{"id":30728,"date":"2023-05-02T15:57:54","date_gmt":"2023-05-02T08:57:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30728"},"modified":"2023-05-02T15:57:54","modified_gmt":"2023-05-02T08:57:54","slug":"dieu-tri-thieu-mau","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/02\/dieu-tri-thieu-mau\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh th\u1eadn m\u1ea1n"},"content":{"rendered":"

\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf b\u1ec7nh th\u1eadn m\u1ea1n nh\u1eb1m c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n oxy trong c\u01a1 th\u1ec3 v\u00e0 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng. M\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 nh\u1ea5t l\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c EPO \u0111\u1ec3 th\u00fac \u0111\u1ea9y s\u1ea3n xu\u1ea5t h\u1ed3ng c\u1ea7u trong c\u01a1 th\u1ec3.Ngo\u00e0i ra, s\u1eed d\u1ee5ng s\u1eaft \u0111\u1ec3 h\u1ed7 tr\u1ee3 s\u1ea3n xu\u1ea5t h\u1ed3ng c\u1ea7u c\u0169ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u li\u00ean quan \u0111\u1ebfn b\u1ec7nh th\u1eadn m\u1ea1n.<\/strong><\/p>\n

1. \u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u b\u1eb1ng ESAs (Erythropoiesis Stimulating Agents)<\/strong><\/h1>\n

L\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng nh\u1ea5t( \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y \u1edf m\u1ed9t b\u00e0i ri\u00eang, b\u00e0i n\u00e0y ch\u1ec9 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn m\u1ed9t v\u00e0i \u0111i\u1ec3m ch\u00ednh)<\/p>\n

1.1. Th\u1eddi \u0111i\u1ec3m<\/strong><\/h3>\n

N\u00ean b\u1eaft \u0111\u1ea7u d\u00f9ng ESAs cho ng\u01b0\u1eddi b\u1ec7nh CKD c\u00f3 m\u1ee9c Hb 90-100g\/l. Tr\u01b0\u1edbc khi d\u00f9ng, n\u00ean ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y thi\u1ebfu m\u00e1u kh\u00e1c, c\u00e2n nh\u1eafc l\u1ee3i \u00edch v\u00e0 t\u00e1c h\u1ea1i c\u1ee7a thu\u1ed1c \u0111\u1ed1i v\u1edbi t\u1eebng ng\u01b0\u1eddi b\u1ec7nh c\u1ee5 th\u1ec3.<\/p>\n

1.2. M\u1ee5c ti\u00eau<\/strong><\/h3>\n

N\u1ed3ng \u0111\u1ed9 Hb m\u1ee5c ti\u00eau l\u00e0 115g\/l. Ng\u1eebng li\u1ec7u ph\u00e1p ESAs n\u1ebfu Hb>130g\/l.<\/p>\n

Li\u1ec1u<\/strong>:<\/p>\n

– Li\u1ec1u kh\u1edfi \u0111\u1ea7u: d\u1ef1a v\u00e0o Hb, c\u00e2n n\u1eb7ng v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

+ V\u1edbi Epoetin alfa ho\u1eb7c Epoetin beta l\u00e0 20-50UI\/kg x 3 l\u1ea7n m\u1ed7i tu\u1ea7n.<\/p>\n

+ V\u1edbi Darbeopetin-alfa l\u00e0 0,45mg\/kg x 1l\u1ea7n m\u1ed7i tu\u1ea7n ti\u00eam d\u01b0\u1edbi da ho\u1eb7c t\u0129nh m\u1ea1ch, ho\u1eb7c 0,75mg\/kg x 1l\u1ea7n m\u1ed7i 2 tu\u1ea7n ti\u00eam d\u01b0\u1edbi da.<\/p>\n

+ V\u1edbi CERA l\u00e0 0,6mg\/kg x1 l\u1ea7n m\u1ed7i 2 tu\u1ea7n ti\u00eam d\u01b0\u1edbi da ho\u1eb7c t\u0129nh m\u1ea1ch, ho\u1eb7c 1,2mg\/kg x1l\u1ea7n m\u1ed7i 4 tu\u1ea7n ti\u00eam d\u01b0\u1edbi da.<\/p>\n

– Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u n\u00ean d\u1ef1a v\u00e0o n\u1ed3ng \u0111\u1ed9 Hb v\u00e0 s\u1ef1 thay \u0111\u1ed5i c\u1ee7a n\u00f3, li\u1ec1u ESAs hi\u1ec7n d\u00f9ng v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

1.3. \u0110\u01b0\u1eddng d\u00f9ng<\/strong><\/h3>\n

– V\u1edbi ng\u01b0\u1eddi b\u1ec7nh th\u1eadn nh\u00e2n t\u1ea1o, n\u00ean ti\u00eam ESAs d\u01b0\u1edbi da ho\u1eb7c t\u0129nh m\u1ea1ch<\/p>\n

– V\u1edbi ng\u01b0\u1eddi b\u1ec7nh CKD v\u00e0 ng\u01b0\u1eddi b\u1ec7nh l\u1ecdc m\u00e0ng b\u1ee5ng, n\u00ean ti\u00eam ESAs d\u01b0\u1edbi da.<\/p>\n

\"\"
Ngu\u1ed3n: Use of Erythropoiesis-Stimulating Agents in Patients With Anemia of Chronic Kidney Disease: Overcoming the Pharmacological and Pharmacoeconomic Limitations of Existing Therapies<\/strong><\/figcaption><\/figure>\n

2. \u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u\u00a0 b\u1eb1ng b\u1ed5 sung s\u1eaft<\/strong><\/h2>\n

2.1. L\u1ee3i \u00edch <\/strong><\/h3>\n

B\u1ed5 sung s\u1eaft lu\u00f4n \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh nh\u01b0 l\u00e0 m\u1ed9t trong nh\u1eefng \u0111i\u1ec3m m\u1ea5u ch\u1ed1t c\u1ee7a \u0111i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf ng\u01b0\u1eddi b\u1ec7nh CKD. H\u01a1n n\u1eefa, b\u1ed5 sung s\u1eaft c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng l\u1ee3i \u00edch ngo\u00e0i kh\u00eda c\u1ea1nh huy\u1ebft h\u1ecdc, bao g\u1ed3m c\u1ea3i thi\u1ec7n c\u00e1c ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c, mi\u1ec5n d\u1ecbch, \u0111i\u1ec1u nhi\u1ec7t, th\u00edch nghi v\u1edbi luy\u1ec7n t\u1eadp th\u1ec3 l\u1ef1c.<\/p>\n

2.2. C\u00e1c ch\u1ebf ph\u1ea9m<\/strong><\/h3>\n

– S\u1eaft u\u1ed1ng<\/strong>: th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng h\u01a1n k\u00e9m h\u01a1n s\u1eaft t\u0129nh m\u1ea1ch. Tuy v\u1eady, do gi\u00e1 th\u00e0nh th\u1ea5p v\u00e0 d\u1ec5 s\u1eed d\u1ee5ng, s\u1eaft u\u1ed1ng v\u1eabn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u01b0\u1edbc s\u1eaft t\u0129nh m\u1ea1ch. \u0110\u00e1p \u1ee9ng k\u00e9m \u0111\u01b0\u1ee3c cho l\u00e0 (1): m\u1ea5t m\u1ed9t l\u01b0\u1ee3ng s\u1eaft qua th\u1eadn nh\u00e2n t\u1ea1o trong khi s\u1eaft h\u1ea5p thu qua ru\u1ed9t kh\u00f4ng k\u1ecbp b\u00f9, (2) s\u1ef1 k\u1ebft h\u1ee3p t\u1ed1i \u0111a c\u1ee7a s\u1eaft v\u00e0 t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u x\u1ea3y ra mu\u1ed9n( 33 ng\u00e0y so v\u1edbi 8,6 ng\u00e0y n\u1ebfu ti\u00eam t\u0129nh m\u1ea1ch); (3): n\u1ed3ng \u0111\u1ed9 hepcidin ( t\u0103ng l\u00ean trong suy th\u1eadn) cao g\u00e2y \u1ee9c ch\u1ebf h\u1ea5p thu s\u1eaft u\u1ed1ng t\u1eeb t\u00e1 tr\u00e0ng.<\/p>\n

– S\u1eaft t\u0129nh m\u1ea1ch<\/strong>: Nhi\u1ec1u d\u1ea1ng s\u1eaft t\u0129nh m\u1ea1ch s\u1eb5n c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng. S\u1eaft dextrans c\u00f3 2 lo\u1ea1i c\u1ea5u t\u1ea1o: ph\u00e2n t\u1eed l\u01b0\u1ee3ng cao( \u00edt s\u1eed d\u1ee5ng do li\u00ean quan \u0111\u1ebfn c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7) v\u00e0 ph\u00e2n t\u1eed l\u01b0\u1ee3ng th\u1ea5p. S\u1eaft sucrose \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u \u2264200-300 mg trong 2 gi\u1edd, li\u1ec1u 400-500 mg c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 HA v\u00e0 co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh . S\u1eaft gluconate \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u 125-250 mg trong 1-4 gi\u1edd, li\u1ec1u cao h\u01a1n c\u0169ng th\u01b0\u1eddng g\u00e2y h\u1ea1 HA. C\u00f3 nhi\u1ec1u lo ng\u1ea1i khi s\u1eed d\u1ee5ng s\u1eaft t\u0129nh m\u1ea1ch, b\u1ea5t k\u1ec3 ch\u1ebf ph\u1ea9m n\u00e0o. Nguy c\u01a1 c\u1ee7a qu\u00e1 t\u1ea3i s\u1eaft khi t\u1ed5ng l\u01b0\u1ee3ng s\u1eaft trong c\u01a1 th\u1ec3 >5g( v\u01b0\u1ee3t qu\u00e1 kh\u1ea3 n\u0103ng c\u1ee7a h\u1ec7 li\u00ean v\u00f5ng n\u1ed9i m\u00f4), \u00edt g\u1eb7p khi Ferritin m\u00e1u <2000 ng\/ml.<\/p>\n

– Nh\u1eefng thu\u1ed1c s\u1eaft m\u1edbi ho\u1eb7c \u0111ang th\u1ef1c nghi\u1ec7m:<\/p>\n

+ S\u1eaft u\u1ed1ng: C\u00e1c lo\u1ea1i s\u1eaft heme \u0111\u01b0\u1ee3c h\u1ea5p thu qua d\u1ea1 d\u00e0y ru\u1ed9t hi\u1ec7u qu\u1ea3 10 l\u1ea7n h\u01a1n s\u1eaft kh\u00f4ng heme.<\/p>\n

+ S\u1eaft t\u0129nh m\u1ea1ch: Ferurnoxytol( Feraheme), kh\u00f4ng c\u00f3 ch\u1ee9a s\u1eaft t\u1ef1 do, c\u00f3 th\u1ec3 d\u00f9ng li\u1ec1u 510 mg trong 17 gi\u00e2y m\u00e0 kh\u00f4ng t\u00e1c d\u1ee5ng n\u1eb7ng n\u1ec1 n\u00e0o. S\u1eaft carboxymaltose ( Ferinject), ch\u1ee9a m\u1ed9t ch\u00fat s\u1eaft t\u1ef1 do v\u00e0 c\u00f3 th\u1ec3 d\u00f9ng li\u1ec1u 1g trong 15 ph\u00fat. S\u1eaft Isomaltoside 1000 mg ( Monofer), l\u00e0 d\u1ea1ng s\u1eaft t\u0129nh m\u1ea1ch m\u1edbi nh\u1ea5t, t\u01b0\u01a1ng \u0111\u1ed1i tinh khi\u1ebft v\u00e0 c\u00f3 nhi\u1ec1u \u01b0u \u0111i\u1ec3m v\u01b0\u1ee3t tr\u1ed9i.<\/p>\n

2.3. Ph\u00e1c \u0111\u1ed3\u0111i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u b\u1eb1ng b\u1ed5 sung s\u1eaft<\/strong><\/h3>\n

– N\u00ean c\u00e2n nh\u1eafc l\u1ee3i \u00edch v\u00e0 nh\u1eefng nguy c\u01a1 ti\u1ec1m t\u00e0ng( s\u1ed1c ph\u1ea3n v\u1ec7, c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb c\u1ea5p t\u00ednh ho\u1eb7c c\u00e1c nguy c\u01a1 l\u00e2u d\u00e0i ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft) tr\u01b0\u1edbc khi k\u00ea toa.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh thi\u1ebfu m\u00e1u ch\u01b0a s\u1eed d\u1ee5ng ESAs ho\u1eb7c s\u1eaft, c\u00f3 th\u1ec3 d\u00f9ng s\u1eaft t\u0129nh m\u1ea1ch( ho\u1eb7c \u1edf ng\u01b0\u1eddi b\u1ec7nh m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n kh\u00f4ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u00f3 th\u1ec3 d\u00f9ng s\u1eaft u\u1ed1ng trong 1-3 th\u00e1ng) n\u1ebfu:<\/p>\n

+ N\u1ed3ng \u0111\u1ed9 Hemoglobin t\u0103ng l\u00ean m\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng ESA v\u00e0<\/p>\n

+ TSAT \u226430% v\u00e0 ferrtin\u2264500 ng\/ml<\/p>\n

– V\u1edbi ng\u01b0\u1eddi b\u1ec7nh \u0111ang d\u00f9ng ESAs kh\u00f4ng k\u00e8m b\u1ed5 sung s\u1eaft, c\u00f3 th\u1ec3 d\u00f9ng s\u1eaft t\u0129nh m\u1ea1ch (ho\u1eb7c \u1edf ng\u01b0\u1eddi b\u1ec7nh m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n kh\u00f4ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u00f3 th\u1ec3 d\u00f9ng s\u1eaft u\u1ed1ng trong 1-3 th\u00e1ng) n\u1ebfu:<\/p>\n

+ N\u1ed3ng \u0111\u1ed9 Hemoglobin t\u0103ng l\u00ean ho\u1eb7c gi\u1ea3m \u0111\u01b0\u1ee3c li\u1ec1u ESA v\u00e0<\/p>\n

+ TSAT \u226430% v\u00e0 ferritin\u2264500ng\/ml<\/p>\n

– L\u1ef1a ch\u1ecdn \u0111\u01b0\u1eddng d\u00f9ng d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 thi\u1ebfu s\u1eaft, s\u1ef1 s\u1eb5n c\u00f3 m\u1ed9t \u0111\u01b0\u1eddng v\u00e0o t\u0129nh m\u1ea1ch, \u0111\u00e1p \u1ee9ng v\u1edbi s\u1eaft u\u1ed1ng tr\u01b0\u1edbc \u0111\u00f3, t\u00e1c d\u1ee5ng ph\u1ee5 v\u1edbi s\u1eaft u\u1ed1ng ho\u1eb7c s\u1eaft t\u0129nh m\u1ea1ch tr\u01b0\u1edbc \u0111\u00f3, gi\u00e1 c\u1ea3, s\u1ef1 ch\u1ea5p thu\u1eadn c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

– H\u01b0\u1edbng d\u1eabn \u0111\u01b0\u1eddng d\u00f9ng s\u1eaft ti\u1ebfp theo d\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng c\u1ea3i thi\u1ec7n n\u1ed3ng \u0111\u1ed9 Hb v\u1edbi li\u1ec7u ph\u00e1p b\u1ed5 sung s\u1eaft g\u1ea7n \u0111\u00e2y, c\u0169ng nh\u01b0 t\u00ecnh tr\u1ea1ng m\u1ea5t m\u00e1u ti\u1ebfp di\u1ec5n, c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 d\u1ef1 tr\u1eef s\u1eaft( TSAT, Ferritin), n\u1ed3ng \u0111\u1ed9 Hb, \u0111\u00e1p \u1ee9ng v\u1edbi ESA v\u00e0 li\u1ec1u ESA, di\u1ec5n bi\u1ebfn c\u1ee7a m\u1ed7i th\u00f4ng s\u1ed1 v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

– V\u1edbi ng\u01b0\u1eddi b\u1ec7nh tr\u1ebb em c\u00f3 thi\u1ebfu m\u00e1u nh\u01b0ng hi\u1ec7n t\u1ea1i kh\u00f4ng s\u1eed d\u1ee5ng ESA ho\u1eb7c b\u1ed5 sung s\u1eaft, c\u00f3 th\u1ec3 d\u00f9ng s\u1eaft u\u1ed1ng( ho\u1eb7c s\u1eaft t\u0129nh m\u1ea1ch \u1edf ng\u01b0\u1eddi b\u1ec7nh th\u1eadn nh\u00e2n t\u1ea1o) khi TSAT\u226420% v\u00e0 Ferritin \u2264 100ng\/ml (\u2264100\u00b5g\/l)<\/p>\n

– V\u1edbi ng\u01b0\u1eddi b\u1ec7nh tr\u1ebb em \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ESA nh\u01b0ng kh\u00f4ng b\u1ed5 sung s\u1eaft, c\u00f3 th\u1ec3 d\u00f9ng s\u1eaft u\u1ed1ng( ho\u1eb7c s\u1eaft t\u0129nh m\u1ea1ch cho ng\u01b0\u1eddi b\u1ec7nh th\u1eadn nh\u00e2n t\u1ea1o) \u0111\u1ec3 duy tr\u00ec TSAT>20% v\u00e0 Ferritin >100ng\/ml(>100\u00b5g\/l)<\/p>\n

2.4. \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1eaft<\/strong><\/h3>\n

– \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1eaft( TSAT v\u00e0 Ferritin) \u00edt nh\u1ea5t 3 th\u00e1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ESA, tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh b\u1eaft \u0111\u1ea7u ho\u1eb7c ti\u1ebfp t\u1ee5c li\u1ec7u ph\u00e1p.<\/p>\n

– X\u00e9t nghi\u1ec7m t\u00ecnh tr\u1ea1ng s\u1eaft( TSAT v\u00e0 Ferritin) th\u01b0\u1eddng xuy\u00ean h\u01a1n khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ho\u1eb7c khi t\u0103ng li\u1ec1u ESA, khi c\u00f3 m\u1ea5t m\u00e1u, khi theo d\u00f5i \u0111\u00e1p \u1ee9ng sau m\u1ed9t \u0111\u1ee3t truy\u1ec1n s\u1eaft t\u0129nh m\u1ea1ch, v\u00e0 trong c\u00e1c ho\u00e0n c\u1ea3nh kh\u00e1c khi c\u00f3 gi\u1ea3m d\u1ef1 tr\u1eef s\u1eaft.<\/p>\n

2.5. C\u00e1c c\u1ea3nh b\u00e1o khi b\u1ed5 sung s\u1eaft<\/strong><\/h3>\n

– Khi truy\u1ec1n s\u1eaft, n\u00ean theo d\u00f5i ng\u01b0\u1eddi b\u1ec7nh 60 ph\u00fat sau khi b\u1eaft \u0111\u1ea7u v\u00e0 n\u00ean chu\u1ea9n b\u1ecb s\u1eb5n s\u00e0ng c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n h\u1ed3i s\u1ee9c( bao g\u1ed3m thu\u1ed1c) c\u0169ng nh\u01b0 \u0111\u1ed9i ng\u0169 y t\u1ebf \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o \u0111\u1ec3 x\u1eed tr\u00ed c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng.<\/p>\n

– Tr\u00e1nh s\u1eed d\u1ee5ng s\u1eaft t\u0129nh m\u1ea1ch \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111ang c\u00f3 nhi\u1ec5m tr\u00f9ng to\u00e0n th\u00e2n.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u b\u1eb1ng truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u<\/strong><\/h2>\n

– N\u00ean tr\u00e1nh truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u n\u1ebfu c\u00f3 th\u1ec3, \u0111\u1ec3 t\u1ed1i thi\u1ec3u h\u00f3a nh\u1eefng nguy c\u01a1 li\u00ean quan \u0111\u1ebfn li\u1ec7u ph\u00e1p n\u00e0y.<\/p>\n

– \u1ede ng\u01b0\u1eddi b\u1ec7nh ch\u1edd gh\u00e9p th\u1eadn, \u0111\u1eb7c bi\u1ec7t n\u00ean tr\u00e1nh truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u \u0111\u1ec3 t\u1ed1i thi\u1ec3u h\u00f3a nguy c\u01a1 m\u1eabn c\u1ea3m th\u1eadn gh\u00e9p.<\/p>\n

– Tuy nhi\u00ean, truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u v\u1eabn l\u00e0 c\u1ea7n thi\u1ebft n\u1ebfu:<\/p>\n

+ Li\u1ec7u ph\u00e1p ESAs kh\u00f4ng hi\u1ec7u qu\u1ea3( v\u00ed d\u1ee5 b\u1ec7nh Hemoglobin, suy t\u1ee7y x\u01b0\u01a1ng, kh\u00e1ng ESAs).<\/p>\n

+ Nguy c\u01a1 c\u1ee7a li\u1ec7u ph\u00e1p ESAs c\u00f3 th\u1ec3 l\u1edbn h\u01a1n l\u1ee3i \u00edch c\u1ee7a n\u00f3( ung th\u01b0 tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c hi\u1ec7n t\u1ea1i, \u0111\u1ed9t qu\u1ef5 tr\u01b0\u1edbc \u0111\u00f3)<\/p>\n

– Quy\u1ebft \u0111\u1ecbnh truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u khi kh\u00f4ng c\u00f3 m\u1ea5t m\u00e1u c\u1ea5p kh\u00f4ng n\u00ean d\u1ef1a tr\u00ean b\u1ea5t c\u1ee9 ng\u01b0\u1ee1ng Hemoglobin t\u00f9y \u00fd n\u00e0o, m\u00e0 n\u00ean d\u1ef1a tr\u00ean s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng thi\u1ebfu m\u00e1u.<\/p>\n

– Truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u c\u1ea5p: Trong c\u00e1c t\u00ecnh hu\u1ed1ng c\u1ea5p c\u1ee9u, n\u00ean truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u khi l\u1ee3i \u00edch c\u1ee7a n\u00f3 nhi\u1ec1u h\u01a1n nguy c\u01a1, bao g\u1ed3m:<\/p>\n

+ C\u1ea7n \u0111i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u nhanh ch\u00f3ng \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh(v\u00ed d\u1ee5 ch\u1ea3y m\u00e1u, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh kh\u00f4ng \u1ed5n \u0111\u1ecbnh)<\/p>\n

+ C\u1ea7n \u0111i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u nhanh ch\u00f3ng tr\u01b0\u1edbc ph\u1eabu thu\u1eadt<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh th\u1eadn \u2013 ti\u1ebft ni\u1ec7u theo B\u1ed9 Y t\u1ebf 2015<\/p>\n","protected":false},"excerpt":{"rendered":"

\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf b\u1ec7nh th\u1eadn m\u1ea1n nh\u1eb1m c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n oxy trong c\u01a1 th\u1ec3 v\u00e0 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng. M\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 nh\u1ea5t l\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c EPO \u0111\u1ec3 th\u00fac \u0111\u1ea9y s\u1ea3n xu\u1ea5t h\u1ed3ng c\u1ea7u trong c\u01a1 th\u1ec3.Ngo\u00e0i ra, s\u1eed d\u1ee5ng s\u1eaft \u0111\u1ec3 h\u1ed7 […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh th\u1eadn m\u1ea1n - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf b\u1ec7nh th\u1eadn m\u1ea1n nh\u1eb1m c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n oxy trong c\u01a1 th\u1ec3 v\u00e0 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh th\u1eadn m\u1ea1n - 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