Methemoglobinemia

Methemoglobinemia (MetHb) yog cov ntshav tsis txaus uas ua rau tsis txaus siab ntawm cov tshuaj methemoglobin. Hemoglobin yog cov protein nyob hauv cov ntshav liab (RBCs) uas nqa thiab xa cov pa oxygen rau lub cev. Methemoglobin yog ib hom tshuaj hemoglobin.

Nrog methemoglobinemia, hemoglobin tuaj yeem nqa oxygen, tab sis tsis muaj peev xwm tso nws tawm kom zoo rau cov ntaub so ntswg ntawm lub cev.

Kev mob MetHb tuaj yeem yog:

• Dhau los ntawm cov tsev neeg (niam txiv caj ces los yog yug los)
• Ua los ntawm kev kis rau qee yam tshuaj, tshuaj lom neeg, lossis khoom noj (yuav tsum tau)

Nws muaj ob hom ntawv ntawm kev muab tshuaj xws li MetHb. Thawj daim yog kis los ntawm ob leeg niam thiab txiv. Cov niam txiv feem ntau tsis muaj qhov xwm txheej lawv tus kheej. Lawv nqa lub noob uas ua rau muaj mob. Nws tshwm sim thaum muaj teeb meem nrog qhov enzyme hu ua cytochrome b5 reductase.

Nws muaj ob hom kev pub tau ntawm MetHb:

• Hom 1 (tseem hu ua erythrocyte reductase deficiency) tshwm sim thaum RBCs tsis muaj enzyme.
• Yam 2 (tseem hu ua qhov tsis muaj peev xwm ua kom dav ntxiv) tshwm sim thaum lub enzyme tsis ua haujlwm hauv lub cev.

Daim foos thib ob ntawm cov kab mob txuas los ntawm MetHb yog hu ua hemoglobin M disease. Nws tshwm sim los ntawm qhov tsis xws hauv hemoglobin protein nws tus kheej. Tsuas yog ib tus niam txiv yuav tsum tau tso cov noob keeb rau tus me nyuam kom tau tus kab mob.

Nrhiav MetHb yog ib qho ntau dua li cov faus cov qauv muaj. Nws tshwm sim hauv qee cov neeg tom qab lawv raug qee yam tshuaj thiab cov tshuaj, suav nrog:

• Tshuaj loog xws li benzocaine
• Nitrobenzene
• Qee yam tshuaj tua kab mob (suav nrog dapsone thiab chloroquine)
• Nitrites (siv ua additives los tiv thaiv cov nqaij los ntawm lwj)

Cov tsos mob ntawm hom 1 MetHb suav nrog:

• Bluish xim ntawm daim tawv nqaij

Cov tsos mob ntawm hom 2 MetHb suav nrog:

• Kev loj hlob qeeb
• Ua tsis tiav
• Kev txawj ntse
• Qaug dab peg

Cov tsos mob ntawm tus mob hemoglobin M muaj xws li:

• Bluish xim ntawm daim tawv nqaij

Cov tsos mob ntawm tus mob nrhiav MetHb suav nrog:

• Bluish xim ntawm daim tawv nqaij
• Mob taub hau
• Kev siab dav
• Hloov kev puas siab puas ntsws lub xeev
• Nkees
• Ua tsis taus pa
• Tsis muaj lub zog

Ib tug menyuam mos uas muaj tus mob no yuav muaj ib daim tawv nqaij xiav (xiav cyanosis) thaum yug los lossis tom qab ntawd. Tus kws kho mob yuav kuaj ntshav seb puas muaj mob. Kev ntsuam xyuas yuav muaj xws li:

• Txheeb xyuas cov pa theem hauv cov ntshav (mem tes oximetry)
• Kev kuaj ntshav los xyuas cov qib ntawm cov roj ntsha hauv cov ntshav (txoj hlab ntshav hauv txoj hlab ntshav)

Cov neeg mob hemoglobin M tsis muaj cov tsos mob tshwm sim. Yog li, tej zaum lawv tsis xav tau kho.

Ib hom tshuaj hu ua methylene xiav siv rau kev kho mob hnyav MetHb. Methylene xiav tej zaum yuav tsis zoo nyob hauv cov neeg uas muaj lossis yuav raug pheej hmoo ua mob ntshav hu ua G6PD tsis txaus. Lawv yuav tsum tsis txhob noj cov tshuaj no. Yog tias koj lossis koj tus menyuam muaj G6PD tsis txaus, nco ntsoov qhia koj tus kws khomob uantej yuav mus khomob.

Ascorbic acid kuj tseem siv tau los txo qib ntawm methemoglobin.

Lwm txoj kev khomob suav nrog kev kho hyperbaric oxygen, ntshav liab rau ntshav thiab ntshav sib hloov.

Feem ntau ntawm cov mob me me uas tau txais MetHb, tsis tas kho mob dab tsi. Tab sis koj yuav tsum zam ntawm cov tshuaj lossis tshuaj uas ua rau qhov teeb meem. Cov mob loj yuav xav tau ntxiv ntshav ntxiv.

Cov neeg muaj tus mob 1 MetHb thiab hemoglobin M feem ntau ua tau zoo. Hom 2 MetHb raug hnyav dua. Nws feem ntau ua rau tuag hauv thawj ob peb xyoos ntawm lub neej.

Cov neeg uas tau txais MetHb feem ntau ua tau zoo heev thaum noj tshuaj, zaub mov, lossis tshuaj uas ua rau muaj qhov teeb meem pom thiab zam tau.

Teeb meem ntawm MetHb suav nrog:

• Poob Siab
• Qaug dab peg
• Kev Tuag

Hu rau koj tus kws khomob yog koj:

• Muaj ib tse neeg muaj keeb kwm ntawm MetHb
• Tsim cov tsos mob ntawm qhov tsis zoo no

Hu rau koj lub chaw kho mob lossis kev pab thaum muaj xwm ceev (911) tam sim yog tias koj ua tsis taus pa hnyav.

Kev tawm tswv yim txog caj ces yog cov niam txiv muaj keeb kwm ntawm MetHb thiab xav tias yuav muaj menyuam.

Cov menyuam mosliab 6 lub hlis lossis hnub yau dua muaj feem ntau yuav ua mob methemoglobinemia. Yog li, cov zaub mov yug menyuam mos ua zaub mov uas ua los ntawm cov zaub uas muaj nitrates ntau ntau, xws li carrots, zaub ntsuab, lossis zaub ntsuab yuav tsum zam.

Hemoglobin M kab mob; Erythrocyte reductase tsis muaj peev xwm; Generalized reductase deficiency; MetHb

• Cov qe ntshav

Benz EJ, Ebert BL. Hemoglobin muaj ntau yam cuam tshuam nrog kev mob ntshav qab zib (hemolytic anemia), hloov cov pa oxygen sib txawv, thiab methemoglobinemias. Hauv: Hoffman R, Benz EJ, Silberstein LE, eds. Hematology: Qhov Ntsiab Cai thiab Kev Coj UaCov. 7 tus ed. Philadelphia, PA: Elsevier; 2018: chaaj 43.

Letterio J, Pateva I, Petrosiute A, Ahuja S. Hematologic thiab teeb meem oncologic hauv tus me nyuam hauv plab thiab lub cev neonate. Hauv: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff thiab Martin's Neonatal-Perinatal TshuajCov. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 79.

Txhais tau tias RT. Mus kom ze rau lub anemias. Hauv: Goldman L, Schafer AI, eds. Goldman-Cecil TshuajCov. 26th ed. Philadelphia, PA: Elsevier; 2020: cha 149.