Yonke into ekufuneka uyazi malunga neTum Lysis Syndrome

Umxholo

• Yintoni i-tumor lysis syndrome?
• Ziintoni iimpawu?
• Kutheni isenzeka?
• Ngaba zikhona izinto ezinobungozi?
• Kufunyaniswa njani?
• Inyangwa njani?
• Ngaba iyathinteleka?
• Yintoni imbonakalo?

Yintoni i-tumor lysis syndrome?

Injongo yonyango lomhlaza kukutshabalalisa amathumba. Xa amathumba anomhlaza aqhekeka ngokukhawuleza okukhulu, izintso zakho kufuneka zisebenze nzima ngakumbi ukususa zonke izinto ezazikho kwezo tumors. Ukuba abanako ukuqhubeka, unokukhulisa into ebizwa ngokuba yi-tumor lysis syndrome (TLS).

Esi sifo sixhaphake kakhulu kubantu abanomhlaza onxulumene negazi, kubandakanya ezinye ii-leukemi kunye nee-lymphomas. Oku kwenzeka ngaphakathi kweeyure ezimbalwa ukuya kwiintsuku ezimbalwa emva konyango lokuqala lwe-chemotherapy.

I-TLS ayiqhelekanga, kodwa inokubasongela ubomi ngokukhawuleza. Kubalulekile ukwazi ukuba ungayiqonda njani ukuze ufumane unyango kwangoko.

Ziintoni iimpawu?

I-TLS yonyusa isixa sezinto ezininzi egazini lakho, ezinokubangela uluhlu lweempawu.

Ezi zinto zibandakanya:

• Potassium. Amanqanaba aphezulu e-potassium anokukhokelela kutshintsho lwe-neurological kunye neengxaki zentliziyo.
• Uric acid. Ukugqithisa kwe-uric acid (hyperuricemia) kunokubangela amatye kwizintso kunye nokonakala kwezintso. Unako kwakhona ukuphuhlisa iidipozithi uric acid kumalungu akho, nto leyo ebangela imeko ebuhlungu efana sifo.
• Iphosphate. I-phosphate eyakhiweyo inokukhokelela kukusilela kwezintso.
• Ikhalsiyam. I-phosphate eninzi inokubangela ukuba amanqanaba e-calcium ehle, ekunokwenzeka ukuba ikhokelele ekusweleni kwezintso.

Ngelixa iimpawu ze-TLS zihlala zinobulali ekuqaleni, njengoko izinto zakha egazini lakho, unokufumana:

• ukungazinzi, ukucaphuka
• ubuthathaka, ukudinwa
• Ukuba ndindisholo, ukurhawuzelela
• isicaphucaphu, ukugabha
• urhudo
• ukuxhamla izihlunu
• intlungu edibeneyo
• ukuncipha kokuchama, umchamo onamafu

Ukuba ishiywe inganyangwa, i-TLS inokukhokelela kwiimpawu ezinzima, kubandakanya:

• ukuphulukana nolawulo lwezihlunu
• arrhythmia yentliziyo
• ukuxhuzula
• nemibono, delirium

Kutheni isenzeka?

Ngelixa ngamanye amaxesha i-TLS iyenzeka yodwa ngaphambi konyango lomhlaza, oku kunqabile kakhulu. Kwiimeko ezininzi, kwenzeka ngokukhawuleza emva kokuba i-chemotherapy iqale.

I-Chemotherapy ibandakanya amayeza ayilelwe ukuhlasela amathumba. Njengoko amathumba eqhekeka, akhuphela imixholo yawo kumjelo wegazi. Uninzi lwexesha, izintso zakho zinokucoca ezi zinto ngaphandle kwengxaki.

Nangona kunjalo, ngamanye amaxesha amathumba aphuka ngokukhawuleza kunokuba izintso zakho zinokukwazi ukuphatha. Oku kwenza ukuba kube nzima kwizintso zakho ukucoca iziqulatho zethumba egazini lakho.

Uninzi lwexesha, oku kwenzeka ngokukhawuleza emva konyango lwakho lokuqala lwe-chemotherapy, xa inani elikhulu leeseli zomhlaza libhujiswa ngexesha elincinci. Inokwenzeka kwakhona emva kwexesha kunyango.

Ukongeza kwi-chemotherapy, i-TLS ikwadityaniswa ne:

• unyango lwemitha
• Unyango lwehomoni
• unyango lwebhayoloji
• Unyango lwe-corticosteroid

Ngaba zikhona izinto ezinobungozi?

Kukho izinto ezininzi ezinokunyusa umngcipheko wokuphuhlisa i-TLS, kubandakanya uhlobo lomhlaza onawo. Umhlaza oqhele ukudityaniswa ne-TLS ubandakanya:

• Ileukemia
• i-lymphoma engekho yeHodgkin
• Iimpawu ze-myeloproliferative, ezinjenge-myelofibrosis
• blastomas esibindini okanye kwingqondo
• Umhlaza ochaphazela ukusebenza kwezintso ngaphambi konyango

Ezinye izinto ezinokubangela umngcipheko zibandakanya:

• ubungakanani obukhulu bethumba
• ukungasebenzi kakuhle kwezintso
• amathumba akhula ngokukhawuleza
• amayeza athile e-chemotherapy, kubandakanya i-cisplatin, cytarabine, etoposide, kunye ne-paclitaxel

Kufunyaniswa njani?

Ukuba ufumana i-chemotherapy kwaye unayo nayiphi na ingozi kwi-TLS, ugqirha wakho uya kwenza uvavanyo lwegazi kunye nomchamo rhoqo kwiiyure ezingama-24 kwangoko emva konyango lwakho lokuqala. Oku kuvumela ukuba bajonge nayiphi na imiqondiso yokuba izintso zakho azicoci yonke into ngaphandle.

Iindidi zovavanyo abazisebenzisayo zibandakanya:

• igazi urea nitrogen
• calcium
• inani elipheleleyo leeseli zegazi
• creatinine
• I-lactate dehydrogenase
• ifosforasi
• i-serum electrolyte
• iuric acid

Zimbini iiseti zeenqobo zovavanyo abanokuthi bazisebenzise ukufumanisa i-TLS:

• Iikhrayitheriya zeCairo-Bishop. Uvavanyo lwegazi kufuneka lubonise ukonyuka kweepesenti ezingama-25 kumanqanaba ezinto ezithile.
• Iikhrayitheriya zika Howard. Iziphumo zelebhu kufuneka zibonise imilinganiselo emibini okanye nangaphezulu engaqhelekanga kwisithuba seeyure ezingama-24.

Inyangwa njani?

Ukunyanga i-TLS, ugqirha wakho uya kuqala ngokukunika i-intravenous (IV) fluids ngelixa ujonga ukuba urhoqo kangakanani. Ukuba awuvelisi umchamo owaneleyo, ugqirha usenokukunika umchamo.

Olunye unyango onokulufuna lubandakanya:

• i-allopurinol (Aloprim, Lopurin, Zyloprim) ukumisa umzimba wakho ekwenzeni i-uric acid
• I-rasburicase (i-Elitek, i-Fasturtec) yokuphula i-uric acid
• i-sodium bicarbonate okanye i-acetazolamide (i-Diamox Sequels) yokuthintela i-uric acid ekwenzeni iikristali

Kukho iintlobo ezimbini ezintsha zonyango ezinokukunceda:

• i-kinase inhibitors yomlomo, njenge-ibrutinib (Imbruvica) kunye ne-idelalisib (iZydelig)
• I-B-cell lymphoma-2 protein inhibitors, enje nge-venetoclax (Venclexta)

Ukuba amanzi kunye namayeza awancedi okanye umsebenzi wakho wezintso uqhubeka nokuhla, unokufuna i-dialysis yezintso. Olu luhlobo lonyango olunceda ekususeni inkunkuma, kubandakanya leyo yamathumba atshatyalalisiweyo, egazini lakho.

Ngaba iyathinteleka?

Asinguye wonke umntu owenza i-chemotherapy ovelisa i-TLS. Ukongeza, oogqirha bachonge ngokucacileyo umngcipheko obalulekileyo kwaye bahlala besazi ukuba ngubani onomngcipheko ophezulu.

Ukuba unayo nayiphi na imeko yomngcipheko, ugqirha wakho unokugqiba kwelokuba aqale ukukunika ii-fluids ezongezelelweyo kwiintsuku ezimbini ngaphambi konyango lwakho lokuqala lwe-chemotherapy. Baza kujonga imveliso yakho yomchamo kwiintsuku ezimbini ezizayo kwaye bakunike umchamo ukuba awuvelisi ngokwaneleyo.

Ungaqala kwakhona ukuthatha i-allopurinol kwangaxeshanye ukukhusela umzimba wakho ekwenzeni i-uric acid.

La manyathelo anokuqhubeka kangangeentsuku ezimbini okanye ezintathu emva kweseshoni yekhemotherapy, kodwa ugqirha wakho unokuqhubeka nokujonga igazi lakho kunye nomchamo kulo lonke unyango lwakho.

Yintoni imbonakalo?

Umngcipheko opheleleyo wokuphuhlisa i-TLS usezantsi. Nangona kunjalo, xa abantu beyikhulisa, inokubangela iingxaki ezinzulu, kubandakanya nokufa. Ukuba kufuneka uqale unyango lomhlaza, buza malunga nemingcipheko yakho ye-TLS nokuba ugqirha wakho ucebisa naluphi na unyango lokhuselo.

Kufuneka uqinisekise ukuba uyazi zonke iimpawu ukuze uqale ukufumana unyango ngokukhawuleza xa uqala ukuzibona.