Lefu la HELLP

HELLP syndrome ke sehlopha sa matšoao a hlahang ho bakhachane ba nang le:

• H: hemolysis (ho senyeha ha lisele tse khubelu tsa mali)
• EL: li-enzyme tse phahameng tsa sebete
• LP: palo e tlase ea platelet

Sesosa sa lefu la HELLP ha se fumanoe. E nkuoa e le mofuta o fapaneng oa preeclampsia. Ka linako tse ling boteng ba HELLP syndrome bo bakoa ke lefu le ka tlase le kang antiphospholipid syndrome.

HELLP syndrome e hlaha moimana a le mong ho isa ho ba babeli ho ba 1000. Basali ba nang le preeclampsia kapa eclampsia, boemo bona bo hlaha ho 10% ho isa ho 20% ea bokhachane.

Hangata HELLP e hlaha nakong ea likhoeli tse tharo tsa bokhachane (pakeng tsa libeke tse 26 ho isa ho tse 40 tsa boimana). Ka linako tse ling e hlaha bekeng kamora hore ngoana a hlahe.

Basali ba bangata ba na le khatello e phahameng ea mali mme ba fumanoa ba na le preeclampsia pele ba tšoaroa ke HELLP syndrome. Maemong a mang, matšoao a HELLP ke tlhokomeliso ea pele ea preeclampsia. Boemo ka linako tse ling bo fumanoa hampe e le:

• Flu kapa mafu a mang a vaerase
• Lefu la gallbladder
• Lefu la sebete
• Idiopathic thrombocytopenic purpura (ITP)
• Lupus flare
• Thrombotic thrombocytopenic purpura

Matšoao a kenyelletsa:

• Mokhathala kapa ho ikutloa o sa phele hantle
• Ho boloka metsi le ho eketsa boima ba 'mele
• Ho opeloa ke hlooho
• Ho nyekeloa le ho hlatsa ho tsoelang pele ho mpefala
• Bohloko bo karolong e kaholimo ho le letona kapa bohareng ba mpa
• Pono e lerootho
• Ho tsoa mali kapa ho tsoa mali a mang a ke keng a emisa habonolo (ka seoelo)
• Ho oa kapa ho tsitsipana (ka seoelo)

Nakong ea tlhahlobo ea 'mele, mofani oa tlhokomelo ea bophelo a ka fumana:

• Bonolo ba mpa, haholo-holo lehlakoreng le ka holimo le letona
• Sebete se atolositsoeng
• Khatello ea mali e phahameng
• Ho ruruha maotong

Liteko tsa ts'ebetso ea sebete (li-enzyme tsa sebete) li ka ba holimo. Lipalo tsa liplatelete li kanna tsa ba tlase. Sesepa sa CT se ka bonts'a ho tsoa mali sebeteng. Protheine e feteletseng e ka fumanoa morong.

Liteko tsa bophelo bo botle ba lesea li tla etsoa. Liteko li kenyelletsa tlhahlobo ea "fetal non-stress" ea "fetal" le "ultrasound" hara tse ling.

Kalafo ea mantlha ke ho pepa lesea kapele kamoo ho ka khonehang, leha lesea le ka pele ho nako. Mathata a sebete le mathata a mang a lefu la HELLP a ka mpefala kapele mme a ba kotsi ho mme le ngoana.

Mofani oa hau a ka tsosa basebetsi ka ho u fa meriana ho qala mosebetsi, kapa a ka etsa karolo ea C.

U ka amohela:

• Tšelo ea mali haeba mathata a tsoang mali a le matla
• Meriana ea Corticosteroid e thusang matšoafo a lesea ho hola kapele
• Meriana ea ho phekola khatello e phahameng ea mali
• Magnesium sulfate infusion ho thibela ho oa

Liphetho hangata li ntle ha bothata bo fumanoa kapele. Ho bohlokoa haholo ho etsa tlhahlobo ea bakhachane khafetsa. U lokela hape ho tsebisa mofani oa hau hanghang haeba u na le matšoao a boemo bona.

Ha boemo bo sa phekoloe kapele, ho fihlela ho 1 ho basali ba bane ba ba le mathata a tebileng. Ntle le kalafo, basali ba fokolang ba shoa.

Sekhahla sa lefu hara masea a tsoaloang ke bo-mme ba nang le lefu la HELLP se latela boima ba 'mele le kholo ea litho tsa lesea, haholo-holo matšoafo. Masea a mangata a hlaha pele ho nako (a hlaha pele ho libeke tse 37 tsa bokhachane).

Lefu la HELLP le ka 'na la khutla ho ea ho moimana a le mong ho ba bane ba kamoso.

Ho ka ba le mathata pele le kamora ho pepa, ho kenyelletsa:

• E phatlalalitse coagulation ea methapo ea methapo (DIC). Bothata ba ho hoama bo lebisang ho tsoa mali a mangata (hemorrhage).
• Mokelikeli matšoafong (edema ea pulmonary)
• Ho hloleha ha liphio
• Ho tsoa mali sebeteng le ho hloleha
• Ho arohana ha placenta ho tloha leboteng la popelo

Kamora hore ngoana a hlahe, HELLP syndrome e ea fela maemong a mangata.

Haeba matšoao a lefu la HELLP a hlaha nakong ea bokhachane:

• Bona mofani oa hau hang-hang.
• Letsetsa nomoro ea lehae ea maemo a tšohanyetso (joalo ka 911).
• E-ea kamoreng ea tšohanyetso ea sepetlele kapa lefapheng la ho pepa le ho pepa.

Ha ho na mokhoa o tsebahalang oa ho thibela lefu la HELLP. Bakhachane bohle ba lokela ho qala tlhokomelo ea bakhachane pele ho nako le ho e tsoala nakong ea bokhachane. Sena se lumella mofani hore a fumane le ho alafa maemo a kang lefu la HELLP hanghang.

• Preeclampsia

Esposti SD, Reinus JF. Mathata a mala le a sebete ho mokuli ea nang le moimana. Ka: Feldman M, Friedman LS, Brandt LJ, bahlophisi. Sleisenger le Fordtran's Mafu a ka Mpeng le a Sebete: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: khaolo ea 39.

Sibai BM. Preeclampsia le mathata a khatello ea mali. Ka: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Likokoana-hloko: Bokhachane bo tloaelehileng le ba bothata. La 7th. Philadelphia, PA: Elsevier; 2017: khaolo ea 31.