anti-D imunoglobulinis gamoyeneba rezus D profilaqtikisaTvis Aakad. o. RuduSauris saxelobis Eerovnuli samedicino centri, sameano ganyofilebis ufrosi mamuka nemsaZe rezus (Rh)-sistema 1940 wels K.Landsteiner-isa da A.Wiener-is mier eriTrocitebSi aRmoCenil iqna cilovani fraqcia, romelsac antigenuri Tvisebebi gaaCnda. am antigens ewoda D-faqtori, Rh-faqtori K.Landsteiner Rhesus mamacue A.Wiener eriTrocitebis antigenuri struqtura identificirebulia wiTeli sisxlis 400-mde antigeni. kell, duff, c, s, ABO, RH-sistemis da sxv. mniSvnelovani imunologiuri da genetikuri mniSvneloba ABO da RH sistema. rezus sistemis antigenebi sisxlis Rh sistema Sedgeba C, c, D, E da e antigenebisagan. Rh(D) dadebiTi sisxlis kuTvnileba-aqvs Rh(D) antigeni (85%) Rh(D) uaryofiTi sisxlis kuTvnileba-ar aqvs Rh(D) antigeni (15%) Rh sensibilizacia izoimunizacia Rh (D) uaryofiTi orsulebis Rh (D) dadebiTi nayofiT. Nnayofis hemolizuri daavadebis gamowveva. aucilebeli pirobaa bavSvis mamas hqondes Rh dadebiTi sisxlis kuTvnileba izoimunizacia rezus-sistemiT pirveladi imunuri pasuxi (sensibilizacia)-orsulis organizmSi antigenis pirveladi SeRwevis Semdeg warmoiqmneba IgM meoradi imunuri pasuxi-antigenis Semdgomi zemoqmedebisas antisxeulebi - IgG,IgE,IgD,IgA mcire zomis gamo placentaSi gadis da nayofamde aRwevs mxolod IgG antisxeuli sayuradRebo faqtorebi orsulobis 30 dRis vadaze Rh(D) antigeni gamoixateba rogorc embrionis eriTrocitaruli membranis nawili. serologiuri gamovlena SesaZlebelia izoimunizaciidan 5-15kviris Semdeg. ganmapirobebeli faqtorebi (fetomaternuli sisxldenis sixSire, dedisa da nayofis sisxlis sistemiT SeTavseba, homozigoturia Tu heterozigoturi nayofi antigenis mixedviT da sxv.). imunuri pasuxis intensivoba analogiuri antigenebTan Semdgomi kontaqtis Semdeg Zlierdeba. izoimunizacia rezus-sistemiT mizezebi orsulobis ganmavlobaSi transplacentarulad - feto-maternaluri sisxlis Sereva. Rh(D) dadebiTi sisxliT kontaminirebuli nemsiT ineqcia. Rh(D) dadebiTi sisxlis transfuzia . Ffeto-maternaluri sisxlis Sereva (riskebi) minimaluri raodenoba (0,1ml) (1964, K.Cohen) TviTnebiTi abortebi eqtopiuri orsuloba invaziuri saSvilosnosSida procedurebi nayofis Tavze mobruneba sakeisro kveTa, nayofis sikvdili orsulobis periodSi sisxlisdena Ffeto-maternaluri sisxlis Sereva (riskebi) mSobiarobisas 16% aqedan 2%- mSobiarobis momentisaTvis 7%-mSobiarobidan 6 Tvis Semdeg 7%-sensibilizirebulia. izoimunizacia rezus-sistemiT nayofis eriTroblastozi eriTrocitebis hemolizi anemia hiperbilirubinemia qsovilovani hipoqsia da acidozi eriTropoetinebis sinTezis stimulacia eqstramedularuli sisxlwarmoqnis kerebis warmoqmna viTardeba nayofis eriTroblastozi gansakuTrebiT aRsaniSnavia, rom arapirdapiri bilirubini, romelis cximSi xsnadi nivTierebaa advilad aRwevs lipidebiT mdidar qsovilebSi, maT Soris Tavis tvinis birTvebSi da iwvevs e.w. birTvul siyviTles - kernicterus. imunizaciis xarisxis mixedviT orsulobis 22-23kviridan nebismieri simwvaviT SeiZleba ganviTardes. ufro xSirad viTardeba dabadebidan ramodenime saaTSi an dReSi. daavadebis simZimidan gamomdinare sxvadasxva formiT gamovlindes: anemiuri. siyviTlis. universaluri SeSupebis. Tumca yvela formis dros gamoxatulia anemia. izoimunizacia rezus-sistemiT antenataluri meTvalyureoba skriningi dadastureba monitoringi marTva izoimunizacia rezus-sistemiT antenataluri meTvalyureoba skriningi pirveli antenataluri vizitis dros: orsulis sisxlis jgufisa da rezusis tipireba dedis rezus-uaryofiTi sisxlis kuTvnilebis SemTxvevaSi bavSvis mamis Rh(D) tipireba yoveli orsulobis dros yvela Rh(D) uaryofiTi orsulis skriningi antisxeulebze (Grade-IB) skriningi Rh(D)-antisxeulebis diagnostikis mizniT gamoiyeneba arapirdapiri kumbsis testi. aloimunizaciis gamovlenis aloimunizaciis xarisxis dadgenis mizniT. anti-Rh(D) antisxeulebis deteqciis mizniT avtomatizirebuli enzimaturi meTodebis gamoyeneba ar aris rekomendirebuli antenataluri meTvalyureoba monitoringi Tu pirveli antenataluri vizitis dros: antisxeulebze skriningi uaryofiTia, maSin antisxeulebze skriningi unda ganmeordes: orsulobis 28 kviris vadaze mSobiarobis dros Tu antisxeulebis titri dadebiTi, maSin ganmeorebiTi testireba antisxeulebze tardeba: orsulobis 20 kviris Semdeg 2-4kviraSi erTxel kumbsis titri ≤1:8 rekomendirebulia yovelTviuri retestireba orsulobis 24 kviris vadamde, Semdeg ki mSobiarobamde 2 kviraSi erTxel. Tu titri kritikulia-1:16 an 1:32 unda ganxorcieldes nayofis anemizaciis xarisxis deteqcia. antenataluri meTvalyureoba monitoringi nayofis anemiis simwvavis Sefaseba eqoskanireba doplerometria Tavisufali fetaluri dnm amniocentezi kordocentezi anemiis simwvavis Sefaseba iwyeba orsulobis 18 kviris vadidan. Tu wina orsulobis dros axalSobils aReniSneboda wyalmanki, anemia, maSin Semdgomi osulobis dros nayofis anemizaciis ganviTareba ueWvelia nayofis mwvave anemiad iTvleba hematokriti <30% anemizaciis xarisxis Sefaseba eqoskenireba ultrasonografiuli parametrebi: placentis sisqe (momatebuli 0,5-1sm-iT) Wiplaris venebis diametri (10mm-mde da metad gafarToeba ) RviZlis zoma elenTis zoma sanayofo wylebi (gamoxatulia asciti da mravalwylianoba) nayofis Sua cerebraluri arteriis sistoluri pikis doplerometriuli Sefaseba anemiuri nayofi inarCunebs Tavis tvinis JangbadiT momaragebas dabali siblantis sisxliT nayofis cerebraluri sisxlisdinebis matebis xarjze. dedis sisxlis plazmaSi Tavisufali fetaluri Rh(D) DNA gansazRvra PCR-is reaqciis gamoyenebiT am testirebis gamoyenebiTSesaZlebelia: aloimunizirebul qalebSi nayofis sisxlis tipirebis invaziuri procedurebis Catarebis SezRudva arasensibilizebuli qalebisaTvis antenatalur profilaqtikis ar Catareba anti-D imunoglobuliniT anemizaciis xarisxis Sefaseba amniocentezi ultrabgeris kontrolis qveS transabdominalurad wvrili nemsis Seyvana amnionur RruSi ukunaCvenebia orsulobis 15 kviris vadamde TviTnebiTi abortis riski 1% bilirubinis optikuri simkvrive speqtraluri analiziT fetaluri sisxlis genotipireba polimerizaciis jaWvuri reaqciis (PCR) daxmarebiT anemizaciis xarisxis Sefaseba kordocentezi exoskopiuri kontrolis qveS wvrili nemsis WiplarSi Seyvana nayofis sisxlis misaRebad tardeba orsulobis 20kviris Semdeg nayofis daRupvis riski 1% nayofis hematokritis ganasazRvra, kumbsis pirdapiri titri fetaluri sisxlis jgufi da Rh(D), retikulocitebis raodenoba, saerTo bilirubini, Trombocitebis raodenoba izoimunizacia rezus-sistemiT marTva saSvilosnosSida transfuzia Cveneba: dadasturebuli fetaluri anemiis diagnozi ( Ht <30%-ze) umwifari nayofi nayofis RviZlis momwifebis dasaCqareblad per- oralurad fenobarbitali mSobiarobade 7dRis ganmavlobaSi izoimunizacia rezus-sistemiT prevencia anti-D imunoglobulinis rutinuli gamoyeneba 28-34kviris vadaze. (Grade 1A) Rh(D) dadebiTi axalSobilis dabadebidan 72–is ganmavlobaSi anti-D globulinis Seyvana (Grade 1A) Tu anti-D imunoglobulinis Seyvana mSobiarobis Semdeg ver moxerxda, Seyvana SesaZlebelia ganxorcieldes rac SeiZleba adre, mSobiarobidan 10 dRis ganmavlobaSi. optimaluri dozireba- 1000-1500 s/e. 1500 IU (300 micrograms) USA, 500–600 IU (100–120 micrograms) Canada 1000–1250 IU (200–250 micrograms) Europe. aloimunizaciis sixSire mcirdeba16-dan 0,1%-mde mSobiaromis Semdgomi imunoprofilaqtikis gamoyeneba 1969 wlidan daiwyo gaerTianebul samefoSi, Rh D aloimunizacia 46/100 000 dan 1.6/100 000 SemTxvevamde Semcirda. Aanti-D imunoglobulinis dozireba mSobiarobis Semdgom periodSi Kleinhauer- is testiT feto-maternaluri sisxlis Serevis (FMH) xasisxis dadgena mSobiarobidan araugvianes 2 sTSi. 99% 4mlze naklebi 50% meti 4mlze. 0.3 % meti 15 mlze. i/m Sesayvani doza 500 s/e rodesac FMH < 4mlze. damatebiT 125 s/e TiToeul ml-ze rodesac FMH >4mlze. qveynebSi sadac ver xerxdeba Kleinhauer-is testis Catareba optimalur dozad miCneulia 1000-1500 s/e Seyvanis gzebi warmatebuli Sedegis misaRwevad imunoglobulinis Seyvana xdeba deltoidur kunTSi Hhemolizuri da Trombocitopeniuli daavadebis Tanxlebis dros – kanqveS an i.v. D-GAM® (Bio Products Laboratory, Elstree,UK): 250 iu, 500 iu, 1500 iu and 2500 iu vials for intramuscular use only Partobulin SDF (Baxter BioScience,Thetford,UK): 1250 iu prefilled syringe for intramuscular use only Rhophylac® (CSL Behring,Haywards Heath,UK): 1500 iu prefilled syringe for intramuscular or intravenous use WinRho SDF® (Baxter BioScience): 1500 and 5000 IU vials for intramuscular or intravenous use (in the UK this product is used solely for the treatment of idiopathic thrombocytopenic purpura). Aanti-D imunoglobulinis gamoyeneba da dozireba orsulobis ganmavlobaSi arasensibilizirebul orsulebSi rutinuli gamoyeneba 28-34kviris vadaze an erTjeradad 28 kviraze saSvilosnos gare orsulobis saSvilosnos gamofxekis spontanuri sruli an arasruli aborti orsulobis 12 kv. vadazeAan metze. saSvilosSida instrumentuli Carevis Semdgom gestaciis vadis miuxedavad saSvilosnodan perioduli sisxldenebis dros orsulobis ganamvlobaSi. sxvadasxva invaziuri gamokvlevebis Semdgom (amniocentezi, kordocentezi) Mmkvdari nayofiT mSobiarobis Semdgom. Anti-D Ig Seyvana ar aris saWiro: 12 kviramde spontanuri abortis SemTxvevaSi rodesac ar aris nawarmoebi instrumentuli Careva. SeTavazebul unda iqnas: Mmedinkamentozurad orsulobis Sewyvetis Semdgom. Ddozireba ორსულობის 28- ე და 34- ე კვირას- 500 ს/ე ; ან ორსულობის 28- ე კვირას 1,500 ს/ე. 19 + 6/7 kv.mde-- 250 s/e. 20 kv. Dda meti gestaciis vadis dros-- 500 s/e. gmadlobT yuradRebisaTvis!
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