I-Hemoglobin (Hb) iyi-metalloprotein eyinkimbinkimbi equkethe insimbi ehlala ngaphakathi kwama-erythrocyte (amangqamuzana egazi abomvu). Umsebenzi wayo oyinhloko wokuphila—ukubopha umoya-mpilo okuguqukayo kanye nokuthuthwa kusuka ku-pulmonary alveoli kuya ezicutshini ezingaphandle, kuhlanganiswe nokuthuthwa kwe-carbon dioxide okubuyayo—kuyenza ibe yinto ebalulekile ekuphefumuleni kwamaseli kanye ne-metabolic homeostasis. Ngenxa yalokho, ukulinganiswa kwelebhu kokuhlushwa kwe-hemoglobin kungenye yezivivinyo zokuxilonga ezihlelwe njalo futhi eziyisisekelo ngokwemitholampilo. Ukubaluleka kwayo kudlulela ngale kokuhlonza okulula kwe-anemia; isebenza njengethuluzi lokuhlola elibalulekile, ikhampasi yokuxilonga ehlukile, inkomba yokubikezela izifo ezingamahlalakhona, kanye nepharamitha yokwenza izinqumo ezibalulekile ekunakekelweni kwe-perioperative kanye ne-oncological.

Ukuhlolwa Okuyinhloko kanye Nezinsiza Zokuxilonga

Ukubaluleka okuyinhloko kokuhlolwa kwe-hemoglobin kusekukwazini kwayo ukulinganisa amandla okuthwala umoya-mpilo egazini. Ukuphambuka emazingeni okubhekisela amisiwe—ngokuvamile angu-130-175 g/L kwabesilisa abadala kanye no-115-150 g/L kwabesifazane abangakhulelwe—kusebenza njengesibonakaliso sokuqala sezimpawu ezimbili zezifo eziphikisana kakhulu. Ukuhlushwa okungaphansi komkhawulo ophansi kubonisa i-anemia, isimo esibonakala nge-tissue hypoxia ebonakala ngokwezokwelapha njengokukhathala, ubomvu, ukuphelelwa umoya, kanye nokukhubazeka kokuqonda. Ezimweni ezimbi kakhulu (Hb <70 g/L), lesi simo se-hypoxic sibeka umthwalo we-hyperdynamic ohlelweni lwezinhliziyo, okungenzeka ukuthi kubangele ukwehluleka kwenhliziyo okuphezulu. Ngakolunye uhlangothi, ukuhlushwa okungaphezu komkhawulo ophezulu kubonisa i-erythrocytosis, ephakamisa i-viscosity yegazi futhi ikhulise kakhulu ingozi ye-thromboembolic, okwenza iziguli zibe nezingozi ze-cerebrovascular kanye ne-deep vein thrombosis.

Ukuxilongwa Okuhlukile Ngezinkomba Ze-Erythrocyte

Nakuba inani eliphelele le-hemoglobin libonisa ukuba khona kokuphazamiseka, amandla ayo okuxilonga angempela akhishwa uma ehunyushwa kanye nezinkomba zamaseli abomvu egazi—ikakhulukazi, i-Mean Corpuscular Volume (MCV) kanye ne-Mean Corpuscular Hemoglobin (MCH). Lokhu kuhlukaniswa kwesimo semvelo kuyitshe lesisekelo locwaningo lwe-etiological. Iphrofayili ye-microcytic hypochromic (i-MCV ephansi kanye ne-MCH) iphakamisa kakhulu ukuntuleka kwensimbi, okuvame ukuvela ekuphumeni kwegazi okungapheli kwesisu noma i-menorrhagia, noma, kukhomba uphawu lwe-thalassemia noma i-anemia yesifo esingamahlalakhona. Lo mehluko ubaluleke kakhulu ngokwezokwelapha, njengoba ukwengezwa kwensimbi okungafanele ezigulini ze-thalassemia kungabangela ukugcwala kwensimbi okubulalayo. Iphrofayili ye-macrocytic (i-MCV ephakanyisiwe) iqondisa izinsolo zezokwelapha mayelana ne-cobalamin (i-vitamin B12) noma ukuntuleka kwe-folate, okuhlobene ne-neurological sequelae, noma maqondana ne-myelodysplastic syndromes. Iphethini ye-normocytic ivame ukuvusa ukuhlolwa kokuphuma kwegazi okukhulu, i-hemolysis, noma ukwehluleka komnkantsha. Ngakho-ke, ukuhlolwa kwe-hemoglobin, kuhlanganiswe nezinkomba, kunciphisa ngempumelelo umehluko omkhulu endleleni yokuxilonga eqondiwe.

Uphawu Lokugada Lwezifo Ezingalapheki Zesimiso

Ngaphandle kwezifo zegazi eziyinhloko, ukuqapha i-hemoglobin ngokulandelana kusebenza njengomlindi ozwelayo wokuqhubeka kwezimo ezahlukahlukene zesistimu ezingamahlalakhona. Esifweni sezinso esingamahlalakhona (i-CKD), i-renal interstitium ehlulekayo ikhiqiza i-erythropoietin (i-EPO) enganele, okuholela ekuntulekeni kwegazi okuqhubekayo, okuvamile. Izinga lokwehla kwe-hemoglobin lihlobene ngqo nokuwohloka kokusebenza kwezinso futhi lilawula isinqumo somtholampilo sokuqala ukwelashwa kokufaka esikhundleni se-EPO yangaphandle. Ku-oncology, i-hemoglobin engachazeki, eqhubekayo yehla esigulini esinesifo esifayo ivame ukukhombisa ukungena komnkantsha wethambo nge-metastases noma imele umphumela we-paraneoplastic wama-cytokine angapheli okuvuvukala. Ngaphezu kwalokho, ezigulini ezithola i-myelosuppressive chemotherapy noma i-radiotherapy, i-hemoglobin nadir iyipharamitha ebalulekile esetshenziswa odokotela be-oncologists ukunquma ukulungiswa komthamo, isidingo sokusekelwa kokumpontshelwa igazi, noma isidingo sokuphazamiseka kokwelashwa.

Ukuhlelwa Kwezingozi Nokuqapha Ukwelapha

Esikhathini sangaphambi kokuhlinzwa, ukuhlolwa kwe-hemoglobin ngaphambi kokuhlinzwa akunakuxoxiswana ngakho. Kusebenza njengesibikezelo esinamandla sokugula kokuhlinzwa; iziguli ezine-anemia yangaphambi kokuhlinzwa zibonisa amazinga aphezulu okutheleleka ngemva kokuhlinzwa, ukuphola kwenxeba okulibaziseka, kanye nokuhlala esibhedlela isikhathi eside. Amaqembu okuhlinzwa ngokuvamile asebenzisa isiqalisi sokumpontshelwa igazi (ngokuvamile i-Hb < 70-80 g/L ezigulini ezizinzile) ukuze kuthuthukiswe ukulethwa komoya-mpilo ngaphambi kwezinqubo eziyingozi kakhulu. Ngaphezu kwalokho, i-hemoglobin iyisilinganiso esijwayelekile segolide sokuhlola ukusebenza kahle kokwelapha. Isibonelo, ku-anemia yokuntuleka kwensimbi, ukwanda okulinganiselwe okungenani okungu-10-20 g/L kokuhlushwa kwe-Hb phakathi kwamasonto amabili kuya kwamane okwelashwa ngensimbi ngomlomo kunikeza ubufakazi obuqondile nobuqinisekisayo bokumuncwa kwamathumbu kanye nokusabela komnkantsha. Ukungabikho kwayo kuholela ekuhlolweni kabusha okusheshayo kokuxilongwa noma ukuhlolwa kokunganamatheli.

Ekuphetheni, ukuhlolwa kwe-hemoglobin akuyona nje ipharamitha ejwayelekile yokubala igazi; kuyi-biomarker ebalulekile, enezici eziningi ehlanganisa i-physiology ye-oxygen kanye nokuqonda kwe-pathophysiological. Ukuhlolwa kwayo njalo kwenza kube nesixwayiso kusenesikhathi, ukuhlukaniswa okunembile kwe-etiological, ukulandelela okunamandla kwezifo ezingamahlalakhona, kanye nokuphathwa kwezokwelapha okuphephile, okusekelwe ebufakazini cishe kuzo zonke izikhungo zezokwelapha.