{"id":8996,"date":"2019-07-21T13:08:15","date_gmt":"2019-07-21T11:08:15","guid":{"rendered":"https:\/\/aa-pnh.org\/?page_id=8996"},"modified":"2026-04-04T13:49:32","modified_gmt":"2026-04-04T11:49:32","slug":"aplastic-anaemia","status":"publish","type":"page","link":"https:\/\/aa-pnh.org\/vi\/diseases\/aplastic-anaemia\/","title":{"rendered":"Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n (AA) (Aplastic Anaemia)"},"content":{"rendered":"<h1><span style=\"color: #ffcc00\">Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n (AA)<\/span><\/h1>\n<p><!-- N\u1ed9i dung --><\/p>\n<h4><a href=\"#aawasist\">1 AA l\u00e0 g\u00ec?<\/a><\/h4>\n<h4><a href=\"#aasymptome\">2 Tri\u1ec7u ch\u1ee9ng<\/a><\/h4>\n<h4><a href=\"#aadiagnostik\">3 Ch\u1ea9n \u0111o\u00e1n<\/a><\/h4>\n<h4><a href=\"#aaverlauf\">4 Di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng<\/a><\/h4>\n<h4><a href=\"#aatherapie\">5 \u0110i\u1ec1u tr\u1ecb<\/a><\/h4>\n<h4><a href=\"#aaprognose\">6 Ti\u00ean l\u01b0\u1ee3ng<\/a><\/h4>\n<h4><a href=\"#aaregister\">7 \u0110\u0103ng k\u00fd<\/a><\/h4>\n<p>&nbsp;<\/p>\n<h2><a name=\"aawasist\"><\/a><span style=\"color: #ffcc00\">1 AA l\u00e0 g\u00ec?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<h3><span style=\"color: #ffcc00\">1.1 T\u1ed5ng quan<\/span><\/h3>\n<p>Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n l\u00e0 m\u1ed9t b\u1ec7nh huy\u1ebft h\u1ecdc kh\u00f4ng \u00e1c t\u00ednh (kh\u00f4ng \u00e1c t\u00ednh). Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh l\u00e0 do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u1ee7y x\u01b0\u01a1ng, d\u1eabn \u0111\u1ebfn gi\u1ea3m s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u.<br \/>\nT\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y ra thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n, ng\u01b0\u1eddi ta ph\u00e2n bi\u1ec7t gi\u1eefa c\u00e1c d\u1ea1ng b\u1ea9m sinh (v\u00ed d\u1ee5: thi\u1ebfu m\u00e1u Diamond-Blackfan ho\u1eb7c Fanconi, telomeropathy) v\u00e0 c\u00e1c d\u1ea1ng m\u1eafc ph\u1ea3i. C\u1ea3 hai d\u1ea1ng n\u00e0y \u0111\u1ec1u c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i.<br \/>\nR\u1ed1i lo\u1ea1n t\u1ea1o m\u00e1u sau h\u00f3a tr\u1ecb ho\u1eb7c x\u1ea1 tr\u1ecb kh\u00f4ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n.<\/p>\n<h3><span style=\"color: #ffcc00\">1.2 T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh (d\u1ecbch t\u1ec5 h\u1ecdc)<\/span><\/h3>\n<p>T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh (t\u1ef7 l\u1ec7 m\u1eafc) \u1edf Trung \u00c2u l\u00e0 2-3 ca m\u1edbi tr\u00ean 1 tri\u1ec7u ng\u01b0\u1eddi m\u1ed7i n\u0103m. Do \u0111\u00f3, thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh r\u1ea5t hi\u1ebfm g\u1eb7p. H\u1ea7u h\u1ebft nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh n\u00e0y \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 10 \u0111\u1ebfn 25 tu\u1ed5i v\u00e0 tr\u00ean 60 tu\u1ed5i, v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh \u1edf c\u1ea3 hai gi\u1edbi l\u00e0 nh\u01b0 nhau.<\/p>\n<h3><span style=\"color: #ffcc00\">1.3 Nguy\u00ean nh\u00e2n (b\u1ec7nh sinh)<\/span><\/h3>\n<p>Theo c\u00e1c nghi\u00ean c\u1ee9u, trong b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n m\u1eafc ph\u1ea3i, m\u1ed9t ph\u1ea7n c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch t\u1ea5n c\u00f4ng c\u00e1c t\u1ebf b\u00e0o trong t\u1ee7y x\u01b0\u01a1ng. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i t\u1ebf b\u00e0o lympho, ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c t\u1ebf b\u00e0o m\u00e1u m\u1edbi th\u00f4ng qua qu\u00e1 tr\u00ecnh t\u1ef1 mi\u1ec5n d\u1ecbch n\u00e0y. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n m\u1eafc ph\u1ea3i, ng\u01b0\u1eddi ta nghi ng\u1edd nguy\u00ean nh\u00e2n l\u00e0 do thu\u1ed1c ho\u1eb7c ch\u1ea5t \u0111\u1ed9c (kho\u1ea3ng 20%) ho\u1eb7c nhi\u1ec5m virus (kho\u1ea3ng 5%).<br \/>\nTuy nhi\u00ean, trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n m\u1eafc ph\u1ea3i (kho\u1ea3ng 75%), kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y ra b\u1ec7nh, do \u0111\u00f3 ngu\u1ed3n g\u1ed1c c\u1ee7a b\u1ec7nh v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng (v\u00f4 c\u0103n). Tuy nhi\u00ean, c\u0169ng c\u00f3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p m\u00e0 m\u1ed9t s\u1ef1 thay \u0111\u1ed5i b\u1ea9m sinh l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c di\u1ec5n bi\u1ebfn c\u1ee7a thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n.<br \/>\nC\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y m\u1ed9t ph\u1ea7n \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n m\u1eafc ph\u1ea3i th\u1ef1c ch\u1ea5t l\u00e0 m\u1eafc ph\u1ea3i m\u1ed9t d\u1ea1ng b\u1ea9m sinh, ch\u1ec9 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng mu\u1ed9n. Hi\u1ec7n t\u1ea1i, t\u1ef7 l\u1ec7 c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ea9m sinh ch\u1ec9 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh l\u00e0 5-15% trong t\u1ed5ng s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh. C\u00f3 th\u1ec3 gi\u1ea3 \u0111\u1ecbnh r\u1eb1ng t\u1ef7 l\u1ec7 n\u00e0y s\u1ebd ti\u1ebfp t\u1ee5c t\u0103ng do c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n ng\u00e0y c\u00e0ng c\u1ea3i ti\u1ebfn. \u0110i\u1ec1u n\u00e0y r\u1ea5t quan tr\u1ecdng v\u00ec ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y kh\u00e1c v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n m\u1eafc ph\u1ea3i. \u0110i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi vi\u1ec7c c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c.<\/p>\n<h3><a id=\"diakrit\"><\/a><span style=\"color: #ffcc00\">1.4 Ti\u00eau ch\u00ed ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i<\/span><\/h3>\n<p><strong>\u0110\u1ec3 c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n, c\u00e1c ti\u00eau ch\u00ed sau ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng:<\/strong><\/p>\n<ul>\n<li>S\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o trong t\u1ee7y x\u01b0\u01a1ng (t\u1ebf b\u00e0o h\u1ecdc) \u00edt h\u01a1n 25% so v\u1edbi t\u1ee7y x\u01b0\u01a1ng kh\u1ecfe m\u1ea1nh, \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean sinh thi\u1ebft t\u1ee7y x\u01b0\u01a1ng. S\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o c\u00f3 th\u1ec3 gi\u1ea3m (hypoplastic) ho\u1eb7c ho\u00e0n to\u00e0n kh\u00f4ng c\u00f3 (aplastic) trong b\u1ec7nh n\u00e0y.<\/li>\n<li>Gi\u1ea3m hai (bizytopenie) ho\u1eb7c ba h\u00e0ng t\u1ebf b\u00e0o (tri- ho\u1eb7c panzytopenie) \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau trong m\u00e1u.<\/li>\n<li>Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u h\u00ecnh th\u00e0nh (m\u1edbi) m\u00f4 li\u00ean k\u1ebft trong t\u1ee7y x\u01b0\u01a1ng (x\u01a1 h\u00f3a) ho\u1eb7c s\u1ef1 x\u00e2m l\u1ea5n t\u1ee7y x\u01b0\u01a1ng b\u1edfi c\u00e1c t\u1ebf b\u00e0o \u00e1c t\u00ednh (malign) ho\u1eb7c c\u00e1c t\u1ebf b\u00e0o kh\u00f4ng thu\u1ed9c t\u1ee7y x\u01b0\u01a1ng.<\/li>\n<li>Ngo\u00e0i ra, kh\u00f4ng \u0111\u01b0\u1ee3c c\u00f3 nh\u1eefng thay \u0111\u1ed5i t\u1ebf b\u00e0o \u0111\u00e1ng k\u1ec3 (lo\u1ea1n s\u1ea3n) trong qu\u00e1 tr\u00ecnh t\u1ea1o m\u00e1u (hematopoiesis).<\/li>\n<li>G\u1ea7n \u0111\u00e2y kh\u00f4ng c\u00f3 x\u1ea1 tr\u1ecb ho\u1eb7c h\u00f3a tr\u1ecb n\u00e0o c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch s\u1ef1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u1ee7y x\u01b0\u01a1ng (suy t\u1ee7y x\u01b0\u01a1ng).<\/li>\n<li>Kh\u00f4ng c\u00f3 ti\u1ebfp x\u00fac v\u1edbi b\u1ee9c x\u1ea1 ph\u00f3ng x\u1ea1.<\/li>\n<\/ul>\n<p>Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean c\u00e1c ch\u1ec9 s\u1ed1 m\u00e1u (xem b\u1ea3ng d\u01b0\u1edbi \u0111\u00e2y) th\u00e0nh:<\/p>\n<ul>\n<li><strong>kh\u00f4ng n\u1eb7ng<\/strong> Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n = nSAA (&#8220;non-severe AA&#8221;)\/thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n v\u1eeba ph\u1ea3i (&#8220;Moderate AA&#8221;)<\/li>\n<li><strong>Tr\u1ea7m tr\u1ecdng<\/strong> Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n = SAA (\u201esevere AA\u201c)<\/li>\n<li><strong>R\u1ea5t tr\u1ea7m tr\u1ecdng<\/strong> Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n = vSAA (\u201every severe AA\u201c)<\/li>\n<\/ul>\n<p>v\u00e0 c\u00f3 \u00fd ngh\u0129a quy\u1ebft \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi ti\u00ean l\u01b0\u1ee3ng v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<div id=\"attachment_9010\" style=\"width: 510px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9010\" class=\"wp-image-9010 size-large\" src=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet-500x277.png\" alt=\"\" width=\"500\" height=\"277\" srcset=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet-500x277.png 500w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet-300x166.png 300w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet-768x425.png 768w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet-700x387.png 700w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet-1100x609.png 1100w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild1-viet.png 1478w\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" \/><p id=\"caption-attachment-9010\" class=\"wp-caption-text\">Ph\u00e2n lo\u1ea1i thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n d\u1ef1a tr\u00ean c\u00f4ng th\u1ee9c m\u00e1u (\u0111\u1ebfm t\u1ebf b\u00e0o v\u00e0 ph\u1ebft t\u1ebf b\u00e0o). Ph\u1ea3i \u0111\u00e1p \u1ee9ng hai trong ba ti\u00eau ch\u00ed. *\u0110\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 vSAA, ti\u00eau ch\u00ed b\u1ea1ch c\u1ea7u h\u1ea1t &lt; 0,2 G\/l ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng b\u1eaft bu\u1ed9c.<\/p><\/div>\n<h2><a name=\"aasymptome\"><\/a><span style=\"color: #ffcc00\">2 Tri\u1ec7u ch\u1ee9ng<\/span><\/h2>\n<h3><span style=\"color: #ffcc00\">2.1 Thi\u1ebfu m\u00e1u<\/span><\/h3>\n<p>S\u1ef1 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u v\u1eadn chuy\u1ec3n oxy (erythrocytes) c\u00f3 th\u1ec3 g\u00e2y ra suy nh\u01b0\u1ee3c, m\u1ec7t m\u1ecfi v\u00e0 kh\u00f3 th\u1edf, th\u1eadm ch\u00ed l\u00e0 tim \u0111\u1eadp nhanh, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi g\u1eafng s\u1ee9c. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n da xanh xao, \u0111\u1eb7c bi\u1ec7t l\u00e0 l\u00f2ng b\u00e0n tay, tuy nhi\u00ean, da xanh xao kh\u00f4ng ph\u1ea3i l\u00e0 b\u1eb1ng ch\u1ee9ng c\u1ee7a thi\u1ebfu m\u00e1u.<\/p>\n<h3><span style=\"color: #ffcc00\">2.2 T\u0103ng kh\u1ea3 n\u0103ng nhi\u1ec5m tr\u00f9ng&lt;\/ span&gt;<\/span><\/h3>\n<p>S\u1ef1 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u (leukocytes) l\u00e0m c\u01a1 th\u1ec3 d\u1ec5 b\u1ecb nhi\u1ec5m tr\u00f9ng h\u01a1n. Do h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng hi\u1ec7u qu\u1ea3 khi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh, m\u1ed9t lo\u1ea1i b\u1ea1ch c\u1ea7u, gi\u1ea3m, nhi\u1ec5m tr\u00f9ng c\u00f3 th\u1ec3 tr\u1edf n\u00ean nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng trong v\u00f2ng v\u00e0i gi\u1edd v\u00e0 d\u1eabn \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng m\u00e1u.<br \/>\nDo \u0111\u00f3, khi b\u1ecb s\u1ed1t, b\u1ea1n c\u1ea7n th\u00f4ng b\u00e1o ngay cho b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb. S\u1ed1t \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 tr\u00ean 38 \u00b0C \u0111\u01b0\u1ee3c \u0111o hai l\u1ea7n trong v\u00f2ng m\u1ed9t gi\u1edd b\u1eb1ng nhi\u1ec7t k\u1ebf tai ho\u1eb7c tr\u00ean 38,3 \u00b0C \u0111\u01b0\u1ee3c \u0111o m\u1ed9t l\u1ea7n b\u1eb1ng nhi\u1ec7t k\u1ebf tai.<\/p>\n<h3><span style=\"color: #ffcc00\">2.3 Ch\u1ea3y m\u00e1u<\/span><\/h3>\n<p>Khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u (thrombocytes) gi\u1ea3m, qu\u00e1 tr\u00ecnh c\u1ea7m m\u00e1u c\u00f3 th\u1ec3 b\u1ecb r\u1ed1i lo\u1ea1n. Khi \u0111\u00f3, n\u01b0\u1edbu r\u0103ng s\u1ebd ch\u1ea3y m\u00e1u v\u00e0 xu\u1ea5t hi\u1ec7n c\u00e1c n\u1ed1t ban xu\u1ea5t huy\u1ebft, c\u00e1c v\u1ebft ch\u1ea5m nh\u1ecf tr\u00ean da ho\u1eb7c v\u1ebft b\u1ea7m t\u00edm (hematomas). Nh\u1eefng hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n m\u1ed9t c\u00e1ch t\u1ef1 ph\u00e1t, t\u1ee9c l\u00e0 kh\u00f4ng c\u00f3 ch\u1ea5n th\u01b0\u01a1ng tr\u01b0\u1edbc \u0111\u00f3. Khi qu\u00e1 tr\u00ecnh c\u1ea7m m\u00e1u b\u1ecb r\u1ed1i lo\u1ea1n, ngay c\u1ea3 m\u1ed9t v\u1ebft ch\u1ea3y m\u00e1u ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng t\u01b0\u01a1ng \u0111\u1ed1i nh\u1eb9 (v\u00ed d\u1ee5 nh\u01b0 khi \u0111i kh\u00e1m nha s\u0129) c\u0169ng c\u00f3 th\u1ec3 tr\u1edf n\u00ean nguy hi\u1ec3m. Do \u0111\u00f3, n\u1ebfu b\u1ecb ch\u1ea3y m\u00e1u, b\u1ea1n n\u00ean li\u00ean h\u1ec7 ngay v\u1edbi b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 b\u00e1c s\u0129 c\u00f3 th\u1ec3 quy\u1ebft \u0111\u1ecbnh xem c\u00f3 c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u1eb7c bi\u1ec7t (v\u00ed d\u1ee5 nh\u01b0 truy\u1ec1n ti\u1ec3u c\u1ea7u) hay kh\u00f4ng.<\/p>\n<p>&nbsp;<\/p>\n<h2><a name=\"aadiagnostik\"><\/a><span style=\"color: #ffcc00\">3 Ch\u1ea9n \u0111o\u00e1n<\/span><\/h2>\n<p>N\u1ebfu c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ec3u hi\u1ec7n n\u00eau tr\u00ean, b\u00e1c s\u0129 gia \u0111\u00ecnh s\u1ebd ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m m\u00e1u. N\u1ebfu ph\u00e1t hi\u1ec7n b\u1ea5t th\u01b0\u1eddng trong c\u00f4ng th\u1ee9c m\u00e1u, b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn b\u00e1c s\u0129 chuy\u00ean khoa v\u1ec1 huy\u1ebft h\u1ecdc v\u00e0 ung th\u01b0.<\/p>\n<p><strong>T\u1ea1i \u0111\u00f3, m\u1ed9t lo\u1ea1t c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c s\u1ebd \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n:<\/strong><\/p>\n<ul>\n<li>Ti\u1ec1n s\u1eed b\u1ec7nh (ti\u1ec1n s\u1eed b\u1ec7nh), bao g\u1ed3m c\u1ea3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh, bao g\u1ed3m ghi ch\u00e9p chi ti\u1ebft c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u00e3 d\u00f9ng<\/li>\n<li>Kh\u00e1m s\u1ee9c kh\u1ecfe, v\u00ed d\u1ee5 nh\u01b0 c\u00e1c d\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u v\u00e0 ch\u1ea3y m\u00e1u<\/li>\n<li>X\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>C\u00f4ng th\u1ee9c m\u00e1u vi th\u1ec3 kh\u00e1c bi\u1ec7t<\/li>\n<li>T\u1ebf b\u00e0o l\u01b0\u1edbi<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n PNH (hemoglobin ni\u1ec7u k\u1ecbch ph\u00e1t ban \u0111\u00eam) (m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 t\u1ebf b\u00e0o PNH c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong t\u1edbi 70% c\u00e1c tr\u01b0\u1eddng h\u1ee3p AA), xem <a href=\"https:\/\/aa-pnh.org\/erkrankungen\/pnh\/#diagnostik\">PNH, 3 Ch\u1ea9n \u0111o\u00e1n<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>H\u00f3a h\u1ecdc l\u00e2m s\u00e0ng\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>C\u00e1c th\u00f4ng s\u1ed1 tan m\u00e1u: \u0111\u1eb7c bi\u1ec7t l\u00e0 LDH, haptoglobin, bilirubin<\/li>\n<li>\u0110\u00f4ng m\u00e1u: gi\u00e1 tr\u1ecb Quick, PTT, fibrinogen<\/li>\n<li>Tham s\u1ed1 ch\u1ee9c n\u0103ng gan: AST, ALT v\u00e0 AP<\/li>\n<li>Tham s\u1ed1 ch\u1ee9c n\u0103ng th\u1eadn: Creatinine, axit uric<\/li>\n<li>\u0110\u01b0\u1eddng huy\u1ebft<\/li>\n<li>Protein t\u1ed5ng, \u0111i\u1ec7n di, immunoglobulin<\/li>\n<li>Tham s\u1ed1 vi\u00eam CRP<\/li>\n<li>M\u1ee9c vitamin B12 v\u00e0 axit folic<\/li>\n<li>T\u00ecnh tr\u1ea1ng s\u1eaft: Ferritin. N\u1ebfu gi\u00e1 tr\u1ecb ferritin &gt; 1000 ng\/ml, c\u1ea7n ki\u1ec3m tra th\u00eam \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan do qu\u00e1 t\u1ea3i s\u1eaft<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n virus: Vi\u00eam gan A, B, C; HIV, EBV, CMV, Parvovirus B19<\/li>\n<li>Kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n v\u00e0 kh\u00e1ng DNA<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n ch\u1ee9c n\u0103ng\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Si\u00eau \u00e2m tim v\u00e0 v\u00f9ng b\u1ee5ng tr\u00ean (si\u00eau \u00e2m)<\/li>\n<li>Ch\u1ee5p X-quang l\u1ed3ng ng\u1ef1c (thorax)<\/li>\n<li>\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 (EKG)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Kh\u00e1m nghi\u1ec7m \u0111\u1eb7c bi\u1ec7t\n<ul>\n<li>X\u00e1c \u0111\u1ecbnh ki\u1ec3u gen HLA c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 anh ch\u1ecb em c\u1ee7a b\u1ec7nh nh\u00e2n<\/li>\n<li>X\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i telomere<\/li>\n<li>N\u1ebfu nghi ng\u1edd m\u1eafc h\u1ed9i ch\u1ee9ng suy t\u1ee7y b\u1ea9m sinh, c\u1ea7n ti\u1ebfn h\u00e0nh ch\u1ea9n \u0111o\u00e1n s\u00e2u h\u01a1n, v\u00ed d\u1ee5 nh\u01b0 ph\u00e2n t\u00edch g\u00e3y nhi\u1ec5m s\u1eafc th\u1ec3 n\u1ebfu nghi ng\u1edd m\u1eafc b\u1ec7nh thi\u1ebfu m\u00e1u Fanconi, x\u00e9t nghi\u1ec7m gen<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>N\u1ebfu x\u00e1c nh\u1eadn s\u1ed1 l\u01b0\u1ee3ng m\u1ed9t ho\u1eb7c nhi\u1ec1u d\u00f2ng t\u1ebf b\u00e0o m\u00e1u gi\u1ea3m m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng d\u1eabn \u0111\u1ebfn s\u1ef1 ti\u00eau th\u1ee5 ho\u1eb7c ph\u00e2n h\u1ee7y t\u0103ng cao c\u1ee7a c\u00e1c t\u1ebf b\u00e0o m\u00e1u n\u00e0y, th\u00ec c\u1ea7n ti\u1ebfn h\u00e0nh ki\u1ec3m tra t\u1ee7y x\u01b0\u01a1ng ngay l\u1eadp t\u1ee9c. B\u1eb1ng c\u00e1ch n\u00e0y, c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh xem c\u00f3 r\u1ed1i lo\u1ea1n t\u1ea1o m\u00e1u hay nguy\u00ean nh\u00e2n kh\u00e1c hay kh\u00f4ng.<\/p>\n<p>\u0110\u1ec3 l\u00e0m \u0111i\u1ec1u n\u00e0y, c\u1ea7n ti\u1ebfn h\u00e0nh ch\u1ecdc t\u1ee7y x\u01b0\u01a1ng, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n t\u1ea1i ph\u00f2ng kh\u00e1m ngo\u1ea1i tr\u00fa. D\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c g\u00e2y t\u00ea c\u1ee5c b\u1ed9 (g\u00e2y t\u00ea t\u1ea1i ch\u1ed7), b\u00e1c s\u0129 s\u1ebd d\u00f9ng kim r\u1ed7ng (kim Jamshidi) l\u1ea5y m\u1ed9t m\u1eabu x\u01b0\u01a1ng h\u00ecnh tr\u1ee5 (sinh thi\u1ebft t\u1ee7y x\u01b0\u01a1ng, l\u1ea5y m\u1eabu t\u1ee7y x\u01b0\u01a1ng) t\u1eeb x\u01b0\u01a1ng ch\u1eadu c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1eabu n\u00e0y c\u00f3 chi\u1ec1u d\u00e0i kho\u1ea3ng 1,5 cm v\u00e0 \u0111\u01b0\u1eddng k\u00ednh 2-3 mm, sau \u0111\u00f3 \u0111\u01b0\u1ee3c ki\u1ec3m tra v\u00e0 \u0111\u00e1nh gi\u00e1 d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi (m\u00f4 h\u1ecdc).<\/p>\n<p>Ngo\u00e0i ra, m\u00e1u, t\u1ee7y x\u01b0\u01a1ng v\u00e0 c\u00e1c ph\u1ea7n m\u1ee1 x\u01b0\u01a1ng (&#8220;m\u1ea3nh t\u1ee7y&#8221;) c\u0169ng \u0111\u01b0\u1ee3c l\u1ea5y ra (ch\u1ecdc h\u00fat t\u1ee7y x\u01b0\u01a1ng), \u0111\u01b0\u1ee3c ph\u1ebft l\u00ean k\u00ednh hi\u1ec3n vi, s\u1ea5y kh\u00f4, nhu\u1ed9m m\u00e0u v\u00e0 c\u0169ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi v\u1ec1 t\u1ed5ng th\u1ec3 ho\u1eb7c v\u1ecb tr\u00ed c\u1ee7a ch\u00fang so v\u1edbi nhau (ki\u1ec3m tra t\u1ebf b\u00e0o h\u1ecdc).<\/p>\n<p>Ngo\u00e0i ra, c\u00e1c t\u1ebf b\u00e0o t\u1ee7y x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m tra di truy\u1ec1n, k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c ki\u1ec3m tra n\u00e0y c\u00f3 th\u1ec3 gi\u00fap ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c.<\/p>\n<p>V\u00ec c\u00e1c b\u01b0\u1edbc th\u00ed nghi\u1ec7m ri\u00eang l\u1ebb trong qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t m\u00f4 h\u1ecdc t\u1ee7y x\u01b0\u01a1ng r\u1ea5t t\u1ed1n th\u1eddi gian, n\u00ean ph\u1ea3i m\u1ea5t kho\u1ea3ng 1-2 tu\u1ea7n \u0111\u1ec3 c\u00f3 k\u1ebft qu\u1ea3 ho\u00e0n ch\u1ec9nh. N\u1ebfu th\u1ea5y s\u1ef1 gi\u1ea3m s\u00fat trong s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a hai ho\u1eb7c ba h\u00e0ng t\u1ebf b\u00e0o (h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u, ti\u1ec3u c\u1ea7u) theo <span style=\"color: #000080\"><a style=\"color: #000080\" href=\"#diakrit\">ti\u00eau ch\u00ed ch\u1ea9n \u0111o\u00e1n<\/a><\/span> m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n \u0111\u1ed3ng th\u1eddi c\u1ee7a c\u00e1c t\u1ebf b\u00e0o b\u1ecb bi\u1ebfn \u0111\u1ed5i b\u1ec7nh l\u00fd (v\u00ed d\u1ee5: t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u) v\u00e0 kh\u00f4ng c\u00f3 h\u00f3a tr\u1ecb ho\u1eb7c x\u1ea1 tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3, th\u00ec ng\u01b0\u1eddi ta g\u1ecdi \u0111\u00f3 l\u00e0 thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"attachment_9012\" style=\"width: 510px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9012\" class=\"wp-image-9012 size-large\" src=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild2-Viet-500x379.png\" alt=\"\" width=\"500\" height=\"379\" srcset=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild2-Viet-500x379.png 500w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild2-Viet-300x227.png 300w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild2-Viet-700x530.png 700w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild2-Viet.png 742w\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" \/><p id=\"caption-attachment-9012\" class=\"wp-caption-text\">K\u1ebft qu\u1ea3 ki\u1ec3m tra t\u1ee7y x\u01b0\u01a1ng c\u1ee7a m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n so v\u1edbi t\u1ee7y x\u01b0\u01a1ng kh\u1ecfe m\u1ea1nh. Trong t\u1ee7y x\u01b0\u01a1ng b\u1ecb b\u1ec7nh, ch\u1ee7 y\u1ebfu c\u00f3 th\u1ec3 nh\u1eadn th\u1ea5y m\u00f4 li\u00ean k\u1ebft v\u00e0 t\u1ebf b\u00e0o m\u1ee1. Trong t\u1ee7y x\u01b0\u01a1ng kh\u1ecfe m\u1ea1nh, c\u00e1c t\u1ebf b\u00e0o m\u00e1u n\u1ed5i b\u1eadt nh\u01b0 nh\u1eefng ch\u1ea5m nh\u1ecf c\u00f3 m\u00e0u kh\u00e1c nhau so v\u1edbi c\u00e1c t\u1ebf b\u00e0o m\u1ee1 tr\u1eafng l\u1edbn.<\/p><\/div>\n<p><strong>M\u1ee5c \u0111\u00edch c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y l\u00e0<\/strong><\/p>\n<ul>\n<li>lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh kh\u00e1c,<\/li>\n<li>l\u00e0m r\u00f5 c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 (c\u0103n nguy\u00ean),<\/li>\n<li>x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n,<\/li>\n<li>x\u00e1c \u0111\u1ecbnh ti\u00ean l\u01b0\u1ee3ng.<\/li>\n<\/ul>\n<p>\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n r\u1ea5t n\u1eb7ng v\u00e0 n\u1eb7ng, d\u01b0\u1edbi 50 tu\u1ed5i v\u00e0 c\u00f3 th\u1ec3 tr\u1ea1ng t\u1ed1t, n\u00ean ti\u1ebfn h\u00e0nh ph\u00e2n lo\u1ea1i HLA cho b\u1ec7nh nh\u00e2n ngay khi ch\u1ea9n \u0111o\u00e1n. N\u1ebfu c\u00f3 anh ch\u1ecb em ru\u1ed9t, h\u1ecd c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng hi\u1ebfn t\u1eb7ng t\u1ebf b\u00e0o g\u1ed1c.<\/p>\n<p>&nbsp;<\/p>\n<h2><a name=\"aaverlauf\"><\/a><span style=\"color: #ffcc00\">4 Di\u1ec5n bi\u1ebfn<\/span><\/h2>\n<p>N\u1ebfu kh\u00f4ng c\u00f3 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3, thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong trong 70% tr\u01b0\u1eddng h\u1ee3p.<\/p>\n<p>C\u00f3 kh\u1ea3 n\u0103ng b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n chuy\u1ec3n sang h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n t\u1ea1o m\u00e1u (MDS) ho\u1eb7c b\u1ec7nh b\u1ea1ch c\u1ea7u t\u1ee7y c\u1ea5p t\u00ednh (AML). Ngo\u00e0i ra, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n AA c\u00f3 \u0111\u1ed9t bi\u1ebfn \u0111\u1eb7c tr\u01b0ng c\u1ee7a PNH, do \u0111\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh ti\u1ec3u \u0111\u00eam paroxysmal (PNH) c\u0169ng c\u00f3 th\u1ec3 tr\u1edf n\u00ean li\u00ean quan.<\/p>\n<p>&nbsp;<\/p>\n<h2><a name=\"aatherapie\"><\/a><span style=\"color: #ffcc00\">5 \u0110i\u1ec1u tr\u1ecb<\/span><\/h2>\n<p>&nbsp;<\/p>\n<h3><span style=\"color: #ffcc00\">5.1 T\u1ed5ng quan<\/span><\/h3>\n<p>H\u1ed3i ph\u1ee5c t\u1ef1 ph\u00e1t v\u1ec1 m\u1eb7t huy\u1ebft h\u1ecdc (thuy\u00ean gi\u1ea3m t\u1ef1 ph\u00e1t) h\u1ea7u nh\u01b0 kh\u00f4ng x\u1ea3y ra trong tr\u01b0\u1eddng h\u1ee3p suy t\u1ee7y x\u01b0\u01a1ng n\u1eb7ng.<\/p>\n<p><strong>C\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau<\/strong><\/p>\n<ul>\n<li>thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n n\u1eb7ng (vSAA) v\u00e0 n\u1eb7ng (SAA)<\/li>\n<li>thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n kh\u00f4ng n\u1eb7ng (nSAA) v\u1edbi s\u1ef1 gi\u1ea3m r\u00f5 r\u1ec7t c\u1ee7a \u00edt nh\u1ea5t m\u1ed9t d\u00f2ng t\u1ebf b\u00e0o (cytopenia), d\u1eabn \u0111\u1ebfn nhu c\u1ea7u truy\u1ec1n m\u00e1u th\u01b0\u1eddng xuy\u00ean ho\u1eb7c nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ho\u1eb7c ch\u1ea3y m\u00e1u<\/li>\n<\/ul>\n<p>Trong khi v\u00e0i th\u1eadp k\u1ef7 tr\u01b0\u1edbc, h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 hy v\u1ecdng ch\u1eefa kh\u1ecfi ho\u1eb7c c\u1ea3i thi\u1ec7n l\u00e2u d\u00e0i, th\u00ec ng\u00e0y nay c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng \u0111\u1ea7y h\u1ee9a h\u1eb9n. C\u00f3 hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh: li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (IST) v\u00e0 c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c (SZT) ho\u1eb7c c\u1ea5y gh\u00e9p t\u1ee7y x\u01b0\u01a1ng (KMT). Ngo\u00e0i ra, c\u00f2n c\u00f3 c\u00e1c li\u1ec7u ph\u00e1p \u0111\u1eb7c bi\u1ec7t cho m\u1ed9t s\u1ed1 nh\u00f3m b\u1ec7nh nh\u00e2n nh\u1ea5t \u0111\u1ecbnh. Li\u1ec7u ph\u00e1p n\u00e0o ph\u00f9 h\u1ee3p v\u1edbi m\u1ed9t b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh, tu\u1ed5i t\u00e1c v\u00e0 c\u00e1c b\u1ec7nh k\u00e8m theo c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a b\u1ec7nh nh\u00e2n, c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng th\u00edch HLA (t\u01b0\u01a1ng th\u00edch HLA) v\u1edbi m\u1ed9t ng\u01b0\u1eddi hi\u1ebfn t\u1ee7y x\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0 ng\u01b0\u1eddi th\u00e2n ho\u1eb7c kh\u00f4ng ph\u1ea3i ng\u01b0\u1eddi th\u00e2n.<\/p>\n<p>N\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, c\u1ea7n b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra (v\u00ed d\u1ee5: thi\u1ebfu m\u00e1u n\u1eb7ng, nhi\u1ec5m tr\u00f9ng, ch\u1ea3y m\u00e1u v\u00e0 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u). Do \u0111\u00f3, vi\u1ec7c l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb s\u1edbm v\u1edbi s\u1ef1 h\u1ee3p t\u00e1c c\u1ee7a m\u1ed9t trung t\u00e2m chuy\u00ean khoa l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/p>\n<p>Quy tr\u00ecnh \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n n\u1eb7ng v\u00e0 r\u1ea5t n\u1eb7ng \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong h\u00ecnh d\u01b0\u1edbi \u0111\u00e2y.<\/p>\n<div id=\"attachment_9013\" style=\"width: 452px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9013\" class=\"wp-image-9013 size-large\" src=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild3-viet-442x500.png\" alt=\"\" width=\"442\" height=\"500\" srcset=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild3-viet-442x500.png 442w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild3-viet-265x300.png 265w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild3-viet-768x868.png 768w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild3-viet-700x791.png 700w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild3-viet.png 1014w\" sizes=\"auto, (max-width: 442px) 100vw, 442px\" \/><p id=\"caption-attachment-9013\" class=\"wp-caption-text\">Bi\u1ec3u di\u1ec5n \u0111\u01a1n gi\u1ea3n h\u00f3a r\u00f5 r\u00e0ng c\u1ee7a thu\u1eadt to\u00e1n \u0111i\u1ec1u tr\u1ecb. Thu\u1eadt to\u00e1n ho\u00e0n ch\u1ec9nh \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong h\u01b0\u1edbng d\u1eabn c\u1ee7a DGHO t\u1ea1i <a href=\"https:\/\/www.onkopedia.com\/de\/onkopedia\/guidelines\/aplastische-anaemie\/@@guideline\/html\/index.html\">Onkopedia<\/a><\/p><\/div>\n<h3><span style=\"color: #ffcc00\">5.2 Li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (IST)<\/span><\/h3>\n<p>&nbsp;<\/p>\n<h4><span style=\"color: #ffcc00\">Antithymozytenglobulin (ATG) v\u00e0 Ciclosporin (CsA)<\/span><\/h4>\n<p>V\u00ec trong tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n m\u1eafc ph\u1ea3i, h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 t\u1ea5n c\u00f4ng t\u1ee7y x\u01b0\u01a1ng c\u1ee7a ch\u00ednh m\u00ecnh, n\u00ean th\u01b0\u1eddng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau:<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n vSAA ho\u1eb7c SAA &gt; 50 tu\u1ed5i<\/li>\n<li>B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng HLA ph\u00f9 h\u1ee3p (anh ch\u1ecb em ru\u1ed9t)<\/li>\n<li>B\u1ec7nh nh\u00e2n vSAA ho\u1eb7c SAA &lt; 50 tu\u1ed5i trong t\u00ecnh tr\u1ea1ng th\u1ec3 ch\u1ea5t k\u00e9m<\/li>\n<li>B\u1ec7nh nh\u00e2n nSAA\/MAA c\u00f3 nguy c\u01a1 b\u1ecb gi\u1ea3m t\u1ebf b\u00e0o m\u00e1u nghi\u00eam tr\u1ecdng trong \u00edt nh\u1ea5t m\u1ed9t d\u00f2ng t\u1ebf b\u00e0o<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch th\u01b0\u1eddng l\u00e0 s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa thu\u1ed1c antithymocyte globulin v\u00e0 ciclosporin. \u0110i\u1ec1u n\u00e0y gi\u00fap t\u1ee7y x\u01b0\u01a1ng ph\u1ee5c h\u1ed3i. Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, t\u00ecnh tr\u1ea1ng m\u00e1u th\u01b0\u1eddng x\u1ea5u \u0111i trong th\u1eddi gian ng\u1eafn tr\u01b0\u1edbc khi c\u00f3 s\u1ef1 c\u1ea3i thi\u1ec7n.<\/p>\n<p>ATG l\u00e0 m\u1ed9t kh\u00e1ng th\u1ec3 ph\u00e1 h\u1ee7y c\u00e1c t\u1ebf b\u00e0o lympho T ho\u1ea1t \u0111\u1ed9ng qu\u00e1 m\u1ee9c v\u00e0 g\u00e2y t\u1ed5n th\u01b0\u01a1ng t\u1ee7y x\u01b0\u01a1ng. Th\u00f4ng th\u01b0\u1eddng, ATG \u0111\u01b0\u1ee3c ti\u00eam v\u00e0o m\u1ed9t t\u0129nh m\u1ea1ch l\u1edbn qua m\u1ed9t \u1ed1ng th\u00f4ng t\u0129nh m\u1ea1ch trung t\u00e2m (ZVK) trong 4-5 ng\u00e0y. Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ATG, n\u1ebfu c\u1ea7n, n\u00ean t\u0103ng ho\u1eb7c duy tr\u00ec s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u l\u00ean 30 G\/l b\u1eb1ng c\u00e1ch truy\u1ec1n ti\u1ec3u c\u1ea7u, v\u00ec trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 gi\u1ea3m nhanh ch\u00f3ng. \u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ATG, b\u1ec7nh nh\u00e2n ph\u1ea3i nh\u1eadp vi\u1ec7n kho\u1ea3ng 1-2 tu\u1ea7n. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a li\u1ec7u ph\u00e1p ATG c\u00f3 th\u1ec3 l\u00e0 c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng nh\u01b0 ph\u00e1t ban v\u00e0 s\u1ed1t. \u0110\u1ec3 \u1ee9c ch\u1ebf c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ea5p t\u00ednh c\u1ee7a ATG, m\u1ed9t ch\u1ebf ph\u1ea9m cortisone, v\u00ed d\u1ee5 nh\u01b0 prednisone ho\u1eb7c prednisolone, c\u0169ng \u0111\u01b0\u1ee3c ti\u00eam trong m\u1ed9t th\u1eddi gian ng\u1eafn. Ngo\u00e0i ra, c\u00f2n c\u00f3 nguy c\u01a1 cao nhi\u1ec5m m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, do \u0111\u00f3 c\u1ea7n ph\u1ea3i th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba th\u00edch h\u1ee3p.<\/p>\n<p>M\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng kh\u00e1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00e0 ciclosporin, m\u1ed9t lo\u1ea1i thu\u1ed1c \u1ee9c ch\u1ebf s\u1ef1 ti\u1ebft ra c\u00e1c ch\u1ea5t k\u00edch th\u00edch mi\u1ec5n d\u1ecbch. Khi d\u00f9ng CsA, c\u1ea7n ti\u1ebfn h\u00e0nh ki\u1ec3m tra th\u01b0\u1eddng xuy\u00ean t\u1ea1i ph\u00f2ng th\u00ed nghi\u1ec7m \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng n\u1ebfu c\u1ea7n thi\u1ebft nh\u1eb1m \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u. M\u1ee5c ti\u00eau l\u00e0 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 th\u1ea5p nh\u1ea5t trong m\u00e1u t\u1eeb 170\u2013225 ng\/ml. \u0110\u1ec3 duy tr\u00ec n\u1ed3ng \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh, c\u1ea7n d\u00f9ng thu\u1ed1c r\u1ea5t \u0111\u1ec1u \u0111\u1eb7n, c\u00e1ch nhau 12 gi\u1edd.<\/p>\n<p>C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra c\u1ee7a li\u1ec7u ph\u00e1p CsA l\u00e0 nhi\u1ec5m tr\u00f9ng, suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, t\u0103ng huy\u1ebft \u00e1p, t\u0103ng sinh n\u01b0\u1edbu r\u0103ng (t\u0103ng s\u1ea3n n\u01b0\u1edbu r\u0103ng), t\u0103ng tr\u01b0\u1edfng t\u00f3c, co th\u1eaft c\u01a1, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c ho\u1eb7c run (rung gi\u1eadt). C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u l\u01b0\u1ee3ng v\u00e0 th\u01b0\u1eddng bi\u1ebfn m\u1ea5t khi ng\u1eebng li\u1ec7u ph\u00e1p CsA.<\/p>\n<p>CsA \u0111\u01b0\u1ee3c d\u00f9ng d\u01b0\u1edbi d\u1ea1ng vi\u00ean nang ho\u1eb7c n\u01b0\u1edbc u\u1ed1ng trong \u00edt nh\u1ea5t 12 th\u00e1ng. N\u1ebfu \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb r\u1ea5t t\u1ed1t v\u00e0 \u1ed5n \u0111\u1ecbnh, \u0111\u1ec3 tr\u00e1nh b\u1ec7nh t\u00e1i ph\u00e1t, khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb, c\u1ea7n gi\u1ea3m li\u1ec1u CsA r\u1ea5t ch\u1eadm v\u00e0 d\u1ea7n d\u1ea7n. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n ph\u1ea3i d\u00f9ng CsA l\u00e2u h\u01a1n ho\u1eb7c v\u0129nh vi\u1ec5n \u0111\u1ec3 duy tr\u00ec hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Nh\u1edd li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch t\u0103ng c\u01b0\u1eddng, kho\u1ea3ng 50-75% b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1eefa kh\u1ecfi (thuy\u00ean gi\u1ea3m ho\u00e0n to\u00e0n, CR) ho\u1eb7c \u00edt nh\u1ea5t l\u00e0 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 (thuy\u00ean gi\u1ea3m m\u1ed9t ph\u1ea7n, PR), kh\u00f4ng c\u1ea7n truy\u1ec1n m\u00e1u v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 ch\u1ea3y m\u00e1u. Ph\u1ea3i m\u1ea5t kho\u1ea3ng 2-4 th\u00e1ng, \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n l\u00e0 6 th\u00e1ng, \u0111\u1ec3 c\u00e1c ch\u1ec9 s\u1ed1 m\u00e1u \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. M\u1ee5c ti\u00eau l\u00e0 ch\u1ea5m d\u1ee9t c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 r\u1ee7i ro. \u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111i\u1ec1u n\u00e0y, kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i b\u00ecnh th\u01b0\u1eddng h\u00f3a ho\u00e0n to\u00e0n c\u00e1c ch\u1ec9 s\u1ed1 m\u00e1u, \u0111i\u1ec1u th\u01b0\u1eddng kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c.<\/p>\n<p>N\u1ebfu kh\u00f4ng c\u00f3 ph\u1ea3n \u1ee9ng, c\u00f3 th\u1ec3 xem x\u00e9t l\u1eb7p l\u1ea1i li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch sau 4-6 th\u00e1ng.<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p t\u00e1i ph\u00e1t (t\u00e1i ph\u00e1t), c\u0169ng c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, v\u00ec c\u01a1 h\u1ed9i \u0111\u00e1p \u1ee9ng l\u1ea1i l\u00e0 30-60%.<\/p>\n<p>\u0110i k\u00e8m v\u1edbi li\u1ec7u ph\u00e1p c\u1ee5 th\u1ec3, m\u1ed7i b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3 (supportive therapy) href=&#8221;#suppther&#8221;&gt;li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3.<\/p>\n<h4><span style=\"color: #ffcc00\">Alemtuzumab<\/span><\/h4>\n<p>C\u0169ng c\u00f3 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c ho\u1ea1t \u0111\u1ed9ng theo c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch t\u01b0\u01a1ng t\u1ef1. Trong s\u1ed1 \u0111\u00f3 c\u00f3 Alemtuzumab, m\u1ed9t kh\u00e1ng th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng l\u1ea1i t\u1ebf b\u00e0o lympho T. Thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh b\u1ea1ch c\u1ea7u lympho m\u00e3n t\u00ednh (CLL) ho\u1eb7c b\u1ec7nh \u0111a x\u01a1 c\u1ee9ng (MS), nh\u01b0ng trong c\u00e1c nghi\u00ean c\u1ee9u, thu\u1ed1c n\u00e0y c\u0169ng cho th\u1ea5y t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng t\u1ed1t trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i. M\u1ed9t l\u1ee3i th\u1ebf c\u1ee7a thu\u1ed1c n\u00e0y l\u00e0 ch\u1ec9 c\u1ea7n ti\u00eam d\u01b0\u1edbi da, do \u0111\u00f3 kh\u00f4ng c\u1ea7n ph\u1ea3i nh\u1eadp vi\u1ec7n. N\u1ebfu b\u1ec7nh nh\u00e2n t\u1eebng b\u1ecb nhi\u1ec5m virus cytomegalovirus (CMV), c\u1ea7n ki\u1ec3m tra ch\u1ec9 s\u1ed1 m\u00e1u n\u00e0y th\u01b0\u1eddng xuy\u00ean, v\u00ec nhi\u1ec5m virus n\u00e0y c\u00f3 th\u1ec3 t\u00e1i ph\u00e1t trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p kh\u00e1c \u0111\u00e3 cho th\u1ea5y t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng t\u1eeb 37-48% khi s\u1eed d\u1ee5ng Alemtuzumab.<\/p>\n<h3><span style=\"color: #ffcc00\">5.3 C\u1ea5y gh\u00e9p \u0111\u1ed3ng lo\u1ea1i<\/span><\/h3>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 50 tu\u1ed5i (\u0111i\u1ec1u quan tr\u1ecdng l\u00e0 t\u00ecnh tr\u1ea1ng chung, &#8220;tu\u1ed5i sinh h\u1ecdc&#8221;) b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n n\u1eb7ng ho\u1eb7c r\u1ea5t n\u1eb7ng (SAA ho\u1eb7c vSAA) v\u00e0 c\u00f3 anh ch\u1ecb em ru\u1ed9t l\u00e0 ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng ho\u00e0n to\u00e0n t\u01b0\u01a1ng th\u00edch v\u1ec1 c\u1ea5u tr\u00fac t\u01b0\u01a1ng th\u00edch m\u00f4 (HLA) v\u1edbi b\u1ec7nh nh\u00e2n (HLA-ident), ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u01b0u ti\u00ean (\u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean) l\u00e0 c\u1ea5y gh\u00e9p \u0111\u1ed3ng lo\u1ea1i.<\/p>\n<p>B\u1ec7nh nh\u00e2n d\u01b0\u1edbi 30 tu\u1ed5i c\u0169ng c\u00f3 th\u1ec3 nh\u1eadn t\u1ebf b\u00e0o g\u1ed1c t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng kh\u00f4ng c\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng nh\u01b0ng t\u01b0\u01a1ng th\u00edch HLA (ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng ngo\u00e0i gia \u0111\u00ecnh) n\u1ebfu h\u1ecd kh\u00f4ng c\u00f3 ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng trong gia \u0111\u00ecnh t\u01b0\u01a1ng th\u00edch HLA. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i ti\u1ebfn h\u00e0nh ph\u00e2n lo\u1ea1i chi ti\u1ebft (\u00edt nh\u1ea5t 10 kh\u00e1ng nguy\u00ean HLA) v\u00e0 ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng v\u00e0 ng\u01b0\u1eddi nh\u1eadn ph\u1ea3i ho\u00e0n to\u00e0n t\u01b0\u01a1ng th\u00edch.<\/p>\n<p>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng trong c\u1ea5y gh\u00e9p t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng kh\u00f4ng c\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng c\u00f3 HLA t\u01b0\u01a1ng th\u00edch \u0111\u00e3 gi\u1ea3m \u0111\u00e1ng k\u1ec3. Do \u0111\u00f3, c\u1ea5y gh\u00e9p t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng kh\u00f4ng c\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng c\u00f3 HLA t\u01b0\u01a1ng th\u00edch ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng nhi\u1ec1u h\u01a1n cho b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 50 tu\u1ed5i v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/p>\n<p>M\u1ee5c ti\u00eau c\u1ee7a c\u1ea5y gh\u00e9p d\u1ecb gen l\u00e0 thay th\u1ebf t\u1ee7y x\u01b0\u01a1ng kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n b\u1eb1ng t\u1ebf b\u00e0o g\u1ed1c kh\u1ecfe m\u1ea1nh c\u1ee7a ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng. \u0110\u1ec3 l\u00e0m \u0111\u01b0\u1ee3c \u0111i\u1ec1u n\u00e0y, tr\u01b0\u1edbc ti\u00ean t\u1ee7y x\u01b0\u01a1ng c\u1ee7a b\u1ec7nh nh\u00e2n s\u1ebd b\u1ecb ph\u00e1 h\u1ee7y b\u1eb1ng c\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c nhau (h\u00f3a tr\u1ecb, li\u1ec7u ph\u00e1p kh\u00e1ng th\u1ec3, x\u1ea1 tr\u1ecb). Qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong nh\u1eefng ng\u00e0y ngay tr\u01b0\u1edbc khi c\u1ea5y gh\u00e9p.<br \/>\nSong song v\u1edbi \u0111\u00f3, c\u00e1c t\u1ebf b\u00e0o g\u1ed1c m\u1edbi, kh\u1ecfe m\u1ea1nh s\u1ebd \u0111\u01b0\u1ee3c thu th\u1eadp t\u1eeb m\u1ed9t ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng kh\u1ecfe m\u1ea1nh, c\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng ho\u1eb7c kh\u00f4ng c\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng.<br \/>\nC\u00e1c t\u1ebf b\u00e0o g\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y tr\u1ef1c ti\u1ebfp t\u1eeb t\u1ee7y x\u01b0\u01a1ng b\u1eb1ng c\u00e1ch sinh thi\u1ebft t\u1ee7y x\u01b0\u01a1ng d\u01b0\u1edbi g\u00e2y m\u00ea. Vi\u1ec7c ch\u1ecdc v\u00e0o x\u01b0\u01a1ng ch\u1eadu \u0111\u1ec3 l\u1ea5y t\u1ee7y x\u01b0\u01a1ng c\u00f3 th\u1ec3 g\u00e2y b\u1ea7m t\u00edm v\u00e0 \u0111au \u0111\u1edbn trong v\u00e0i ng\u00e0y. Ngo\u00e0i ra, c\u00f2n c\u00f3 r\u1ee7i ro chung c\u1ee7a g\u00e2y m\u00ea.<\/p>\n<p>Ngo\u00e0i ra, ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng s\u1ebd \u0111\u01b0\u1ee3c ti\u00eam m\u1ed9t lo\u1ea1i thu\u1ed1c k\u00edch th\u00edch s\u1ef1 h\u00ecnh th\u00e0nh b\u1ea1ch c\u1ea7u h\u1ea1t (G-CSF) trong v\u00e0i ng\u00e0y. C\u00e1c t\u1ebf b\u00e0o g\u1ed1c m\u00e1u \u0111\u01b0\u1ee3c s\u1ea3n sinh nhi\u1ec1u h\u01a1n do \u0111\u00f3 s\u1ebd di chuy\u1ec3n t\u1eeb t\u1ee7y x\u01b0\u01a1ng v\u00e0o m\u00e1u. C\u00e1c t\u1ebf b\u00e0o g\u1ed1c m\u00e1u ngo\u1ea1i vi (PBSZ) n\u00e0y sau \u0111\u00f3 s\u1ebd \u0111\u01b0\u1ee3c l\u1ea5y ra b\u1eb1ng m\u1ed9t thi\u1ebft b\u1ecb \u0111\u1eb7c bi\u1ec7t, gi\u1ed1ng nh\u01b0 khi hi\u1ebfn m\u00e1u (Apherese). Qu\u00e1 tr\u00ecnh n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ed1ng c\u00fam v\u00e0 \u0111au \u0111\u1edbn.<\/p>\n<p>N\u1ebfu t\u1ebf b\u00e0o g\u1ed1c \u0111\u01b0\u1ee3c l\u1ea5y tr\u1ef1c ti\u1ebfp t\u1eeb t\u1ee7y x\u01b0\u01a1ng, th\u00ec \u0111\u00f3 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u1ea5y gh\u00e9p t\u1ee7y x\u01b0\u01a1ng (KMT), c\u00f2n n\u1ebfu t\u1ebf b\u00e0o g\u1ed1c \u0111\u01b0\u1ee3c l\u1ea5y b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p Apherese, th\u00ec \u0111\u00f3 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c (SZT).<br \/>\nC\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng \u0111i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n b\u1eb1ng t\u1ebf b\u00e0o g\u1ed1c t\u1eeb m\u00e1u ngo\u1ea1i vi c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng gia t\u0103ng, ch\u1eb3ng h\u1ea1n nh\u01b0 ph\u1ea3n \u1ee9ng th\u1ea3i gh\u00e9p c\u1ea5p t\u00ednh ho\u1eb7c m\u00e3n t\u00ednh. Do \u0111\u00f3, n\u1ebfu c\u00f3 th\u1ec3, n\u00ean s\u1eed d\u1ee5ng t\u1ebf b\u00e0o g\u1ed1c \u0111\u01b0\u1ee3c l\u1ea5y tr\u1ef1c ti\u1ebfp t\u1eeb t\u1ee7y x\u01b0\u01a1ng.<\/p>\n<p>B\u1ea5t k\u1ec3 t\u1ebf b\u00e0o g\u1ed1c \u0111\u01b0\u1ee3c thu th\u1eadp b\u1eb1ng c\u00e1ch n\u00e0o, ch\u00fang s\u1ebd \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch v\u00e0 ki\u1ec3m tra c\u00e1c t\u00e1c nh\u00e2n g\u00e2y nhi\u1ec5m tr\u00f9ng. Sau \u0111\u00f3, b\u1ec7nh nh\u00e2n s\u1ebd nh\u1eadn \u0111\u01b0\u1ee3c t\u1ebf b\u00e0o g\u1ed1c \u0111\u01b0\u1ee3c hi\u1ebfn t\u1eb7ng. Qu\u00e1 tr\u00ecnh c\u1ea5y gh\u00e9p di\u1ec5n ra gi\u1ed1ng nh\u01b0 truy\u1ec1n m\u00e1u. N\u1ebfu m\u1ecdi th\u1ee9 di\u1ec5n ra su\u00f4n s\u1ebb, t\u1ebf b\u00e0o g\u1ed1c c\u1ee7a ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng s\u1ebd &#8220;ph\u00e1t tri\u1ec3n&#8221; v\u00e0 d\u1eabn \u0111\u1ebfn ch\u1ee9c n\u0103ng t\u1ee7y x\u01b0\u01a1ng v\u00e0 t\u1ea1o m\u00e1u b\u00ecnh th\u01b0\u1eddng. \u0110\u1ec3 th\u1ef1c hi\u1ec7n c\u1ea5y gh\u00e9p, b\u1ec7nh nh\u00e2n ph\u1ea3i n\u1eb1m vi\u1ec7n \u00edt nh\u1ea5t 4 tu\u1ea7n.<\/p>\n<p>Trong qu\u00e1 tr\u00ecnh c\u1ea5y gh\u00e9p, b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c d\u00f9ng thu\u1ed1c \u0111\u1ec3 ph\u00f2ng ng\u1eeba (ph\u00f2ng ng\u1eeba) nhi\u1ec5m tr\u00f9ng do vi khu\u1ea9n v\u00e0 n\u1ea5m. Ngo\u00e0i ra, m\u1ed9t lo\u1ea1i thu\u1ed1c cortisone, v\u00ed d\u1ee5 nh\u01b0 prednisolone, v\u00e0 ciclosporin (CsA) s\u1ebd \u0111\u01b0\u1ee3c d\u00f9ng trong v\u00e0i th\u00e1ng \u0111\u1ec3 t\u00e1c \u0111\u1ed9ng l\u00ean h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch.<\/p>\n<p><strong>C\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra do c\u1ea5y gh\u00e9p l\u00e0:<\/strong><\/p>\n<ul>\n<li>T\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u1ed9c h\u1ea1i trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb chu\u1ea9n b\u1ecb<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng<\/li>\n<li><span style=\"color: #000080\"><a style=\"color: #000080\" href=\"#gvhd\">B\u1ec7nh gh\u00e9p ch\u1ed1ng ch\u1ee7 (GvHD)<\/a><\/span><\/li>\n<li>T\u1eeb ch\u1ed1i gh\u00e9p<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><a id=\"gvhd\"><\/a>B\u1ec7nh gh\u00e9p ch\u1ed1ng ch\u1ee7 (GvHD): <\/strong> Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p ph\u1ea3n \u1ee9ng l\u1ea1i v\u1edbi c\u00e1c t\u1ebf b\u00e0o c\u1ee7a c\u01a1 th\u1ec3. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra trong th\u1eddi gian ng\u1eafn (c\u1ea5p t\u00ednh) ho\u1eb7c mu\u1ed9n h\u01a1n v\u00e0 k\u00e9o d\u00e0i (m\u00e3n t\u00ednh), do \u0111\u00f3 trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i \u1ee9c ch\u1ebf h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch v\u0129nh vi\u1ec5n (li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch).<\/p>\n<p>&nbsp;<\/p>\n<h3><span style=\"color: #ffcc00\">5.4 C\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/span><\/h3>\n<p>&nbsp;<\/p>\n<h4><span style=\"color: #ffcc00\">Danazol<\/span><\/h4>\n<p>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n c\u00f3 m\u1ed9t r\u1ed1i lo\u1ea1n b\u1ea9m sinh hi\u1ebfm g\u1eb7p, trong \u0111\u00f3 c\u00e1c \u0111\u1ea7u c\u1ee7a nhi\u1ec5m s\u1eafc th\u1ec3 (telomere) b\u1ecb ng\u1eafn l\u1ea1i, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 telomeropathy. S\u1ef1 ng\u1eafn l\u1ea1i c\u1ee7a telomere d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n ph\u00e2n chia t\u1ebf b\u00e0o v\u00e0 do \u0111\u00f3 l\u00e0m gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c t\u1ebf b\u00e0o m\u00e1u trong t\u1ee7y x\u01b0\u01a1ng.<\/p>\n<p>Danazol, m\u1ed9t bi\u1ebfn th\u1ec3 t\u1ed5ng h\u1ee3p c\u1ee7a hormone sinh d\u1ee5c nam testosterone, \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 th\u1ec3 l\u00e0m d\u00e0i telomere. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 th\u1eadm ch\u00ed l\u00e0 b\u00ecnh th\u01b0\u1eddng h\u00f3a qu\u00e1 tr\u00ecnh t\u1ea1o m\u00e1u.<\/p>\n<h4><span style=\"color: #ffcc00\">Eltrombopag (Revolade\u00ae)<\/span><\/h4>\n<p>K\u1ec3 t\u1eeb n\u0103m 2015, Eltrombopag \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n n\u1eb7ng (SAA) khi h\u1ecd<\/p>\n<ul>\n<li>kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c<\/li>\n<li>\u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb m\u1ea1nh v\u00e0<\/li>\n<li>kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 gh\u00e9p t\u1ee7y x\u01b0\u01a1ng ho\u1eb7c t\u1ebf b\u00e0o g\u1ed1c.<\/li>\n<\/ul>\n<p>Do t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng r\u1ea5t t\u1ed1t trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, Eltrombopag \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn \u1edf Hoa K\u1ef3 \u0111\u1ec3 s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi hATG v\u00e0 CsA trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean c\u1ee7a b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n. Thu\u1ed1c n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn cho \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u \u1edf EU. Tuy nhi\u00ean, do hi\u1ec7u qu\u1ea3 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh, Hi\u1ec7p h\u1ed9i Huy\u1ebft h\u1ecdc v\u00e0 Ung th\u01b0 Y h\u1ecdc \u0110\u1ee9c khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng Eltrombopag trong \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u SAA\/vSAA m\u1eafc ph\u1ea3i trong khu\u00f4n kh\u1ed5 c\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a m\u00ecnh.<\/p>\n<p>Eltrombopag c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u ch\u1ec9nh s\u1ef1 h\u00ecnh th\u00e0nh t\u1ebf b\u00e0o g\u1ed1c m\u00e1u v\u00e0 ti\u1ec3u c\u1ea7u. Thu\u1ed1c n\u00e0y k\u00edch ho\u1ea1t thrombopoietin, ch\u1ea5t \u0111i\u1ec1u ch\u1ec9nh s\u1ef1 h\u00ecnh th\u00e0nh ti\u1ec3u c\u1ea7u v\u00e0 m\u00e1u (huy\u1ebft t\u1ea1o). Li\u1ec1u l\u01b0\u1ee3ng hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi SAA l\u00e0<br \/>\n150 mg\/ng\u00e0y. Nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng Eltrombopag \u1edf h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n gi\u00fap c\u1ea3i thi\u1ec7n c\u1ea3 c\u0169ng nh\u01b0 c\u00e1c gi\u00e1 tr\u1ecb h\u1ed3ng c\u1ea7u v\u00e0 b\u1ea1ch c\u1ea7u trung t\u00ednh. Eltrombopag c\u0169ng gi\u00fap c\u1ea3i thi\u1ec7n ho\u1eb7c b\u00ecnh th\u01b0\u1eddng h\u00f3a t\u1ebf b\u00e0o t\u1ee7y x\u01b0\u01a1ng. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00e2y c\u1ea7n truy\u1ec1n m\u00e1u th\u01b0\u1eddng xuy\u00ean, s\u1ed1 ng\u00e0y \u0111\u1ebfn l\u1ea7n truy\u1ec1n m\u00e1u ti\u1ebfp theo \u0111\u00e3 t\u0103ng l\u00ean ho\u1eb7c h\u1ecd kh\u00f4ng c\u00f2n c\u1ea7n truy\u1ec1n m\u00e1u n\u1eefa.<\/p>\n<h4><span style=\"color: # ffcc00\">Kh\u00e1c<\/span><\/h4>\n<p>C\u00e1c li\u1ec7u ph\u00e1p ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3, v\u00ed d\u1ee5 nh\u01b0 li\u1ec7u ph\u00e1p \u0111\u01a1n tr\u1ecb b\u1eb1ng steroid ho\u1eb7c li\u1ec7u ph\u00e1p \u0111\u01a1n tr\u1ecb b\u1eb1ng c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u1ea1o m\u00e1u, n\u00ean \u0111\u01b0\u1ee3c tr\u00e1nh v\u00ec ch\u00fang ch\u1ec9 l\u00e0m m\u1ea5t th\u1eddi gian v\u00e0 c\u00f3 th\u1ec3 l\u00e0m t\u00ecnh tr\u1ea1ng ban \u0111\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n x\u1ea5u \u0111i \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3.<\/p>\n<p>&nbsp;<\/p>\n<h3><a id=\"suppther\"><\/a><span style=\"color: #ffcc00\">5.5 Li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3 (Supportive)<\/span><\/h3>\n<p>Ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng, tr\u00e1nh ch\u1ea3y m\u00e1u, chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n m\u00e1u ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng c\u00e1 nh\u00e2n v\u00e0 \u0111i\u1ec1u tr\u1ecb qu\u00e1 t\u1ea3i s\u1eaft c\u00f3 \u00fd ngh\u0129a \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3. C\u00e1c bi\u1ec7n ph\u00e1p n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n trong nh\u1eefng n\u0103m qua v\u00e0 g\u00f3p ph\u1ea7n c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t, ngay c\u1ea3 khi \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c ph\u1ea3n \u1ee9ng ho\u00e0n to\u00e0n.<\/p>\n<h4><span style=\"color: #ffcc00\">Nhi\u1ec5m tr\u00f9ng<\/span><\/h4>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng c\u00f3 s\u1ed1t, c\u1ea7n \u0111\u1ebfn g\u1eb7p b\u00e1c s\u0129 c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u1ec3 ph\u00f2ng ng\u1eeba vi khu\u1ea9n v\u00e0 thu\u1ed1c ch\u1ed1ng n\u1ea5m \u0111\u1ec3 ph\u00f2ng ng\u1eeba n\u1ea5m c\u00f3 th\u1ec3 h\u1eefu \u00edch.<\/p>\n<ul>\n<li>\u1ede b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t n\u1eb7ng (s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u h\u1ea1t\/b\u1ea1ch c\u1ea7u trung t\u00ednh &lt; 0,5 G\/l)<\/li>\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng globulin kh\u00e1ng thymocyte (ATG) ho\u1eb7c alemtuzumab, c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba b\u1ed5 sung ch\u1ed1ng l\u1ea1i c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00e1c (v\u00ed d\u1ee5: Pneumocystis jirovecii, cytomegalovirus).<\/li>\n<\/ul>\n<p><strong>Ngo\u00e0i ra, khi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u h\u1ea1t\/b\u1ea1ch c\u1ea7u trung t\u00ednh gi\u1ea3m (&lt; 0,5 G\/l), c\u1ea7n tu\u00e2n th\u1ee7 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba sau:<\/strong><\/p>\n<ul>\n<li>Tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m tr\u00f9ng<\/li>\n<li>Tr\u00e1nh ti\u1ebfp x\u00fac th\u00e2n th\u1ec3 g\u1ea7n g\u0169i v\u1edbi \u0111\u1ed9ng v\u1eadt<\/li>\n<li>Tr\u00e1nh nh\u1eefng n\u01a1i \u0111\u00f4ng ng\u01b0\u1eddi, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong nh\u1eefng th\u00e1ng m\u00f9a \u0111\u00f4ng<\/li>\n<li>Th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p v\u1ec7 sinh th\u00f4ng th\u01b0\u1eddng, v\u00ed d\u1ee5 nh\u01b0 r\u1eeda tay, ch\u0103m s\u00f3c r\u0103ng mi\u1ec7ng, ch\u00fa \u00fd \u0111\u1ebfn \u0111\u1ed9 t\u01b0\u01a1i v\u00e0 s\u1ea1ch s\u1ebd c\u1ee7a th\u1ef1c ph\u1ea9m s\u1ed1ng<\/li>\n<li>Tr\u00e1nh ti\u1ebfp x\u00fac g\u1ea7n g\u0169i v\u1edbi b\u00e0o t\u1eed n\u1ea5m, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi l\u00e0m v\u01b0\u1eddn, kh\u00f4ng l\u00e0m s\u1ea1ch th\u00f9ng r\u00e1c sinh h\u1ecdc ho\u1eb7c \u0111\u1ea3o ph\u00e2n compost<\/li>\n<\/ul>\n<p>Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u1ea5t hi\u1ebfm, v\u00ed d\u1ee5 nh\u01b0 nhi\u1ec5m tr\u00f9ng n\u1eb7ng, c\u00f3 th\u1ec3 xem x\u00e9t s\u1eed d\u1ee5ng c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u1ea1o m\u00e1u G-CSF ho\u1eb7c GM-CSF \u0111\u1ec3 k\u00edch th\u00edch h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 ho\u1eb7c truy\u1ec1n m\u00e1u t\u1eadp trung b\u1ea1ch c\u1ea7u (t\u1eadp trung b\u1ea1ch c\u1ea7u h\u1ea1t).<\/p>\n<p><strong>Th\u00f4ng tin th\u00eam c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y trong <a href=\"https:\/\/www.leukaemie-hilfe.de\/fileadmin\/user_upload\/dlh-broschueren\/2025_Hygiene_Immunsuppression_Patientenbroschuere_DLH_VAH_web_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">t\u00e0i li\u1ec7u &#8220;Nhi\u1ec5m tr\u00f9ng? Kh\u00f4ng, c\u1ea3m \u01a1n!&#8221;<\/a> c\u1ee7a M. Exner v\u00e0 A. Simon thu\u1ed9c Qu\u1ef9 H\u1ed7 tr\u1ee3 B\u1ec7nh nh\u00e2n B\u1ea1ch c\u1ea7u &amp; U lympho \u0110\u1ee9c.<\/strong><\/p>\n<h4><span style=\"color: #ffcc00\">Ch\u1ea3y m\u00e1u<\/span><\/h4>\n<p>Do s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u gi\u1ea3m, b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n c\u00f3 th\u1ec3 b\u1ecb ch\u1ea3y m\u00e1u nghi\u00eam tr\u1ecdng, th\u1eadm ch\u00ed \u0111e d\u1ecda t\u00ednh m\u1ea1ng. Ch\u1ea3y m\u00e1u c\u00f3 th\u1ec3 t\u0103ng l\u00ean ho\u1eb7c k\u00e9o d\u00e0i khi b\u1ecb th\u01b0\u01a1ng ho\u1eb7c ph\u1eabu thu\u1eadt, c\u0169ng nh\u01b0 ch\u1ea3y m\u00e1u \u0111\u1ed9t ng\u1ed9t m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng.<\/p>\n<p>Do \u0111\u00f3, vi\u1ec7c kh\u00f4ng h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c ti\u1ec3u c\u1ea7u hi\u1ec7n c\u00f3 b\u1eb1ng thu\u1ed1c l\u00e0 r\u1ea5t quan tr\u1ecdng. C\u00e1c lo\u1ea1i thu\u1ed1c nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u l\u00e0 v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh, v\u00ec ch\u00fang ng\u0103n ch\u1eb7n s\u1ef1 k\u1ebft t\u1eadp c\u1ee7a ti\u1ec3u c\u1ea7u v\u00e0 do \u0111\u00f3 c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh c\u1ea7m m\u00e1u.<\/p>\n<p>Do \u0111\u00f3, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c ti\u1ec3u c\u1ea7u hi\u1ec7n c\u00f3 b\u1eb1ng thu\u1ed1c. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m thu\u1ed1c \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, v\u00ec ch\u00fang ng\u0103n ch\u1eb7n s\u1ef1 k\u1ebft t\u1eadp c\u1ee7a ti\u1ec3u c\u1ea7u v\u00e0 do \u0111\u00f3 c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh c\u1ea7m m\u00e1u. V\u00ec v\u1eady, vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u nh\u01b0 axit acetylsalicylic (ASS) c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 m\u1ed9t c\u00e1ch c\u1ef1c k\u1ef3 th\u1eadn tr\u1ecdng, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u r\u1ea5t th\u1ea5p, v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng.<\/p>\n<p>\u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef c\u00f3 kinh nguy\u1ec7t ra nhi\u1ec1u, \u0111\u1ec3 tr\u00e1nh m\u1ea5t m\u00e1u qu\u00e1 nhi\u1ec1u khi thi\u1ebfu ti\u1ec3u c\u1ea7u, c\u00f3 th\u1ec3 t\u1ea1m th\u1eddi ng\u1eebng kinh nguy\u1ec7t b\u1eb1ng li\u1ec7u ph\u00e1p hormone, v\u00ed d\u1ee5 nh\u01b0 u\u1ed1ng thu\u1ed1c tr\u00e1nh thai li\u00ean t\u1ee5c ho\u1eb7c ti\u00eam thu\u1ed1c 3 th\u00e1ng m\u1ed9t l\u1ea7n.<\/p>\n<p>Ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 tr\u00e1nh ch\u1ea3y m\u00e1u v\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ea3y m\u00e1u hi\u1ec7n c\u00f3 l\u00e0 truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng ti\u1ec3u c\u1ea7u.<\/p>\n<h4><a id=\"tx\"><\/a><br \/>\n<span style=\"color: #ffcc00\">Truy\u1ec1n m\u00e1u (truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng)<\/span><\/h4>\n<p>Truy\u1ec1n m\u00e1u l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ed1i v\u1edbi nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ee9c kh\u1ecfe th\u1ec3 ch\u1ea5t v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u0169ng nh\u01b0 \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u. Truy\u1ec1n m\u00e1u c\u00f3 th\u1ec3 t\u1ea1m th\u1eddi thay th\u1ebf c\u00e1c t\u1ebf b\u00e0o m\u00e1u b\u1ecb thi\u1ebfu khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng \u1ee9ng (thi\u1ebfu m\u00e1u, ch\u1ea3y m\u00e1u). Trong qu\u00e1 tr\u00ecnh n\u00e0y, kh\u00f4ng ph\u1ea3i to\u00e0n b\u1ed9 m\u00e1u \u0111\u01b0\u1ee3c truy\u1ec1n (truy\u1ec1n m\u00e1u), m\u00e0 ch\u1ec9 truy\u1ec1n lo\u1ea1i t\u1ebf b\u00e0o c\u1ea7n thi\u1ebft (h\u1ed3ng c\u1ea7u ho\u1eb7c ti\u1ec3u c\u1ea7u).<\/p>\n<p><strong>\u0110\u1ec3 s\u1ea3n xu\u1ea5t huy\u1ebft t\u01b0\u01a1ng, sau khi hi\u1ebfn m\u00e1u, m\u00e1u s\u1ebd \u0111\u01b0\u1ee3c ki\u1ec3m tra \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh truy\u1ec1n nhi\u1ec5m, sau \u0111\u00f3 c\u00e1c t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u s\u1ebd \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf, v\u00e0 cu\u1ed1i c\u00f9ng c\u00e1c th\u00e0nh ph\u1ea7n m\u00e1u kh\u00e1c nhau s\u1ebd \u0111\u01b0\u1ee3c t\u00e1ch ra v\u00e0 c\u00f4 \u0111\u1eb7c. C\u00e1c th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e9p hi\u1ebfn m\u00e1u, v\u00ec vi\u1ec7c hi\u1ebfn m\u00e1u c\u00f3 m\u1ee5c \u0111\u00edch c\u1ee5 th\u1ec3 n\u00e0y ti\u1ec1m \u1ea9n nh\u1eefng r\u1ee7i ro \u0111\u1eb7c bi\u1ec7t.<\/strong><\/p>\n<h4><span style=\"color: #ffcc00\">Truy\u1ec1n h\u1ed3ng c\u1ea7u\/huy\u1ebft t\u01b0\u01a1ng h\u1ed3ng c\u1ea7u (truy\u1ec1n EK)<\/span><\/h4>\n<p>\u0110\u1ec3 \u0111\u1ea3m b\u1ea3o kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch t\u1ed1t, ch\u1ebf ph\u1ea9m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng kh\u00f4ng ch\u1ec9 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn theo nh\u00f3m m\u00e1u (A, B, AB, 0) v\u00e0 y\u1ebfu t\u1ed1 Rhesus, m\u00e0 m\u1ed7i ch\u1ebf ph\u1ea9m ri\u00eang l\u1ebb c\u00f2n \u0111\u01b0\u1ee3c ki\u1ec3m tra ri\u00eang cho t\u1eebng b\u1ec7nh nh\u00e2n. \u0110\u1ec3 l\u00e0m \u0111\u01b0\u1ee3c \u0111i\u1ec1u n\u00e0y, trong m\u1ed9t th\u1eed nghi\u1ec7m t\u01b0\u01a1ng th\u00edch, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u1eed nghi\u1ec7m ch\u00e9o, m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c tr\u1ed9n v\u1edbi m\u00e1u t\u1eeb h\u1ed3ng c\u1ea7u c\u00f4 \u0111\u1eb7c (EK) v\u00e0 \u0111\u01b0\u1ee3c ki\u1ec3m tra. \u0110\u1eb7c bi\u1ec7t khi c\u00f3 kh\u00e1ng th\u1ec3, vi\u1ec7c t\u00ecm ki\u1ebfm h\u1ed3ng c\u1ea7u c\u00f4 \u0111\u1eb7c ph\u00f9 h\u1ee3p c\u00f3 th\u1ec3 m\u1ea5t nhi\u1ec1u th\u1eddi gian h\u01a1n. N\u1ebfu b\u1ec7nh nh\u00e2n \u00e2m t\u00ednh v\u1edbi virus cytomegalovirus (CMV) v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng c\u1ea5y gh\u00e9p t\u1ee7y x\u01b0\u01a1ng ho\u1eb7c t\u1ebf b\u00e0o g\u1ed1c sau n\u00e0y, n\u00ean s\u1eed d\u1ee5ng h\u1ed3ng c\u1ea7u c\u00f4 \u0111\u1eb7c \u00e2m t\u00ednh v\u1edbi CMV.<\/p>\n<p>N\u00f3i chung, n\u00ean s\u1eed d\u1ee5ng h\u1ed3ng c\u1ea7u c\u00f4 \u0111\u1eb7c m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng, v\u00ec ch\u00fang c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn qu\u00e1 t\u1ea3i s\u1eaft trong c\u01a1 th\u1ec3. <strong>C\u00e1c ch\u1ec9 \u0111\u1ecbnh cho truy\u1ec1n m\u00e1u l\u00e0<\/strong><\/p>\n<ul>\n<li>suy gi\u1ea3m s\u1ee9c kh\u1ecfe r\u00f5 r\u1ec7t k\u00e8m theo m\u1ec7t m\u1ecfi ho\u1eb7c kh\u00f3 th\u1edf, v\u00ed d\u1ee5 nh\u01b0 khi g\u1eafng s\u1ee9c, v\u00e0 t\u00f9y thu\u1ed9c v\u00e0o c\u00e1c b\u1ec7nh k\u00e8m theo, v\u00ed d\u1ee5 nh\u01b0 suy tim<\/li>\n<li>h\u00e0m l\u01b0\u1ee3ng hemoglobin r\u1ea5t th\u1ea5p (&lt; 8 g\/dl)<\/li>\n<\/ul>\n<p>N\u00f3i chung, \u0111\u1ed1i v\u1edbi li\u1ec7u ph\u00e1p truy\u1ec1n m\u00e1u:<br \/>\n<strong>C\u00e0ng nhi\u1ec1u c\u00e0ng t\u1ed1t, c\u00e0ng \u00edt c\u00e0ng t\u1ed1t!<\/strong><\/p>\n<p>Do \u0111\u00f3, ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n m\u00e1u ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc ri\u00eang cho t\u1eebng b\u1ec7nh nh\u00e2n d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 sau:<\/p>\n<ul>\n<li>tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng (v\u00ed d\u1ee5: nh\u1ecbp tim, nh\u1ecbp th\u1edf, kh\u00f3 th\u1edf, d\u1ea5u hi\u1ec7u ch\u1ea3y m\u00e1u, s\u1ed1t, nhi\u1ec5m tr\u00f9ng&#8230;)<\/li>\n<li>tri\u1ec7u ch\u1ee9ng ch\u1ee7 quan (v\u00ed d\u1ee5: suy gi\u1ea3m s\u1ee9c kh\u1ecfe r\u00f5 r\u1ec7t, m\u1ec7t m\u1ecfi, suy nh\u01b0\u1ee3c, \u0111au \u0111\u1ea7u, \u00f9 tai<br \/>\n&#8230;)<\/li>\n<li>c\u00e1c b\u1ec7nh k\u00e8m theo\/ti\u1ec1n s\u1eed c\u00e1 nh\u00e2n (v\u00ed d\u1ee5: suy tim, ch\u1ea3y m\u00e1u)<\/li>\n<li>Thu\u1ed1c\/ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb (v\u00ed d\u1ee5: li\u1ec7u ph\u00e1p ATG, ph\u1eabu thu\u1eadt)<\/li>\n<li>Kh\u1ea3 n\u0103ng theo d\u00f5i v\u00e0 truy\u1ec1n m\u00e1u ng\u1eafn h\u1ea1n (ngo\u1ea1i tr\u00fa\/n\u1ed9i tr\u00fa)<\/li>\n<\/ul>\n<p>Chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n m\u00e1u th\u1eadn tr\u1ecdng \u00e1p d\u1ee5ng ch\u1ee7 y\u1ebfu cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebf ho\u1ea1ch c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c \u0111\u1ed3ng lo\u1ea1i. Trong tr\u01b0\u1eddng h\u1ee3p c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c \u0111\u01b0\u1ee3c l\u00ean k\u1ebf ho\u1ea1ch, tuy\u1ec7t \u0111\u1ed1i kh\u00f4ng \u0111\u01b0\u1ee3c truy\u1ec1n m\u00e1u t\u1eeb ng\u01b0\u1eddi th\u00e2n.<\/p>\n<h4><span style=\"color: #ffcc00\">Truy\u1ec1n ti\u1ec3u c\u1ea7u\/huy\u1ebft t\u01b0\u01a1ng ti\u1ec3u c\u1ea7u (truy\u1ec1n TK)<\/span><\/h4>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u, c\u00f3 th\u1ec3 truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng (huy\u1ebft t\u01b0\u01a1ng, TK) \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng. V\u00ec ch\u1ea3y m\u00e1u khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u th\u1ea5p c\u00f3 th\u1ec3 l\u00e0 t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u \u0111e d\u1ecda t\u00ednh m\u1ea1ng, n\u00ean trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y ph\u1ea3i h\u00e0nh \u0111\u1ed9ng ngay l\u1eadp t\u1ee9c. N\u1ebfu s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u r\u1ea5t th\u1ea5p, huy\u1ebft t\u01b0\u01a1ng c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c truy\u1ec1n \u0111\u1ec3 ph\u00f2ng ng\u1eeba. Tu\u1ed5i th\u1ecd c\u1ee7a ti\u1ec3u c\u1ea7u ch\u1ec9 v\u00e0i ng\u00e0y. Do \u0111\u00f3, n\u1ebfu s\u1ea3n xu\u1ea5t ti\u1ec3u c\u1ea7u trong t\u1ee7y x\u01b0\u01a1ng r\u1ea5t \u00edt ho\u1eb7c kh\u00f4ng c\u00f3, c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i truy\u1ec1n ti\u1ec3u c\u1ea7u c\u00f4 \u0111\u1eb7c nhi\u1ec1u l\u1ea7n trong tu\u1ea7n.<\/p>\n<p>Ti\u1ec3u c\u1ea7u mang c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 (d\u1ea5u hi\u1ec7u HLA) kh\u00e1c nhau \u1edf m\u1ed7i ng\u01b0\u1eddi. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i c\u00e1c d\u1ea5u hi\u1ec7u HLA n\u00e0y. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra m\u1ed9t c\u00e1ch t\u1ef1 ph\u00e1t, trong b\u1ed1i c\u1ea3nh b\u1ec7nh t\u1eadt ho\u1eb7c sau khi mang thai. N\u1ebfu c\u00f3 c\u00e1c kh\u00e1ng th\u1ec3 HLA nh\u01b0 v\u1eady, c\u00e1c ti\u1ec3u c\u1ea7u \u0111\u01b0\u1ee3c truy\u1ec1n s\u1ebd b\u1ecb ph\u00e1 h\u1ee7y ngay l\u1eadp t\u1ee9c, d\u1eabn \u0111\u1ebfn s\u1ef1 gia t\u0103ng ti\u1ec3u c\u1ea7u kh\u00f4ng \u0111\u1ee7 sau khi truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng ti\u1ec3u c\u1ea7u. \u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, huy\u1ebft t\u01b0\u01a1ng ti\u1ec3u c\u1ea7u t\u01b0\u01a1ng th\u00edch HLA \u0111\u1eb7c bi\u1ec7t ph\u1ea3i \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb nh\u1eefng ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m HLA ph\u00f9 h\u1ee3p.<br \/>\n<strong><br \/>\nCh\u1ec9 \u0111\u1ecbnh truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng ti\u1ec3u c\u1ea7u l\u00e0:<\/strong><\/p>\n<ul>\n<li>khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u &lt; 20 G\/l v\u00e0 s\u1ed1t &gt; 38\u00b0 C, nhi\u1ec5m tr\u00f9ng, c\u00f3 d\u1ea5u hi\u1ec7u ch\u1ea3y m\u00e1u ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u n\u1eb7ng (WHO c\u1ea5p 3 ho\u1eb7c 4) c\u0169ng nh\u01b0 khi c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng mi\u1ec5n d\u1ecbch d\u1ecb \u1ee9ng (kh\u00e1ng th\u1ec3 HLA, xem \u1edf tr\u00ean)<\/li>\n<li>n\u1ebfu kh\u00f4ng c\u00f3 r\u1ee7i ro l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u (v\u00ed d\u1ee5: s\u1ed1t, nhi\u1ec5m tr\u00f9ng, ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u n\u1eb7ng, mi\u1ec5n d\u1ecbch d\u1ecb \u1ee9ng), th\u00ec ch\u1ec9 c\u1ea7n truy\u1ec1n m\u00e1u khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u &lt; 5 G\/l. \u0110i\u1ec1u ki\u1ec7n ti\u00ean quy\u1ebft l\u00e0 ph\u1ea3i ki\u1ec3m tra th\u01b0\u1eddng xuy\u00ean v\u00e0 ch\u1eb7t ch\u1ebd (v\u00ed d\u1ee5: \u00edt nh\u1ea5t m\u1ed9t l\u1ea7n m\u1ed7i tu\u1ea7n), kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u ch\u1ea3y m\u00e1u (v\u00ed d\u1ee5: ban xu\u1ea5t huy\u1ebft) v\u00e0 c\u00f3 th\u1ec3 truy\u1ec1n m\u00e1u nhanh ch\u00f3ng khi c\u00f3 d\u1ea5u hi\u1ec7u ch\u1ea3y m\u00e1u.<\/li>\n<li>\u201cGi\u1edbi h\u1ea1n ri\u00eang cho t\u1eebng b\u1ec7nh nh\u00e2n\u201d: Nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 gi\u1edbi h\u1ea1n \u1ed5n \u0111\u1ecbnh, khi gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi gi\u1edbi h\u1ea1n n\u00e0y s\u1ebd xu\u1ea5t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ea3y m\u00e1u m\u1ea1nh h\u01a1n.<\/li>\n<li>Tr\u01b0\u1edbc v\u00e0 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ATG, gi\u00e1 tr\u1ecb ti\u1ec3u c\u1ea7u n\u00ean \u0111\u01b0\u1ee3c n\u00e2ng l\u00ean 50 G\/l, v\u00ec truy\u1ec1n ATG c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3m ti\u1ec3u c\u1ea7u nhanh ch\u00f3ng.<\/li>\n<li>Tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p, b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb ph\u1ea3i \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o tr\u01b0\u1edbc v\u1ec1 b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n v\u00e0 t\u1ed1t nh\u1ea5t l\u00e0 \u0111\u01b0\u1ee3c cung c\u1ea5p k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m m\u00e1u m\u1edbi nh\u1ea5t!<\/li>\n<\/ul>\n<h4><span style=\"color: #ffcc00\">Qu\u00e1 t\u1ea3i s\u1eaft<\/span><\/h4>\n<p>V\u1edbi m\u1ed7i h\u1ed3ng c\u1ea7u c\u00f4 \u0111\u1eb7c, l\u01b0\u1ee3ng s\u1eaft \u0111\u01b0\u1ee3c h\u1ea5p th\u1ee5 g\u1ea5p h\u01a1n 100 l\u1ea7n l\u01b0\u1ee3ng s\u1eaft \u0111\u01b0\u1ee3c cung c\u1ea5p h\u00e0ng ng\u00e0y qua th\u1ee9c \u0103n. Do c\u01a1 th\u1ec3 con ng\u01b0\u1eddi kh\u00f4ng th\u1ec3 b\u00e0i ti\u1ebft s\u1eaft m\u1ed9t c\u00e1ch ch\u1ee7 \u0111\u1ed9ng, s\u1eaft s\u1ebd \u0111\u01b0\u1ee3c t\u00edch tr\u1eef trong c\u00e1c c\u01a1 quan kh\u00e1c nhau, ch\u1ee7 y\u1ebfu l\u00e0 gan, tim, th\u1eadn, t\u1ee7y x\u01b0\u01a1ng (xem b\u1ea3ng 2) v\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng cho c\u00e1c c\u01a1 quan n\u00e0y. B\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n ho\u1eb7c h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n t\u1ea1o m\u00e1u (MDS) c\u00f3 nguy c\u01a1 b\u1ecb qu\u00e1 t\u1ea3i s\u1eaft ngay c\u1ea3 khi kh\u00f4ng \u0111\u01b0\u1ee3c truy\u1ec1n m\u00e1u, v\u00ec ch\u1ee9c n\u0103ng t\u1ee7y x\u01b0\u01a1ng k\u00e9m l\u00e0m gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh h\u1ed3ng c\u1ea7u m\u1edbi v\u00e0 s\u1eaft kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ho\u00e0n to\u00e0n \u0111\u1ec3 t\u1ea1o ra c\u00e1c t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u m\u1edbi.<\/p>\n<div id=\"attachment_9014\" style=\"width: 510px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9014\" class=\"wp-image-9014 size-large\" src=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet-500x328.png\" alt=\"\" width=\"500\" height=\"328\" srcset=\"https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet-500x328.png 500w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet-300x197.png 300w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet-768x503.png 768w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet-700x459.png 700w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet-1100x721.png 1100w, https:\/\/aa-pnh.org\/wp-content\/uploads\/AABild4-viet.png 1410w\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" \/><p id=\"caption-attachment-9014\" class=\"wp-caption-text\">C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a qu\u00e1 t\u1ea3i s\u1eaft<\/p><\/div>\n<p>Th\u00f4ng th\u01b0\u1eddng, trong nh\u1eefng th\u00e1ng \u0111\u1ea7u ti\u00ean sau khi ch\u1ea9n \u0111o\u00e1n, n\u1ed3ng \u0111\u1ed9 s\u1eaft d\u1ef1 tr\u1eef (ferritin) ho\u1eb7c s\u1eaft trong gan ch\u01b0a \u0111\u1ea1t \u0111\u1ebfn m\u1ee9c c\u1ea7n \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c \u0111\u1ec3 li\u00ean k\u1ebft v\u00e0 lo\u1ea1i b\u1ecf s\u1eaft d\u01b0 th\u1eeba (\u0111i\u1ec1u tr\u1ecb b\u1eb1ng chelat). Do \u0111\u00f3, n\u00ean ch\u1edd \u00edt nh\u1ea5t 6 th\u00e1ng sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n truy\u1ec1n m\u00e1u th\u01b0\u1eddng xuy\u00ean, li\u1ec7u ph\u00e1p chelat \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi n\u1ed3ng \u0111\u1ed9 ferritin huy\u1ebft thanh tr\u00ean 1.000 \u00b5g\/l. \u0110i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t \u00e1p d\u1ee5ng cho c\u00e1c b\u1ec7nh nh\u00e2n c\u1ea7n gh\u00e9p t\u1ea1ng, v\u00ec qu\u00e1 t\u1ea3i s\u1eaft \u0111i k\u00e8m v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn gh\u00e9p t\u1ea1ng cao h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh cao h\u01a1n.<\/p>\n<p>C\u00e1c lo\u1ea1i thu\u1ed1c hi\u1ec7n nay \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb qu\u00e1 t\u1ea3i s\u1eaft th\u01b0\u1eddng \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ch\u00ednh bao g\u1ed3m bu\u1ed3n n\u00f4n, ti\u00eau ch\u1ea3y v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn, nh\u01b0ng c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y s\u1ebd gi\u1ea3m d\u1ea7n sau khi ng\u1eebng d\u00f9ng thu\u1ed1c.<\/p>\n<p>N\u1ebfu ferritin huy\u1ebft thanh d\u01b0\u1edbi 1.000 \u00b5g\/l, c\u00f3 th\u1ec3 xem x\u00e9t ng\u1eebng \u0111i\u1ec1u tr\u1ecb trong tr\u01b0\u1eddng h\u1ee3p qu\u00e1 t\u1ea3i s\u1eaft do truy\u1ec1n m\u00e1u, t\u00f9y thu\u1ed9c v\u00e0o nhu c\u1ea7u truy\u1ec1n m\u00e1u c\u1ee7a t\u1eebng c\u00e1 nh\u00e2n. Tuy nhi\u00ean, \u0111i\u1ec1u n\u00e0y ph\u1ea3i lu\u00f4n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau khi tham kh\u1ea3o \u00fd ki\u1ebfn c\u1ee7a b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>N\u1ebfu kh\u00f4ng c\u1ea7n truy\u1ec1n m\u00e1u v\u00e0 n\u1ed3ng \u0111\u1ed9 hemoglobin \u0111\u1ee7 cao, li\u1ec7u ph\u00e1p l\u1ea5y m\u00e1u (l\u01b0\u1ee3ng m\u00e1u l\u1ea5y t\u00f9y theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p, v\u00ed d\u1ee5: l\u01b0\u1ee3ng m\u00e1u l\u1ea5y \u00edt nh\u01b0 100 ml m\u1ed7i l\u1ea7n) \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u1ed1i v\u1edbi t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i s\u1eaft.<\/p>\n<p>N\u00f3i chung, t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i s\u1eaft c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m tra th\u01b0\u1eddng xuy\u00ean v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh.<\/p>\n<p><strong>Th\u00f4ng tin th\u00eam c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y trong <a href=\"https:\/\/www.leukaemie-hilfe.de\/fileadmin\/user_upload\/DLH_Broschuere_Eisenueberladung_2024_lowres.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">t\u00e0i li\u1ec7u &#8220;Qu\u00e1 t\u1ea3i s\u1eaft do truy\u1ec1n m\u00e1u&#8221;<\/a> c\u1ee7a Qu\u1ef9 H\u1ed7 tr\u1ee3 B\u1ec7nh nh\u00e2n B\u1ea1ch c\u1ea7u &amp; U lympho \u0110\u1ee9c.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<h4><span style=\"color: #ffcc00\">Ho\u1ea1t \u0111\u1ed9ng<\/span><\/h4>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n, ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t v\u00e0 v\u1eadn \u0111\u1ed9ng l\u00e0 h\u1eefu \u00edch t\u00f9y thu\u1ed9c v\u00e0o ch\u1ec9 s\u1ed1 m\u00e1u v\u00e0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe. Tuy nhi\u00ean, c\u1ea7n ch\u00fa \u00fd \u0111\u1ec3 kh\u00f4ng b\u1ecb qu\u00e1 s\u1ee9c. Do \u0111\u00f3, n\u00ean t\u1eadp th\u1ec3 d\u1ee5c trong khi ki\u1ec3m so\u00e1t nh\u1ecbp tim. \u0110i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u, v\u00ec khi s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u gi\u1ea3m, c\u01a1 th\u1ec3 th\u01b0\u1eddng c\u1ed1 g\u1eafng b\u00f9 \u0111\u1eafp s\u1ef1 thi\u1ebfu h\u1ee5t n\u00e0y b\u1eb1ng c\u00e1ch t\u0103ng nh\u1ecbp tim, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn qu\u00e1 t\u1ea3i cho tim. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n gi\u1ea3m ti\u1ec3u c\u1ea7u, c\u1ea7n tuy\u1ec7t \u0111\u1ed1i tr\u00e1nh c\u00e1c m\u00f4n th\u1ec3 thao c\u00f3 nguy c\u01a1 ch\u1ea5n th\u01b0\u01a1ng, v\u00ed d\u1ee5 nh\u01b0 v\u00f5 thu\u1eadt ho\u1eb7c leo n\u00fai.<\/p>\n<h4><span style=\"color: #ffcc00\">Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/span><\/h4>\n<p>N\u1ebfu b\u1ec7nh thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n khi\u1ebfn b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 tham gia v\u00e0o cu\u1ed9c s\u1ed1ng &#8220;b\u00ecnh th\u01b0\u1eddng&#8221; nh\u01b0 tr\u01b0\u1edbc \u0111\u00e2y, c\u00e1c bi\u1ec7n ph\u00e1p ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u ngo\u1ea1i tr\u00fa ho\u1eb7c ch\u0103m s\u00f3c t\u00e2m l\u00fd ho\u1eb7c t\u00e2m l\u00fd tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 h\u1eefu \u00edch. C\u00e1c bi\u1ec7n ph\u00e1p n\u00e0y n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh ri\u00eang cho t\u1eebng b\u1ec7nh nh\u00e2n.<br \/>\nN\u1ebfu c\u00f3 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb chuy\u00ean s\u00e2u, th\u00ec ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb. V\u1eadt l\u00fd tr\u1ecb li\u1ec7u ho\u1eb7c tr\u1ecb li\u1ec7u t\u00e2m l\u00fd ho\u1eb7c t\u00e2m l\u00fd tr\u1ecb li\u1ec7u c\u0169ng h\u1eefu \u00edch trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Khi t\u00e1i h\u00f2a nh\u1eadp m\u1ed9t \u0111\u1ee9a tr\u1ebb b\u1ecb thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n sau khi k\u1ebft th\u00fac li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c c\u1ea5y gh\u00e9p, do \u00e1p l\u1ef1c t\u00e2m l\u00fd x\u00e3 h\u1ed9i l\u1edbn \u0111\u1ed1i v\u1edbi gia \u0111\u00ecnh, c\u00e1c bi\u1ec7n ph\u00e1p h\u01b0\u1edbng \u0111\u1ebfn gia \u0111\u00ecnh t\u1ea1i m\u1ed9t c\u01a1 s\u1edf ch\u0103m s\u00f3c sau ung th\u01b0 nhi khoa c\u00f3 th\u1ec3 l\u00e0 h\u1eefu \u00edch.<\/p>\n<h2><a name=\"aaprognose\"><\/a><span style=\"color: #ffcc00\">6 Ti\u00ean l\u01b0\u1ee3ng<\/span><\/h2>\n<p>S\u1ed1 l\u01b0\u1ee3ng <em>b\u1ea1ch c\u1ea7u h\u1ea1t<\/em> c\u00e0ng cao v\u00e0 tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n c\u00e0ng nh\u1ecf, ti\u00ean l\u01b0\u1ee3ng c\u00e0ng t\u1ed1t.<\/p>\n<p>D\u1eef li\u1ec7u v\u1ec1 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau \u0111\u01b0\u1ee3c n\u00eau d\u01b0\u1edbi \u0111\u00e2y l\u00e0 d\u1eef li\u1ec7u th\u1ed1ng k\u00ea. \u0110i\u1ec1u n\u00e0y c\u00f3 ngh\u0129a l\u00e0 d\u1eef li\u1ec7u n\u00e0y kh\u00f4ng th\u1ec3 t\u1ef1 \u0111\u1ed9ng \u00e1p d\u1ee5ng cho t\u1eebng b\u1ec7nh nh\u00e2n. Danh s\u00e1ch n\u00e0y ch\u1ec9 nh\u1eb1m cung c\u1ea5p m\u1ed9t c\u00e1i nh\u00ecn t\u1ed5ng quan v\u1ec1 nh\u1eefng c\u1ea3i thi\u1ec7n trong kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. Th\u01b0\u1eddng c\u00f3 nh\u1eefng nh\u00f3m nh\u1ecf kh\u00f4ng \u0111\u01b0\u1ee3c t\u00ednh \u0111\u1ebfn \u1edf \u0111\u00e2y. \u0110\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c h\u00ecnh th\u1ee9c \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3, k\u1ebft qu\u1ea3 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 20 tu\u1ed5i r\u00f5 r\u00e0ng t\u1ed1t h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n tr\u00ean 20 tu\u1ed5i. \u0110i\u1ec1u t\u01b0\u01a1ng t\u1ef1 c\u0169ng \u00e1p d\u1ee5ng cho b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 40\/50 tu\u1ed5i so v\u1edbi b\u1ec7nh nh\u00e2n tr\u00ean 40\/50 tu\u1ed5i. \u0110\u1ed1i v\u1edbi c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c, k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n \u0111\u00e1ng k\u1ec3 n\u1ebfu ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng cung c\u1ea5p t\u1ebf b\u00e0o g\u1ed1c tr\u1ef1c ti\u1ebfp t\u1eeb t\u1ee7y x\u01b0\u01a1ng ch\u1ee9 kh\u00f4ng ph\u1ea3i t\u1ebf b\u00e0o g\u1ed1c <em>ngo\u1ea1i vi<\/em> l\u1ea5y t\u1eeb m\u00e1u.<\/p>\n<p><strong>Theo d\u1eef li\u1ec7u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t t\u1ed5ng th\u1ec3 \u0111\u1ed1i v\u1edbi SAA\/vSAA sau 3-6 n\u0103m v\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n chia theo c\u00e1c h\u00ecnh th\u1ee9c \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 kh\u00e1c nhau:<\/strong><\/p>\n<ul>\n<li>sau SZT \u0111\u1ed3ng lo\u1ea1i t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng trong gia \u0111\u00ecnh HLA-identem 75\u201390 %<\/li>\n<li>sau SZT \u0111\u1ed3ng lo\u1ea1i t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng kh\u00f4ng c\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng HLA-identen 65\u201373 %<\/li>\n<li>sau \u0111i\u1ec1u tr\u1ecb <em>ATG<\/em>\/<em>CsA<\/em> 76\u201396 %<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><a name=\"aaregister\"><\/a><span style=\"color: #ffcc00\">7 \u0110\u0103ng k\u00fd<\/span><\/h2>\n<p><strong>B\u1ec7nh nh\u00e2n c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 m\u1ed9t d\u00f2ng PNH<\/strong> c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ghi v\u00e0o s\u1ed5 \u0111\u0103ng k\u00fd PNH qu\u1ed1c t\u1ebf (PNH Registry) qua B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Essen \u0111\u1ec3 c\u00f3 th\u1ec3 thu th\u1eadp th\u00eam th\u00f4ng tin v\u1ec1 nh\u00f3m b\u1ec7nh nh\u00e2n AA n\u00e0y.<\/p>\n<p><strong>N\u1ebfu quan t\u00e2m ho\u1eb7c c\u00f3 th\u1eafc m\u1eafc, vui l\u00f2ng g\u1eedi email \u0111\u1ebfn Prof. Dr. med. Alexander R\u00f6th (<a href=\"mailto:alexander.roeth@uk-essen.de\">alexander.roeth(at)uk-essen.de<\/a>).<\/strong><\/p>\n<p><strong>B\u1ec7nh nh\u00e2n m\u1eafc <em>telomeropathy<\/em><\/strong> c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ghi v\u00e0o <a href=\"https:\/\/www.ukaachen.de\/?id=7382\" target=\"_blank\" rel=\"noopener\">\u0110\u0103ng k\u00fd AA-BMF<\/a> t\u1ea1i B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Aachen \u0111\u1ec3 c\u00f3 th\u1ec3 thu th\u1eadp th\u00eam th\u00f4ng tin v\u1ec1 nh\u00f3m b\u1ec7nh nh\u00e2n AA n\u00e0y.<\/p>\n<p><strong>N\u1ebfu quan t\u00e2m ho\u1eb7c c\u00f3 th\u1eafc m\u1eafc, vui l\u00f2ng g\u1eedi email \u0111\u1ebfn Prof. Dr. med. Tim H. Br\u00fcmmendorf (<a href=\"mailto:tbruemmendorf@ukaachen.de\">tbruemmendorf(at)ukaachen.de<\/a>).<\/strong><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n (AA) 1 AA l\u00e0 g\u00ec? 2 Tri\u1ec7u ch\u1ee9ng 3 Ch\u1ea9n \u0111o\u00e1n 4 Di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng 5 \u0110i\u1ec1u tr\u1ecb 6 Ti\u00ean l\u01b0\u1ee3ng 7 \u0110\u0103ng k\u00fd &nbsp; 1 AA l\u00e0 g\u00ec? &nbsp; 1.1 T\u1ed5ng quan Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n l\u00e0 m\u1ed9t b\u1ec7nh&#8230;<\/p>\n","protected":false},"author":12,"featured_media":0,"parent":8967,"menu_order":23,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8996","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/pages\/8996","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/comments?post=8996"}],"version-history":[{"count":4,"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/pages\/8996\/revisions"}],"predecessor-version":[{"id":9136,"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/pages\/8996\/revisions\/9136"}],"up":[{"embeddable":true,"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/pages\/8967"}],"wp:attachment":[{"href":"https:\/\/aa-pnh.org\/vi\/wp-json\/wp\/v2\/media?parent=8996"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}