ʻO Hemoglobin (Hb) kahi metalloprotein paʻakikī i loaʻa ka hao e noho ana i loko o nā erythrocytes (nā ʻulaʻula koko). ʻO kāna hana physiological mua—ka hoʻopaʻa ʻana i ka oxygen a me ka lawe ʻana mai ka alveoli pulmonary i nā ʻiʻo peripheral, me ka hoʻihoʻi ʻana o ke kalapona dioxide—e hoʻolilo iā ia i mea pono no ka hanu ʻana o ke kelepona a me ka homeostasis metabolic. No laila, ʻo ke ana ʻana o ka hemoglobin i loko o ka hale hana kekahi o nā hoʻokolohua diagnostic i kauoha pinepine ʻia a me ke kumu o ke kauka. ʻOi aku kona koʻikoʻi ma mua o ka ʻike maʻalahi ʻana o ka anemia; hana ia ma ke ʻano he mea hana nānā pivotal, kahi compass diagnostic differential, kahi hōʻailona prognostic no nā maʻi maʻi, a me kahi palena hoʻoholo koʻikoʻi i ka mālama perioperative a me ka oncological.

Ka Pono Hana Nānā Mua a me ka Diagnostic

ʻO ke koʻikoʻi nui o ka hoʻāʻo ʻana i ka hemoglobin aia i kona hiki ke ana i ka hiki ke lawe i ka oxygen o ke koko. ʻO nā ʻokoʻa mai nā pae kuhikuhi i hoʻokumu ʻia—ma ke ʻano maʻamau he 130–175 g/L no nā kāne makua a me 115–150 g/L no nā wahine hāpai ʻole—e lawelawe ma ke ʻano he hōʻailona hae ʻulaʻula mua no ʻelua mau kūlana pathological kūʻē. ʻO ka nui ma lalo o ka palena haʻahaʻa e hōʻike ana i ka anemia, kahi kūlana i hōʻike ʻia e ka hypoxia o nā ʻiʻo e hōʻike ʻia ma ke ʻano he luhi, pallor, dyspnea, a me ka hōʻino ʻike. I nā hihia koʻikoʻi (Hb < 70 g/L), hoʻokau kēia kūlana hypoxic i kahi kaumaha hyperdynamic ma ka ʻōnaehana cardiovascular, hiki ke hoʻoulu i ka hāʻule ʻana o ka puʻuwai kiʻekiʻe. I ka ʻaoʻao ʻē aʻe, ʻo ka nui ma mua o ka palena kiʻekiʻe e hōʻike ana i ka erythrocytosis, kahi e hoʻokiʻekiʻe ai i ka viscosity koko a hoʻonui nui i ka pilikia thromboembolic, e hoʻomākaukau ana i nā maʻi i nā ulia cerebrovascular a me ka thrombosis vein hohonu.

ʻIke ʻokoʻa ma o nā ʻōkuhi Erythrocyte

ʻOiai ʻo ka waiwai hemoglobin piha e hōʻike ana i ke alo o kahi pupule, ua hoʻokuʻu ʻia kona mana diagnostic maoli ke unuhi ʻia me nā ʻōkuhi o nā cell koko ʻulaʻula—ʻo ia hoʻi, ka Mean Corpuscular Volume (MCV) a me ka Mean Corpuscular Hemoglobin (MCH). ʻO kēia hoʻokaʻawale morphological ke kihi o ka noiʻi etiological. Hōʻike ikaika kahi ʻikepili hypochromic microcytic (MCV haʻahaʻa a me MCH) i ka nele o ka hao, pinepine mai ke kahe koko gastrointestinal huna a menorrhagia paha, a i ʻole, kuhikuhi i ke ʻano thalassemia a i ʻole anemia o ka maʻi maʻi. He mea koʻikoʻi kēia ʻokoʻa therapeutically, no ka mea, ʻo ka hoʻohui hao pono ʻole i nā maʻi thalassemia hiki ke hoʻoulu i ka nui o ka hao make. Kuhikuhi kahi ʻikepili macrocytic (MCV kiʻekiʻe) i ka kānalua lapaʻau i ka cobalamin (vitamin B12) a i ʻole nā ​​​​hemahema folate, i pili i nā hopena neurological, a i ʻole i nā syndromes myelodysplastic. ʻO kahi ʻano normocytic e hoʻoulu pinepine i kahi hana no ka hemorrhage acute, hemolysis, a i ʻole ka hāʻule ʻana o ka iwi iwi. No laila, ʻo ka hoʻāʻo ʻana o ka hemoglobin, i hui pū ʻia me nā ʻōkuhi, e hoʻohaʻahaʻa maikaʻi i kahi ʻokoʻa ākea i loko o kahi ala diagnostic i kuhikuhi ʻia.

He Māka Kiaʻi no nā Maʻi Pūnaha Mau Loa

Ma waho aʻe o nā maʻi hematological mua, lawelawe ka nānā ʻana i ka hemoglobin serial ma ke ʻano he kiaʻi koʻikoʻi no ka holomua o nā ʻano maʻi ʻōnaehana like ʻole. I ka maʻi puʻupaʻa mau (CKD), ʻo ka interstitium renal hāʻule ʻole e hana i ka erythropoietin (EPO) lawa ʻole, e alakaʻi ana i kahi anemia holomua, normocytic. ʻO ka nui o ka emi ʻana o ka hemoglobin e pili pono ana me ka hōʻino ʻana o ka hana renal a hoʻomalu i ka hoʻoholo lapaʻau e hoʻomaka i ka lāʻau hoʻololi EPO exogenous. I ka oncology, i wehewehe ʻole ʻia, ʻo ka hāʻule ʻana o ka hemoglobin holomua i kahi maʻi afebrile e hōʻike pinepine i ka infiltration o ka iwi iwi e nā metastases a i ʻole e hōʻike ana i ka hopena paraneoplastic o nā cytokines inflammatory mau. Eia kekahi, i nā poʻe maʻi e hana ana i ka chemotherapy myelosuppressive a i ʻole radiotherapy, ʻo ka hemoglobin nadir kahi parameter koʻikoʻi i hoʻohana ʻia e nā oncologists e hoʻoholo i nā hoʻoponopono dosis, ka pono no ke kākoʻo transfusion, a i ʻole ka pono o ka hoʻopau ʻana i ka lāʻau.

Ka Hoʻokaʻawale ʻana i nā Pōpilikia a me ka Nānā ʻana i ka Therapeutic

I ke kūlana perioperative, ʻaʻole hiki ke kūkākūkā ʻia ka loiloi hemoglobin preoperative. Hana ia ma ke ʻano he wānana ikaika o ka maʻi ʻoki; hōʻike nā maʻi me ka anemia preoperative i nā helu kiʻekiʻe o nā maʻi postoperative, ka hoʻōla ʻana o ka ʻeha, a me ka noho lōʻihi ʻana i ka haukapila. Hoʻohana pinepine nā hui ʻoki i kahi mea hoʻoulu transfusion (ʻo Hb < 70-80 g/L maʻi paʻa) e hoʻomaikaʻi i ka lawe ʻana o ka oxygen ma mua o nā kaʻina hana kiʻekiʻe. Eia kekahi, ʻo ka hemoglobin ke ana gula-standard no ka loiloi ʻana i ka pono therapeutic. No ka laʻana, i ka anemia nele i ka hao, ʻo ka piʻi ʻana o ka liʻiliʻi o 10-20 g/L i ka nui o Hb i loko o ʻelua a ʻehā pule o ka lāʻau lapaʻau hao waha e hāʻawi i ka hōʻike kūpaʻa, hōʻoia o ka omo ʻana o ka ʻōpū a me ka pane ʻana o ka iwi iwi. ʻO kona nele e koi ai i ka loiloi hou ʻana o ka hōʻailona a i ʻole ka ʻimi ʻana i ka non-adherence.

I ka hopena, ʻaʻole wale ka hoʻāʻo ʻana o ka hemoglobin he helu koko maʻamau; he biomarker koʻikoʻi ia, he nui nā ʻaoʻao e hoʻohui i ka physiology oxygen me ka ʻike pathophysiological. ʻO kāna loiloi maʻamau e hiki ai i ka ʻōlelo aʻo mua, ka hoʻokaʻawale etiological pololei, ka nānā ʻana i ka maʻi maʻi mau, a me ka hoʻokele lapaʻau palekana, ma muli o nā hōʻike ma waena o nā ʻoihana lapaʻau āpau.