Go Dula Madi go go Tsenyang Botshelo mo Kotsing mo Diokobatsing tse di Sesanelang Madi kgotsa mo Bolwetseng jwa Hemophilia¶

Fa motho yo o nwang diokobatsi tse di fokotsang madi a mantsi (diokobatsi tse di thibelang madi go tlhotlhorega kgotsa tse di thibelang madi go tlhotlhorega) kgotsa a tshela ka bolwetse jwa go dutla madi jo bo ruilweng ka boswa (Hemophilia A, Hemophilia B, kgotsa Bolwetse jwa von Willebrand) a kgaoga, a wa, a thunya mo tlhogong, kgotsa a tswa madi mo teng ga nako e e tlwaelegileng. Ka gonne bokgoni jwa mmele jwa go bopa letlowa le le tlhomameng la fibrin kana polaka ya dipolatelete bo thibetswe ke dikhemikale kgotsa bo seyo ka ntlha ya dijini, tota le go phatloga go sekae ga letlalo la tlhogo, go tswa madi mo nkong kgotsa go thunya go go lebegang go le botlhofo mo tlhogong go ka tswelela pele go fitlha go tswa madi go go bolayang kgotsa go gatelelwa ga boboko. Thuso ya ntlha e tlhoka kgatelelo e e tlhamaletseng e e atolositsweng, e e sa ineeleng (bonnye metsotso e le 15 go ya go e le 30 e e tswelelang pele kwantle ga go tlhodumela), e e laolwang ke Mokgatlho wa Lefatshe Lotlhe wa Hemophilia (WFH) molao wa "FACTOR FIRST / Alafa Pele, Sekaseka jalo Bobedi", le kitsiso ya tshoganyetso ya bookelo ka bonako ka nako e e beilweng ditlhopha di ka baakanyetsa dipilisi tse di rileng tsa go busetsa morago ga ditshika pele ga ambulense e goroga.

Dira se jaanong¶

1. Dirisa kgatelelo e e tswelelang, e e tiileng e e tlhamaletseng mo mading ape a a tswang kwa ntle metsotso e e tletseng e le 15 go ya go e le 30 kwantle ga go tsholetsa gauze go tlhola. Tobetsa fa fatshe ka thata ka tlhamalalo mo godimo ga ntlha ya madi o dirisa gauze e e senang megare, seaparo se se thibelang madi (jaaka gauze ya kaolin kgotsa chitosan), kgotsa clothd e e phepa. O se ka wa tsholetsa letsela metsotso mengwe le mengwe e le 2 go bona gore a madi a eme: mo molwetseng yo o dirisang dipilisi tse di fokotsang madi kgotsa yo o nang le hemophilia, go tsholetsa pad go gagola polaka e e bopang e e bokoa mme go seta gape tshupanako ya go dutla madi go nna lefela. Go tswa madi a a tshologang mo letsogong a a tshosetsang botshelo a a ka se emeng ka kgatelelo e e tlhamaletseng, dirisa tourniquet ya windlass \(5\text{ go ya go }8\text{ disentimetara}\) (\(2\text{ go ya go }3\text{ diintšhe}\)) fa godimo ga ntho (bona go dutla madi).
2. Leletsa nomoro ya gago ya tshoganyetso ya selegae ka bonako fa go na le go dutla madi thata kwa ntle, kgobalo epe ya tlhogo/molala/sehuba/mpa, kgotsa matshwao a go dutla madi mo teng. Letsetsa 911 kwa United States le Canada, 112 go ralala European Union, 999 kwa United Kingdom, kgotsa bona tsotlhe dinomoro tsa tshoganyetso. Bolelela moromedi ka tlhamalalo leina le le tlhomameng la melemo (ka sekai, "Apixaban," "Rivaroxaban," "Dabigatran," "Warfarin," kgotsa "Clopidogrel") kgotsa bolwetse jo bo tlhomameng jwa go dutla madi ("Hemophilia A e e Masisi e e nang le dithibela-malwetse).
3. Fa molwetse a na le Bolwetse jwa Hemophilia kgotsa von Willebrand mme a na le seokobatsi sa ntlha ya gae mo seatleng, tshela selekanyo sa tshoganyetso JAANONG. Latela porothokholo ya tshoganyetso ya Lefelo la Kalafi ya Hemophilia (HTC) la molwetse go bopa sešwa le go tshela Seokobatsi sa Ntlha ya VIII, Ntlha ya IX, seokobatsi sa Will. VIIa (rFVIIa) ka bonako (kgotsa go tsenya desmopressin [DDAVP] mo dinkong fa e le gore e laetswe bolwetse jo bo seng bogale jwa Hemophilia A kgotsa jwa Mofuta wa 1 wa von Willebrand). Paka mabokoso a mangwe a le 2 go ya go a le 3 a seokobatsi sa molwetse sa kwa gae mo kgetsaneng e e sireleditsweng go tsenya mo ambulenseng, ka gonne dikokelo tsa baagi gantsi ga di boloke letshwaokgwebo lengwe le lengwe le le rileng la ntlha kgotsa setlhagiswa sa thibela.
4. Fa molwetse yo o mo diokobatsing tse di fokotsang madi kgotsa yo o nang le bolwetse jwa hemophilia a ka itaya tlhogo (le fa e le botlhofo fela a se na matshwao a bolwetse jono), ya kwa Lefapheng la Maemo a Tshoganyetso ka bonako go ya go dira CT ya Tlhogo. Go tswa madi mo teng ga tlhogo ke gone go bakang loso lo logolo mo balwetseng ba hemophilia le ba ba nang le diokobatsi tse di thibelang madi go ema. Go tswa madi ka bonya mo bobokong (subdural hematoma) gantsi go na le "lucid interval" mo motho a ikutlwang a siame diperesente di le lekgolo ka lobaka lwa diura di le mmalwa morago ga go thula tlhogo ya gagwe mo khabineteng kgotsa go relela fa fatshe, pele ga a otsela ka tshoganyetso, a kgwa, le go boga ka herni ya boboko e e bolayang.
5. **Kwala nako e e tlhomameng ya tshupanako e pilisi ya bofelo ya seokobatsi se se fokotsang madi e neng ya mediwa ka yone (kgotsa tlhabelo ya bofelo e e neng ya tsenngwa ka fa tlase ga letlalo). sethibela-malwetse (Seokobatsi sa Dilo tse di Raraaneng tsa Prothrombine sa Dintlha di le 4 [4F-PCC], Andexanet alfa, Idarucizumab, kgotsa Porotamine).
6. Boloka molwetse a robetse a le sephaphathi, a thutafetse ka fa tlase ga dikobo tse di omileng, mme a sa je sepe ka molomo (NPO). Go nna le mogote o o kwa tlase (thempheretšha ya mmele e e kwa tlase ga \(35^\circ\text{C}\) kgotsa \(95^\circ\text{F}\)) go dira gore tiro epe fela ya dipolatelete le enzyme e e setseng e swa bogatsu. O se ka wa mo naya dijo, metsi kgotsa diokobatsi dipe tsa NSAID tse di okobatsang ditlhabi (le ka motlha o se ka wa mo naya aspirin, ibuprofen kgotsa naproxen).

Setlhare sa tshwetso ya go tlhaola ka tshoganyetso le go busetsa madi morago¶

Dirisa tšhate eno ya kalafi go gokaganya taolo ya go dutla madi kwa gae ka bonako, go emisetsa dintlha, le go tsenngwa tirisong ga seokobatsi sa bookelo.

flowchart TD
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    SiteCheck -->|"NNYAA: Go tswa madi mo nkong, go tswa madi mo molomong, go segwa go sekae,<br/>kgotsa go tswa madi mo lelokololong/mesifeng e e kgaoganeng"| LocalCare["Go thibela madi go go ikaeletsweng + Go tlhaola ka bonako:<br/>- Kgatelelo e e tswelelang ka tlhamalalo Metsotso e le 15-30 (GA GO TLHOKOMELE)<br/>- Setlhatswamolomo/pilisi ya Tranexamic acid (TXA) fa e laetswe<br/>- R.I.C.E. + Tshelo ya Ntlha ya Ka bonako ya go dutla madi mo malokololong/mesifeng"]

    LifeThreat --> DisorderType{"Kgato 2: A molwetse o na le<br/>Hemophilia / vWD KGOTSA o nwa Diokobatsi tse di Sesanelang Madi?"}

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    DisorderType -->|"Seokobatsi se se Sesanetseng Madi: Warfarin, DOAC (Apixaban/Rivaroxaban/Dabigatran),<br/>Heparin/Enoxaparin, kgotsa Clopidogrel/Ticagrelor"| ReversalPath["POROTOKOLO B: TLHOKOMEDISO YA GO BUSEDIWA MORAGO GA DILO TSE DI LWANTSANG MADI<br/>1. Kgatelelo e e tswelelang e e tlhamaletseng (gase e e thibelang madi) / sethibela<br/>2. Supa leina la seokobatsi LE LE TOTA + Ura e e TOTA ya selekanyo sa bofelo<br/>3. Tlhagisa EMS le Khemisi ya Bookelo go sa le gale go baakanya Setlhare sa IV: Warfarin -> PCC ya Mabaka a le 4 + Bitamine ya IV - Dabigatran - Idarucizumab (Praxbind) - Apixaban / Rivaroxaban -> kgotsa Andexanet P4factor"]

    LocalCare --> PersistCheck{"A go tswa madi go tswelela go feta metsotso e le 20-30<br/>KGOTSA a go ruruga ga malokololo/mesifa mo nokeng, mo seropeng, mo namaneng, kgotsa mo letsogong la pele?"}
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Karolo 1: Taolo ya tshoganyetso ya go dutla madi ka Diokobatsi tse di Sesanelang Madi (Diokobatsi tse di Thibelang Madi go Elela le Dipolatelete)¶

Dimilionemilione tsa batho ba bagolo di nwa melemo e e thibelang go elela ga madi letsatsi le letsatsi ya go roroma ga madi mo ditshikaneng, go elela ga madi mo ditshikaneng tse di kwa teng, go elela ga madi mo makgwafong, dibelofo tsa pelo tsa metšhini kgotsa di- stent tsa ditshika tsa pelo. Go itse ke setlhopha sefe sa seokobatsi se molwetse a se nwang go botlhokwa thata ka gonne setlhopha sengwe le sengwe se thibela kgato e e farologaneng gotlhelele ya go tlhotlhorega ga madi mme se tlhoka seokobatsi se se rileng sa bookelo.

Lenaneo le le Tletseng la go Busetsa Dithibela-Madi le Dipolatelete (Dikaelo tsa ACC / ASH / ISTH)¶

Molao wa "Go Diega go Tswa Madi mo Bobokong" Morago ga go Thula Tlhogo epe mo Dithinreng tsa Madi¶

Nngwe ya dilo tse di bakang loso lo lo ka thibelwang kgapetsakgapetsa mo bagolong ba ba godileng ba ba nwang apixaban, rivaroxaban, dabigatran, warfarin, kgotsa clopidogrel ke go wa go sekae fa fatshe kgotsa go thula tlhogo mo lebating la koloi, mo shelofong, kgotsa mo leboteng moo motho **a sa latlhegelweng ke tlhaloganyo morago ga go idibala mme a na le setlhabi sa go idibala. - Ke ka ntlha yang fa seno e le serai: Mo teng ga legata, ditshika tse dinnye tsa kgatelelo e e kwa tlase tse di kopanyang di otlolla go kgabaganya sebaka sa subdural fa gare ga boalogodimo jwa boboko le dura mater e e thata ya kwa ntle. Go tshikhinyega go go seng kalo go gagola nngwe ya ditshika tseno tse dinnye. Mo mothong yo o nang le go tlhotlhorega go go tlwaelegileng, mothapo o tswalega mo metsotsong e le 2. Mo mothong yo o mo setlhatswaneng sa madi, mothapo o elela ka iketlo lerothodi ka lerothodi ka diura di le 3 go ya go di le 24. - Porothokholo e e Tlamang: Dipholisi tsa kalafi go tswa kwa Kholetšheng ya Dingaka tsa Maemo a Tshoganyetso ya Amerika (ACEP) le UK NICE (Kaelo ya Dikgobalo tsa Tlhogo tsa NG232) di akantsha gore mongwe le mongwe yo o nwang seokobatsi se se thibelang madi go ema kgotsa seokobatsi sa P2Y12 se se thibelang dipolatelete yo o tswelelang go ama tlhogo ka tlhamalalo o tshwanetse go dira tlhatlhobo e e potlakileng kwa bookelong knocked out mme o nne le tlhatlhobo e e tlwaelegileng ya methapo gone jaanong. - Gape, le fa CT scan ya ntlha ya tlhogo e bonala sentle, mogolo yo o ikanyegang o tshwanetse go ela tlhoko molwetse mo diureng tse di latelang tsa 24 go ya go di le 72 go bona go tswa madi mo tlhogong go go diegileng (go opiwa ke tlhogo go gosha, go robala go go sa tlwaelegang, go tlhakana tlhogo, bothata jwa go nna tekatekano, kgotsa go kgwa).

Karolo 2: Go laola ka tshoganyetso Bolwetse jwa Madi A, Madi B, le Bolwetse jwa von Willebrand¶

Go Tlhaloganya Malwetse a a Ruilweng a go Dula Madi¶

1. Hemophilia A (Hemophilia ya Bogologolo): Go tlhaela ga dijini go go golaganeng le X ga go tlhotlhorega ga madi Ntlha ya VIII (8). E arogantswe go ya ka selekanyo sa tiro ya ntlha ya motheo mo mading:
2. Go masisi (\(<1\%\) Tiro ya Factor VIII): Go tswa madi ka go itiragalela fela mo manonyeletsong, mo mesifeng e e kwa teng, le mo dirweng le fa go sena kgobalo e e itsiweng.
3. Magareng (\(1\%\text{ go ya go }5\%\) tiro): Go dutla madi thata morago ga dithuthuntshwane tse dinnye, go phatloga, kgotsa tiro ya meno.
4. Botlhofo (\(5\%\text{ go ya go }40\%\) tiro): Go dutla madi thata ka kgobalo kgotsa karo.
5. Hemophilia B (Bolwetse jwa Keresemose): Go tlhaela ga go tlhotlhorega madi Ntlha ya IX (9). E tshwana le Hemophilia A ka kalafi ka bokete jwa go dutla madi, mme e tlhoka Ntlha ya IX e e tseneletseng (go naya molwetse wa Hemophilia B Ntlha ya VIII ga go dire sepe).
6. Balwetse ba ba mo Emicizumab (Hemlibra) kgotsa ba ba nang le "Dithibela-Dilo":
7. Emicizumab (Hemlibra): Balwetse ba le bantsi ba ba nang le Hemophilia A jaanong ba tlhabelwa beke le beke kgotsa kgwedi le kgwedi ka fa tlase ga letlalo la go tlhokomela twantsho e e bidiwang emicizumab e e etsisang Ntlha ya VIII go thibela go tswa madi letsatsi le letsatsi. Molao o o botlhokwa wa tshoganyetso: Emicizumab e neelana ka tshireletso ya motheo e e lekanang le tiro ya ntlha e e ka nnang \(10\%\text{ go ya go }15\%\), e E SA lekaneng go emisa go dutla madi go gogolo ga kgobalo kgotsa go dutla madi mo bobokong. Molwetse yo o mo emicizumab yo o gobetseng mo tlhogong kgotsa yo o tswang madi a mantsi o sa ntse a tlhoka go tsenngwa ga Factor VIII ka bonako mo tshikeng (kgotsa Factor VIIa e e kopantsweng sešwa fa e le gore ba na le dithibela-madi).
8. Tlhagiso e e Botlhokwa ya Balwetse ba ba Thibelang Emicizumab (O se ka wa Naya aPCC / FEIBA ya Selekanyo se se Kwa Godimo): Go fitlha go diperesente di le 30 tsa balwetse ba ba masisi ba Hemophilia A ba nna le dilwantsha-masole tsa mmele (dithibela) tse di senyang Ntlha ya VIII e e tsenngwang e e tlwaelegileng. Ka nako ya go dutla madi go go thubegileng mo molwetseng yo o dirisang thibela-emisi yo o tsayang emicizumab, kalafi ya tshoganyetso e e tlhophiwang ke Ntlha ya VII e e dirilweng sešwa (rFVIIa, NovoSeven / Sevenfact). Ditekanyo tse di kwa godimo kgotsa tse di boaboelediwang tsa Seokobatsi sa Prothrombin e e Dirilweng (aPCC / FEIBA \(>100\text{ U/kg/letsatsi}\)) di tshwanetse go tilwa ka tlhoafalo mo balwetseng ba ba dirisang emicizumab, ka gonne motswako ono o baka go tlhotlhorega ga madi a a kotsi le iTMAang ya go tlhotlhorega ga madi a mantsi.
9. Bolwetse jwa Von Willebrand (vWD): Bolwetse jo bo tlwaelegileng thata jwa go dutla madi jo bo ruiwang mo banneng le mo basading, jo bo bakiwang ke go tlhaela kgotsa bokoa mo von Willebrand Factor (vWF), e leng "sekgomaretsi" sa molekhule se se thusang dipolatelete go ngaparela mabota a ditshika tsa madi tse di gagogileng mo moleng wa madi wa VIII. Ka tlwaelo e baka go dutla madi a mantsi mo legogong (go dutla madi a mantsi mo nkong go go sa laolegeng, go dutla madi thata mo kgweding, go dutla madi mo marinining, le go dutla madi mo maleng), go laolwa ka bogale ka esiti ya tranexamic, desmopressin (DDAVP) (mo balwetseng ba ba tsibogang ba V/FIII ya Mofuta wa V/FIII (jaaka Humate-P, Wilate, kgotsa Vonvendi).

"Mafelo a Matlhano a a Bolayang a go Tshola Madi" mo Hemophilia (Mo go Rurugang go Bolayang Pele Madi a Bonwa)¶

Mo bolwetseng jwa hemophilia, madi a a bolayang thata ga a bonale gotlhelele fa o le kwa ntle ka gonne madi a kokoana mo teng ga dikhutsi tse di tswetsweng tsa mmele kgotsa mo dikarolong tse di gagametseng tsa fascial. Alafa botlhoko kgotsa go ruruga mo go epe ya dikarolo tseno tse tlhano tsa mmele jaaka Maemo a Tshoganyetso a a Tshosetsang Botshelo a 100%-Level:

Go lemoga Aura ya "Kopano e e Ikaeletsweng" le go Dirisa R.I.C.E. (Tlhakantsho Ntlha)¶

Fa madi a simolola go tswa mo teng ga lelokololo la lengole, lekhutshwane, kgotsa sekgono (hemarthrosis), batho ba ba nang le hemophilia ba utlwa "aura e e tlhaolegileng, go budulela, bothitho, kgotsa go gagamala" mo teng ga lelokololo diura di le 1 go ya go di le 2 pele ga lelokololo le lebega le rurugile kgotsa le le mogote mo mothong yo o tswang kwa ntle. - Ka metlha dumela maikutlo a molwetse a "bubbling": Go tsenya clotting factor ka nako ya aura eo ya ntlha ya go tlhotlhorega go emisa madi pele ga lefufuru le senyega. - Kopanya tshelo ya ntlha ya ka bonako le R.I.C.E.: Rest lelokololo (ga e rwale bokete), tshasa Ice e e phuthetsweng ka letsela metsotso e le 15 mo / metsotso e le 15 e tima, tshasa tshegetso e e bonolo ya Compression fa e itshokelwa, mme E.mblevate li

Taolo ya go dutla madi mo mmeleng kgato ka kgato ya dintho tse di kwa ntle le go dutla madi mo dinkong¶

Le fa molwetse a ka tswa a le mo apixaban, warfarin, kgotsa a na le bolwetse jwa von Willebrand, dirisa mekgwa eno e e kgethegileng go laola go dutla madi kwa ntle fa go ntse go busediwa morago ga kalafi:

1. Go Sega le go Phatloga ga Letlalo la Kwa Ntle: Molao wa Kgatelelo e e sa Kgaogeng wa Metsotso e le 20¶

1. Dirisa Gauze e e Thibelang Madi fa e le Teng: Fa e le gore sedirisiwa sa gago sa thuso ya potlako se na le sethibela madi se se tsentsweng ka kaolin (Gause ya Ntwa ya QuikClot / Seaparo sa go Laola Madi), chitosan (Celox / ChitoGauze), kgotsa **se se gateletsweng mo ditshikaneng ka tlhamalalo, se se tlhabolotsweng sešwa Di- dressing tsa chitosan di dira ka maatla a motlakase mo diseleng tse dikhibidu tsa madi le fa dilo tse di dirang gore madi a tlhotlhorege a thibetswe ke diokobatsi tse di dirang gore madi a nne masesane kgotsa ke bolwetse jwa hemophilia.
2. Tobetsa Fatshe ka Thata ka Diatla ka Bobedi o bo o Simolola Sebalanako Metsotso e le 20 e e Tletseng:
3. O se ka wa dirisa go tlhotlhora go go botlhofo. Ikaega ka bokete jwa mmele wa gago ka serethe sa seatla sa gago ka tlhamalalo mo lebading (ntle le fa e le kgobalo ya leitlho kgotsa go robega ga legata le le bulegileng).
4. Fa madi a ka ina mo sethibelong sa ntlha sa gauze: O SE KE wa tlosa sethibela se se kolobeditsweng ke madi. Go se tlosa go gagola polaka ya dipolatelete e e bopang. Fapa sethibela gauze sa bobedi se se omileng ka tlhamalalo mo godimo ga sa ntlha mme o tobetse thata metsotso e mengwe e le 15 go ya go e le 20.
5. Nako ya go Dirisa Tourniquet ya Ditokololo: Fa madi a mahibidu a a galotseng a tshologa kgotsa a kokoana ka bonako go tswa mo lebadi la letsogo kgotsa la leoto mme kgatelelo e e tlhamaletseng e sa kgone go e laola, dirisa tourniquet ya kgwebo ya windlass w \(5\text{ go ya go }8\text{ centimeters}\) ($2\text{ go ya go }3 windlass go fitlha madi otlhe a ema gotlhelele, kwala nako mo mogala, mme o se ke wa e bofolola pele ga o fitlha kwa bookelong (bona go dutla madi).

2. Go tswa madi a mantsi mo nkong (Epistaxis) mo Diokobatsing tse di Sesanelang Madi kgotsa mo vWD / Hemophilia¶

Go tswa madi mo nkong ke gone go tlwaelegileng thata go etela kwa phaposing ya maemo a tshoganyetso ga balwetse ba ba dirisang diokobatsi tse di thibelang madi go ema le ba ba nang le bolwetse jwa von Willebrand. Latela tlhomamo porothokholo ya go tswa madi mo nkong ka nako e e atolositsweng: 1. Nna o tlhamaletse mme o sekame go se kae kwa PELE mo lethekeng (o se ke wa sekamisa tlhogo kwa morago, se se ntshang madi go ya kwa tlase mo kgokgotsong go tsena mo mpeng le mo tseleng ya mowa, se se tsosang go kgwa ga madi). 2. Buka nko ka bonolo gangwe go tlosa matlhotlhora a a sa bopegang a a tshwanang le jeli, mme fa o na le oxymetazoline (\(0.05\%\)) seporei sa nko se se rekwang kwa khaontareng (Afrin) kgotsa tharabololo ya tranexamic acid (TXA) e e tsenngwang mo tharabololong ya ngaka, gasetsa diporei di le 2 tsa go tsenya mo mading oxymetazoline kgotsa TXA ka bonolo mo pele ga nko). 3. Pinch diphuka tse di boleta, tse di nang le nama tse di kwa tlase tsa nko ka thata kgatlhanong le septum metsotso e le 20 go ya go e le 30 e e tswelelang ka tshupanako o sa e tlogele gangwe fela go tlhola. 4. Tshwara sephuthelwana sa aese go kgabaganya borogo jwa nko le marama, mme o anye aese (go tsidifatsa marulelo a molomo go pitlaganya ditshika tsa palatine le tsa nko). 5. O ka ya leng kwa Lefapheng la Maemo a Tshoganyetso: Fa madi a a tswang mo nkong a sa ntse a rotha ka matlhagatlhaga morago ga metsotso e le 20 go ya go e le 30 ya go tswelela o tshwaratshwara, fa madi a tshologela kwa morago ga mometso (madi a nko a a kwa morago), kgotsa fa motho a ikutlwa a tsewa ke sedidi, a le mosetlha, kgotsa a na le pelo e e bofefo.

3. Go Dula Madi mo Molomong, mo Marine, kgotsa mo Lelemeng: Mokgwa wa Tranexamic Acid (TXA) le Kgetsi ya Teye e e Metsi¶

• Fa go dutla madi mo molomong, mo marinining, kgotsa morago ga go ntshiwa ga leino mo molwetseng yo o nang le bothata jwa go dutla madi kgotsa yo o mo dipilising tse di thibelang madi go ema, kalafi ya go thibela madi go tswa madi ka Esiti ya Tranexamic (TXA, Lysteda/Cyklokapron) kgotsa Esiti ya Aminocaproic (Amicarcked) e e nang le ensaeme ya tlholego ya mathe e botlhokwa thata mo bathong (plasmin) tse di tlhaolosang matlhotlhora a madi ka bonako.
• Fa go laetswe, go tlhotlhora \(10\text{ mL}\) ya 4.8% kgotsa 5% ya tharabololo ya tranexamic acid ka bonolo mo molomong metsotso e le 2 (kgotsa go thubaganya letlapa la TXA la \(500\text{ mg}\) mo metsing a a tlhomameng go dira pheisete/go tlhatswa molomo ka tsela e e tshosang) go tlhomama.
• Kwa gae, go loma ka thata metsotso e le 20 go ya go e le 30 mo kgetsaneng e e tsidifetseng, e e kolobeditsweng ya teye e ntsho e e phuthetsweng ka llaga e le nngwe ya gauze e tshesane go thusa go fokotsa go tswa madi mo soketeng ya marinini ka gonne tannic acid ya tlholego mo matlhareng a teye e ntsho e rotloetsa go pitlagana ga ditshika tsa selegae le go elela ga diporoteine.

Mokwalo o o tlhomameng wa tlhaeletsano wa 911 / 112 / 999 le Tlhopho ya Bookelo¶

Ka gonne gantsi diphaposi tsa maemo a tshoganyetso tsa baagi di tlhaola balwetse ka go latlhegelwa ke madi a a bonalang a a tswang kwa ntle, o tshwanetse go bitsa ka tlhamalalo "Phetolo ya Anticoagulant" kgotsa "Porothokholo ya Ntlha ya Ntlha ya Hemophilia" mo lefokong la ntlha fela:

• Go Molwetse yo o mo Dipilisi Tse di Sesanetseng Madi:

  "Ke tlhoka ambulense kwa [Atereseng e e Tlhomameng]. Molwetse ke [Dingwaga] [monna/mosadi] yo o nwang seokobatsi se se fokotsang madi [Apixaban / Rivaroxaban / Dabigatran / Warfarin / Clopidogrel] mme o nnile le [thulano e e sa laolegeng ya go tswa madi mo tlhogong / go wa ga madi. Leina, X mg] e ne ya tsewa ka [Nako e e Tlhomameng Tsweetswee tsibosa lephata la maemo a tshoganyetso la bookelo le le amogelang gore molwetse a ka nna a tlhoka go busediwa morago ka bonako seokobatsi se se thibelang madi go ema mo ditshikaneng [4-Factor PCC / Andexanet alfa / Idarucizumab]."

• Go Molwetse yo o nang le Bolwetse jwa Madi kgotsa jwa von Willebrand:

  *"Ke tlhoka ambulense kwa [Aterese e e Tlhomameng] ya molwetse yo o nang le [Bolwetse jo bo Masisi jwa Hemophilia A / Hemophilia B / von Willebrand / Hemophilia e e nang le Dithibela]. go emisetsa ka bonako 'Factor First' go dira tiro ya diperesente di le 100 PELE ga re leta di-CT scans tsa go tlhatlhoba bolwetse.

Lenaanenetefatso la go-bag la bookelo la maemo a tshoganyetso a go dutla madi¶

• Go balwetse ba Hemophilia / vWD: Tlaya le mabokoso OTLHE a kwa gae a clotting factor concentrate, di-vial tsa diluant, dinalete tsa go bopa gape, le dilwana tsa go tshela madi (le fa o ya kwa bookelong jo bogolo, go tla ka ditlamelo tsa gago go thibela tiego ya khemisi ya diura di le 2 fa bookelo bo ntse bo otara setlhagiswa sa gago se se rileng).
• "Karata ya Tlhokomelo ya Tshoganyetso ya Bothata jwa Madi / Lekwalo la HTC Triage" la semmuso la molwetse (le le kwadilweng mo lenaaneng la selekanyo sa ntlha ya motheo, seemo sa thibela, fomula ya selekanyo sa tshoganyetso e e ikaegileng ka bokete, le nomoro ya mogala ya ngaka ya madi e e leletsang diura di le 24).
• Go balwetse ba Blood Thinner: Mabotlolo a dipilisi tsa mmatota a di-anticoagulant tsotlhe le di-antiplatelet, mmogo le nako e e tlhomameng ya tshupanako e pilisi ya bofelo e neng ya mediwa ka yone.
• Dipholo tsa bošeng tsa tiro ya diphilo (creatinine/eGFR) le tsa laboratori ya INR fa di le teng mo app ya portal ya molwetse.

Dipotso tse di bodiwang kgapetsakgapetsa¶

Fa motho yo o nwang Eliquis (apixaban), Xarelto (rivaroxaban) kgotsa warfarin a thula tlhogo go se kae mme a ikutlwa a tlwaelegile gotlhelele, a tota o tlhoka go tlhatlhobiwa ka CT scan kwa bookelong?¶

Ee. Mo balwetseng ba ba nwang diokobatsi tse di fokotsang madi a mantsi, tota le go thunya go se kae ga tlhogo kwantle ga go idibala go ka gagola mothapo o monnye o o kopanyang wa kgatelelo e e kwa tlase o o mo godimo ga boboko. Ka gonne sedirisiwa se se fokotsang madi se thibela go dutla go go nnye goo go tswalega, madi a ka elela ka iketlo mo legatleng mo lobakeng lwa diura di le 3 go ya go di le 24 (hematoma ya subdural) ka matshwao a lefela kwa tshimologong ("the lucid interval") pele ga a baka go idibala ka tshoganyetso le loso; CT scan e e potlakileng ya tlhogo ya bookelo e tshwara madi fa a sa ntse a ka busediwa morago ka dipilisi tse di tsenngwang mo ditshikaneng.

Molao wa "Ntlha Pele" o kaya eng mo maemong a tshoganyetso a hemophilia?¶

Mokgatlho wa Lefatshe Lotlhe wa Hemophilia (WFH) le Mokgatlho wa Bosetšhaba wa Mathata a go Tshola Madi (NBDF) o laela gore nako le nako fa motho yo o nang le bolwetse jwa hemophilia a gobala mo tlhogong, a ruruga molala, a utlwa botlhoko jo bo tseneletseng mo mpeng/mo sehubeng, kgotsa a utlwa botlhoko jo bogolo, go tshwanetse ga tsenngwa selekanyo sa go tlhotlhorega ga madi KA BONAKO go fitlha go100 go ya go100. a letetse go tlhatlhobiwa ke ngaka, go tlhatlhobiwa ka di- X-ray kgotsa go tlhatlhobiwa ka CT scan ya tlhogo. Infusing factor e tsaya metsotso fela, ga e bake kotsi epe fa go se na madi a a tswang, mme e emisa go dutla madi go go bolayang mo teng kgotsa mo bobokong mo ura e e tsewang go wetsa go tsaya ditshwantsho kwa bookelong.

Ke ka ntlha yang fa botlhoko jo bo tseneletseng jwa mo sehubeng kgotsa mo nokeng (go tswa madi mo iliopsoas) bo tsewa e le boemo jwa tshoganyetso jo bo ka tsenyang botshelo mo kotsing mo bolwetseng jwa hemophilia?¶

Go tswa madi ga iliopsoas go diragala mo teng ga mesifa e megolo e e tswang mo mokwatleng o o kwa tlase go feta mo lethekeng go ya kwa lethekeng. Ka gonne sebaka seno se se tseneletseng sa retroperitoneal se fitlhegile mo teng ga mmele, ga go na mabadi ape a a bonalang mo letlalong, le fa go ntse jalo madi a a ka fitlhang go dilitara di le 1 go ya go di le 3 a ka tshologela mo kgapetleng ya mesifa, a baka go tshoga ga madi go go ka tsenyang botshelo mo kotsing fa a ntse a thubaganya mothapo wa femoral le go baka parasis ya serope ya sennelaruri. Letshwao la tlhagiso la bogologolo ke botlhoko jwa mokwatla kgotsa jwa mokwatla o o kwa tlase jo bo kopantsweng le go tshwara letheka le obegile (le obegile) le go sa kgone go tlhamalatsa leoto.

Ke ka ntlha yang fa ke tshwanetse go tshwara kgatelelo e e tlhamaletseng metsotso e le 15 go ya go e le 30 e e tletseng ke sa tsholetse gauze go bona gore a madi a eme?¶

Mo mothong yo o nwang diokobatsi tse di thibelang madi go ema kana yo o tshelang ka bothata jwa go dutla madi, go bopa le eleng legogo le le bokoa la ntlha go tsaya lobaka lo loleele thata go feta metsotso e e tlwaelegileng e le 3 go ya go e le 5. Nako le nako fa o tsholetsa gauze pad go "tlhodumela" mo nthong, o gagola ka motšhini ditlhale tsa fibrin tse di bokoa le polaka ya dipolatelete mo leboteng le le gagogileng la sejana, o simolola gape go dutla madi a mantsi go tswa kwa tshimologong. Boloka kgatelelo e e tiileng, e e sa kgaotseng mo sethibeng bobotlana metsotso e le 15 go ya go e le 30 ka tshupanako, mme fa madi a ka ina, baya sethibela sa bobedi ka tlhamalalo mo godimo ga sa ntlha kwantle ga go se tlosa.

Metswedi e tlhotlhomisitswe¶

• Mokgatlho wa Lefatshe Lotlhe wa Bolwetse jwa Madi (WFH): Dikaelo tsa WFH tsa Taolo ya Bolwetse jwa Madi, Kgatiso ya bo3 (Srivastava et al., Bolwetse jwa Madi, "Ntlha ya Ntlha" ya go tlhaola ka tshoganyetso le maemo a dintlha tse di ikaeletsweng tsa di-hemophilia tse di mo teng ga tlhogo, tse di kwa morago ga tlhogo, le tse di kwa morago ga tlhogo).
• Mokgatlho wa Bosetšhaba wa Mathata a go Dula Madi (NBDF, e e kileng ya bo e le Mokgatlho wa Bosetšhaba wa Hemophilia, United States) Lekgotla la Bogakolodi la Kalafi le Saense (MASAC): Tokomane ya MASAC 275 / Lefapha la Tshoganyetso Taolo ya Batho ba ba nang le Hemophilia le Mathata a mangwe a go Dula Madi (go akaretsa le tlhagiso ya pabalesego ya FEBACC/EPCC).
• Kholetšhe ya Amerika ya Pelo (ACC, United States): Tsela ya Tshwetso ya Tumelano ya Baitseanape ba ACC ya 2020 ka ga Taolo ya go Dula Madi mo Balwetseng ba ba Nwang Dithibela-Madi tsa Molomo (Tomaselli et al., Jenale ya Kholetšhe ya Amerika ya Pelo, diporothokholo tsa go busetsa morago tsa 4F-PCC, al.
• Mokgatlho wa Amerika wa Thuto ya Madi (ASH), Mokgatlho wa Boditšhabatšhaba wa go Tlhatlhoba Madi le go Thibela Madi (ISTH), NHF, le WFH: Dikaelo tsa 2021 tsa go Tlhatlhoba le go Laola Bolwetse jwa von Willebrand (Kgatelopele ya Madi, James le ba bangwe / Connell le ba bangwe).
• Setheo sa Bosetšhaba sa Boitekanelo le Tlhokomelo ya Boleng jo bo kwa Godimo (NICE, United Kingdom): Kgobalo ya Tlhogo: Tlhatlhobo le Taolo ya Pele (Kaelo ya NICE NG232, dikelo tsa go tsaya ditshwantsho tsa methapo ya balwetse ba ba nang le dithibela-madi).

Dikaedi tse di tsamaelanang¶

• Go laola go dutla madi thata, go phuthela ntho, le di- tourniquet
• Dikgobalo tsa tlhogo, go roroma ga tlhogo, le go dutla madi mo teng ga tlhogo difolaga tse dikhibidu
• Go tswa madi mo dinkong (epistaxis) thuso ya potlako kgato ka kgato
• Go dutla madi mo mpeng, go kgwa madi le melena
• Kgobalo ya go thubega le go lemoga bolwetse jwa karolo