Top Banner

of 21

Hc viem tang ferritine tang bch c§u

Jul 07, 2015

ReportDownload

Education

  • 1. Hi chng vimHi chng vim PGS.TS Trn Th Mng HipPGS.TS Trn Th Mng Hip PCN B Mn Nhi vYHG TrPCN B Mn Nhi vYHG Trng HYK PNTng HYK PNT Gio sGio s cc Trcc Trng HYK ti Phpng HYK ti Php

2. ChnChn onon Lm sng:Lm sng: T lu: "sT lu: "sng, nng,ng, nng, ,, au"au" NhNhng: khng phi lc no cng cng: khng phi lc no cng c Du hiu ton thn:Du hiu ton thn: St : kch thch trung tmSt : kch thch trung tm iu nhit,iu nhit, do cc cht gy nhit:do cc cht gy nhit: lipopolysaccharide ca VT, cytokine...lipopolysaccharide ca VT, cytokine... 3. Sinh hcSinh hc St huyt thanhSt huyt thanh gim (st b bt gi tronggim (st b bt gi trong i thci thc bo),bo), FerritineFerritine ttngng Thiu muThiu mu (him khi < 8g/dL) khng(him khi < 8g/dL) khng p ng ty,p ng ty, ng bo lcng bo lc u, HC nh v sauu, HC nh v sau Tiu cu tTiu cu tngng: tip tc t: tip tc tng khi bnhng khi bnh lui, khng cnlui, khng cn iu tr chngiu tr chng ngng BCBC: t: tng trong NT nng, vim khp thiu nin (Still)ng trong NT nng, vim khp thiu nin (Still) gim : nhim siu vigim : nhim siu vi Phosphatase alcalinePhosphatase alcaline ttng: NT do VT nng, ung thng: NT do VT nng, ung th (thn)(thn) 4. Sinh hcSinh hc Hin tHin tng vimng vim VSVS in diin di mm CRPCRP ProcalcitonineProcalcitonine FibrinogenFibrinogen OrosomucoideOrosomucoide HaptoglobulineHaptoglobuline 5. Sinh hcSinh hc Hin tHin tng vimng vim VS:VS: Tr em: < 30mm giTr em: < 30mm gi uu TTng vi tui, cao hng vi tui, cao hn ph nn ph n Cch tnh gii hn trn:Cch tnh gii hn trn: Nam: [tui (nNam: [tui (nm)] /2m)] /2 N: [tui (nN: [tui (nm) +10] /2m) +10] /2 VS khngVS khng c hiu, nn cn xt thm kt quc hiu, nn cn xt thm kt qu caca inin didi mm 6. m ca hin tm ca hin t ng vimng vim inin didi m:m: TTng:ng: Alpha 1 globuline (orosomucoide)Alpha 1 globuline (orosomucoide) Alpha 2 globuline (haptoglobuline)Alpha 2 globuline (haptoglobuline) Gammaglobuline (CRP)Gammaglobuline (CRP) inin didi m bnh thm bnh thng nu hin tng nu hin tng vim nhng vim nh Gim:Gim: AlbuminAlbumin (Transferrine,(Transferrine, o trc tip)o trc tip) 7. in diin di m tr em (g/l):m tr em (g/l): Protid Albumine alpha 1 alpha 2 Bta Gamma 55-78 40-58 2-4 5-8 5-9 3-10 8. Sinh hcSinh hc Hin tHin tng vimng vim CRP: tng vo gi th 6, tr v bnh thng trong vi ngy sau gim hin tng vim Gip nh gi nhanh chng hiu qu iu tr (VS, haptoglobuline, Fibrinogen: tr v bt sau 2-3 tun) Tuy nhin, CRP tng khng phi lun lun l nhim trng, ngc li trong VRT, CRP c th bt Cn da vo bnh cnh lm sng quyt nh 9. Sinh hcSinh hc Hin tHin tng vimng vim Procalcitonine:Procalcitonine: l mt tin hormone cal mt tin hormone ca calcitonine, gipcalcitonine, gip nh gi hin tnh gi hin tng vimng vim TTng trong cc bnh l nhim trng ton thnng trong cc bnh l nhim trng ton thn Tuy nhin: cn da vo bnh cnh lm sngTuy nhin: cn da vo bnh cnh lm sng B th C3:B th C3: TTng trong hin tng trong hin tng vimng vim C3 gim:C3 gim: Lupus, bnh cu thn, vim ni tm mcLupus, bnh cu thn, vim ni tm mc 10. TTng Ferritine trong mung Ferritine trong mu CC ch:ch: Hy t bo gan hoc cHy t bo gan hoc c TTng tng hp Ferritine do rng tng hp Ferritine do ru (ngu (ngi ln)i ln) t bin gen ca Ferritinet bin gen ca Ferritine Tr s bnh thTr s bnh thng tr em: 15 - 80 g/Lng tr em: 15 - 80 g/L ss sinh: 50 - 250 g/Lsinh: 50 - 250 g/L 11. TTng Ferritin trong mung Ferritin trong mu Nguyn nhnNguyn nhn Hy t bo:Hy t bo: gan: vim gan cp hay mn (SGPT, SGOT)gan: vim gan cp hay mn (SGPT, SGOT) cc: vim c: vim c tim (CPK, aldolase)tim (CPK, aldolase) Hin tHin tng vim ton thng vim ton th: km gim st huyt thanh: km gim st huyt thanh Vim khp mn thiu nin, cVim khp mn thiu nin, cng gip, c tnh, bnhng gip, c tnh, bnh v muv mu Siu vi:Siu vi: EBV, HerpsEBV, Herps Bnh di truynBnh di truyn ( st),( st), bnh chuyn habnh chuyn ha 12. ThayThay ii m ca hin tm ca hin tng vimng vim khng do vim:khng do vim: AlbuminAlbumin < 22g/L: tm nguyn nhn ti gan, SDD,< 22g/L: tm nguyn nhn ti gan, SDD, km hp thu, thot qua nkm hp thu, thot qua nc tiu, tiu ha...c tiu, tiu ha... TransferrineTransferrine ttng: thiu mu thiu stng: thiu mu thiu st HaptoglobulineHaptoglobuline gim: huyt tngim: huyt tn FibrinogenFibrinogen gim: khi dng corticoid, MNMLT,gim: khi dng corticoid, MNMLT, Hc thc bo muHc thc bo mu Fibrinogen tFibrinogen tng: dng oestrogen, suy thnng: dng oestrogen, suy thn Suy gan: gim tt cSuy gan: gim tt c m ca hin tm ca hin tng vim dong vim do gim tng hpgim tng hp 13. Khi no quytKhi no quyt nh kho stnh kho st hin thin tng vim ?ng vim ? 3 tnh hung lm sng:3 tnh hung lm sng: 1.1. Khi chKhi cha xca xc nhnh c nguyn nhn (vd:c nguyn nhn (vd: au khp,au khp, nhcnhc u, st, gy nhiu...): s hin din ca ht vimu, st, gy nhiu...): s hin din ca ht vim l yu t gip nghl yu t gip ngh n 1 bnh thc thn 1 bnh thc th 2.2. Bnh nhn c tBnh nhn c tng VS chng VS cha r nguyn nhn. Cna r nguyn nhn. Cn iinn didi mm tm bt thtm bt thng Igng Ig 3.3. Khi bnh nhn c 1 bnh l do vimKhi bnh nhn c 1 bnh l do vim c xcc xc nh: nhmnh: nhm nh gi din tin vinh gi din tin vi iu triu tr Khng chKhng ch nh VS v CRP nhnh VS v CRP nh xt nghim thxt nghim thng quyng quy ng ngi lnhi lnh 14. 1414 Tng bch cuTng bch cu TngTng GimGim BC a nhn TTBC a nhn TT >7000>7000 4000 400 100 MonoMono >800>800 7000/mm33 2 tnh hung:2 tnh hung: a. Phi hp vi bnh l khc:a. Phi hp vi bnh l khc: Du hiu thng thDu hiu thng thng trng trc mi nhim trng ti ch (vim hc mi nhim trng ti ch (vim h VRT) hoc ton thn (NTH)VRT) hoc ton thn (NTH) Hi chng vim cp hay mn (vimHi chng vim cp hay mn (vim a khp dng thp)a khp dng thp) Hoi t t bo cp (vim cHoi t t bo cp (vim c tim, nhi mu ctim, nhi mu c tim...)tim...) Ung thUng th tin trintin trin Bnh v mu: Vaquez, HodgkinBnh v mu: Vaquez, Hodgkin 16. Tng bch cuTng bch cu b.Tb.Tng PNng PN n thun:n thun: nguyn nhn:nguyn nhn: Sinh l bnh thSinh l bnh thng: sau dng thuc (corticoid, lithium)ng: sau dng thuc (corticoid, lithium) Nhim trng do VT sinh m: TMH, NTT, rNhim trng do VT sinh m: TMH, NTT, rngng nhim trng da v vt thnhim trng da v vt thng ti phtng ti pht Khi khng c yu t nhim trng, nhKhi khng c yu t nhim trng, nhng c hin tng c hin tngng vim: ung thvim: ung th (thn, phi)(thn, phi) 17. Tng bch cuTng bch cu Ngoi ra: tNgoi ra: tng PNng PN n thun cn do:n thun cn do: .. Dng di truyn trong giaDng di truyn trong gia nh (him)nh (him) . Du hiu ban. Du hiu ban u (tru (trc nhiu nc nhiu nm) cam) ca bnh l c tnh v mu => cn kim trabnh l c tnh v mu => cn kim tra huythuyt X tr:X tr: ty nguyn nhnty nguyn nhn 18. Tng bch cuTng bch cu 2/ T2/ Tng BC lympho:ng BC lympho: S lS lng BC Lympho 4000/mmng BC Lympho 4000/mm33 Ch tr em c tCh tr em c tng BC Lympho sinh l (ng BC Lympho sinh l ( n 5-8n 5-8 tui)tui) tr em: ho g, nhim siu vi: si, quai b, virus tr em: ho g, nhim siu vi: si, quai b, virus ng h hp, vim gan, ruboleng h hp, vim gan, rubole ng ngi ln:i ln: . t. tng BC Lympho > 2 thng, nghng BC Lympho > 2 thng, ngh n bnh BCn bnh BC mn dng lymphomn dng lympho 19. Tng bch cuTng bch cu X tr:X tr: Khm CK trong dng tin trin hoc kmKhm CK trong dng tin trin hoc km cc du hiu v bnh mu (hch, lchcc du hiu v bnh mu (hch, lch to, thiu mu, gim tiu cu)to, thiu mu, gim tiu cu) TTng BC lymphong BC lympho n thun, s ln thun, s lng tng t ( 400/mm33 Nguyn nhn:Nguyn nhn: DoDo iu tr: thuc chng co git (carbamazpine),iu tr: thuc chng co git (carbamazpine), bta lactamines, isoniazide, amphotericine B,bta lactamines, isoniazide, amphotericine B, allopurinolallopurinol Giun sn: soi phn,Giun sn: soi phn, nh lnh lng IgEng IgE Bnh da d ngBnh da d ng Bnh phi tBnh phi tng BC i toan:ng BC i toan: Do thuc khng sinh, chng nm, amiodaroneDo thuc khng sinh, chng nm, amiodarone KST (giun ch), nm phi , suynKST (giun ch), nm phi , suyn Tiu ha: bnh CrohnTiu ha: bnh Crohn 21. Tng bch cu i toanTng bch cu i toan Nguyn nhn:Nguyn nhn: Bnh ton th: vim nt quanhBnh ton th: vim nt quanh ng mch,ng mch, vim mch mu, vimvim mch mu, vim a khp dng thp..a khp dng thp.. Nhim siu vi: VGSV C, HIVNhim siu vi: VGSV C, HIV Bnh c tnh: tBnh c tnh: tng BC i toan nhiu thng trng BC i toan nhiu thng trcc khi pht hin ung thkhi pht hin ung th (phi,(phi, i trng,)i trng,) Bnh mu v suy gim min dch: Hodgkin, uBnh mu v suy gim min dch: Hodgkin, u lympho, nhim HTLV 1lympho, nhim HTLV 1