{"id":28666,"date":"2023-04-26T23:04:18","date_gmt":"2023-04-26T16:04:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28666"},"modified":"2023-04-26T23:04:18","modified_gmt":"2023-04-26T16:04:18","slug":"xuat-huyet-giam-tieu-cau-mien-dich-khi-nao-truyen-mau","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/xuat-huyet-giam-tieu-cau-mien-dich-khi-nao-truyen-mau\/","title":{"rendered":"Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch: khi n\u00e0o truy\u1ec1n m\u00e1u?"},"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

\"xuat-huyet-giam-tieu-cau\"
\n1. Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n:<\/h2>\n

– Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u\u00a0 m\u1edbi ph\u00e1t hi\u1ec7n c\u00f3 xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c.
\n– L\u00e2m s\u00e0ng xu\u1ea5y huy\u1ebft n\u1eb7ng hay nguy k\u1ecbch.
\n– Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u \u2265 3 th\u00e1ng c\u1ea7n nh\u1eadp vi\u1ec7n l\u00e0m x\u00e9t nghi\u1ec7m t\u1ee7y \u0111\u1ed3.
\n– Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u c\u1ea7n ch\u1ea9n \u0111o\u00e1n t\u00ecm nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t.
\n– Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u c\u1ea7n can thi\u1ec7p th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n c\u00f3 kh\u1ea3 n\u0103ng xu\u1ea5t huy\u1ebft hay ph\u1eabu thu\u1eadt v\u00e0 TC < 50.000\/mm3.<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u:<\/h2>\n

 <\/p>\n\n\n\n\n\n\n
M\u1ee9c \u0111\u1ed9
\nnh\u1eb9<\/td>\n		Xu\u1ea5t huy\u1ebft da, kh\u00f4ng xu\u1ea5t huy\u1ebft ni\u00eam\u00a0 m\u1ea1c, ti\u1ec3u c\u1ea7u\u00a0 > 20.000\/mm3.<\/td>\nKh\u00f4ng \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i di\u1ec5n ti\u1ebfn l\u00e2m
\ns\u00e0ng v\u00e0 ki\u1ec3m tra huy\u1ebft \u0111\u1ed3 trong 1 \u2013 2
\ntu\u1ea7n \u0111\u1ea7u ti\u00ean.<\/td>\n<\/tr>\n
M\u1ee9c \u0111\u1ed9
\ntrung
\nb\u00ecnh<\/td>\n		Xu\u1ea5t huy\u1ebft da to\u00e0n th\u00e2n c\u00f3 ti\u1ec3u c\u1ea7u < 20.000\/mm3
\nho\u1eb7c xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c.<\/td>\n		Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng Corticoid:
\n– Li\u1ec1u Prednison 2mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 60 \u2013 80 mg\/ng\u00e0y) trong 14 ng\u00e0y (th\u1eddi gian dung n\u1ea1p c\u1ee7a Corticoid) sau \u0111\u00f3 gi\u1ea3m trong 7 ng\u00e0y (t\u1ed5ng th\u1eddi gian d\u00f9ng ph\u1ea3i lu\u00f4n \u2264 21 ng\u00e0y).
\n– Ho\u1eb7c Prednison 4mg\/kg\/ng\u00e0y trong 7 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u sau m\u1ed7i 7 ng\u00e0y v\u00e0 ng\u1eebng h\u1eb3n trong 21 ng\u00e0y.
\n– C\u00f3 \u0111\u00e1p \u1ee9ng khi kh\u00f4ng c\u00f3 XH ni\u00eam m\u1ea1c th\u00eam v\u00e0 Ti\u1ec3u c\u1ea7u (TC) > 30.000\/mm3.<\/td>\n<\/tr>\n
M\u1ee9c \u0111\u1ed9
\nn\u1eb7ng<\/td>\n		Xu\u1ea5t huy\u1ebft \u00a0ni\u00eam m\u1ea1c
\nnhi\u1ec1u v\u1ecb tr\u00ed, \u00a0xu\u1ea5t huy\u1ebft n\u1ed9i t\u1ea1ng nh\u01b0 ti\u1ec3u m\u00e1u, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, rong kinh nhi\u1ec1u.<\/td>\n		– Methylprednisolon 30mg\/kg\/ti\u00eam m\u1ea1ch
\nch\u1eadm 1 l\u1ea7n ho\u1eb7c 10mg\/kg\/ng\u00e0y chia 2 l\u1ea7n ti\u00eam TM trong 3 ng\u00e0y.- Ho\u1eb7c Immunoglobulin 0,8g\/kg\/TTM m\u1ed9t l\u1ea7n,<\/strong> c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i sau 24 gi\u1edd ho\u1eb7c 48 gi\u1edd n\u1ebfu l\u00e2m s\u00e0ng c\u00f2n xu\u1ea5t huy\u1ebft tr\u1ea7m tr\u1ecdng.
\n– C\u00f3 \u0111\u00e1p \u1ee9ng khi ng\u1eebng xu\u1ea5t huy\u1ebft v\u00e0 ti\u1ec3u c\u1ea7u > 20.000\/mm3 sau 48 gi\u1edd<\/td>\n<\/tr>\n
M\u1ee9c \u0111\u1ed9
\nnguy
\nk\u1ecbch<\/td>\n		Xu\u1ea5t huy\u1ebft\u00a0 n\u1ed9i t\u1ea1ng \u1ed3 \u1ea1t, xu\u1ea5t huy\u1ebft n\u00e3o, b\u1ecb ch\u1ea5n th\u01b0\u01a1ng.<\/td>\nPh\u1ed1i h\u1ee3p:
\n– Truy\u1ec1n IVIG.
\n– Truy\u1ec1n ti\u1ec3u c\u1ea7u:
\n+ Ch\u1ec9 \u0111\u1ecbnh khi ti\u1ec3u c\u1ea7u < 10.000\/mm3 v\u00e0 c\u00f3 XH l\u00e2m s\u00e0ng n\u1eb7ng, ho\u1eb7c TC < 50.000\/mm3 k\u00e8m XH n\u1eb7ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng hay c\u1ea7n ph\u1eabu thu\u1eadt ho\u1eb7c th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n.
\n+ Li\u1ec1u: 1 \u0111\u01a1n v\u1ecb\/5 \u2013 7kg c\u00e2n n\u1eb7ng.
\nKi\u1ec3m tra l\u1ea1i 1 gi\u1edd sau truy\u1ec1n, 24 gi\u1edd, 3 ng\u00e0y sau.
\n– Methylprednisolon 30 mg\/kg\/ng\u00e0y trong 1 \u2013 3 ng\u00e0y
\nM\u1ee5c ti\u00eau: ng\u1eebng xu\u1ea5t huy\u1ebft l\u00e2m s\u00e0ng v\u00e0 TC > 20 \u2013 30.000\/mm3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3. \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u m\u1ea1n t\u00ednh:<\/h2>\n

– Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u l\u00e0 b\u1ec7nh t\u1ef1 gi\u1edbi h\u1ea1n. N\u1ebfu b\u1ec7nh k\u00e9o d\u00e0i, ti\u1ec3u c\u1ea7u gi\u1ea3m < 100.000\/mm3 sau 1 n\u0103m g\u1ecdi l\u00e0 xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u m\u1ea1n t\u00ednh.<\/strong>
\n<\/strong>– Y\u1ebfu t\u1ed1 d\u1ec5 tr\u1edf th\u00e0nh m\u1ea1n t\u00ednh:
\n+ Gi\u1edbi n\u1eef.
\n+ Tu\u1ed5i l\u1edbn.<\/p>\n

+ C\u00f3 b\u1ec7nh t\u1ef1 mi\u1ec5n \u0111i k\u00e8m (Lupus, suy gi\u1ea3m mi\u1ec5n d\u1ecbch ti\u00ean ph\u00e1t, Wiskott Aldrich, b\u1ec7nh kh\u00e1ng th\u1ec3 kh\u00e1ng h\u1ed3ng c\u1ea7u Coombs tr\u1ef1c ti\u1ebfp (+), nhi\u1ec5m HIV, CMV, HBV\u2026).
\n– Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb khi: c\u00f3 xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c, c\u1ea7n can thi\u1ec7p ph\u1eabu thu\u1eadt v\u00e0 nh\u1ed5 r\u0103ng, ra kinh nhi\u1ec1u v\u00e0 k\u00e9o d\u00e0i \u1edf tr\u1ebb n\u1eef.
\n<\/strong>– Corticoid t\u1eebng \u0111\u1ee3t ng\u1eafn \u0111\u1ec3 tr\u00e1nh l\u1ec7 thu\u1ed9c, n\u1ebfu \u0111\u00e3 l\u1ec7 thu\u1ed9c th\u00ec s\u1eed d\u1ee5ng c\u00e1ch ng\u00e0y \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng. Li\u1ec1u: Prednison 2 mg\/kg\/ng\u00e0y x 5 \u2013 7 ng\u00e0y.
\n– Ch\u1ec9 \u0111\u1ecbnh IVIG 0,5g\/kg\/ng\u00e0y x 2 ng\u00e0y khi c\u00f3 xu\u1ea5t huy\u1ebft nguy k\u1ecbch.
\n– Khi corticoid kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 -> xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u kh\u00e1ng corticoid (ti\u1ebfp t\u1ee5c xu\u1ea5t huy\u1ebft n\u1eb7ng v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u1eb7ng) th\u00ec c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng Cyclosporin 5 mg\/kg\/ng\u00e0y chia 2 l\u1ea7n x 4 tu\u1ea7n, c\u1eaft l\u00e1ch.<\/strong>
\n– C\u1eaft l\u00e1ch khi xu\u1ea5t huy\u1ebft n\u1eb7ng k\u00e9o d\u00e0i, kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, th\u01b0\u1eddng c\u1eaft \u1edf tr\u1ebb l\u1edbn v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ee7ng ng\u1eeba k\u0129 c\u00e0ng.\u00a0 C\u1eaft l\u00e1ch ch\u1ec9 hi\u1ec7u qu\u1ea3 30-40% do h\u1ec7 v\u00f5ng n\u1ed9i m\u00f4 n\u01a1i kh\u00e1c v\u1eabn c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n ti\u1ebfp t\u1ee5c b\u1eaft gi\u1eef ti\u1ec3u c\u1ea7u thay cho l\u00e1ch, m\u00e0 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng \u1edf tr\u1ebb em l\u1ea1i r\u1ea5t cao.<\/span>
\n+ Anti RhO (Anti D) immune globulin 75mg\/kg TTM trong 30 ph\u00fat. C\u01a1 ch\u1ebf: hi sinh h\u1ed3ng c\u1ea7u \u0111\u1ec3 c\u1ee9u ti\u1ec3u c\u1ea7u n\u00ean \u00edt d\u00f9ng. T\u00e1c d\u1ee5ng ph\u1ee5: nguy c\u01a1 thi\u1ebfu m\u00e1u t\u00e1n huy\u1ebft.
\n+ Ngo\u00e0i ra, c\u00f2n c\u00f3 Rituximab 375 mg\/m2 da TTM 4 \u2013 6 gi\u1edd m\u1ed7i tu\u1ea7n trong 4 tu\u1ea7n,<\/strong> c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch d\u1ecbch th\u1ec3 lympho B.<\/p>\n

4. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng:<\/h2>\n

– Truy\u1ec1n ti\u1ec3u c\u1ea9u:
\n+ C\u1ea7n ph\u1ed1i h\u1ee3p thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch trong khi ch\u1edd truy\u1ec1n ti\u1ec3u c\u1ea7u.
\n– Ngo\u00e0i ra, c\u00f3 th\u1ec3 truy\u1ec1n h\u1ed3ng c\u1ea7u l\u1eafng khi c\u00f3 thi\u1ebfu m\u00e1u, Hct < 25%. L\u01b0\u1ee3ng 10 \u2013 15 ml\/kg.<\/p>\n

5. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/h2>\n
    \n
  • C\u1ea7n h\u1ea1n ch\u1ebf c\u00e1c tr\u00f2 th\u1ec3 thao c\u00f3 nguy c\u01a1 ch\u1ea5nth\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c m\u00f4n th\u1ec3 thao \u0111\u1ed1i kh\u00e1ng nh\u01b0 \u0111\u00e1 banh, b\u00f3ngr\u1ed5. Tr\u1ebb c\u00f3 th\u1ec3 b\u01a1i l\u1ed9i hay \u0111i xe \u0111\u1ea1p. Ch\u1ee7ng ng\u1eeba s\u1edfi, quai b\u1ecb, Rubellav\u1eabn c\u00f3 th\u1ec3 ti\u00eam theo l\u1ecbch. Kh\u00f4ng d\u00f9ng c\u00e1c thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3uc\u1ea7u nh\u01b0 Aspirin\u2026<\/li>\n
  • C\u1eaft l\u00e1ch: ch\u1ec9 hi\u1ec7u qu\u1ea3 30-40% do h\u1ec7 v\u00f5ng n\u1ed9i m\u00f4 n\u01a1i kh\u00e1c v\u1eabn c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n ti\u1ebfp t\u1ee5cb\u1eaft gi\u1eef TC thay cho l\u00e1ch, m\u00e0 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng \u1edf tr\u1ebb em l\u1ea1i r\u1ea5t cao.<\/li>\n
  • T\u00e1i kh\u00e1m:
    \n– \u0110\u1ebfm ti\u1ec3u c\u1ea7u m\u1ed7i 1 \u2013 2 tu\u1ea7n trong giai \u0111o\u1ea1n xu\u1ea5t huy\u1ebft tr\u1ea7m tr\u1ecdng \u0111\u1ebfn khi h\u1ebft xu\u1ea5t huy\u1ebft, sau \u0111\u00f3 3 \u2013 4 tu\u1ea7n \u0111\u1ebfn khi TC > 150.000\/mm3.
    \n– Ng\u1eebng t\u00e1i kh\u00e1m khi TC > 150.000\/mm3 m\u1ed7i th\u00e1ng, TC \u1ed5n \u0111\u1ecbnh trong 3 th\u00e1ng li\u00ean ti\u1ebfp.<\/li>\n
  • Theo d\u00f5i bi\u1ebfn ch\u1ee9ng sau d\u00f9ng corticosteroids li\u1ec1u cao k\u00e9o d\u00e0i\u00a0 nh\u01b0 lo\u00e3ng x\u01b0\u01a1ng,vi\u00eam d\u1ea1 d\u00e0y, nhi\u1ec5m tr\u00f9ng , r\u1ed1i lo\u1ea1n n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i, ti\u1ec3u \u0111\u01b0\u1eddng.<\/span><\/li>\n<\/ul>\n

    6. Ti\u00ean l\u01b0\u1ee3ng:<\/h2>\n

    Tr\u1edf th\u00e0nh m\u1ea1n t\u00ednh<\/strong><\/p>\n

    + Th\u01b0\u1eddng trong giai \u0111o\u1ea1n gi\u1ea3m li\u1ec1u\/ m\u1ea1n t\u00ednh
    \n+ Nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 m\u1ea1n t\u00ednh
    \n+ D\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u n\u00e3o
    \n+ \u0110ang d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, \u1ee9c ch\u1ebf ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u cho b\u1ec7nh kh\u00e1c
    \nD\u1eb6N D\u00d2:<\/strong>
    \nTr\u00e1nh d\u00f9ng c\u00e1c thu\u1ed1c: Heparin, kh\u00e1ng vitamin K, kh\u00e1ng ng\u01b0ng t\u1eadp TC, NSAID nh\u01b0 aspirin, ibuprofen.
    \nKh\u00f4ng ti\u00eam ng\u1eeba trong th\u1eddi gian d\u00f9ng corticoid (do kh\u00f4ng sinh \u0111\u01b0\u1ee3c kh\u00e1ng th\u1ec3) -> sau ng\u01b0ng corticoid 2 tu\u1ea7n (n\u1ebfu c\u1ea7n th\u00ec trong th\u1eddi gian gi\u1ea3m li\u1ec1u, ch\u1ea5p nh\u1eadn hi\u1ec7u qu\u1ea3 ch\u1ee7ng ng\u1eeba kh\u00f4ng cao).
    \nKh\u00f4ng ph\u1ea3i l\u00e0 b\u1ec7nh di truy\u1ec1n v\u1eabn t\u0103ng nguy c\u01a1 3 l\u1ea7n<\/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":"\nXu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch: khi n\u00e0o truy\u1ec1n m\u00e1u? - 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 t\u1ef1 sinh 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=\"Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch: khi n\u00e0o truy\u1ec1n m\u00e1u? 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