Iindlela Ezizezinye Ezisemgangathweni Ezinokusetyenziswa Kunotofelo-gazi

Usenokuvakalelwa kukuba, ‘Utofelo-gazi luyingozi, kodwa ngaba zikho iindlela ezizezinye ezisemgangathweni ophakamileyo ezinokusetyenziswa?’ Lo ngumbuzo omhle, ibe phawula igama elithi “ezisemgangathweni.”

Wonk’ ubani, kuquka amaNgqina kaYehova, ufuna unyango olunempumelelo nolukumgangatho ophakamileyo. UGqr. Grant E. Steffen waphawula oothunywashe ababini abayintloko: “Ukunyanyekelwa ngokwezamayeza okusemgangathweni kungamandla abanawo oothunywashe bolo nyango ukuze kufikelelwe unyango olululo nosukelo olungelolwezamayeza.” (IThe Journal of the American Medical Association, kaJulayi 1, 1988) “Usukelo olungelolwezamayeza” beluya kuquka ukungenzi ngokungqubana nemigaqo yokuziphatha okanye isazela somguli esiqeqeshwe yiBhayibhile.—IZenzo 15:28, 29.

Ngaba kukho iindlela ezizizo nezinempumelelo zokuhlangabezana neengxaki ezinzulu zonyango ngaphandle kokusebenzisa igazi? Okonwabisayo kukuba, impendulo ithi zikho.

Nangona inkoliso yoogqirha botyando iye yema ngelithi ibilitofela igazi kuphela xa bekungekho ndlela iyenye ebinokuyisebenzisa, emva kokuvela kobhubhani onguGawulayo ukusebenzisa kwabo igazi kuye kwehla kakhulu. Inqaku lomhleli elikwiMayo Clinic Proceedings (kaSeptemba 1988) lathi “enye yeengenelo ezimbalwa zalo bhubhani” ibe kukuba “uphumele kumaphulo awahlukahlukeneyo enziwa ngabaguli noogqirha ukuze baphephe utofelo-gazi.” Igosa lendawo yokugcina igazi lichaza oku: “Into eye yaguquka bubunzulu besigidimi, indlela abasebenzi bezonyango abasamkela ngayo (ngenxa yokuqondwa ngokubanzi kweengozi), nemfuneko yokuqwalaselwa kweendlela ezizezinye ezinokusetyenziswa.”—ITransfusion Medicine Reviews, kaOktobha 1989.

Phawula oku, zikho iindlela ezizezinye ezinokusetyenziswa! Oku kuthi kuqondakale xa sihlolisisa isizathu sokuba igazi litofelwe.

Isibomvisi-gazi (hemoglobin) esikwiiseli ezibomvu sithwala ioksijini eyimfuneko kwimpilo entle nobomi. Ngoko ukuba umntu uye wopha kakhulu, kusenokubonakala kusengqiqweni ukusuka kubuyiselwe nje elo gazi. Ngokuqhelekileyo kuzo zonke iikyubhiki sentimitha ezili-100 zegazi kukho iigram ezili-14 okanye ezili-15 zesibomvisi-gazi. (Omnye umlinganiselo walo mxube yihematocrit, ngokuqhelekileyo eba malunga nama-45 ekhulwini.) “Umgaqo” owamkelekileyo wawukukuba umguli makatofelwe igazi ngaphambi kotyando ukuba umlinganiselo wesibomvisi-gazi sakhe ungaphantsi kwe-10 (okanye ihematocrit engama-30 ekhulwini). Ulindixesha waseSwitzerland iVox Sanguinis (kaMatshi 1987) wanikela ingxelo yokuba “[iingcali zokuphelisa iintlungu ebudeni botyando] ezingama-65 ekhulwini zafuna ukuba abaguli babe nomlinganiselo weedesilitha ezili-10 zesibomvisi-gazi ngegram ekhulwini nganye ngaphambi kotyando ukuze kwenziwe utyando oluyimfuneko.”

Kodwa kwinkomfa eyayingowe-1988 yotofelo-gazi, uNjingalwazi Howard L. Zauder wabuza oku, “Salifumana Njani Eli ‘Nani Lomlingo’?” Wacacisa esithi: “Into yokuba kuthiwe kuyimfuneko ngomguli oneegram ezili-10 zesibomvisi-gazi (Hgb) ngaphambi kokuba afumane iipilisi zokudambisa iintlungu ifihlakele kwisithethe, igutyungelwe bubumnyama yaye ayiqinisekiswa bubungqina obungokwezamayeza okanye obolingelo.” Khawufan’ ucinge nje ngamawaka-waka amaninzi abaguli abatofelwa igazi ngenxa yokushukunyiswa yimfuneko ‘yesithethe nengaqinisekiswanga’!

Bambi basenokubuza besithi, ‘Kutheni umlinganiselo wesibomvisi-gazi oli-14 ungoqhelekileyo ukuba unokuxomoloza nangongaphantsi kwalowo?’ Kaloku, oku kuthetha ukuba unesixa esisengqiqweni esilungiselelwe ithuba lamanqam sokuthwala ioksijini ukuze ukulungele ukwenza umthambo okanye umsebenzi onzima. Uhlolisiso olwenziwa kubaguli abanomlinganiselo omncinane weeseli ezibomvu zegazi wada watyhila nokuba “kunzima ukubona intsilelo kumlinganiselo wokusebenza kubantu abanomxube wesibomvisi-gazi esingaphantsi kangangeedesilitha ezisi-7 kwigram nganye. Abanye baye bafumana ubungqina bokusebenza okungaphazamisekanga kangako.”—IContemporary Transfusion Practice, yowe-1987.

Ngoxa abantu abakhulileyo benokuphila ngomlinganiselo ophantsi wesibomvisi-gazi, kuthekani ngabantwana? UGqr. James A. Stockman III uthi: “Ngaphandle kwakwiimeko ezimbalwa, iintsana ezizelwe ngaphambi kwexesha zijamelana nokuhla kwesibomvisi-gazi kwinyanga enye ukusa kwezintathu zokuqala . . . Iimbonakaliso zemfuneko yotofelo-gazi kwindawo yogcino-ntsana azichazwa kakuhle. Eneneni, iintsana ezininzi zibonakala zixomoloza ngokuphawulekayo ngomlinganiselo omncinane wesibomvisi-gazi kungekho bunzima bubonakalayo kwezonyango.”—IPediatric Clinics of North America, kaFebruwari 1986.

Inkcazelo enjalo ayithethi ukuba akuyomfuneko ukuthabatha inyathelo elithile xa umntu esopha kakhulu ngenxa yengozi ethile okanye ebudeni botyando. Ukuba umntu wopha ngokukhawuleza ibe esopha kanobom, uxinzelelo lwegazi lomntu luyehla, ibe usenokufa isiqaqa. Eyona nto ifuneka ngokuyintloko kukuba kunqunyanyiswe ukopha oko kuze kubuyiselwe umthamo wegazi elophileyo emzimbeni wakhe. Oko kuya kunceda ukuthintela ukufa isiqaqa kuze kugcine iiseli ezibomvu ezisaseleyo nezinye iziyilelo zijikeleza.

Lo mthamo wegazi elophileyo unokubuyiselwa ngaphandle kokusebenzisa nje igazi njengoko linjalo okanye isiyilelo segazi (blood plasma).a Ulwelo olungenagazi oluziintlobo ezahlukahlukeneyo lunempumelelo ekwandiseni umthamo wegazi. Olona lwelo luqhelekileyo ngumxube wesaline (wetyuwa), ongabizi mali novanayo negazi lethu. Kukwakho neentlobo zolwelo ezixutywe nezinto ezikhethekileyo, njengedextran (ulwelo olusetyenziswa endaweni yesiyilelo nolwenziwe ngeemolekyuli zeglukhosi), iHaemaccel, nomxube wetyuwa ovela elubisini nowafunyanwa nguRinger (Ringer’s solution). IHetastarch (HES) ngumxube omtsha wokwandisa umthamo wegazi, ibe “unokunconyelwa ngokukhuselekileyo kwabo baguli [batshileyo] abangavaniyo nezinye iimveliso zegazi.” (IJournal of Burn Care & Rehabilitation, kaJanuwari/Februwari 1989) Iintlobo ezinjalo zolwelo zineengenelo ezipheleleyo. “Le mixube yokwenene necwengekileyo [njengeyetyuwa eqhelekileyo nomxube wobisi kaRinger], iDextran neHES ngokwentelekiso azinabungozi ibe azibizi mali ininzi, zifumaneka lula, zinokugcinwa kumaqondo obushushu basendlwini, akuyomfuneko ukuba kuvavanywe ukuvana kwazo negazi ibe zikhuselekile kwiingozi zezifo ezidluliselwa ngotofelo-gazi.”—IBlood Transfusion Therapy—A Physician’s Handbook, yowe-1989.

Noko ke, usenokubuza uthi, ‘Kutheni le nto ulwelo olungelogazi olusetyenziswayo lusebenza kakuhle, ekubeni ndifuna iiseli ezibomvu ukuze ndifumane ioksijini kuwo wonke umzimba wam?’ Njengoko sekukhankanyiwe, uneendawo ezigcina ioksijini ukulungiselela imeko yamanqam. Ukuba uyopha, inkqubo emangalisayo yokubuyisela igazi elilungelelanisiweyo iqalisa ukusebenza. Intliziyo yakho impompa igazi elingakumbi sihlandlo ngasinye ibetha. Ekubeni igazi ophulukene nalo belibuyiselwa ngolwelo olufanelekileyo, ngoku igazi elixutyiweyo libaleka ngokulula ngakumbi, kwanakwimithanjana emincinane. Ngenxa yoku kuguquka kungokwemichiza, ioksijini engakumbi ithunyelwa kwizicubu (tissues) zomzimba. Ezi nguquko zinempumelelo gqitha kangangokuba ukuba usele nje nesiqingatha seeseli zakho ezibomvu, umlinganiselo wokuhamba kweoksijini unokuba malunga nama-75 ekhulwini kunalowo uqhelekileyo. Umguli ohleli nje usebenzisa kuphela ioksijini engama-25 ekhulwini kwekhoyo kwigazi lakhe. Ibe iipilisi ezininzi neziqhelekileyo zokudambisa iintlungu zibangela ukuba umzimba ungafuni oksijini ininzi.

BANOKUNCEDA NJANI OOGQIRHA?

Oogqirha abanobuchule banokumnceda lowo wophe kakhulu waza ngoko wasala eneeseli ezibomvu ezimbalwa. Wakuba umthamo wegazi ubuyiselwe, oogqirha banokumlungiselela ukuba afumane ioksijini eninzi. Oku kwenza ukuba engakumbi yayo iveliselwe emzimbeni ibe ngokufuthi oku kuye kwanemiphumo ephawulekayo. Oogqirha baseBritani bakwenza oku kwibhinqa elithile elalophe kakhulu ngokokude “umlinganiselo walo wesibomvisi-gazi wehla waba ziidesilitha ezisisi-1,8 kwigram nganye. Lanyangwa ngokuphumelelayo . . . [kusetyenziswa] umlinganiselo omninzi weoksijini ibe kutofelwa imithamo engakumbi yomxube wolwelo lwamathambo igelatin, [Haemaccel].” (IAnaesthesia, kaJanuwari 1987) Le ngxelo ikwathi abanye abaye balahlekelwa ligazi elininzi baye banyangwa ngokuphumelelayo kumagumbi aneoksijini eninzi kakhulu.

Oogqirha bakwanokubanceda abaguli ababanyamekelayo ukuba bavelise iiseli ezingakumbi ezibomvu. Njani? Ngokubanika amayeza anesiqalelo sentsimbi (iron) esemzimbeni (ezihlunwini okanye kwimithambo), lawo anokunceda umzimba ekwenzeni iiseli ezibomvu ngokukhawuleza kangangezihlandlo ezithathu ukusa kwezine kunokuba usenza ngokuqhelekileyo. Kutshanje kuye kwafumaneka olunye uncedo. Izintso zakho zivelisa incindi yedlala ekuthiwa yierythropoietin (EPO), evuselela umongo emathanjeni ukuba wenze iiseli ezibomvu. Ngoku iEPO eyenziwayo (ngokudityaniswa kweziyilelo ezithile) iyafumaneka. Oogqirha basenokubanika olu lwelo abaguli abathile abanomlinganiselo omncinane weeseli ezibomvu, ngaloo ndlela bebanceda ukuba babuyisele umthamo weeseli ezibomvu ngokukhawuleza okukhulu.

Kwanasebudeni botyando, oogqirha neengcali zokudambisa iintlungu ezinobuchule nezinenkathalo zinokunceda ngokusebenzisa iindlela zenkqubo zokulondoloza igazi. Kunconyelwa ukuba kusetyenziswe izixhobo zobugcisa ezisetyenziswa kutyando lwenyameko, njengesixhobo esithile sokutshisa isihlunu esisebenza ngombane ukuze kuncitshiswe ukopha. Maxa wambi igazi elimpompozela enxebeni linokutsalwa, licocwe, lize libuyiselwe kumjikelezo wegazi.b

Abaguli abasebenzisa umatshini wentliziyo nemiphunga ohanjiswa ngolwelo olungenagazi basenokuncedakala koku kungxengwa kwegazi ngolwelo, belahlekelwa ziiseli ezibomvu ezingengako.

Kwaye kukho nezinye iindlela zokunceda. Ukuthoba umlinganiselo wobushushu bomguli ukuze kuhliswe umlinganiselo asebenzisa ngawo ioksijini ebudeni botyando. Izidambisi-zintlungu ezehlisa uxinzelelo-gazi. Unyango oluthile olubangela ukuyileka kwamahlwili ngokukhawuleza. IDesmopressin (DDAVP) yokunqumamisa ukopha. “Iingadla” zoogqirha ezisebenza ngombane. Kuya kubakho iindlela ezininzi ngakumbi njengoko oogqirha nabaguli abaxhalabileyo befuna ukukuphepha ukutofela igazi. Sinethemba lokuba akusokuze uphulukane nesixa esikhulu segazi. Kodwa ukuba oko kuyenzeka, kusenokwenzeka ukuba oogqirha abanamava basenokukunyamekela ngaphandle kokusebenzisa utofelo-gazi, oluneengozi ezininzi kangaka.

UTYANDO, LUNOKWENZIWA—NGAPHANDLE KOTOFELO-GAZI

Abantu abaninzi namhlanje abayi kulamkela igazi. Ngenxa yezizathu zempilo, bacela oko amaNgqina ngokuyintloko akufunela izizathu zonqulo: ukunyanyekelwa kwempilo okusemgangathweni ngokusetyenziswa kweendlela ezizezinye ezingasebenzisi gazi. Njengoko siye saphawula, utyando olukhulu lusenokwenziwa. Ukuba usenawo nawaphi na amathandabuzo azingayo, obunye ubungqina obuvela kwiincwadi zonyango busenokuwaphelisa.

Inqaku elithi “Ukubuyiselwa Kwamalungu Amane Amakhulu Komnye WamaNgqina KaYehova” (Orthopaedic Review, ka-Agasti 1986) lathetha ngomguli onomlambo “owayenomonakalo omkhulu emadolweni nakoosikrotyana bobabini.” Kwasetyenziswa i-iron dextran ebudeni nasemva kotyando olwalusenziwa, nto leyo eyaba yimpumelelo. IBritish Journal of Anaesthesia (yowe-1982) yanikela ingxelo ngeNgqina elalineminyaka engama-52 ubudala nelalinomlinganiselo wesibomvisi-gazi ongaphantsi kwe-10. Ngokusetyenziswa kwezidambisi-zintlungu ezithoba uxinzelelo-gazi ukuze kunqunyanyiswe ukopha, wabuyiselwa ngokupheleleyo usikrotyana negxalaba. Iqela loogqirha beYunivesithi yaseArkansas (eUnited States) bakwasebenzisa le ndlela kutyando loosikrotyana kumaNgqina amaninzi, yaye bonke abaguli babuyela empilweni. Unjingalwazi oyintloko kweli sebe ugqabaza ngelithi: “Oko siye sakufunda kwabo baguli (bangamaNgqina), ngoku sikusebenzisa kubo bonke abatyandwa oosikrotyana.”

Isazela samanye amaNgqina siyawavumela ukuba alwamkele uqhaqho-fakelo lwelungu elithile ukuba lwenziwa ngaphandle kwegazi. Ingxelo ngoqhaqho-fakelo lwezintso kubaguli abali-13 yaqukumbela ngokuthi: “Le miphumo iyonke ibonisa ukuba uqhaqho-fakelo lwezintso lunokwenziwa ngokukhuselekileyo nangokunempumelelo kwawona maNgqina kaYehova maninzi.” (ITransplantation, kaJuni 1988) Ngokukwanjalo, ukungalamkeli igazi akuluthintelanga kwanoqhaqho-fakelo oluphumelelayo lwentliziyo.

Usenokubuza oku, ‘Kuthekani ngotyando olungenagazi lwezinye iintlobo?’ IMedical Hotline (ka-Aprili/Meyi 1983) yabalisa ngotyando olwenziwa “kumaNgqina kaYehova ekwaye kwafuneka ukuba enziwe utyando olukhulu oluphathelele izifo zabafazi nokubelekisa [kwiYunivesithi iWayne State yaseUnited States] ngaphandle kokutofelwa igazi.” Lo lindixesha wanikela le gxelo: “Akuzange kufe bantu bangakumbi yaye kwakungekho nazingxaki zintsonkothileyo kunabafazi abafumana utyando olufanayo baza batofelwa igazi.” Wandula ke lo lindixesha wathi: “Imiphumo yolu hlolisiso isenokufuna ukuqwalaselwa ngokutsha kombandela wokusetyenziswa kwegazi kubo bonke abafazi abenziwa utyando lokubelekisa nolwezifo zabafazi.”

Kwisibhedlele seYunivesithi iGöttingen (eJamani), abaguli abangama-30 abangazange balamkele igazi batyandwa nje ngokuqhelekileyo. “Akuzange kuvele zingxaki ezazingenakuvela nakubaguli abakwamkelayo ukutofelwa igazi. . . . Into yokuba akunakubhenelwa kutofelo-gazi ayifanele ibalaseliswe kakhulu, ibe ngaloo ndlela ayifanele ikhokelele ekungalwenzini utyando oluyimfuneko nolwamkelekileyo kwezonyango.”—IRisiko in der Chirurgie, yowe-1987.

Ngokomzekelo, kwanotyando lobuchopho ngaphandle kokuba kusetyenziswe igazi luye lwenziwa kubantu abakhulileyo nakubantwana abaninzi kwiZiko Lezamayeza kwiYunivesithi yaseNew York. Ngowe-1989 uGqr. Joseph Ransohoff, intsumpa yesebe lotyando lwemithambo-luvo, wabhala oku: “Kucace mhlophe ukuba kwiimeko ezininzi ukuphetshwa kwezinto eziyimveliso yegazi kunokwenzeka kuze kungabikho bungozi bungako kubaguli abaneenkolelo zonqulo ezichasene nokusetyenziswa kwezi mveliso, ngokukodwa ukuba utyando lunokwenziwa ngokukhawuleza nangempumelelo ngethutyana nje elincinane lotyando. Okubangela umdla kakhulu sisibakala sokuba ndisoloko ndilibala ukuba umguli lowo uliNgqina de kube lixesha laxa ekhululwa esibhedlele xa abantu abo bendibulela ngenxa yokuba ndizihlonele iinkolelo zabo zonqulo.”

Ekugqibeleni, ngaba utyando oluntsonkothileyo lwentliziyo nemithambo-luvo ngaphandle kwegazi lunokwenziwa kubantu abakhulileyo nasebantwaneni? UGqr. Denton A. Cooley waba ngugqirha wokuqala ukwenza kanye oko. Njengoko unokubona kwinqaku elingezonyango elishicilelwe ngokutsha kwiSihlomelo, kwiphepha 27-9, elisekelwe kuhlolisiso lwangaphambili, isigqibo sikaGqr. Cooley saba “kukuba ingozi yotyando kubaguli abangamaNgqina kaYehova ayizange ibe nkulu kangako kuneyabanye abantu.” Ngoku, emva kokwenza iintlobo zolu tyando ezili-1 106, ubhala oku: “Kuzo zonke iimeko ndenza ngokwesivumelwano sam nomguli,” oko kukuthi, ukungasebenzisi gazi.

Oogqirha botyando baye baphawula ukuba isimo sengqondo esihle siyenye into ephawulekayo ngamaNgqina kaYehova. Ngo-Oktobha 1989 uGqr. Cooley wabhala oku, “Isimo sengqondo saba baguli besingumzekelo. Aboyiki miphumo eyingxaki enokuvela okanye kwanokufa nto ezo inkoliso yabaguli ezoyikayo. Banokholo olunzulu nolusekelwe kwiinkolelo zabo nakuThixo wabo.”

Oku akuthethi ukuba asebenzisa ilungelo lokufa. Ngenkuthalo afuna unyango olusemgangathweni ngenxa yokuba afuna ukuphila. Eyisekile kukuba ukuthobela umthetho kaThixo ngegazi kububulumko, mbono leyo enempembelelo entle kutyando olungelolwagazi.

Unjingalwazi uGqr. V. Schlosser, wesibhedlele sotyando kwiYunivesithi yaseFreiburg (eJamani), waphawula oku: “Phakathi kwaba baguli, umlinganiselo wokopha ebudeni botyando wawungekho mkhulu kakhulu; iingxaki zazimbalwa, ukuba zazikho. Imbono ekhethekileyo, leyo amaNgqina kaYehova anayo ngokugula, yaba nempembelelo entle kwinkqubo yotyando.”—IHerz Kreislauf, ka-Agasti 1987.

[Imibhalo esemazantsi]

[Ibhokisi ekwiphepha 13]

“Simele sigqibe kwelokuba okwangoku kukho abaguli abaninzi abafumana ezinye zezinto ezibumba igazi ekungekho nanye into kubo efunisa uncedo lotofelo-gazi (igazi aliyomfuneko) nabathi sekunjalo babe sengozini ephawulekayo yomphumo onganqwenelekiyo. Akukho gqirha obeya kuthi enolwazi achanabe umguli kunyango olungenakumnceda kodwa olusenokumenzakalisa, kodwa oko koko kanye kwenzekayo xa kutofelwa igazi ngokungeyomfuneko.”—I-“Transfusion-Transmitted Viral Diseases,” yowe-1987.

[Ibhokisi ekwiphepha 14]

“Bambi ababhali baye bathi imilinganiselo yesibomvisi-gazi emalunga ne-2 kuse kwisi-2,5 seegram kwiimililitha ezili-100 isenokujongwa njengenik’ ithemba. . . . Umntu osempilweni usengaxomoloza ngoxa elahlekelwe ngama-50 ekhulwini eeseli ezibomvu zegazi ibe phantse usenokungazibonakalisi ngokupheleleyo iimpawu zokugula ukuba wophe ebudeni bethuba elithile elidluleyo.”—I“Techniques of Blood Transfusion,” yowe-1982.

[Ibhokisi ekwiphepha 15]

“Iingcamango zakudala malunga nokuhanjiswa kweoksijini kwizicubu, ukuphilisa inxeba, ‘nomlinganiselo wokondliwa’ kwegazi iphoswa kwelokulibala. Amava abanawo oogqirha ngabaguli abangamaNgqina kaYehova abonisa ukuba umntu usenokuxomoloza ngoxa ephulukene negazi elininzi.”—I-“The Annals of Thoracic Surgery,” kaMatshi 1989.

[Ibhokisi ekwiphepha 16]

Ngaba oku kunjalo nangabantwana abancinane? “Iinkqubo zotyando lwentliziyo kubantwana abancinane abangamashumi amane anesibhozo zaphunyezwa ngaphandle kokusetyenziswa kwegazi kungakhathaliseki ukuntsonkotha kotyando.” Abantwana babe bancinane kangangokuba babenobunzima beekhilogram ezisisi-4,7. “Ngenxa yempumelelo esoloko ikho ngakumaNgqina kaYehova nesibakala sokuba utofelo-gazi luneengxaki ezinzulu, okwangoku kwinkoliso yotyando lwentliziyo esilwenza ebantwaneni asisebenzisi gazi.”—I-“Circulation,” kaSeptemba 1984.

[Umfanekiso okwiphepha 15]

Umatshini wentliziyo nemiphunga ube luncedo olukhulu kutyando lwentliziyo kubaguli abangalamke- liyo igazi