13 research outputs found
NEW GUIDELINES FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA
Anemija je rijeÄ grÄkog porijekla Å”to znaÄi beskrvnost. Prema kriterijima WHO, anemija je stanje u kojem je vrijednost Hb <130g/L kod muÅ”karaca, a kod žena vrijednost Hb <120g/L. U klasifikaciji anemije najÄeÅ”Äe se koriste dvije klasifikacije, patofizioloÅ”ka i morfoloÅ”ka klasifikacija. NajÄeÅ”Äa vrsta anemije u populaciji je anemija uslijed nedostatka željeza ili sideropeniÄna anemija, koja uglavnom nastaje zbog gubitka krvi ili poveÄanih potreba organizma za željezom. Adekvatna dijagnoza ovog stanja se postiže uzimanjem dobre anamneze, fizikalnog pregleda i laboratorijskih nalaza, pri Äemu treba posebno treba obratiti pozornost na vrijednosti serumskog feritina i TSAT-a. Prema novim smjernicama terapijsku osnovu Äine preparati željeza,posebice intravenski pripravci, dok se u nekim stanjima koriste i eritropoetin te transfuzijsko lijeÄenje.Anemia is the Greek-origin word and it means 'without blood'. According to the WHO criteria, anemia is a condition in which the value of hemoglobin is less than 130g /L for men and less than 120g/L for women.Anemia is classified by pathophysiology or morphology. The most common type of anemia in the population is the iron deficiency anemia or sideropenic anemia, which is mainly due to blood loss or increased iron requirements. For diagnosis it is important to take a good medical history, physical examination and laboratory findings, especially the values of serum ferritin and TSAT. According to the new guidelines, the treatment options include iron preparations, especially intravenous preparations, while in some conditions erythropoietin and transfusion therapy are used
Tissue stem cells
Tkivne matiÄne stanice su nediferencirane stanice koje se nalaze unutar mnogih tkiva i organa u tijelu kao Å”to su koÅ”tana srž, periferna krv, crijevo, jetra, kost i hrskavica, epiderma, mozak, guÅ”teraÄa i oko. Poput svih matiÄnih stanica i njih karakterizira sposobnost samoobnove putem staniÄne diobe i potencijal diferencijacije u nekoliko tipova stanica u tkivu u kojem se nalaze. Prema tom potencijalu mogu se svrstati u multipotentne matiÄne stanice. S obzirom na svoje svojstvo multipotentnosti, tkivne matiÄne stance imaju važnu ulogu u održavanju i obnavljanju svog domaÄinskog tkiva. Zbog moguÄnosti generiranja novih, u potpunosti diferenciranih stanica, utvrÄena je njihova potencijalna primjena u staniÄnoj terapiji kao tretman protiv teÅ”ko izlijeÄivih degenerativnih bolesti. Do danas su otkriveni brojni mehanizmi terapija matiÄnim stanicama koji se uspjeÅ”no primjenjuju u medicinske svrhe. Oni se temelje na transplantaciji stanica generiranih diferencijacijom tkivnih matiÄnih stanica u organizme Äija su tkiva i organi uniÅ”teni boleÅ”Äu. UnatoÄ tome, u istraživanju svojstava i funkcija matiÄnih stanica ostalo je joÅ” puno prostora za nove spoznaje te je potrebno provesti brojne eksperimente i studije koji bi omoguÄili potpuno iskoriÅ”tavanje potencijala matiÄnih stanica.Tissue stem cells are undifferentiated cells that can be found in many tissues and organs such as bone marrow, peripheral blood, gut, liver, bone and cartilage, epidermis, brain, pancreas and eye. As all of the stem cells, tissue stem cells are also characterized by ability to renew themselves through division and potential to differentiate in several cell types found in tissue in which they are localized. According to that potential, they can be classified as multipotent stem cells. Considering their property of multipotency, tissue stem cells have important role in maintaining and renewing its host tissue. Because of the capability to generate new, completely differentiated cells, tissue stem cells have potential application in cell-based therapies as the treatment against hardly curable degenerative diseases. Until today, there are many discovered mechanisms of stem cell treatments that are successfully used in medical purposes. Those mechanisms are based on the transplantation of the cells generated by differentiation of the tissue stem cells in organisms whose tissues and organs have been destroyed because of the disease. However, there is still a lot of space for new cognitions in stem cell research and much more experiments and studies have to be done to enable full use of stem cells' potential
Zdravstvena njega bolesnika oboljelih od anemije
Anemija ili slabokrvnost je opÄe prihvaÄeni naziv za smanjeni broj eritrocita u cirkulaciji, smanjenu koliÄinu krvi u tijelu i smanjenu koliÄinu hemoglobina u eritrocitima. Eritrociti su krvne stanice koje služe za prijenos kisika i ugljikovog dioksida u tijelu Äovjeka. Anemija nije sama za sebe bolest, veÄ opisuje stanje organizma, odnosno postojanje te bolesti. Anemija može biti veoma naporna i ozbiljna bolest za oboljelog i može ozbiljno utjecati na život pacijenta.
U radu Äe se govoriti o klasifikaciji anemija, etioloÅ”koj i morfoloÅ”koj podjeli anemija, simptomima, znakovima, dijagnostici, lijeÄenju te takoÄer i o moguÄim komplikacijama bolesti i zdravstvenoj njezi. Na osnovi etiopatogeneze dobiva se uvid u procese koji su uzrokovali anemiju. TakoÄer na osnovi anamneze, razgovora s pacijentom o njegovim tegobama, pregleda oboljelog i izradom krvne slike, utvrÄuje se postojanje anemije. Pristupi o lijeÄenju anemija su razliÄiti i takoÄer puno ovise o uzroku anemije. LijeÄnik odreÄuje strategiju lijeÄenja, kao Å”to su primjena odreÄenih lijekova i promjena navika ishrane.Anemia is generally accepted name for the reduced number of red blood cells in the circulation, a reduced amount of blood in the body and reduced hemoglobin in red blood cells. The erythrocytes are blood cells that are used to transport oxygen and carbon dioxide in the body. Anemia is not a disease itself, but describes the condition of the body or the existence of the disease. Anemia can be very exhausting and serious disease that can seriously affect the life of a patient. This thesis will discuss the classification of anemia, the etiology and morphological division of anemia, symptoms, signs, diagnosis, treatment, and also the possible complications of the disease and health care. An insight to a process that caused anemia can be given based on the ethiopathogenesis. Also existence of anemia is based on the anamnesis, the conversation with the patient about his problems, medical examination and making the blood test. Approaches to treating anemia are different and depend much on the cause. The doctor determines the strategy of treatment, such as the application of certain drugs and change of eating habits
Proizvodnja i primjena krvnog pripravka za lijeÄenje autoimune hemolitiÄke anemije kroz proces zdravstvene njege
Transfuzija je ujedno i klinika i dio laboratorijske medicine sa zadaÄom proizvodnje
lijekova iz ljudske krvi te lijeÄenje bolesnika sa njima.U ovom radu donosim definicije
potrebne za razumijevanje rada i transfuzijske znanosti.
Za transfuziju krvi je veoma važno dobrovoljno davalaÅ”tvo jer ona s njime poÄinje i o njima
ovisi.Nema proizvodnje lijekova iz krvi bez humanosti i solidarnosti ljudi koji ju
daruju.Davaoci daju punu krv iz koje se dobiju zasebni pripravci eritrocita,trombocita,svježe
smrznute plazme,krioprecipitata...Postoje i aparati koji od davaoca uzimaju samo jedan
sastojak krvi pa je proizvodnja olakŔana.Davanje krvi može kod davaoca izazvati
blage,srednje i teÅ”ke nuspojave.ŽeleÄi osigurati Å”to kvalitetnije i sigurnije krvne
pripravke,svaka doza krvi uzeta od davaoca se testira prema protokolima.Sav taj posao prati
odreÄena dokumentacija koja se trajno Äuva.
Kad se proizvede krvni pripravak potrebno je obaviti odreÄena testiranja prije primjene
bolesniku.Ta testiranja se izvode na odjelima za transfuzijsku medicinu.Kada su ona
obavljena i rezultati odobreni od strane lijeÄnika transfuziologa krvni pripravak se može
transfundirati bolesniku.Naravno,prije i nakon toga mora biti zadovoljen protokol pisanog
traga o svim postupcima.
Autoimuna hemolitiÄka anemija je ozbiljna bolest kratkog životnog vijeka eritrocita u
krvotoku bolesnika.Postoji nekoliko vrsta AIHA-e pa se eritrociti za transfuziju pripremaju
prema njihovim karakteristikama.Potrebna je posebna pažnja i promatranje pacijenta za
vrijeme transfuzije.
Medicinska sestra radi svoju procjenu pacijenta i postavlja sestrinske dijagnoze.Pruža njegu
pacijentu i izvodi intervencije u skladu s prethodno postavljenim dijagnozama.Pri tome se
koristi raznim skalama i obrascima te sve bilježi u sestrinsku dokumentaciju.
U ovom radu sam prikazala sluÄaj pacijenta starog 50 godina s autoimunom hemolitiÄkom
anemijom.Opisala sam sestrinske dijagnoze,ciljeve i intervencije koje se mogu primijeniti na
njegov sluÄaj.
U transfuzijskom lijeÄenju mogu nastati mnoge komplikacije.Neke su manje poznate,neke
viÅ”e.Opisala sam ipak ÄeÅ”Äe i poznatije te dovoljno istražene da ih mogu ovdje spomenuti.Transfusion is also the clinic and part of laboratory medicine with the task to produce medicines
derived from human blood and treating patients with them. This paper presents definitions necessary
for the understanding of the work and transfusion science.
Blood transfusion is very important voluntary blood because it begins with him and depends on
them.There is no production of drugs from the blood without humanity and solidarity of people who is
donating it. People give whole blood from which to obtain a separate preparations of red blood cells,
platelets, fresh frozen plasma, cryoprecipitate...There are also devices that takes from the donor only
one component of blood so production is easier.Giving blood with the donor can lead to mild,medium
and heavy side effects.In desire to provide you a better and safer blood products,each dose of blood
taken from the donor is tested according to standard operative protocols.All this work is followed by
certain documents to be kept permanently.
When producing blood component it is necessary to do some tests before applying to patient.The tests
are preformed at the units for Transfusion medicine.When they are made and the results are approved
by the physician specialist of transfusion,blood component can be transfused to patient.Of
course,before and after the additon,there has to be satisfied protocol of written trail about all
proceedings.
Autoimmune hemolytic anemia is a serious disease of short lifespan of red blood cells in the
bloodstream of sick person.It existes several types of AIHA-e so the red blood cells for transfusion are
preparing by their characteristics.It is necessary special attention and observation of the patient during
transfusion.
The nurse works its assessment of the patient and sets diagnosis.She provides nursing care to the
patient and performes interventions in accordance with thoose diagnosis.During that job she is using
all sorts of scales and patterns and all that is writting down to the nursing documentation.
In this paper I presented the case 50 years old patient with autoimmune hemolytic anemia.I described
nursing diagnosis,objectives and interventions that can be applied to his case.
The transfusion therapy can cause many complications.Some are less well known,some are more.I
described complications that are more often and better-known and researched enough so they can be
mentioned here
The role of biopsy in congenital kidney disease - oligomeganephronia and nephronophthisis
Anomalije mokraÄnog sustava su najuÄestalije kongenitalne anomalije. Nalaze se kao izolirane promjene ili s anomalijama drugih organskih sustava. Promjenama su najpodložniji bubrezi, a kongenitalne bubrežne anomalije Äine 60 % uzroka kroniÄne bubrežne bolesti. Napredovanje oÅ”teÄenja smanjuje bubrežnu funkciju i naposljetku dovodi do kroniÄnog bubrežnog zatajenja. Otkrivanje oligomeganefronije i nefronoftize u ranom stadiju bolesti, te zapoÄinjanje terapije, usporava napredak oÅ”teÄenja, otklanja nastanak komplikacija i odgaÄa nastup kroniÄnog bubrežnog zatajenja. DonoÅ”enje zakljuÄka o tipu promjene na temelju kliniÄke slike, laboratorijskih nalaza i slikovnih pretraga ne predstavlja dovoljno pouzdan izbor. Kao dijagnostiÄko sredstvo u procjeni naravi bolesti, stupnja i raÅ”irenosti patoloÅ”ke promjene, primjenjuje se biopsija. UltrazvuÄno voÄena perkutana biopsija je metoda koja se najÄeÅ”Äe koristi. Primjena ultrazvuka omoguÄuje dobar prikaz intrarenalnih struktura i prikupljanje uzorka tkiva na kojemu su promjene najizraženije. Jasan prikaz krvnih žila i kanalnog sustava otklanja moguÄnost njihova oÅ”teÄenja. Preoperativnom pripremom bolesnika, pravilnim izvoÄenje tehnike i odgovarajuÄom postoperativnom skrbi smanjuje se rizik nastanka komplikacija. U sluÄaju postojanja kontraindikacija za izvoÄenje perkutane biopsije, zahvat se izvodi laparoskopski. Izravan vizualan nadzor uvoÄenja sonde u trbuÅ”nu Å”upljinu, prikaz anatomskih struktura i prikupljanje uzorka pospjeÅ”uju uÄinkovitost ove metode. PatohistoloÅ”ka analiza tkiva dobivenog biopsijom, potvrÄuje dijagnozu i procjenjuje potrebu za primjenom dijalize i transplantacije u djece s kroniÄnom bubrežnom bolesti.Anomalies of the urinary tract are the most common type of congenital anomalies. They occur as isolated changes or related to anomalies of the other organ systems in the body. Kidneys are most vulnerable subject to these anomalies; congenital renal anomalies comprise 60% of the causes of chronic kidney disease (CKD). Progression of this disease abridges kidney functions, and ultimately leads to chronic kidney failure (CKF). Detection of the oligomeganephronia and nephronophthisis in their early stages, as well as the treatment, decelerates the progression of damage to tissue, eliminates the occurrence of complications, and delays the onset of chronic renal failure. Drawing conclusions about the type of anomaly based solely on clinical features, laboratory reports and medical imaging, does not represent a reliable method. On the contrary, renal biopsy serves as more feasible diagnostic tool in assessing the nature of the disease, the degree, and the extent of the pathological changes. Most commonly used method is the ultrasound-guided percutaneous biopsy. The application of ultrasound provides an adequate view of intrarenal structures and collecting tissue samples in which the changes are most visible. A clear image of blood vessels and urinary canal system eliminates the possibility of their damaging. Preoperative preparation, proper techniques, and appropriate postoperative care reduce the risk of possible complications. In the case of contraindications for performing percutaneous biopsy, surgery is performed laparoscopically. Direct visual supervision of insertion of the probe inside the abdominal cavity, images of anatomical structures, and sample collection increase the efficiency of the laparoscopic method. A sample of tissue obtained by biopsy is then analyzed by light microscopy, immunofluorescence, immunohistochemistry, electron microscopy, and in situ hybridization. Pathohistological analysis of tissue obtained by biopsy confirms the diagnosis and evaluates the need for dialysis and transplantation for children with chronic kidney disease
Congenital and acquired aplastic anemia in children
AplastiÄna anemija je bolest u kojoj koÅ”tana srž ne može proizvesti krvne stanice: eritrocite, leukocite i trombocite. PosljediÄno tome nastaje pancitopenija, stanje kad su razine svih triju krvnih loza u cirkulirajuÄoj krvi jako niske. Bolest ponajviÅ”e pogaÄa osobe u dobi od 15 do 24 godine, ali takoÄer djecu ispod 15 godina starosti kao i osobe iznad 60. Dva su oblika ove bolesti: priroÄena i steÄena aplastiÄna anemija. PriroÄena aplastiÄna anemija je, u usporedbi sa steÄenom, rijetka. Uzrokovana je genetskim poremeÄajem. SteÄenu aplastiÄnu anemiju uzrokuju razliÄiti toksini, lijekovi i zraÄenja koji mogu potaknuti abnormalnu rekaciju naÅ”eg imunoloÅ”kog sustava. Znakovi i simptomi aplastiÄne anemije proizlaze iz niske razine triju krvnih loza. Osobe oboljele od ove bolesti imaju poveÄani rizik od infekcija, krvarenja te su obiÄno blijede i prati ih neprestani osjeÄaj umora. Dijagnoza se postavlja na temelju anamneze, fizikalnog pregleda, krvne slike i pretragama koÅ”tane srži. LijeÄenje je simptomatsko i uzroÄno. Simpotmatsko ukljuÄuje suzbijanje simptoma koji se razvijaju kao posljedica anemije, leukocitopenije i trombocitopenije, a uzroÄno lijeÄenje podrazumijeva lijeÄenje poremeÄaja funkcije koÅ”tane srži. PoremeÄaj funkcije koÅ”tane srži lijeÄi se imunosupresivnim lijekovima koji suprimiraju aktivnost naÅ”eg imunoloÅ”kog sustave te alogenom transplantacijom koÅ”tane srži.Aplastic anemia is a disease where the bone marrow is unable to produce blood cells; erythrocytes, leukocytes and platelets. This leads to pancytopenia, a condition when levels of all three blood cell types in the blood are low. It usually affects people at the age from 15-24, but also children under 15 and people over 60. There are two types of this disease: acquired and inherited aplastic anemia. Inherited forms are, compared to the acquired, rare. They are caused by some genetic disorders. Acquired aplastic anemia is caused by some toxins, medications and radiation that can provoke an abnormal reaction of our immune system. Signs and symptoms in aplastic anemia are associated with deficiency of three blood cell types. People who are suffering from this kind of disease have a higher risk of infection, bleeding and they are usually pale and feeling fatigue. The diagnosis is based on history, physical examination, blood count and examination of the bone marrow. Treatment of aplastic anemia includes treatment of symptoms resulting from low erythrocyte, leukocyte and platelet levels and treatment of the bone marrow dysfunction. Treatment of the bone marrow dysfunction involves taking drugs that can suppress the activity of our immune system and allogeneic transplantation
FEATURES OF INTENSIFIED AND PROLONGED HYPERBILIRUBINEMIA IN TERM NEONATES
Cilj istraživanja: Cilj istraživanja bio je istražiti obilježja intenzivirane i prolongirane hiperbilirubinemije terminske novoroÄenÄadi.
Ispitanici i metode: Ovo retrospektivno istraživanje obuhvatilo je 100 novoroÄenÄadi, od kojih je 42 s dijagnozom novoroÄenaÄke hiperbilirubinemije hospitalizirano na Odjelu za gastroenterologiju Klinike za pedijatriju KBC-a "Sestre Milosrdnice" u Zagrebu, a 58 na Klinici za pedijatriju KBC-a Split, u razdoblju od 1. sijeÄnja 2017. do 10. svibnja 2019. godine.
Rezultati: U ovo istraživanje ukljuÄeno je 100 novoroÄenÄadi i mlaÄe dojenÄadi s dijagnosticiranom intenziviranom (68%) i prolongiranom hiperbilirubinemijom (32%) u dobi od 2 do 45 dana. U obje skupine dob majke bila je u prosjeku 30 godina. VeÄina je djece roÄena u 39. gestacijskom tjednu, a 63% djece roÄeno je vaginalnim putem poroda. NovoroÄenÄad u skupini intenzivirane hiperbilirubinemije ÄeÅ”Äe je roÄena u toplijim mjesecima, od ožujka do rujna, a novoroÄenÄad s produljenom hiperbilirubinemijom u hladnijem dijelu godine, tijekom jeseni i zime. VeÄina djece lijeÄena je intravenskom hidracijom, njih 89%, a 56% djece lijeÄeno je i fototerapijom. Utjecaj infekcije urinarnog trakta na hiperbilirubinemiju novoroÄenÄadi nije dokazan. Laboratorijski nalazi eritrocita, hemoglobina i hemtokrita bili su unutar referentnih vrijednosti, a mali broj djece imao je nesignifikantno poviÅ”ene vrijednosti jetrenih enzima. NajveÄa vrijednost bilirubina bila je izmjerena u skupini djece s intenziviranom hiperbilirubinemijom i iznosila je 472 Āµmol / l. Tjelesna masa djece s intenziviranom hiperbilirubinemijom bila je znaÄajno niža pri prijemu u usporedbi s porodnom masom, dok su u skupini s prolongiranom hiperbilirubinemijom djeca imala veÄu tjelesnu masu u trenutku hospitalizacije u odnosu na porodnu masu. 42 od 100 novoroÄenÄadi imalo je uÄinjenu DNA-UGT analizu za UGT1A1*28 genotip. UÄestalost nositelja polimorfizma za
Gilbertov sindrom u ispitivanoj populaciji bila je veÄa od uÄestalosti u kontrolnoj skupini.
ZakljuÄak: NovoroÄenaÄka hiperbilirubinemija znaÄajan je kliniÄki entitet na koji mogu utjecati brojni nasljedni, okoliÅ”ni i drugi Äimbenici. Od svih ispitivanih obilježja hiperbilirubinemije novoroÄenÄadi u ovom je istraživanju najjaÄa povezanost utvrÄena u razlici tjelesne mase pri prijemu i porodne mase, koja je bila negativna u skupini intenzivirane hiperbilirubinemije, a pozitivna u novoroÄenÄadi s prolongiranom hiperbilirubinemijom. Polimorfizam GS je važan utjecajni Äimbenik na pojavnost i trajanje hiperbilirubinemije novoroÄenÄeta. Sva ispitivana obilježja trebalo bi uzeti u obzir pri procjeni ozbiljnosti novoroÄenaÄke hiperbilirubinemije prilikom otpusta iz rodiliÅ”ta, kako se ne bi propustila kliniÄki znaÄajna hiperbilirubinemija koja zahtijeva daljnju obradu i praÄenje.Objectives: The aim of this study was to investigate the features of newborns on the occurrence of intensified and prolonged hyperbilirubinemia in term neonates.
Patients and methods: The retrospective research study included 100 term neonates, out of which 42 diagnosed with neonatal hyperbilirubinemia were hospitalized in the Department of Gastroenterology of the āSestre Milosrdniceā University Hospital in Zagreb and 58 in the Department of Gastroenterology of the University Hospital in Split, in the period between the 1st January 2017 and 10th May 2019.
Results: This study included 100 neonates and younger infants with diagnosed intensified (68%) and prolonged hyperbilirubinemia (32%) in the age of 2 to 45 days. In both groups the age of the mother was in the average 30 years. All the children were born in the 39th gestation week and 63% of children were born vaginal delivery. Newborns in the group of intensified hyperbilirubinemia were more often born during the warmer months, March ā September, and newborns with prolonged hyperbilirubinemia in the colder part of the year. Most children were treated with intravenous fluid supplements, 89% of them, and 56% children were also treated with phototherapy. The influence of urinary infection on newborn hyperbilirubinemia is not proven. Laboratory findings of erythrocytes, hemoglobin and hemtocrit were within the refining values, and a small number of children had insignificantly elevated liver enzymes. The highest value of bilirubin was measured in the group of intensified hyperbilirubinemia and it was 472 Āµmol/l. The body mass of the newborns and infants with intensified
hyperbilirubinemia was significantly lower on admission compared to the birth weight, whereas in the group of prolonged hyperbilirubinemia children had higher body mass at the time of hospitalization than the birth weight. 42 out of 100 newborns and infants had DNA-UGT analysis at UGT1A1*28 genotype done. The frequency of the polymorphism carrier for Gilbert syndrome in the examined population was higher than the frequency in the control group.
Conclusion: Newborn hyperbilirubinemia is a significant clinical entity to which many hereditary, environmental and other factors can be affected. Of all the examined features of newborn hyperbilirubinemia, the strongest correlation was found in the difference in body weight at admission and birth weight, which is negative in the group of intensified hyperbilirubinemia and positive in newborns with prolonged hyperbilirubinemia. GS polymorphism is an important factor influencing the appearance and duration of newborn hyperbilirubinemia. All tested features should be taken into account when assessing the severity of newborn hyperbilirubinemia when discharged from the maternity clinic, in order not to miss a clinically significant hyperbilirubinemia that requires further processing and monitoring