Isifo seHemolytic sosana olusandul 'ukuzalwa

Isifo se-hemolytic sosana olusandul 'ukuzalwa (i-HDN) sisifo segazi kwimveku okanye usana olusandul' ukuzalwa. Kwezinye iintsana, zinokubulala.

Ngokwesiqhelo, iiseli ezibomvu zegazi (RBCs) zihlala malunga neentsuku ezili-120 emzimbeni. Kule ngxaki, ii-RBCs egazini zitshatyalaliswa ngokukhawuleza kwaye ngenxa yoko azihlali ixesha elide.

Ngexesha lokukhulelwa, ii-RBCs ezisuka kusana olungekazalwa zinokuwela kwigazi likamama nge-placenta. I-HDN yenzeka xa amajoni omama omama ebona ii-RBCs zosana njengezangaphandle. Ii-antibodies emva koko zikhula ngokuchasene nee-RBCs zosana. Ezi antibodies zihlasela ii-RBCs egazini lomntwana kwaye zibangele ukuba zonakale kwangoko.

I-HDN inokukhula xa umama nosana lwakhe olungekazalwa baneentlobo ezahlukeneyo zegazi. Iindidi zisekwe kwizinto ezincinci (iantigen) kumphezulu weeseli zegazi.

Zininzi iindlela apho uhlobo lwegazi losana olungekazalwa lunokungafani nolonina.

• A, B, AB, kunye no-O zii-antigen zeqela legazi okanye iintlobo. Le yeyona ndlela iqhelekileyo yokungafani. Kwiimeko ezininzi, oku akunzima kakhulu.
• I-Rh imfutshane kwi "rhesus" antigen okanye uhlobo lwegazi. Abantu banokuba nethemba okanye abangalunganga kule antigen. Ukuba umama une-Rh-negative kwaye umntwana esibelekweni uneeseli ze-Rh, ii-antibodies zakhe kwi-Rh antigen zinokuwela kwi-placenta kwaye zibangele i-anemia emntwaneni. Inokuthintelwa kwiimeko ezininzi.
• Kukho ezinye, ezincinci kakhulu, iintlobo zokungahambelani phakathi kwamaqela amancinci e-antigen. Ezinye zazo zinokubangela iingxaki ezinzima.

I-HDN inokutshabalalisa iiseli zegazi zosana olusandul 'ukuzalwa ngokukhawuleza, ezinokubangela iimpawu ezinje:

• I-Edema (ukudumba phantsi kobuso bolusu)
• I-jaundice esandula kuzalwa eyenzeka msinya kwaye iba qatha kakhulu kunesiqhelo

Iimpawu ze-HDN zibandakanya:

• Anemia okanye ubalo lwegazi olusezantsi
• Ukwandiswa kwesibindi okanye udakada
• IiHydrops (ulwelo kuzo zonke izicwili zomzimba, kubandakanya nezikhewu ezinemiphunga, intliziyo, kunye nezitho zesisu), ezinokuthi zikhokelele kukusilela kwentliziyo okanye ukusilela kokuphefumla kulwelo oluninzi

Zeziphi iimvavanyo ezenziweyo ezixhomekeke kuhlobo lokungahambelani kweqela legazi kunye nobunzima beempawu, kodwa zinokubandakanya:

• Gcwalisa ubalo lwegazi kunye nokubala kweeseli ezibomvu ezingafakwanga (reticulocyte)
• Inqanaba leBilirubin
• Ukuchwetheza igazi

Iintsana ezine-HDN zinokunyangwa nge:

• Ukutya rhoqo kwaye ufumana ulwelo olongezelelekileyo.
• Unyango olukhanyayo (i-phototherapy) usebenzisa izibane ezizodwa eziluhlaza ukuguqula i-bilirubin kwifom ekulula ukuba umzimba womntwana ulahle.
• Iintsholongwane (intravenous immunoglobulin, okanye IVIG) ukunceda ukukhusela iiseli ezibomvu zomntwana ekutshatyalalisweni.
• Amayeza okuphakamisa uxinzelelo lwegazi ukuba yehla kakhulu.
• Kwiimeko ezinzima, ukutshintshwa kotshintshiselwano kungafuna ukwenziwa. Oku kubandakanya ukususa isixa esikhulu segazi lomntwana, kwaye ngenxa yoko i-bilirubin eyongezelelweyo kunye ne-antibodies. Igazi elitsha lomnikeli liyangeniswa.
• Utofelo olulula (ngaphandle kotshintshiselwano). Oku kunokufuna ukuphindwaphindwa emva kokuba umntwana egodukile evela esibhedlele.

Ubunzima bale meko bunokwahluka. Ezinye iintsana azinazimpawu. Ngamanye amaxesha, iingxaki ezinje ngehydrops zinokubangela ukuba umntwana asweleke ngaphambi okanye kungekudala emva kokuzalwa. I-HDN ebukhali inokunyangwa ngaphambi kokuzalwa ngofakelo gazi lwe-intrauterine.

Esona sifo siqatha sesi sifo, nesibangelwa kukungahambelani kweRh, sinokuthintelwa ukuba umama uyavavanywa ngexa lokukhulelwa. Ukuba uyafuneka, unikwa amayeza abizwa ngokuba yiRhoGAM ngamaxesha athile ngexesha nasemva kokukhulelwa kwakhe. Ukuba unosana olunesi sifo, thetha nomboneleli wakho wezempilo ukuba uceba ukuba nomnye umntwana.

Isifo se-hemolytic somntwana kunye nosana olusandul 'ukuzalwa (HDFN); I-Erythroblastosis fetalis; Anemia - HDN; Ukungangqinelani kwegazi-i-HDN; Ukungangqinelani kwe-ABO-HDN; Ukungahambelani kweRh- HDN

• Utofelo-gazi lwangaphakathi
• Iintsholongwane

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UNiss O, Ware RE. Ukuphazamiseka kwegazi. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; 2020: isahl. 124.

Simmons PM, Magann EF. Amajoni omzimba okhuselweyo omzimba kunye non-immune hydrops fetalis. Ku: UMartin RJ, uFanaroff AA, uWalsh MC, ii-eds. UFanaroff kunye noNyango lwe-Neonatal-Perinatal: Izifo ze-Fetus ne-Infant. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 23.