#1
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ãåìîãëîáèí.
Äîáðûé äåíü,äîêòîð.
Ïîñëå ïåðåñàäêè ïî÷êè ìåñÿö íàçàä. Ïðèíèìàþ: ïðîãðàô2.5ìã ììô 500ìã 4 òàá â ñóò êî-òðèìàêñàçîë480ìã 1ò âàëãàíâèð 460ìã 1ò. ìåäðîë 12ìã â ñóò. Ó ìåíÿ,ïî÷åìó-òî,íå ïðîõîäèò àíåìèÿ,õîòÿ ôåððåòèí âûøå íîðì.Ïðè÷èíó íå íàõîäÿò. Ìîæåò áûòü ïîíèæåí ãåìîãëîáèí îò íåõâàòêè Â12.? Åñëè âû ïîìîæèòå ìíå ïîíÿòü ïðè÷èíó áóäó âàì áëàãîäàðíà. Àíàëèçû ïðèëàãàþ. |
#2
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ðàçìåñòèòå äëÿ íà÷àëà ñêàíû â íîðìàëüíîì âèäå, à íå áîêîì; íå çíàþ êîììåð÷åñêèõ íàçâàíèé ëåêàðñòâ, íàïèøèòå ìåæäóíàðîäíûå - ââîäÿò ëè âàì ýðèòðîïîýòèí?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ýðèòðîïîýòèí äî ïåðåñàäêè ââîäèëè,ñåé÷àñ íåò.
ïðîãðàô ( òîêðîëèìóñ) ÌÌÔ(ìèêîôåíîëàòà ìîôåòèë) Ìåäðîë (ìåòèëïðåäíèçîëîí) Êî-òðèìàêñîçîë (ñóëüôàìåòîêñàçîë) |
#4
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Ñíèìêè ðàñïëûâàþòñÿ.
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#5
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ïåðâûé ñêàí íå â ôîêóñå âñå öèôðû ðàçìûòû
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Âûñîêèé ôåððèòèí êàê ïðàâèëî èñêëþ÷àåò äåôèöèò æåëåçà, íî â òàêîé ñèòóàöèè êàê ó âàñ, íóæíî ñäåëàòü ñûâ. æåëåçî è îæññ è åñëè èõ ñîîòíîøåíèå ìåíåå 0.2, òî äåôèöèò æåëåçà áóäåò ïîäòâåðæäåí, èíîãäà òàêè ïðîâîäÿò ïðîáíûå êóðñû ýðèòðîïîýòèíîì â ìàëûõ äîçàõ, äî ïîâûøåíèÿ ãåìîãëîáèíà â ïðåäåëàõ 115-125, äåôèöèò â12 ïîñëå òðàíñïëàíòàöèè êàê ïðè÷èíà àíåìèè áûâàåò â 20-25% ñëó÷àåâ, òàê ÷òî òîæå íóæíî èñêëþ÷èòü, íî ïðèçíàêîâ Â12 äåôèöèòà íå âèäíî â ÎÀÊ.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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ÄÎÁÐÛÉ ÂÅ×ÅÐ.
ÒÐÀÍÑÏËÎÍÒÀÖÈß ÏÎ×ÊÈ 2019 Ã. Ïîñëåäíèå 4 ìåñ ñíèæåí ãåìîãëîáèí è ýðèòðîöèòû.Ïîñòîÿííàÿ ñëàáîñòü ,ñíèçèëàñü êîíöåíòðàöèÿ âíèìàíèÿ. Ôåððèòèí 2 ìåñ íàçàä áûë 230 (20-200),òðàíñôåðèí 2.23 ã/ë (2-3.6). Æåëåçî 13.5 mmol/l (9-30.4).  áîëüíèöå íàçíà÷èëè ïèòü æåëåçî Òàðäèôåðîí 80ìã 2ð â äåíü ìåñÿö. Ìîæíî ëè ïèòü æåëåçî ïðè ïîâûøåííîì Ôåððèòèíå? È íóæíî ëè âîîáùå åãî ïðèíèìàòü,ìîæåò ïðîáëåìà â ÷åì -òî äðóãîì? WBC 4.65 ( 10'9/L) ÍÎÐÌÀ: (3.5-9.00) RBC 3.63 (10^ 12/L) (3.8-5.8) HGB 110 (G/L) (110-170) HCT 33.0% 35-50 ÌCV 90.9 F/L 80-97 MCH 30.3 PG 26.5-33.5 MCHC 333G/L 315-380 PLT 198 10^9/L 150-400 RDW-SD 44.0 FL 35.1-46.3 RDW-ÑV 13.1 % 11-15 PDW 9.5 FL 10-18 MPV 9.6 FL 9-13 Ð-LCR 20.6% 13-43 PCT 0.19 % 0.17-0.35 NEUT 1.93 ( 10^9/L) 41.5% (34-72) LUMPH 2.17(10^9/L) 46.7% (17-50) MONO 0.35(10^9/L) 7.5% (4.7-10) EO 1.19 (10^9/L) 4.1% (0.7-5) BASO 0.01 0.2 % (0.1-1.2) IG 0.00 MICROR 1.0% ( 0-999.9) MACROR 3.1% (0- 999.9) COÝ 12 ÏÀËÎ×ÊÎßÄÅÐÍÛÅ 4 ÑÅÃÌÅÍÒÎßÄÅÐÍÛÅ 38 ÝÎÇÈÍÎÔÈËÛ 5 ÌÎÍÎÖÈÒÛ 7 ËÈÌÎÖÈÒÛ 46 |
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#8
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âàì íóæåí ýðèòðîïîýòèí (ESA) â ïåðâóþ î÷åðåäü, åñëè ïîíàäîáèòñÿ æåëåçî, òî â/â
the optimal target Hb level in kidney transplant recipients with anemia should probably be up to 125–130 g/L. In order to achieve this target, appropriate treatment with ESA and i.v. iron should be given. Posttransplantation Anemia in Kidney Transplant Recipients [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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Âðà÷è ,íàøè,íå îñîáî íàçíà÷àþò ýðèòðîïîýòèí,äî äèàëèçà.
Áóäóò òÿíóòü äî ïîñëåäíåãî. Òåì áîëåå ,÷òî ãåìîãëîáèí 110 . ß âûøå ïðî÷èòàëà âàøè ðåêîìåíäàöèè,î ñäà÷å àíàëèçà ÎÆÑÑ èëè â ìîåì ñëó÷àå ýòî áåñïîëåçíî.? |
#10
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íàâåðíîå, íóæíî ñàìîñòîÿòåëüíî èçûñêèâàòü ðåçåðâû íà å-ïîåòèí, îò åòîãî ìîæåò çàâèñåòü ñîñòîÿíèå òðàíñïëàíòèðîâàííîé ïî÷êè, âûøå íàïèñàë ìåæäóíàð. ðåêîìåíäàöèè ïî öåëåâûì öèôðàì; îæññ ñåé÷àñ íå íóæíî òî÷íî, íóæíî ëå÷åíèå; ïåíòîêñèôèëëèí-òðåíòàë â òàáëåòêàõ ìîæåò óëó÷øàòü àíåìèþ ïðè ÕÏÍ, íî íå çíàþ ðàáîòàåò ëè îí íà ôîíå òðàíñïëàíòàöèè?
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
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Äîáðûé âå÷åð.
Ñêàæèòå, Ìîæåò ëè áûòü ñêðûòàÿ àíåìèÿ ,åñëè ôåððèòèí íåìíîãî çàâûøåí. îáùèé àíàëèç êðîâè â íîðìå,íî ñàìî÷óâñòâèå,êàê ïðè íèçêîì æåëåçå. Ñëàáîñòü,êîíöåíòðàöèÿ óïàëà,èëíåò õîäèòü äîëãî. |
#12
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åñòü ëè ñìûñë ñäàâàòü àíàëèç íà ýðèòðîïîýòèí,åñëè ãåìîãëîáèí â íîðìå.
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#13
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îòíîñèòåëüíûé äåôèöèò æåëåçà ìîæåò áûòü è ïðè ôåððèòèíå ìåíåå 300, íî â âàøåé ñèòóàöèè, åñëè ñîáèðàþòñÿ ëèêâèäèðîâàòü àíåìèþ, òî æåëåçî ââîäÿò â/â à åïîåòèí ïîäêîæíî, öåëåâàÿ öèôðà ãåìîãëîáèíà äîëæíà áûòü 125-130
The optimal target hemoglobin level in kidney transplant recipients with anemia is higher than recommended in chronic kidney disease and should probably be up to 125–130 g/L. In order to achieve this target, appropriate treatment with erythropoiesis-stimulating agents (ESA) and iron is indicated.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#14
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âðà÷è ýòîãî äåëàòü íå áóäóò.
ìíå íóæíî ñàìîé íàéòè ïðè÷èíó. ìîæåò åñòü êàêèå-òî àíàëèçû,êîòîðûå ÿ ìîãëà áû ñäàòü. èëè ïîïðîáûâàòü ïðîïèòü æåëåçî è ïîñìîòðåòü íà ñàìî÷óâñòâèå. |
#15
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Ñêàæèòå, Âû æèâåòå íà óëèöå? åäó ñîáèðàåòå ñ èñòåêøèì ñðîêîì íà ìóñîðêàõ? Èëè è ïëàòèòå êâàðòïëàòó è ïîêóïàåòå â ìàãàçèíàõ? Ïî÷åìó î ñâî¸ì çäîðîâüå íåëüçÿ òàêæå ïîçàáîòèòñÿ, åñëè âàøèì âðà÷àì íàïëåâàòü íà Âàñ? "Ïðîïèòîå" æåëåçî îêðàñèò Âàø êàë â ò¸ìíûé öâåò íå óñâàèâàÿñü, åñëè åòî Âàøà öåëü - "ïðîïåéòå" è åãî
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |