. Isikhathi esiningi, izinso zakho zingazihluza lezi zinto ngaphandle kwezinkinga.

Kodwa-ke, kwesinye isikhathi izicubu zehla ngokushesha kunokuba izinso zakho zingakwazi ukusingatha. Lokhu kwenza kube nzima ngezinso zakho ukuhlunga okuqukethwe yisimila egazini lakho.

Isikhathi esiningi, lokhu kwenzeka ngemuva nje kokwelashwa kwakho kokuqala ngamakhemikhali, lapho inani elikhulu lamaseli womdlavuza libhujiswa ngesikhathi esifushane. Kungenzeka futhi kamuva ekwelashweni.

Ngaphezu kwe-chemotherapy, i-TLS iphinde ixhunyaniswe ne:

• ukwelashwa ngemisebe
• ukwelashwa kwamahomoni
• ukwelashwa kwezinto eziphilayo
• ukwelashwa kwe-corticosteroid

Ingabe zikhona izinto eziyingozi?

Kunezinto eziningana ezingakhuphula ubungozi bokuthuthukisa i-TLS, kufaka phakathi uhlobo lomdlavuza onawo. Umdlavuza ovame ukuhlotshaniswa ne-TLS ufaka:

• i-leukemia
• i-non-Hodgkin's lymphoma
• izimila ze-myeloproliferative, njenge-myelofibrosis
• blastomas esibindi noma ebuchosheni
• Umdlavuza othinta ukusebenza kwezinso ngaphambi kokwelashwa

Ezinye izinto ezingaba yingozi zifaka:

• usayizi omkhulu wesimila
• ukungasebenzi kahle kwezinso
• izimila ezikhula ngokushesha
• imishanguzo ethile yamakhemikhali, kufaka phakathi i-cisplatin, cytarabine, etoposide, ne-paclitaxel

Kutholakala kanjani?

Uma uthola i-chemotherapy futhi unezici ezinobungozi ze-TLS, udokotela wakho uzokwenza ukuhlolwa kwegazi nomchamo njalo emahoreni angama-24 ngemuva nje kokwelashwa kwakho kokuqala. Lokhu kubavumela ukuthi babheke noma yiziphi izimpawu zokuthi izinso zakho azihluzi konke.

Izinhlobo zezivivinyo abazisebenzisayo zifaka:

• igazi urea nitrogen
• i-calcium
• gcwalisa ukubalwa kwamaseli egazi
• i-creatinine
• i-lactate dehydrogenase
• i-phosphorus
• i-serum electrolyte
• i-uric acid

Kunezinhlobo ezimbili zezinqubo odokotela abangazisebenzisa ukuthola i-TLS:

• Imigomo ye-Cairo-Bishop. Ukuhlolwa kwegazi kumele kubonise okungenani ukwanda ngamaphesenti angama-25 emazingeni ezinto ezithile.
• Indlela yokulinganisa uHoward. Imiphumela yelabhoratri kumele ikhombise izilinganiso ezimbili noma ngaphezulu ezingavamile esikhathini samahora angama-24.

Ilashwa kanjani?

Ukwelapha i-TLS, udokotela wakho kungenzeka aqale ngokukunikeza uketshezi oluthile lwe-intravenous (IV) ngenkathi ubheka ukuthi uchama kangaki. Uma ungakhiqizi umchamo owanele, udokotela wakho futhi angakunikeza isisu.

Eminye imithi ongayidinga ifaka:

• i-allopurinol (i-Aloprim, iLopurin, iZyloprim) ukumisa umzimba wakho ekwenzeni i-uric acid
• rasburicase (Elitek, Fasturtec) ukudiliza i-uric acid
• i-sodium bicarbonate noma i-acetazolamide (i-Diamox Sequels) ukuvikela i-uric acid ekwakheni amakristalu

Kunezinhlobo ezimbili ezintsha zemithi ezingasiza futhi:

• i-oral kinase inhibitors, njenge-ibrutinib (Imbruvica) ne-idelalisib (iZydelig)
• I-B-cell lymphoma-2 protein inhibitors, efana ne-venetoclax (Venclexta)

Uma uketshezi nemithi kungasizi noma umsebenzi wakho wezinso uqhubeka nokwehla, ungadinga i-dialysis yezinso. Lolu uhlobo lwezokwelapha olusiza ukususa imfucuza, kufaka phakathi lokho okuvela kwizicubu ezibhujisiwe, egazini lakho.

Ingabe kungavikeleka?

Akuwona wonke umuntu owelashwa ngamakhemikhali oba ne-TLS. Ngaphezu kwalokho, odokotela baveze ngokusobala izici ezibalulekile zobungozi futhi imvamisa bayazi ukuthi ubani onobungozi obukhulu.

Uma unezici zobungozi, udokotela wakho anganquma ukuqala ukukunikeza uketshezi oluthe xaxa lwe-IV ezinsukwini ezimbili ngaphambi kokwelashwa kwakho kokuqala ngamakhemikhali. Bazokubheka okukhipha umchamo wakho ezinsukwini ezimbili ezizayo futhi bakunikeze isisu uma ungakhiqizi ngokwanele.

Ungaqala futhi ukuthatha i-allopurinol ngasikhathi sinye ukuvimbela umzimba wakho ekwenzeni i-uric acid.

Lezi zinyathelo zingaqhubeka izinsuku ezimbili noma ezintathu ngemuva kweseshini ye-chemotherapy, kepha udokotela wakho angaqhubeka nokuqapha igazi nomchamo wakho kulo lonke ukwelashwa kwakho.

Uyini umbono?

Ingozi ephelele yokuthuthukisa i-TLS iphansi. Kodwa-ke, lapho abantu beyithuthukisa, kungadala izinkinga ezinkulu, kubandakanya nokufa. Uma kufanele uqale ukwelashwa komdlavuza, buza ngezingozi zakho ze-TLS nokuthi udokotela wakho uncoma noma yikuphi ukwelashwa okuvimbelayo.

Kufanele futhi uqiniseke ukuthi uyazi zonke izimpawu ukuze uqale ukuthola ukwelashwa ngokushesha nje lapho uqala ukuzibona.