Anisocytosis: tanthauzo, zizindikiro ndi chithandizo

Anisocytosis ndi mawu omwe amagwiritsidwa ntchito mu hematology pakakhala kukula kwakukulu pakati pa maselo am'magazi amtundu womwewo monga:

• maselo ofiira amwazi, amatchedwanso maselo ofiira kapena ma erythrocyte;
• mapulateleti amwazi, amatchedwanso thrombocytes.

Ndikotheka kusiyanitsa ma anisocytoses angapo kutengera mzere wama cell womwe ukukhudzidwa:

• matenda amitsempha yamagazi pamene vuto limakhudza ma erythrocyte (maselo ofiira amwazi);
• kupatsidwa zinthu za m'mwazi anisocytosis.

Kutengera mtundu wazovuta zomwe zimapezeka, anisocytosis nthawi zina amatchedwa:

• kusandulika, nthawi zambiri amafupikitsidwa ngati microcytosis, pomwe maselo a magazi amakhala ochepa mowirikiza;
• aniso-macrocytosis, imafupikitsidwa ngati macrocytosis, pomwe maselo amwazi amakhala akulu modabwitsa.

Anisocytosis ndimagazi osadziwika omwe amapezeka mu hemogram, yotchedwanso Magazi Owerengera ndi Njira (NFS). Zomwe zimachitika potenga magazi ochepa a magazi, kafukufukuyu amapereka zambiri pamaselo amwazi.

Mwa zina zomwe zimapezeka pakuwerengera magazi, chiwonetsero chofalitsa maselo ofiira (RDI) chimatchedwanso index ya anisocytosis. Kupangitsa kuti athe kuwunika kusiyanasiyana kwa kukula kwa maselo ofiira m'magazi, mndandandandawu umathandizira kuzindikira erythrocyte anisocytosis. Amawonedwa ngati abwinobwino ali pakati pa 11 ndi 15%.

Nthawi zambiri, anisocytosis ndi mawu omwe amagwiritsidwa ntchito ndi madokotala kutanthauza erythrocyte anisocytosis. Ponena za maselo ofiira ofiira, kuchepa kwamagazi kumachitika chifukwa cha kuperewera kwa magazi, kutsika kwachilendo pamlingo wamagazi ofiira kapena hemoglobin m'magazi. Kulephera kumeneku kumatha kubweretsa zovuta chifukwa maselo ofiira am'maselo ofunikira kuti mpweya ugawe m'thupi. Ipezeka m'maselo ofiira ofiira, hemoglobin ndi puloteni yomwe imatha kumangiriza mamolekyulu angapo a oxygen (O2) ndikuwamasula m'maselo.

Ndikotheka kusiyanitsa mitundu ingapo ya kuchepa kwa magazi komwe kumayambitsa erythrocyte anisocytosis, kuphatikiza:

• ndichitsulo akusowa magazi m'thupi, amayamba chifukwa chosowa chitsulo, chomwe chimawerengedwa kuti ndi kuchepa kwa magazi m'thupi chifukwa chitha kuyambitsa anisocytosis ndikupanga maselo ofiira ang'onoang'ono;
• kuchepa kwa vitamini, omwe amapezeka kwambiri ndi mavitamini B12 osowa anemias ndi mavitamini B9, omwe amadziwika kuti macrocytic anemias chifukwa amatha kuyambitsa aniso-macrocytosis ndikupanga maselo ofiira akuluakulu opunduka.
• ndikuchepa magazi m'thupi, wodziwika ndi kuwonongeka msanga kwa maselo ofiira am'magazi, omwe amayamba chifukwa cha zovuta zamatenda kapena matenda.

Platelet anisocytosis imakhalanso ndi matenda. Platelet anisocytosis makamaka imatha kukhala chifukwa cha myelodysplastic syndromes (MDS), yomwe imapanga matenda ambiri chifukwa cha kusokonekera kwa mafupa.

Zomwe Zimayambitsa Anisocytosis

Zachilengedwe

Osati nthawi zonse kukhalapo kwa anisocytosis kumawonetsa matenda aliwonse. Mwachitsanzo, mwa ana akhanda, thupi la macrocytosis limawonedwa. Izi zimachitika chifukwa cha kusasitsa kwapang'onopang'ono kwa mafupa ndi njira za mitosis mu maselo a hematopoietic. Pofika mwezi wa 2 wa moyo, anisocytosis imakhazikika yokha.

kuchepa kwachitsulo

Chomwe chimayambitsa matenda a anisocytosis ndi kusowa kwachitsulo. Ndi kusowa kwachitsulo m'thupi, pali kuphwanya kusasitsa kwa erythrocytes, mapangidwe a maselo awo, komanso mapangidwe a hemoglobin. Zotsatira zake, kukula kwa maselo ofiira a m'magazi kumachepa (microcytosis). Ndi kusowa kwachitsulo, kuchuluka kwa hemoglobini m'magazi kumachepa, ndipo kuchepa kwa iron anemia (IDA) kumayamba.

Pamodzi ndi anisocytosis, hypochromia nthawi zambiri zimachitika, mwachitsanzo, yafupika hemoglobin machulukitsidwe a erythrocytes. Anisocytosis, pamodzi ndi kusintha kwina kwa zizindikiro za erythrocyte (MCV, MCH, MCHC), zikhoza kutsogola chitukuko cha IDA, chomwe chimatchedwa kuchepa kwachitsulo chobisika.

Komanso, anisocytosis angapitirire kumayambiriro kwa chitsulo chothandizira pochiza kuchepa kwa magazi m'thupi. Komanso, ali ndi khalidwe lapadera - pali chiwerengero chachikulu cha ma microcytes ndi macrocytes m'magazi, chifukwa chake histogram ya kugawa kwa erythrocytes imakhala ndi maonekedwe awiri apamwamba.

Zifukwa za kusowa kwachitsulo:

• Alimentary factor.
• Ubwana, unyamata, mimba (nthawi zakusowa kwachitsulo).
• Kusamba kwa nthawi yayitali.
• Kutaya magazi kosatha: zilonda zam'mimba kapena duodenum, zotupa, hemorrhagic diathesis.
• Chikhalidwe pambuyo resection m`mimba kapena matumbo.
• Kusokonezeka kwa ma genetic a iron metabolism: hereditary atransferrinemia.

Kutenga magazi pofufuza

Vitamini B12 ndi kuperewera kwa folic acid

Chifukwa china cha anisocytosis, chomwe ndi macrocytosis, ndikusowa kwa B12 ndi folic acid, komanso kusowa kwa vitamini komwe kumawonedwa nthawi zambiri. Izi ndichifukwa cha machitidwe awo a metabolic omwe amapezeka kwambiri. Kuperewera kwa B12 kumalepheretsa kusintha kwa folic acid kukhala mawonekedwe a coenzyme. Chochitika cha biochemical ichi chimatchedwa folate trap.

Kuperewera kwa mavitaminiwa kumayambitsa kuphwanya maziko a purine ndi pyrimidine (zigawo zazikulu za DNA), zomwe zimakhudza kwambiri ntchito ya m'mafupa, monga chiwalo chokhala ndi ntchito yapamwamba kwambiri ya kuchuluka kwa maselo. Mtundu wa megaloblastic wa hematopoiesis umayamba - osati maselo okhwima omwe ali ndi zinthu zamtundu wa cell, kuchuluka kwa machulukitsidwe a hemoglobini ndi kukula kowonjezereka kulowa m'magazi ozungulira, mwachitsanzo, kuchepa kwa magazi m'thupi ndi macrocytic ndi hyperchromic m'chilengedwe.

Zifukwa zazikulu za kuchepa kwa B12:

• Zakudya zokhwima komanso kupatula nyama.
• atrophic gastritis.
• Autoimmune gastritis.
• Kutuluka m'mimba.
• Kuperewera kwa cholowa cha intrinsic factor Castle.
• Malabsorption : matenda a celiac, matenda otupa m'matumbo.
• Matenda a nyongolotsi: diphyllobothriasis.
• Kuwonongeka kwa chibadwa kwa transcobalamin.

Komabe, kusowa kwa folate kumatha kuchitika. Zikatero, yekha pathological kusintha kwa magazi kungakhale anisocytosis (macrocytosis). Izi makamaka zimapezeka mu uchidakwa, monga ethyl mowa kubweza mayamwidwe folate mu m`mimba thirakiti. Komanso, kusowa kwa kupatsidwa folic acid ndi wotsatira macrocytosis kumachitika odwala amene kutenga m`kamwa kulera kwa nthawi yaitali, mu amayi apakati.

Thalassemia

Nthawi zina, anisocytosis (microcytosis), pamodzi ndi hypochromia, akhoza kukhala zizindikiro za thalassemia, gulu la matenda yodziwika ndi chibadwa sali bwino mu synthesis unyolo globin. Kutengera masinthidwe a jini inayake, pamakhala kusowa kwa unyolo wa ma globin ndi ena ochulukirapo (maketani a alpha, beta kapena gamma). Chifukwa cha kuchepa kwa mamolekyu a hemoglobini, maselo ofiira a m'magazi amachepetsa kukula kwake (microcytosis), ndipo nembanemba yawo imatha kuwonongeka (hemolysis).

Cholowa cha microspherocytosis

Mu Minkowski-Choffard matenda, chifukwa cha masinthidwe a jini kabisidwe mapangidwe structural mapuloteni a erythrocyte nembanemba, ndi permeability wa selo khoma kumawonjezeka mu maselo ofiira a magazi, ndi madzi kudziunjikira mwa iwo. Erythrocyte imachepa kukula kwake ndikukhala ozungulira (microspherocytes). Anisocytosis mu matenda nthawi zambiri pamodzi ndi poikilocytosis.

Sideroblastic anemias

Nthawi zambiri, anisocytosis ikhoza kukhala chifukwa cha kukhalapo kwa sideroblastic anemia, matenda omwe amalephera kugwiritsa ntchito chitsulo, pomwe chitsulo m'thupi chingakhale chachilendo kapena chokwera. Zifukwa za sideroblastic anemia:

• Myelodysplastic syndrome (chifukwa chofala kwambiri).
• Kumwa mankhwala omwe amasokoneza kagayidwe ka vitamini B6.
• Kuledzera kwanthawi zonse.
• Kusintha kwamtundu wa ALAS2.

Diagnostics

Kuzindikira kwa mawu akuti "anisocytosis" mu mawonekedwe a kuyezetsa magazi kumafuna kudandaula dokotala wamba kuti adziwe chomwe chayambitsa vutoli. Pakusankhidwa, dokotala amasonkhanitsa mbiri yakale, amawonetsa kukhalapo kwa madandaulo omwe ali ndi vuto la kuchepa kwa magazi (kufooka kwathunthu, chizungulire, kuwonongeka kwa ndende, etc.). Imafotokozera ngati wodwalayo akumwa mankhwala mosalekeza.

Pa cholinga kufufuza, chidwi ndi kukhalapo kwa matenda zizindikiro za magazi m`thupi syndrome: wotumbululuka khungu ndi mucous zimagwira ntchito zosiyanasiyana, otsika magazi, kuchuluka kugunda kwa mtima, etc. Pakuti cholowa hemolytic magazi m`thupi, pamaso pa zizindikiro za mapindikidwe fupa. Mafupa ndi khalidwe.

Maphunziro owonjezera akonzedwa:

• Kusanthula magazi kwathunthu. Mu KLA, chizindikiro cha hematological analyzer, kusonyeza kukhalapo kwa anisocytosis, ndi RDW. Komabe, ikhoza kukhala yokwera molakwika chifukwa cha kukhalapo kwa ma agglutinins ozizira. Chifukwa chake, kuyezetsa kwapang'onopang'ono kwa kuyeza magazi ndikofunikira. Komanso, ma microscopy amatha kuzindikira zizindikiro za kuchepa kwa B12 (matupi a Jolly, mphete za Kebot, hypersegmentation ya neutrophils) ndi zina za pathological inclusions (basophilic granularity, matupi a Pappenheimer).
• Chemistry ya magazi. Pakuyezetsa magazi kwachilengedwe, mulingo wa chitsulo cha seramu, ferritin, ndi transferrin amawunikidwa. Zizindikiro za hemolysis zingadziwikenso - kuwonjezeka kwa lactate dehydrogenase ndi indirect bilirubin.
• Kafukufuku wa Immunological. Ngati chotupa cha autoimmune cha m'mimba chikuganiziridwa, kuyezetsa kumayesedwa kwa ma antibodies ku maselo a parietal a m'mimba, ma antibodies ku transglutaminase, ndi gliadin.
• Kuzindikira kwa hemoglobin yachilendo. Pozindikira thalassemia, hemoglobin electrophoresis pa filimu ya cellulose acetate kapena high performance liquid chromatography imachitidwa.
• Kuzindikira kwa microspherocytosis. Kutsimikizira kapena kuchotsera cholowa microspherocytosis, kukana kwa osmotic kwa erythrocytes ndi mayeso a EMA amachitika pogwiritsa ntchito utoto wa fulorosenti eosin-5-maleimide.
• kafukufuku wa parasitological. Ngati mukukayikira za diphyllobothriasis, ma microscopy akukonzekera ndowe amaperekedwa kuti afufuze mazira a tapeworm.

Nthawi zina pamafunika kuzindikiritsa kusiyana pakati pa IDA ndi thalassemia yaying'ono. Izi zitha kuchitika kale poyesa magazi. Kwa izi, index ya Mentzer imawerengedwa. Chiŵerengero cha MCV ku chiwerengero cha maselo ofiira a magazi oposa 13 ndizofanana ndi IDA, zosakwana 13 - za thalassemia.

Kuyeza magazi

Zizindikiro za anisocytosis ndizo zakuchepa kwa magazi m'thupi. Ngakhale pali mitundu yosiyanasiyana komanso chiyambi cha kuchepa kwa magazi, zizindikilo zingapo zimawoneka kawirikawiri:

• kumva kutopa;
• kupuma movutikira
• kugunda;
• kufooka ndi chizungulire;
• kuyamwa;
• kupweteka mutu.

Chithandizo cha anisocytosis chimadalira chifukwa cha kusakhazikika. Pakakhala kusowa kwa magazi m'thupi kapena kuchepa kwa mavitamini kuperewera kwa mavitamini, zowonjezera zowonjezera zowonjezera zitha kulimbikitsidwa kuchiza anisocytosis.