{"id":22422,"date":"2023-04-16T18:01:09","date_gmt":"2023-04-16T11:01:09","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22422"},"modified":"2023-04-17T12:25:00","modified_gmt":"2023-04-17T05:25:00","slug":"dai-cuong-hoi-chung-xuat-huyet-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/dai-cuong-hoi-chung-xuat-huyet-o-tre-em\/","title":{"rendered":"\u0110\u1ea1i c\u01b0\u01a1ng h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft \u1edf tr\u1ebb em"},"content":{"rendered":"

Xu\u1ea5t huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u ch\u1ea3y ra kh\u1ecfi th\u00e0nh m\u1ea1ch, xu\u1ea5t huy\u1ebft c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft n\u1ed9i hay xu\u1ea5t huy\u1ebft ngo\u1ea1i (nh\u01b0 ch\u1ea3y m\u00e1u m\u0169i, tai, \u00e2m \u0111\u1ea1o, h\u1eadu m\u00f4n, da…). H\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng, th\u1eadm ch\u00ed l\u00e0 t\u1eed vong.<\/strong><\/p>\n

1. Sinh l\u00fd \u0111\u00f4ng c\u1ea7m m\u00e1u<\/h2>\n

\u0110\u00f4ng c\u1ea7m m\u00e1u bao g\u1ed3m 4 y\u1ebfu t\u1ed1: th\u00e0nh m\u1ea1ch, ti\u1ec3u c\u1ea7u, y\u1ebfu t\u1ed1 VIII Von Willebrand (vWF), Fibrinogen:
\n– \u0110\u1ea7u ti\u00ean: Th\u00e0nh m\u1ea1ch: Ngay sau khi m\u1ea1ch b\u1ecb t\u1ed5n th\u01b0\u01a1ng, m\u1ea1ch m\u00e1u b\u1ecb co l\u1ea1i do t\u00ednh \u0111\u00e0n h\u1ed3i c\u1ee7a th\u00e0nh m\u1ea1ch. Co m\u1ea1ch c\u00f2n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1edd c\u01a1 ch\u1ebf th\u1ea7n kinh v\u00e0 th\u1ea7n kinh – th\u1ec3 d\u1ecbch. Nh\u1eefng k\u00edch th\u00edch g\u00e2y \u0111au t\u1eeb n\u01a1i t\u1ed5n th\u01b0\u01a1ng, nh\u1eefng ch\u1ea5t trung gian ho\u00e1 h\u1ecdc \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng khi \u0111au g\u00e2y ph\u1ea3n x\u1ea1 co c\u01a1 tr\u01a1n th\u00e0nh m\u1ea1ch. \u0110\u1ed3ng th\u1eddi l\u00fac n\u00e0y t\u1ea1i n\u01a1i t\u1ed5n th\u01b0\u01a1ng, ti\u1ec3u c\u1ea7u b\u1ecb v\u1ee1 ra, gi\u1ea3i ph\u00f3ng serotonin g\u00e2y co m\u1ea1ch t\u1ea1i ch\u1ed7.
\n– Sau \u0111\u00f3: Ti\u1ec3u c\u1ea7u t\u1edbi. Khi th\u00e0nh m\u1ea1ch t\u1ed5n th\u01b0\u01a1ng th\u00ec l\u1eadp t\u1ee9c ti\u1ec3u c\u1ea7u d\u00ednh v\u00e0o n\u01a1i t\u1ed5n th\u01b0\u01a1ng (vWF: gi\u00fap ti\u1ec3u c\u1ea7u d\u00ednh v\u00e0o th\u00e0nh m\u1ea1ch qua GPIb) v\u00e0 \u0111\u01b0\u1ee3c ho\u1ea1t ho\u00e1. Khi b\u1ecb ho\u1ea1t ho\u00e1, ti\u1ec3u c\u1ea7u b\u1ecb bi\u1ebfn d\u1ea1ng (ph\u1ed3ng to, tr\u1ea3i r\u1ed9ng, h\u00ecnh th\u00e0nh ch\u00e2n gi\u1ea3, co l\u1ea1i v\u00e0 l\u1ed9 ra ch\u00e2n IIb, IIIa) v\u00e0 gi\u1ea3i ph\u00f3ng ra c\u00e1c y\u1ebfu t\u1ed1 ho\u1ea1t h\u00f3a. (thromboxan A2, ADP\u2026) l\u00e0m ho\u1ea1t ho\u00e1 c\u00e1c ti\u1ec3u c\u1ea7u b\u00ean c\u1ea1nh. Ch\u00fang d\u00ednh v\u00e0o nhau t\u1eebng \u0111\u00e1m t\u1ea1o n\u00ean n\u00fat ti\u1ec3u c\u1ea7u g\u00e2y ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u nh\u1edd fibrinogen (li\u00ean k\u1ebft v\u1edbi GPIIb\/GPIIIa \u0111\u00e3 \u0111\u01b0\u1ee3c ho\u1ea1t ho\u00e1 c\u00f3 m\u1eb7t \u1edf l\u1edbp ngo\u00e0i b\u00e0o t\u01b0\u01a1ng).<\/p>\n

\u0110\u00f4ng m\u00e1u huy\u1ebft t\u01b0\u01a1ng:
\n<\/strong>– Con \u0111\u01b0\u1eddng n\u1ed9i sinh t\u00ednh b\u1eb1ng ph\u00fat, \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t b\u1eb1ng c\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ee5ng ch\u1ea1m (gi\u1ea3i th\u00edch t\u1ea1i sao b\u1ecf m\u00e1u v\u00e0o \u1ed1ng nghi\u1ec7m l\u1ea1i \u0111\u00f4ng m\u00e1u: k\u00edch ho\u1ea1t con \u0111\u01b0\u1eddng n\u00e0y).
\n– Con \u0111\u01b0\u1eddng ngo\u1ea1i sinh \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t tr\u01b0\u1edbc, t\u00ednh b\u1eb1ng gi\u00e2y. \u0110\u01b0\u1ee3c k\u00edch ho\u1ea1t t\u1eeb t\u1ed5n th\u01b0\u01a1ng m\u00f4 ho\u1eb7c stress (tissue factor).<\/p>\n

2. Ti\u1ebfp c\u1eadn h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft \u1edf tr\u1ebb em.\u00a0<\/b><\/h2>\n

2.1 B\u1ec7nh s\u1eed:<\/strong><\/h3>\n
    \n
  • V\u1ecb tr\u00ed v\u00e0 t\u00ednh ch\u1ea5t xu\u1ea5t huy\u1ebft: xu\u1ea5t huy\u1ebft \u1edf da, ni\u00eam m\u1ea1c d\u01b0\u1edbi d\u1ea1ng petechiae hay m\u1ea3ng b\u1ea7m th\u01b0\u1eddng l\u00e0 do c\u00e1c r\u1ed1i lo\u1ea1n do th\u00e0nh m\u1ea1ch hay ti\u1ec3u c\u1ea7u. Xu\u1ea5t huy\u1ebft \u1edf m\u00f4 m\u1ec1m, c\u01a1, kh\u1edbp g\u1ee3i \u00fd b\u1ec7nh hemophia hay c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u huy\u1ebft t\u01b0\u01a1ng kh\u00e1c. Nh\u1eefng v\u1ebft b\u1ea7m nh\u1ecf \u1edf c\u1eb3ng ch\u00e2n d\u01b0\u1edbi \u0111\u1ea7u g\u1ed1i c\u00f3 th\u1ec3 ch\u1ec9 do va ch\u1ea1m th\u00f4ng th\u01b0\u1eddng v\u00e0 \u00edt c\u00f3 \u00fd ngh\u0129a b\u1ec7nh l\u00fd. Ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c \u00f3i m\u00e1u hay do th\u1ee9c \u0103n, ti\u1ec3u m\u00e1u hay ti\u1ec3u \u0111\u1ecf do nguy\u00ean nh\u00e2n kh\u00e1c…<\/li>\n
  • X\u00e1c \u0111\u1ecbnh xu\u1ea5t huy\u1ebft t\u1ea1i ch\u1ed7 hay to\u00e0n th\u00e2n.<\/li>\n
  • M\u1ee9c \u0111\u1ed9 xu\u1ea5t huy\u1ebft: xu\u1ea5t huy\u1ebft da (nh\u1eb9), ni\u00eam (trung b\u00ecnh), hay xu\u1ea5t huy\u1ebft n\u1ed9i t\u1ea1ng (n\u1eb7ng).<\/li>\n
  • Th\u1eddi gian xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng xu\u1ea5t huy\u1ebft (c\u1ea5p t\u00ednh hay m\u1ea1n t\u00ednh), khi n\u00e0o ch\u1ea3y m\u00e1u v\u00e0 khi n\u00e0o h\u1ebft ch\u1ea3y m\u00e1u.<\/li>\n
  • Y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y: ch\u1ea5n th\u01b0\u01a1ng (sau ch\u00edch thu\u1ed1c, ch\u1ed7 ch\u00edch ng\u1eeba, ch\u1ea3y m\u00e1u cu\u1ed1ng r\u1ed1n..), t\u00e9 ng\u00e3, hay ph\u1eabu thu\u1eadt, hay xu\u1ea5t huy\u1ebft t\u1ef1 nhi\u00ean l\u01b0u \u00fd c\u00e1c xu\u1ea5t huy\u1ebft kh\u00f4ng do tai n\u1ea1n do b\u1ea1o h\u00e0nh tr\u1ebb em. M\u1ee9c \u0111\u1ed9 c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng c\u00f3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi m\u1ee9c xu\u1ea5t huy\u1ebft hay kh\u00f4ng.<\/li>\n
  • H\u1ecfi tu\u1ed5i v\u00e0 gi\u1edbi t\u00ednh: th\u01b0\u1eddng tu\u1ed5i nh\u1ecf hay c\u00f3 b\u1ec7nh s\u1eed gia \u0111\u00ecnh di truy\u1ec1n, gi\u1edbi nam th\u01b0\u1eddng ngh\u0129 c\u00e1c b\u1ec7nh hemophila. Xu\u1ea5t hi\u1ec7n \u1edf l\u1ee9a tu\u1ed5i l\u1edbn c\u00f3 th\u1ec3 do nguy\u00ean nh\u00e2n t\u1ef1 mi\u1ec5n…<\/li>\n
  • Thu\u1ed1c: h\u1ecfi c\u1ea9n th\u1eadn ti\u1ec1n c\u0103n s\u1eed d\u1ee5ng thu\u1ed1c g\u1ed3m: th\u1ea3o d\u01b0\u1ee3c, s\u1eed d\u1ee5ng aspirin v\u00e0 c\u00e1c NSAIDS kh\u00e1c nh\u01b0 ibuprofen, naproxen. Ti\u1ec1n s\u1eed d\u00f9ng kh\u00e1ng sinh, c\u00e1c lo\u1ea1i h\u00f3a ch\u1ea5t.<\/li>\n
  • H\u1ecfi t\u00ecm c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a xu\u1ea5t huy\u1ebft: n\u00f4n, \u0111au \u0111\u1ea7u, y\u1ebfu li\u1ec7t, thi\u1ebfu m\u00e1u.<\/li>\n
  • H\u1ecfi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c k\u00e8m theo: s\u1ed1t, s\u1ee5t c\u00e2n, bi\u1ebfng \u0103n, \u0111au nh\u1ee9c, \u0111\u1ed5 m\u1ed3 h\u00f4i \u0111\u00eam.<\/li>\n
  • Ti\u1ec1n c\u0103n gia \u0111\u00ecnh :\u00a0c\u00f3 b\u1ec7nh l\u00fd ch\u1ea3y m\u00e1u t\u01b0\u01a1ng t\u1ef1. Anh em trai, c\u1eadu b\u00ean h\u1ecd ngo\u1ea1i b\u1ecb r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u t\u01b0\u01a1ng t\u1ef1 g\u1ee3i \u00fd hemophilia.<\/li>\n<\/ul>\n

    \"minh-hoa-hoi-chung-xuat-huyet\"<\/p>\n

      \n
    • H\u1ecfi ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd: b\u1ec7nh ch\u1ea3y m\u00e1u tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh l\u00fd gan m\u1eadt, th\u1eadn, b\u1ec7nh t\u1ef1 mi\u1ec5n, nhi\u1ec5m tr\u00f9ng , si\u00eau vi tr\u00f9ng.<\/li>\n<\/ul>\n

      2.2 Kh\u00e1m l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft<\/strong><\/h3>\n
        \n
      • X\u00e1c \u0111\u1ecbnh c\u00e1c d\u1ea5u nguy hi\u1ec3m to\u00e0n th\u00e2n (ABCD): Tri gi\u00e1c, \u0111\u01b0\u1eddng th\u1edf, tu\u1ea7n ho\u00e0n, th\u1ea7n kinh.<\/li>\n
      • \u0110\u00e1nh gi\u00e1 t\u1ed5ng tr\u1ea1ng: c\u00e2n n\u1eb7ng, chi\u1ec1u cao, b\u1ea5t th\u01b0\u1eddng h\u00ecnh th\u1ec3.<\/li>\n
      • \u0110\u00e1nh gi\u00e1 xu\u1ea5t huy\u1ebft:\n
          \n
        • V\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft: da, ni\u00eam (ni\u00eam m\u1ea1c mi\u1ec7ng, m\u0169i, k\u1ebft m\u1ea1c m\u1eaft..), n\u1ed9i t\u1ea1ng (\u00f3i m\u00e1u, ti\u00eau ph\u00e2n \u0111en, ti\u1ec3u m\u00e1u, xu\u1ea5t huy\u1ebft n\u00e3o, thay \u0111\u1ed5i tri gi\u00e1c. Xu\u1ea5t huy\u1ebft c\u01a1 kh\u1edbp.<\/li>\n
        • D\u1ea1ng xu\u1ea5t huy\u1ebft (petechiae, b\u1ea7m, t\u1ee5 m\u00e1u).<\/li>\n
        • \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 m\u1ea5t m\u00e1u.<\/li>\n
        • Kh\u00e1m gan, l\u00e1ch, h\u1ea1ch, v\u00e0ng da, vi\u00eam kh\u1edbp, sang th\u01b0\u01a1ng da.<\/li>\n
        • Ph\u00e2n bi\u1ec7t r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u do th\u00e0nh m\u1ea1ch ti\u1ec3u c\u1ea7u hay huy\u1ebft t\u01b0\u01a1ng:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n\n
          L\u00e2m s\u00e0ng<\/td>\nR\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u huy\u1ebft t\u01b0\u01a1ng<\/td>\nDo th\u00e0nh m\u1ea1ch hay ti\u1ec3u c\u1ea7u<\/td>\n<\/tr>\n
          Petechia \u1edf da<\/p>\n

          M\u1ea3ng xu\u1ea5t huy\u1ebft<\/p>\n

          T\u1ee5 m\u00e1u m\u00f4 m\u1ec1m<\/p>\n

          Xu\u1ea5t huy\u1ebft kh\u1edbp<\/p>\n

          Xu\u1ea5t huy\u1ebft tr\u1ec5<\/p>\n

          Xu\u1ea5t huy\u1ebft khi b\u1ecb tr\u1ea7y da<\/p>\n

          Ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u<\/p>\n

          Gi\u1edbi t\u00ednh b\u1ec7nh nh\u00e2n<\/td>\n

          		Th\u01b0\u1eddng \u00edt g\u1eb7p<\/p>\n

          Th\u01b0\u1eddng g\u1eb7p 1 hay nhi\u1ec1u m\u1ea3ng<\/p>\n

          \u0110i\u1ec3n h\u00ecnh<\/p>\n

          \u0110i\u1ec3n h\u00ecnh: ti\u00eau chu\u1ea9n v\u00e0ng
          \nTh\u01b0\u1eddng g\u1eb7p<\/p>\n

          Kh\u00f4ng th\u01b0\u1eddng g\u1eb7p<\/p>\n

          Th\u01b0\u1eddng g\u1eb7p<\/p>\n

          Th\u01b0\u1eddng l\u00e0 nam<\/td>\n

          		\u0110i\u1ec3n h\u00ecnh<\/p>\n

          \u0110i\u1ec3n h\u00ecnh: m\u1ea3ng nh\u1ecf, r\u1ea3i r\u00e1c<\/p>\n

          Hi\u1ebfm g\u1eb7p<\/p>\n

          \u00cdt g\u1eb7p<\/p>\n

          Hi\u1ebfm g\u1eb7p<\/p>\n

          Th\u01b0\u1eddng g\u1eb7p<\/p>\n

          Hi\u1ebfm g\u1eb7p<\/p>\n

          N\u1eef nhi\u1ec1u h\u01a1n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          2.3 X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/h3>\n
            \n
          • X\u00e9t nghi\u1ec7m b\u01b0\u1edbc \u0111\u1ea7u:\n
              \n
            • C\u00f4ng th\u1ee9c m\u00e1u, ph\u1ebft m\u00e1u ngo\u1ea1i vi.<\/li>\n
            • \u00b1Th\u1eddi gian m\u00e1u ch\u1ea3y (TS), m\u00e1u \u0111\u00f4ng (TC).<\/li>\n
            • \u0110\u00f4ng m\u00e1u to\u00e0n b\u1ed9 (PT, APPT, fibrinogen), \u00b1 TT<\/li>\n<\/ul>\n<\/li>\n
            • X\u00e9t nghi\u1ec7m ti\u1ebfp theo:\n
                \n
              • \u0110\u1ed9 t\u1eadp trung ti\u1ec3u c\u1ea7u.<\/li>\n
              • PFA -100 (Platalet function analyser).<\/li>\n
              • TCK h\u1ed7n h\u1ee3p.<\/li>\n
              • \u0110\u1ecbnh l\u01b0\u1ee3ng c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u.<\/li>\n
              • X\u00e9t nghi\u00eam ch\u1ea9n \u0111o\u00e1n VWD.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                M\u1ed8T S\u1ed0 R\u1ed0I LO\u1ea0N \u0110\u00d4NG M\u00c1U TH\u01af\u1edcNG G\u1eb6P:<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
                <\/td>\n\u2193 TC<\/td>\nB\u1ec7nh gan<\/td>\nDIC<\/td>\nThi\u1ebfu<\/p>\n

                Vit K<\/td>\n

                		Warf<\/td>\nHeparin<\/td>\nVWD<\/td>\nHem<\/p>\n

                A<\/td>\n

                		Hem<\/p>\n

                B<\/td>\n

                		Truy\u1ec1n m\u00e1u KL l\u1edbn<\/td>\n<\/tr>\n
                TC \u0111\u1ebfm<\/td>\n\u2193<\/td>\n\u2534, \u2193<\/td>\n\u2193<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534, \u2193<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2193<\/td>\n<\/tr>\n
                PT<\/td>\n\u2534<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2191<\/td>\n<\/tr>\n
                aPPT<\/td>\n\u2534<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2534, \u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2191<\/td>\n<\/tr>\n
                TT<\/td>\n\u2534<\/td>\n\u2191<\/td>\n\u2191<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2191<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534, \u2191<\/td>\n<\/tr>\n
                Fibrinogen<\/td>\n\u2534<\/td>\n\u2193<\/td>\n\u2193<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534, \u2193<\/td>\n<\/tr>\n
                Fibrin degradation<\/td>\n\u2534<\/td>\n\u2534, \u2191<\/td>\n\u2191<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534<\/td>\n\u2534, \u2191<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                3.\u00a0 X\u1eed tr\u00ed h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft \u1edf tr\u1ebb em.\u00a0<\/strong><\/h2>\n

                3.1 Nguy\u00ean t\u1eafc:<\/strong><\/h3>\n
                  \n
                • X\u1eed l\u00fd c\u00e1c t\u00ecnh hu\u1ed1ng c\u1ea5p c\u1ee9u: s\u1ed1c m\u1ea5t m\u00e1u, s\u1ed1c nhi\u1ec5m tr\u00f9ng, suy h\u00f4 h\u1ea5p.<\/li>\n
                • \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7:\n
                    \n
                  • C\u1ea7m m\u00e1u ch\u1ed7 ch\u1ea3y m\u00e1u n\u1ebfu \u0111\u01b0\u1ee3c.<\/li>\n
                  • Gi\u1ea3m \u0111au b\u1eb1ng paracetamol, ch\u01b0\u1eddm l\u1ea1nh, g\u00e2y t\u00ea.<\/li>\n
                  • H\u1ea1n ch\u1ebf va ch\u1ea1m, tr\u00e1nh v\u1eadn \u0111\u1ed9ng m\u1ea1nh<\/li>\n<\/ul>\n<\/li>\n
                  • \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u: \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft, b\u00f9 c\u00e1c y\u1ebfu t\u1ed1 khi\u1ebfm khuy\u1ebft<\/li>\n
                  • \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3: truy\u1ec1n m\u00e1u khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh, tr\u00e1nh ti\u00eam b\u1eafp, d\u00f9ng thu\u1ed1c aspirin, NSAIDS…<\/li>\n<\/ul>\n

                    3.2 X\u1eed l\u00fd m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng th\u01b0\u1eddng g\u1eb7p.<\/h3>\n
                      \n
                    • Xu\u1ea5t huy\u1ebft m\u00e0ng n\u00e3o mu\u1ed9n: vitamin K 1-5mg\/IV, truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i.<\/li>\n
                    • Hemophila A: Truy\u1ec1n k\u1ebft t\u1ee7a l\u1ea1nh, y\u1ebfu t\u1ed1 VIII. Hemophila B: huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i, y\u1ebfu t\u1ed1 IX. Hemophila: ch\u01b0a x\u00e1c \u0111\u1ecbnh th\u00ec truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i 10-20 ml\/kg.<\/li>\n
                    • Von Willebrand: truy\u1ec1n k\u1ebft t\u1ee7a l\u1ea1nh hay huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i.<\/li>\n
                    • Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch: IVIG, steroids.<\/li>\n
                    • B\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ea3y m\u00e1u di truy\u1ec1n c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt:<\/li>\n
                    • C\u1ea7n \u0111\u00e1nh gi\u00e1 lo\u1ea1i h\u00ecnh ph\u1eabu thu\u1eadt, th\u1eddi gian m\u1ed5, th\u1eddi gian l\u00e0nh v\u1ebft m\u1ed5, t\u00ecnh tr\u1ea1ng b\u1ec7nh, k\u0129 thu\u1eadt g\u00e2y m\u00ea.<\/li>\n
                    • Truy\u1ec1n y\u1ebfu t\u1ed1 1 ng\u00e0y tr\u01b0\u1edbc m\u1ed5 v\u00e0 ti\u1ebfp t\u1ee5c 5-10 ng\u00e0y sau m\u1ed5, t\u00f9y v\u00e0o nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft sau m\u1ed5.<\/li>\n
                    • Truy\u1ec1n ti\u1ec3u c\u1ea7u: ch\u1ec9 \u0111\u1ecbnh khi xu\u1ea5t huy\u1ebft nhi\u1ec1u n\u01a1i v\u00e0 TC < 50.000\/mm3, truy\u1ec1n m\u1ed9t gi\u1edd tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n

                      \u00a0<\/strong>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n

                        \n
                      1. L\u00e2m th\u1ecb M\u1ef9, \u201cH\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft\u201d, Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Nhi Khoa b\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng 1 2013, 865-870.<\/li>\n
                      2. L\u00e2m th\u1ecb M\u1ef9, \u201cXu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch\u201d, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Nhi Khoa b\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng 1 2013,871-875<\/li>\n
                      3. L\u00e2m th\u1ecb M\u1ef9, \u201cB\u1ec7nh hemophia Av\u00e0 B\u201d, Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Nhi Khoa b\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng 1 2013. 876-878.<\/li>\n
                      4. Catherine S. Manno, \u201cManagement of bleeding in children\u201d, ASH Education Book January 1, 2005 2005 no. 1 416-422.<\/li>\n
                      5. Donald L Y ee, MD, \u201cApproach to the child with bleeding symptom\u201d, Uptodate 2014.<\/li>\n
                      6. Cris JOHNSON . P.de ALARCON, \u201c Evaluation of a child with thrombocypenia\u201d, coagulation disorders, practical algorithms in Pediatric Hematology and Oncology<\/em>, 2003.<\/li>\n
                      7. Cris JOHNSON . P.de ALARCON, \u201cEvaluation of a child with bleeding or abnormal coagulation screening tests\u201d, coagulation disorders. practical algorithms in Pediatric Hematology and Oncology<\/em>, 2003 57-58.<\/li>\n<\/ol>\n

                         <\/p>\n

                         <\/p>\n","protected":false},"excerpt":{"rendered":"

                        Xu\u1ea5t huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u ch\u1ea3y ra kh\u1ecfi th\u00e0nh m\u1ea1ch, xu\u1ea5t huy\u1ebft c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft n\u1ed9i hay xu\u1ea5t huy\u1ebft ngo\u1ea1i (nh\u01b0 ch\u1ea3y m\u00e1u m\u0169i, tai, \u00e2m \u0111\u1ea1o, h\u1eadu m\u00f4n, da…). H\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ebfn ch\u1ee9ng nghi\u00eam […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[3],"yoast_head":"\n\u0110\u1ea1i c\u01b0\u01a1ng h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u ch\u1ea3y ra kh\u1ecfi th\u00e0nh m\u1ea1ch, xu\u1ea5t huy\u1ebft c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft n\u1ed9i hay xu\u1ea5t huy\u1ebft ngo\u1ea1i (m\u0169i,tai, \u00e2m \u0111\u1ea1o,..).\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110\u1ea1i c\u01b0\u01a1ng h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft \u1edf tr\u1ebb em - 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