#1
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Ñòàáèëüíî âûñîêèé ãåìàòîêðèò ó ïîäðîñòêà
Çäðàâñòâóéòå. Ïîäðîñòêó 18 ëåò. Ñ 10-11 ëåò ïîêàçàòåëè ýðèòðîöèòîâ, ãåìîãëîáèíà è ãåìàòîêðèòà íà âåðõíåé ãðàíèöå íîðìû. Ñåé÷àñ ñòàáèëüíî âûøå íîðìû. Ïîñëå àêòèâíîãî óïîòðåáëåíèÿ âîäû, ãåìàòîêðèò ìîæåò áûòü 49, íî íèæå óæå äàâíî íå âèäåëà. Íå êóðèò, íå ïüåò, ðîñò 182, âåñ 78, ñïîðòîì çàíèìàåòñÿ, íî íå ïðîôåññèîíàëüíî. Ñäàâàëè âñ¸, ÷òî ìîæíî, íèêàêèõ ìóòàöèé íå îáíàðóæåíî. Ýðèòðîïîýòèí, ôåððèòèí â íîðìå. Äèàãíîç - âòîðè÷íûé/ñåìåéíûé ýðèòðîöèòîç. Âîïðîñû ê óâàæàåìûì äîêòîðàì òàêèå: 1) íàñêîëüêî êðèòè÷íî æèòü ñ òàêèì ãåìàòîêðèòîì? 2) íóæíà ëè áèîïñèÿ êîñòíîãî ìîçãà, ìû åå íå äåëàëè? 3) íóæíî ëè ïðè òàêèõ ïîêàçàòåëÿõ êðîâè äåëàòü êðîâîïóñêàíèå èëè ýðèòðîöèòîôåðåç? 4) íóæíî ëè ïðèíèìàòü êàêèå-ëèáî òàáëåòêè? Çàðàíåå áëàãîäàðþ çà îòâåòû.
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#2
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Íóæíî çíàòü, ÷òî  Âàøåì è âàøèõ äîêòîðîâ ïîíèìàíèè - âûñîêèé ãåìîãëîáèí/ãåìàòîêðèò? Òàê â îäíîì åâðîïåéñêîì èññëåäîâàíèè èñêàëè ïðè÷èíû ïîâûøåíèå ãåìîãëîáèíà ÑÂÛØÅ 185 ã/ë ó ëþäåé 18-35 ëåò è íå íàøëè íè îäíîãî ñëó÷àÿ èñòèííîé ïîëèöèòåìèè, à Âû ñâîåãî êàê-áû Âàì "âñå åøå ðåáåíî÷êà", à êàê áû ñ 15 ëåò ïîëîâîçðåëîãî ìóæ÷èíû, ñ êàêèõ öèôð ãåìîãëîáèíà ñòàëè èñòÿçàòü ïîèñêàìè?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Çäðàâñòâóéòå) èñòÿçàþ óæå äàâíî. Íàøè ãåìàòîëîãè, íà ìèíóòî÷êó, ðóêîâîäèòåëü öåíòðà ãåìàòîëîãèè èçâåñòíîé äåòñêîé áîëüíèöû, ñêàçàëà ìíå, ÷òî ãåìàòîêðèò 55 - ýòî íàçûâàåòñÿ òâåðäàÿ êðîâü, òî åñòü ðèñê èíôàðêòà, èíñóëüòà, òðîìáîâ, íåçàâèñèìî îò òîãî, ñêîëüêî ÷åëîâåêó ëåò è îò íàëè÷èÿ âðåäíûõ ïðèâû÷åê. Ïîýòîìó äà, ÿ áåñïîêîþñü, ïðîøó åãî ïèòü âîäó. Âðà÷ ïðåäëàãàåò ëèáî ñòàòü äîíîðîì, ëèáî ýðèòðîöèòîôåðåç
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#4
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íåò, åòî íå òàê: ðóêîâîäèòü öåíòðàìè â ñîâðåìåííîé ðîññèè áåðóò ïîðîé íóæíûõ/ñâîèõ äèëåòàíòîâ, à íå ñïåöèàëèñòîâ ó êîòîðûõ åñòü ñâîå ìíåíèå, â ñîâðåìåííîé ìåäèöèíå íåò ïîíÿòèÿ "òâåðäàÿ êðîâü", "ñãóùåíèå êðîâè" èëè "ñòàâèòü óêîëû", õîòÿ è 95% íîñèòåëåé îòå÷åñòâåííûõ äèïëîìîâ ïîâòîðÿþò âñå åòè ãëóïîñòè; ïîêà ëè÷íî äëÿ âàñ - èñêëþ÷åíèå êàê íîâè÷êó - ïîïðîáóéòå ïðî÷åñòü ïðàâèëà ðàçäåëà è ïîíÿòü, ÷òî âû óïóñòèëè â îïèñàíèè ïðîáëåìû
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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ïîêà âû â ðàçäóìèÿõ, ïî÷èòàéòå ýòó ïóáëèêàöèþ, õîòü òàì è åñòü îïèñêè-ëÿïû, â öåëîì âàì áóäåò ïîíÿòíî ÷òî ìîæíî äåëàòü è ÷òî íóæíî äåëàòü, åñëè ó ïîäðîñòêà ïîãðàíè÷íî-âûñîêèé ãåìàòîêðèò - â ïîëîâèíå ñëó÷àåâ ïðè÷èíó íå íàéòè è ëå÷åíèå íóæíî êðàéíå-ðåäêî, åñëè íåò îïóõîëåâîé ïîëèöèòåìèè.
What is known 1) We found no polycythemia vera in the population of children with erythrocytosis 2)43 percent of polycythemia remains idiopathic. Therefore, genetic evaluation must progress with the targeted genome analysis. What is new? 1).We report a novel c.2089C>G (p.Pro697Ala) EPAS1 gene mutation in a polycythemic patient. This mutation is VUS, probably pathogenic. Further studies are essential. 2).The family history of polycythemia is unexpectedly higher in the secondaries than in the idiopathic group. 3).The idiopathic erythrocytosis population is older, and bone marrow erythroid hyperplasia is more frequent than in the second group. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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ß î÷åíü èçâèíÿþñü, íî ïîíÿëà íå âñ¸. ß ïîíÿëà, ÷òî áîëüøèíñòâî ñëó÷àåâ ýðèòðîöèòîçà ëå÷èòü íå íóæíî, åñëè ýòî íå èñòèííàÿ ïîëèöèòåìèÿ. Íî ó ìåíÿ âîïðîñ, êàê ïîíÿòü, åñòü ëè ó ñûíà èñòèííàÿ ïîëèöèòåìèÿ, êàê ýòî ïîíÿòü?
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#7
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íåò, Âû íå ïîíÿëè:
18 ëåòíèé - óæå âçðîñëûõ ÷åëîâåê è ñàì ïðèíèìàåò ðåøåíèå ïî ñâîåìó çäîðîâüþ; âûêëàäûâàåòñÿ âåñü àíàëèç êðîâè ñ ïðîáëåìàìè, à íå öèôðà òâåðäî-ëîáîãî ãåìàòîêðèòà ó Âàøåãî ðåáåíêà ÍÅÒ èñòèííîé ïîëèöèòåìèè, äî ïðè÷èíû ìîæíî äîêîïàòüñÿ ïîòðàòèâ íåñê. òûñ óå íà ïîèñê ïðè÷èíû ó ðåáåíêà çà ïðåäåëàìè ÐÔ, åñëè òàêîâîé âîçìîæíîñòè íåò, îñòàâëÿåòå åãî â ïîêîå è ìîëèòå Áîãà, ÷òî Âû åãî ñâîèìè òàñêàíèÿìè ïî äèëåòàíòàì íå ïðåâðàòèëè â èïîõîíäðèêà-íåâðàñòåíèêà; âîñïîëüçîâàâøèñü ïîèñêîì ïî ôîðóìó, Âû ìîæåòå ïî÷èòàòü, ÷òî òâîðÿò ðîññ. äîêòîðà ñâîèìè êðîâîïóñêàíèÿìè ñî çäîðîâûìè ìîëîäûìè ëþäüìè ñ ïîãðàíè÷íî-íîðìàëüíî-âûñîêèì ãåìîãëîáèíîì.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#8
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ïîêàæèòå ñâîåìó äèëåòàíòó ïðè âñòðå÷å - Âèêòîð Ãîðäåþê ~5 ëåò íàçàä îá ýòîì íàïèñàë, à íà÷àëüíè÷êè ïðîäîëæàþò "íåñòè äè÷ü", êîãäà "òâ¸ðäàÿ êðîâü" ïîïàäàåò â ïóñòûå ãîëîâû:
Thrombosis is common in Chuvash erythrocytosis and polycythemia vera. Although the increased thrombotic risk is assumed to be due to the elevated hematocrit and an associated increase in blood viscosity, thrombosis does not accompany most types of erythrocytosis. We review studies indicating that the occurrence of thrombosis in Chuvash erythrocytosis is independent of hematocrit, that the thrombotic risk is paradoxically increased by phlebotomy in Chuvash erythrocytosis, and that, when compared to chemotherapy, phlebotomy is associated with increased thrombotic risk in polycythemia vera. Inherited and environmental causes that lead to polycythemia and erythrocytosis are accompanied by diverse cellular changes that could directly affect thrombotic risk, irrespective of the elevated hematocrit. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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Ñïàñèáî áîëüøîå!
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