Jini Mai Barazana Rayuwa akan Masu Sirin Jini ko a Hemophilia¶

Lokacin da mutumin da ya sha maganin kashe jini (anticoagulants ko antiplatelet drugs) ko kuma yana rayuwa tare da ciwon jini da aka gada (Hemophilia A, Hemophilia B, ko von Willebrand Disease) yana fama da yanke, faduwa, ciwon kai, ko zub da jini na ciki, daidaitattun lokutan clotting ba sa aiki. Saboda karfin jiki na samar da tsayayyen ragar fibrin ko filogin platelet yana toshewa ta hanyar sinadarai ko kuma babu shi a cikin kwayoyin halitta, har ma da karan laceration na fatar kan mutum, zubar da jini, ko kuma da alama mai rauni a kai na iya ci gaba zuwa mutuwa ko matsewar kwakwalwa. Taimakon farko yana buƙatar ** tsawaita, matsa lamba kai tsaye (aƙalla mintuna 15 zuwa 30 na ci gaba ba tare da leƙewa ba)**, wanda Ƙungiyar Ƙungiyar Hemophilia ta Duniya (WFH) ke gudanarwa ta "FACTOR FIRST / Treat First, Scan Na biyu" ka'idar **, da sanarwar asibiti nan da nan tare da ** ainihin suna da lokacin ƙarshe na masu ba da gudummawar jini na iya shirya takamaiman maganin gaggawa. ya isa.

Yi wannan yanzu¶

1. ** Aiwatar da ci gaba, matsa lamba kai tsaye zuwa kowane jini na waje na tsawon mintuna 15 zuwa 30 ba tare da ɗaga gauze ɗin don dubawa ba.** Latsa ƙasa da ƙarfi kai tsaye akan wurin zubar jini ta amfani da gauze mara kyau, suturar hemostatic (kamar kaolin ko chitosan gauze), ko kyalle mai tsafta. Kada a ɗaga rigar kowane minti 2 don ganin ko jini ya daina: a cikin majiyyaci da ke ɗauke da kayan aikin jini ko mai ciwon haemofilia, ɗaga kullin yaga daga cikin filogi mai rauni sannan ya sake saita agogon zubar jini zuwa sifili. Don zubar jini mai saurin rai wanda ba zai tsaya tare da matsi kai tsaye ba, a yi amfani da gilashin iska ** yawon shakatawa ** \(5\rubutu{zuwa }8\rubu {centimeters}\) (\(2\rubutu{zuwa}3\rubu{inci}\))) sama da raunin (duba zub da jini).
2. Kira lambar gaggawar gaggawa ta gida don tsananin zubar jini na waje, duk wani ciwon kai/wuyansa/kirji/jini, ko alamun zubar jini na ciki. Kira lamba 911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a Burtaniya, ko duba duka. lambobin gaggawa. A fayyace ma mai aikawa da sakon ** ainihin sunan magani ** (misali, "Apixaban," "Rivaroxaban," "Dabigatran," "Warfarin," ko "Clopidogrel") ko kuma ** daidaitaccen rashin jini*
3. ** Idan majiyyaci yana da Hemophilia ko von Willebrand Disease kuma yana da abubuwan gida a hannu, saka maganin gaggawa YANZU. (rFVIIa)** nan da nan (ko gudanar da intranasal ** desmopressin [DDAVP]** idan an wajabta shi don cutar Hemophilia A ko Nau'in 1 von Willebrand). Kunshin ** 2 zuwa 3 ƙarin kwalaye na abubuwan gida na majiyyaci suna mai da hankali ** a cikin jakar da aka keɓe don ɗauka a cikin motar asibiti, kamar yadda asibitocin al'umma akai-akai basa adana kowane takamaiman alama ko samfurin hanawa.
4. **Idan majiyyaci dake dauke da sinadarin jini ko ciwon haemofiliya ya bugi kansa (koda kadan da alamun sifiri), nan da nan yaje sashin gaggawa domin a duba lafiyar sa. Jinin jini a hankali a kwakwalwa (subdural hematoma) sau da yawa yana da "lucid interval" inda mutum ke jin tarar kashi 100 na tsawon sa'o'i da yawa bayan sun yi karo da kai a kan kujera ko kuma su zame a kasa, kafin nan da nan ya zama barci, amai, da kuma fama da ciwon kwakwalwa.
5. Rubuta daidai lokacin agogon da aka haɗiye kwayar ta ƙarshe ta jini (ko allurar subcutaneous na ƙarshe da aka yi). [4F-PCC], Andexanet alfa, Idarucizumab, ko Protamine).
6. Kiyaye majiyyaci kwance, dumi a ƙarƙashin busassun bargo, kuma babu wani abu da baki (NPO) Hypothermia (zazzabi na jiki da ke ƙasa da \(35^\circ\rubutu{C}\) ko \(95^\circ\text{F}\)) yana gurgunta duk wani aikin platelet da enzyme ya rage. Kada ku ba da abinci, ruwa, ko duk wani maganin NSAID masu zafi (kada ku ba da aspirin, ibuprofen, ko naproxen).

Yanayin gaggawa da bishiyar yanke shawara¶

Yi amfani da wannan taswira na asibiti don daidaita sarrafa jini na gida nan take, maye gurbin abubuwa, da kunna maganin maganin asibiti.

flowchart TD
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    SiteCheck -->|"Ee: Duk wani gabatarwa 1 (Ko da ciwon kai yayi kama da ƙarami)"| LifeThreat["JINI MAI BARAZANAR RAYUWA KO RASHIN HANKALI:<br/>Kira 911/112/999 Nan da nan"]

    SiteCheck -->|"A'a: Zubar da hanci, zubar da jini, zubar da jini, kananan yanke, <br/>ko warewar hadin gwiwa/jini na tsoka"| LocalCare["Hemostasis da ake Nufi + Tsarin Gaggawa: <br/> - Ci gaba da matsa lamba kai tsaye 15-30 mins (BABU PEEKING)<br/>- Tranexamic acid (TXA) wankin baki/kwaya idan an rubuta<br/>- R.I.C.E. + Jikowar Factor na gaggawa don zubar jini na haɗin gwiwa / tsoka"]

    LifeThreat --> DisorderType{"Mataki na 2: Shin majiyyaci yana da<br/>Hemophilia / vWD KO shan Maganin Sirin Jini?"}

    DisorderType -->|"Ciwon Jini da Aka Gada:<br/>Hemophilia A, Hemophilia B, ko vWD"| FactorFirst["PROTOCOL A: 'FACTOR FARKO' (Maganin Kafin Bincike) <br/>1. Sanya kashi na gaggawa na Factor VIII / IX / vWF / rFVIIa YANZU <br/> (Ayyukan 80-100% don kai/wuyansa/GI/babban rauni) <br/>2. Kunna akwatunan abubuwan gida na majiyyaci + Wasiƙar Gaggawa ta HTC<br/>3. Aiwatar da ci gaba da matsa lamba kai tsaye / yawon shakatawa idan zubar jini na waje"]

    DisorderType -->|"Maganin Maganin Jini: <br/>Warfarin, DOAC (Apixaban/Rivaroxaban/Dabigatran),<br/>Heparin/Enoxaparin, ko Clopidogrel/Ticagrelor"| ReversalPath["PROTOCOL B: FADAKARWA MAI SAUKAR DA MAGANAR MAGANA<br/>1. Ci gaba da matsa lamba kai tsaye (hemostatic gauze) / yawon shakatawa <br/>2. Gano EXACT sunan magani + EXACT sa'a na kashi na ƙarshe<br/>3. Jijjiga EMS & Asibitin Pharmacy da wuri don shirya maganin rigakafin IV: <br/> - Warfarin -> 4-Factor PCC + IV Vitamin K<br/> - Dabigatran -> Idarucizumab (Praxbind) <br/> - Apixaban / Rivaroxaban -> Andexanet alfa ko 4-Factor PCC"]

    LocalCare --> PersistCheck{"Shin zubar jini yana ci gaba da wuce 20-30 mins<br/> KO kumburin haɗin gwiwa/ tsoka ne a hip, cinya, maraƙi, ko gaban hannu?"}
    PersistCheck -->|"EE"| LifeThreat

Sashe na 1: Gaggawa Gudanar da zubar jini akan Likitan Magungunan Jini (Anticoagulants & Antiplatelet)¶

Miliyoyin manya suna shan magungunan antithrombotic na yau da kullun don fibrillation, thrombosis mai zurfi, bugun jini na huhu, bawul ɗin zuciya na inji, ko tasoshin jijiyoyin jini. Sanin wane nau'in maganin majiyyaci yana da mahimmanci saboda kowane aji yana toshe matakin guda ɗaya na daban kuma yana buƙatar takamaiman maganin asibiti.

Cikakken Maganganun Maganin Ciwon Jiki & Teburin Juyawar Antiplatelet (Jagororin ACC / ASH / ISTH)¶

Dokar "Jin Jini na Kwakwalwa" Bayan Duk wani Ciwon kai akan Sirin Jini¶

Ɗaya daga cikin abubuwan da ke haifar da mutuwa mai yawa a cikin tsofaffi masu shan apixaban, rivaroxaban, dabigatran, warfarin, ko clopidogrel ** shine ƙaramar matakin ƙasa ko buga kai a ƙofar mota, faifai, ko bango inda mutum ** baya rasa hayyacinsa kuma ba shi da ciwon kai kai tsaye bayan haka. - Me yasa wannan tarko ne: A cikin kwanyar, ƙananan ƙananan matsa lamba ** haɗakar da jijiyoyin bugun jini ** ya shimfiɗa a sararin samaniya tsakanin saman kwakwalwa da tauri na waje * dura mater . Wani sanyin murya mai laushi yaga ɗaya daga cikin waɗannan ƙananan jijiyoyi. A cikin mutumin da ke da gudan jini na yau da kullun, jijiyar tana rufewa a cikin mintuna 2. A cikin mutumin da ke da sikari na jini, jijiya tana fitowa sannu a hankali ta ragu da digo har tsawon awanni 3 zuwa 24*. - ** Yarjejeniya Ta Wajaba: *** Manufofin asibiti daga Kwalejin Likitocin Gaggawa na Amurka (ACEP) da UK NICE (NG232 Jagorar Rauni na Shugaban) sun ba da shawarar cewa ** duk wanda ke shan maganin anticoagulant ko P2Y12 antiplatelet wanda ke da tasirin kai tsaye ya kamata a yi gwajin gaggawa na shugaban CT scan a cikin sa'o'i, koda kuwa ba a taɓa samun bugun jini na yau da kullun ba. - Har ila yau, ko da CT scan na farko ya bayyana sarai, babban abin dogara ya kamata ya lura da majiyyaci na tsawon awanni 24 zuwa 72 na gaba don ** jinkirin zubar jini na cikin ciki ** (sabon ciwon kai, rashin bacci, rudani, matsalar daidaito, ko amai).

Sashe na 2: Gudanar da gaggawa na Hemophilia A, Hemophilia B, da von Willebrand Cuta¶

Fahimtar Ciwon Jini da Aka Gada¶

1. Hemophilia A (Classic Hemophilia): Rancin kwayoyin halittar da ke da alaƙa da X na clotting ** Factor VIII (8)**. Rarraba ta hanyar matakin aiki na asali a cikin jini:
2. Mai tsanani (\(<1\%\) Factor VIII Aiki): Zubar da jini na kwatsam zuwa gabobin jiki, zurfafa tsoka, da gabobin jiki koda ba tare da sanin rauni ba.
3. Matsakaicin (\(1%\rubutu{zuwa} }5\%\) aiki): Zubar da jini mai tsanani bayan qananan kusoshi, sprains, ko aikin hakori.
4. Maɗaukaki (\(5%\rubutu{zuwa} }40\%\) aiki): Zubar da jini mai tsanani tare da rauni ko tiyata.
5. Hemophilia B (Cutar Kirsimeti): Rashin zubar jini ** Factor IX (9). A asibiti yayi kama da Hemophilia A cikin tsananin zub da jini, amma ** yana buƙatar Factor IX concentrate (ba da Factor VIII ga majinyacin Hemophilia B ba ya yin komai).
6. ** Marasa lafiya a kan Emicizumab (Hemlibra) ko tare da "Masu hana Factor":**
7. Emicizumab (Hemlibra): Yawancin marasa lafiya da ke ɗauke da Hemophilia A yanzu suna ɗaukar allurar rigakafin rigakafin rigakafi na mako-mako ko kowane wata da ake kira emicizumab wanda ke kwaikwayon Factor VIII don hana zubar jini yau da kullun. Muhimmin Dokar gaggawa: Emicizumab yana ba da kariya ta asali daidai da kusan \(10\%\rubutu{zuwa} } 15 \%\) ayyuka na al'ada, wanda ** bai isa ya dakatar da babban zubar da jini ko zubar da jini ba**. Mara lafiya a kan emicizumab wanda ke fama da rauni a kai ko babban jini ** har yanzu yana buƙatar Factor VIII na cikin jini nan take (ko Factor VIIa na sake haɗawa idan suna da masu hanawa)**.
8. ** Gargaɗi mai Mahimmanci ga Marasa lafiya Mai hanawa akan Emicizumab (Kada a Ba da Babban Dose aPCC / FEIBA):** Har zuwa kashi 30 cikin ɗari na Hemophilia mai tsanani A marasa lafiya suna haɓaka rigakafi na rigakafi (** masu hanawa *) waɗanda ke lalata daidaitattun abubuwan da aka haɗa Factor VIII. A yayin ci gaba da zubar jini a cikin mai hana mai hanawa wanda ya ɗauki ** emicizumab , zaɓin zaɓi na gaggawa shine ** sake haɗawa Factor VII (rFVIIa, NovoSeven / Sevenfact). ** Dole ne a nisantar da babban ko maimaita allurai na Activated Prothrombin Complex Concentrate (aPCC / FEIBA \(>100\rubutu{U/kg/day}\)) a cikin marasa lafiya da ke kan emicizumab, saboda haɗuwa yana haifar da ɗigon jini da kuma ** thrombotic microangiopathy (TMA)**.
9. Von Willebrand Disease (vWD): Cutar da aka fi samun gado a cikin maza da mata, wanda ke haifar da rashi ko lahani a cikin von Willebrand Factor (vWF), “manne” kwayoyin halitta wanda ke taimaka wa platelet su manne bangon jijiyoyin jini da ya yage kuma yana ɗaukar Factor VIII a cikin jini. Yawanci yana haifar da zub da jini mai tsanani ** (jini na hanci wanda ba a iya sarrafa shi, zubar jinin al'ada mai nauyi, jinin danko, da zubar jini na ciki), ana gudanar da shi sosai tare da tranexamic acid, desmopressin (DDAVP) (a cikin masu amsawa na nau'in 1), ko na cikin jini vWF/Factor VIII concentrate as-

"Yankunan Jini na Kisa guda biyar" a cikin Hemophilia (Inda Kumburi ke Kashe Kafin Jin Jini)¶

A cikin hemophilia, mafi munin zubar jini gaba ɗaya ba a iya gani daga waje saboda tafkunan jini a cikin rufaffiyar kogon jiki ko matsattsun sassan jikin. Magance zafi ko kumburi a cikin ɗayan waɗannan yankuna biyar na jiki azaman ** 100% -Gaggawa-Mai Barazana Rayuwa*:

Gane "Haɗin gwiwar Target" Aura da Aiwatar da R.I.C.E. (Plus Factor)¶

Lokacin da zubar jini ya fara a cikin gwiwa, idon kafa, ko haɗin gwiwar gwiwar hannu (** hemarthrosis**), mutanen da ke fama da ciwon haemophilia suna jin wani nau'i na musamman ** "tingling, bubbling, dumi, ko aura" ** a cikin haɗin gwiwa ** 1 zuwa 2 hours kafin *** haɗin gwiwa yana kallon kumbura ko zafi ga wani waje. - Koyaushe yarda da abin da majiyyaci ke ji na “kumburi”: Haɓakar daɗaɗɗen ƙwayar cuta a lokacin farkon tingling aura yana dakatar da zubar jini kafin a lalata guringuntsi. - Haɗa jiko na gaggawa tare da ** R.I.C.E.**: ** R *** est haɗin gwiwa (ba mai ɗaukar nauyi), shafa ** I *** ce a nannade cikin zane na mintuna 15 akan / 15 mintuna, shafa tausasawa **C *** goyon bayan motsin rai idan an jure, kuma E haɓaka gaɓa.

Mataki-mataki-mataki kula da zubar jini na jiki don raunuka na waje da zubar jini¶

Ko majiyyaci yana kan apixaban, warfarin, ko yana da cutar von Willebrand, yi amfani da waɗannan dabaru na musamman don sarrafa zubar jini na waje yayin da ake ci gaba da jujjuyawar likita:

1. Yanke Fatar Waje da Ragewa: Dokokin Matsi na Minti 20 mara karye¶

1. Yi amfani da Gauze na Hemostatic idan Akwai: Idan kayan taimakon farko ɗinku sun ƙunshi ** suturar hemostatic ** ciki tare da ** kaolin ** (QuikClot Combat Gauze / Dressing Control Dressing), ** chitosan** (Celox / ChitoGauze), ko ** oxidized sabunta cellulose shi kai tsaye, shirya ko danna kan jirgin ruwa kai tsaye. Tufafin Chitosan yana aiki ta hanyar cajin lantarki akan jajayen ƙwayoyin jini ko da lokacin da abubuwan da ke tattare da majiyyaci ke toshe su ta hanyar masu ba da jini ko haemophilia.
2. ** Latsa ƙasa da ƙarfi da hannaye biyu kuma fara mai ƙidayar lokaci na tsawon mintuna 20 cikakke:**
3. Kada a yi amfani da dabbing haske. Ka jingina nauyin jikinka ta diddigin hannunka kai tsaye zuwa ga rauni (sai dai idan rauni ne na ido ko fashewar kokon kai).
4. Idan jini ya jike ta gauze pad na farko: KADA a cire kushin da jini ya jike. Cire shi yana kawar da toshewar platelet. Dora busasshen gauze na biyu kai tsaye a saman na farko kuma danna da ƙarfi don ƙarin mintuna 15 zuwa 20.
5. Lokacin da za a Aiwatar da Tafiya: Idan jinin ja mai haske yana tasowa ko kuma yana taruwa cikin sauri daga rauni na hannu ko ƙafa kuma matsa lamba kai tsaye ba zai iya sarrafa shi ba, a shafa yawon shakatawa na iska na kasuwanci \(5\text{ to }8\text{ centimeters}\) (\(2\text{ to }3\text{ inci}\)) sama da raunin, duk lokacin da iskar ta tsaya a kan rauni, sai zubar jini ya tsaya. Kada ku saki jiki kafin ku isa asibiti (duba zub da jini).

2. Jinin Hanci mai tsanani (Epistaxis) akan Sirin Jini ko a vWD/Hemophilia¶

Ciwon hanci shine mafi yawan ziyarar dakin gaggawa ga marasa lafiya akan maganin rigakafi da wadanda ke da cutar von Willebrand. Bi daidai ka'idar zubar jini tare da dogon lokaci: 1. Ki zauna tsaye ki dangana GABA a kugu (Kada ku karkatar da kai baya, wanda ke fitar da jini daga makogwaro zuwa cikin ciki da hanyar iska, yana jawo amai na jini). 2. A hankali busa hanci ** sau daya** don cire sako-sako, jelly-kamar clots marasa tsari, kuma idan kuna da kan-kan-kan-kansa oxymetazoline ($ 0.05 \%$) maganin hanci (Afrin) ko maganin tranexamic acid (TXA), a fesa 2 a cikin hancin hancin jini (ko sanya auduga a cikin hancin oxymetazoline a hankali). gaban hanci). 3. ** Maƙe fuka-fuki masu laushi masu laushi na hanci da ƙarfi a kan septum na tsawon mintuna 20 zuwa 30 na ci gaba da agogo** ba tare da barin sau ɗaya don dubawa ba. 4. Rike fakitin kankara a kan gadar hanci da kumatunta, sannan a tsotse kankara (sanyi rufin baki yana takurawa palatine da jijiyoyin hanci). 5. Lokacin da za'a je sashin gaggawa: Idan har yanzu jinin hanci yana digowa sosai bayan ** mintuna 20 zuwa 30 na ci gaba da tsukewa**, idan jini na zubowa bayan makogwaro (ciwon hancin baya), ko kuma idan mutum ya ji dimuwa, kodadde, ko saurin zuciya.

3. Jinin Baki, Gum, ko Harshe: Hanyar Tranexamic Acid (TXA) & Hanyar Jakar shayi¶

• Don zubar jini a baki, gumi, ko bayan hakoran haƙori a cikin majiyyaci mai fama da ciwon jini ko a kan maganin rigakafi, ** maganin antifibrinolytic ** tare da ** Tranexamic Acid (TXA, Lysteda / Cyklokapron)** ko ** Aminocaproic Acid (Amicar)** yana da mahimmanci saboda jinin ɗan adam yana narkewa da sauri.
• Idan an rubuta, swishing \(10\text{mL}\) na 4.8% ko 5% maganin tranexamic acid a hankali a cikin baki na tsawon mintuna 2 (ko murkushe kwamfutar \(500\text{mg}\) TXA cikin \(10\rubu{mL}\)) na ruwa don yin manna/wanke baki) yana daidaita daskarewar baki sosai.
• A gida, cizon minti 20 zuwa 30 a cikin jakar shayi mai sanyi mai sanyi** an nannade shi da siraran gauze guda ɗaya yana taimakawa rage zub da jini na gut saboda na halitta tannic acid a cikin baƙar fata ganye yana haɓaka vasoconstriction na gida da hazo.

Madaidaicin rubutun sadarwa na 911/112/999 da Triage na Asibiti¶

Saboda dakunan gaggawa na al'umma sukan bambanta marasa lafiya ta hanyar hasarar jini na waje, dole ne ku yi kira a fili "Anticoagulant Reversal" ko "Hemophilia Factor Protocol Farko" a farkon kalma:

• Ga majiyyaci akan Likitan Maganin Magani:

  "Ina bukatan motar asibiti a [Adireshin Daidai] Mai haƙuri shine [Shekaru] mai shekaru [namiji / mace] wanda ke ɗaukar jini na jini [Apixaban / Rivaroxaban / Dabigatran / Warfarin / Clopidogrel] kuma ya sha wahala [jini mara ƙarfi / faɗuwa tare da tasirin kai / zubar jini na ƙarshe]. sashen gaggawa wanda majiyyaci na iya buƙatar jujjuyawar maganin jijiyoyi na cikin jini nan da nan [4-Factor PCC / Andexanet alfa / Idarucizumab]."

• Ga Marasa lafiya tare da Hemophilia ko von Willebrand Cutar:

  • "Ina buƙatar motar asibiti a [Adireshin Daidai] ga mai haƙuri tare da [Mai tsanani Hemophilia A / Hemophilia B / von Willebrand Disease / Hemophilia with Inhibitors]. KAFIN jiran bincike na CT Mun riga mun riga mun shigar da shi/ta) na gida na [Aikin Factor Brand Name] da wasiƙar yarjejeniya ta gaggawa ta Hemophilia."*

Lissafin jeka-bag na asibiti don abubuwan gaggawa na zubar jini¶

• **Ga marasa lafiya na Hemophilia / vWD: Kawo DUKAN akwatunan gida na abubuwan da ke tattare da ƙwayar cuta, vials mai narkewa, alluran sake gyarawa, da kayan jiko ** (ko da zuwa babban asibiti, kawo kayan aikin ku yana hana jinkirin kantin magani na awa 2 yayin da asibiti ya ba da umarnin takamaiman samfurin ku).
• Jami'an majiyyaci "Katin Kulawar Gaggawa na Cutar Jini / Wasiƙar Triage HTC" (wanda ke lissafin matakin tushe, matsayi mai hanawa, dabarar maganin gaggawa na tushen nauyi, da lambar wayar likitan jini na awa 24 akan kira).
• Ga majinyatan Jini: Ainihin kwalaben kwaya na duk maganin kashe jini da kuma maganin sabulu, da daidai lokacin da aka hadiye kwaya ta ƙarshe.
• ** Yawancin aikin koda na baya-bayan nan (creatinine/eGFR) da sakamakon binciken INR ** idan akwai akan aikace-aikacen tashar mara lafiya.

Tambayoyin da ake yawan yi¶

Idan wani yana shan Eliquis (apixaban), Xarelto (rivaroxaban), ko warfarin ya buge kansa da sauƙi kuma ya ji gaba ɗaya, shin da gaske suna buƙatar CT scan na asibiti?¶

Ee. A cikin marasa lafiya da ke shan magungunan kashe-kashe jini, ko da ciwon kai mai laushi ba tare da asara ba na iya yaga wata karamar jijiya mai saurin matsa lamba a saman kwakwalwa. Domin siriri na jini yana hana wannan ɗigon ɗigo daga hatimi, jini na iya zubowa a hankali a cikin kwanyar sama da sa'o'i 3 zuwa 24 (hematoma subdural) tare da alamun sifili da farko ("tsawon lokaci") kafin ya haifar da suma da mutuwa kwatsam; shugaban asibiti na gaggawa CT scan ya kama jinin yayin da har yanzu ana iya jujjuya shi tare da maganin maganin jijiya.

Menene dokar "Factor First" ke nufi a cikin gaggawar haemophilia?¶

The World Federation of Hemophilia (WFH) and National Bleeding Disorders Foundation (NBDF) mandate that whenever a person with hemophilia suffers a head injury, neck swelling, deep abdominal/groin pain, or major trauma, clotting factor concentrate must be infused IMMEDIATELY to raise factor levels to 80 to 100 percent BEFORE waiting for a doctor's examination, X-rays, or a head CT scan. Matsakaicin sanyawa yana ɗaukar mintuna kaɗan kawai, ba ya ɗaukar kusan haɗari idan babu jini, kuma yana dakatar da zubar jini na ciki ko na kwakwalwa a cikin sa'ar da ake ɗauka don kammala hoton asibiti.

Me yasa aka yi la'akari da maƙarƙashiya mai zurfi ko ciwon hip (jini na iliopsoas) a matsayin gaggawa mai barazana ga rayuwa a cikin hemophilia?¶

Jinin iliopsoas yana faruwa a cikin babban tsoka da ke gudana daga ƙananan kashin baya ta ƙashin ƙugu zuwa kwatangwalo. Domin wannan sararin retroperitoneal mai zurfi yana ɓoye a cikin jiki, ba a iya ganin ɓarna a fata, duk da haka har zuwa lita 1 zuwa 3 na jini na iya zubowa a cikin kullin tsoka, yana haifar da barazanar zubar jini mai barazana ga rayuwa yayin da yake murkushe jijiyar femoral kuma yana haifar da gurguntaccen cinya na dindindin. Alamar faɗakarwa ta al'ada ita ce maƙarƙashiya ko ƙananan ciwon baya wanda aka haɗa tare da riƙe hip ɗin lankwasa (mai sassauƙa) da rashin iya daidaita ƙafa.

Me yasa zan riƙe matsi kai tsaye na tsawon mintuna 15 zuwa 30 ba tare da ɗaga gauze ba don bincika ko zubar jinin ya tsaya?¶

A cikin mutumin da ke shan maganin ƙwanƙwasa jini ko kuma yana rayuwa tare da matsalar zubar jini, ƙirƙirar ko da rauni na farko yana ɗaukar tsayi fiye da mintuna 3 zuwa 5 na al'ada. A duk lokacin da ka ɗaga gauze ɗin don “duba” raunin, da injina za ka yaga zaren fibrin masu rauni da platelet ɗin da ke toshe bangon jirgin ruwan da ya yayyage, yana sake fara zubar jini mai nauyi daga karce. Tsaya tsayin daka, matsa lamba mara yankewa akan kushin na akalla mintuna 15 zuwa 30 da agogo, kuma idan jini ya ratsa, sanya kushin na biyu kai tsaye a saman na farko ba tare da cire shi ba.

An duba tushe¶

• ** Ƙungiyar Hemophilia ta Duniya (WFH): *** * Sharuɗɗan WFH don Gudanar da Hemophilia, 3^rd Edition* (Srivastava et al., * Haemophilia *, "Factor First" na gaggawa na gaggawa da matakan da ake nufi don intracranial, retropharyngeal, da iliopsoas hemorrhage).
• National Bleeding Disorders Foundation (NBDF, tsohon National Hemophilia Foundation, United States) Medical and Science Advisory Council (MASAC): Takardar MASAC 275 / Ma'aikatar Gaggawa Gudanar da Mutane masu fama da Hemophilia da Sauran Ciwon Jini (ciki har da gargaɗin aminci akan emicizumab da AP).
• ** Kwalejin Ilimin Zuciya ta Amurka (ACC, Amurka):** * Hanyar Shawarar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun ACC akan Gudanar da Jini a cikin Marasa lafiya akan Maganin Maganin Maganin Maganin Baka* (Tomaselli et al., * Journal of the American College of Cardiology)
• American Society of Hematology (ASH), International Society on Thrombosis and Haemostasis (ISTH), NHF, and WFH: 2021 Guidelines on the Diagnosis and Management of von Willebrand Disease (Blood Advances, James et al. / Connell et al.).
• ** Cibiyar Harkokin Kiwon Lafiya da Kulawa ta Kasa (NICE, United Kingdom): *** Raunin kai: Ƙimar da Gudanarwa da Farko * (NICE Guideline NG232, neuroimaging ma'auni don marasa lafiya da aka hana su).

Jagora masu alaƙa¶

• Tsananin sarrafa zubar jini, tattara raunuka, da yawon shakatawa
• Raunin kai, juzu'i, da zubar jini na cikin ciki da jajayen tutoci
• Jinin hanci (epistaxis) taimakon farko na mataki-mataki
• Zubar da jini na hanji, amai jini, da melena
• Murkushe rauni da ganewar ciwon sashe