{"id":28661,"date":"2023-04-26T23:03:09","date_gmt":"2023-04-26T16:03:09","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28661"},"modified":"2023-04-27T15:36:59","modified_gmt":"2023-04-27T08:36:59","slug":"tiep-can-chan-doan-xuat-huyet-giam-tieu-cau-mien-dich","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/tiep-can-chan-doan-xuat-huyet-giam-tieu-cau-mien-dich\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch"},"content":{"rendered":"

Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch ->(XHGTCMD) – ->(Immune Thrombocytopenic Purpura – ITP) \u00a0l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m ti\u1ec3u c\u1ea7u m\u1eafc ph\u1ea3i do kh\u00e1ng th\u1ec3 t\u1ef1 sinh b\u00e1m l\u00ean kh\u00e1ng nguy\u00ean tr\u00ean m\u00e0ng ti\u1ec3u c\u1ea7u, ph\u1ee9c h\u1ee3p kh\u00e1ng th\u1ec3 v\u00e0 ti\u1ec3u c\u1ea7u b\u1ecb c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o b\u1eaft gi\u1eef g\u00e2y gi\u1ea3m ti\u1ec3u c\u1ea7u \u1edf m\u00e1u ngo\u1ea1i bi\u00ean.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch<\/h2>\n

1.1 \u0110\u1ecbnh ngh\u0129a<\/strong><\/p>\n

– B\u1ec7nh c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng ch\u00ednh l\u00e0 xu\u1ea5t huy\u1ebft da d\u1ea1ng ch\u1ea5m<\/a> hay m\u1ea3ng m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t tr\u00ean c\u01a1 \u0111\u1ecba \u0111ang kh\u1ecfe m\u1ea1nh, t\u1ee7y \u0111\u1ed3 b\u00ecnh th\u01b0\u1eddng.
\n– B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em, \u0111\u1ec9nh cao l\u00e0 2 \u2013 5 tu\u1ed5i, tr\u1ebb nh\u1ecf nam > n\u1eef, d\u1eady th\u00ec nam < n\u1eef v\u00e0 th\u01b0\u1eddng t\u1ef1 gi\u1edbi h\u1ea1n trong 3 \u2013 6 th\u00e1ng ->90%), m\u1ed9t s\u1ed1 \u00edt khi k\u00e9o d\u00e0i tr\u00ean 6 th\u00e1ng ->10%).<\/p>\n\n\n\n\n
Nguy\u00ean ph\u00e1t ->80%) ->Primary ITP)<\/td>\nTh\u1ee9 ph\u00e1t ->20%) ->Secondary ITP)<\/td>\n<\/tr>\n
T\u1ef1 mi\u1ec5n d\u1ecbch
\nGi\u1ea3m TC \u0111\u01a1n \u0111\u1ed9c -><100.000\/\u03bcL)
\nKh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c<\/td>\n		T\u1ea5t c\u1ea3 c\u00e1c d\u1ea1ng XHGTC qua trung
\ngian mi\u1ec5n d\u1ecbch ngo\u1ea1i tr\u1eeb XHGTC
\nnguy\u00ean ph\u00e1t.
\nITP th\u1ee9 ph\u00e1t ->lupus), ITP th\u1ee9 ph\u00e1t
\n->HIV)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

1.2 Sinh b\u1ec7nh h\u1ecdc v\u00e0 nguy\u00ean nh\u00e2n<\/strong><\/p>\n

Y\u1ebfu t\u1ed1 g\u00e2y ho\u1ea1t h\u00f3a t\u1ef1 kh\u00e1ng th\u1ec3:
\n<\/strong>\u00b7 Sau nhi\u1ec5m tr\u00f9ng: + tr\u1ebb nh\u1ecf: HBV, H\u1ed8I CH\u1ee8NG V, HIV, EBV, CMV\u2026
\n+ 5, 6 tu\u1ed5i ->tu\u1ed5i \u0111i ch\u01a1i \u0111i h\u1ecdc): Helicobacter pylori
\n+ sau ch\u1ee7ng ng\u1eeba vaccine s\u1ed1ng.
\n\u00b7 Sau d\u00f9ng thu\u1ed1c: + kh\u00e1ng sinh
\n+ thu\u1ed1c s\u1ed1t r\u00e9t
\n+ kh\u00e1ng \u0111\u00f4ng
\n+ ch\u1ed1ng \u0111\u1ed9ng kinh ->b\u00e9 b\u1ea1i n\u00e3o).
\n\u00b7 XHGTCMD m\u1ea1n t\u00ednh c\u00f3 c\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a ho\u1ea1t \u0111\u1ed9ng lympho T v\u00e0 B: \u0110TB tr\u00ecnh di\u1ec7n ph\u1ee9c h\u1ee3p kh\u00e1ng nguy\u00ean gp IIb\/IIIa hay Ib\/IX cho lympho Th -> \u00a0ho\u1ea1t h\u00f3a s\u1ea3n xu\u1ea5t IL6 v\u00e0 CD154, k\u00edch ho\u1ea1t lympho B -> \u00a0T\u1ea1o kh\u00e1ng th\u1ec3 g\u1eafn l\u00ean kh\u00e1ng nguy\u00ean m\u00e0ng ti\u1ec3u c\u1ea7u -> \u00a0b\u1ecb \u0110TB b\u1eaft gi\u1eef; kh\u00e1ng th\u1ec3 g\u1eafn v\u00e0o m\u1eabu ti\u1ec3u c\u1ea7u trong t\u1ee7y x\u01b0\u01a1ng -> gi\u1ea3m s\u1ea3n xu\u1ea5t ti\u1ec3u c\u1ea9u.<\/p>\n

T\u1ebf b\u00e0o ch\u1ea5t ch\u1ee9a 2 lo\u1ea1i h\u1ea1t:
\n\u00b7 C\u00e1c h\u1ea1t \u0111\u1eadm: ch\u1ee9a c\u00e1c ch\u1ea5t k\u00edch ho\u1ea1t ti\u1ec3u c\u1ea7u: ADP, ATP, Ca2+ v\u00e0 Serotonin.
\n\u00b7 C\u00e1c h\u1ea1t alpha: fibrinogen, y\u1ebfu t\u1ed1 V, y\u1ebfu t\u1ed1 VIII\u2026
\nD\u1ecb d\u1ea1ng ti\u1ec3u c\u1ea7u ch\u1ea3y m\u00e1u Bernard Soulier (di truy\u1ec1n autosom l\u1eb7n): thi\u1ebfu glycoprotein Ib tr\u00ean m\u00e0ng -> \u00a0ti\u1ec3u c\u1ea7u kh\u00f4ng k\u1ebft d\u00ednh v\u00e0o \u0111\u01b0\u1ee3c n\u1ed9i m\u1ea1ch.
\nB\u1ec7nh Von Willebrand (di truy\u1ec1n autosom tr\u1ed9i): vWf \u0111\u00f3ng vai tr\u00f2 k\u1ebft \u0111\u1ecbnh v\u1edbi glycoprotein Ib r\u1ed3i k\u1ebft d\u00ednh v\u00e0o th\u00e0nh m\u1ea1ch -> vWf gi\u1ea3m ho\u1eb7c c\u00f3 c\u1ea5u t\u1ea1o b\u1ea5t th\u01b0\u1eddng, TC kh\u00f4ng d\u00ednh v\u00e0o th\u00e0nh m\u1ea1ch l\u00e0m TS k\u00e9o d\u00e0i.
\nLi\u1ec7t ti\u1ec3u c\u1ea7u Glanzman (di truy\u1ec1n autosom l\u1eb7n): gi\u1ea3m glycoprotein IIb v\u00e0 IIIa tr\u00ean
\nm\u00e0ng l\u00e0m c\u00e1c TC kh\u00f4ng k\u1ebft d\u00ednh \u0111\u01b0\u1ee3c v\u1edbi nhau.
\nB\u1ec7nh ti\u1ec3u c\u1ea7u tr\u1ed1ng r\u1ed7ng: ti\u1ec3u c\u1ea7u kh\u00f4ng c\u00f3 c\u00e1c h\u1ea1t \u0111\u1eadm l\u00e0m gi\u1ea3m k\u1ebft ch\u1ee5m v\u1edbi
\nnhau.<\/p>\n

2. L\u00e2m s\u00e0ng xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u:<\/h2>\n

2.1. H\u1ecfi b\u1ec7nh:<\/strong>
\n– T\u01b0\u01a1ng t\u1ef1 nh\u01b0 ti\u1ebfp c\u1eadn BN xu\u1ea5t huy\u1ebft.
\n– Trong v\u00f2ng 6 tu\u1ea7n tr\u1edf l\u1ea1i:
\n+ Tr\u1ebb c\u00f3 b\u1ecb s\u1ed1t, ho, s\u1ed5 m\u0169i hay ph\u00e1t ban.
\n+ Ch\u1ee7ng ng\u1eeba, \u0111\u1eb7c bi\u1ec7t ch\u1ee7ng ng\u1eeba s\u1edfi, quai b\u1ecb, rubella.
\n+ D\u00f9ng thu\u1ed1c: Quinin, Sulfonamid, Aspirin, Ibuprofen (2 tu\u1ea7n g\u1ea7n \u0111\u00e2y).<\/p>\n

+ Tr\u1ebb < 6 th\u00e1ng: m\u1eb9 c\u00f3 ti\u1ec1n c\u0103n xu\u1ea5t huy\u1ebft, d\u00f9ng thu\u1ed1c, d\u1ecb \u1ee9ng, b\u1ec7nh t\u1ef1 mi\u1ec5n.
\n2.2. Th\u0103m kh\u00e1m:<\/strong>
\n– Ghi nh\u1eadn t\u1ed5ng tr\u1ea1ng, tri gi\u00e1c, sinh hi\u1ec7u.
\n– Ph\u00e2n \u0111\u1ed9 xu\u1ea5t huy\u1ebft:
\n+ Nh\u1eb9: xu\u1ea5t huy\u1ebft da r\u1ea3i r\u00e1c: d\u1ea1ng \u0111i\u1ec3m, \u0111\u1ed1m hay m\u1ea3ng b\u1ea7m (xu\u1ea5t huy\u1ebft kh\u00f4<\/strong>).
\n+ Trung b\u00ecnh: xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c: m\u1eaft, m\u0169i, mi\u1ec7ng, h\u1ecdng, ti\u1ec3u m\u00e1u, rong kinh (xu\u1ea5t huy\u1ebft \u01b0\u1edbt).
\n+ N\u1eb7ng: xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c nhi\u1ec1u v\u1ecb tr\u00ed, xu\u1ea5t huy\u1ebft n\u1ed9i t\u1ea1ng (v\u00f5ng m\u1ea1c, ch\u1ea3y m\u00e1u h\u1ecdng, th\u00e0nh sau h\u1ecdng, ti\u1ec3u m\u00e1u, XHTH, ra kinh nhi\u1ec1u ng\u00e0y, l\u01b0\u1ee3ng nhi\u1ec1u \u1edf n\u1eef d\u1eady th\u00ec).
\n+ Nguy k\u1ecbch: xu\u1ea5t huy\u1ebft n\u00e3o (\u00f3i, nh\u1ee9c \u0111\u1ea7u, l\u01a1 m\u01a1, co gi\u1eadt), nguy c\u01a1 t\u1eed vong cao, th\u01b0\u1eddng g\u1eb7p \u1edf ITP b\u1ecb ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u c\u00f3 TC < 20 x 109\/L.
\n– Kh\u00e1m: t\u00ecm gan, l\u00e1ch, h\u1ea1ch (th\u01b0\u1eddng kh\u00f4ng to). N\u1ebfu to c\u1ea7n theo d\u00f5i ITP th\u1ee9 ph\u00e1t sau t\u1ef1 mi\u1ec5n.<\/p>\n

\"xuat-huyet-giam-tieu-cau-mien-dich\"<\/p>\n

PH\u00c2N \u0110\u1ed8 GAN TO \u1ede TR\u1eba EM:
\n– Gan to nh\u1eb9: <4 cm
\n– Gan to trung b\u00ecnh: 5-7 cm
\n– Gan l\u1edbn: >7 cm
\nPH\u00c2N \u0110\u1ed8 L\u00c1CH TO \u1ede TR\u1eba EM
\n– L\u00e1ch \u0111\u1ed9 1: m\u1ea5p m\u00e9 b\u1edd s\u01b0\u1eddn, 1-2cm
\n– L\u00e1ch \u0111\u1ed9 2: n\u1eb1m gi\u1eefa b\u1edd s\u01b0\u1eddn v\u00e0 r\u1ed1n
\n– L\u00e1ch \u0111\u1ed9 3: n\u1eb1m ngang r\u1ed1n
\n– L\u00e1ch \u0111\u1ed9 4: n\u1eb1m d\u01b0\u1edbi r\u1ed1n
\nM\u1ed8T S\u1ed0 T\u1eacT B\u1ea8M SINH:
\n– H\u1ed8I CH\u1ee8NG FANCONI: \u0111\u1ea7u nh\u1ecf, tai \u0111\u00f3ng th\u1ea5p, l\u00f4ng m\u00e0y giao nhau.
\n– H\u1ed8I CH\u1ee8NG \u00a0WISKOTT: ch\u00e0m da, ti\u00eau m\u00e1u k\u00e9o d\u00e0i.
\n– H\u1ed8I CH\u1ee8NG \u00a0TAR: xu\u1ea5t huy\u1ebft + m\u1ea5t x\u01b0\u01a1ng quay.
\n– H\u1ed8I CH\u1ee8NG \u00a0GLANZMANN: b\u1ec7nh l\u00fd gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng TC. Tr\u00ean l\u00e2m s\u00e0ng kh\u00f4ng c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t
\n– Soi \u0111\u00e1y m\u1eaft: khi c\u00f3 nh\u1ee9c \u0111\u1ea7u, \u00f3i, l\u01a1 m\u01a1 hay b\u1ecf \u0103n \u0111\u1ec3 t\u00ecm d\u1ea5u ph\u00f9 gai hay xu\u1ea5t huy\u1ebft v\u00f5ng m\u1ea1c.<\/p>\n

3. C\u1eadn l\u00e2m s\u00e0ng:<\/h2>\n

– Huy\u1ebft \u0111\u1ed3 (c\u00f4ng th\u1ee9c m\u00e1u v\u00e0 ph\u1ebft m\u00e1u): l\u00e0 x\u00e9t nghi\u1ec7m b\u1eaft bu\u1ed9c.
\n+ TC < 100 x 109\/L: gi\u1ea3m ti\u1ec3u c\u1ea7u \u0111\u01a1n thu\u1ea7n, kh\u00f4ng c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u.<\/p>\n

+ TC b\u00ecnh th\u01b0\u1eddng hay kh\u00f4ng t\u01b0\u01a1ng \u1ee9ng t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft th\u00ec l\u00e0m x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u v\u00e0 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.
\n+ Gi\u1ea3m h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u th\u00ec xem x\u00e9t l\u1ea1i l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00e2n nh\u1eafc t\u1ee7y \u0111\u1ed3.
\n+ Sau 3 ng\u00e0y \u0111i\u1ec1u tr\u1ecb, cho l\u00e0m l\u1ea1i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 xem c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c kh\u00f4ng: b\u1ea1ch c\u1ea7u c\u00f3 b\u1ea5t th\u01b0\u1eddng g\u00ec kh\u00f4ng (s\u1ed1 l\u01b0\u1ee3ng, t\u1ec9 l\u1ec7, h\u00ecnh d\u1ea1ng) v\u00ec n\u1ebfu nh\u01b0 ch\u1ea9n \u0111o\u00e1n nh\u1ea7m b\u1ea1ch c\u1ea7u c\u1ea5p (giai \u0111o\u1ea1n ch\u1ec9 m\u1edbi gi\u1ea3m ti\u1ec3u c\u1ea7u, b\u1ea1ch c\u1ea7u ch\u01b0a thay \u0111\u1ed5i) th\u00ec d\u00f9ng Corticoid s\u1ebd kh\u00f4ng hi\u1ec7u qu\u1ea3, b\u1ec7nh nh\u00e2n kh\u00f4ng nh\u1eefng v\u1eabn gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00e0 xu\u1ea5t
\nhuy\u1ebft, m\u00e0 c\u00f2n l\u00e0m m\u1ea5t d\u1ea5u hi\u1ec7u thay \u0111\u1ed5i tr\u00ean t\u1ee7y \u0111\u1ed3, ch\u1eadm tr\u1ec5 cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 m\u00e1u. Trong khi ch\u1edd k\u1ebft qu\u1ea3 t\u1ee7y \u0111\u1ed3, c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u1edbi IVIG.
\n+ Ph\u1ebft m\u00e1u bi\u1ec3u hi\u1ec7n gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u khi ti\u1ec3u c\u1ea7u r\u1eddi r\u1ea1c (b\u00ecnh th\u01b0\u1eddng k\u1ebft c\u1ee5m 3 \u2013 5 ti\u1ec3u c\u1ea7u). Ch\u00fa \u00fd k\u00edch th\u01b0\u1edbc ti\u1ec3u c\u1ea7u: ti\u1ec3u c\u1ea7u to -> c\u00f3 th\u1ec3 l\u00e0 XHGTCMD, ti\u1ec3u c\u1ea7u nh\u1ecf -> h\u1ed9i ch\u1ee9ng Wiskott Aldrich.
\n– Si\u00eau \u00e2m n\u00e3o: khi xu\u1ea5t huy\u1ebft n\u1eb7ng v\u00e0 \u00f3i, l\u01a1 m\u01a1, h\u00f4n m\u00ea, co gi\u1eadt.
\n– XN th\u01b0\u1eddng quy g\u1ed3m huy\u1ebft \u0111\u1ed3, si\u00eau \u00e2m n\u00e3o, TPTNT, soi \u0111\u00e1y m\u1eaft.
\n– X\u00e9t nghi\u1ec7m ki\u1ec3m tra l\u1ea1i sau \u0111i\u1ec1u tr\u1ecb 1 \u2013 3 th\u00e1ng t\u00f9y thu\u1ed9c v\u00e0o l\u00e2m s\u00e0ng, \u0111\u1ec3 ki\u1ec3m tra xem c\u00f3 nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t kh\u00f4ng.
\n– T\u1ee7y \u0111\u1ed3: c\u00f3 ch\u1ec9 \u0111\u1ecbnh khi:
\n<\/strong>+ Gi\u1ea3m ti\u1ec3u c\u1ea7u k\u00e8m b\u1ea5t th\u01b0\u1eddng v\u1ec1 b\u1ea1ch c\u1ea7u, h\u1ed3ng c\u1ea7u.
\n+ Gi\u1ea3m ti\u1ec3u c\u1ea7u c\u00f3 k\u00e8m s\u1ed1t cao k\u00e9o d\u00e0i, \u0111au nh\u1ee9c x\u01b0\u01a1ng c\u01a1 v\u00e0 gan, l\u00e1ch hay h\u1ea1ch to.<\/p>\n

+ Gi\u1ea3m ti\u1ec3u c\u1ea7u k\u00e9o d\u00e0i sau 3 \u2013 6 th\u00e1ng.
\n– <\/strong>X\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u: \u0111\u1ed9 t\u1eadp trung ti\u1ec3u c\u1ea7u, th\u1eddi gian m\u00e1u ch\u1ea3y TS, th\u1eddi gian co c\u1ee5c m\u00e1u, \u0111\u00e0n h\u1ed3i c\u1ee5c m\u00e1u \u0111\u1ed3, PFA 100.
\n– X\u00e9t nghi\u1ec7m huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m si\u00eau vi: HIV, HBV, H\u1ed8I CH\u1ee8NG V, Helicobacter pylori.
\n– X\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch: \u0111i\u1ec7n di protein, \u0111\u1ecbnh l\u01b0\u1ee3ng IgG, IgM, IgE, IgA (\u0111\u1ec3 ph\u00e2n bi\u1ec7t SGMD ti\u00ean ph\u00e1t), Coombs, ANA, anti dsDNA, kh\u00e1ng th\u1ec3 kh\u00e1ng gi\u00e1p.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/h2>\n

– S\u1ed1t xu\u1ea5t huy\u1ebft: s\u1ed1t cao li\u00ean t\u1ee5c 2 \u2013 7 ng\u00e0y, xu\u1ea5t huy\u1ebft da ni\u00eam, gan to \u0111au, c\u00f3 th\u1ec3 c\u00f3 s\u1ed1c v\u00e0o N4 \u2013 5, Hct t\u0103ng, ti\u1ec3u c\u1ea7u gi\u1ea3m.
\n– Hemophillia: BN nam, xu\u1ea5t huy\u1ebft da d\u1ea1ng m\u1ea3ng l\u1edbn, t\u1ee5 m\u00e1u, xu\u1ea5t huy\u1ebft kh\u1edbp, ti\u1ec3u c\u1ea7u b\u00ecnh th\u01b0\u1eddng, PT b\u00ecnh th\u01b0\u1eddng, APTT d\u00e0i.
\n– B\u1ec7nh b\u1ea1ch c\u1ea7u \u00e1c t\u00ednh: s\u1ed1t, \u0111au nh\u1ee9c x\u01b0\u01a1ng kh\u1edbp, thi\u1ebfu m\u00e1u, gan l\u00e1ch h\u1ea1ch to, CTM gi\u1ea3m WBC v\u00e0 thi\u1ebfu m\u00e1u, ph\u1ebft m\u00e1u ngo\u1ea1i bi\u00ean c\u00f3 t\u1ebf b\u00e0o non.
\n– Suy t\u1ee7y: gi\u1ea3m 3 d\u00f2ng t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i bi\u00ean, ch\u1ea9n \u0111o\u00e1n b\u1eb1ng t\u1ee7y \u0111\u1ed3.
\n– Nhi\u1ec5m tr\u00f9ng \u0111ang ho\u1ea1t \u0111\u1ed9ng: nhi\u1ec5m si\u00eau vi EBV, CMV, vi\u00eam gan C, HIV c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m ti\u1ec3u c\u1ea7u.
\n– Thi\u1ebfu m\u00e1u t\u00e1n huy\u1ebft t\u1ef1 mi\u1ec5n AIHA: h\u1ed3ng c\u1ea7u h\u00ecnh c\u1ea7u, HC \u0111a s\u1eafc, t\u0103ng h\u1ed3ng c\u1ea7u l\u01b0\u1edbi, Coombs tr\u1ef1c ti\u1ebfp (+).
\n– B\u1ec7nh t\u1ef1 mi\u1ec5n Lupus<\/p>\n","protected":false},"excerpt":{"rendered":"

Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch ->(XHGTCMD) – ->(Immune Thrombocytopenic Purpura – ITP) \u00a0l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m ti\u1ec3u c\u1ea7u m\u1eafc ph\u1ea3i do kh\u00e1ng th\u1ec3 t\u1ef1 sinh b\u00e1m l\u00ean kh\u00e1ng nguy\u00ean tr\u00ean m\u00e0ng ti\u1ec3u c\u1ea7u, ph\u1ee9c h\u1ee3p kh\u00e1ng th\u1ec3 v\u00e0 ti\u1ec3u c\u1ea7u b\u1ecb c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o b\u1eaft gi\u1eef g\u00e2y gi\u1ea3m ti\u1ec3u c\u1ea7u \u1edf m\u00e1u […]<\/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":[],"yoast_head":"\nTi\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch - Vinmec<\/title>\n<meta name=\"description\" content=\"Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch\u00a0l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m ti\u1ec3u c\u1ea7u m\u1eafc ph\u1ea3i do kh\u00e1ng th\u1ec3 b\u00e1m l\u00ean kh\u00e1ng nguy\u00ean tr\u00ean m\u00e0ng ti\u1ec3u c\u1ea7u.\" \/>\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=\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch - 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