I-Hemoglobin (Hb) yi-metalloprotein eyinkimbinkimbi equlethe i-iron ehlala ngaphakathi kwee-erythrocytes (iiseli zegazi ezibomvu). Umsebenzi wayo oyintloko womzimba—ukubopha i-oksijini eguqukayo kunye nokuthutha ukusuka kwi-pulmonary alveoli ukuya kwizicubu ezingaphandle, kunye nokuhanjiswa kwe-carbon dioxide kwakhona—kwenza ukuba ibe yinto ebalulekileyo ekuphefumleni kweseli kunye ne-metabolic homeostasis. Ngenxa yoko, ukulinganiswa kwe-hemoglobin kwilebhu yenye yezona zilingo zokuxilonga ezicwangcisiweyo rhoqo nezisisiseko sezonyango. Ukubaluleka kwayo kudlulela ngaphaya kokuchonga i-anemia; isebenza njengesixhobo sokuhlola esibalulekileyo, ikhampasi yokuxilonga eyahlukileyo, isalathisi sokuxela kwangaphambili izifo ezingapheliyo, kunye nepharamitha ebalulekileyo yokwenza izigqibo kunyango lwe-perioperative kunye ne-oncological.

Uvavanyo oluPhambili kunye neNzuzo yokuHlola

Eyona nto ibalulekileyo kuvavanyo lwe-hemoglobin kukuba ingakanani na amandla okulinganisa amandla okuthwala ioksijini egazini. Ukuphambuka kwiindidi ezimiselweyo zesalathiso—ngokubanzi i-130–175 g/L kumadoda amadala kunye ne-115–150 g/L kumabhinqa angakhulelwanga—kusebenza njengesalathisi sokuqala se-red-flag kwiimeko ezimbini ze-pathological ezichasene kakhulu. Uxinzelelo olungaphantsi komda osezantsi lubonisa i-anemia, imeko ebonakaliswa yi-tissue hypoxia ebonakala ngokwezonyango njengokudinwa, ubomvu, ukuphelelwa ngamandla, kunye nokuphazamiseka kwengqondo. Kwiimeko ezinzima (Hb < 70 g/L), le meko ye-hypoxic ibeka umthwalo omkhulu kwinkqubo yentliziyo, nto leyo enokubangela ukungaphumeleli kwentliziyo okuphezulu. Ngokwahlukileyo koko, uxinzelelo oludlula umda ophezulu lubonisa i-erythrocytosis, ephakamisa i-viscosity yegazi kwaye inyusa kakhulu umngcipheko we-thromboembolic, ibeka izigulane kwingozi ze-cerebrovascular kunye ne-deep vein thrombosis.

Ukuxilongwa Okuhlukeneyo Ngee-Erythrocyte Indices

Nangona ixabiso elipheleleyo le-hemoglobin libonisa ukuba kukho ukuphazamiseka, amandla ayo okwenyani okuxilonga ayakhululwa xa etolikwa kunye neempawu zeeseli ezibomvu zegazi—ngokukodwa, i-Mean Corpuscular Volume (MCV) kunye ne-Mean Corpuscular Hemoglobin (MCH). Olu hlobo lolwahlulo lomzimba lusisiseko sophando lwe-etiological. Iprofayili ye-microcytic hypochromic (i-MCV ephantsi kunye ne-MCH) icebisa kakhulu ukunqongophala kwesinyithi, okuhlala kuvela ekuphumeni kwegazi okungapheliyo kwesisu okanye i-menorrhagia, okanye ngenye indlela, ikhomba kuphawu lwe-thalassemia okanye i-anemia yesifo esingapheliyo. Olu mahluko lubaluleke kakhulu ngokwezonyango, njengoko ukongezwa kwesinyithi okungacwangciswanga kwizigulane ze-thalassemia kunokubangela ukugqithiswa kwesinyithi okubulalayo. Iprofayili ye-macrocytic (i-MCV ephakanyisiweyo) ikhokelela ukurhanelwa kweklinikhi kwi-cobalamin (i-vitamin B12) okanye ukusilela kwe-folate, okunxulunyaniswa ne-neurological sequelae, okanye kwi-myelodysplastic syndromes. Ipateni ye-normocytic idla ngokubangela uvavanyo lokuphuma kwegazi ngokukhawuleza, i-hemolysis, okanye ukusilela komongo wethambo. Ngoko ke, uvavanyo lwe-hemoglobin, kunye ne-indices, lunciphisa umahluko omkhulu kwindlela yokuxilongwa ekujoliswe kuyo.

Uphawu lweSentinel lweZifo ezingapheliyo zeNkqubo

Ngaphaya kweengxaki zegazi eziphambili, ukujonga i-hemoglobin ngokulandelelana kusebenza njengomlindi obuthathaka wokuqhubela phambili kweemeko ezahlukeneyo zenkqubo ezingapheliyo. Kwisifo sezintso esingapheliyo (CKD), i-renal interstitium engasebenzi kakuhle ivelisa i-erythropoietin (EPO) eyaneleyo, ekhokelela kwi-anemia eqhubekayo, eqhelekileyo. Izinga lokuhla kwe-hemoglobin lihambelana ngokuthe ngqo nokuwohloka komsebenzi wezintso kwaye lilawula isigqibo seklinikhi sokuqalisa unyango lokutshintsha i-EPO lwangaphandle. Kwi-oncology, i-hemoglobin engachazwanga, eqhubekayo ehla kwisigulana esinesifo esibuthathaka idla ngokubonisa ukungena komongo wethambo yi-metastases okanye imele isiphumo se-paraneoplastic se-cytokines ezingapheliyo ezivuthayo. Ngaphezu koko, kwizigulana ezisebenzisa i-myelosuppressive chemotherapy okanye i-radiotherapy, i-hemoglobin nadir yiparameter ebalulekileyo esetyenziswa ziingcali ze-oncologists ukumisela uhlengahlengiso lwedosi, imfuneko yokuxhaswa ngegazi, okanye imfuneko yokuphazamiseka konyango.

Ukubekwa kweMingcipheko kunye nokuBekwa kweliso kwezonyango

Kwimeko yotyando, uvavanyo lwe-hemoglobin ngaphambi kotyando aluxoxiswana. Lusebenza njengesibikezelo esiqinileyo sesifo sotyando; izigulane ezine-anemia yangaphambi kotyando zibonisa amazinga aphezulu osulelo emva kotyando, ukuphola kwenxeba okulibazisekayo, kunye nokuhlala ixesha elide esibhedlele. Amaqela otyando adla ngokusebenzisa isixhobo sokutofela igazi (ngesiqhelo i-Hb < 70–80 g/L kwizigulane ezizinzileyo) ukuphucula ukuhanjiswa kweoksijini ngaphambi kweenkqubo ezinobungozi obukhulu. Ngaphezu koko, i-hemoglobin yindlela efanelekileyo yokuvavanya ukusebenza kakuhle konyango. Umzekelo, kwi-anemia yokunqongophala kwe-iron, ukunyuka okulinganiselweyo okungenani kwe-10–20 g/L kuxinzelelo lwe-Hb kwiiveki ezimbini ukuya kwezine zonyango lwe-iron ngomlomo kubonelela ubungqina obuqinisekileyo bokufunxwa kwamathumbu kunye nokuphendula komongo wethambo. Ukungabikho kwayo kubangela ukuvavanywa kwakhona kwangoko kokuxilongwa okanye ukuphononongwa kokunganamatheli.

Ukuqukumbela, uvavanyo lwe-hemoglobin aluyonto nje eqhelekileyo yokubala igazi; luphawu olubalulekileyo, olunemiba emininzi oludibanisa i-oxygen physiology kunye nokuqonda i-pathophysiological. Uvavanyo lwayo oluqhelekileyo luvumela isilumkiso kwangethuba, ukuhlelwa ngokuchanekileyo kwe-etiological, ukulandelela okunamandla kwesifo esingapheliyo, kunye nolawulo olukhuselekileyo, olusekelwe kubungqina beklinikhi phantse kuzo zonke iinkalo zonyango.