Anisocytosis: tlhaloso, matšoao le kalafo

Anisocytosis ke lentsoe le sebelisoang ho hematology ha ho na le boholo bo sa tloaelehang lipakeng tsa lisele tsa mali tsa mohala o tšoanang oa sele joalo ka:

• lisele tse khubelu tsa mali, eo hape e bitsoang lisele tse khubelu tsa mali kapa erythrocyte;
• liplatelete tsa mali, eo hape e bitsoang thrombocyte.

Hoa khoneha ho khetholla li-anisocytose tse 'maloa ho latela mohala oa sele o amehang:

• erythrocyte anisocytosis ha ntho e sa tloaelehang e ama erythrocyte (lisele tse khubelu tsa mali);
• platelet anisocytosis, ka linako tse ling e bitsoa thrombocytic anisocytosis, ha ntho e sa tloaelehang e ama li-thrombocyte (liplatelete tsa mali).

Ho latela mofuta oa ho se tloaelehe ho fumanoeng, ka linako tse ling anisocytosis e hlalosoa e le:

• boqhetseke, hangata e khutsufatsoa e le microcytosis, ha lisele tsa mali li le nyenyane ka tsela e sa tloaelehang;
• aniso-macrocytosis, hangata e khutsufatsoa e le macrocytosis, ha lisele tsa mali li le khōlō ka tsela e sa tloaelehang.

Anisocytosis ke boemo bo sa tloaelehang ba mali bo bonoang nakong ea a hemogram, eo hape e bitsoang Blood Count and Formula (NFS). E entsoe ka ho nka sampole ea mali a maqhubu, tlhahlobo ena e fana ka tlhaiso-leseling e ngata haholo ka lisele tsa mali.

Har'a litekanyetso tse fumanoang nakong ea palo ea mali, index ea kabo ea lisele tse khubelu tsa mali (RDI) e boetse e bitsoa index ea anisocytosis. Ho etsa hore ho khonehe ho lekola ho fapana ha boholo ba lisele tse khubelu tsa mali maling, index ena e etsa hore ho khonehe ho khetholla erythrocyte anisocytosis. E nkoa e le ntho e tloaelehileng ha e pakeng tsa 11 le 15%.

Ka kakaretso, anisocytosis ke lentsoe le sebelisoang ke lingaka ho bua ka erythrocyte anisocytosis. Mabapi le lisele tse khubelu tsa mali, sena se sa tloaelehang sa mali hangata se bakoa ke khaello ea mali, ho theoha ho sa tloaelehang ha tekanyo ea lisele tse khubelu tsa mali kapa hemoglobin maling. Khaello ena e ka baka mathata hobane lisele tse khubelu tsa mali ke lisele tsa bohlokoa bakeng sa kabo ea oksijene 'meleng. Ha e le liseleng tse khubelu tsa mali, hemoglobin ke protheine e khonang ho tlama limolek'hule tse 'maloa tsa oksijene (O2) ebe e li ntša liseleng.

Ho khonahala ho khetholla mefuta e 'maloa ea phokolo ea mali e bakang erythrocyte anisocytosis, ho kenyeletsoa:

• eakhaello ea mali ea tšepe, e bakoang ke khaello ea tšepe, e nkoang e le microcytic anemia hobane e ka lebisa ho anisocytosis ka ho thehoa ha lisele tse nyenyane tse khubelu tsa mali;
• khaello ea vithamine khaello ea mali, tse atileng haholo ho tsona ke khaello ea khaello ea vithamine B12 le khaello ea khaello ea vithamine B9, e nkoang e le macrocytic anemias hobane e ka baka aniso-macrocytosis ka tlhahiso ea lisele tse khubelu tsa mali tse holofetseng.
• eahaemolytic khaello ea mali, e tšoauoang ka ho senngoa ha lisele tse khubelu tsa mali pele ho nako, tse ka bakoang ke ho se tloaelehe ha liphatsa tsa lefutso kapa maloetse.

Platelet anisocytosis le eona e na le tšimoloho ea mafu. Platelet anisocytosis e ka ba ka ho khetheha ka lebaka la myelodysplastic syndromes (MDS), e etsang sehlopha sa mafu ka lebaka la ho se sebetse ha moko oa masapo.

Lisosa tse khethehileng tsa anisocytosis

Tlhaho

Hase kamehla boteng ba anisocytosis bo bontšang lefu leha e le lefe. Ka mohlala, ho masea a sa tsoa tsoaloa, macrocytosis ea 'mele e hlokomeloa. Sena se bakoa ke ho hola butle-butle ha moko oa masapo le lits'ebetso tsa mitosis liseleng tsa stem tsa hematopoietic. Ka khoeli ea 2 ea bophelo, anisocytosis e ikemela butle-butle.

khaello ea tšepe

Sesosa se atileng haholo sa pathological sa anisocytosis ke khaello ea tšepe. Ka khaello ea tšepe 'meleng, ho na le tlolo ea kholo ea erythrocyte, ho thehoa ha lera la lisele tsa bona, le ho thehoa ha hemoglobin. Ka lebaka leo, boholo ba lisele tse khubelu tsa mali bo fokotseha (microcytosis). Ka lebaka la khaello ea tšepe, kakaretso ea hemoglobin maling e ea fokotseha, 'me khaello ea mali ea anemia (IDA) ea hlaha.

Hammoho le anisocytosis, hypochromia hangata haholo le hlaha, ke hore, fokotsa hemoglobin saturation ea erythrocytes. Anisocytosis, hammoho le liphetoho tse ling tsa li-indices tsa erythrocyte (MCV, MCH, MCHC), li ka 'na tsa etella pele tsoelo-pele ea IDA, ho thoeng ke khaello ea tšepe e patehileng.

Hape, anisocytosis e ka 'na ea phehella qalong ea tlatsetso ea tšepe bakeng sa phekolo ea khaello ea mali ea tšepe. Ho feta moo, e na le sebopeho se ikhethileng - ho na le palo e kholo ea li-microcyte le macrocyte maling, ke ka lebaka leo histogram ea kabo ea erythrocyte e nang le ponahalo ea litlhōrō tse peli.

Lisosa tsa khaello ea tšepe:

• Alimentary factor.
• Bongoaneng, bocha, bokhachane (linako tsa tlhokahalo e eketsehileng ea tšepe).
• Ho ea khoeling nako e telele.
• Ho lahleheloa ke mali ka nako e telele: seso sa peptic ka mpeng kapa duodenum, hemorrhoids, hemorrhagic diathesis.
• Boemo ka mor'a ho ntša mpa kapa mala.
• Mathata a lefutso a metabolism ea tšepe: hereditary atransferrinemia.

Sampling ea mali bakeng sa lipatlisiso

Ho haella ha vithamine B12 le folic acid

Lebaka le leng la anisocytosis, e leng macrocytosis, ke khaello ea B12 ka folic acid, mme khaello ea vithamine e kopaneng hangata e bonoa. Sena se etsahala ka lebaka la ts'ebetso ea bona ea metabolic 'meleng. Ho haella ha B12 ho thibela phetoho ea folic acid hore e be sebopeho se sebetsang sa coenzyme. Ketsahalo ena ea biochemical e bitsoa folate trap.

Ho haella ha livithamine tsena ho lebisa ho tlōlo ea metheo ea purine le pyrimidine (likarolo tse ka sehloohong tsa DNA), tse amang haholo-holo mosebetsi oa moko oa masapo, e le setho se nang le mosebetsi o phahameng ka ho fetisisa oa ho ata ha lisele. Mofuta oa megaloblastic oa hematopoiesis o hlaha - lisele tse seng tse hōlileng ka ho feletseng tse nang le likarolo tsa nucleus ea sele, ho eketseha ha hemoglobin le ho eketseha ha boholo ho kena maling a peripheral, ke hore, phokolo ea mali ke macrocytic le hyperchromic ka tlhaho.

Lisosa tse kholo tsa khaello ea B12:

• Lijo tse thata le ho qheleloa ka thoko ho lihlahisoa tsa liphoofolo.
• atrophic gastritis.
• Autoimmune gastritis.
• Ho ruruha hoa mpa.
• Khaello ea lefutso ea Intrinsic factor Castle.
• Malabsorption : lefu la celiac, lefu la ho ruruha ha mala.
• Tšoaetso ea liboko: diphyllobothriasis .
• Phoso ea liphatsa tsa lefutso tsa transcobalamin.

Leha ho le joalo, khaello ea folate e ka thoko e ka hlaha. Maemong a joalo, phetoho ea pathological feela maling e ka ba anisocytosis (macrocytosis). Sena se fumanoa haholo-holo ho tahi, kaha joala ba ethyl bo fokotsa ho monya ha folate ka har'a pampiri ea gastrointestinal. Hape, ho haella ha folic acid le macrocytosis e latelang ho etsahala ho bakuli ba nkang lithibela-pelehi tsa molomo ka nako e telele, ho bakhachane.

Thalassemia

Maemong a mang, anisocytosis (microcytosis), hammoho le hypochromia, e ka 'na ea e-ba matšoao a thalassemia, sehlopha sa mafu a khetholloang ke ho se tloaelehe ha liphatsa tsa lefutso ho kopantsoeng ha liketane tsa globin. Ho ipapisitse le phetoho ea mofuta o itseng, ho na le khaello ea liketane tse ling tsa li-globin le tse ling tse ngata (alpha, beta kapa liketane tsa gamma). Ka lebaka la boteng ba limolek'hule tsa hemoglobin tse nang le bokooa, lisele tse khubelu tsa mali li fokotseha ka boholo (microcytosis), 'me lera la tsona le kotsing ea ho timetsoa (hemolysis).

Hereditary microspherocytosis

Lefu la Minkowski-Choffard, ka lebaka la phetoho ea liphatsa tsa lefutso tse kenyelletsang sebopeho sa liprotheine tsa sebopeho sa lera la erythrocyte, ho kenella ha lerako la lisele tsa bona ho eketseha ka lisele tse khubelu tsa mali, 'me metsi a bokellana ho tsona. Li-erythrocyte li fokotseha ka boholo 'me li fetoha spherical (microspherocytes). Anisocytosis lefu lena hangata e kopantsoe le poikilocytosis.

Sideroblastic anemias

Haholo ka seoelo, anisocytosis e ka 'na ea bakoa ke ho ba teng ha sideroblastic anemia, boemo ba pathological moo ts'ebeliso ea tšepe e senyehang, ha tšepe e' meleng e ka ba e tloaelehileng kapa e phahame. Lisosa tsa anemia ea sideroblastic:

• Myelodysplastic syndrome (sesosa se tloaelehileng haholo).
• Ho noa meriana e sitisang metabolism ea vithamine B6.
• Botahoa bo sa feleng ba loto.
• Phetoho ea lefutso la ALAS2.

tlhathoba

Ho fumanoa ha qeto ea "anisocytosis" ka mokhoa oa tlhahlobo ea mali ho hloka boipiletso ho ngaka e akaretsang ho fumana sesosa sa boemo bona. Nakong ea kopano, ngaka e bokella histori e qaqileng, e senola boteng ba litletlebo tse khethollang khaello ea mali (bofokoli bo akaretsang, ho tsekela, ho senyeha ha mahloriso, joalo-joalo). E hlakisa hore na mokuli o noa meriana leha e le efe kamehla.

Nakong ea tlhahlobo ea sepheo, ho lebisa tlhokomelo ho boteng ba matšoao a kliniki a lefu la phokolo ea mali: letlalo la letlalo le lera la mucous, khatello e tlase ea mali, ho otla ha pelo, joalo-joalo. skeleton ke tšobotsi.

Lithuto tse ling li reriloe:

• Tlhahlobo ea mali ka kakaretso. Ho KLA, letšoao la hematological analyzer, le bontšang boteng ba anisocytosis, ke RDW. Leha ho le joalo, e ka 'na ea e-ba holimo ka phoso ka lebaka la ho ba teng ha li-agglutinins tse batang. Ka hona, tlhahlobo ea microscopic ea smear ea mali ke tlamo. Hape, microscopy e ka lemoha matšoao a khaello ea B12 ('mele ea Jolly, mehele ea Kebot, hypersegmentation ea li-neutrophils) le lintho tse ling tse kenyelletsang mafu (basophilic granularity,' mele ea Pappenheimer).
• Khemistri ea mali. Tekong ea mali ea biochemical, boemo ba tšepe ea serum, ferritin le transferrin lia hlahlojoa. Matšoao a hemolysis a ka boela a hlokomeloa - ho eketseha ha khatello ea lactate dehydrogenase le bilirubin e sa tobang.
• Patlisiso ea Immunological. Haeba ho belaelloa hore ho na le leqeba la autoimmune la pampitšana ea gastrointestinal, liteko li etsoa bakeng sa li-antibodies ho lisele tsa parietal tsa mpa, li-antibodies ho transglutaminase, le gliadin.
• Ho fumanoa ha hemoglobin e sa tloaelehang. Ha ho fumanoa thalassemia, hemoglobin electrophoresis ho cellulose acetate filimi kapa high performance liquid chromatography e etsoa.
• Ho hlahlojoa ha microspherocytosis. Ho netefatsa kapa ho qhelela ka thoko microspherocytosis ea lefutso, ho hanyetsa osmotic ea erythrocyte le tlhahlobo ea EMA ho etsoa ho sebelisoa dae ea fluorescent eosin-5-maleimide.
• lipatlisiso tsa parasitological. Haeba ho belaelloa hore ho na le diphyllobothriasis, ho fanoa ka microscope ea mantle a tlhaho ho batla mahe a tapeworm.

Ka linako tse ling hoa hlokahala ho etsa tlhahlobo e fapaneng lipakeng tsa IDA le thalassemia e nyane. Sena se ka etsoa ka tlhahlobo ea mali e akaretsang. Bakeng sa sena, index ea Mentzer e baloa. Karolelano ea MCV ho palo ea lisele tse khubelu tsa mali ho feta 13 e tloaelehile bakeng sa IDA, ka tlase ho 13 - bakeng sa thalassemia.

Ho hlahloba mali

Matšoao a anisocytosis ke a phokolo ea mali. Le hoja ho na le mefuta e fapaneng le tšimoloho ea khaello ea mali, matšoao a 'maloa a atisa ho hlokomeloa:

• boikutlo ba mokhathala o akaretsang;
• phefumoloho e khutšoanyane
• ho otla ha pelo;
• bofokoli le ho tsekela;
• pallor;
• ho tšoaroa ke hlooho.

Kalafo ea anisocytosis e itšetlehile ka sesosa sa ho se tloaelehe. Ha ho na le khaello ea mali ea khaello ea tšepe kapa khaello ea mali ea vithamine, tlatsetso ea phepo e ka khothaletsoa ka mohlala ho phekola anisocytosis.