I-Rh Factor Kanye Nawe

UBABA oziqhenyayo ubuka umntwana wakhe osanda kuzalwa elele ethule ezandleni zikanina. Bekuwubusuku obude egumbini lokubelethisa, kodwa manje konke lokho sekudlulile. Kungena udokotela ezoxilonga iziguli zakhe futhi abahalalisele bonke. “Kunentwana eyodwa, empeleni iyinto evamile,” esho.

Igazi likamama alinayo i-Rh, kanti ukuxilonga kubonise ukuthi elomntwana linayo, ngakho umama kuyodingeka anikezwe umjovo wokugoma. “Umjovo omncane nje owenziwe ngezakhi zomuntu ezilwa nezifo kodwa obaluleke kakhulu,” udokotela ebaqinisekisa, “ekuvimbeleni izinkinga lapho ukhulelwa esikhathini esizayo.”

Nakuba udokotela engase abheke lomjovo njengovamile, ukukhuluma ngawo “nezinkinga” ezingaba khona kuletha imibuzo eminingi ezingqondweni zabazali abathintekile. Lomjovo wenzani ngempela? Udingeke kangakanani? Yini ebiyokwenzeka ukuba abazali bebengawufuni? KumaKristu kuphakama omunye umbuzo. Njengoba iBhayibheli lithi, ‘Niyeke igazi,’ ingabe umKristu angawamukela lomjovo ngonembeza omuhle uma unezakhi zomuntu ezilwa nezifo ezithathwe egazini lomunye umuntu?—IzEnzo 15:20, 29.

Umlando Wenkinga Ye-Rh

Emashumini eminyaka adlule izazi zesayensi zathola ukuthi igazi lomuntu linezici eziningi, noma ama-antigen, ezenza igazi lomuntu ngamunye lihluke. Ngokuhamba kwesikhathi zathola ukuthi izimiso ezimbili zama-antigen ezisemangqamuzaneni egazi abomvu zazibangela eziningi zezinkinga zezokwelapha uma igazi lomuntu othile lihlanganiswa nelomunye. Enye yalama-antigen ibizwa ngokuthi i-“ABO”; enye ibizwa ngokuthi i-“Rh.” Ukubukeza kafushane isimiso se-Rh kuzosisiza ukuba siphendule imibuzo ebalulekile lababazali abathintekile abanayo naleyo nawe okungenzeka ukuthi uke wazibuza ngayo.

Ngo-1939, odokotela bakhipha indaba edidayo yowesifazane oneminyaka engu-25 ubudala owafelwa umntwana wakhe wesibili ngesikhathi sokukhulelwa. Ngemva kokubeletha leyongane efile, lowo wesifazane wampontshelwa igazi futhi umzimba wasabela kabi ngisho noma lelogazi lalivela kumyeni wakhe futhi ngokusobala lifana nelakhe ngama-antigen e-ABO. Kamuva odokotela bacabanga ukuthi isici esithile esingaziwa, esasivela egazini lomntwana wakhe wokuqala, saxubana negazi lakhe futhi ‘salenza lasabela ngokweqile,’ sabangela ukusabela kwakhe egazini lomyeni wakhe nasekulahlekelweni umntwana wakhe wesibili.

Lesisici esingaziwa kamuva satholakala ngokuhlola okwakuhilela izinkawu ezingama-rhesus, ngakho sabizwa ngokuthi i-“Rh factor.” Lesisici segazi sathakazelelwa kakhulu abezokwelapha ngawo-1960 ngoba kwatholakala ukuthi siyimbangela yesifo sabantwana cishe esivamile futhi esivame ukubhubhisa esibizwa ngokuthi i-erythroblastosis fetalis. Njengoba odokotela babehlola i-Rh factor nalesisifo, kwembuleka indaba ethakazelisayo yezokwelapha.

I-Rh, Izici Zofuzo, Nabantwana Abagulayo

Abantu abaningi bayathinteka lapho umntwana osanda kuzalwa egula ngokungathi sína noma efa. Ukubona nje usana lugula noma lucindezelekile kuyabakhathaza abaningi, futhi nodokotela abahlukile. Ezinye izizathu ezimbili zenza le-Rh factor ebulala abantwana ibakhathaze ngokukhethekile odokotela.

Esokuqala sasiwukuthi odokotela baqala ukubona uhlelo oluthile lwalesisifo nokuqonda indlela i-Rh factor eyayihileleke ngayo ekuguleni nasekufeni. I-Rh factor ikhona emangqamuzaneni abomvu egazi kubantu abangamaphesenti cishe angu-85 kuya ku-95, kokubili amadoda nabesifazane. Babizwa ngokuthi “bane-Rh.” Amaphesenti amahlanu kuya kwayishumi nanhlanu angenayo abizwa ngokuthi “angenayo i-Rh.” Uma umuntu ongena-Rh ethola igazi lomuntu one-Rh, angaba nama-molecule abizwa ngokuthi izakhi zomzimba ezilwa nezifo abhubhisa igazi eline-Rh.

Lokhu ngempela kuwukusabela okungokwemvelo kwesimiso somzimba sokuzivikela njengoba silwa nabahlaseli bangaphandle. Inkinga iwukuthi, umama ongenayo i-Rh angaba nomntwana othola njengefa igazi eline-Rh kuyise. Lokhu akubi yinkinga uma i-placenta isebenza kahle negazi lomntwana ligcinwa lihlukanisiwe kwelikanina. (Qhathanisa neHubo 139:13, NW.) Kodwa ngenxa yokuthi imizimba yethu ayiphelele, isilinganiso esincane segazi lomntwana ngezinye izikhathi singavuza futhi sihlangane nelikanina. Ngokuvamile, lokhu kwenzeka ngenxa yenqubo ethile yezokwelapha, njenge-amniocentesis (ukudonsa isampula loketshezi olwebwini oluzungeze umntwana owakhekayo). Noma elinye igazi lomntwana lingaxubana nelikanina lapho ebeletha. Kungakhathaliseki ukuthi iyini imbangela, unina angasabela ngokweqile futhi akhe izakhi zomzimba ezilwa negazi eline-Rh.

Cabanga ngenkinga edalekayo: Lapho nje unina eba nezakhi zomzimba ezinjalo ezilwa nezifo, bonke abantwana abalandelayo basengozini uma bezuza njengefa igazi eline-Rh kuyise. Lokhu kungenxa yokuthi umama manje usenezakhi zomzimba ezilwa negazi eline-Rh.

Uyabona, ngokuvamile izakhi zomzimba ezithile ezilwa nezifo ziyadlula kuyi-placenta. Lokhu kuyinto enhle, ebangela bonke abantwana ukuba bazalwe benesilinganiso esithile sekhono lokuzivikela komzimba okwesikhashana ngokwemvelo ngenxa yonina. Nokho, ngenxa yesifo se-Rh izakhi zomzimba zikamama ezilwa ne-Rh ezisabela ngokweqile zidlula i-placenta futhi zihlasele igazi lomntwana eline-Rh. Lokhu akuvamile ukumthinta umntwana wokuqala, njengoba kuvame kakhulu nganoma ibaphi abantwana abalandelayo. Kubangela isifo, esibizwa ngokuthi i-Rh hemolysis sabasanda kuzalwa (i-erythroblastosis fetalis uma umonakalo umkhulu).

Kunezindlela eziningi zokulawula lesisifo, nakuba ngokuvamile zinempumelelo elinganiselwe, njengoba sizobona. Manje ake sigxile esicini esisodwa sezokwelapha salenkinga—indlela okungavinjelwa ngayo.

Impumelelo Ekuvimbeleni

Kungenzeka uyakhumbula ukuthi kwakunezizathu ezimbili ezenza lesisifo sabathakazelisa kangaka odokotela. Esokuqala sasiwukuthi ukusebenza kwalesisifo kwaba okwaziwayo futhi kwaqondakala. Sasiyini isizathu sesibili?

Savela ngo-1968. Ngemva kweminyaka eminingi yokucwaninga nemizamo ekhungathekisayo yodokotela yokwelapha bona kanye lababantwana abagula kakhulu, okungazange kube nempumelelo engako, kwasungulwa indlela yokugoma eyayiphumelela ekuvimbeleni inkinga “yabantwana abane-Rh.” Lezi kwakuyizindaba ezinhle. Kodwa yayisebenza kanjani?

Khumbula ukuthi inkinga ye-Rh (kubantwana abane-Rh owesibili nabalandelayo) iqala lapho igazi elivela kumntwana wokuqala one-Rh “livuzela” egazini likamama elingenayo i-Rh futhi limbangela ukuba akhiqize izakhi zomzimba ezilwa nezifo. Yayingaba khona yini indlela yokunqanda amangqamuzana abomvu egazi lomntwana esimisweni sikanina ngaphambi kokuba abe nethuba lokumenza asabele ngokweqile?

Lenqubo eyaqanjwa kwakuwumjovo ogoma umama obizwa ngokuthi i-Rh immune globulin, noma i-RhIG, eyaziwa kwamanye amazwe ngamagama abakhiqizi, njengelithi RhoGAM nelithi Rhesonativ. Wakhiwa ngezakhi zomzimba ezilwa ne-antigen ene-Rh. Ukuthi usebenza kanjani ngempela kuyinkimbinkimbi, futhi akucacile nokucaca, kodwa ngokuyisisekelo kubonakala kungalendlela elandelayo.

Lapho umama ongenayo i-Rh kusoleka ukuthi uthole igazi eline-Rh, njengalapho esebelethe umntwana one-Rh, umama unikezwa umjovo i-RhIG. Lezizakhi zomzimba ezilwa nezifo ngokushesha zihlasela noma imaphi amangqamuzana abomvu egazi ane-Rh avuze kumntwana futhi ziwabulale ngaphambi kokuba enze umama asabele ngokweqile. Lokhu kuyiqeda ngokuphumelelayo ingozi kumntwana olandelayo, njengoba kungekho zakhi zomzimba ezilwa nezifo ezikhiqizwa umama ngokumelene negazi eline-Rh. Inzuzo yangempela odokotela abayibonayo kulokhu iwukuthi kuvimbela isifo, kunokuba kuzame ukuselapha lapho sesiqalile.

Lokhu kuzwakala kukuhle, kodwa ingabe kuye kwasebenza? Kubonakala sengathi kuye kwasebenza. Kwelinye izwe, i-United States, ukutholakala kwesifo se-Rh hemolysis kwehla ngamaphesenti angu-65 phakathi nawo-1970. Nakuba kunezinto eziningi okungenzeka zabangela lokhu, amaphesenti angu-60 kuya ku-70 alokhu kwehla kwakuthiwa abangelwa ukusetshenziswa kwe-RhIG. Kwesinye isifundazwe saseCanada, inani labantwana ababulawa isifo se-Rh hemolysis lehla lisuka ku-29 ngo-1964 laya koyedwa phakathi kuka-1974 no-1975. Umphakathi wezokwelapha wabona lokhu njengokuqiniswa kwesimiso esithi “kungcono ukuyinqanda okhalweni kunokuyikhipha ekhaya.” Ngalesisizinda esiyisisekelo, singacabangela eminye imibuzo eqondile evame ukuphakama ngokuqondene nesifo se-Rh.

Ziyini izingozi zokuba nenkinga yesifo se-Rh ngesikhathi ngisakhulelwe?

Ukuhlolwa kwegazi okuvamile kungathola uhlobo lwegazi lwe-Rh lukamama nolukababa; cishe umshado owodwa kweyisikhombisa ungowesifazane ongenayo i-Rh nendoda enayo. Izici zokwakheka kwezakhi zofuzo zikababa zinciphisa lengozi iyonke cishe ngamaphesenti ayishumi.a

Nokho, leyo imininingwane yabantu sebebonke. Uma ungowesifazane ongenayo i-Rh oshade nendoda ene-Rh, unamathuba angamaphesenti angu-50 noma amaphesenti ayikhulu okuba nomntwana one-Rh, kuye ngokwakheka kwezici zofuzo zendoda yakho.b (Ayikho indlela eqinisekile yokuthola ukuthi zinjani izakhi zofuzo zendoda, njengoba nje ingakabikho indlela elula yokuthola ukuthi umntwana osesibelethweni une-Rh noma cha.)

Kumama ongenayo i-Rh okhulelwe umntwana one-Rh, kunamathuba angamaphesenti angu-16 okuthi isikhathi ngasinye lapho ekhulelwa uyosabela ngokweqile, ngaleyondlela ebeka engozini ukukhulelwa kwakhe esikhathini esizayo. Yebo, lokho kumane nje kuyisilinganiso. Ngaphandle kokumpontshelwa igazi kwangaphambili noma okunye ukuthola kukamama igazi, umntwana wokuqala womshado ngokuvamile akabhekene nengozi yesifo se-Rh. Ngemva kwalowomntwana wokuqala, kunzima eqinisweni ukubikezela ingozi kunoma isiphi isimo esikhona. Omunye wesifazane angasabela ngokweqile ngomntwana wakhe wokuqala one-Rh. Omunye angaba nabantwana abane-Rh abahlanu noma ngaphezulu kodwa angasabeli ngokweqile. Uma umama esabela ngokweqile, ingozi yokufa kombungu ngamunye olandelayo one-Rh ingamaphesenti angu-30, futhi lokhu akushintshwa ukuthi ukhulelwa ngemva kwesikhathi esingakanani. Ngakho lokhu akufanele kuthathwe kalula.

Ingabe ukuxilonga endaweni yokuhlola kungangitshela ukuthi umntwana owakhekayo usengozini noma cha?

Yebo, ngesilinganiso esithile. Amazinga ezakhi zomzimba ezilwa nezifo ezisegazini likamama angakalwa ngesikhathi sokukhulelwa ukuze kutholakale ukuthi uyazikhiqiza yini izakhi zomzimba ezilwa negazi lomntwana. Futhi, i-amniocentesis ingasiza ekutholeni ukuthi igazi lomntwana licekelwa phansi nokuthi umntwana usengozini yini. Nokho, i-amniocentesis ngezinye izikhathi inezinkinga zayo, ngakho kufanele kuqashelwe uma kucatshangelwa ukuba isetshenziswe noma cha.

Ingabe umjovo we-RhIG unemiphumela engemihle?

Kusenokuphikisana okuthile ngokusetshenziswa kwawo ngesikhathi sokukhulelwa ngenxa yokulimala okungenzeka kwesimiso sokuzivikela komzimba embungwini owakhekayo. Nokho, ochwepheshe abaningi baphetha ngokuthi ukugoma kuphephile ngokuqhathaniswa kumama nakumntwana okhula ngaphakathi kuye.

Ngokodokotela, kufanele ngijove kangaki?

Izikhulu zithi lomjovo kufanele uhlatshwe ngokushesha ngemva kwanoma isiphi isehlakalo okungenzeka sibangele igazi eline-Rh ukuba lingene egazini lowesifazane ongenayo i-Rh. Ngakho-ke, manje kutuswa ukuba lomjovo uhlatshwe phakathi namahora angu-72 ngemva kokubelethwa komntwana uma igazi lakhe litholakala line-Rh. Kutuswa okufanayo nge-amniocentesis noma ukuphuphuma kwesisu.

Ngaphezu kwalokho, njengoba ukuhlola kuye kwabonisa ukuthi isilinganiso esincane segazi lomntwana singangena egazini likamama ngesikhathi sokukhulelwa okuvamile, abanye odokotela batusa ukuthi umjovo uhlatshwe emasontweni angu-28 okukhulelwa ukuze kuvinjelwe ukusabela ngokweqile. Kulesosimo lowomjovo ubungatuseka futhi ngemva kokuba umntwana esezelwe.

Ingabe kukhona ukwelashwa okunganikezwa umntwana lapho ethola isifo se-Rh?

Yebo. Nakuba isifo se-hemolysis sosanda kuzalwa siyisifo esingathi sína, kunobufakazi obuhle obusekela ukwelashwa okungahileli ukushintshwa kwegazi lomntwana ngokumpontshelwa. Inkinga esatshwa kakhulu yalesisifo ihilela ukunqwabelana kwekhemikhali elibizwa ngokuthi i-bilirubin, okubangelwa ukuwohloka kwamangqamuzana abomvu egazi. Lokhu kubangela i-jaundice futhi kwezinye izimo kungabangela umonakalo ezithweni zomntwana. (Cishe i-jaundice engeyimbi kangako ingavela lapho kunokushayisana kwe-ABO phakathi kwegazi likamama nelomntwana, kodwa lokhu ngokuvamile akukubi kangako.)

Eminyakeni eminingi odokotela babecabanga ukuthi izinga elithile le-jaundice laliyinkomba yokuthi kushintshwe igazi ngokumpontshelwa kulababantwana, kodwa ukucwaninga okuqhubekayo kuye kwembula okunye ukwelapha okuhlukahlukene okungasetshenziswa. Ukubeletha ngaphambi kwesikhathi noma ngokuhlinzwa, ukwelashwa ngokukhanya (ukukhanya okuluhlaza okwesibhakabhaka), nemithi enjenge-phenobarbital, i-activated charcoal, nokunye ukwelapha kuye kwaba usizo kakhulu futhi kuye kwasinciphisa ngokuphawulekayo isidingo sokukhetha ukumpontshelwa igazi. Eqinisweni, eminye imibiko yamuva iye yaqokomisa ukuhluleka ngisho nezingozi zokushintsha igazi ngokumpontshelwa kubantwana abanesifo se-Rh.—Bheka ibhokisi, ekhasini 26.

Nakuba kunjalo, zikhona izimo ezibucayi lapho odokotela besagomela khona ngokuthi ukushintsha igazi ngokumpontshelwa kuwukuphela kokwelapha okwamukelekayo. Ngakho-ke, abanye abazali banomuzwa wokuthi kungcono ukugwema yonke lenkinga ngomjovo oyovimbela lesisifo futhi ngaleyondlela uvimbele ne-jaundice.

Ingabe umjovo we-RhIG wenziwe ngegazi?

Yebo. Izakhi zomzimba ezilwa nezifo okwenziwa lomjovo ngazo zithathwa egazini labantu asebegonyiwe noma abasabela ngokweqile kuyi-Rh factor. I-RhIG eyenziwe ngezakhi zofuzo engathathwanga egazini ingase itholakale esikhathini esizayo.

Ingabe umKristu angakhululwa unembeza ukuba asebenzise i-RhIG?

Inkinga ehilelekile iwukusetshenziswa kabi kwegazi okungaba khona. ImiBhalo ikwenqabela ngokugcizelela okukhulu ukudliwa noma okunye ukusetshenziswa kabi kwegazi. (Levitikusi 17:11, 12; IzEnzo 15:28, 29) Njengoba i-RhIG yenziwa ngegazi, ingabe bekuyoba ukweqa umyalo weBhayibheli wokuyeka igazi uma owesifazane ongumKristu amukela lomjovo?

Leliphephabhuku nomngane walo, INqabayokulinda, aye akhuluma ngokungaguquguquki ngalendaba.c Siye saphawula ukuthi kukho konke ukukhulelwa izakhi zomzimba ezilwa nezifo zidlula ngokukhululekile kuyi-placenta phakathi kukamama nomntwana. Ngakho amanye amaKristu aye aphetha ngokuthi kuwo akubonakali kuwukweqa umthetho weBhayibheli ukwamukela umjovo onezakhi zomzimba ezilwa nezifo, njenge-RhIG, njengoba lenqubo ngokuyisisekelo ifana nalokho okwenzeka ngokwemvelo.

Nokho, isinqumo sokwamukela i-RhIG noma cha, ekugcineni siyindaba okufanele inqunywe umbhangqwana ngamunye wamaKristu ngokusebenzisa unembeza. Nokho, uma indoda nowesifazane ababhekene nendaba ye-Rh benquma ukungayamukeli i-RhIG lapho isikiselwa kwezokwelapha, kudingeka bazimisele ukwamukela ingozi yokuba nengane esikhathini esizayo ethinteke kabi ngenxa yesifo ebesingavinjelwa. Kulesisimo bangase banqume ngisho nokuthi inkambo yokuhlakanipha iwukuqapha nangokwengeziwe ukuba bangabi nezingane ezengeziwe futhi bazifake engozini yenhlekelele enjalo. Abazali abangamaKristu abathintekile kufanele bazicabangele ngomthandazo zonke izici ngaphambi kokwenza izinqumo ezinjalo ezisindayo.

[Imibhalo yaphansi]

[Ibhokisi ekhasini 26]

I-bilirubin Ephakeme—Ingabe Iyisizathu Sokumpontshelwa Igazi?

Sekuyisikhathi eside odokotela besaba imiphumela ye-bilirubin ephakeme kubantwana, kangangokuba lapho i-bilirubin iqala ukuphakama—ikakhulukazi iya ku-20 mg/100 ml—odokotela ngokuvamile bama kwelokuthi kushintshwe igazi ngokumpontshelwa “ukuze kuvinjelwe ukulimala kobuchopho” (i-kernicterus). Ingabe ukwesaba kwabo, nokubaluleka kokumpontshelwa igazi, kuyafaneleka?

UDkt. Anthony Dixon uyaphawula: “Ukuhlolwa okuningana kwezinsana ezinjalo akukwazanga ukuthola noma imiphi imiphumela, kungakhathaliseki ukuthi eyesikhathi esifushane noma eside, yamazinga e-bilirubin phakathi kuka-18 mg kuya ku-51 mg/100 ml.” UDkt. Dixon uyaqhubeka echaza “i-vigintiphobia: ukwesaba angu-20.” Nakuba kungekho nzuzo eye yatholakala ekwelapheni lamazinga aphakeme e-bilirubin, uDkt. Dixon uyaphetha: “Inkinga icacile. Ukwelapha ngokunamandla amazinga aphakeme e-serum bilirubin manje sekuwumkhuba oyinkambiso. Umkhuba oyinkambiso akufanele ubekelwe inselele kuze kube yilapho usutholakale unephutha, kodwa noma imuphi umzamo wokubonisa ukuthi unephutha uphambene nokulungile!”—Canadian Family Physician, October 1984, ikhasi 1981.

Ngakolunye uhlangothi, isikhulu sase-Italy, uDkt. Ersilia Garbagnati, siye sabhala ngendima yokuvikela ye-bilirubin kanye “nezingozi ezingalindelekile ezingaba khona ezibangelwa amazinga aphansi ngokungafanele e-serum bilirubin.” (Omalukeke sizenzele.) (Pediatrics, March 1990, ikhasi 380) Enezela, uDkt. Joan Hodgman uyabhala kuyi-Western Journal of Medicine: “Ukushintsha igazi ngokumpontshelwa ngeke kuvimbele ukungcolisa kwe-bilirubin ubuchopho uma kunamazinga aphansi e-bilirubin, futhi uma kubhekwa umsebenzi wokuhlola ocashunwe ngenhla, kungase kube okulimazayo.”—June 1984, ikhasi 933.