Ukuhlolwa kwe-D-Dimer: Lokho Okungakutshela Khona Nokungakwazi Ukukutshela Ngawo Amahlule Egazi

Ukuthatha okhiye

• Ukuhlolwa kwe-D-dimer kuwukuhlolwa okungenamthetho, hhayi ukuhlolwa okungenamthetho, kuwusizo kakhulu lapho umphumela ungemuhle futhi izinsolo zomtholampilo seziphansi kakade.
• I-D-dimer ephakanyisiwe ayiqinisekisi ukuthi kukhona ihlule. Ukutheleleka, ukuhlinzwa, ukulimala, ukukhulelwa, umdlavuza, isifo sesibindi kanye nokuguga konke kuphakamisa i-D-dimer.
• I-D-dimer engemihle ayikususi ukuqhekeka kwegazi uma amathuba okuthola isifo ephezulu; izithombe ziyadingeka kungakhathaliseki ukuthi imiphumela ye-D-dimer injani ezimweni ezinjalo.
• Ukunqunywa kwe-D-dimer, amayunithi kanye nezindlela zokuhlola kuyahluka phakathi kwama-laboratory, ngakho-ke imiphumela evela kuma-laboratory ahlukene ayifani ngqo.
• Ukuqoqwa kwegazi kuthatha imizuzu embalwa; ukuhlolwa kwe-D-dimer ngokwakho akukutsheli ukuthi ihlule likuphi.

Nge-shazi

Obeye aziwe njengo

• Ukuhlolwa kwegazi kwe-D dimer
• Ukuhlolwa kwengxenye yokuwohloka kwe-fibrin
• Ukuhlolwa kwe-D-dimer okunobuningi/okuzwela okuphezulu kwe-D-dimer
• Ngokuvamile eNdiya kucelwa "ukuhlolwa kwe-clot", "ukuhlolwa kwe-DD" noma "umbiko we-D-dimer" kanye nephrofayili yokujiya (PT/INR, aPTT)

Kuyini ukuhlolwa kwe-D-dimer

Uma umzimba wakha ihlule, ubeka phansi i-mesh ye-cross-linked fibrin. Uma lelo hlule liphinde lahlukaniswa yi-enzyme plasmin, izingcezu ezincane zikhishwa egazini. Enye yalezo zingcezu yi-D-dimer. Ukuhlolwa kwe-D-dimer kulinganisa ukuhlushwa kwalezi zingcezu.

Ngakho-ke i-D-dimer ibonisa ukwakheka kwamahlule kanye nokuwohloka okwenzeka endaweni ethile emzimbeni. Ayisho ukuthi ihlule likuphi, kungani, likhulu kangakanani noma lidala kangakanani. Ayikwazi ukuhlukanisa ihlule emthanjeni womlenze nokujika kwe-fibrin okubangelwa yi-pneumonia, ukuhlinzwa kwamuva noma ukulimala.

Amalabhorethri ahlukene asebenzisa amapulatifomu ahlukene okuhlola. Amanye abika ngamayunithi e-D-dimer kanti amanye kumayunithi alinganayo e-fibrinogen, acishe abe kabili. Ngenxa yalokhu, inombolo evela kwelinye ilabhorethri akufanele iqhathaniswe ngqo nenombolo evela kwelinye. Njalo funda umphumela ngokuqhathanisa nobubanzi bokubhekisela obuphrintiwe kulowo mbiko othize.

Kungani kwenziwa ukuhlolwa kwe-D-dimer

• I-Deep Vein Thrombosis (DVT) esolwayo: Ithole noma ithanga elibuhlungu, elivuvukile, elifudumele. I-D-dimer engemihle esigulini esithole amaphuzu angenakwenzeka ku-DVT yenza i-DVT ingenzeki ngokwanele ukuthi i-ultrasound yemilenze ingagwenywa.
• I-embolism yamaphaphu esolwayo (PE): ukuphelelwa umoya ngokuzumayo, ubuhlungu besifuba obuhambisana ne-pleuritic, ukushaya kwenhliziyo okusheshayo okungachazeki. I-D-dimer isetshenziswa ngemuva kokuhlolwa kwamathuba omtholampilo (njengeWells noma iGeneva), hhayi ngaphambi kwayo.
• Ukujiya kwegazi okusolwayo okusakazekile ngaphakathi kwemithambo yegazi (DIC): I-D-dimer yakha ingxenye eyodwa yephaneli yokulinganisa i-DIC kanye nenani lama-platelet, isikhathi se-prothrombin kanye ne-fibrinogen. I-D-dimer iyodwa ayihloli i-DIC.
• Ukunquma ubude besikhathi sokuvimbela ukujiya kwegazi: Kwezinye iziguli ezine-venous thrombosis engavuswanga, i-D-dimer elinganiswe ngemva kokuyeka ukuvimbela ukujiya kwegazi ingasiza umahluleli ochwepheshe ukuba aphinde avele. Lesi yisinqumo sochwepheshe, hhayi esivamile.
• Ukusoleka kokusikwa kwe-aorta: Ngezinye izikhathi i-D-dimer isetshenziswa njengengxenye yokuhlola ubungozi, kodwa ayithathi indawo yesithombe esiphuthumayo lapho kusolwa ukuthi kukhona ukuhlukaniswa kwezicubu.

Ubani okufanele athole lolu vivinyo

• Abantu abanezimpawu eziphakamisa ukuthi i-DVT noma i-PE odokotela abahlole ukuthi ziyizimpawu zabo. okuphansi noma okuphakathi amathuba omtholampilo.
• Iziguli ezihlolwa i-DIC ngokwesimo se-sepsis esibi, ukulimala okukhulu, izinkinga zokubeletha noma umdlavuza othile.
• Iziguli ezikhethiwe ezine-venous thromboembolism engavuswanga zihlolwa ngudokotela we-hematologist ukuthi zizoqhubeka isikhathi esingakanani nokuvimbela ukujiya kwegazi.

Ubani okungafanele akwenze lokhu kuhlolwa?

• Abantu ku high amathuba omtholampilo e-PE noma i-DVT, badinga ukuthwetshulwa kwezithombe ngqo, ngoba i-D-dimer engemihle ngeke ishintshe ukuphathwa.
• Abantu abangenazo izimpawu abafuna ukuhlolwa "kokuhlolwa kwamahlule". I-D-dimer akuyona ukuhlolwa kokuhlolwa kwabantu abaphilile futhi ivame ukukhiqiza imiphumela ephakeme eholela ekuhlolweni okungadingekile.
• Abantu abacishe babe nomphumela ophakeme futhi ongenakuchazeka kubo, isibonelo ngokushesha ngemva kokuhlinzwa okukhulu, ngaphandle kokuthi kubuzwa umbuzo othile wezokwelapha.

Lokho ukuhlolwa kwe-D-dimer okungenakukuthola noma okungakubandakanyi

• Ayikwazi ukuthola ihlule. I-D-dimer ephakanyisiwe ayinikezi ulwazi mayelana nokuthi yisiphi isitsha esithintekayo. Kudingeka izithombe.
• Ayikwazi ukuqinisekisa i-DVT noma i-PE. Ukucaciswa kuphansi. Abantu abaningi abane-D-dimer ephakanyisiwe abanawo nhlobo amahlule.
• Akunakwenzeka ukuthi i-clot ingasuswa ngokuthembekile ezigulini ezinamathuba aphezulu okutheleleka. Kuleli qembu i-D-dimer evamile isashiya ingozi engamukeleki engamukeleki, ngakho-ke ukuthwebula izithombe kuyaqhubeka noma kunjalo.
• Amahlule amancane, akude noma amadala angase angakhulisi i-D-dimer ngokwanele. I-thrombi encane ye-calf vein ehlukanisiwe, i-embolism encane ye-pulmonary subsegmental kanye nama-clots anezinsuku noma amasonto ambalwa ubudala kungahlotshaniswa nomphumela ojwayelekile noma ocishe ube ojwayelekile.
• Ukuvimbela ukujiya kwegazi kwehlisa i-D-dimer. Isiguli esivele sithatha i-heparin, i-warfarin noma i-anticoagulant yomlomo eqondile singase sibe ne-D-dimer evamile naphezu kwe-thrombosis.
• Ayihloli ingozi yokopha futhi akuthathi indawo ye-PT/INR, i-aPTT noma inani lama-platelet.
• Ayihloli umdlavuza, i-COVID-19, ukuhlaselwa yinhliziyo noma isifo sohlangothi, noma i-D-dimer ingakhuphuka kuzo zonke lezi zinto.

I-"ayitholakalanga" noma i-D-dimer evamile ichaza lokho okuhlolwayo okulinganiswe kuleyo sampula ngaleso sikhathi. Akufani nokuthi ihlule likhishwe. Uma ukuphelelwa umoya, ubuhlungu besifuba noma ukuvuvukala kwemilenze kuqhubeka noma kuba kubi naphezu kwe-D-dimer evamile, buyela kudokotela wakho.

Ukuhlolwa okuhlobene kodwa okuhlukile: indlela ukuhlolwa kwe-D-dimer okuqhathaniswa ngayo

Lezi zivivinyo ziphendula imibuzo ehlukene. Akukho neyodwa kuzo engcono kakhulu emhlabeni wonke; ukuhlolwa kokuqala okufanele kuncike ekwethulweni kwezokwelapha kanye nokuthi kungenzeka kangakanani ukuthi ihlule libonakale likhona.

Futhi hlukanisa i-D-dimer eseceleni kombhede/indawo yokunakekelwa esezingeni eliphezulu nokuhlolwa kwelebhu okunozwela oluphezulu. Ukuhlolwa okunozwela oluphezulu kuphela okuqinisekiswayo ukuze kukhishwe i-PE ngokuphephile ezindleleni zokuxilonga.

Indlela yokulungiselela ukuhlolwa kwe-D-dimer

Ukulungiselela kuncane kakhulu, kodwa imiyalelo ibekwa endaweni yilabhorethri ngayinye. Lapho imiyalelo yesikhungo sakho sokuqoqa ihlukile kunoma yini engezansi, landela isikhungo sakho sokuqoqa.

• Ukuzila ukudla: ngokuvamile akudingekile ekuhlolweni kwe-D-dimer. Yidla futhi uphuze ngokujwayelekile ngaphandle kokuthi ukudonswa kwegazi okufanayo kufaka phakathi ukuhlolwa okudinga ukuzila ukudla.
• Imithi: Tshela udokotela ocelayo kanye nodokotela we-phlebotomist ngama-anticoagulant (i-heparin, i-warfarin, i-apixaban, i-rivaroxaban, i-dabigatran), ama-antiplatelet kanye nanoma yikuphi ukwelashwa kwe-thrombolytic. Ungayeki noma ushintshe noma yimuphi umuthi owunikezwe yi-prescribe for this test, khuluma nodokotela kuqala.
• Imicimbi yakamuva: khuluma ngokuhlinzwa kwakamuva, ukulimala, ukwaphuka, ukungeniswa esibhedlela, ukutheleleka, ukuhamba ibanga elide, ukwelashwa komdlavuza osebenzayo noma ukulahlekelwa noma ukubeletha muva nje, njengoba konke lokhu kuthonya incazelo.
• Ukufakwa kwamanzi emzimbeni kanye nemithambo yegazi: Ukuba namanzi anele kwenza kube lula ukudonswa. Uma unemikhawulo yoketshezi ngenxa yokwehluleka kwenhliziyo noma isifo sezinso, ungandisi umthamo wakho woketshezi kulolu vivinyo, gcina umkhawulo obekwe udokotela wakho.
• Izingubo: umkhono okhululekile ogoqeka ngaphezu kwendololwane uyasiza.

ukukhulelwa

I-D-dimer ikhuphuka kancane kancane ngesikhathi sokukhulelwa okuvamile futhi ihlala iphakanyisiwe esikhathini sokuqala kokubeletha. Imikhawulo ejwayelekile ayisebenzi kahle ngesikhathi sokukhulelwa, futhi izindlela ze-PE okusolwa ukuthi ikhulelwe ziyahlukahluka. Tshela ithimba ukuthi ukhulelwe noma usanda kubeletha ngaphambi kokuba kuthathwe isampula.

Izingane

I-D-dimer ayisetshenziswa kakhulu ezinganeni futhi izikhawu zokubhekisela ziyahlukahluka ngokweminyaka, ikakhulukazi ezinsaneni ezisanda kuzalwa. Imiphumela yezingane idinga ukuchazwa kwezingane.

Abantu abadala abadala

I-D-dimer iyanda ngokuguga. Odokotela abaningi basebenzisa indlela yokusika elungisiwe ngokweminyaka yeziguli ezingaphezu kweminyaka engama-50 lapho behlola i-PE esolwayo, okunciphisa izithombe ezingadingekile. Ukuthi umkhawulo olungisiwe ngokweminyaka usetshenziswa yini kuncike ekuhlolweni kanye nenqubo yendawo.

Abantu asebevele besebenzisa ama-anticoagulant

Ukuvimbela ukujiya kwegazi kunciphisa i-D-dimer futhi kungaveza umphumela oqinisekisayo ngamanga. Ukuhlolwa akunalo ulwazi oluningi kumuntu osevele eselashwa. Qhubeka nomuthi wakho owunikeziwe bese wazisa udokotela ukuthi uyawuthatha.

Isifo sezinso noma isibindi

I-D-dimer ivame ukuba phezulu ezifweni zezinso ezingamahlalakhona ezithuthukile kanye nasezifweni zesibindi ezingamahlalakhona, ngaphandle kwanoma yikuphi ukugoba. Lokhu kunciphisa ukusebenza komkhawulo ojwayelekile kula maqembu.

Kwenzekani ngesikhathi sokuhlolwa kwe-D-dimer

• Ukubhalisa nokuhlola: imininingwane yakho kanye nemiyalelo kadokotela eceliwe kuqinisekisiwe.
• Ukuqoqwa kwegazi: Kufakwa i-tourniquet, kuhlanzwe isikhumba esingaphakathi kwendololwane, bese igazi lidonswa lifakwe epayipini le-citrate, ngokuvamile eliluhlaza okwesibhakabhaka ngaphezulu. Ipayipi kumele ligcwaliswe kuze kube umugqa ophawuliwe, njengoba ukugcwalisa ngaphansi kungenza isampula ingasebenzi.
• Isikhathi: inaliti ivame ukuba semthanjeni isikhathi esingaphansi komzuzu. Ukudonsa konke kuthatha cishe imizuzu emihlanu, futhi abantu abaningi basuke bengena futhi bephuma endaweni yokuqoqwa zingakapheli imizuzu eyi-15-30.
• Ngemva kwalokho: kufakwa ingcindezi umzuzu owodwa noma emibili bese kufakwa ibhandeji elincane. Umsebenzi ojwayelekile ungaqhubeka ngokushesha. Gwema ukuphakamisa okunzima ngaleyo ngalo ihora noma ngaphezulu uma indawo ibuhlungu.
• Iyacubungula: isampula ifakwa ku-centrifuge bese ihlaziywa ku-automated coagulation analyzer. Eminyangweni yezimo eziphuthumayo, i-D-dimer ivame ukuqhutshwa ngokushesha ngoba umphumela uthinta izinqumo ezisheshayo; ukujika kwesiguli esigulayo njalo kuthatha isikhathi eside futhi kubekwa yilabhorethri ngayinye.

Ukuqonda umbiko wakho we-D-dimer

Funda inombolo ngokuqhathanisa nobubanzi bereferensi kanye neyunithi ephrintiwe embikweni wakho. Izinto ezimbili kumele zifane ngaphambi kokuba noma yikuphi ukuqhathanisa kube nomqondo: uhlelo lweyunithi (i-DDU noma i-FEU) kanye neplatifomu yokuhlola.

• Umphumela ongaphansi komkhawulo webhulebhu: esigulini esinodokotela osevele ehlulele ukuthi i-clot ayinakwenzeka, lokhu kwenza i-DVT noma i-PE ingenzeki ngokwanele kangangokuthi izithombe ngokuvamile azidingeki. Akusho ukuthi akukho qhubu elingaba khona.
• Umphumela ongaphezu komkhawulo webhulebhu: Lokhu kusho ukuthi i-fibrin iyaqhekeka ndawana thize. Kuvamile, kuvame ukuba nencazelo yokungaqhekeki, futhi ngokwako akusona isifo. Isinyathelo esilandelayo esijwayelekile ukuthwebula izithombe okuqondiwe ngokusekelwe ezimpawini, i-leg Doppler yokuskena okusolwayo kwe-DVT, i-CTPA noma i-V/Q ukuze kuhlolwe i-PE okusolwayo.
• Imiphumela ephezulu kakhulu: amanani aphezulu ngokwezibalo angase ahlotshaniswe ne-thrombosis, kodwa akukho nombolo eyodwa eqinisekisa ukuqhekeka kwegazi, futhi akukho mkhawulo ongaphezu kwalokho okungase kweqiwe khona izithombe.

Ukuhlolwa kwe-D-dimer akukaze kuhunyushwe kukodwa. Kuhunyushwa kanye nezimpawu zakho, okutholakele ekuhlolweni, izici eziyingozi kanye namaphuzu amathuba omtholampilo ngudokotela okucelile. Imiphumela iyahlukahluka kuye ngezimo zomtholampilo ngazinye.

Uma imiphumela ye-D-dimer ingadukisa

Izimbangela ze-D-dimer ephakanyisiwe ngokungeyikho noma engaphakanyisiwe ngokuqondile

• Ukukhula ngeminyaka, ngisho noma kungekho sifo
• Ukukhulelwa kanye nesikhathi sokubeletha
• Ukuhlinzwa kwakamuva, ukulimala, ukwaphuka noma ukuphuka okukhulu
• Ukutheleleka kanye ne-sepsis, okuhlanganisa i-pneumonia enzima kanye ne-dengue
• Umdlavuza osebenzayo
• Isifo sesibindi esingamahlalakhona kanye nesifo sezinso esingamahlalakhona esithuthukile
• Ukuhlaselwa yinhliziyo kwakamuva, isifo sohlangothi, i-atrial fibrillation noma ukwehluleka kwenhliziyo
• Isifo sokuvuvukala kanye nesokuzivikela komzimba
• I-hematoma enkulu, ukusha noma i-thrombolysis yakamuva
• I-rheumatoid factor kanye nama-antibodies athile e-heterophile aphazamisa ukuhlolwa
• Amasampula ane-hemolysis noma i-lipidaemic acacile, kuye ngokuthi ipulatifomu ikuphi

Izimbangela ze-D-dimer eyehlisiwe ngokungeyikho

• Ukwelashwa kwe-anticoagulant sekuqalile kakade
• Ihlule elincane, elihlukaniswe emithanjeni ye-calf ekude, noma engxenyeni engaphansi
• Izimpawu ziba khona izinsuku eziningi, lapho i-D-dimer kungenzeka ukuthi isiwile khona
• Ishubhu le-citrate elingagcwalisiwe kahle elihlanza isampula
• Ukuthutha okulibazisekile noma ukugcinwa okungalungile kwesampula
• Amazinga aphezulu kakhulu e-lipid noma e-bilirubin aphazamisa ezinye izivivinyo zokubona
• Akuvamile ukuthi "umphumela we-hook" ube nokugxila okuphezulu kakhulu ekuhlolweni okuthile

Izingozi nokuphepha kokuhlolwa kwe-D-dimer

Ukuhlolwa kwe-D-dimer kudinga kuphela isampula yegazi elijwayelekile lemithambo yegazi. Izingozi zingaba zanoma yikuphi ukubhoboza kwegazi futhi ngokuvamile zincane.

• Okuvamile nokuncane: ukuhlaba okufushane, ukudumba okuncane, ubuhlungu obuncane endaweni yokubhoboza.
• Okungajwayelekile kakhulu: uzizwa ubuthakathaka noma unekhanda elibuhlungu, unesilonda esikhulu (kungenzeka kakhulu uma uthatha ama-anticoagulant noma ama-antiplatelet), kudingeka umzamo wesibili uma umthambo unzima.
• Akuvamile: iqoqo elincane legazi ngaphansi kwesikhumba, ukutheleleka kwendawo, noma ukucasuka kwesikhashana kwemizwa okubangela ukuqaqamba.

Tshela udokotela we-phlebotomist kusengaphambili uma uke waquleka ngesikhathi sokuhlolwa kwegazi ngaphambilini, unesifo sokopha, uthatha imithi yokunciphisa igazi, noma une-lymphoedema noma i-dialysis fistula engalweni eyodwa ukuze kusetshenziswe enye ingalo.

Izimo ezikhethekile

Ukukhulelwa kanye nesikhathi sokubeletha

I-D-dimer ikhuphuka ngokujwayelekile phakathi nezinyanga ezintathu, ngakho-ke umphumela okhuphukile ekukhulelweni uvame ukukhombisa ukukhulelwa uqobo. I-PE esolwayo ekukhulelweni ihlolwa kusetshenziswa izindlela ezenzelwe ukukhulelwa, ezingase zihilele i-leg Doppler kuqala, bese kuba yi-V/Q scan noma i-CTPA kanye nokucabangela umthamo. Izinqumo lapha zenziwa amaqembu okubelethisa kanye nezokwelapha ndawonye.

Izingane

I-venous thrombosis ayivamile ezinganeni futhi ivame ukwenzeka ngomugqa ophakathi, ukutheleleka okukhulu noma isimo esingaphansi. I-D-dimer ayikaqinisekiswa ezinganeni njengoba iqinisekisiwe kubantu abadala, ngakho-ke izinqumo zezingane zincike kakhulu ekuthathweni kwezithombe nasekuhlolweni kwezokwelapha.

Abantu abadala abadala

Ngenxa yokuthi i-D-dimer eyisisekelo iyanda ngokuguga, umkhawulo ohleliwe uphawula ukuthi abantu abaningi asebekhulile abanempilo abaphilile abavamile. Umkhawulo olungisiwe ngeminyaka uvame ukusetshenziswa kubantu abasolwa nge-PE engaphezu kweminyaka engu-50 ukunciphisa ukuskena okungadingekile, lapho ukuhlolwa kusekela lokho.

Abantu abanesifo sikashukela

Akukho ushintsho oludingekayo emithini yokwehlisa ushukela egazini ekuhlolweni kwe-D-dimer, ngoba ukuzila ukudla akuvamile ukudingeka. Uma ukudonswa kwegazi kuhlanganiswa nokuhlolwa kokuzila ukudla, xoxani nodokotela kuqala ngesikhathi sokusetshenziswa kwe-insulin noma i-sulfonylureas ukuze kugwenywe i-hypoglycemia.

Isifo sezinso ezingapheli

I-D-dimer ivame ukuba phezulu ku-CKD ethuthukile ngaphandle kwamahlule. Uma kudingeka izithombe, ukusetshenziswa kokungafani kwe-CTPA kudinga ukulinganisela ukusebenza kwezinso, okuzohlolwa yithimba elilaphayo.

Ukuhluleka kwenhliziyo

I-D-dimer ingakhuliswa ekuhlulekeni kwenhliziyo okungenamali kanye ne-atrial fibrillation, kanti ukuphelelwa umoya ngenxa yokwehluleka kwenhliziyo kungafana ne-PE. Ungandisi uketshezi oludliwayo ngaphambi kokuhlolwa uma unqunyelwe uketshezi.

Cancer

Umdlavuza osebenzayo ukhulisa i-D-dimer futhi ukhulisa ingozi yangempela yokuqhekeka kwegazi, ngakho-ke ukuhlolwa kulahlekelwa ikhono layo elikhulu lokuhlukanisa. Izithombe zivame ukukhethwa kusenesikhathi kubantu abanomdlavuza.

Ukuhlolwa kwe-D-dimer kumongo waseNdiya

• Ukwanda okubangelwa ukutheleleka kuvamile. I-dengue, umkhuhlane wamathumbu, isifo sofuba, i-pneumonia enzima kanye ne-sepsis konke kuphakamisa i-D-dimer. Esigulini esinomkhuhlane, i-D-dimer ephakanyisiwe ivame ukuchazwa ukutheleleka hhayi yi-clot.
• Imikhuba yokuhlola ngemva kwe-COVID. I-D-dimer yaqala ukusetshenziswa kabanzi ngesikhathi sobhubhane futhi ngezinye izikhathi isacelwa kubantu abangenazo izimpawu zokuqhekeka kwegazi. Ngaphandle kombuzo ophuthumayo wezokwelapha, i-D-dimer kumuntu ophilile ivame ukubangela ukukhathazeka kanye nokuskena kwe-CT okungadingekile kunokuba kube sobala.
• I-venous thromboembolism ayiqashelwa kahle. I-DVT kanye ne-PE zazibhekwa njengezingavamile kubantu baseNingizimu Asia, futhi lokho kucabanga kusabambezela ukuxilongwa. I-thrombosis yangemva kokuhlinzwa, yangemva kokubeletha kanye nokukhubazeka kokunyakaza iyenzeka futhi kufanele icatshangelwe uma izimpawu zihambisana.
• Isifo senhliziyo esihambisana ne-rheumatic kanye ne-atrial fibrillation zihlala zivame kakhulu futhi zingahlotshaniswa nokuphakama kwe-D-dimer kanye nemicimbi ye-cardioembolic.
• Amasampula e-anemia kanye ne-hemolysis. Ukudonsa okunzima kanye nesampula ye-hemolysis kungathinta amanye amapulatifomu okuhlola; isampula ephindaphindwayo ingacelwa.
• Ukwehluka kokuhlolwa phakathi kwamalebhu. Amalabhorethri aseNdiya asebenzisa amapulatifomu amaningana ahlukene kanye nezinhlelo zamayunithi. Phatha umbiko wokuqala hhayi inombolo kuphela lapho ubona udokotela omusha, bese ulindela ukuphindwa esikhundleni sokuqhathanisa okuqondile.

Izindleko kanye nomshuwalense eNdiya

Ukuhlolwa kwe-D-dimer kuwukuhlolwa kwelabhorethri okutholakala njalo, okunentengo esukela ku-low kuya ku-middle ukuze kuphenywe ngokujiya kwegazi. Izindleko ziyahlukahluka kakhulu phakathi kwamadolobha, phakathi kwezikhungo zokuqoqa ezizimele kanye nama-laboratory ezibhedlela, kanye naphakathi kokucubungula okuvamile nokuphuthumayo. Buza ilabhorethri ngesilinganiso sayo samanje ngaphambi kokuba kuthathwe isampula.

Yini ethinta intengo:

• Ipulatifomu yokuhlola esetshenzisiwe, ukuhlolwa kwenani okunozwela oluphezulu ngokuvamile kubiza kakhulu kunekwekhwalithi
• Ukucutshungulwa okuphuthumayo noma kwezibalo uma kuqhathaniswa nokuhlanganiswa okuvamile
• Kungakhathaliseki ukuthi ukuhlolwa kuzimele noma kuhlanganiswe kuphaneli yokujiya noma yezimo eziphuthumayo
• Izindleko zesibhedlela uma kuqhathaniswa nezelabhorethri ezizimele, kanye nezinga ledolobha
• Izindleko zokuqoqa amasampula ekhaya
• Isimo sokugunyazwa kwelebhu

Umshwalense: uma ukuhlolwa kwe-D-dimer kwenziwa ngesikhathi sokwamukelwa noma sokunakekelwa kwasemini, kuvame ukumbozwa njengengxenye yesimangalo sokulaliswa esibhedlela, kuye ngemigomo yenqubomgomo. Uphenyo lweziguli zangaphandle luvame ukumbozwa kuphela uma inqubomgomo ifaka inzuzo ye-OPD noma ikhava ethile yokuxilonga. Izigaba zesifo ezikhona kakade kanye nezikhathi zokulinda zingasebenza. Qinisekisa nomshwalense wakho noma ideski lomshwalense wesibhedlela ngaphambi kokuthatha ikhava.

Izinganekwane namaqiniso

Imibuzo ejwayelekile ukubuzwa

Iyini i-D-dimer test esetshenziselwa yona?

Ukuhlolwa kwe-D-dimer kusiza odokotela ukuthi banqume ukuthi i-deep vein thrombosis noma i-pulmonary embolism akunakwenzeka yini ukugwema izithombe, ezigulini esezihlolwe njengengozi ephansi noma ephakathi. Ukuhlolwa kwe-D-dimer nakho kunegalelo ezinhlelweni zokuthola amaphuzu okusabalalisa i-intravascular coagulation, kanye nenani lama-platelet, isikhathi se-prothrombin kanye ne-fibrinogen.

Kuthatha isikhathi esingakanani ukuhlolwa kwe-D-dimer?

Ukudonswa kwegazi ngokwako kuthatha cishe imizuzu emihlanu, futhi abantu abaningi bachitha imizuzu eyi-15-30 esikhungweni sokuqoqa igazi okuhlanganisa nokubhalisa. Ukuhlaziywa kwelabhorethri kuyashesha kuma-analyzer azenzakalelayo, futhi iminyango yezimo eziphuthumayo ivame ukucubungula i-D-dimer ngokuphuthumayo. Isikhathi sokubika esijwayelekile sesiguli esingalaliswa esibhedlela sinqunywa yilabhorethri ngayinye, buza ukuthi unikeza nini isampula.

Ingabe kudingeka ngizile ukudla ngaphambi kokuhlolwa kwe-D-dimer?

Ukuzila ukudla ngokuvamile akudingeki ekuhlolweni kwe-D-dimer, ngakho ungadla futhi uphuze ngendlela evamile. Uma ukuvakasha okufanayo kuhlanganisa ukuhlolwa kokuzila ukudla okufana nama-lipid noma i-glucose yokuzila ukudla, landela leyo miyalelo esikhundleni salokho. Uma uthatha amaphilisi e-insulin noma esifo sikashukela futhi ucelwa ukuba uzile ukudla, xoxa ngesikhathi nodokotela wakho kuqala.

I-D-dimer yami iphakanyisiwe kodwa ukuskena kwami ​​​​bekujwayelekile. Manje kuzokwenzekani?

Lokhu kuyinhlanganisela evamile futhi evame ukuqinisekisa. I-D-dimer ephakanyisiwe enezithombe ezijwayelekile eziqondisiwe ivame ukukhombisa ukutheleleka, ukuvuvukala, ukuhlinzwa kwamuva, ukukhulelwa, ubudala noma enye imbangela yokungaqhekeki kwamahlule. Udokotela wakho uzofuna leyo ncazelo. Buyela ngokushesha uma kukhula ukuphelelwa umoya, ubuhlungu besifuba noma ukuvuvukala kwemilenze.

Ingabe ukuhlolwa kwe-D-dimer kungaba yiphutha?

Ukuhlolwa kwe-D-dimer kuyazwela kodwa akuqondile, ngakho-ke imiphumela ephakanyisiwe ivame ukwenzeka ngaphandle kwehlule. Imiphumela ephansi ngamanga ingenzeka nge-anticoagulation, amahlule amancane noma akude, izimpawu ezihlala izinsuku eziningi, noma ishubhu lesampula elingagcwalisiwe ngokwanele. Ukuchazwa kuhlale kuncike emathubeni omtholampilo ahlolwe udokotela wakho.

Ingabe i-D-dimer ifana nephrofayili yokujiya noma i-PT/INR?

Cha. I-PT/INR kanye ne-aPTT zilinganisa ukuthi igazi liwakha kahle kangakanani amahlule futhi zisiza ekuhloleni ingozi yokopha noma ukunqunywa kwe-warfarin. Ukuhlolwa kwe-D-dimer kulinganisa izingcezu ezisele ngemva kokuqhekeka kwamahlule. Ziphendula imibuzo ephikisanayo futhi azikwazi ukushintshaniswa, yize zombili zingacelwa ndawonye.

Ingabe kufanele ngihlolwe i-D-dimer uma ngizizwa ngiphilile kodwa ngikhathazekile ngamahlule?

Ngokuvamile cha. Ukuhlolwa kwe-D-dimer akuqinisekisiwe njengokuhlolwa kokuhlolwa kubantu abangenazo izimpawu. Kubantu abaphilile kuvame ukubuyisela inani eliphakanyisiwe kancane, elingachazeki eliholela ekukhathazekeni nasekuhlolweni kwe-CT okungagwenywa. Xoxa ngezinto zakho eziyingozi nodokotela esikhundleni salokho.

Ingabe ukusebenzisa imithi yokwehlisa igazi kuthinta imiphumela ye-D-dimer?

Yebo. Ama-anticoagulant afana ne-heparin, i-warfarin, i-apixaban, i-rivaroxaban kanye ne-dabigatran anciphisa amazinga e-D-dimer futhi angaveza umphumela oqinisekisayo ngokungeyikho. Tshela ilabhorethri kanye nodokotela ocelayo ukuthi uthatha ini. Ungayeki noma ulungise noma iyiphi i-anticoagulant ukuze uhlolwe ngaphandle kokukhuluma nodokotela.

Kungani i-D-dimer yami iphezulu ngesikhathi sokukhulelwa?

Ukukhulelwa ngokwemvelo kwandisa umsebenzi we-clotting factor kanye nokujika kwe-fibrin, ngakho-ke i-D-dimer iyanda phakathi nezinyanga ezintathu futhi ihlale iphakanyisiwe ngemva kokubeletha. Ngakho-ke, imikhawulo ejwayelekile ayisebenzi kahle ekukhulelweni. Ukuqunjelwa okusolwayo ekukhulelweni kuhlolwa kusetshenziswa izindlela ezithile zokukhulelwa, ngokuvamile kuqala nge-leg Doppler ultrasound.

Imithombo

• I-National Institute for Health and Care Excellence (NICE), isiqondiso ngezifo ze-venous thromboembolic: ukuxilongwa, ukuphathwa kanye nokuhlolwa kwe-thrombophilia (NG158).
• Iziqondiso ze-European Society of Cardiology mayelana nokuxilongwa nokuphathwa kwe-acute pulmonary embolism.
• Iziqondiso ze-American Society of Hematology mayelana ne-venous thromboembolism: ukuxilongwa kwe-venous thromboembolism.
• Isiqondiso se-International Society on Thrombosis and Haemostasis mayelana nokuxilongwa nokuphathwa kwe-disseminated intravascular coagulation.
• Isiqondiso se-Clinical and Laboratory Standards Institute mayelana nokuhlolwa kokuqina kwegazi, ukuqoqwa kwamasampula kanye nokugcwaliswa kwamashubhu e-citrate.