Chilichonse Chimene Muyenera Kudziwa Zokhudza Tumor Lysis Syndrome

Zamkati

• Kodi tumor lysis syndrome ndi chiyani?
• Zizindikiro zake ndi ziti?
• Chifukwa chiyani zimachitika?
• Kodi pali zoopsa zilizonse?
• Kodi amapezeka bwanji?
• Amachizidwa bwanji?
• Kodi ndizotheka?
• Maganizo ake ndi otani?

Kodi tumor lysis syndrome ndi chiyani?

Cholinga cha chithandizo cha khansa ndikuwononga zotupa. Matenda a khansa akatha msanga, impso zanu zimayenera kugwira ntchito molimbika kuti zichotse zonse zomwe zinali m'matumba amenewo. Ngati sangakwanitse, mutha kupanga china chotchedwa tumor lysis syndrome (TLS).

Matendawa amapezeka kwambiri kwa anthu omwe ali ndi khansa yokhudzana ndi magazi, kuphatikiza ma leukemias ndi ma lymphomas. Nthawi zambiri zimachitika patangopita maola ochepa mpaka masiku angapo mutalandira mankhwala oyamba a chemotherapy.

TLS sizachilendo, koma imatha kukhala pachiwopsezo cha moyo. Ndikofunika kudziwa momwe mungazindikire kuti muthe kupeza chithandizo mwachangu.

Zizindikiro zake ndi ziti?

TLS imakulitsa kuchuluka kwa zinthu zingapo m'magazi anu, zomwe zimatha kuyambitsa zizindikilo zingapo.

Zinthu izi ndi monga:

• Potaziyamu. Kuchuluka kwa potaziyamu kumatha kubweretsa kusintha kwamitsempha ndi mavuto amtima.
• Uric asidi. Kuchuluka kwa uric acid (hyperuricemia) kumatha kuyambitsa impso ndi kuwonongeka kwa impso. Muthanso kukhala ndi magawo a uric acid m'magulu anu, omwe amayambitsa vuto lofanana ndi gout.
• Mankwala. Phosphate yambiri imatha kubweretsa kufooka kwa impso.
• Calcium. Phosphate yochulukirapo imatha kupangitsanso kuchepa kwa calcium, mwina zomwe zingayambitse impso.

Ngakhale zizindikiro za TLS nthawi zambiri zimakhala zofewa pachiyambi, monga momwe zinthu zimakhalira m'magazi anu, mutha kuwona:

• kusakhazikika, kukwiya
• kufooka, kutopa
• dzanzi, kumva kulasalasa
• nseru, kusanza
• kutsegula m'mimba
• kuphwanya minofu
• kupweteka pamodzi
• kuchepa pokodza, mkodzo wamtambo

Ngati sangasamalidwe, TLS pamapeto pake imatha kubweretsa zizindikilo zowopsa, kuphatikiza:

• kutayika kwa minofu
• mtima arrhythmia
• kugwidwa
• kuyerekezera zinthu zakale, delirium

Chifukwa chiyani zimachitika?

Ngakhale TLS nthawi zina imadzichitira yokha isanachitike khansa, izi ndizosowa kwambiri. Nthawi zambiri, zimachitika posachedwa chemotherapy atangoyamba.

Chemotherapy imaphatikizapo mankhwala omwe amapangidwa kuti athane ndi zotupa. Pamene zotupa zikutha, amatulutsa mkatimo mumtsinje wamagazi. Nthawi zambiri, impso zanu zimatha kusefa izi popanda zovuta.

Komabe, nthawi zina zotupa zimawonongeka msanga kuposa momwe impso zanu zingathetsere. Izi zimalepheretsa impso zanu kusefa zomwe zili ndi chotupacho m'magazi anu.

Nthawi zambiri, izi zimachitika mukangomaliza kulandira mankhwala a chemotherapy, pomwe maselo ambiri a khansa amawonongedwa munthawi yochepa. Zitha kuchitika pambuyo pake kuchipatala.

Kuphatikiza pa chemotherapy, TLS imagwirizananso ndi:

• mankhwala a radiation
• mankhwala a mahomoni
• mankhwala achilengedwe
• mankhwala a corticosteroid

Kodi pali zoopsa zilizonse?

Pali zinthu zingapo zomwe zingapangitse chiopsezo chanu chokhala ndi TLS, kuphatikiza mtundu wa khansa yomwe muli nayo. Khansa yomwe imagwirizanitsidwa ndi TLS ndi iyi:

• khansa ya m'magazi
• non-Hodgkin's lymphoma
• zotupa za myeloproliferative, monga myelofibrosis
• blastomas pachiwindi kapena muubongo
• Khansa yomwe imakhudza impso musanalandire chithandizo

Zina mwaziwopsezo zomwe zingachitike ndi monga:

• kukula kwakukulu kwa chotupa
• vuto la impso
• zotupa zomwe zikukula mofulumira
• mankhwala ena a chemotherapy, kuphatikizapo cisplatin, cytarabine, etoposide, ndi paclitaxel

Kodi amapezeka bwanji?

Ngati mukumwa mankhwala a chemotherapy ndipo muli ndi zoopsa zilizonse za TLS, dokotala wanu azichita mayeso a magazi ndi mkodzo pafupipafupi maola 24 mutangolandira chithandizo choyamba. Izi zimawathandiza kuti awone ngati pali impso zakuti impso zanu sizimasefa chilichonse.

Mitundu ya mayeso omwe amagwiritsa ntchito ndi awa:

• magazi urea asafe
• kashiamu
• kuwerengera kwathunthu kwama cell
• alireza
• lactate dehydrogenase
• phosphorous
• ma seramu ma electrolyte
• uric asidi

Pali njira ziwiri zomwe madokotala angagwiritse ntchito pozindikira TLS:

• Njira za Cairo-Bishop. Kuyezetsa magazi kuyenera kuwonetsa kuwonjezeka kwa 25% m'magawo azinthu zina.
• Njira za Howard. Zotsatira zasayansi ziyenera kuwonetsa magawo awiri kapena kupitilira apo mkati mwa maola 24.

Amachizidwa bwanji?

Pofuna kuchiza TLS, dokotala wanu angayambe ndikukupatsani madzi amadzimadzi (IV) poyang'anira momwe mumakodza nthawi zambiri. Ngati simukutulutsa mkodzo wokwanira, adotolo amathanso kukupatsirani okodzetsa.

Mankhwala ena omwe mungafunike ndi awa:

• allopurinol (Aloprim, Lopurin, Zyloprim) kuyimitsa thupi lanu kuti lisapangitse uric acid
• rasburicase (Elitek, Fasturtec) kuti athyole uric acid
• sodium bicarbonate kapena acetazolamide (Diamox Sequels) yoteteza uric acid kuti isapange makhiristo

Palinso mitundu iwiri yatsopano ya mankhwala omwe angathandizenso:

• oral kinase inhibitors, monga ibrutinib (Imbruvica) ndi idelalisib (Zydelig)
• B-cell lymphoma-2 protein inhibitors, monga venetoclax (Venclexta)

Ngati madzi ndi mankhwala sizikuthandizani kapena ntchito yanu ya impso ikupitirira kuchepa, mungafunike dialysis ya impso. Uwu ndi mtundu wamankhwala omwe amathandizira kuchotsa zinyalala, kuphatikiza zotupa zomwe zawonongeka, m'magazi anu.

Kodi ndizotheka?

Sikuti aliyense amene amalandira chemotherapy amadwala TLS. Kuphatikiza apo, madokotala azindikira momveka bwino zomwe zimayambitsa chiopsezo ndipo nthawi zambiri amadziwa omwe ali pachiwopsezo chachikulu.

Ngati muli ndi zoopsa zilizonse, dokotala angaganize zoyamba kukupatsani madzi owonjezera a IV masiku awiri musanalandire chithandizo chamankhwala oyamba. Adzawunika momwe mwatulukira mkodzo masiku awiri otsatira ndikukupatsani diuretic ngati simukubereka zokwanira.

Muthanso kuyamba kumwa allopurinol nthawi yomweyo kuti thupi lanu lisapangitse uric acid.

Izi zitha kupitilira masiku awiri kapena atatu mutangomaliza kumene chemotherapy, koma dokotala akhoza kupitiliza kuwunika magazi anu ndi mkodzo munthawi yonse ya chithandizo chanu.

Maganizo ake ndi otani?

Chiwopsezo chonse chokhala ndi TLS ndikotsika. Komabe, anthu akamakula, zimatha kubweretsa zovuta zazikulu, kuphatikizapo kufa. Ngati mukuyenera kuyamba chithandizo cha khansa, funsani za ziwopsezo zanu za TLS komanso ngati dokotala angavomereze njira iliyonse yodzitetezera.

Muyeneranso kuonetsetsa kuti mukudziwa zizindikiro zonse kuti mutha kuyamba kulandira chithandizo mukangoyamba kuzizindikira.