‫ا ﻟ ﻤ ﻘﺪ ﻣ ﺔ‬

‫ﺑﺴ ﻢ ﷲ ا ﻟ ﺮ ﺣ ﻤ ﻦ اﻟ ﺮ ﺣ ﻴ ﻢ‬
‫أﻣﺎ ﺑﻌﺪ‪.....‬‬
‫ﻓ ﺈ ن اﻋ ﻄ ﺎ ء ا ﻟ ﺪ م ﻫ ﻮ ﻣ ﺴ ﺆ و ﻟ ﻴ ﺔ ﺗ ﻀ ﺎ ﻣ ﻨ ﻴ ﺔ ﺗ ﺸ ﺘ ﺮ ك ﻓ ﻴ ﻬ ﺎ ﺟ ﻤ ﻴ ﻊ ا ﻟ ﻮ ﺣ ﺪ ا ت ﺑ ﺎ ﻟﻤ ﺴ ﺘ ﺸ ﻔ ﻰ ﻣ ﻦ اﻟ ﻤ ﺨ ﺘ ﺒ ﺮ‬
‫و ﻣﺼﺮف اﻟﺪم و اﻟﺘﻤﺮﻳﺾ و اﻻﻃﺒﺎء و اﻟﻬﺪف ﻣﻦ ﻫﺬا اﻟﺘﻀﺎﻣﻦ ﻫﻮ ﻣﻦ اﺟﻞ اﻳﺼﺎل اﻟﺪم‬
‫اﻟﻰ اﻟﻤﺮﺿﻰ ﺑﺸﻜﻞ آﻣﻦ و ﺳﻠﻴﻢ و ﺗﻼﻓﻲ اﻟﻤﻀﺎﻋﻔﺎت اﻟﺠﺎﻧﺒﻴﺔ اﻟﺘﻲ ﺗﻈﻬﺮ ﻣﻦ ﺟﺮاء ﻋﻤﻠﻴﺎت‬
‫ﻧ ﻘ ﻞ ا ﻟﺪ م ‪.‬‬

‫و ﻟﻠﻪ اﻟﺤﻤﺪ اوﻻ و اﺧﻴﺮاً ﺟﻤﻌﻨﺎ ﻟﻜﻢ ﻓﻲ ﻫﺬا اﻟﻜﺘﺎب اﻟﺒﺴﻴﻂ اﻟﺬي ﻣﺎ ﻫﻮ اﻻ ﺗﺮﺟﻤﺔ ﺑﺎﻟﻠﻐﺔ‬
‫اﻟﻌﺎﻣﻴﺔ و اﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ ﻣﻦ اﺟﻞ ﻣﻌﺮﻓﺔ اﻟﺤﺎﻻت و اﻻﻋﺮاض اﻟﺠﺎﻧﺒﻴﺔ اﻟﻨﺎﺗﺠﺔ ﻣﻦ ﻧﻘﻞ اﻟﺪم‬
‫ﻟ ﻴﺘ ﺴ ﻨ ﻰ ﻟﻠ ﻌﺎ ﻣﻠ ﻴ ﻦ ﻓ ﻲ ا ﻟ ﻮ ﺣﺪ ا ت ا ﻟ ﻤﺬﻛ ﻮ ر ة ﻛ ﻴ ﻔ ﻴ ﺔ ا ﻟ ﺘ ﻌﺎ ﻣ ﻞ ﻣ ﻊ ا ﻟﺪ م و زﻳﺎ دة ﺣ ﺮ ﺻ ﻬ ﻢ ا ﻟ ﻜ ﺒ ﻴ ﺮ‬
‫ﻋﻠ ﻰ ا د ا ء ا ﻟ ﻮ ا ﺟ ﺐ د و ن ﻛﻠ ﻞ ا و ﻣﻠ ﻞ ﺑ ﺴ ﺒ ﺐ ﻓﻬ ﻤ ﻬ ﻢ ﻟ ﻤﺎ ﺳ ﻴ ﺮ و ﻧﻪ ﻣ ﻦ ا ﺿ ﺮ ا ر ﻛ ﺒ ﻴ ﺮة و ﻛ ﺜﻴ ﺮ ة‬
‫ﺗ ﻨ ﺘ ﺞ ﻋ ﻦ ﻧ ﻘ ﻞ ا ﻟﺪ م و ﻣ ﺸﺘ ﻘ ﺎ ﺗ ﺔ و ﻻ ﻧ ﺮ ﺟ ﻮ ﻣ ﻦ ﷲ ﺳ ﻮ ى ا ﻟﺘ ﻮ ﻓ ﻴ ﻖ ﻟ ﺘ ﻘﺪﻳ ﻢ ا ﻟ ﻤ ﺰﻳﺪ ﺧﺪ ﻣ ﺔ ﻻ‬
‫ﺑ ﻨ ﺎ ء ا ﻟ ﻤ ﻬ ﻨ ﺔ و ا ﻟﺸ ﻌ ﺐ و ﺧ ﺪ ﻣ ﺔ ﻟ ﻠ ﺼ ﺎﻟ ﺢ اﻟ ﻌ ﺎ م‬

‫ﻟﻌﺎم ‪2023‬‬ ‫اﻻول‬ ‫ﺗﻤﺖ اﻟﻜﺘﺎﺑﺔ ﺑﺘﺎرﻳﺦ ‪ 10‬ﻛﺎﻧﻮن‬

‫اﻟ ﺘ ﻘﻨ ﻲ اﻟ ﻄﺒ ﻲ‬
‫ﻛ ﺮ ا ر ﻋ ﺒ ﺪ ا ﻟ ﺮ ﺿ ﺎ ﻣ ﻬﺪ ي‬
‫ﻣﺴﺘﺸﻔﻰ اﻟﺤﺎج ﺟﻼل ﻟﻠﻨﺴﺎﺋﻴﺔ و اﻻﻃﻔﺎل‬
 ‫‪Transfusion Associated Fatalities‬‬
‫ا ﻟ ﻮ ﻓ ﻴﺎ ت اﻟ ﻤ ﺘ ﻌﻠ ﻘ ﺔ ﺑ ﻨ ﻘ ﻞ اﻟ ﺪ م‬
‫ﻗ ﺎ ﻣ ﺖ ﻣ ﻦ ﻣ ﺠ ﻤ ﻮ ﻋ ﺔ ﻣ ﻦ ا ﻟﻤ ﻨ ﻈ ﻤ ﺎ ت و ﻣ ﺮ ا ﻛ ﺰ ا ﻟ ﺒ ﺤ ﻮ ث ﻣ ﻨ ﻬ ﺎ‬
‫)‪ Food and Drug Administration (FDA‬‬
‫)‪ Center for Biologics Evaluation and Research (CBER‬‬
‫)‪ Centers for Disease Control and Prevention (CDC‬‬
‫)‪ National Healthcare Safety Network (NHSN‬‬
‫ﺑﺪراﺳﺔ ﻣﻦ اﻛﺘﻮﺑﺮ ‪ 2014‬اﻟﻰ ﻧﻮﻓﻤﺒﺮ ‪ 2015‬ﻣﻦ اﺟﻞ اﺣﺼﺎء ﻋﺪد اﻟﻮﻓﻴﺎت اﻟﻨﺎﺗﺠﺔ ﻋﻦ‬
‫ﻧﻘﻞ اﻟﺪم ﻓﺘﻢ ﺗﺴﺠﻴﻞ ‪ 42‬ﺣﺎﻟﺔ ‪ %80‬ﻣﻨﻬﺎ ﻛﺎﻧﺖ ﺑﺴﺒﺐ اﻟﺪم ﻏﻴﺮ اﻟﻤﺘﻮاﻓﻖ و ﺗﻢ ذﻟﻚ‬
‫ﺑﺸﻜﻞ ﻣﺆﻛﺪ ‪ %100‬ﻓﻲ ﺣﻴﻦ إن اﻟﺒﻘﻴﺔ ﻛﺎﻧﺖ ﺑﺴﺒﺐ اﻟﻌﻮارض اﻟﺠﺎﻧﺒﻴﺔ ﻋﻨﺪ ﻧﻘﻞ اﻟﺪم ﻣﻨﻬﺎ‬
‫)‪Transfusion related acute lung injury (TRALI‬‬
‫)‪transfusion associated circulatory overload (TACO‬‬
‫)‪transmission transmitted bacterial infections (TTBIs‬‬
‫و ﻗﺪ وﺟﺪت اﻟﺪراﺳﺔ إن اﻏﻠﺐ اﻟﺤﺎﻻت ﻧﺎﺗﺠﺔ ﻋﻦ‬
‫‪TACO and TRALI‬‬

‫‪Recognition and Evaluation of Transfusion Reactions‬‬

‫ﺗﻤ ﻴ ﻴ ﺰ و ﺗ ﻘ ﻴ ﻴ ﻢ ا ﻟ ﺘ ﻔ ﺎﻋ ﻞ ا ﻟ ﻨ ﺎ ﺗ ﺞ ﻋ ﻦ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ) ا ﻟ ﺘ ﺤ ﺴ ﺲ (‬
‫ﻳﺘﻢ ﺗﻘﻴﻴﻢ ذﻟﻚ ﻣﻦ ﺧﻼل ﺧﻄﻴﻦ‬
‫اﻻول ‪ //‬ﻫﻮ اﻟﺸﺨﺺ اﻟﻤﻮﺟﻮد اﺛﻨﺎء ﻧﻘﻞ اﻟﺪم ) ﻣﻤﺮض ‪ ،‬ﻃﺒﻴﺐ (‬
‫اﻟﺜﺎﻧﻲ ‪ //‬ﻫﻮ اﻻﺟﺮاءات اﻟﻤﺨﺘﺒﺮﻳﺔ‬

‫اﻣﺎ اﻟﻘﺴﻢ اﻻول‬

‫ﺧﻼل اﻟﻌﻼﻣﺎت اﻟﺴﺮﻳﺮﻳﺔ اﻟﻮاﺿﺤﺔ ﻋﻠﻰ اﻟﻤﺮﻳﺾ او ﻣﺴﺘﻠﻢ اﻟﺪم و اﻟﺘﻲ‬ ‫ﻳﺘﻢ اﻟﺘ ﻘﻴﻴﻢ ﻣ ﻦ‬
‫ﺗﺸﻤﻞ‬
‫ا ر ﺗ ﻔﺎ ع د ر ﺟ ﺔ ا ﻟ ﺤ ﺮ ا رة‬ ‫‪‬‬
‫ﻧﻘﺼﺎن اﻻوﻛﺴﺠﻴﻦ‬ ‫‪‬‬
‫ﺗﺴ ﺎ رع ا ﻟ ﻘ ﻠ ﺐ‬ ‫‪‬‬
‫ﺗ ﺒﺎ ﻃ ﺆ ا ﻟ ﺘ ﻨ ﻔ ﺲ‬ ‫‪‬‬
‫ا ر ﺗ ﻔﺎ ع ا و ا ﻧ ﺨ ﻔﺎ ض ﺿ ﻐ ﻂ ا ﻟﺪ م‬ ‫‪‬‬
‫و ﺟ ﻮ د ا ﻟﺪ م ﻓ ﻲ ا ﻟ ﺒ ﻮ ل‬ ‫‪‬‬
‫و ﺟ ﻮ د ا ﻟ ﻬ ﻴ ﻤ ﻮ ﻏﻠ ﻮ ﺑ ﻴ ﻦ ﻓ ﻲ اﻟ ﺒ ﻮ ل‬ ‫‪‬‬
‫ﻏ ﺜ ﻴﺎ ن و ﺗ ﻘ ﻴ ﺆ‬ ‫‪‬‬
‫ﺣﻜﺔ‬ ‫‪‬‬
‫ا ﺣﻤ ﺮ ار‬ ‫‪‬‬
‫ﺗﻘﻠﺺ اﻻوﻋﻴﺔ اﻟﺘﻨﻔﺴﻴﺔ‬ ‫‪‬‬
‫ﺗ ﺠﻤ ﻊ اﻟﺴ ﻮ ا ﺋﻞ ﻓ ﻲ اﻟﺮ ﺋ ﻪ‬ ‫‪‬‬
‫ﻗ ﺸﻌ ﺮﻳ ﺮة‬ ‫‪‬‬
‫اﻟﻢ ﻓﻲ اﻟﺒﻄﻦ و اﻻﺿﻼع و اﻻﻃﺮاف و اﻟﺮأس‬ ‫‪‬‬
‫ﺗ ﻘﻠ ﺺ ﻛ ﻤ ﻴ ﺔ اﻟ ﺒ ﻮ ل ا و ا ﻧ ﻘ ﻄ ﺎع ا ﻟ ﺒ ﻮ ل‬ ‫‪‬‬
‫ﺗ ﺨ ﺜ ﺮ ا ت ﻣ ﻨ ﺘ ﺸ ﺮ ة ﻓ ﻲ اﻟ ﺠﺴ ﻢ‬ ‫‪‬‬
 ‫و اﻟﺨﻄﻮة اﻻوﻟﻰ ﻫﻲ اﻳﻘﺎف ﻋﻤﻠﻴﺔ ﻧﻘﻞ اﻟﺪم و اﻟﺨﻄﻮة اﻟﺜﺎﻧﻴﺔ ﻫﻲ ارﺳﺎل اﻟﻌﻴﻨﺎت اﻟﻰ‬
‫ﺷﻌﺒﺔ اﻟﻤﺨﺘﺒﺮ ﻣﻦ اﺟﻞ اﻟﺘﺤﺮي ﻋﻦ اﻟﺘﻔﺎﻋﻞ اﻟﻨﺎﺗﺞ ‪ .‬ﻣﻊ ﻣﻄﺎﺑﻘﺔ اﻻﻋﺮاض اﻟﺘﻲ ﻇﻬﺮت‬

‫ا ﻟ ﻘ ﺴ ﻢ ا ﻟ ﺜ ﺎ ﻧ ﻲ ﻫ ﻮ ا ﻟﻤ ﺨ ﺘ ﺒ ﺮ‬
‫و ﻳﺘﻢ ﻓﻴﺔ اوﻻ اﺳﺘﻼم اﻟﻌﻴﻨﺎت ﻟﻠﺘﺤﺮي ﻋﻦ ﺗﺤﻠﻞ اﻟﺪم ﻣﻦ ﺧﻼل ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻﺧﺘﺒﺎرات‬
‫و ﺛﺎ ﻧ ﻴﺎ ً ﻳ ﺘ ﻢ ﻣ ﻄ ﺎ ﺑ ﻘ ﺔ ﻣ ﻜ ﻮ ن ا ﻟ ﺤ ﻘ ﻴ ﺒ ﺔ ‪ ،‬ر ﻗ ﻢ ا ﻟ ﺤ ﻘ ﻴ ﺒ ﺔ ‪ ،‬ﺗ ﻔ ﺎ ﺻ ﻴ ﻞ اﻟ ﺤ ﻘ ﻴ ﺒ ﺔ ﻣ ﻊ ﻓ ﺤ ﻮ ﺻﺎ ت ﻣﺎ ﻗ ﺒ ﻞ‬
‫اﻋﻄﺎء اﻟﺪم ‪ ،‬ﻳﺘﻢ اﻋﺎدة ﻓﺤﺺ ﻓﺼﻴﻠﺔ اﻟﺪم ﺑﻌﺪ اﻻﻋﻄﺎء و ﻣﺸﺎﻫﺪة ﻣﺪى اﻟﺘﻐﻴﺮات ﻣﺎ ﺑﻴﻦ‬
‫ﻗﺒﻞ و ﺑﻌﺪ اﻻﻋﻄﺎء و ﻛﺬﻟﻚ ﻋﻤﻞ ﻓﺤﺺ اﻟﻐﻠﻮﺑﻴﻮﻟﻴﻦ اﻟﻤﺒﺎﺷﺮ ‪ . DAT‬ﺛﻢ ﻳﺘﻢ ارﺳﺎل ﻫﺬة‬
‫ا ﻟ ﻨ ﺘ ﺎ ﺋ ﺞ ا ﻟ ﻰ ﻣ ﺴ ﺆ و ل ﻣ ﺼ ﺮ ف ا ﻟ ﺪ م ا و ا ﻟ ﻄ ﺒ ﻴ ﺐ ا ﻟﻤ ﻌ ﺎﻟ ﺞ ا و ﻣ ﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ ا ﻟ ﺪ م‬
‫ﻟ ﺘ ﺤ ﺪ ﻳ ﺪ ﻓ ﻴ ﻤ ﺎ اذ ا ﻛ ﺎ ﻧ ﺖ ﻫ ﻨ ﺎ ﻟ ﻚ ﺣ ﺎ ﺟ ﺔ ﻻ ﺟ ﺮ ا ء ﻓ ﺤ ﻮ ﺻ ﺎ ت ا ﺧ ﺮ ى ‪ .‬ا ﻟ ﺘ ﻘ ﻴ ﻴ ﻢ ا ﻟ ﻨ ﻬ ﺎ ﺋ ﻲ ﻟ ﺘ ﻔ ﺎﻋ ﻞ ﻧ ﻘ ﻞ‬
‫اﻟ ﺪ م ﻫ ﻮ ﻣ ﻦ ﻣ ﺴ ﺆ و ﻟ ﻴ ﺔ ا ﻟ ﻤ ﺪ ﻳ ﺮ ا ﻟ ﻤ ﺒ ﺎ ﺷ ﺮ ﻟﻤ ﺼ ﺮ ف ا ﻟ ﺪ م ا و ﻣ ﻦ ﻳ ﻨ ﻮ ب ﻋ ﻨ ﻪ ﻣ ﻦ ا ﻟ ﻜ ﻮ ا د ر ا ﻟ ﺘ ﻘ ﻨ ﻴ ﺔ‬
‫ا ﻟﻤ ﻮ ﺟ ﻮ د ة ﻓ ﻲ ﻣ ﺼ ﺮ ف ا ﻟ ﺪ م و ﻛ ﺬ ﻟ ﻚ ﻣﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ اﻟ ﺪ م ﻓ ﻲ ا ﻟﻤ ﺴ ﺘ ﺸ ﻔ ﻰ ‪ .‬ﻷ ﻧ ﻬ ﺎ‬
‫ﻣ ﺴ ﺆ و ﻟ ﻴ ﺔ ﺗ ﻀ ﺎ ﻣﻨﻴ ﺔ ﺑ ﻴ ﻦ ﻋ ﺪة ا ﻃ ﺮ ا ف ﻓ ﻲ ا ﻟ ﻤ ﺴﺘ ﺸ ﻔ ﻰ ‪.‬‬
 ‫ﻫﻨﺎ ﻳﺘﻢ ﻃﺮح اﻟﺴﺆال اﻟﻤﻬﻢ و ﻫﻮ ﻣﺎ ﻫﻲ اﻻﺟﺮاءات اﻟﻤﺨﺘﺒﺮﻳﺔ اﻟﻮاﺟﺐ اﺗﺒﺎﻋﻬﺎ ﻓﻲ ﺣﺎل‬
‫ﺣﺼﻮل اﻟﺘﺤﺴﺲ او ﺗﻔﺎﻋﻞ ﻧﺘﻴﺠﺔ ﻧﻘﻞ اﻟﺪم ؟!‬

‫‪ ‬اﻋ ﺎ د ة ﻓ ﺤ ﺺ و ﻣ ﻄ ﺎ ﺑ ﻘ ﺔ ﻣ ﺎ ﻳ ﻠ ﻲ‬
‫ﻓﺤﺺ دم اﻟﻤﺮﻳﺾ ﺑﻌﺪ ﻋﻤﻠﻴﺔ اﻻﻋﻄﺎء‬
‫اﻟﺘﺄﻛﺪ ﻣﻦ اﻟﺴﺠﻼت ) ﺻﺎدر اﻟﺪم و ﺳﺠﻞ ﻣﻄﺎﺑﻘﺔ اﻟﺪم (‬
‫ﻓ ﺤ ﺺ ﺣ ﻘ ﻴ ﺒ ﺔ ا ﻟﺪ م ﻣ ﺮة ا ﺧ ﺮ ى‬

‫ﻓ ﻲ ﺣ ﺎ ل و ﺟ ﻮ د ﺗ ﻨﺎ ﻗ ﺾ ﻳ ﺘ ﻢ‬
‫اﻋ ﻄ ﺎ ء ﺧ ﺒ ﺮ ا ﻟ ﻰ ﻣ ﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ ا ﻟ ﺪ م ﺑﺴ ﺮ ﻋ ﻪ‬
‫ﻓﻲ ﺣﺎل وﺟﻮد ﻣﺮﻳﺾ اﺧﺮ ﻳﺤﻤﻞ ﻧﻔﺲ اﻟﻔﺼﻴﻠﺔ ﻳﺠﺐ اﻟﺘﺄﻛﺪ ﻣﻦ ﻋﺪم اﺧﺘﻼط او ﺗﺒﺎدل‬
‫ﺣ ﻘﺎ ﺋ ﺐ ا ﻟﺪ م‬
‫ا ﻟ ﻠ ﺠ ﻮ ء ا ﻟ ﻰ ﻓ ﺤ ﻮ ﺻ ﺎ ت ا ﺧ ﺮ ى ﻳ ﺘ ﻢ ﺗ ﻮ ﺟ ﻴ ﻬ ﻬ ﺎ ﻣ ﻦ ﻣﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ اﻟ ﺪ م‬

‫‪ ‬ﻣﻼﺣﻈﺔ اﻟﺘﺤﻠﻞ ﻓﻲ دم اﻟﻤﺮﻳﺾ‬

‫ﺣﻴﺚ ﻳﺘﺤﻮل ﻟﻮن اﻟﺒﻼزﻣﺎ اﻟﻰ اﻟﻠﻮن اﻻﺣﻤﺮ ﻧﺘﻴﺠﺔ وﺟﻮد اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ اﻟﺤﺮ‬
‫ﻓ ﻲ ﺣ ﺎ ل و ﺟ ﻮ د ﺗ ﺤﻠ ﻞ‬
‫ﻳ ﺘ ﻢ ا ﻋﺎ دة ا ﻟ ﻔ ﺤ ﺺ ﻣ ﺮ ة ا ﺧ ﺮ ى‬
‫ﻓﻲ ﺣﺎل وﺟﻮدة ﻳﺘﻢ اﺧﺒﺎر ﻣﺴﺆول ﻟﺠﻨﺔ ﺧﺪﻣﺎت ﻧﻘﻞ اﻟﺪم و اﻟﻠﺠﻮء اﻟﻰ اﻟﻔﺤﻮﺻﺎت اﻻ‬
‫ﺧ ﺮ ى اﻟ ﻤ ﻮ ﺟ ﻬ ﻪ ﻣ ﻦ ا ﻟ ﻤ ﺴ ﺆ و ل‬

‫‪ ‬ﻓﺤﺺ اﻟﻐﻠﻮﺑﻴﻮﻟﻴﻦ اﻟﻤﺒﺎﺷﺮ ‪DAT‬‬

‫و ﻫﻮ ﻳﻜﺸﻒ ﻋﻦ وﺟﻮد ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء اﻟﻤﺘﺤﺴﺴﻪ داﺧﻞ ﺟﺴﻢ اﻻﻧﺴﺎن ‪.‬‬
‫ﻓ ﻲ ﺣ ﺎ ل ﻛﺎ ن ﻣ ﻮ ﺟ ﺐ‬
‫ﻳ ﺘ ﻢ ا ﺧ ﺒ ﺎ ر ﻣ ﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧﺪ ﻣﺎ ت ﻧ ﻘ ﻞ ا ﻟﺪ م ﺑ ﺴ ﺮ ﻋ ﺔ‬
‫و اﻟﻠﺠﻮء اﻟﻰ اﻟﻔﺤﻮﺻﺎت اﻻﺧﺮى اﻟﺨﺎﺻﻪ ﺑﺎﻟﻤﺮﻳﺾ‬
‫ا ﻣﺎ ا ذ ا ﻛﺎ ن ﺳﻠ ﺒ ﻲ‬
‫و ﻟ ﻜ ﻦ ا ﻟﻌ ﻼ ﻣ ﺎ ت ا ﻟ ﺴ ﺮ ﻳ ﺮ ﻳ ﺔ ﺗ ﺸ ﻴ ﺮ ا ﻟ ﻰ و ﺟ ﻮ د ﺗ ﺤ ﺴ ﺲ‬
‫ﻳﺘﻢ اﺧﺒﺎر ﻣﺴﺆول ﻟﺠﻨﺔ ﺧﺪﻣﺎت ﻧﻘﻞ اﻟﺪم و ﻛﺬﻟﻚ اﻟﻠﺠﻮء اﻟﻰ اﻟﻔﺤﻮﺻﺎت اﻻﺧﺮى اﻟﺨﺎﺻﻪ‬
‫ﺑ ﺎ ﻟﻤ ﺮ ﻳ ﺾ‬

‫‪ ‬اﻋﺎدة ﻓﺤﺺ ﻓﺼﺎﺋﻞ اﻟﺪم ‪ABO‬‬

‫ﻓﻲ ﺣﺎل وﺟﻮد ﺗﻨﺎﻗﺾ ﻋﻦ اﻟﻨﺘﺎﺋﺞ اﻻﺻﻠﻴﺔ‬
‫ﻳ ﺘ ﻢ ا ﻋﺎ دة ﻃﻠ ﺐ ا ﻟ ﺘ ﺤﺎ ﻟ ﻴ ﻞ ﻣ ﺮة ا ﺧ ﺮ ى‬
‫و ﻓﻲ ﺣﺎل وﺟﻮد ﺷﺨﺺ ﻣﻦ ﻧﻔﺲ اﻟﻔﺼﻴﻠﺔ ﻳﺘﻢ اﻟﺘﺒﻠﻴﻎ ﻣﻦ اﺟﻞ ﺗﻼﻓﻲ اﻻﺷﺘﺒﺎة ﻓﻲ‬
‫ا ﻟ ﻌ ﻴ ﻨﺎ ت ا و ﻓ ﻲ ﻧ ﺘﺎ ﺋ ﺞ ا ﻟ ﻔ ﺤ ﺺ ﻟ ﻤ ﻨ ﻊ ﺣ ﺼ ﻮ ل ﻛ ﺎ ر ﺛ ﺔ ا ﺧ ﺮ ى ‪.‬‬
‫ﻳ ﺘ ﻢ ا ﺧ ﺒ ﺎ ر ﻣ ﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧﺪ ﻣﺎ ت ﻧ ﻘ ﻞ ا ﻟﺪ م ﺑ ﺴ ﺮ ﻋ ﺔ‬
‫ا ﻟ ﻠ ﺠ ﻮ ء ا ﻟ ﻰ ا ﻟ ﻔ ﺤ ﻮ ﺻ ﺎ ت ا ﻟﻤ ﻮ ﺟ ﻬ ﻪ ﻣ ﻦ ﻣ ﺴ ﺆ و ل ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ ا ﻟ ﺪ م‬
 ‫ﺗﻨﻘﺴﻢ اﻻﺿﺮار اﻟﻨﺎﺗﺠﺔ ﻋﻦ ﻧﻘﻞ اﻟﺪم اﻟﻰ ﻗﺴﻤﻴﻦ‬
‫‪ ‬ﺗﻔﺎﻋﻼت ﻏﻴﺮ ﻣﻌﺪﻳﺔ ) اﻟﺴﺒﺐ اﻟﻜﺎﻣﻦ وراﻫﺎ ﻏﻴﺮ ﻣﻌﺪي (‬
‫‪Noninfectious Transfusion Reactions‬‬
‫ﺗﻔﺎﻋﻼت ﻣﻌﺪﻳﺔ ) اﻟﺴﺒﺐ اﻟﻜﺎﻣﻦ وراﻫﺎ ﻳﻜﻮن ﻣﻌﺪي و ﺧﻄﺮ ﻓﻲ ذات اﻟﻮﻗﺖ (‬ ‫‪‬‬
‫‪infectious Transfusion Reactions‬‬

‫‪Noninfectious Transfusion Reactions‬‬

‫ﻟ ﻨ ﺘ ﻜﻠ ﻢ ا و ﻻ ﻋ ﻦ‬
‫اﻟﺘﻔﺎﻋﻼت ﻏﻴﺮ اﻟﻤﻌﺪﻳﺔ و ﻫﻲ ﻋﺪة اﻗﺴﺎم‬
‫‪‬‬ ‫‪Alloimmunization to RBC Antigens‬‬
‫ﻧ ﺤ ﻦ ﻧ ﻌ ﺮ ف إ ن ﺗ ﻌ ﺮ ض ا ﻟ ﺠ ﺴ ﻢ ﻻ ﺷ ﻴ ﺎ ء ﻏ ﺮ ﻳ ﺒ ﺔ ﺗ ﺜ ﻴ ﺮ اﻟ ﻤ ﻨ ﺎﻋ ﺔ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻜ ﻮ ﻳ ﻦ ا ﺿ ﺪ ا د‬
‫‪ antibodies‬و ﻫﺬة اﻻﺿﺪاد ﺗﻬﺎﺟﻢ اﻟﺠﺴﻢ اﻟﻐﺮﻳﺐ ﻓﻲ ﺣﺎل ﺗﻌﺮض ﻟﻪ اﻟﺠﺴﻢ ﻣﺮة اﺧﺮى‬
‫ﻣ ﺴ ﺒ ﺒ ﺔ ﺑ ﺬ ﻟ ﻚ رد ة ﻓ ﻌ ﻞ ﻣ ﻨ ﺎﻋ ﻲ ﻗ ﻮ ﻳ ﺔ ‪.‬‬
‫ﻧﻔﺲ اﻟﺤﺎل ﺑﺎﻟﻨﺴﺒﺔ ﻟﻜﺮﻳﺎت دم اﻟﻮاﻫﺐ ﻓﻬﻲ ﺗﻌﺘﺒﺮ ﻏﺮﻳﺒﺔ و ﻟﺬﻟﻚ ﻓﺈن اﻻﺧﺘﻼف ﻓﻲ‬
‫اﻟﻤﺴﺘﻀﺪات ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﺗﻬﺎﺟﻢ ﺗﻠﻚ اﻟﻤﺴﺘﻀﺪات ‪ antigens‬و ﻟﻜﻦ ﻫﻨﺎ‬
‫ﻧﺘﻜﻠﻢ ﻋﻦ اﺿﺪاد ﻏﻴﺮ ﻣﻮﺟﻮدة ﻓﻲ اﻻﺳﺎس و ﺗﺘﻜﻮن ﻧﺘﻴﺠﺔ اﻟﺘﻌﺮض ﻟﺨﻼﻳﺎ ﻏﺮﻳﺒﺔ ﻏﻴﺮ ﺧ‬
‫ﻼﻳﺎ ﺟﺴﻢ اﻟﻤﺮﻳﺾ و ﻟﺬﻟﻚ ﺗﺴﻤﻰ اﺿﺪاد ﻏﻴﺮ اﻻﺿﺪاد اﻟﻄﺒﻴﻌﻴﺔ اﻟﺘﻜﻮﻳﻦ ‪anti ABO‬‬
‫‪ antibodies‬و ﺗﻌﺘﺒﺮ ﻫﺬة اﻻﺿﺪاد واﺣﺪة ﻣﻦ اﻫﻢ اﻟﺘﺤﺪﻳﺎت اﻟﺘﻲ ﺗﻮاﺟﺔ ﻣﺼﺎرف اﻟﺪم و‬
‫ﺧ ﺎ ﺻ ﻪ ﻟ ﺤ ﺎ ﻣ ﻠ ﻲ ا ﻟ ﻔ ﺼ ﺎ ﺋ ﻞ ا ﻟ ﺴ ﺎ ﻟ ﺒ ﺔ و ﺗ ﻌ ﺘ ﺒ ﺮ ﺳ ﺒ ﺐ ر ﺋ ﻴ ﺴ ﻲ ﻓ ﻲ ﺣ ﺼ ﻮ ل رد ة ا ﻟ ﻔ ﻌ ﻞ ا ﻟ ﻤ ﻨ ﺎ ﻋ ﻲ‬
‫ا ﻟ ﺤ ﺎ د ة ا و ا ﻟ ﻤ ﺘ ﺄ ﺧ ﺮ ة ا ﻟ ﺘ ﻲ ﺗ ﺆد ي ا ﻟ ﻰ ﺗ ﺤ ﻠ ﻞ ا ﻟ ﺪ م‬
‫ﺣﺪوث ﺗﻜﻮﻳﻦ ﻫﺬة اﻻﺿﺪاد ﻳﻌﺘﻤﺪ ﻋﻠﻰ‬
‫‪ ‬اﻟﺪراﺳﺎت اﻟﺴﺮﻳﺮﻳﺔ ﻋﻠﻰ اﻟﺤﺎﻻت اﻟﺤﺎوﻳﺔ ﻟﻬﺬا اﻟﻨﻮع‬
‫‪ ‬ﻇ ﺮ و ف اﻟﻤ ﺮﻳ ﺾ‬
‫اذا اردﻧﺎ اﺣﺼﺎﺋﻴﺔ ﻋﻦ اﻟﺤﺎﻻت اﻟﺘﻲ ﺗﻌﻄﻲ ﺗﻜﻮﻳﻦ ﻟﻬﺬا اﻟﻨﻮع ﻣﻦ اﻻﺿﺪاد ﻓﻬﻲ ﻣﺘﻔﺮﻗﺔ و‬
‫ﻟ ﻜ ﻦ ﻧ ﺴ ﺒ ﺔ ﺣ ﺪ و ﺛ ﻬ ﺎ ﻛ ﺒ ﻴ ﺮ ة ﻋ ﻦ ا ﻟ ﻤ ﺮ ﺿ ﻰ ا ﻟﻤ ﺼ ﺎ ﺑ ﻴ ﻦ ب‬
‫‪ chronically transfused patients with sickle cell disease‬‬
‫‪ myelodysplastic syndrome‬‬
‫‪ thalassemia‬‬
‫‪ autoimmune hemolytic disease‬‬
‫اﻟﻤﺴﺘﻀﺪات اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ ﻫﺬة اﻻﺿﺪاد ﺗﻜﻮن اﻻﺳﺘﺠﺎﺑﺔ اﻟﻤﻨﺎﻋﻴﺔ ﺿﻌﻴﻔﺔ ﻣﺎ ﻋﺪا‬
‫ﻧﻈﺎم ‪ Rh‬و ﺧﺎﺻﺔ اﻟﻤﺴﺘﻀﺪ ﻧﻮع ‪ D‬ﺣﻴﺚ وﺟﺪت اﻟﺪراﺳﺎت إن ‪ %85‬ﻣﻦ اﻟﺤﺎﻻت اﻟﺴﺎﻟﺒﺔ‬
‫‪ D negative‬ﻋﻨﺪ ﺗﻌﺮﺿﻬﺎ ﻟﻜﺮﻳﺎت دم ﺣﺎﻣﻠﺔ ﻟﻠﻤﺴﺘﻀﺪ ‪ D positive‬ﺗﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ‬
‫اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﺑﻴﻨﻤﺎ اﻟﺘﻌﺮض اﻟﻰ ﻣﺴﺘﻀﺪ ‪ K‬ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ ‪ anti K‬و ﻳﺤﺪث ﻓﻲ ‪%10‬‬
‫ﻣﻦ ﺣﺎﻻت ﻋﺪم اﻟﺘﻮاﻓﻖ ﺑﻴﻦ اﻟﻮاﻫﺐ و اﻟﻤﺴﺘﻠﻢ‬
‫اﻣﺎ اﻟﺘﻌﺮض اﻟﻰ ﻣﺴﺘﻀﺪ ‪ E‬ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ ‪ anti E‬و ﻳﺤﺪث ﻓﻲ ‪ %7‬ﻣﻦ اﻟﺤﺎﻻت و‬
‫ﻛﺬﻟﻚ اﻟﺘﻌﺮض اﻟﻰ ﻣﺴﺘﻀﺪ ‪ c‬ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ ‪ anti c‬ﻓﻲ ‪ %3‬ﻣﻦ ﺣﺎﻻت ﻋﺪم اﻟﺘﻮاﻓﻖ‬
‫ﺑ ﻴ ﻦ ا ﻟ ﻮ ا ﻫ ﺐ و ا ﻟ ﻤ ﺴﺘﻠ ﻢ‬
‫و ﻳﻌﺘﺒﺮ اﻟﺘﻌﺮض اﻟﻰ ﻓﺼﺎﺋﻞ اﻟﺪم اﻟﺜﺎﻧﻮﻳﺔ واﺣﺪ ﻣﻦ اﻫﻢ اﺳﺒﺎب ﺗﻜﻮﻳﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ‬
‫ﻓﻲ ‪ %3‬ﻣﻦ اﻟﺤﺎﻻت‬

‫ﻓ ﻲ ا ﻟ ﻨ ﻬ ﺎ ﻳ ﺔ ﺗ ﻜ ﻮ ﻳ ﻦ ا ﺿ ﺪ ا د ﺑ ﻬ ﺬ ة ا ﻟ ﻄ ﺮ ﻳ ﻘ ﺔ ﻳ ﻌ ﺘﻤ ﺪ ﻋ ﻠ ﻰ‬
‫‪ ‬ا ﻣ ﺮ ا ض ا ﺧ ﺮ ى ﻟﺪ ى اﻟ ﻤ ﺮ ﻳ ﺾ‬
 ‫‪ ‬ﻋ ﺪد ﻣ ﺮ ا ت ﻧ ﻘ ﻞ ا ﻟ ﺪ م‬
‫‪ ‬ا ﺳ ﺒﺎ ب ﻣ ﺆ دﻳ ﺔ ا ﻟ ﻰ ﻓ ﻘ ﺮ ا ﻟﺪ م‬
‫‪ ‬ﻣ ﻨ ﺎ ﻋ ﻴ ﺔ ا و ﻏ ﺮ ا ﺑ ﺔ ا ﻟ ﻤﺴ ﺘ ﻀ ﺪ ا ﻟ ﻤ ﻮ ﺟ ﻮ د ﻋ ﻠ ﻰ ﺳ ﻄ ﺢ ﻛ ﺮ ﻳ ﺎ ت د م ا ﻟ ﻮ ا ﻫ ﺐ ا ﻟ ﺤ ﻤ ﺮ ا ء‬
‫ا ﻟ ﻤ ﻔﻬ ﻮ م ا ﻟ ﻤ ﺘ ﻘﺪ م‬
‫وﺟﺪت اﻟﺪراﺳﺎت إن ﻫﻨﺎﻟﻚ ﺑﻌﺾ اﻻﺷﺨﺎص ﻋﻨﺪﻣﺎ ﻳﺘﻌﺮﺿﻮن اﻟﻰ دم ﻏﺮﻳﺐ‬
‫) د م ا ﻟ ﻮ ا ﻫ ﺐ ( ﻓﺈ ﻧ ﻪ ﻳ ﻮﻟ ﺪ ﺗ ﻜ ﻮ ﻳ ﻦ ا ﺿﺪ ا د ﻣ ﻨﺎ ﻋ ﻴ ﺔ ﺑ ﻜ ﻤ ﻴﺎ ت ﻛ ﺒ ﻴ ﺮ ة و ﻟﺬ ﻟ ﻚ ا ﻃﻠ ﻘ ﻨﺎ ﻋﻠ ﻴ ﻬ ﻢ ا ﺳ ﻢ‬
‫اﻟﻤﺴﺘﺠﻴﺒﻮن ‪ . responders‬و ﻗﺪ وﺟﺪت اﻟﺪراﺳﺎت إن رﺑﻊ ﻫﻮﻻء ﻳﻨﺘﺠﻮن اﺟﺴﺎم ﻣﻀﺎدة‬
‫ﻣﺘﻨﻮﻋﻪ ‪ subgroup‬و ﻟﺬﻟﻚ ﻳﻄﻠﻖ ﻋﻠﻴﻬﻢ اﻻﺷﺨﺎص ذوي اﻻﺳﺘﺠﺎﺑﺔ اﻟﻌﺎﻟﻴﺔ ‪hyper‬‬
‫‪ responders‬و ﻗﺪ اوﻟﺖ اﻟﺪراﺳﺔ إن ﻫﻨﺎﻟﻚ ﻋﻮاﻣﻞ ﺑﺎﻳﻠﻮﺟﻴﺔ و ﺳﺮﻳﺮﻳﺔ ﻫﻲ اﻟﺴﺒﺐ ﻓﻲ‬
‫ﻫﺬة اﻻﺳﺘﺠﺎﺑﺔ و ﻫﻲ ﻗﺪ ﺗﻜﻮن‬
‫‪ genetics‬‬
‫‪ the inflammatory state of the patient‬‬
‫‪ sex‬‬
‫‪ age‬‬
‫ﺗﻨﻮع اﻟﻤﺴﺘﻀﺪات ﻣﺎ ﺑﻴﻦ اﻟﻮاﻫﺐ و اﻟﻤﺴﺘﻠﻢ ﻳﻮﺿﺢ ﺑﻌﺾ اﻟﻤﻔﺎﻫﻴﻢ اﻟﻤﻬﻤﻪ ‪ .‬ﻓﻤﺜﻼ اﻻ‬
‫ﺷﺨﺎص اﻟﻤﺼﺎﺑﻴﻦ ﺑﻔﻘﺮ اﻟﺪم اﻟﻤﻨﺠﻠﻲ و اﺧﺘﻼف ﻣﺴﺘﻀﺪات ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ اﻟﻨﻮع اﻟﺜﺎﻧﻲ‬
‫‪ HLA II‬ﻫﻮ ﻣﺎ ﻳﺪﻋﻢ إن اﻟﻌﻮاﻣﻞ اﻟﻮراﺛﻴﺔ ﺗﻠﻌﺐ دور ﻛﺒﻴﺮ ﻓﻲ ﻫﺬة اﻻﺳﺘﺠﺎﺑﺔ ‪ .‬ﻛﺬﻟﻚ‬
‫اﻟﺘﻌﺮض اﻟﻰ اﻻﻟﺘﻬﺎب ﻳﺆدي اﻟﻰ اﻻﺳﺘﻌﺪاد ﻟﺘﻜﻮﻳﻦ ﻫﺬة اﻻﺿﺪاد ‪ .‬اﻣﺎ ﻣﻦ ﻧﺎﺣﻴﺔ اﻟﺠﻨﺲ ﻓ‬
‫ﻼ ﺗﻮﺟﺪ ادﻟﺔ دﻗﻴﻘﺔ ﻟﺮﺑﻂ ﺗﻜﻮﻳﻦ ﻫﺬة اﻻﺿﺪاد و ﻟﻜﻦ ﺑﺎﻟﻌﻤﻮم ﻓﺈن اﻻﻃﻔﺎل و ﺣﺪﻳﺜﻲ اﻟﻮﻻ‬
‫دة ﻳﻜﻮﻧﻮن اﻗﻞ ﻋﺮﺿﺔ ﻟﺘﻜﻮﻳﻦ ﻫﺬة اﻻﺿﺪاد‬

‫ﻳﻜﻮن ﻣﻌﺪل ﺗﻜﻮﻳﻦ اﻻﺿﺪاد ﻓﻲ اﻟﻤﺼﺎﺑﻴﻦ ﺑﻔﻘﺮ اﻟﺪم اﻟﻤﻨﺠﻠﻲ اﻋﻠﻰ ﻣﻦ ﺑﻘﻴﺔ اﻻﺷﺨﺎص ‪.‬‬
‫ﻛﺬﻟﻚ اﻻﺷﺨﺎص اﻟﻤﻌﺮﺿﻴﻦ اﻟﻰ ﻧﻘﻞ اﻟﺪم ﺑﺎﺳﺘﻤﺮار ‪ .‬و ﻣﻊ وﺟﻮد اﺟﺮاءات ﻛﺜﻴﺮة ﻟﻤﻄﺎﺑﻘﺔ‬
‫اﻟﻨﻤﻂ اﻟﻈﺎﻫﺮي ﻟﻠﺪم ‪ phenotype‬إﻻ إن ﻫﺬة اﻟﺤﺎﻻت ﻣﻨﺘﺸﺮة و ﺧﺎﺻﺔ ﻓﻲ اﻣﺮﻳﻜﺎ و‬
‫ا ﻓ ﺮﻳ ﻘ ﻴ ﺎ‬

‫)‪ Acute Hemolytic Transfusion Reaction (AHTR‬‬

‫و ا ﺣﺪ ة ﻣ ﻦ ا ﻫ ﻢ ا ﻟ ﺘ ﺤﺪ ﻳﺎ ت ا ﻟ ﺘ ﻲ ﺗ ﻮ ا ﺟ ﻪ ﻣ ﺼﺎ ر ف اﻟ ﺪ م و ا ﻟ ﺘ ﻲ ﺗ ﻬ ﻈ ﻒ ﻓ ﺤ ﻮ ﺻﺎ ت اﻟ ﻤ ﻄﺎ ﺑ ﻘ ﺔ ا ﻟ ﻰ‬
‫ﻣﻨﻌﻬﺎ ﻫﻲ ﺗﺤﻠﻞ اﻟﺪم اﻟﻤﻨﻘﻮل ﺑﺸﻜﻞ ﺣﺎد ‪ .‬و ﻫﻲ ﻧﺎﺗﺠﻪ ﻋﻦ ﻣﻬﺎﺟﻤﺔ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ‬
‫ﻟ ﻤ ﺴ ﺘ ﻀﺪ ا ت ﻛ ﺮﻳ ﺎ ت د م ا ﻟ ﻮ ا ﻫ ﺐ ا ﻟ ﺤ ﻤ ﺮ ا ء ﻣ ﻤ ﺎ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﺤﻠﻠ ﻬﺎ ﺑ ﺸ ﻜ ﻞ ﺳ ﺮﻳ ﻊ ‪ .‬ﺣ ﻴ ﺚ ﺗ ﺮ ﺗ ﺒ ﻂ ا‬
‫ﻻﺿﺪاد اﻟﻰ ﻛﺮﻳﺎت اﻟﺪم اﻟﻤﻨﻘﻮﻟﺔ و ﻳﺘﻢ ازاﻟﺘﻬﺎ ﻣﻦ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﺑﺴﺮﻋﺔ و ﺗﻨﻘﺴﻢ ﻫﺬة‬
‫ا ﻟ ﺤ ﺎ ﻟ ﺔ ا ﻟ ﻰ ﻗ ﺴﻤ ﻴ ﻦ‬
‫‪ Acute‬‬
‫‪ Delayed‬‬
‫اﻋ ﺘ ﻤ ﺎ د ا ﻋ ﻠ ﻰ اﻟ ﺘ ﻄ ﻮ ر ا ﻟ ﺰ ﻣ ﻨ ﻲ ﻟ ﻠ ﺤ ﺎ ﻟ ﺔ‬

‫‪Acute hemolytic transfusion reaction‬‬

‫ﻳﺘﻢ ﺗﻌﺮﻳﻔﻬﺎ ﻋﻠﻰ إﻧﻬﺎ ﻣﺤﻤﻮﻋﺔ ﻣﻦ اﻟﻌﻼﻣﺎت و اﻻﻋﺮاض اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺘﺤﻠﻞ ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ‬
‫ﻣ ﺠ ﻤ ﻮﻋ ﺔ ﻣ ﻦ ا ﻟ ﻤ ﺘ ﻐ ﻴ ﺮ ا ت اﻟ ﺒ ﺎ ﻳ ﻮ ﻛ ﻴﻤ ﻴ ﺎ ﺋ ﻴ ﺔ و ا ﻟ ﺴ ﻴ ﺮ و ﻟ ﻮ ﺟ ﻴ ﺔ ا ﻟ ﺪ ا ﻟ ﺔ ﻋ ﻠ ﻰ ا ﻟ ﺘ ﺤ ﻠ ﻞ ﺑ ﺸ ﻜ ﻞ ﻣ ﺆ ﻛ ﺪ و‬
‫ﻋﺪم ﺗﻮاﻓﻖ اﻟﺪم ‪.‬ﺗﺤﺪث اﻟﺤﺎﻟﺔ ﺧﻼل ‪ 24‬ﻣﻦ اﻋﻄﺎء اﻟﺪم او ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ ﻋﻦ اﻻﻋﻄﺎء و‬
‫ﺧﻼل دﻗﺎﺋﻖ ﻣﻌﺪودة و ﻫﺬة ﺗﺤﺪث ﻓﻲ اﻏﻠﺐ اﻟﺤﺎﻻت او ﺑﻌﺪ اﻛﺘﻤﺎل ﻋﻤﻠﻴﺔ ﻧﻘﻞ اﻟﺪم‬
‫ﺑ ﻔ ﺘ ﺮ ة ﻗ ﻠ ﻴ ﻠ ﺔ ﻣ ﻦ ا ﻟ ﺴ ﺎﻋ ﺎ ت ‪.‬‬
‫اﻏﻠﺐ اﻟﺤﺎﻻت ﻧﺎﺗﺠﺔ ﻣﻦ ﻋﺪم ﺗﻮاﻓﻖ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء ﻟﻜﻨﻬﺎ ﻗﺪ ﺗﺤﺪث ﻧﺘﻴﺠﺔ ﻧﻘﻞ اﻟﺒﻼ‬
 ‫ا ز ﻣ ﺎ ا ﻟ ﺘ ﻲ ﺗ ﺤ ﺘ ﻮ ي ﻋ ﻠ ﻰ ا ﺿ ﺪ اد ﻣ ﻨ ﺎﻋ ﻴ ﺔ ﺗ ﻬ ﺎ ﺟ ﻢ ﻛ ﺮ ﻳ ﺎ ت د م ا ﻟ ﻤ ﺴ ﺘ ﻠ ﻢ ﻣ ﻤ ﺎ ﻳ ﺆ د ي ا ﻟ ﻰ ﺣ ﺪ و ث ر د ة‬
‫ﻓ ﻌ ﻞ ﻣ ﻨﺎ ﻋ ﻲ ﻗ ﻮﻳ ﺔ ا و ﻋ ﻨﺪ ﻧ ﻘ ﻞ د م ﺣ ﺎ و ي ﻋﻠ ﻰ ﻛ ﻤ ﻴ ﺔ ﻣ ﻦ ا ﻟ ﺒ ﻼ ز ﻣﺎ و ﻳ ﻤ ﻜ ﻦ ا ن ﻳ ﺤﺪ ث ﺗ ﺤﻠ ﻞ‬
‫اﻟﺪم ﺑﺸﻜﻞ ﻣﻨﺎﻋﻲ او ﻏﻴﺮ ﻣﻨﺎﻋﻲ و ﺣﺴﺐ اﻟﺤﺎﻟﻪ ‪ .‬ﺑﺸﻜﻞ ﻋﺎم ‪ ،‬ﺷﺪة اﻻﺳﺘﺠﺎﺑﺔ اﻟﻤﻨﺎﻋﻴﺔ‬
‫ﺗ ﻌ ﺘ ﻤ ﺪ ﻋ ﻠ ﻰ ﻛﻤ ﻴ ﺔ ا ﻟ ﺪ م ا ﻟ ﻐ ﻴ ﺮ ﻣ ﺘ ﻮ ا ﻓ ﻖ ا و ا ﻟ ﺒ ﻼ ز ﻣ ﺎ ﻏ ﻴ ﺮ ا ﻟ ﻤ ﺘ ﻮ ا ﻓ ﻘ ﺔ ا ﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ ا ﻟ ﻰ ا ﻟﻤ ﺮ ﻳ ﺾ ‪ .‬و‬
‫ﻟﻜﻦ ﻓﻲ ﺣﺎﻻت ﻣﻌﻴﻨﺔ و ﻧﺎدرة ﻳﺘﻢ ﻧﻘﻞ وﺣﺪة دم ﻛﺎﻣﻠﺔ دون ﻣﻼﺣﻈﺔ اي ﻋﻮارض ﻣﻌﻴﻨﺔ‬
‫) ﻓﻲ ﺣﺎل ﻧﻘﻞ دم ﻏﻴﺮ ﻣﺘﻮاﻓﻖ ﺣﺴﺐ ﻧﻈﺎم ‪ ( Rh‬اﻣﺎ ﻓﻲ ﺣﺎل ﻧﻘﻞ دم ﻏﻴﺮ ﻣﺘﻮاﻓﻖ‬
‫ﺣﺴﺐ ﻧﻈﺎم ‪ ABO‬ﻓﺈن ذﻟﻚ ﻳﺆدي اﻟﻰ ﺣﺎﻻت ﻗﺪ ﺗﻜﻮن ﻗﺎﺗﻠﺔ ﺣﺘﻰ ﻟﻮ ﻛﺎﻧﺖ ﻛﻤﻴﺔ اﻟﺪم‬
‫ا ﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ ﻗﻠ ﻴﻠ ﺔ ‪.‬‬

‫ا ﻟ ﻌ ﻼ ﻣ ﺎ ت ا و ا ﻟ ﺪ ﻻ ﺋ ﻞ ا ﻟﻤ ﺸ ﻴ ﺮ ة ﻟ ﺘ ﺤ ﻠ ﻞ ا ﻟ ﺪ م ا ﻟ ﺤ ﺎ د ﺗ ﺸﻤ ﻞ‬
‫اﻻﻋﺮاض ﺗﺸﻤﻞ‬
‫‪ -1‬ارﺗﻔﺎع درﺟﺔ اﻟﺤﺮارة‬
‫‪ -2‬ﻗﺸﻌﺮﻳﺮة‬
‫‪ -3‬اﻟﻢ ﻗﺪ ﻳﻜﻮن ﻣﻮﺿﻌﻲ ) ﻓﻲ ﻣﻜﺎن اﻋﻄﺎء اﻟﺪم ( ‪ ،‬اﻟﺒﻄﻦ ‪ ،‬اﺳﻔﻞ اﻟﻈﻬﺮ و‬
‫ﻋﻨﺪ اﻻﻃﺮاف‬
‫‪ -4‬اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم‬
‫‪ -5‬اﺻﺎﺑﺎت ﻛﻠﻮﻳﺔ و ﻋﻼﻣﺎﺗﻬﺎ‬
‫ا ر ﺗ ﻔﺎ ع اﻟ ﻴ ﻮ ر ﻳﺎ و ا ﻟ ﻜ ﺮ ﻳﺎ ﺗ ﻨ ﻴ ﻦ‬
‫ا ر ﺗ ﻔ ﺎ ع اﻟ ﻬ ﻴ ﻤ ﻮﻏ ﻠ ﻮ ﻟ ﻴ ﻦ ا ﻟ ﺤ ﺮ ﻓ ﻲ ا ﻟ ﺪ م‬
‫ﺗﺨﺜﺮات اﻟﺪم اﻟﻤﻨﺘﺸﺮة ﻓﻲ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ‬
‫‪ -6‬اﻟﺠﻠﻄﺎت‬
‫‪ -7‬ﻏﺜﻴﺎن‬
‫‪ -8‬ﺗﺴﺎرع اﻟﻘﻠﺐ‬
‫‪ -10‬ﺿﻴﻖ اﻟﺘﻨﻔﺲ‬

‫ﺗﻌﺘﺒﺮ اﻟﺨﻄﻮة اﻻوﻟﻰ‬

‫‪ ‬ﻫ ﻲ ﻣ ﺮ ا ﻗ ﺒ ﺔ ﺿ ﻐ ﻂ ا ﻟﺪ م‬
‫‪ ‬و ا ﻋ ﻄ ﺎ ء اﻟ ﺴ ﻮ ا ﺋ ﻞ ﻟ ﻤ ﻨ ﻊ ا ﻟ ﻔ ﺸ ﻞ ا ﻟ ﻜﻠ ﻮ ي و ا ﻟ ﺠﻠ ﻄﺎ ت‬
‫و ﻳﺠﺪر اﻻﺷﺎرة إن ﻣﻦ اﻟﺼﻌﺐ اﻟﺘﻤﻴﻴﺰ ﺑﻴﻦ ﻣﺸﺎﻛﻞ اﻟﺘﺨﺜﺮ و اﻟﺨﺜﺮ اﻟﺪﻣﻮﻳﺔ اﻟﻤﻨﺘﺸﺮة‬
‫‪DIC and other coagulation abnormalities‬‬
‫و ﻟﺬﻟﻚ ﻳﻤﻜﻦ اﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻤﺆﺷﺮات اﻟﺨﺎﺻﺔ ﺑﺎﻟﺘﺨﺜﺮ ﻛﺪﻻﻻت ﻟﻠﺘﺸﺨﻴﺺ ‪.‬‬

‫ا ﻟ ﺘ ﺤ ﺎ ﻟ ﻴ ﻞ ا ﻟﻤ ﺨ ﺘ ﺒ ﺮ ﻳ ﺔ اﻟ ﻤ ﻬ ﻤ ﻪ‬
‫‪‬‬ ‫‪PT‬‬
‫‪‬‬ ‫‪aPTT‬‬
‫‪‬‬ ‫‪D dimer‬‬
‫‪‬‬ ‫‪PLt‬‬
‫‪‬‬ ‫‪Fibrinogen level‬‬

‫اﻛﺜﺮ اﻟﺤﺎﻻت اﻟﻤﺴﺒﺒﺔ ﻟﻬﺬا اﻟﻨﻮع ﻣﻦ اﻟﺘﺤﻠﻞ ﻫﻲ‬

‫‪‬‬ ‫‪Major ABO incompatibility‬‬
‫‪‬‬ ‫‪Minor ABO incompatibility‬‬

‫ﻛ ﻴ ﻒ ﺗ ﺤ ﺪ ث ا ﻟ ﻤ ﻀ ﺎﻋ ﻔ ﺎ ت 🤔‬
 ‫ﻧ ﺎ ﺗ ﺠ ﺔ ﻣ ﻦ ا ر ﺗ ﺒ ﺎ ط ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ﻣ ﻊ اﻟ ﻀ ﺪ و ﺗ ﻜ ﻮ ﻳ ﻦ ﻣ ﻌ ﻘ ﺪ ﻣ ﻨ ﺎﻋ ﻲ‬
‫ﻳ ﺘ ﻢ ﺗ ﺤ ﻔ ﻴ ﺰ ﻧ ﻈ ﺎ م ا ﻟ ﻤ ﺘ ﻤ ﻢ ا ﻟ ﺬ ي ﻳﻌ ﻤ ﻞ ﺑ ﺪ و ر ة ﻋ ﻠ ﻰ ﺗ ﺪ ﻣ ﻴ ﺮ ﻛ ﺮ ﻳ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء ‪.‬‬

‫ﻳﺤﺪث ﺗﺤﻠﻞ اﻟﺪم اﻟﺤﺎد ﻓﻲ ﻛﺜﻴﺮ ﻣﻦ اﻟﺤﺎﻻت اﻟﻤﺄﺧﺆذة ﺑﺎﻻﻋﺘﺒﺎر ‪ .‬ﻛﺬﻟﻚ ﻳﺤﺪث ﻓﻲ‬
‫اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ ﻳﻜﻮﻧﻮن ﻏﻴﺮ ﻗﺎدرﻳﻦ ﻋﻠﻰ اﻇﻬﺎر اﻻﻋﺮاض و اﻟﻌﻼﻣﺎت ﻣﺜﻞ ﻓﻲ ﺣﺎﻻت‬
‫‪ ‬اﻻﻏﻤﺎء‬
‫‪ ‬اﻻﻃﻔﺎل و ﺣﺪﻳﺜﻲ اﻟﻮﻻدة‬
‫‪ ‬ﻣﺮﺿﻰ اﻻﻋﺘﻼل اﻟﻌﺼﺒﻲ‬
‫‪ ‬ا ﻟ ﻤ ﺮ ﺿ ﻰ اﻟ ﺬ ﻳ ﻦ ﻫ ﻢ ﺗ ﺤ ﺖ ﺗﺄ ﺛ ﻴ ﺮ ا ﻟ ﻤ ﺨﺪ ر‬
‫‪ ‬ا ﻟ ﻤ ﺮ ﺿ ﻰ ا ﺛ ﻨ ﺎ ء اﻟ ﻌ ﻤﻠ ﻴﺎ ت و ﻓ ﻲ و ﺣﺪ ة ا ﻟ ﻌ ﻨﺎ ﻳ ﺔ اﻟ ﻤ ﺮ ﻛ ﺰ ة و ا ﻟﺬ ﻳ ﻦ ﻫ ﻢ ﺗ ﺤ ﺖ ﺗ ﺄ ﺛ ﻴ ﺮ ا د و ﻳ ﺔ‬
‫ﺗ ﺨ ﻔ ﻲ ا ﻟ ﻬ ﺒ ﻮ ط ﻓ ﻲ ﺿ ﻐ ﻂ د م ا ﻟ ﻤ ﺮﻳ ﺾ ا ﻟ ﻤ ﺘ ﺤ ﺴ ﺲ ﻣ ﻦ ا ﻟﺪ م ‪.‬‬
‫‪ ‬ﺗﺤﺪث ﻫﺬة اﻟﺤﺎﻟﺔ أﻳﻀﺎً ﻋﻨﺪ ﻧﻘﻞ ﺻﻔﺎﺋﺢ دﻣﻮﻳﺔ ﻏﻴﺮ ﻣﺘﻮاﻓﻘﺔ ﺣﺴﺐ ﻧﻈﺎم ‪ ABO‬و‬
‫ﻛ ﻤ ﺎ ﻧ ﻌ ﻠ ﻢ ﻓ ﺈ ن ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ﻳ ﺘ ﻢ ا ﺧ ﺘ ﻴ ﺎ ر ﻫ ﺎ ا ﻋ ﺘﻤ ﺎ د ا ﻋ ﻠ ﻰ ﻋ ﻤ ﺮ ﻫ ﺎ و اﻟ ﺮ ﺻ ﻴ ﺪ ا ﻟ ﻤ ﺘ ﻮ ﻓ ﺮ ﺑ ﻐ ﺾ‬
‫اﻟﻨﻈﺮ ﻋﻦ ﻧﻈﺎم ‪ ABO‬اﻟﺮﺋﻴﺴﻲ او اﻟﺜﺎﻧﻮي ‪.‬‬
‫اﻻﺧﺘﻼف ﻓﻲ اﻟﻔﺼﺎﺋﻞ اﻻﺳﺎﺳﻴﺔ او اﻟﺮﺋﻴﺴﻴﺔ و ﻧﻘﻞ ﺻﻔﺎﺋﺢ دم ﻏﻴﺮ ﻣﺘﻮاﻓﻘﺔ ﻳﻼﺣﻆ إﻧﻪ‬
‫ﻳ ﺼ ﺎ ﺣ ﺐ ﺑ ﺘ ﻌ ﻨ ﺖ ا ر ﺗ ﻔ ﺎ ع ﻣﺴ ﺘ ﻮ ى اﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ﻟ ﺪ ى ا ﻟ ﻤ ﺮ ﻳ ﺾ ) ﺻ ﻌ ﻮ ﺑ ﺔ ز ﻳ ﺎ د ة ﻋ ﺪ د ﻫ ﺎ (‬
‫اﻣﺎ اﻻﺧﺘﻼف ﻓﻲ اﻟﻔﺼﺎﺋﻞ او اﻟﻤﻄﺎﺑﻘﺔ اﻟﺜﺎﻧﻮﻳﺔ ﻓﻬﻮ ﻓﻲ اﻟﻐﺎﻟﺐ ﻳﺆدي اﻟﻰ ﺗﺤﻠﻞ ﻛﺮﻳﺎت‬
‫اﻟﺪم اﻟﺤﻤﺮاء ﻧﺘﻴﺠﺔ ﻧﻘﻞ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ اﻟﻤﺘﻮاﺟﺪة ﻓﻲ اﻟﺒﻼزﻣﺎ او ﻣﻊ اﻟﺼﻔﺎﺋﺢ ‪ .‬و اﻛﺜﺮ‬
‫ﺻ ﻔﺎ ﺋ ﺢ ﺗ ﺴ ﺒ ﺐ ﻫﺬ ة اﻟ ﺤﺎ ﻟ ﺔ ﻫ ﻲ ﺗﻠ ﻚ ا ﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ ﻣ ﻦ ﺷ ﺨ ﺺ ﻓ ﺼ ﻴﻠ ﺔ د ﻣ ﺔ ‪ A‬ا ﻟ ﻰ ﺷ ﺨ ﺺ ﻓ ﺼ ﻴﻠ ﺔ‬
‫دﻣﺔ ‪ . O‬و ﻋﻼوة ﻋﻠﻰ ذﻟﻚ ‪ ،‬ﺗﺸﻴﺮ اﻟﺪراﺳﺎت إن ﻧﻘﻞ اﻟﺼﻔﺎﺋﺢ ﻏﻴﺮ اﻟﻤﺘﻮاﻓﻘﺔ ﻣﻊ اﻟﻤﺮﻳﺾ‬
‫ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ اﺟﺴﺎم ﻣﻀﺎدة ﻟﻜﻦ ﺗﺮﻛﻴﺰﻫﺎ ﻳﻜﻮن ﻏﻴﺮ واﺿﺢ ﻓﻲ ﺑﺪاﻳﺔ اﻻﻣﺮ ﻣﻤﺎ ﻳﺸﻴﺮ ا‬
‫ﻻ إ ﻧﻪ ﻗﺪ ﺗ ﻜ ﻮ ن ﻫ ﻨﺎ ﻟ ﻚ ا ﻟ ﻴ ﺔ ا ﺧ ﺮ ى ا و ﺗ ﺘ ﻜ ﻮ ن ا ﺿﺪ ا د ﺛ ﺎ ﻧ ﻮﻳ ﺔ‬
‫‪subgroup of antibodies‬‬
‫ﻣ ﺘ ﻮ ر ﻃ ﺔ ﻓ ﻲ ﻫﺬة ا ﻟ ﻌ ﻤﻠ ﻴ ﺔ‬
‫ﺗ ﺤ ﻠ ﻞ ا ﻟ ﺪ م ﻧ ﺘ ﻴ ﺠ ﺔ ﻋ ﺪ م ﺗ ﻮ ا ﻓ ﻖ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ﻏ ﻴ ﺮ ﻣﻤ ﻴ ﺰ و ﻫ ﺬ ا ﻧ ﺎ ﺗ ﺞ ﻋ ﻦ ﻗ ﻠ ﺔ اﻟ ﻮﻋ ﻲ ا ﻟ ﻄ ﺒ ﻲ ﻟ ﻬ ﺬ ة‬
‫ا ﻟ ﻤ ﺸﺎ ﻛ ﻞ ا و ﻧ ﺘ ﻴ ﺠ ﺔ ﻋﺪ م ﻇ ﻬ ﻮ ر ا ﻟ ﻌ ﻼ ﻣ ﺎ ت ا ﻟﺪ ا ﻟ ﺔ ﻋﻠ ﻰ ا ﻟ ﺤ ﺎﻟ ﺔ ﻋ ﻨﺪ ﻧ ﻘ ﻞ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ و ﺑﺬ ﻟ ﻚ ﻳ ﺘ ﻢ‬
‫ا ﺳ ﻨ ﺎ د ﻓ ﻘ ﺮ ا ﻟﺪ م ا ﻟ ﺤﺎ ﺻ ﻞ ﻧ ﺘﻴ ﺠ ﺔ ا ﻟﺘ ﺤﻠ ﻞ ﻻ ﺳ ﺒﺎ ب ا ﺧ ﺮ ى‬
‫اﻟﺘﺤﻠﻞ ﻧﺘﻴﺠﺔ ﻧﻘﻞ اﻟﺼﻔﺎﺋﺢ ﻳﺠﺐ ان ﻳﺆﺧﺬ ﺑﻨﻈﺮ اﻻﻋﺘﺒﺎر و ﺧﺎﺻﺔ ﻋﻨﺪ ﻋﺪم وﺟﻮد ﺳﺒﺐ‬
‫و ا ﺿ ﺢ ﻟ ﻬ ﺒ ﻮ ط ﻧ ﺴ ﺒ ﺔ ا ﻟ ﻬ ﻴ ﻤ ﻮﻏ ﻠ ﻮ ﺑ ﻴ ﻦ ﻓ ﻲ ا ﻟ ﺪ م ﺑﻌ ﺪ ﻧ ﻘ ﻞ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ا ﻟ ﻰ ا ﻟ ﻤ ﺮ ﻳ ﺾ‬

‫ا ﻟ ﻤ ﻔﻬ ﻮ م ا ﻟ ﻤ ﺘ ﻘﺪ م‬
‫ﻛﻴﻒ ﻳﺤﺪث ﺗﺤﻠﻞ اﻟﺪم ﻋﻦ ﻃﺮﻳﻖ ﻧﻘﻞ اﻟﺪم؟!‬
‫ﻳ ﺤ ﺪ ث ﻧ ﺘ ﻴ ﺠ ﺔ ﺗ ﻔ ﺎ ﻋ ﻞ اﻟ ﻀ ﺪ ﺑ ﺎ ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ و ﺗ ﻜ ﻮ ﻳ ﻦ ﻣ ﻌ ﻘ ﺪ ﻣ ﻨ ﺎﻋ ﻲ ا ﻟ ﺬ ي ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﺜ ﺒ ﻴ ﺖ ا ﻟ ﻤ ﺘ ﻤ ﻢ‬
‫و ا ﻟ ﺬ ي ﺑ ﺪ و ر ة ﻳﻌ ﻤ ﻞ ﻋ ﻠ ﻰ ﺗ ﻨ ﺸ ﻴ ﻂ ا ﻓ ﺮ اد ا ﻟ ﻤ ﺘ ﻤ ﻢ ا ﻟ ﺨ ﺎ ﻣ ﻠ ﻴ ﻦ و ﺑ ﺎ ﻟ ﺘ ﺎ ﻟ ﻲ ﺣ ﺼ ﻮ ل ﺗ ﺪ ﻣ ﻴ ﺮ ﻟ ﻠ ﺨ ﻼ ﻳ ﺎ‬
‫ا ﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ و ﻳ ﻌ ﺒ ﺮ ﻋ ﻦ ذ ﻟ ﻚ ﻋﻠ ﻰ إ ﻧ ﺔ ا ﺳﺘ ﺠﺎ ﺑ ﺔ ا ﻟﺘ ﻬﺎ ﺑ ﻴ ﺔ ﺟ ﻬﺎ زﻳ ﺔ ﺗ ﺸ ﻤ ﻞ ﻋﺪة ا ﻋ ﻀ ﺎ ء‬
‫ﻣﻦ اﻟﺠﺴﻢ ‪ .‬او ﻳﺘﻢ ذﻟﻚ ﻣﻦ ﺧﻼل اﻟﻄﺮف اﻟﺤﺮ ﻟﻠﻀﺪ و اﻟﺬي ﺳﺮﻋﺎن ﻣﺎ ﻳﺮﺗﺒﻂ ﻣﻊ‬
‫ﻣﺴﺘﻘﺒﻼﺗﺔ اﻟﻤﻮﺟﻮدة ﻋﻠﻰ ﺳﻄﺢ ﺧﻼﻳﺎ اﻟﺒﻠﻌﻤﺔ اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﻄﺤﺎل و ﺑﺎﻟﺘﺎﻟﻲ ازاﻟﺔ ﻛﺮﻳﺎت‬
‫ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء ا ﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ و ا ﻟ ﻐ ﻴ ﺮ ﻣ ﺘ ﻮ ا ﻓ ﻘ ﺔ ﻣ ﻊ د م ا ﻟﻤ ﺮ ﻳ ﺾ ﻣ ﻦ اﻟ ﻮﻋ ﺎ ء ا ﻟ ﺪ ﻣ ﻮ ي‬
 ‫ﺑﺸ ﻜ ﻞ ﻋ ﺎ م‬
‫ﻓﺈن اﻟﺘﺤﻠﻞ اﻟﺤﺎد ﻧﺎﺗﺞ ﻋﻦ وﺟﻮد اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﻧﻮع ‪ IgM‬اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﺗﺤﻠﻞ ﻛﺮﻳﺎت‬
‫اﻟﺪم اﻟﺤﻤﺮاء داﺧﻞ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﻣﻦ ﺧﻼل ﺗﺜﺒﻴﺖ اﻟﻤﺘﻤﻢ‬
‫اﻣﺎ اﻟﺘﺤﻠﻞ اﻟﻤﺘﺄﺧﺮ ﻫﻮ ﻧﺎﺗﺞ ﻋﻦ وﺟﻮد اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﻧﻮع ‪ IgG‬و اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﺤﻠﻞ‬
‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء ﺧﺎرج اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ) ﻓﻲ اﻟﻜﺒﺪ و اﻟﻄﺤﺎل ( ﻣﻦ ﺧﻼل وﺟﻮد‬
‫ﻣﺴﺘﻘﺒﻼت ﻫﺬا اﻟﻨﻮع ﻋﻠﻰ ﺳﻄﺢ ﺧﻼﻳﺎ اﻻﻟﺘﻬﺎم او اﻟﺒﻠﻌﻤﺔ‬
‫ﻓﻲ اﻟﺤﻘﻴﻘﻴﺔ ﻳﺘﻢ ﺗﻔﻌﻴﻞ اﻟﻄﺮﻳﻘﻴﻦ اﻻول و اﻟﺜﺎﻧﻲ ﻟﻜﻦ ﺑﺪرﺟﺎت ﻣﺨﺘﻠﻔﺔ ‪ .‬و ﻣﻤﺎ ﻳﺜﻴﺮ اﻻ‬
‫ﻫﺘﻤﺎم إن اﻟﺘﺤﻠﻞ ﻳﻨﺘﺞ ﻋﻨﻪ ﺗﻜﻮﻳﻦ اوﺳﺎط ﻣﺎ ﻗﺒﻞ اﻻﻟﺘﻬﺎب ‪pro inflammatory‬‬
‫‪ mediators‬و اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﻇﻬﻮر ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻﻋﺮاض و اﻟﻌﻼﻣﺎت اﻟﺘﻲ ﻧﻼﺣﻈﻬﺎ ﻋﻦ‬
‫اﻟﻤﺮﻳﺾ اﻟﻤﻨﻘﻮﻟﻪ اﻟﻴﺔ اﻟﺪم ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ذﻟﻚ ﻓﺈن اﻟﺘﺮاﺑﻂ ﺑﻴﻦ اﻟﻄﺮﻳﻘﻴﻦ ﻣﻌﻘﺪ ﺑﺸﻜﻞ ﻛﺒﻴﺮ‬
‫ﻳﻨﺘﺞ ﻋﻨﻪ اﺳﺘﺠﺎﺑﺔ ﻧﻬﺎﻳﺘﻬﺎ ﺗﺤﻠﻞ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء اﻟﻤﻨﻘﻮﻟﺔ ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ﺗﻔﺎﻗﻢ اﻟﺤﺎﻟﺔ‬
‫ا ﻟ ﺼ ﺤ ﻴ ﺔ ﻟﻠ ﻤ ﺮﻳ ﺾ ‪.‬‬

‫ﻓ ﻬ ﻢ ا ﻟ ﻔ ﺴ ﻴ ﻮ ﻟ ﻮ ﺟ ﻴﺎ ا ﻟ ﻤ ﺮ ﺿ ﻴ ﺔ ﻟ ﻬﺬ ة اﻟ ﺤﺎ ﻟ ﺔ ﻳ ﻤ ﺜ ﻼ ﺗ ﺤﺪ ﻳ ﺎ ً ﻛ ﺒ ﻴ ﺮ ا ً ﺣ ﺴ ﺐ ا ﻟ ﺘ ﺒﺎ ﻳ ﻦ ا ﻟ ﻤﻠ ﺤ ﻮ ظ ﺑ ﻴ ﻦ ﺷﺪ ة‬
‫اﻻﻧﺤﻼل اﻟﺪﻣﻮي و اﻟﻌﻼﻣﺎت اﻟﺴﺮﻳﺮﻳﺔ اﻟﻮاﺿﺤﺔ ﻋﻠﻰ اﻟﻤﺮﻳﺾ ﻓﻲ ﺣﺎل ﻧﻘﻞ دم ﻏﻴﺮ‬
‫ﻣﺘﻮاﻓﻖ ‪ .‬اﻟﻤﺨﺘﺒﺮات ﺗﺮﻛﺰ ﻋﻠﻰ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﺑﺎﻟﺨﺼﻮص ‪ IgM‬و ‪ IgG‬ﻟﻜﻦ‬
‫ا ﻟ ﻐ ﻠ ﻮ ﺑ ﻴ ﻮ ﻟ ﻴ ﻨ ﺎ ت ا ﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ ا ﻟ ﺒ ﺸ ﺮ ﻳ ﺔ ا ﻛ ﺜ ﺮ ﺗ ﻌ ﻘ ﻴ ﺪ ا ً و ﺗ ﻨ ﻮﻋ ﺎ ً ﻣ ﻦ ذ ﻟ ﻚ ‪ .‬ﻋ ﻠ ﻰ ﺳ ﺒ ﻴ ﻞ ا ﻟ ﻤ ﺜ ﺎ ل ﺗ ﻮ ﺟ ﺪ‬
‫ﻣﺠﺎﻣﻴﻊ ﻓﺮﻋﻴﺔ ﻛﺜﻴﺮة ﻟﻠﻀﺪ ‪ IgG‬و ﻛﻞ واﺣﺪ ﻣﻨﻬﺎ ﻳﺨﺘﻠﻒ ﻓﻲ ﻣﺪى ﻗﻮة ارﺗﺒﺎﻃﺔ اﻟﻰ‬
‫ﻣ ﺴ ﺘ ﻘ ﺒ ﻼ ﺗ ﺔ ﻋ ﻠ ﻰ ﺳ ﻄ ﺢ اﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟﻤ ﻨ ﺎﻋ ﻴ ﺔ و ﻗ ﻮ ة ا ر ﺗ ﺒ ﺎ ﻃ ﺔ ا ﻟ ﻰ ا ﻟ ﻤﺴ ﺘ ﻀ ﺪ و ﻛ ﺬ ﻟ ﻚ ﻳ ﺨ ﺘ ﻠ ﻒ ﻓ ﻲ‬
‫ﻣﺪى ﻗﺪرﺗﺔ ﻋﻠﻰ ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ ‪ .‬و ﺗﻮﺟﺪ ‪ 6‬اﻧﻮاع ﻣﻦ اﻟﻤﺴﺘﻘﺒﻼت اﻟﺨﺎﺻﺔ ﺑﻬﺬا‬
‫اﻟﻨﻮع ﻣﻦ اﻻﺿﺪاد و ﺗﺨﺘﻠﻒ ﻓﻲ ﻣﺪى ﻗﻮة ﺟﺬﺑﻬﺎ ﻟﻠﻀﺪ اﻟﻰ ﺳﻄﺢ اﻟﺨﻠﻴﺔ اﻟﻤﻨﺎﻋﻴﺔ و ﻣﺪى‬
‫ﺗﺄ ﺛﻴ ﺮ ﻫ ﺎ ﻋﻠ ﻰ ا ﻟ ﺨﻠ ﻴ ﺔ ) ﺗ ﺨ ﻔ ﻴ ﺰ ا و ﺗ ﺜ ﺒ ﻴ ﻂ (‬
‫ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ وﺟﻮد ﻣﺰﻳﺞ ﻣﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻓﻲ ﻣﺼﻞ اﻟﻤﺮﻳﺾ اﻻ أﻧﻨﺎ ﻧﺸﺎﻫﺪ ﻧﻮع او‬
‫ﻧ ﻮﻋ ﻴ ﻦ ﻫ ﻲ ا ﻟ ﺸ ﺎ ﺋﻌ ﺔ ‪ .‬و ﻟ ﺬ ﻟ ﻚ ﻓ ﺈ ن ﻛ ﺮ ﻳ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﻐ ﻴ ﺮ ﻣ ﺘ ﻮ ا ﻓ ﻘ ﺔ ﻳ ﺠ ﺐ ا ن ﺗ ﺤ ﺎ ط ا و ﺗ ﺘ ﺤ ﺴ ﺲ‬
‫ﺑﻮاﺳﻄﺔ ﻫﺬة اﻻﺿﺪاد اﻟﺘﻲ ﺑﺸﻜﻞ ﺿﻌﻴﻒ ﺗﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ او ﺗﺮﺗﺒﻂ اﻟﻰ‬
‫ﻣﺴﺘﻘﺒﻼﺗﻬﺎ ﻓﺘﺜﺒﻂ اﻟﺨﻼﻳﺎ اﻟﻤﻨﺎﻋﻴﺔ او ﺗﻨﺸﻄﻬﺎ ‪ .‬ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ذﻟﻚ ﻫﻨﺎﻟﻚ ﺗﻨﻮع ﻛﺒﻴﺮ ﻓﻲ‬
‫ا ﻟ ﻤ ﺴ ﺘ ﻀﺪ ا ت ا ﻟ ﻤ ﻮ ﺟ ﻮ د ه ﻋﻠ ﻰ ﺳ ﻄ ﺢ ﻛ ﺮ ﻳﺎ ت ا ﻟﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء ﻓ ﻲ ا ﻟ ﺸ ﺨ ﺺ ﻧ ﻔ ﺴ ﻪ و ﻛ ﺬﻟ ﻚ ﻓ ﻲ‬
‫اﻟ ﺘ ﺠ ﻤ ﻌﺎ ت اﻟ ﺒ ﺸ ﺮ ﻳ ﺔ ا ﻟ ﻤ ﺨ ﺘﻠ ﻔ ﺔ‬
‫ﻓﻲ اﻟﻨﻬﺎﻳﺔ اﻟﻄﺮﻳﻖ اﻟﺬي ﻳﺆدي اﻟﻰ ازاﻟﺔ اﻻﺳﺘﺠﺎﺑﺔ اﻻﻟﺘﻬﺎﺑﻴﺔ ﻳﻈﻬﺮ اﻟﻜﺜﻴﺮ ﻣﻦ اﻟﺘﻨﻮع‬
‫اﻟﻮﻇﻴﻔﻲ و اﻟﺠﻴﻨﻲ اﻟﺬي ﻳﺆﺛﺮ ﻋﻠﻰ اﻻﻋﺮاض اﻟﻈﺎﻫﺮة ﻋﻠﻰ اﻟﻤﺮﻳﺾ اﻟﻤﻨﻘﻮل اﻟﺪم اﻟﻴﺔ‬

‫ا ﻟ ﺨ ﻄ ﻮ ا ت ا ﻟ ﻼ ﺣ ﻘ ﺔ ﻟﻠ ﺘ ﺤﻠ ﻞ اﻟ ﺘ ﻲ ﺗ ﻮ ﻟﺪ ا ﺳ ﺘ ﺠﺎ ﺑ ﺔ ا ﻟ ﺘ ﻬ ﺎ ﺑ ﻴ ﺔ ﺟ ﻬﺎ ز ﻳ ﺔ ﺗﻠ ﻌ ﺐ د و ر ﻛ ﺒ ﻴ ﺮ ﻓ ﻲ ﻣ ﻈ ﻬ ﺮ و‬
‫ﺷ ﺪ ة اﻟ ﻌ ﻼ ﻣ ﺎ ت ا ﻟ ﺴ ﺮ ﻳ ﺮ ﻳ ﺔ ﻋ ﻠ ﻰ اﻟ ﻤ ﺮ ﻳ ﺾ ‪ .‬ﺑ ﻌ ﺪ ﺗ ﺤ ﻠ ﻞ ﻛ ﺮ ﻳ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء د ا ﺧ ﻞ ا ﻟ ﻮﻋ ﺎ ء‬
‫اﻟ ﺪ ﻣ ﻮ ي ﻳ ﺮ ﺗ ﺒ ﻂ ا ﻟ ﻬ ﺎ ﺑ ﺘ ﻮ ﻏ ﻠ ﻮ ﺑ ﻴ ﻮﻟ ﻴ ﻦ ﺑ ﻘ ﻮ ة ﻣ ﻊ اﻟ ﻬ ﻴ ﻤ ﻮﻏ ﻠ ﻮ ﺑ ﻴ ﻮ ﻟ ﻴ ﻦ و ﻳ ﺘ ﻜ ﻮ ن ﻣ ﻌ ﻘ ﺪ ا ﻟ ﺬ ي ﺳ ﺮ ﻋ ﺎ ن ﻣ ﺎ‬
‫ﻳﺮﺗﺒﻂ ﻣﻊ ‪ CD 163‬اﻟﻤﻮﺟﻮد ﻋﻠﻰ ﺳﻄﺢ ﺧﻼﻳﺎ اﻟﻤﻮﻧﻮﺳﺎﻳﺖ و ﺧﻼﻳﺎ اﻟﻤﺎﻛﺮوﻓﻴﺞ و ﻫﺬا اﻻ‬
‫ر ﺗ ﺒ ﺎ ط ﻳ ﺤ ﻔ ﺰ ﺑ ﺪ ء ﺗ ﺤ ﻄ ﻴ ﻢ ا ﻟ ﻬ ﻴﻤ ﻮﻏ ﻠ ﻮ ﺑ ﻴ ﻮ ﻟ ﻴ ﻦ ‪ .‬و ﻟ ﺴ ﻮ ء ا ﻟ ﺤ ﻆ ﺳ ﺮﻋ ﺎ ن ﻣ ﺎ ﻳ ﻨ ﺨ ﻔ ﺾ‬
‫ا ﻟ ﻬ ﺎ ﺑ ﺘ ﻮﻏ ﻠ ﻮ ﺑ ﻴ ﻮ ﻟ ﻴ ﻦ ﺣ ﺘ ﻰ ﻟ ﻮ ﻛ ﺎ ن ا ﻟ ﺘ ﺤ ﻠ ﻞ ﻣ ﺘ ﻮ ﺳ ﻂ ا ﻟ ﺸ ﺪ ة ‪ .‬و ﻟ ﺬ ﻟ ﻚ ﻳ ﻈ ﻬ ﺮ ا ﻟ ﻬ ﻴﻤ ﻮﻏ ﻠ ﻮ ﺑ ﻴ ﻮ ﻟ ﻴ ﻦ ا ﻟ ﺤ ﺮ‬
‫ﻓﻲ اﻟﺒﻼزﻣﺎ ﻣﻤﺎ ﻳﻌﻄﻴﻬﺎ اﻟﻠﻮن اﻻﺣﻤﺮ ﺑﻌﺪ اﻧﺤﻼل اﻟﺪم )‪ (hemoglobinemia‬و ﻟﻮن‬
‫ﺑﻨﻔﺴﺠﻲ اﻟﻰ اﺣﻤﺮ ﻓﻲ اﻟﺒﻮل )‪ . (hemoglobinuria‬اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ اﻟﺤﺮ ﻳﺴﺒﺐ اﻟﻌﺪﻳﺪ ﻣﻦ‬
‫اﻟﺘﺄﺛﻴﺮات ﻋﻠﻰ ﺧﻼﻳﺎ اﻟﺪم و اﻟﺨﻼﻳﺎ اﻟﻤﺒﻄﻨﺔ ﻟﻠﻮﻋﺎء اﻟﺪﻣﻮي و اﻟﺬي ﻳﺴﺒﺐ ﻧﺸﻮء و ﺑﺪء اﻻ‬
‫ﺳﺘﺠﺎﺑﺔ اﻻﻟﺘﻬﺎﺑﻴﺔ ‪ .‬ﻛﺬﻟﻚ ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ ﻋﻦ ﻃﺮﻳﻖ اﻟﻤﺴﺘﻘﺒﻼت ﻳﺤﻔﺰ اﻧﺘﺎج اوﺳﺎط ﻣﺎ ﻗﺒﻞ‬
‫اﻻﻟﺘﻬﺎب و ﺗﺴﻤﻰ اﻻﺳﺘﺠﺎﺑﺔ اﻻﻟﺘﻬﺎﺑﻴﺔ ﻟﻨﻘﻞ اﻟﺪم و اﻟﺘﻲ ﺗﻌﻄﻲ اﻟﻤﻈﺎﻫﺮ اﻟﺴﺮﻳﺮﻳﺔ اﻟﻮاﺿﺤﺔ‬
‫ﻋﻠ ﻰ ا ﻟ ﻤ ﺮﻳ ﺾ‬
 ‫‪‬‬ ‫) ‪Delayed Hemolytic and Serologic Transfusion Reaction ( DHTR‬‬
‫و اول دﻻﻟﺔ ﻫﻲ ﻓﺤﺺ ﻛﻮﻣﺒﺲ اﻟﻤﺒﺎﺷﺮ ﺣﻴﺚ ﻳﻜﻮن اﻳﺠﺎﺑﻲ ﺧﻼل ‪ 24‬ﺳﺎﻋﺔ اﻟﻰ ‪ 28‬ﻳﻮم‬
‫ﻣ ﻦ ا ﻟ ﺘﻌ ﺮ ض ا ﻟ ﻰ ا ﻟ ﺪ م ا ﻟ ﻐ ﺮ ﻳ ﺐ ‪ .‬و ا ﻟ ﺪ ﻟ ﻴ ﻞ ﻋ ﻠ ﻰ ا ﻟ ﺘ ﺤ ﻠ ﻞ ﻫ ﻮ ﻋ ﺪ م ﺻ ﻌ ﻮ د ﻧ ﺴ ﺒ ﺔ ا ﻟ ﻬ ﻴ ﻤ ﻮ ﻏ ﻠ ﻮ ﺑ ﻴ ﻦ ﺑ ﻌ ﺪ‬
‫ﻧ ﻘ ﻞ اﻟ ﺪ م ‪ .‬ا ﻟ ﻬ ﺒ ﻮ ط ا ﻟ ﺴ ﺮ ﻳ ﻊ ﻟ ﻤ ﺴ ﺘ ﻮ ى ا ﻟ ﻬ ﻴ ﻤ ﻮﻏ ﻠ ﻮ ﺑ ﻴ ﻦ ا د ﻧ ﻰ ﻣ ﻦ ا ﻟ ﻤ ﻌ ﺪ ل ا ﻟ ﺬ ي ﻛ ﺎ ن ﻋ ﻠ ﻴ ﺔ ﻗ ﺒ ﻞ ا ﻋ ﻄ ﺎ ء‬
‫اﻟﺪم ‪ .‬ﻇﻬﻮر اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎوﻳﺔ اﻟﺸﻜﻞ ‪ spherocytes‬ﻓﻲ ﻣﺴﺤﺔ اﻟﺪم اﻟﻤﺤﻴﻄﻲ‬
‫ﻫ ﻨ ﺎ ﻟ ﻚ ﺗﺴ ﻤ ﻴ ﺔ ا ﺧ ﺮ ى ﺗ ﻄ ﻠ ﻖ ﻋ ﻠ ﻰ ا ﻟ ﺤ ﺎ ﻟ ﺔ و ﻫ ﻲ‬
‫)‪Delayed serologic transfusion reaction (DSTR‬‬
‫و ﻫﻲ ﻧﻔﺲ اﻟﻌﻼﻣﺎت اﻟﺴﻴﺮوﻟﻮﺟﻴﺔ ﻟﻜﻦ ﻻ وﺟﻮد ﻟﻌﻼﻣﺎت داﻟﺔ ﻋﻠﻰ ﺗﺤﻠﻞ اﻟﺪم ‪ .‬اﻏﻠﺐ اﻟﺤﺎﻻ‬
‫ت ﺗﻈﻬﺮ ﻋﻠﻴﻬﺎ اﻻﻋﺮاض ﻓﻲ ‪ 10-7‬اﻳﺎم ﺑﻌﺪ اﻋﻄﺎء اﻟﺪم و ﺧﺎﺻﺔ ﺑﻌﺪ اﻋﻄﺎء اﻟﺪم ﻟﻠﻌﻤﻠﻴﺎت‬
‫اﻟﺠﺮاﺣﻴﺔ ﺣﻴﺚ ﻳﻜﻮن ﻓﻘﺮ اﻟﺪم ﻏﻴﺮ ﻣﺘﻮﻗﻊ ﻻﻧﻨﺎ ﻧﺸﻚ ﻓﻲ اﺣﺘﻤﺎﻻت اﺧﺮى ﻏﻴﺮ اﻟﺘﺤﺴﺲ ﻣﻦ‬
‫اﻟﺪم اﻟﻤﻨﻘﻮل ﻣﺜﻞ ) اﻟﻨﺰﻳﻒ اﺛﻨﺎء اﻟﻌﻤﻠﻴﺔ ‪..........‬اﻟﺦ ( ‪ .‬و رﺑﻤﺎ ﻻ ﺗﻠﻘﻰ اﻟﺘﺤﺎﻟﻴﻞ اﻟﻤﺨﺘﺒﺮﻳﺔ‬
‫ا ﻫ ﺘ ﻤ ﺎ م ﻣ ﻦ ا ﻟ ﻄ ﺒ ﻴ ﺐ ا ﻟﻤ ﻌ ﺎﻟ ﺞ ا و ﻗ ﺪ ﺗ ﻜ ﻮ ن ﻏ ﻴ ﺮ ﻛ ﺎ ﻣ ﻠ ﺔ ﻟ ﺬ ﻟ ﻚ ﺗ ﻬ ﻤ ﻞ ‪ .‬و ﻟ ﺬ ﻟ ﻚ ﺗ ﺸ ﺨ ﻴ ﺺ ﻫ ﺬ ة ا ﻟ ﺤ ﺎﻟ ﺔ‬
‫ﻣ ﻦ ا ﻟ ﻤ ﺤ ﺘ ﻤ ﻞ ﺟ ﺪ ا ً إ ن ﻳ ﺘ ﺮ ك ﻃ ﻲ ا ﻟ ﻨ ﺴ ﻴ ﺎ ن ا ﻟ ﻰ ﺣ ﻴ ﻦ ﻇ ﻬ ﻮ ر ﻣ ﻀ ﺎ ﻋ ﻔ ﺎ ت اﻛ ﺒ ﺮ ﻋ ﻠ ﻰ ا ﻟ ﻤ ﺮ ﻳ ﺾ ‪.‬‬

‫ا ﻟ ﻤ ﻔﻬ ﻮ م ا ﻟ ﻤ ﺘ ﻘﺪ م‬
‫ﻳ ﻌ ﺘ ﺒ ﺮ ﺗ ﺤ ﻠ ﻞ ا ﻟ ﺪ م ا ﻟ ﻤ ﺘ ﺄ ﺧ ﺮ و ا ﺣ ﺪ ﻣ ﻦ ا ﻫ ﻢ ا ﻟ ﻤ ﺸ ﺎﻛ ﻞ ا ﻟ ﺘ ﻲ ﺗ ﻮ ا ﺟ ﺔ ﻣ ﺮ ﺿ ﻰ ﻓ ﻘ ﺮ ا ﻟ ﺪ م ا ﻟ ﻤ ﻨ ﺠ ﻠ ﻲ و‬
‫ا ﻟ ﻤ ﺮ ﺿ ﻰ اﻟ ﺬ ﻳ ﻦ ﻳ ﻨ ﻘ ﻠ ﻮ ن ا ﻟ ﺪ م ﺑ ﺎ ﺳ ﺘ ﻤ ﺮ ا ر ‪ .‬ﻟ ﺬ ﻟ ﻚ ﻓ ﺈ ن اﻟ ﻤ ﺸ ﻜ ﻠ ﺔ ﺗ ﺤ ﺘ ﺎ ج ر ﻋ ﺎ ﻳ ﺔ ﻣ ﺴ ﺘﻤ ﺮ ة ﻣ ﻦ ﻗ ﺒ ﻞ‬
‫ا ﻟ ﻤ ﺴ ﺘ ﺸ ﻔ ﻰ و ا ﻟﻌ ﻴ ﺎد ا ت ا ﻟ ﺨ ﺎ ر ﺟ ﻴ ﺔ ‪ .‬و ﻗ ﺮ أ ة ﻛ ﺎ ﻣ ﻠ ﺔ ﻟ ﻠﻤ ﺮ ض و ا ﺟ ﺮ ا ء ﻓ ﺤ ﺺ ا ﻟﻤ ﻄ ﺎ ﺑ ﻘ ﺔ ا ﻟ ﺘ ﺎ م ﺑ ﻴ ﻦ‬
‫اﻟﻮاﻫﺐ و اﻟﻤﺴﺘﻠﻢ ﻋﻠﻰ ﺣﺴﺎب اﻟﻄﺮز اﻟﻤﻈﻬﺮﻳﺔ ‪ .‬ﺗﻜﻮن ﻓﺮص ﻧﺠﺎة اﻻﺷﺨﺎص اﻟﻤﺼﺎﺑﻴﻦ‬
‫ﺑﻔﻘﺮ اﻟﺪم اﻟﻤﻨﺠﻠﻲ اﻗﻞ ﻣﻘﺎرﻧﺔ ﺑﺎﻻﺷﺨﺎص اﻟﺬﻳﻦ ﻻ ﺗﺘﻜﻮن ﻟﺪﻳﻬﻢ اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ‪ .‬و ﻫﺬا‬
‫ﻧﺎﺗﺞ ﻣﻦ ﺗﻜﻮﻳﻦ اﻻوﺳﺎط ﻣﺎ ﻗﺒﻞ اﻻﻟﺘﻬﺎب ﺑﺸﻜﻞ ﺟﻠﻲ ﻟﺪى ﻫﻮﻻء اﻻﺷﺨﺎص ‪.‬‬
‫اﻫﻢ اﻻﻋﺮاض اﻟﺘﻲ ﺗﻈﻬﺮ ﻋﻠﻰ اﻟﻤﺮﻳﺾ ﻫﻲ وﺟﻮد اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ﻓﻲ اﻟﺒﻮل ‪ .‬ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ا‬
‫ﻻﻟﻢ و ﻣﺘﻼزﻣﺔ اﻟﺼﺪر اﻟﺤﺎدة ‪ .‬ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ذﻟﻚ ﻓﺈن اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ ﻳﺤﻤﻠﻮن اﻟﻔﺼﺎﺋﻞ‬
‫اﻟﺴﺎﻟﺒﺔ ﻳﻜﻮﻧﻮن اﻛﺜﺮ ﻋﺮﺿﻪ ﻟﺘﻜﻮﻳﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ اﻟﺘﻲ ﺗﺰﻳﺪ ﻣﻦ اﺿﻄﺮاب اﻟﺤﺎﻟﺔ ‪.‬‬
‫اﻟﺘﺤﻠﻴﻞ اﻟﺠﺰﻳﺌﻲ ﻟﻠﻄﺮاز اﻟﺠﻴﻨﻲ اﻟﺨﺎص ﺑﺎﻟﻤﺮﻳﺾ ﻳﺠﺐ ان ﻳﺆﺧﺬ ﺑﻨﻈﺮ اﻻﻋﺘﺒﺎر ﻟﺘﺤﺪﻳﺪ اﻻ‬
‫ﺧﺘﻼف او اﻟﻤﺴﺘﻀﺪ اﻟﺠﺰﻳﺌﻲ ﻣﺜﻞ‬
‫‪D, c, E, and U‬‬
‫و ﻟﺬﻟﻚ ﻳﺠﺐ ﺗﻘﻴﻴﺪ ﻋﻤﻠﻴﺎت ﻧﻘﻞ اﻟﺪم ﻟﻬﻮﻻء اﻻﺷﺨﺎص ﺑﺸﻜﻞ ﻛﺒﻴﺮ‬
‫ﻻﻧﻪ ﻣﻦ اﻟﺼﻌﺐ اﻟﺤﺼﻮل ﻋﻠﻰ دم ﻣﺘﻮاﻓﻖ ﻟﻬﻢ ﺑﻨﺴﺒﺔ ‪ %100‬ﺑﺴﺒﺐ اﻻﺧﺘﻼف اﻟﻜﺒﻴﺮ ﻓﻲ‬
‫ا ﻟﻤ ﺴ ﺘ ﻀ ﺪ ا ت ‪.‬‬

‫اﻻﺷﺨﺎص اﻟﻤﺼﺎﺑﻴﻦ ﺑﻔﻘﺮ اﻟﺪم اﻟﻤﻨﺠﻠﻲ ﻳﻜﻮﻧﻮن اﻗﻞ ﻋﺮﺿﺔ ﻟﺤﺼﻮل ﻣﺘﻼزﻣﺔ ﺗﺤﻠﻞ اﻟﺪم‬
‫اﻟﻌﺎﻟﻲ ‪ hyperhemolysis syndrome‬و اﻟﺘﻲ ﺗﻢ ﺗﺴﺠﻴﻠﻬﺎ ﻓﻲ ﻇﺮوف اﺧﺮى ﻣﻨﻬﺎ‬
‫‪ thalassemia‬‬
‫‪ myelofibrosis‬‬
‫‪ lymphoma‬‬
‫و ﻟﺬ ﻟ ﻚ ﻓ ﻬ ﻲ اﻛﺜ ﺮ ﺿ ﺮ ا وة و ﻗﺪ ﺗ ﻜ ﻮ ن ﻗ ﺎ ﺗﻠ ﺔ ﻟ ﻮ ﺣ ﺪﺛ ﺖ ﻟﺪ ى ﻣ ﺮﻳ ﺾ ﻓ ﻘ ﺮ ا ﻟﺪ م ا ﻟ ﻤ ﻨ ﺠﻠ ﻲ ‪ .‬و‬
‫ﺗﺘﻄﻮر ﺧﻼل‪ 10 -7‬اﻳﺎم ﺑﻌﺪ اﻋﻄﺎء اﻟﺪم‬
 ‫و ﺗ ﻈ ﻬ ﺮ ا ﻟ ﻌ ﻼ ﻣ ﺎ ت ا ﻟ ﺪ ا ﻟ ﺔ ﻋ ﻠ ﻰ ﺗ ﺤ ﻠ ﻞ ﻛ ﺮ ﻳ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء د ا ﺧ ﻞ ا ﻟ ﻮﻋ ﺎ ء ا ﻟ ﺪ ﻣ ﻮ ي ‪ .‬ﻣ ﺜ ﻞ‬
‫‪ ‬اﻧﻐﻼق اﻟﻮﻋﺎء اﻟﺪﻣﻮي اﻟﻤﺆﻟﻢ‬
‫‪ ‬ﻓ ﻘ ﺮ د م ﺣﺎ د‬
‫‪ ‬ﻧﻘﺼﺎن اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ اﻗﻞ ﻣﻦ اﻟﻤﻌﺪل اﻟﺬي ﻛﺎن ﻋﻠﻴﺔ ﻗﺒﻞ اﻻﻋﻄﺎء‬
‫و ﻣﻦ اﻟﺠﺪﻳﺮ ﺑﺎﻟﺬﻛﺮ ﻓﺈن ﻓﺤﺺ اﻟﻐﻠﻮﺑﻴﻮﻟﻴﻦ اﻟﻤﺒﺎﺷﺮ ﻗﺪ ﻳﻜﻮن ﺳﻠﺒﻲ ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت‬
‫رﻏﻢ وﺟﻮد اﻻﻋﺮاض اﻟﺪاﻟﺔ ﻋﻠﻰ اﻟﺘﺤﻠﻞ ‪ .‬و ﻳﻤﻜﻦ ﻣﻌﺮﻓﺔ اﻟﺘﺤﻠﻞ ﻓﻲ ﻛﺮﻳﺎت دم اﻟﻮاﻫﺐ و‬
‫اﻟﻤﺴﺘﻠﻢ ﻣﻦ ﺧﻼل اﻟﺘﺮﺣﻴﻞ اﻟﻜﻬﺮﺑﺎﺋﻲ ﻟﻠﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ‪.‬‬
‫اﻟﻴﺔ اﻻﻣﺮاﺿﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻤﺘﻼزﻣﺔ ﺗﺤﻠﻞ اﻟﺪم اﻟﻌﺎﻟﻲ ﻏﻴﺮ ﻣﻔﻬﻮﻣﺔ ﺑﺸﻜﻞ واﺿﺢ ﻟﻜﻦ ﻫﻨﺎﻟﻚ‬
‫ا ﻟ ﻌ ﺪ ﻳ ﺪ ﻣ ﻦ ا ﻟ ﻤ ﻴ ﻜ ﺎ ﻧ ﻴ ﻜ ﻴ ﺎ ت ا ﻟ ﺘ ﻲ ﺗ ﻤ ﺎ ﺛ ﻠ ﻬ ﺎ ‪ .‬ﻣ ﺜ ﻞ اﻟ ﺘ ﺤ ﻠ ﻞ ا ﻟ ﻌ ﺎ ﺑ ﺮ ﻧ ﺘ ﻴ ﺠ ﺔ ﺗ ﻔ ﻌ ﻴ ﻞ ا ﻟﻤ ﺘ ﻤ ﻢ و ا ﻟ ﺬ ي ﻳ ﺰ ﻳ ﺪ‬
‫ﻣﻦ ﺗﺤﻄﻴﻢ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء ﻣﻦ ﺧﻼل ﺧﻼﻳﺎ اﻟﻤﺎﻛﺮوﻓﻴﺞ ‪ .‬ﻛﺬﻟﻚ ﻳﺰﻳﺪ ﻣﻦ اﻟﻤﻮت‬
‫اﻟﻤﺒﺮﻣﺞ ﻟﺨﻼﻳﺎ اﻟﺪم اﻟﺤﻤﺮاء ﺑﻤﺎ ﻳﺴﻤﻰ ‪ eryptosis‬ﺑﺴﺒﺐ زﻳﺎدة ﺗﺮﻛﻴﺰ اوﺳﺎط ﻣﺎ ﻗﺒﻞ اﻻ‬
‫ﻟ ﺘ ﻬﺎ ب ﺑ ﺸ ﻜ ﻞ ﻛ ﺒ ﻴ ﺮ ‪ .‬ﻧ ﻘ ﻞ اﻟ ﺪ م ﻳ ﺠ ﺐ ا ن ﻳ ﺘ ﻢ ا ﻳ ﻘ ﺎ ﻓ ﺔ ﻻ ﻧ ﻪ ﻳ ﺰ ﻳ ﺪ ﻣ ﻦ ﻣ ﺸ ﻜﻠ ﺔ ﺗ ﺤﻠ ﻞ ا ﻟ ﻜ ﺮ ﻳ ﺎ ت‬

‫‪‬‬ ‫)‪Transfusion-Related Acute Lung Injury (TRALI‬‬

‫ﻫﻲ ﺣﺎﻻت ﻧﺎدرة اﻟﺤﺪوث ﺗﺘﻤﻴﺰ ﺑﻀﻴﻖ اﻟﻨﻔﺲ اﻟﺤﺎد اﻟﺬي ﻳﺆدي اﻟﻰ ﻣﻌﺪل وﻓﻴﺎت ﺟﺪاً ﻋ‬
‫ﺎﻟﻲ ﻧﺘﻴﺠﺔ اﻟﺨﻄﺄ ﻓﻲ ﻧﻘﻞ اﻟﺪم ‪ .‬و ﻻ ﺗﻮﺟﺪ اﺧﺘﺒﺎرات ﻟﺘﺤﺪﻳﺪ اﻻﺳﺒﺎب و اﻧﻤﺎ ﻳﺘﻢ اﻻ‬
‫ﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻌﻼﻣﺎت و اﻻﻋﺮاض اﻟﺴﺮﻳﺮﻳﺔ ﻟﻠﺤﺎﻟﺔ اﻟﻤﺮﺿﻴﺔ ‪.‬‬
‫ﻓﻲ اﻟﺨﻼﺻﺔ ﺣﺘﻰ ﻧﻘﻮل إن اﻟﻤﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ﻫﺬة اﻟﺤﺎﻟﺔ ﻳﺠﺐ ﺗﻮﻓﺮ ﻣﺎ ﻳﻠﻲ ﻋﻠﻴﺔ ‪-:‬‬
‫‪ ‬ﻋ ﺪ م و ﺟ ﻮ د ﺿ ﺮ ر ﺗ ﻨ ﻔﺴ ﻲ ﺣ ﺎ د ﺳ ﺎ ﺑ ﻖ‬
‫‪ ‬ﻳﺠﺐ ﺣﺪوث اﻟﺤﺎﻟﻪ ﺧﻼل ‪ 6‬ﺳﺎﻋﺎت ﺑﻌﺪ اﻋﻄﺎء اﻟﺪم‬
‫‪ ‬دﻟﻴﻞ ﻣﺨﺘﺒﺮي ﻋﻠﻰ ﻧﻘﺺ اﻻوﻛﺴﺠﻴﻦ ﻓﻲ اﻟﺪم‬
‫‪ ‬د ﻟ ﻴ ﻞ ﺷ ﻌ ﺎ ﻋ ﻲ ﻋ ﻠ ﻰ و ﺟ ﻮد ﺗ ﺠ ﻤ ﻊ ﺳ ﻮ ا ﺋ ﻞ ﻓ ﻲ ا ﻟ ﺮ ﺋ ﺔ‬
‫‪ ‬ﻋﺪم وﺟﻮد ﺗﺠﻤﻊ ﺳﻮاﺋﻞ ﻓﻲ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ‬

‫ﻫ ﻨ ﺎ ﻟ ﻚ ﻧ ﻮﻋ ﻴ ﻦ ﻣ ﻦ ا ﻟ ﺤ ﺎ ﻟ ﺔ‬
‫‪ .1‬ﺣﺎدة و ﺗﺤﺪث ﻋﻨﺪ وﺟﻮد اﻟﻌﻼﻣﺎت اﻟﺴﺎﺑﻘﺔ‬
‫‪ .2‬ﻣﺘﺄﺧﺮة و ﺗﺤﺪث ﺑﻌﺪ ‪ 6‬اﻟﻰ ‪ 72‬ﺳﺎﻋﻪ ﻣﻦ اﻋﻄﺎء اﻟﺪم‬

‫ﻛﺬﻟﻚ ﻫﻨﺎﻟﻚ ﺗﻨﻮع ﻛﺒﻴﺮ ﻓﻲ ﺷﺪة اﻟﺤﺎﻟﺔ ﻓﻘﺪ ﻧﺤﺘﺎج اﻟﻰ اﻟﻠﺠﻮء اﻟﻰ اﻟﺘﻨﻔﺲ اﻟﺼﻨﺎﻋﻲ ﺑﺎﻻ‬
‫ﺟﻬ ﺰ ة ا و ﻗﺪ ﺗ ﻜ ﻮ ن ﻗﺎ ﺗﻠ ﺔ و ﻣ ﻤ ﻴ ﺘﻪ ‪.‬‬

‫ا ﻟ ﻌ ﻼ ﻣ ﺎ ت ا ﻟ ﺪ ا ﻟ ﺔ ﻋ ﻠ ﻰ ا ﻟ ﺤ ﺎﻟ ﺔ اﻟ ﺤ ﺎ د ة ﺗﺸ ﻤ ﻞ‬
‫‪‬‬ ‫‪dyspnea‬‬
‫‪‬‬ ‫‪tachypnea‬‬
‫‪‬‬ ‫‪hypoxemia‬‬
‫‪‬‬ ‫‪fever‬‬
‫‪‬‬ ‫‪rigors‬‬
‫‪‬‬ ‫‪tachycardia‬‬
‫‪‬‬ ‫‪hypothermia‬‬
‫‪‬‬ ‫‪hypotension‬‬
‫‪‬‬ ‫‪acute pulmonary edema‬‬
‫و ﺗ ﻜ ﻮ ن ا ﻟ ﺘ ﺤ ﺎ ﻟ ﻴ ﻞ اﻟ ﻤ ﺨ ﺘ ﺒ ﺮ ﻳ ﺔ ﻏ ﻴ ﺮ ﻣ ﻔ ﻴ ﺪ ة ا و ﻣ ﺠ ﺰ ﻳ ﺔ ﻟ ﺘﺸ ﺨ ﻴ ﺺ ا ﻟ ﺤ ﺎ ﻟ ﺔ ﻻ ﻧ ﻬ ﺎ ﺳ ﺮ ﻳ ﻌ ﺔ ا ﻟ ﺘ ﻄ ﻮ ر ‪.‬‬
‫ﻟﻜﻦ ﻧﻼﺣﻆ‬
 ‫‪‬‬ ‫‪Transient leukopenia‬‬
‫‪‬‬ ‫‪thrombocytopenia‬‬
‫ﻓﻲ ‪ %25‬ﻣﻦ اﻟﺤﺎﻻت‬
‫ﻣ ﻤ ﻜ ﻦ ا ﺟ ﺮ ا ء ﻓ ﺤ ﻮ ﺻﺎ ت ا ﺧ ﺮ ى ﻣ ﻨﻬ ﺎ‬
‫‪‬‬ ‫‪antihuman neutrophil antigen‬‬
‫)‪(HNA‬‬
‫‪ anti-HLA antibodies‬‬
‫ﻋ ﻠ ﻰ ا ﻟ ﻤ ﺎ ﻧ ﺤ ﻴ ﻦ ﻟ ﻠ ﺪ م ﻻ ﻧ ﻬ ﺎ ﻗ ﺪ ﺗ ﻜ ﻮ ن ﻣ ﺘ ﻮ ر ﻃ ﺔ ﻓ ﻲ ا ﻟ ﻬ ﺠ ﻮ م ا ﻟﻤ ﻀ ﺎ د ا ﻟ ﺬ ي ﺣ ﺼ ﻞ د ا ﺧ ﻞ ﺟ ﺴ ﻢ‬
‫ا ﻟ ﻤ ﺴﺘﻠ ﻢ‬
‫و ﻛﺬﻟﻚ ﻳﻤﻜﻦ اﺟﺮاء ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻﺧﺘﺒﺎرات اﻟﺘﻤﻴﻴﺰﻳﺔ ﻟﻠﺤﺎﻟﺔ ﻋﻦ ﺑﻘﻴﺔ اﻟﺤﺎﻻت ﻣﺜﻞ‬
‫‪ sepsis‬‬
‫‪ anaphylactic reactions,‬‬
‫‪ TRALI‬‬
‫‪ transfusion associated circulatory overload‬‬
‫‪ other causes of acute lung injury.‬‬
‫و ﻫﻨﺎﻟﻚ ادﻟﺔ ﻛﺒﻴﺮة ﺗﺜﺒﺖ ﺗﻮرط اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ‬
‫‪ anti-WBC antibodies‬‬
‫ﻓﻲ ﻣﻬﺎﺟﻤﺔ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ ﻟﻠﻤﺮﻳﺾ و ﺗﺴﺒﺐ ﻫﺬة اﻟﻤﻀﺎﻋﻔﺎت ‪ .‬ﻓﻘﺪت وﺟﺪت دراﺳﺎت‬
‫ﻋﺎم ‪2000‬م ﻋﻦ وﺟﻮد ﻋﻼﻗﺔ ﺗﺮﺑﻂ ﺑﻴﻦ اﻟﻨﺴﺎء اﻟﻤﺘﺒﺮﻋﺎت و اﻟﺬﻳﻦ ﻛﺎﻧﻮا ﻗﺒﻞ ﻓﺘﺮة ﻗﻠﻴﻠﺔ‬
‫ﺣﻮاﻣﻞ و اﻻﺻﺎﺑﺎت اﻟﺮﺋﻮﻳﺔ اﻟﺤﺎدة ﻧﺘﻴﺠﺔ ﻧﻘﻞ اﻟﺪم ‪ .‬ﻓﻔﻲ اﻟﻮاﻗﻊ اﻧﺘﺎج اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ‬
‫اﻟﺘﻲ ﺗﻬﺎﺟﻢ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ ﻳﺰداد ﻣﻊ ﻛﻞ ﺣﻤﻞ ‪ .‬دراﺳﺎت اﺧﺮى ﻓﻲ اﻣﻤﻠﻜﺔ اﻟﻤﺘﺤﺪة و‬
‫ﻛ ﻨﺪ ا ا ﺛ ﺒ ﺘ ﺖ و ﺟ ﻮ د ﻧ ﻔ ﺲ ا ﻟ ﻌ ﻼ ﻗ ﺔ ‪ .‬و ﻟﺬ ﻟ ﻚ ﻋ ﻤﺪ ت ﻫﺬ ة ا ﻟ ﺒﻠﺪ ا ن ﻋﻠ ﻰ ﺗ ﺨ ﻔ ﻴ ﻒ اﻟ ﺪ م ا و ا ﻟ ﺒ ﻼ ز ﻣ ﺎ‬
‫اﻟﻤﻨﻘﻮﻟﺔ ﻣﻦ اﺟﻞ ﺗﻘﻠﻴﻞ اﺻﺎﺑﺎت اﻟﺮﺋﺔ و ﻫﺬا دﻓﻊ اﻟﻰ اﺳﺘﺨﺪام ﻧﻔﺲ اﻻﺳﺘﺮاﺗﺠﻴﺔ ﻓﻲ اﻟﻮﻻ‬
‫ﻳﺎت اﻟﻤﺘﺤﺪة و اﻟﺘﻲ ﺗﻢ اﻋﺘﻤﺎدﻫﺎ ﻣﻦ ﻗﺒﻞ راﺑﻄﺔ ﻣﺼﺎرف اﻟﺪم اﻻﻣﺮﻳﻜﻴﺔ و ﺗﻢ ﺗﻄﺒﻴﻘﻬﺎ‬
‫ﻓ ﻲ ﻣ ﺨ ﺘ ﻠ ﻒ ﻣ ﺮ اﻛ ﺰ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ‪.‬‬

‫ا ﻟ ﻤ ﻔﻬ ﻮ م ا ﻟ ﻤ ﺘ ﻘﺪ م‬
‫ﺑ ﺎ ﻟ ﺮﻏ ﻢ ﻣ ﻦ ا ﺳ ﺘ ﺨ ﺪ ا م ﺗ ﻘ ﻨ ﻴ ﺎ ت اﻟ ﺘ ﺨ ﻔ ﻴ ﻒ ﻟ ﻐ ﺮ ض ﺗ ﻘ ﻠ ﻴ ﻞ ﻣﺸ ﺎ ﻛ ﻞ ﺿ ﺮ ر ا ﻟ ﺮ ﺋ ﺘ ﻴ ﻦ ﻧ ﺘ ﻴ ﺠ ﺔ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ا‬
‫ﻹ ان اﻟﻤﺸﻜﻠﺔ اﺳﺘﻤﺮت و ﻟﻬﺬا ﺗﻢ اﻋﺎدة اﻟﻨﻈﺮ اﻟﻰ اﻟﻤﻮﺿﻮع ﺑﺸﻜﻞ اﺧﺮ ﻟﻠﺘﻌﺮف ﻋﻠﻰ اﻻ‬
‫ﻣﺮاﺿﻴﺔ اﻟﺘﻲ ﺗﻜﻮن ﻧﺘﻴﺠﺔ وﺟﻮد او ﻋﺪم وﺟﻮد اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ و اﻟﺘﻲ ﺗﻜﻮن ﻣﺘﻮرﻃﺔ‬
‫ﻓ ﻲ ﻫﺬ ا ا ﻟ ﻀ ﺮر‬
‫ﻟﻘﺪ وﺟﺪت اﻟﺪراﺳﺎت إن اﻏﻠﺐ اﻟﺤﺎﻻت ﻧﺎﺗﺠﺔ ﻋﻦ ﻧﻘﻞ اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﻣﻊ اﻟﺒﻼزﻣﺎ ﺗﻬﺎﺟﻢ‬
‫‪ HLA type I‬او وﺟﻮد اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﺗﻬﺎﺟﻢ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ اﻟﻌﺪﻟﺔ ‪ . anti HNA‬ﺣﻴﺚ‬
‫ﻳﺘﻢ ﺗﻔﻌﻴﻞ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ اﻟﻌﺪﻟﺔ ﺑﺸﻜﻞ ﻏﻴﺮ ﻣﺒﺎﺷﺮ ﻣﻦ ﺧﻼل ارﺗﺒﺎط اﻻﺿﺪاد ﻣﻊ ﺧﻼﻳﺎ‬
‫اﻟﻤﻮﻧﻮﺳﺎﻳﺖ او ﻣﻦ ﺧﻼل اﻻرﺗﺒﺎط ﻣﻊ ﺧﻼﻳﺎ اﻟﺒﻄﺎﻧﺔ اﻟﺪاﺧﻠﻴﺔ ﻟﻠﻮﻋﺎء اﻟﺪﻣﻮي او ﺑﺸﻜﻞ‬
‫ﻣﺒﺎﺷﺮ ﻣﻦ ﺧﻼل اﻻرﺗﺒﺎط اﻟﻰ ﻫﺬة اﻟﺨﻼﻳﺎ ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ ‪.‬‬
‫ا ﻟ ﻌ ﻮ ا ﻣ ﻞ اﻟ ﺘ ﻲ ﺗ ﺆ د ي ا ﻟ ﻰ ﺗ ﻔ ﺎ ﻗ ﻢ اﻟ ﺤﺎ ﻟ ﺔ ﻫ ﻲ‬
‫‪ ‬ﻛﻤﻴﺔ اﻻﺿﺪاد اﻟﺘﻲ ﺗﻬﺎﺟﻢ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ‬
‫‪ ‬ﻛ ﻤ ﻴ ﺔ اﻟ ﺒ ﻼ ز ﻣ ﺎ اﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ ا ﻟ ﻰ ا ﻟ ﻤ ﺮ ﻳ ﺾ‬
 ‫و ﻋﻠﻰ اﻟﺮﻏﻢ إن اﻻﺟﺴﺎم اﻟﻤﻀﺎدة ‪ anti HLA‬ﻫﻲ اﻟﺴﺒﺐ اﻻول ﻓﻲ ﺗﻀﺮر اﻟﻤﺮﻳﺾ ﻟﻜﻦ‬
‫و ﺟ ﻮ د ا ﺿﺪ ا د ﻣ ﻨﺎ ﻋ ﻴ ﺔ ﺿﺪ‬
‫‪ HNA-1‬‬
‫‪ HNA-2‬‬
‫‪ HNA-3a‬‬

‫ﺗﻜﻮن ﺳﺒﺐ ﻓﻲ ﺷﺪة اﻟﺤﺎﻟﺔ و ﻛﺬﻟﻚ ﻣﻤﻜﻦ ان ﺗﻜﻮن ﻗﺎﺗﻠﺔ ﻓﻲ ﻛﺜﻴﺮ ﻣﻦ اﻻﺣﻴﺎن ‪.‬‬
‫اﻻﺟﺴﺎم اﻟﻤﻀﺎدة اﻟﺘﻲ ﺗﻬﺎﺟﻢ ﻫﺬة اﻟﻤﺴﺘﻀﺪات ﻳﺠﺐ ﺗﺤﺪﻳﺪ وﺟﻮدﻫﺎ ﻓﻲ ﺑﻼزﻣﺎ اﻟﻤﺮﻳﺾ‬
‫اﻟﻤﺘﺒﺮع ﺑﺎﻟﺪم و ذﻟﻚ ﻟﺪﻋﻢ ﺗﺸﺨﻴﺺ اﻟﺤﺎﻟﺔ ﻋﻠﻰ إن ﺳﺒﺒﻬﺎ ﻫﻮ وﺟﻮد ﻫﺬة اﻻﺿﺪاد ‪ .‬و ﻫﺬا‬
‫اﻟ ﻔ ﺤ ﺺ ﻣ ﻬ ﻢ ﻓ ﻲ ﺗ ﺤ ﺪ ﻳ ﺪ ا ﻟ ﻤ ﺘ ﺒ ﺮﻋ ﻴ ﻦ ا ﻟ ﺬ ﻳ ﻦ ﻗ ﺪ ﻳ ﺸ ﻜ ﻞ د ﻣ ﻬ ﻢ ا و ا ﺣ ﺪ ﻣ ﻜ ﻮ ﻧ ﺎ ﺗ ﻪ ﺧ ﻄ ﻮ ر ة ﻛ ﺒ ﻴ ﺮ ة‬
‫ﻋ ﻠ ﻰ ا ﻟ ﻤ ﺮ ﻳ ﺾ ‪ .‬ﺑ ﺎ ﻟ ﺮﻏ ﻢ ﻣ ﻦ إ ن ﻫ ﺬ ا اﻟ ﻔ ﺤ ﺺ ﻻ ﻳ ﻨ ﻔ ﻊ ﻓ ﻲ ﺗ ﺤ ﺪ ﻳ ﺪ ا ﻟ ﺼ ﺮ ر ا ﻟ ﺤ ﺎ د ا ﻟ ﺤ ﺎ ﺻ ﻞ ﻓ ﻲ‬
‫ا ﻟ ﺮ ﺋ ﺘ ﻴ ﻦ ﻧ ﺘ ﻴ ﺠ ﺔ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ‪ .‬و ﻫ ﻮ ﻣ ﺘ ﻮ ﻓ ﺮ ﻓ ﻘ ﻂ ﻓ ﻲ ﻣ ﺨ ﺘ ﺒ ﺮ ا ت ﻣ ﺮ ﺟﻌ ﻴ ﺔ ﻣ ﺘ ﺨ ﺼ ﺼ ﺔ و ﺗ ﺴ ﺘ ﻐ ﺮ ق‬
‫ﻋﺪة أ ﺳﺎ ﺑ ﻴ ﻊ ﺣ ﺘ ﻰ ﺗ ﺤ ﺼ ﻞ ﻋﻠ ﻰ ا ﻟ ﻨﺘ ﺎ ﺋ ﺞ ‪.‬‬

‫ﺑﻌﺪة ﻋﺪة دراﺳﺎت ﺗﻢ ﺗﺤﺪﻳﺪ إن ﻫﻨﺎﻟﻚ ﺣﺎﻟﺔ ﺗﺴﺒﺐ اﻻﺿﺮار اﻟﻜﺒﻴﺮة ﻓﻲ اﻟﺮﺋﺔ ﻧﺘﻴﺠﺔ ﻧﻘﻞ‬
‫اﻟﺪم ﻟﻜﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﺗﻜﻮن ﻏﻴﺮ ﻣﺘﻮرﻃﺔ ﻓﻲ ﺗﻄﻮر ﻫﺬة اﻟﺤﺎﻟﺔ ﺣﻴﺚ إن ﻧﻘﻞ اﻟﺪم‬
‫اﻟﻰ اﻟﻤﺮﻳﺾ ﻳﺴﺒﺐ ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﻌﺪﻟﺔ ﻓﻲ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ اﻟﺼﻐﻴﺮة اﻟﻤﻮﺟﻮدة ﻓﻲ‬
‫اﻟ ﺮ ﺋ ﺘ ﻴ ﻦ و ﻳ ﺆ د ي ذ ﻟ ﻚ اﻟ ﻰ ﺧ ﺮ و ج اﻟ ﺴ ﻮ ا ﺋ ﻞ ﻣ ﻦ ا ﻟ ﻮﻋ ﺎ ء اﻟ ﺪ ﻣ ﻮ ي و ﻳ ﺴ ﺒ ﺐ ا ﻟ ﻮ ذ ﻣ ﺔ ‪ .‬و ﻗ ﺪ‬
‫وﺿﻌﺖ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﻔﺮﺿﻴﺎت ﺣﻮل ذﻟﻚ ﻣﻨﻬﺎ اﻟﺘﻲ ﺗﻘﻮل إن اوﺳﺎط ﻣﺎ ﻗﺒﻞ اﻻﻟﺘﻬﺎب ﺗﺘﺠﻤﻊ‬
‫ﻓﻲ ﻣﻨﺘﺞ اﻟﺪم ﻓﻲ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء و اﻟﺼﻔﺎﺋﺢ و ﺗُﻄﻠﻖ ﻋﻨﺪ اﻻﻋﻄﺎء ﺧﻼل ﺧﺰن ﻣﻨﺘﺞ‬
‫اﻟﺪم ﻧﺘﻴﺠﺔ ﺗﻘﺪم ﻋﻤﺮ اﻟﻤﻜﻮﻧﺎت اﻟﺪﻣﻮﻳﺔ ‪ .‬و اﻏﻠﺐ ﺗﻠﻚ اﻟﻤﺘﻮرﻃﺎت ﻫﻲ وﺟﻮد ‪ CD40‬و‬
‫اﻟﺬي ﻳﺆدي اﻟﻰ ﺗﻔﺎﻋﻞ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ اﻟﻌﺪﻟﺔ و اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ و ﻫﻲ ﺳﺒﺐ رﺋﻴﺴﻲ‬
‫ﻓ ﻲ ﺗ ﻄ ﻮ ر ﺣ ﺎﻟ ﺔ ﺿ ﺮ ر ا ﻟ ﺮ ﺋ ﺘ ﻴ ﻦ رﻏ ﻢ ﻋ ﺪ م و ﺟ ﻮ د ا ﺿ ﺪ ا د ﻣ ﻨ ﺎﻋ ﻴ ﺔ ‪ .‬ا ﻟ ﺠ ﺰ ﻳ ﺌ ﺎ ت ا ﻟ ﺼ ﻐ ﻴ ﺮ ة و‬
‫ا ﻟ ﺘ ﻐ ﻴ ﺮ ا ت اﻟ ﻤ ﻈ ﻬ ﺮ ﻳ ﺔ و ا ﻟ ﻜ ﻤ ﻴ ﺎ ﺋ ﻴ ﺔ ﻓ ﻲ ا ﻟ ﻤ ﻜ ﻮ ﻧ ﺎ ت ا ﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ﺗ ﺪﻋ ﻢ ا ﻟ ﺘ ﺼ ﺎ ق ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ اﻟ ﺪ ﻣ ﻮ ﻳ ﺔ و‬
‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء اﻟﻰ اﻟﻄﺒﻘﺔ اﻟﻄﻼﺋﻴﺔ اﻟﺪاﺧﻠﻴﺔ ﻟﻼوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ‪ .‬ﻓﻲ ﻧﻬﺎﻳﺔ اﻟﻤﻄﺎف ‪،‬‬
‫ﻓﻘﺪان ﻣﺴﺘﻀﺪات ‪ duffy‬ﻳﺆدي اﻟﻰ زﻳﺎدة اﻟﺴﺎﻳﺘﻮﻛﻴﻨﺎت و اﻟﺬي ﻳﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ ﺧﻼﻳﺎ‬
‫ا ﻟﺪ م ا ﻟ ﺒ ﻴ ﺾ ا ﻟ ﻌﺪ ﻟ ﺔ ‪.‬‬
‫ﻟ ﻴ ﺲ ﻛ ﻞ ﻣ ﻨ ﺘ ﺠ ﺎ ت ا ﻟ ﺪ م و ﻻ ﻛ ﻞ ا ﻟ ﻤ ﺮ ﺿ ﻰ ﻳ ﻜ ﻮ ﻧ ﻮ ن ﻳﻌ ﺎ ﻧ ﻮ ن ﻣ ﻦ ا ﺿ ﺮ ا ر ا ﻟ ﺮ ﺋ ﺔ ا ﻟ ﻤ ﺘﻌ ﻠ ﻘ ﺔ ﺑ ﻨ ﻘ ﻞ‬
‫اﻟﺪم‪ .‬ﻓﻠﻴﺲ ﻛﻞ ﻣﻨﺘﺠﺎت اﻟﺪم اﻟﺘﻲ ﺗﺤﺘﻮي ‪ anti WBC‬ﺗﺴﺒﺐ اﻟﻀﺮر اﻻ اذا وﺟﺪت‬
‫اﻟﻤﺴﺘﻀﺪ اﻟﻤﻨﺎﺳﺐ ‪ .‬و ﻫﺬا ﻳﻌﻨﻲ ان ﻫﻨﺎك ﻣﺴﺎرﻳﻦ اﻻول ﻫﻮ ﻣﺴﺎر ﺟﺬب اﻟﺨﻼﻳﺎ اﻟﻌﺪﻟﺔ‬
‫اﻟﻰ اﻟﺮﺋﺔ و اﻟﻤﺴﺎر اﻟﺜﺎﻧﻲ ﻫﻮ ﺗﻔﻌﻴﻞ ﺗﻠﻚ اﻟﺨﻼﻳﺎ و ﻛﻴﻔﻴﺔ اﻟﺴﻴﻄﺮة ﻋﻠﻰ اﻻﺳﺘﺠﺎﺑﺔ اﻻ‬
‫ﻟﺘ ﻬﺎ ﺑ ﻴ ﺔ ﻓ ﻴ ﻤﺎ ﻟ ﻮ ﺣﺪ ﺛ ﺖ‬

‫‪‬‬ ‫)‪Transfusion-Associated Circulatory Overload (TACO‬‬

‫واﺣﺪة ﻣﻦ اﻫﻢ اﻟﺤﺎﻻت اﻟﺘﻲ ﺗﺴﺒﺐ ﺿﻴﻖ اﻟﺘﻨﻔﺲ اﻟﺤﺎد ﺗﺘﻤﻴﺰ ﺑﺰﻳﺎدة ﺣﺠﻢ اﻟﺴﻮاﺋﻞ‬
‫اﻟﻤﻮﺟﻮدة ﻓﻲ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﺑﺴﺒﺐ زﻳﺎدة او ﺳﺮﻋﺔ ﻧﻘﻞ اﻟﺴﻮاﺋﻞ اﻟﻰ اﻟﻤﺮﻳﺾ وﻋﺪم‬
‫ﻗ ﺪ ر ة ا ﻟ ﻤ ﺮ ﻳ ﺾ ﻋ ﻠ ﻰ ا ﺣ ﺘ ﻮ ا ء اﻟ ﻜ ﻤ ﻴ ﺔ ا ﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ ﺑ ﺴ ﺒ ﺐ ﻓﺸ ﻞ ا ﻟ ﺮ ﺋ ﺘ ﻴ ﻦ ‪ ،‬ا ﻟ ﻘ ﻠ ﺐ ‪ ،‬و ا ﻟ ﻜ ﻠ ﻴ ﺘ ﻴ ﻦ ‪ .‬و‬
‫ﺗﺤﺪث اﻟﺤﺎﻟﺔ ﺧﻼل ‪ 6‬ﺳﺎﻋﺎت و اﻻﻋﺮاض ﺗﻈﻬﺮ ﺧﻼل ‪ 2‬ﺳﺎﻋﻪ ﻣﻦ اﻻﻋﻄﺎء ﻟﻜﻨﻬﺎ ﻗﺪ ﻻ‬
‫ﺗﻈﻬﺮ اﻻ ﺑﻌﺪ ‪ 6‬ﺳﺎﻋﺎت ‪.‬‬
‫و ﺗ ﻌ ﺘ ﺒ ﺮ ﺛ ﺎ ﻧ ﻲ ا ﻫ ﻢ ﺳ ﺒ ﺐ ﺷ ﺎ ﺋ ﻊ ﻳ ﺆ د ي ا ﻟ ﻰ ا ﻟﻤ ﻮ ت و ﻗ ﺪ ﺳ ﺠ ﻠ ﺖ ﻣ ﻨ ﻈ ﻤ ﺔ ا ﻟ ﻐ ﺬ ا ء و ا ﻟ ﺪ و ا ء ز ﻳ ﺎ د ة‬
‫ﻓﻲ ﻋﺪد اﻟﺤﺎﻻت ﺧﻼل اﻟﺴﻨﻮات اﻟﻤﺎﺿﻴﺔ ‪.‬‬
 ‫ﻫ ﺬ ة ا ﻟ ﺤ ﺎ ﻟ ﺔ ﺗ ﺮ ﺗ ﺒ ﻂ ﻣ ﻊ ﻛﻤ ﻴ ﺔ ﻣ ﻨ ﺘ ﺠ ﺎ ت ا ﻟ ﺪ م ا ﻟﻤ ﻨ ﻘ ﻮ ﻟ ﺔ و ﻣﻌ ﺪ ل ﺗ ﺪ ﻓ ﻖ ﺗ ﻠ ﻚ ا ﻟ ﻤ ﻨ ﺘ ﺠ ﺎ ت ا ﻟ ﻰ ﺟ ﺴ ﻢ‬
‫اﻟﻤﺮﻳﺾ و ﻛﺬﻟﻚ ﻋﻮاﻣﻞ ﺧﺎﺻﺔ ﺑﺎﻟﻤﺮﻳﺾ ﻣﺜﻞ اﻣﺮاض اﻟﻘﻠﺐ و ﻏﻴﺮﻫﺎ ﻣﻦ اﻻﻣﻮر ‪ .‬وﺟﺪت‬
‫اﻟﺪراﺳﺎت إن ﻫﻨﺎﻟﻚ ﺗﺮاﺑﻂ ﺑﻴﻦ ﻫﺬة اﻟﺤﺎﻟﺔ و اﻟﻔﺸﻞ اﻟﻜﻠﻮي اﻟﻤﺰﻣﻦ ‪ ،‬ﻓﺸﻞ اﻟﻘﻠﺐ اﻻ‬
‫ﺣ ﺘ ﻘ ﺎ ﻧ ﻲ ‪ ،‬ا ﻟ ﺠﻠ ﻄﺎ ت ا ﻟ ﻨﺎ ز ﻓ ﺔ ‪ ،‬ﻋﺪ د ا ﻟ ﻤ ﻨ ﺘ ﺠﺎ ت ا ﻟﺪ ﻣ ﻮ ﻳ ﺔ اﻟ ﻤ ﻨ ﻘ ﻮ ﻟ ﺔ ﻟﻠ ﻤ ﺮ ﻳ ﺾ و ﻛ ﺬﻟ ﻚ ﻣﺪ ى ﺗ ﺤ ﻤ ﻞ‬
‫ا و ﻋ ﻴ ﺔ ا ﻟﺪ م ﻟﺪ ى ا ﻟ ﻤ ﺮﻳ ﺾ ‪ ،‬ﻛﺬ ﻟ ﻚ و ﺟﺪ ت ا ﻟﺪ ر ا ﺳ ﺎ ت ﻫ ﻨﺎ ﻟ ﻚ ﺗ ﺮ ا ﺑ ﻂ وﺛ ﻴ ﻖ ﺑ ﻴ ﻦ ﻫ ﺬة ا ﻟ ﺤﺎ ﻟ ﺔ و‬
‫ا ﻟ ﻌ ﻤ ﺮ ﻓ ﻬ ﻲ ﻛ ﺜ ﻴ ﺮ ة ا ﻟ ﺤﺪ و ث ﻟﺪ ى ﻛ ﺒﺎ ر ا ﻟ ﺴ ﻦ ‪ .‬ﻛﺬ ﻟ ﻚ و ﺟﺪ ت ا ﻟﺪ ر ا ﺳ ﺎ ت ﺗ ﺮ ا ﺑ ﻂ ﺑ ﻴ ﻦ ﻫﺬ ة ا ﻟ ﺤ ﺎﻟ ﺔ‬
‫و‬
‫‪ emergency surgery‬‬
‫‪ chronic kidney disease‬‬
‫‪ left ventricular heart dysfunction‬‬

‫‪‬‬ ‫‪previous beta-adrenergic receptor antagonist use isolated FFP (vs.‬‬

‫‪RBC) transfusion‬‬
‫‪ mixed product (vs. RBC only) transfusion‬‬
‫‪ increased intraoperative fluid‬‬
‫و ﻳﺤﺘﺎج اﻻﺷﺨﺎص اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ ﻫﺬة اﻟﺤﺎﻟﺔ اﻟﻰ ﺗﻨﻔﺲ ﺻﻨﺎﻋﻲ و اﻟﺮﻗﻮد ﻓﻲ وﺣﺪة‬
‫اﻟﻌﻨﺎﻳﺔ اﻟﻤﺮﻛﺰة ﻟﻔﺘﺮة ﻃﻮﻳﻠﺔ ﻣﻘﺎرﻧﺔ ﺑﺒﻘﻴﺔ اﻻﺷﺨﺎص اﻟﺬﻳﻦ ﻳﻨﻘﻠﻮن ﻛﻤﻴﺎت اﻗﻞ‬
‫ﻣﻦ اﻟﺴﻮاﺋﻞ ‪ .‬و ﺗﻘﺴﻢ ﻃﺒﻴﺎً اﻟﻰ ارﺑﻊ ﻣﺮاﺣﻞ ﺗﺘﻄﻮر ﺗﺪرﻳﺠﻴﺎً ﻓﻲ اﻻﻋﺮاض ‪.‬‬
‫و ا ﺣ ﺪ ﻣ ﻦ ا ﻫ ﻢ اﻟ ﺘ ﺤ ﺎ ﻟ ﻴ ﻞ ا ﻟ ﻤ ﻬﻤ ﻪ ﻫ ﻮ‬
‫)‪brain natriuretic peptide (BNP‬‬
‫اﻟﺬي ﻳﺮﺗﻔﻊ ﻣﺮة و ﻧﺼﻒ اﻛﺜﺮ ﻣﻦ اﻟﺤﺎﻟﺔ اﻟﻄﺒﻴﻌﻴﺔ و ﻟﻜﻨﻪ ﻳﺮﺗﻔﻊ ﻓﻲ ﺣﺎﻻت اﺧﺮى ‪.‬‬
‫اﻣﺎ ﻋﻼج اﻟﺤﺎﻟﺔ ﻳﺘﻢ ﻣﻦ ﺧﻼل اﻳﻘﺎف ﻧﻘﻞ اﻟﺴﻮاﺋﻞ ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ واﺧﺬ اﻻﺣﺘﻴﺎﻃﺎت ﺑﺴﺮﻋﺔ‬
‫ﻣﻦ اﺟﻤﻞ ﻣﻨﻊ ﻣﻀﺎﻋﻔﺎت اﻟﺤﺎﻟﺔ ‪ .‬و وﺿﻊ اﻟﻤﺮﻳﺾ ﻓﻲ وﺿﻊ ﻣﺴﺘﻘﻴﻢ و ﺗﻮﻓﻴﺮ دﻋﻢ اﻻ‬
‫و ﻛ ﺴ ﺠ ﻴ ﻦ ﻟ ﻠﻤ ﺮ ﻳ ﺾ و اﻋ ﻄ ﺎ ء ا ﻟ ﻤ ﺪ ر ا ت ﻟ ﺘ ﻘ ﻠ ﻴ ﻞ ا ﻟ ﺴ ﻮ ا ﺋ ﻞ ﻓ ﻲ اﻟ ﺠﺴ ﻢ و ﻳ ﻤ ﻜ ﻦ ﻟ ﻠ ﻄ ﺒ ﻴ ﺐ ا ﻟ ﻤ ﻌ ﺎ ﻟ ﺞ ا و‬
‫ﻣﺴﺆول ﻟﺠﻨﺔ ﺧﺪﻣﺎت ﻧﻘﻞ اﻟﺪم او اﺣﺪ اﻓﺮاد اﻟﻄﺎﻗﻢ اﻟﻤﺸﺮف ﻋﻠﻰ اﻻﻋﻄﺎء ﻛﺘﺎﺑﺔ اﻟﺘﻘﺎرﻳﺮ‬
‫ا ﻟ ﻄ ﺒ ﻴ ﺔ و ﻣ ﺮ ا ﻗ ﺒ ﺔ ا ﻟ ﺤ ﺎﻟ ﺔ ﻣ ﻊ ا ﺟ ﺮ ا ء ا ﻟ ﺘ ﻮ ﺻ ﻴﺎ ت ا ﻟ ﻼ ز ﻣ ﻪ ﻓ ﻲ ﺣ ﺎ ل ا ﻟ ﺸ ﻚ ﺑ ﻮ ﺟ ﻮ د اﻟ ﺤﺎ ﻟ ﺔ ‪ .‬و‬
‫ﺧ ﺎ ﺻ ﺔ ﻋ ﻨ ﺪ ا ﺳ ﺘ ﺒ ﻌ ﺎ د ﺗ ﺤ ﻠ ﻞ اﻟ ﺪ م اﻟ ﺤ ﺎ د و ﻣ ﺸ ﺎ ﻛ ﻞ ا ﻟ ﺮ ﺋ ﺘ ﻴ ﻦ ا ﻟﻤ ﺘ ﻌ ﻠ ﻘ ﺔ ﺑ ﻨ ﻘ ﻞ ا ﻟ ﺪ م‬

‫‪‬‬ ‫)‪Transfusion Associated Dyspnea (TAD‬‬

‫و ﺗ ﺤ ﺪ ث و ﺣ ﺪ ﻫ ﺎ ا و ﺗ ﺤ ﺪ ث ﻣ ﻊ اﻋ ﺮ ا ض ا ﺧ ﺮ ى و ﺗ ﺤ ﺪ ث ﻓ ﻲ ﺗ ﻔ ﺎ ﻋ ﻞ ا ﻟ ﺘ ﺤﺴ ﺲ و ﻳ ﺘ ﻢ‬
‫ﺗﺸﺨﻴﺼﻬﺎ ﻋﻨﺪ اﺳﺘﺒﻌﺎد اﻻﺳﺒﺎب اﻻﺧﺮى و اﻻﻣﺮاض اﻟﺘﻲ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ اﻟﻤﺮﻳﺾ ﺳﺎﺑﻘﺎً‪ .‬و ﻳﺘﻢ‬
‫ﺗﺸﺨﻴﺺ اﻟﺤﺎﻟﺔ ﻋﻨﺪ ﻇﻬﻮر اﻻﻋﺮاض ﺑﻌﺪ ﻣﺮور ‪ 24‬ﺳﺎﻋﻪ ﻣﻦ اﻋﻄﺎء اﻟﺪم ‪ .‬و اﻟﺴﺒﺐ‬
‫اﻟﻜﺎﻣﻦ وراء اﻟﻤﺮض ﻏﻴﺮ واﺿﺢ ﺑﺸﻜﻞ ﺣﻘﻴﻘﻲ ‪ .‬و ﺗﺼﻨﻒ ﻋﻠﻰ أﻧﻬﺎ ﺣﺎﻟﺔ ‪ TACO‬ﻟﻜﻨﻬﺎ‬
‫ﻣﺘﻮﺳﻄﺔ اﻟﺸﺪة و ﻫﻨﺎﻟﻚ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺘﺴﺎؤﻻت ﺣﻮل اﻟﺤﺎﻟﺔ اﻟﺘﻲ ﻻ زاﻟﺖ ﺗﺤﺘﺎج اﻟﻰ‬
‫ا ﺟ ﺎ ﺑ ﺎت ﻣ ﺆﻛﺪة‬
 ‫‪ Hypotensive Transfusion Reaction‬‬
‫واﺣﺪة ﻣﻦ اﻻﻋﺮاض ﻏﻴﺮ اﻟﺨﺎﺻﺔ اﻟﺘﻲ ﺗﻈﻬﺮ وﺣﺪﻫﺎ ﻋﻨﺪ ﻧﻘﻞ اﻟﺪم او ﺳﻮاﺋﻞ اﺧﺮى اﻟﻰ‬
‫اﻟﺠﺴﻢ او ﺗﻜﻮن ﻣﺼﺤﻮﺑﺔ ﺑﺤﺎﻟﺔ اﺧﺮى و ﻧﺘﻴﺠﺔ اﻟﻤﻀﺎﻋﻔﺎت ﺗﻈﻬﺮ ﻫﺬة اﻟﺤﺎﻟﺔ ‪ .‬و ﻳﻼﺣﻆ‬
‫ﻫﺒﻮط اﻟﻀﻐﻂ اﻗﻞ ﻣﻦ ﻣﻦ اﻟﻤﻌﺪل اﻟﻄﺒﻴﻌﻲ ﺧﻼل ‪ 1‬ﺳﺎﻋﺔ ﺑﻌﺪ اﻛﺘﻤﺎل اﻻﻋﻄﺎء و ﻫﺬا ﻧﺎﺗﺞ‬
‫ﻋﻦ اﻧﺨﻔﺎض اﻟﻀﻐﻂ اﻻﻧﺒﺴﺎﻃﻲ اﻗﻞ ﻣﻦ ‪30‬ﻣﻠﻢ زﺋﺒﻖ و اﻟﻀﻐﻂ اﻻﻧﻘﺒﺎﺿﻲ ﻋﻦ ‪ 80‬ﻣﻠﻢ‬
‫زﺋﺒﻖ ‪ .‬ﻃﺒﻌﺎً ﻧﻼﺣﻆ اﻧﺨﻔﺎض ﻓﻲ ﻋﺪد ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ و اﻧﺨﻔﺎض ﻓﻲ اﻧﺰﻳﻢ ﻣﺤﻮل اﻻ‬
‫ﻧﺠﻴﻮﺗﻨﺴﻴﻦ اﻟﺜﺎﻧﻲ ﻓﻲ اﻟﺤﺎﻻت اﻟﺤﺎدة ‪ .‬زﻳﺎدة ﺗﺮﻛﻴﺰ اﻟﺒﺮادﻳﻜﺎﻳﻨﻴﻦ ﻓﻲ اﻟﺪم اﻟﻤﺨﺰون ﻳﻌﺘﻘﺪ‬
‫إﻧﻬﺎ ﻫﻲ اﻟﻤﺘﻮرﻃﺔ ﻓﻲ اﻻﻣﺮاﺿﻴﺔ اﻟﺨﺎﺻﻪ ﺑﻬﺬة اﻟﺤﺎﻟﺔ ‪ .‬و ﻟﻜﻦ ﺗﻄﻮر ﻫﺬة اﻟﺤﺎﻟﺔ ﻏﻴﺮ‬
‫واﺿﺢ واﺿﺢ ﺑﺸﻜﻞ ﺗﺎم ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ذﻟﻚ ﻫﻨﺎﻟﻚ دراﺳﺎت ﺗﺸﻴﺮ اﻟﻰ ان اﻧﺨﻔﺎض ﺧﻼﻳﺎ‬
‫اﻟﺪم اﻟﺒﻴﺾ ﻳﻜﻮن واﺿﺢ ﺣﺘﻰ ﻗﺒﻞ اﻟﺨﺰن و ﻟﻜﻦ ﻟﺤﺪ اﻻن ﻻ ﺗﻮﺟﺪ ادﻟﺔ ﺟﺎزﻣﺔ ﻋﻦ‬
‫ا ﻟ ﺤﺎ ﻟ ﺔ ‪.‬‬

‫‪‬‬ ‫)‪Febrile Nonhemolytic Transfusion Reaction (FNHTR‬‬

‫واﺣﺪ ﻣﻦ اﻫﻢ اﻟﺤﺎﻻت اﻟﺘﻲ ﺗﺮاﻓﻖ ﻧﻘﻞ اﻟﺪم و ﻻ ﺗﻜﻮن ﻧﺎﺗﺠﺔ ﻣﻦ ﺗﺤﻠﻠﻪ ﻟﻜﻨﻬﺎ ﺗﻜﻮن‬
‫ﻣ ﺘ ﻮ ﺳ ﻄ ﺔ ا ﻟ ﻰ ﻣ ﺤﺪ و دة ا ﻟ ﺸﺪة ‪ .‬و ﻟ ﻜ ﻦ ﻫﺬة ا ﻟ ﺤﺎ ﻟ ﺔ ﻣ ﻬ ﻤﻪ ﺟﺪ ا ً ﻟ ﻌﺪ ة ا ﺳ ﺒ ﺎ ب‬
‫‪ ‬ﺗ ﺆ د ي ا ﻟ ﻰ اﻳ ﻘﺎ ف ﻧ ﻘ ﻞ ا ﻟﺪ م‬
‫‪ ‬ﺗ ﺆ د ي ا ﻟ ﻰ ﻫ ﺪر ا ﻟﺪ م و ﻣ ﺸﺘ ﻘ ﺎ ﺗ ﺔ‬
‫‪ ‬ﺗﺆﺧﺮ ﻋﻤﻠﻴﺎت اﻟﻨﻘﻞ اﻻﺧﺮى‬

‫و ﺗﺤﻜﻲ اﻟﺤﺎﻟﺔ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺘﻔﺎﻋﻼت اﻟﻨﺎﺗﺠﺔ ﻣﻦ ﻧﻘﻞ اﻟﺪم ) وﺟﻮد ﻫﺬة اﻟﺤﺎﻟﺔ ﻗﺪ ﻳﺪل‬
‫ﻋﻠﻰ وﺟﻮد اﻟﺤﺎﻻت اﻻﺧﺮى ( ﻣﺜﻞ‬
‫‪ AHTR‬‬
‫‪ TRALI‬‬
‫‪ TACO‬‬
‫‪ transfusion-transmitted bacterial infection‬‬
‫و ﻳﻤﻜﻦ ﺗﻌﺮﻳﻔﻬﺎ ﻋﻠﻰ إﻧﻬﺎ ارﺗﻔﺎع درﺟﺔ اﻟﺤﺮارة ﻋﻦ ‪ 38‬ﺳﻴﻠﻴﺰي ﻟﺪى اﻟﻤﺮﻳﺾ اي ﺑﻤﻘﺪار‬
‫‪ 1.5‬درﺟﺔ زﻳﺎدة ﻋﻦ درﺟﺔ اﻟﺤﺮارة اﻻﺻﻠﻴﺔ ﻗﺒﻞ اﻋﻄﺎء اﻟﺪم و ﺗﺤﺪث ﺧﻼل او ﻓﻲ ‪4‬‬
‫ﺳ ﺎﻋ ﺎ ت ﻣ ﻦ اﻋ ﻄ ﺎ ء ا ﻟ ﺪ م و ﺗ ﻜ ﻮ ن ﻣ ﺼ ﺤ ﻮ ﺑ ﺔ ﺑ ﺎﻟ ﻘ ﺸ ﻌ ﺮ ﻳ ﺮ ة ‪ .‬و ﻳ ﺘ ﻢ ﺗ ﺸ ﺨ ﻴ ﺼ ﻬ ﺎ ﻋ ﻨ ﺪ ا ﺳ ﺘ ﺒ ﻌ ﺎ د‬
‫وﺟﻮد اﻟﺤﺎﻻت اﻻﺧﺮى او اﻻﻣﺮاض اﻟﺘﻲ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ اﻟﻤﺮﻳﺾ ‪ .‬و ﻣﻦ اﻻﻋﺮاض اﻻﺧﺮى اﻟﺘﻲ‬
‫ﺗ ﺼﺎ ﺣ ﺐ اﻟ ﺤ ﺮ ا ر ة ﻫ ﻲ‬
‫‪ headache‬‬
‫‪ cold feeling‬‬
‫‪ mild dyspnea‬‬
‫‪ mild nausea/vomiting‬‬
‫و ﺗﻈﻬﺮ ﻫﺬة اﻻﻋﺮاض ﺑﻌﺪ ﻣﺮور ‪ 1‬اﻟﻰ ‪ 2‬ﺳﺎﻋﻪ ﻣﻦ اﻧﺘﻬﺎء وﻗﺖ اﻋﻄﺎء اﻟﺪم ‪ .‬إن‬
‫ﺗ ﺸ ﺨ ﻴ ﺺ ﻫﺬ ة ا ﻟ ﺤ ﺎﻟ ﺔ ﺑ ﺸ ﻜ ﻞ د ﻗ ﻴ ﻖ ﻳ ﻮ ا ﺟ ﺔ ا ﻟ ﻜ ﺜ ﻴ ﺮ ﻣ ﻦ ا ﻟ ﺘ ﺤﺪ ﻳﺎ ت ﺑ ﺴ ﺒ ﺐ ا ﻟ ﻌ ﻮ ا ﻣ ﻞ ا ﻟ ﺨﺎ ﺻ ﺔ ﺑ‬
‫ﺎ ﻟ ﻤ ﺮ ﻳ ﺾ و ﻗ ﻠ ﺔ ا ﻟ ﺨ ﺒ ﺮ ة ﻟ ﺪ ى ا ﻟ ﺸ ﺨ ﺺ اﻟ ﻮ ا ﻗ ﻒ ﻋ ﻨ ﺪ اﻋ ﻄ ﺎ ء ا ﻟ ﺪ م و ﻋ ﺪ م ر ﺑ ﻂ ا ﻟ ﺤ ﺎﻟ ﺔ ﺑ ﺎﻋ ﻄ ﺎ ء‬
‫ا ﻟﺪ م و ﺗ ﺸ ﺨ ﻴ ﺼ ﻬﺎ ﻋﻠ ﻰ إ ﻧ ﻬﺎ ﺣﺎ ﻟ ﺔ ا ﺧ ﺮ ى ‪ .‬ﻋ ﻨﺪ ا ر ﺗ ﻔﺎ ع د ر ﺟ ﺔ ا ﻟ ﺤ ﺮ ا رة ‪ 2‬د ر ﺟ ﺔ ﺳ ﻴﻠ ﻴ ﺰﻳ ﺔ‬
‫ﻳ ﺠ ﺐ ﻓ ﺤ ﺺ ا ﻟ ﺪ م ا و ﻣ ﻜ ﻮ ﻧ ﺎ ﺗ ﻪ ﻻ ﺳ ﺘ ﺒ ﻌ ﺎ د ا ﺣ ﺘﻤ ﺎ ﻟ ﻴ ﺔ اﻟ ﺘ ﻠ ﻮ ث اﻟ ﺒ ﻜ ﺘ ﻴ ﺮ ي ﻣ ﺜ ﻞ و ﺟ ﻮ د ﺗ ﻐ ﻴ ﻴ ﺮ ﻓ ﻲ ﻟ ﻮ ن‬
‫ا ﻟ ﻤ ﻨﺘ ﺞ ‪ ،‬و ﺟ ﻮ د ا ﻟ ﺨ ﺜ ﺮ ات ا ﻟﺪ ﻣ ﻮﻳ ﺔ ا و ﻋ ﻦ ﻃ ﺮﻳ ﻖ زر ع ﻋ ﻴ ﻨﻪ ﻣ ﻦ ا ﻟ ﻤ ﻨﺘ ﺞ د ا ﺧ ﻞ ا ﻟ ﻤ ﺨ ﺘ ﺒ ﺮ ‪ .‬و‬
‫ﺗﺤﺪث ﻓﻲ ‪ 1‬ﻣﻦ اﺻﻞ ‪ 200‬وﺣﺪة ﻣﻦ ﻣﻜﻮﻧﺎت اﻟﺪم و ﺗﺤﺪث ﺑﺸﻜﻞ ﻛﺒﻴﺮ ﻓﻲ اﻣﺮاض‬
‫اﻟﺪم و اﻻﺷﺨﺎص اﻟﻤﺼﺎﺑﻴﻦ ﻓﻲ اﻟﺴﺮﻃﺎن و ﻫﻲ ﺷﺎﺋﻌﻪ ﻓﻲ ﻧﻘﻞ اﻟﺪم و ﺗﺤﺪث ﺑﺸﻜﻞ اﻗﻞ‬
‫ﻋ ﻨ ﺪ ﻧ ﻘ ﻞ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ و ا ﻟ ﺒ ﻼ ز ﻣ ﺎ و ﻫ ﺬ ا ﻳ ﻌ ﻮ د ا ﻟ ﻰ ﺳ ﺮﻋ ﺔ ﻣ ﻌ ﺮ ﻓ ﺔ ا ﻟ ﺘ ﻠ ﻮ ث ﻓ ﻲ ا ﻟ ﻤ ﻜ ﻮ ن ﻧ ﺘ ﻴ ﺠ ﺔ ﻟ ﻮ ن‬
‫اﻟﻤﻨﺘﺞ اﻟﻤﻤﻴﺰ ﻟﻪ ‪ .‬ﻗﺒﻞ اﻧﺘﺸﺎر ﻣﺼﻄﻠﺢ اﻧﺨﻔﺎض ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ ﻛﺎن ﻫﻨﺎﻟﻚ اﻋﺘﻘﺎد ﻋﻠﻰ‬
‫إن اﻻﺿﺪاد اﻟﺘﻲ ﺗﻬﺎﺟﻢ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ ﻟﻠﻤﺴﺘﻠﻢ ﻫﻲ اﻟﺴﺒﺐ و ﻟﻜﻦ ﺑﻌﺪ ﻓﺘﺮة و دراﺳﺎت‬
‫و ﻋﻨﺪ اﺳﺘﺨﺪام ﺗﻘﻨﻴﺔ ﺗﺼﻔﻴﺔ اﻟﺪم ﻣﻦ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ ﻟﻠﻮاﻫﺐ اﺳﺘﻤﺮ وﺟﻮد اﻟﺤﺎﻟﺔ ﻣﻤﺎ‬
‫اﻋﻄﻰ ﺗﻔﺴﻴﺮ اﺧﺮ ﻟﻠﺤﺎﻟﺔ اﻻ و ﻫﻮ وﺟﻮد اوﺳﺎط ﻣﺎ ﻗﺒﻞ اﻻﻟﺘﻬﺎب اﻟﺘﻲ ﺗﺤﻔﺰ ﺧﻼﻳﺎ اﻟﺪم‬
‫ا ﻟ ﺒ ﻴ ﺾ ﻟ ﺪ ى ا ﻟ ﻤ ﺴ ﺘ ﻠ ﻢ و ﺗ ﺆ د ي ا ﻟ ﻰ ﻇ ﻬ ﻮ ر ا ﻟ ﺤ ﺎ ﻟ ﺔ و ﻟ ﺬ ﻟ ﻚ ﺑ ﺪ أ ا ﻟﻌ ﻤ ﻞ ﻋ ﻠ ﻰ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ﻗ ﺒ ﻞ ﺗ ﺎ ر ﻳﺦ‬
‫اﻧﺘﻬﺎء ﺻﻼﺣﻴﺘﺔ ﺑﻔﺘﺮة ﺟﻴﺪة ﻻن ﻣﻮت ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ ﻫﻮ ﻣﺎ ﻳﺆدي اﻟﻰ ﻇﻬﻮر ﺗﻠﻚ اﻻ‬
‫و ﺳﺎ ط ‪.‬‬
‫و ﻗﺪ اﺟﺮﻳﺖ دراﺳﺔ ﻋﻠﻰ ﻣﻜﻮن اﻟﺼﻔﺎﺋﺢ اﻟﻤﻨﻘﻮل ﻓﻮﺟﺪت ﻋﻼﻗﺔ وﺛﻴﻘﺔ ﺑﻴﻦ ﻛﻤﻴﺔ ﺧﻼﻳﺎ‬
‫ا ﻟﺪ م ا ﻟ ﺒ ﻴ ﺾ ا ﻟ ﻤ ﻮ ﺟ ﻮ د ة ﻣ ﻊ اﻟ ﺼ ﻔﺎ ﺋ ﺢ و ﻇ ﻬ ﻮ ر ا ﻟ ﺤ ﺎﻟ ﺔ و ﺗ ﻢ ر ﺑ ﻂ ا ﻟ ﺴ ﺒ ﺐ ﻋﻠ ﻰ إ ﻧ ﻪ و ﺟ ﻮ د‬
‫اوﺳﺎط ﻣﺎ ﻗﺒﻞ اﻻﻟﺘﻬﺎب ﻓﻲ ﺣﻘﻴﺒﺔ اﻟﻤﻜﻮن اﻟﻤﻨﻘﻮل و ﻛﺬﻟﻚ وﻗﺖ اﻟﺨﺰن او‬
‫ﻓ ﺘ ﺮ ة اﻟ ﺨ ﺰ ن ‪.‬‬
‫و ﺗ ﺨ ﺘ ﻠ ﻒ ﺷ ﺪ ة ا ﻟ ﺤ ﺎﻟ ﺔ ﺣﺴ ﺐ اﻟ ﻤ ﻜ ﻮ ن ا ﻟ ﻤ ﻨ ﻘ ﻮ ل ﺣ ﻴ ﺚ ﺗ ﻜ ﻮ ن ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ اﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ا ﻛ ﺜ ﺮ ﺷ ﺪ ة و‬
‫ذﻟﻚ ﺑﺴﺒﺐ ﻇﺮوف و وﻗﺖ اﻟﺨﺰن اﻟﺬي ﻳﻘﻠﻞ ﻣﻦ ﻋﻤﺮ اﻟﺼﻔﺎﺋﺢ و ﺑﺎﻟﺘﺎﻟﻲ ﻇﻬﻮر ﻫﺬة اﻻ‬
‫وﺳﺎط اﻟﻤﺤﻔﺰة ﻟﻼﻟﺘﻬﺎب ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ اﻟﻌﻮاﻣﻞ اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﺮﻳﺾ ‪ .‬و اﻟﺪراﺳﺎت اﻟﺘﻲ‬
‫ا ﺟ ﺮ ﻳ ﺖ ﻋﻠ ﻰ ﻛ ﺒﺎ ر ا ﻟ ﺴ ﻦ و ا ﻟﺬ ﻳ ﻦ ﺗ ﻌ ﺮ ﺿ ﻮ ا ﻻ ﻟ ﺘ ﻬ ﺎ ﺑ ﺎ ت ﻣ ﺘ ﻜ ﺮ ر ة ﺗ ﺆ ﻛﺪ ذ ﻟ ﻚ و ﻳ ﻜ ﻮ ن ا ﻟ ﺘ ﺒ ﺮع‬
‫ﺑ ﻤ ﻨ ﺘ ﺠ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﺨ ﺎ ﺻ ﻪ ﺑ ﻬ ﻢ ا ﻛ ﺜ ﺮ ا ﺣ ﺘ ﻤ ﺎ ﻟ ﻴ ﺔ ﻟ ﺤ ﺼ ﻮ ل ﻫ ﺬ ة ا ﻟ ﺤ ﺎ ﻟ ﺔ ﻋ ﻨ ﺪ ا ﻟ ﻨ ﻘ ﻞ ‪ .‬ﻛ ﺬ ﻟ ﻚ ﺗ ﻠﻌ ﺐ‬
‫اﻟ ﻌ ﻮ ا ﻣ ﻞ ا ﻟ ﺠ ﻴ ﻨ ﻴ ﺔ د و ر ﻣ ﻬ ﻢ و ﻛ ﺒ ﻴ ﺮ ﻓ ﻲ ﺗ ﻄ ﻮ ر ا ﻟ ﺤﺎ ﻟ ﺔ ﻓ ﻮ ﺟ ﻮ د ا و ﻋﺪ م و ﺟ ﻮ د ﻣ ﺴ ﺘ ﻘ ﺒ ﻞ‬
‫ا ﻟ ﺴﺎﻳ ﺘ ﻮﻛ ﻴ ﻨﺎ ت ﻋﻠ ﻰ ﺳ ﻄ ﺢ ا ﻟ ﺨ ﻼﻳﺎ ا ﻟ ﻤ ﻨﺎ ﻋ ﻴ ﺔ ﻫ ﻮ ﻣﺎ ﻳ ﺴ ﺒ ﺐ ﺣﺪ و ث ا و ﻋﺪ م ﺣ ﺪ و ث ا ﻟ ﺤﺎ ﻟ ﺔ ‪ .‬و‬
‫ﻻزاﻟﺖ ﻫﺬة اﻟﺤﺎﻟﺔ ﻣﺜﺎر ﺟﺪل ﻛﺒﻴﺮ ﻓﻲ اﻟﻮﺳﻂ اﻟﻌﻠﻤﻲ و اﻟﻄﺒﻲ ﻋﻠﻰ وﺟﻪ اﻟﺘﺤﺪﻳﺪ ‪.‬‬
‫ﻋﻼج اﻟﺤﺎﻟﺔ ﻳﺒﺪأ ﻣﻦ ﺧﻼل ﺻﺮف ﻣﻀﺎدات ارﺗﻔﺎع اﻟﺤﺮارة و ﻟﻜﻦ ﺑﺸﺮط اﺳﺘﺜﻨﺎء او‬
‫ا ﺳ ﺘ ﺒ ﻌ ﺎ د ﺣ ﺪ و ث ﺗ ﺤ ﻠ ﻞ د ﻣ ﻮ ي ﺣ ﺎ د ﻧ ﺘ ﻴ ﺠ ﺔ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ﻛ ﺬ ﻟ ﻚ ﺗ ﺪ ر ﻳ ﺐ ا ﻟ ﻜ ﻮ اد ر ﻟ ﻠ ﺘ ﻤ ﻴ ﻴ ﺰ ﺑ ﻴ ﻦ ﺣ ﺎ ﻟ ﺔ‬
‫ﺗ ﺴ ﻤ ﻢ ا ﻟﺪ م ا و ﺗﻠ ﻮ ث ا ﻟﺪ م و ﺣﺎ ﻟ ﺔ ﺿ ﺮ ر ا ﻟ ﺮ ﺋ ﺘ ﻴ ﻦ ا ﻟ ﻨﺎ ﺗ ﺞ ﻣ ﻦ ﻧ ﻘ ﻞ ا ﻟﺪ م و ﻫﺬ ة اﻟ ﺤﺎ ﻟ ﺔ ‪ .‬ﻓ ﻲ‬
‫ﻧﻬﺎﻳﺔ اﻟﻤﻄﺎف اﻏﻠﺐ اﻟﺤﺎﻻت ﻳﺘﻢ ﻋﻼﺟﻬﺎ ﻣﻦ ﺧﻼل ﻣﻀﺎدات اﻟﺘﺤﺴﺲ او اﻟﺴﺘﻴﺮوﻳﺪات اﻣﺎ‬
‫اﻻﺟﺮاءات اﻻﺧﺮى ﻏﻴﺮ اﻟﻤﺠﺪﻳﺔ ﻓﻼ ﺣﺎﺟﺔ ﻻﺟﺮاؤﻫﺎ ﻣﻦ ﻗﺒﻞ اﻟﻄﺒﻴﺐ‬

‫)‪ Allergic Transfusion Reactions (ATRs‬‬

‫واﺣﺪة ﻣﻦ اﻫﻢ اﻟﺤﺎﻻت اﻟﺘﻲ ﺗﺤﺪث ﻋﻨﺪ ﻧﻘﻞ اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ و ﻛﺬﻟﻚ ﺗﺤﺪث ﻓﻲ ‪%2‬‬
‫ﻣﻦ ﺣﺎﻻت ﻧﻘﻞ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء‪ .‬و ﺗﺆدي اﻟﺤﺎﻻت اﻟﺤﺎدة اﻟﻰ ﻣﺸﺎﻛﻞ و اﺧﺘﻨﺎق ﻓﻲ‬
‫ا ﻟ ﺘ ﻨ ﻔ ﺲ ﻗ ﺪ ﻳ ﻜ ﻮ ن ﻣ ﻤ ﻴ ﺖ ﻟ ﻜ ﻦ ذ ﻟ ﻚ ﻳ ﺤ ﺪ ث ﺑ ﺸ ﻜ ﻞ ﻗ ﻠ ﻴ ﻞ ‪ .‬ﺗ ﻜ ﻮ ن ا ﻟ ﺤ ﺎ ﻟ ﺔ ﻣ ﺘ ﻮ ﺳ ﻄ ﺔ ا ﻟ ﻰ ﺗﺸ ﻴ ﺮ‬
‫اﻟﻰ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻟﻌﻼﻣﺎت و اﻻﻋﺮاض اﻟﺘﻲ ﺗﻈﻬﺮ ﻋﻠﻰ اﻟﺠﻠﺪ و اﻟﻘﻨﺎة اﻟﻬﻀﻤﻴﺔ ‪ .‬و ﺗﻌﺘﺒﺮ‬
‫واﺣﺪة ﻣﻦ اﻫﻢ اﻟﺤﺎﻻت اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﻫﺪر اﻟﺪم و ﻣﺸﺘﻘﺎﺗﺔ ‪ .‬و ﺗﻨﻘﺴﻢ اﻻﻋﺮاض اﻟﻰ‬
‫ﺟﻠﺪﻳ ﺔ‬
‫‪ Urticaria‬‬
‫‪ Pruritis‬‬
‫‪ Facial or generalized flushing‬‬
‫‪ Maculopapular rash‬‬
‫‪ Erythema and swelling around the eyes‬‬
‫‪ Swelling of lips or tongue‬‬
‫‪ Localized angioedema‬‬
 ‫ﻣﻌ ﻮﻳ ﺔ‬
‫‪‬‬ ‫‪Nausea‬‬
‫‪‬‬ ‫‪Vomiting‬‬
‫‪‬‬ ‫‪Abdominal pain or cramps‬‬
‫‪‬‬ ‫‪Diarrhea‬‬
‫ﺗ ﻨ ﻔﺴ ﻴ ﺔ‬
‫‪‬‬ ‫‪Throat tightness‬‬
‫‪‬‬ ‫‪Hoarseness‬‬
‫‪‬‬ ‫‪Stridor‬‬
‫‪‬‬ ‫‪Wheezing‬‬
‫‪‬‬ ‫‪Chest tightness‬‬
‫‪‬‬ ‫‪Dyspnea‬‬
‫و ﻋﺎ ﺋﻴ ﺔ ﻗﻠ ﺒ ﻴ ﺔ‬
‫‪ Hypotension‬‬
‫‪ Tachycardia‬‬
‫‪ Shock‬‬
‫اﻻﻋﺮاض اﻟﺘﻨﻔﺴﻴﺔ ﻳﻤﻜﻦ ﻣﻌﺎﻟﺠﺘﻬﺎ ﺑﺎﺳﺘﺨﺪام اﻟﺴﺘﻴﺮوﻳﺪات او ﻣﻤﻜﻦ اﺳﺘﺨﺪام اﻻدرﻳﻨﺎﻟﻴﻦ‬
‫اﻣﺎ ﻓﻲ اﻟﺤﺎﻻت اﻟﺤﺎدة ﻳﺘﻢ دﻋﻢ اﻟﻤﺮﻳﺾ ﺑﺎﻻوﻛﺴﺠﻴﻦ و اﻟﺴﻴﻄﺮة ﻋﻠﻰ ﺿﻐﻂ اﻟﺪم و ﻳﻤﻜﻦ‬
‫ا ﺳ ﺘ ﺨ ﺪ ا م ﻣ ﻀ ﺎ د ا ت ا ﻟ ﺘ ﺤ ﺴ ﺲ ﺑ ﻌ ﺪ ا ﻋ ﻄ ﺎ ء ا ﻟ ﺪ م ﻟ ﻠﺴ ﻴ ﻄ ﺮ ة ﻋ ﻠ ﻰ ا ﻟ ﺤ ﺎ ﻟ ﺔ ‪ .‬ﻻ ﻳ ﻮ ﺟ ﺪ د ﻟ ﻴ ﻞ ﻳ ﻮ ﺿ ﺢ‬
‫ا ﻟ ﻔﺎ ﺋﺪة ﻣ ﻦ ﻫﺬة ا ﻟ ﻤ ﻤﺎ ر ﺳ ﺔ ﻟ ﻜ ﻨﻬ ﺎ ﻻ ز ا ﻟ ﺖ ﺗ ﺴﺘ ﺨﺪ م ﻓ ﻲ ﻛ ﺜﻴ ﺮ ﻣ ﻦ ا ﻟ ﻤ ﺴﺘ ﺸ ﻔ ﻴﺎ ت‬

‫ا ﻟ ﻤ ﻔﻬ ﻮ م ا ﻟ ﻤ ﺘ ﻘﺪ م‬
‫‪IgE-mediated type I hypersensitivity‬‬
‫ﻻ ﺗ ﻮ ﺿ ﺢ ﻛ ﻞ ا ﻟ ﺘ ﻔﺎ ﺻ ﻴ ﻞ ا ﻟ ﺨﺎ ﺻ ﺔ ﺑ ﻬﺬة ا ﻟ ﺤﺎ ﻟ ﺔ و ﻟ ﻜ ﻦ ﻓ ﺴ ﻴ ﻮ ﻟ ﻮ ﺟ ﻴﺎ ا ﻟ ﻤ ﺮ ض ﺗ ﻜ ﻮ ن ﻣ ﺸﺎ ﺑﻬ ﻪ ﻟﻠ ﺤﺎ ﻟ ﺔ‬
‫اﻋﻼه ‪ .‬ﺣﻴﺚ إن ﻫﻨﺎﻟﻚ اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﻧﻮع ‪ IgE‬ﺗﻌﻤﻞ ﻋﻠﻰ ﻣﻬﺎﺟﻤﺔ ﺑﺮوﺗﻴﻨﺎت اﻟﺒﻼزﻣﺎ‬
‫اﻟﻤﻨﻘﻮﻟﺔ ‪ .‬و اﻟﺤﺎﻻت اﻟﺤﺎدة ﻧﺎﺗﺠﺔ ﻋﻦ وﺟﻮد ‪ IgA‬و ﻛﺬﻟﻚ اﻟﻬﺎﺑﺘﻮﻏﻠﻮﺑﻴﻮﻟﻴﻦ ﻓﻲ اﻟﺒﻼزﻣﺎ‬
‫ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ اﻻﺿﺪاد و ﺗﻔﺎﻗﻢ اﻟﺤﺎﻟﺔ ‪ .‬ﻣﻊ ذﻟﻚ ﻻ ﺗﻮﺟﺪ ادﻟﺔ ﻣﻮﺛﻮﻗﺔ ﺗﺒﻴﻦ اﻟﻌﻼ‬
‫ﻗﺔ ﻓﻲ ذﻟﻚ ‪ .‬ﻛﺬﻟﻚ اﻟﺘﻌﺮض ﻟﻌﻤﻠﻴﺎت ﻧﻘﻞ ﺑﻼزﻣﺎ اﻟﺪم ﺑﺸﻜﻞ ﻣﺘﻜﺮر ﻳﺆدي اﻟﻰ ﻇﻬﻮر ﻫﺬة‬
‫ا ﻟ ﺤ ﺎ ﻟ ﺔ ﻋ ﻨ ﺪ ا ﻟﻤ ﺮ ﻳ ﺾ ‪.‬‬
‫ﻛﺬﻟﻚ وﺟﺪت اﻟﺪراﺳﺎت إن ﻫﻨﺎﻟﻚ ﻧﻮع ﻣﻦ اﻻﺿﺪاد ‪ IgG‬ﻳﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ و‬
‫اﻃﻼق ﻣﺤﺘﻮﻳﺎت اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ و ﺑﺎﻟﺘﺎﻟﻲ ﻳﺆدي اﻟﻰ ﻇﻬﻮر اﻟﺘﺤﺴﺲ اﻟﻈﺎﻫﺮ ﻋﻞ اﻟﻤﺮﻳﺾ‬

‫‪‬‬ ‫‪Adverse Reactions to Infusion of Plasma-Derived Products‬‬

‫وﻳﻘﺼﺪ ﺑﻬﺎ ﻣﺠﻤﻮﻋﻪ اﻻﻋﺮاض اﻟﺠﺎﻧﺒﻴﻪ اﻟﻨﺎﺗﺠﻪ ﻣﻦ ﻧﻘﻞ اﺣﺪ ﻣﺸﺘﻘﺎت اﻟﺒﻼزﻣﺎ ﻣﺜﻞ اﻻ‬
‫ﻟ ﺒ ﻮ ﻣ ﻴ ﻦ و ا ﻟ ﺠﻠ ﻮ ﺑ ﻴ ﻮ ﻟ ﻴ ﻦ ا و ﻧ ﻘ ﻞ ا ﺣ ﺪ ﻋ ﻮ ا ﻣ ﻞ ا ﻟ ﺘ ﺨ ﺜ ﺮ اﻟ ﻰ ا ﻟ ﻤ ﺮ ﻳ ﺾ ‪ .‬و ﻗﺪ ﺗ ﻜ ﻮ ن ﻫﺬ ه ا ﻟ ﺤ ﺎﻟ ﻪ‬
‫اﻟﺴﺒﺐ ﻓﻲ ﻧﻘﻞ اﻟﻔﻴﺮوﺳﺎت اﻟﺸﺨﺺ اﻟﻤﺴﺘﻠﻢ ‪ .‬ﺣﻴﺚ ﺗﻢ ﻣﻼﺣﻈﻪ ﻫﺬه اﻟﺤﺎﻟﻪ ﻋﻨﺪ اﻻ‬
‫ﺷﺨﺎص اﻟﺬﻳﻦ ﻳﺘﻠﻘﻮن ﻋﻮاﻣﻞ اﻟﺘﺨﺜﺮ واﻟﻤﺼﺎﺑﻴﻦ ﺑﺎﻟﻬﻴﻤﻮﻓﻴﻠﻴﺎ ‪ .‬ﻧﻘﻞ اﻻﻟﺒﻮﻣﻴﻦ ﻟﻼﺷﺨﺎص‬
‫اﻟﺬﻳﻦ ﻳﺘﻨﺎوﻟﻮن ﻋﻼج ‪ 2-ACE‬ﻳﺆدي اﻟﻰ اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم اﻟﺴﺮﻳﻊ‪ .‬اﻣﺎ ﻧﻘﻞ اﻟﺠﻠﻮﺑﻴﻮﻟﻴﻦ‬
‫ﻓ ﺎ ﻧ ﻪ ﻳ ﺆ د ي ا ﻟ ﻰ ﺣ ﺼ ﻮ ل ﺣ ﺎ ﻟ ﻪ ﻣ ﻦ ا ﻟ ﺘ ﺤﺴ ﺲ ﺗ ﻜ ﻮ ن ﻣ ﻨ ﺨ ﻔ ﻀ ﻪ ا ﻟ ﻰ ﻣ ﺘ ﻮ ﺳ ﻄ ﻪ اﻟ ﺸ ﺪ ه و ﺗ ﺸ ﻤ ﻞ‬
‫اﻻﻋﺮاض‬
 ‫‪ Headache‬‬
‫‪ Fever‬‬
‫‪ chills‬‬
‫‪ nausea‬‬
‫‪ vomiting‬‬
‫‪ abdominal pain‬‬
‫‪ diarrhea‬‬
‫‪ facial flushing‬‬
‫‪ urticaria‬‬
‫‪ itching‬‬
‫‪ muscular cramps‬‬
‫‪ back pain‬‬
‫وﻗﺪ ﺗﻢ ﻣﺸﺎﻫﺪه ﻫﺬه اﻟﺤﺎﻟﻪ ﻓﻲ اﻛﺜﺮ ﻣﻦ ‪ %80‬ﻣﻦ اﻟﺤﺎﻻت اﻟﺘﻲ ﻳﺘﻢ ﻧﻘﻞ اﻟﺠﻠﻮﺑﻴﻮﻟﻴﻦ‬
‫اﻟﻴﻬﺎ ﻋﻦ ﻃﺮﻳﻖ اﻟﻮرﻳﺪ ‪ .‬ﻣﻦ اﻟﻤﻬﻢ ﺗﻨﺒﻴﻪ اﻟﻤﺮﻳﺾ ﻣﻦ ﻗﺒﻞ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ان اﻻﻋﺮاض ﻗﺪ‬
‫ﺗﺘﺎﺧﺮ وﺗﻈﻬﺮ ﺑﻌﺪ ﺳﺒﻌﻪ اﻳﺎم ﻣﻦ وﻗﺖ اﻳﻘﺎف اﻟﻨﻘﻞ او ﺑﻌﺪ اﻻﻋﻄﺎء‬

‫‪ Transfusion-Associated Graft-Versus-Host Disease‬‬

‫ﻫﺬة اﻟﺤﺎﻟﺔ رﻏﻢ ﻧﺪرﺗﻬﺎ اﻹ ان ﺧﻄﻮاﺗﻬﺎ ﻗﺪ ﺗﻜﻮن ﻗﺎﺗﻠﺔ و ﺗﺘﻤﻴﺰ ﺑﻤﻌﺪل وﻓﻴﺎت ﻋﺎﻟﻲ اﻛﺜﺮ‬
‫ﻣﻦ ﺑﻘﻴﻪ اﻧﻮاع ﺗﻔﺎﻋﻼت اﻟﻨﻘﻞ ﻛﺬﻟﻚ ﺗﺤﺼﻞ ﻋﻨﺪ زراﻋﻪ ﻧﺨﺎع اﻟﻌﻈﻢ و زراﻋﺔ اﻻﻋﻀﺎء‬
‫اﻟ ﺼﻠ ﺒ ﻪ ‪.‬‬
‫وﻳﺘﻢ اﻟﺘﻌﺮف ﻋﻠﻰ اﻟﺤﺎﻟﻪ ﻣﻦ ﺧﻼل اﻻﻋﺮاض اﻟﺘﻲ ﺗﻈﻬﺮ ﻋﻠﻰ اﻟﻤﺮﻳﺾ ﺧﻼل ﻳﻮﻣﺎن اﻟﻰ‬
‫ﺳﺘﺔ اﺳﺎﺑﻴﻊ ‪ .‬وﺗﺸﻤﻞ اﻻﻋﺮاض ﻣﺎ ﻳﻠﻲ‬
‫‪ typical skin rash seen‬‬
‫‪ diarrhea‬‬
‫‪ fever‬‬
‫‪ enlarged liver‬‬
‫‪ elevated‬‬
‫‪liver enzymes‬‬
‫‪ marrow aplasia‬‬
‫‪ pancytopenia‬‬
‫وﻓﻲ اﻏﻠﺐ اﻟﺤﺎﻻت ﻳﻤﻮت اﻟﺸﺨﺺ ﻓﻲ اﻟﻴﻮم اﻟﺮاﺑﻊ واﻟﻌﺸﺮﻳﻦ ﻣﻦ ﻇﻬﻮر اﻻﻋﺮاض ‪ .‬ﺑﺎﻻ‬
‫ﺿﺎﻓﻪ اﻟﻰ اﻻﻋﺮاض اﻟﻤﺬﻛﻮره ﻳﻜﻮن اﻟﻄﻔﺢ اﻟﺠﻠﺪي ﻣﻨﺘﺸﺮ ﻓﻲ ﻣﻨﻄﻘﻪ اﻟﺠﺬع ﺛﻢ ﻳﻨﺘﺸﺮ اﻟﻰ‬
‫اﻻﻃﺮاف وﻫﻮ ﺻﻔﻪ ﻣﻤﻴﺰه ﺑﻴﻦ اﻟﻄﻔﺢ اﻟﺠﻠﺪي اﻟﻨﺎﺗﺞ ﻋﻦ اﻟﻔﻴﺮوﺳﺎت واﻟﻄﻔﺢ اﻟﺠﻠﺪ اﻟﻨﺎﺗﺞ‬
‫ﻋ ﻦ ﻫﺬ ه ا ﻟ ﺤ ﺎﻟ ﻪ‬
‫ﻳ ﺘ ﻢ ﺗ ﺸ ﺨ ﻴ ﺺ ا ﻟ ﺤ ﺎﻟ ﻪ ﻣ ﺨ ﺘ ﺒ ﺮ ﻳﺎ ﻋ ﻦ ﻃ ﺮ ﻳ ﻖ ا ﻟ ﺨ ﺰ ﻋ ﻪ ا ﻟ ﺘ ﻲ ﺗ ﺆ ﺧ ﺬ ﻣ ﻦ ا ﻟ ﻤ ﻨ ﻄ ﻘ ﻪ ا ﻟ ﺘ ﻲ ﺗ ﺤ ﺘ ﻮ ي ﻋﻠ ﻰ‬
‫اﻟﻄﻔﺢ اﻟﺠﻠﺪي ‪ .‬ﻛﺬﻟﻚ ﻳﺘﻢ اﻟﻌﺜﻮر ﻋﻠﻰ ﺧﻼﻳﺎ اﻟﻠﻤﻔﻮﺳﺎﻳﺖ اﻟﺨﺎﺻﻪ ﺑﺎﻟﻤﺘﺒﺮع ﻓﻲ اﻋﻀﺎء‬
‫ا ﻟﻤ ﺮ ﻳ ﺾ ﻛ ﺬ ﻟ ﻚ ﻳﻤ ﻜ ﻦ ﺗ ﺤ ﻠ ﻴ ﻞ ا ﻟ ﺤ ﻤ ﺾ ا ﻟ ﻨ ﻮ و ي و اﻟ ﻜ ﺸ ﻒ ﻋ ﻦ و ﺟ ﻮ د ا ﻟ ﺤ ﻤ ﺾ ا ﻟ ﻨ ﻮ و ي ا ﻟ ﺨ ﺎ ص ﺑ‬
‫ﺎﻟﻤﺘﺒﺮع اﻟﺬي ﻳﻜﻮن ﻣﺨﺘﻠﻂ ﻣﻊ اﻟﺤﻤﺾ اﻟﻨﻮوي اﻟﺨﺎص ﺑﺎﻟﻤﺴﺘﻠﻢ ﻋﻨﺪﻣﺎ ﻳﺘﻢ اﺳﺘﺒﺪال ﺧﻼﻳﺎ‬
‫ا ﻟﺪ م ا ﻟ ﺒ ﻴ ﺾ ا ﻟ ﺨﺎ ﺻ ﻪ ﺑ ﺎﻟ ﻤ ﺴ ﺘﻠ ﻢ ﺑ ﺨ ﻼ ﻳﺎ ا ﻟﺪ م ا ﻟ ﺒ ﻴ ﺾ ا ﻟ ﺨ ﺎ ﺻ ﻪ ﺑﺎ ﻟ ﻤ ﺘ ﺒ ﺮع ‪.‬‬
‫اﻻﻣﺮاﺿﻴﻪ اﻟﺨﺎﺻﻪ ﺑﻬﺬه اﻟﺤﺎﻟﻪ ﻏﻴﺮ ﻣﻔﻬﻮﻣﻪ ﺑﺸﻜﻞ واﺿﺢ وﻟﻜﻦ ﻓﻲ اﻟﻌﻤﻮم ﻫﻲ ﺗﻌﺘﻤﺪ ﻋﻠﻰ‬
‫ﻣ ﺠ ﻤ ﻮ ﻋﻪ ﻣ ﻦ ا ﻟ ﻌ ﻮ ا ﻣ ﻞ ﺗ ﺸ ﻤ ﻞ ﻣﺎ ﻳﻠ ﻲ‬
‫‪ recipient immune status‬‬
‫‪ component‬‬
‫‪characteristics‬‬
‫‪ donor recipient HLA relationships‬‬
‫وﻗﺪ ﺗﻢ ﺗﺴﺠﻴﻞ اوﻟﻰ اﻟﺤﺎﻻت ﻟﺪى اﻻﻃﻔﺎل واﻻﺷﺨﺎص اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ ﻧﻘﺺ اﻟﻤﻨﺎﻋﻪ ‪.‬‬
‫ﻣ ﻊ ذ ﻟ ﻚ ﺗ ﺸ ﻴ ﺮ ا ﻟ ﺪ ر ا ﺳ ﺎ ت ا ن ا ﻟ ﻤ ﻨ ﺎ ﻋ ﻪ ﻟ ﻠ ﻤ ﺴ ﺘ ﻠ ﻢ ﺗ ﻠﻌ ﺐ د و ر ﻛ ﺒ ﻴ ﺮ ﻓ ﻲ ﺗ ﻄ ﻮ ر ﻫ ﺬ ه ا ﻟ ﺤ ﺎ ﻟ ﻪ ‪ .‬و ا ن‬
‫ﻣ ﻦ ا ﻫ ﻢ ا ﻟﻌ ﻮ ا ﻣ ﻞ ا ﻟ ﻤ ﺘ ﻮ ر ﻃ ﻪ ﻓ ﻲ ﻫ ﺬ ه ا ﻟ ﺤ ﺎ ﻟ ﻪ ﻫ ﻲ ﻣ ﺎ ﻳ ﻠ ﻲ‬
‫‪ male sex‬‬
‫‪ age greater than 70 years‬‬
‫‪ cardiovascular surgery‬‬
‫‪ whole blood‬‬
‫‪ fresh blood products‬‬
‫‪ relationship between the donor and recipient‬‬
‫ﺣﻴﺚ وﺟﺪت اﻟﺪراﺳﺎت إن ‪ %90‬ﻣﻦ اﻟﺤﺎﻻت ﺗﺤﺪث ﻧﺘﻴﺠﺔ ﻧﻘﻞ اﻟﺪم اﻟﻄﺎزج اﻟﺬي ﻟﻢ‬
‫ﻳﺘﺠﺎوز ﻋﻠﻰ ﺧﺰﻧﻪ ‪ 10‬اﻳﺎم ‪ .‬وﻛﺬﻟﻚ اﻟﻌﻼﻗﻪ ﻣﺎ ﺑﻴﻦ اﻟﻮاﻫﺐ واﻟﻤﺴﺘﻠﻢ ﺗﻠﻌﺐ دور ﻛﺒﻴﺮ ﻓﻲ‬
‫ﻫﺬه اﻟﻌﻤﻠﻴﻪ ﺣﻴﺚ ان اﻻﺷﺨﺎص اﻟﻤﺘﺒﺮﻋﻴﻦ اﻟﺬﻳﻦ ﻳﻜﻮﻧﻮن‬
‫‪homozygosity for an HLA‬‬
‫و ا ﻟ ﻤ ﺴﺘﻠ ﻤ ﻴ ﻦ ا ﻟﺬﻳ ﻦ ﻳ ﻜ ﻮ ﻧ ﻮ ن‬
‫‪heterozygous‬‬
‫ﻳﺆدي ذﻟﻚ اﻟﻰ ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﻪ ﻟﻠﻤﺘﺒﺮع واﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﻣﻬﺎﺟﻤﻪ ﺧﻼﻳﺎ اﻟﺪم ﻟﻠﻤﺴﺘﻠﻢ‬
‫و ﺑﺎﻟﺨﺼﻮص اﻟﺨﻼﻳﺎ اﻟﺴﺎﻣﻪ ‪ CD8+‬ﻛﺬﻟﻚ ﻻ ﻳﻤﻜﻦ ﺗﻌﺮﻳﻒ اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﻪ ﻟﻠﻮاﻫﺐ ﻋﻠﻰ اﻧﻬﺎ‬
‫ﻏﺮﻳﺒﻪ ﻻﻧﻬﺎ ﺗﺸﺘﺮك ﻣﻊ ﺧﻼﻳﺎ دم اﻟﻤﺴﺘﻠﻢ ﻓﻲ ﻧﻔﺲ اﻟﻤﺴﺘﻀﺪات ‪.‬‬

‫اﻟﻌﻼج‬
‫ﻳﺸﻤﻞ اﻟﻌﻼج ﻣﺠﻤﻮﻋﻪ ﻣﻦ اﻟﻄﺮق اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﺗﺜﺒﻴﻂ اﻟﻤﻨﺎﻋﻪ او زﻳﺎده ﻣﻨﺎﻋﻪ اﻟﺸﺨﺺ‬
‫ا ﻟﻤ ﺴ ﺘ ﻠ ﻢ و ﻣ ﻦ اﻟ ﻌ ﻼ ﺟ ﺎ ت ﻫ ﻲ ﻣ ﺎ ﻳ ﻠ ﻲ‬
‫‪ immunosuppressive medications‬‬
‫‪ Hematopoietic stem cell transplantation‬‬
‫‪ Irradiation of cellular‬‬
‫‪blood components‬‬
‫اﻣﺎ اﻫﻢ اﻻﺳﺒﺎب اﻟﺘﻲ ﺗﺆدي اﻟﻰ اﺳﺘﺨﺪام ﺗﻘﻨﻴﻪ اﻻﺷﻌﺎع ﻫﻲ ﻣﺎ ﻳﻠﻲ‬
‫‪ HLA matched platelets‬‬
‫‪ neonatal exchange transfusion‬‬
‫‪ intrauterine transfusion‬‬
‫‪ hematopoietic stem cell transplant‬‬
‫‪ patients with solid tumors undergoing chemotherapy‬‬

‫ﺣﺘﻰ اﺧﺘﺼﺮﻫﺎ ﻋﻠﻴﻚ و ﻣﺘﺪوخ ﻫﺬة اﻟﺤﺎﻟﺔ ﻫﻲ ) اﺳﺘﻔﺤﺎل ﺧﻼﻳﺎ دم اﻟﻮاﻫﺐ ﻋﻠﻰ ﺧﻼﻳﺎ‬
‫د م ا ﻟ ﻤ ﺴ ﺘ ﻠ ﻢ ﻣ ﻤ ﺎ ﻳ ﺆ د ي ا ﻟ ﻰ ﻣ ﻀ ﺎﻋ ﻔ ﺎ ت ﺧ ﻄ ﻴ ﺮ ة (‬
 ‫‪ Post Transfusion Purpura‬‬
‫و ﻫ ﻲ ﺣ ﺎ ﻟ ﺔ ﺗ ﺘ ﻤ ﻴ ﺰ ﺑ ﺎ ﻧ ﺨ ﻔ ﺎ ض ﻣ ﻔ ﺎ ﺟ ﻰ ء و ﺳ ﺮ ﻳ ﻊ ﻟﻌ ﺪد ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ا ﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ﻟ ﻠ ﻤ ﺮ ﻳ ﺾ و ﺗ ﺤ ﺪ ث ﺧ‬
‫ﻼل ‪ 10 -5‬اﻳﺎم ﺑﻌﺪ اﻋﻄﺎء اﻟﺪم او اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ ﻧﺎﺗﺠﺔ ﻋﻦ وﺟﻮد اﺿﺪاد ﻣﻨﺎﻋﻴﺔ‬
‫ﺗ ﻬ ﺎ ﺟ ﻢ اﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ا ﻟ ﺪ ﻣ ﻮ ﻳ ﺔ و ﺧ ﺎ ﺻ ﺔ ا ﺛ ﻨ ﺎ ء ا ﻟ ﺤ ﻤ ﻞ ‪ .‬و ﺗ ﻢ ﺗ ﻌ ﺮ ﻳ ﻔ ﻬ ﺎ ﻋ ﻠ ﻰ إ ﻧ ﻬ ﺎ ا ﻧ ﺨ ﻔ ﺎ ض ﺑ ﻨﺴ ﺒ ﺔ‬
‫‪ 20%‬اﻗﻞ ﻣﻦ ﻋﺪد اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ اﻟﺬي ﻛﺎﻧﺖ ﻋﻠﻴﺔ ﻗﺒﻞ اﻟﺤﻤﻞ او ﻗﺒﻞ اﻻﻋﻄﺎء و ﻣﻦ‬
‫اﺟﻞ ﺗﺸﺨﻴﺺ اﻟﺤﺎﻟﺔ ﻳﺠﺐ اﻛﺘﺸﺎف اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ اﻟﺘﻲ ﺗﻬﺎﺟﻤﻬﺎ ﻓﻲ ﻣﺼﻞ اﻟﻤﺮﻳﺾ ‪ .‬و‬
‫ﺗﻜﻮن اﻻﺿﺪاد ﻓﻲ اﻟﻐﺎﻟﺐ ﻣﻬﺎﺟﻤﻪ ﻟﻠﻤﺴﺘﻀﺪات اﻟﺘﺎﻟﻴﺔ‬
‫‪HPA-1 or HPA-3a‬‬
‫و ﺗﻢ ﺗﺸﺨﻴﺺ اﻟﺤﺎﻟﺔ ﻋﻠﻰ إﻧﻬﺎ ﺗﺤﺪث ﻓﻲ ‪ 1‬ﻣﻦ اﺻﻞ ‪ 25‬اﻟﻒ وﺣﺪة ﻣﻨﻘﻮﻟﺔ اﻟﻰ‬
‫اﻟﻤﺮﺿﻰ ‪ .‬و ﺗﺤﺪث ﺑﻨﺴﺒﺔ ‪ % 90‬ﻓﻲ اﻟﻨﺴﺎء ‪.‬‬
‫و ﺗﺸﻤﻞ اﻻﻋﺮاض ﻣﺎ ﻳﻠﻲ‬
‫‪ dark red purple patches on the skin‬‬
‫‪ bleeding from mucous membranes‬‬
‫‪ GI bleeding‬‬
‫‪ hematuria‬‬
‫ا ﻣ ﺎ ا ﻟ ﺨ ﻄ ﻮ ا ت ا ﻟ ﻌ ﻼ ﺟ ﻴ ﺔ ﻓ ﺘﺸ ﻤ ﻞ‬
‫)‪ intravenous immunoglobulin (IVIG‬‬
‫او‬
‫‪ Plasma exchange with FFP‬‬
‫ﻓﻲ ﺣﺎل ﻋﺪم اﻻﺳﺘﺠﺎﺑﺔ اﻟﻰ اﻟﻌﻼج اﻻول‬

‫‪‬‬ ‫‪Refractoriness to Platelet Transfusion and Alloimmunization‬‬

‫ا و ﺗ ﻌ ﻨ ﺖ ا ر ﺗ ﻔﺎع ا ﻟ ﺼ ﻔﺎ ﺋ ﺢ ا ﻟﺪ ﻣ ﻮ ﻳ ﺔ‬
‫ﻳ ﻌ ﻨ ﻲ إ ن اﻟ ﻤ ﺮ ﻳ ﺾ اﻟ ﺬ ي ﻳ ﺴ ﺘﻠ ﻢ ا ﻛ ﺜ ﺮ ﻋﺪ د ﻣ ﻦ و ﺣﺪ ا ت ا ﻟ ﺼ ﻔﺎ ﺋ ﺢ د و ن و ﺟ ﻮ د ا ي ز ﻳﺎ د ة‬
‫ﻣﻠ ﺤ ﻮ ﻇ ﻪ ﻓ ﻲ ﻋﺪ د ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ اﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ﺑ ﻌﺪ ﻧ ﻘ ﻞ ﻛ ﻞ ﺗﻠ ﻚ ا ﻟ ﻮ ﺣ ﺪ ا ت ‪ .‬و ﻫﺬ ا ﻳ ﻌ ﻮ د اﻟ ﻰ و ﺟ ﻮ د‬
‫اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﺗﻬﺎﺟﻢ اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ اﻟﻤﺴﺘﻠﻤﺔ و ﻣﺴﺘﻀﺪاﺗﻬﺎ و ﺑﺎﻟﺨﺼﻮص ‪ HLA‬و‬
‫ﺑ ﻄ ﺮ ﻳ ﻘ ﺔ ﻣ ﺸ ﺎ ﺑ ﻬ ﻪ ﻟ ﺘ ﻜ ﻮ ﻳ ﻦ ا ﺿ ﺪ ا د ﻣ ﻨ ﺎﻋ ﻴ ﺔ ﻟ ﻜ ﺮ ﻳ ﺎ ت اﻟ ﺪ م اﻟ ﺤﻤ ﺮ ا ء‬

‫‪ Adverse Metabolic Effects of Transfusion‬‬

‫اﻟﺘﺄﺛﻴﺮات اﻻﻳﻀﻴﺔ اﻟﺮﺋﻴﺴﻴﺔ اﻟﻨﺎﺗﺠﺔ ﻣﻦ ﻧﻘﻞ اﻟﺪم ﻫﻲ اﻟﺘﺴﻤﻢ ﺑﺎﻟﺴﺘﺮﻳﺖ ‪ citrate‬و ﻛﺬﻟﻚ‬
‫ارﺗﻔﺎع اﻟﺒﻮﺗﺎﺳﻴﻮم ‪ . hyperkalemia‬اﻟﺴﺘﺮﻳﺖ ﻫﻮ ﻣﺎﻧﻊ ﺗﺨﺜﺮ ﻣﻮﺟﻮد ﻓﻲ اﻛﻴﺎس اﻟﺪم‬
‫ﺣ ﻴ ﺚ ﻳ ﺮ ﺗ ﺒ ﻂ ا ﻟ ﻰ ا ﻟ ﻜ ﺎ ﻟ ﺴ ﻴ ﻮ م و ﺑ ﺎ ﻟ ﺘ ﺎ ﻟ ﻲ ﻳﻤ ﻨ ﻊ ﺗ ﺨ ﺜ ﺮ اﻟ ﺪ م ‪ .‬و ﺑ ﺎﻟ ﺤ ﺎ ﻟ ﺔ ا ﻟ ﻄ ﺒ ﻴ ﻌ ﻴ ﺔ ﻳ ﺘ ﻢ ا ﻳ ﺾ‬
‫ا ﻟﺴ ﺘ ﺮ ﻳ ﺖ ﺑ ﺴ ﺮﻋ ﺔ ﻓ ﻲ اﻟ ﻜ ﺒ ﺪ ﺑ ﻌ ﺪ ﻋ ﻤ ﻠ ﻴ ﺎ ت ﻧ ﻘ ﻞ ا ﻟ ﺪ م ‪ .‬ا ﻣ ﺎ ﻓ ﻲ ﺣ ﺎ ل ﻧ ﻘ ﻞ ﻛﻤ ﻴ ﺔ ﻛ ﺒ ﻴ ﺮ ة ﻣ ﻦ‬
‫ا ﻟ ﺴ ﺘ ﺮ ﻳ ﺖ ا و ﻋ ﻨ ﺪ و ﺟ ﻮ د ﻣ ﺸ ﺎﻛ ﻞ ﻓ ﻲ ا ﻟ ﻜ ﺒ ﺪ ﻳ ﺆ د ي ذ ﻟ ﻚ ا ﻟ ﻰ ا ﻟ ﺘ ﺴ ﻤ ﻢ ‪ .‬ﻓ ﻴ ﻘ ﻮ م ا ﻟ ﺴ ﺘ ﺮ ﻳ ﺖ ﺑ ﺎ ﻧ ﻘ ﺎ ص‬
‫اﻟﻜﺎﻟﺴﻴﻮم ‪ hypocalcemia‬و اﻧﺨﻔﺎض اﻟﻤﻐﻨﻴﺴﻴﻮم ‪ hypomagnesemia‬ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ‬
‫اﻣﻜﺎﻧﻴﺔ ﺗﺤﻮل اﻟﺪم اﻟﻰ ﻗﺎﻋﺪي ‪ alkalosis‬ﻧﺘﻴﺠﺔ اﻳﺾ اﻟﺸﺘﺮﻳﺖ و ﻇﻬﻮر اﻟﺒﻜﺎرﺑﻮﻧﻴﺖ‪.‬‬
‫ﺧﻼل ﺧﺰن ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء ﻳﺨﺮج اﻟﺒﻮﺗﺎﺳﻴﻮم ﺑﺒﻄﻰء ﻣﻦ اﻟﻜﺮﻳﺎت ﻣﻤﺎ ﻳﺆدي اﻟﻰ زﻳﺎدة‬
‫ﻣﺴﺘﻮاة ﻓﻲ اﻟﻌﺎﻟﻖ و ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ إن ﻫﺬة اﻟﺤﺎﻟﺔ ﻧﺎدرة ﻋﻦ اﻟﻜﺒﺎر اﻻ إﻧﻬﺎ ﺗﺴﺒﺐ اﺛﺎر‬
‫ﺟﺎﻧﺒﻴﺔ ﻛﺒﻴﺮة ﻟﻼﻃﻔﺎل و ﺧﺎﺻﺔ اﻟﺨﺪج ‪ .‬و اﻻﻋﺮاض ﻧﺎﺗﺠﺔ ﻋﻦ زﻳﺎدة اﻟﺒﻮﺗﺎﺳﻴﻮم ﺗﺸﻤﻞ‬
‫اﻟﺘﺄﺛﻴﺮ ﻋﻠﻰ اﻟﻘﻠﺐ و اﻟﻌﻀﻼت و اﻻﻋﺼﺎب ‪ .‬و ﻳﻤﻜﻦ ﺗﻘﻠﻴﻞ ﻫﺬة اﻟﺤﺎﻟﺔ ﻣﻦ ﺧﻼل ﻧﻘﻞ اﻟﺪم‬
‫اﻟﻄﺎزج اﻟﻰ اﻻﻃﻔﺎل ‪ .‬اﻣﺎ ﻓﻲ ﺣﺎل وﺟﻮد ﻛﺮﻳﺎت دم ﺣﻤﺮاء ﻓﻴﺘﻢ ﺗﻘﻠﻴﻞ ﺣﺪوث اﻟﺤﺎﻟﺔ ﻣﻦ‬
 ‫ﺧﻼل ﻏﺴﻞ اﻟﺪم و ﻫﻮ اﺟﺮاء ﻣﻘﺒﻮل ﻛﺒﺪﻳﻞ ‪ .‬إذا ﻛﺎﻧﺖ اﻟﻤﻨﺘﺠﺎت اﻟﻤﺸﻌﺔ ﻣﻄﻠﻮﺑﺔ‪ ،‬ﻓﻴﻤﻜﻦ‬
‫ﻏ ﺴﻠ ﻬﺎ أ و ﺧ ﻔ ﺾ ﺣ ﺠ ﻤﻬ ﺎ إ ذ ا ﻟ ﻢ ﻳﺘ ﻢ ﻧ ﻘﻠﻬ ﺎ ﻋﻠ ﻰ ا ﻟ ﻔ ﻮ ر ﺑ ﻌﺪ ا ﻟﺘ ﺸ ﻌ ﻴ ﻊ ‪.‬‬
‫اﻋ ﺮ ا ض ا ﻟ ﺘ ﺴ ﻤ ﻢ ﺑ ﺎﻟ ﺴ ﺘ ﺮ ﻳ ﺖ ﺗ ﺸﻤ ﻞ‬
‫‪ ‬وﺧﺰ ﻓﻲ اﻟﺸﻔﺎة و اﻃﺮاف اﻻﺻﺎﺑﻊ‬
‫‪ ‬ا ﻟ ﺮ ﺟ ﻔﻪ‬
‫‪ ‬ﺗﻘﻠﺺ اﻟﻌﻀﻼت‬
‫‪ ‬زﻳﺎدة ﻃﻮل ﻣﻮﺟﺔ ‪ QT‬ﻓﻲ ﺗﺨﻄﻴﻂ اﻟﻘﻠﺐ‬
‫ا ﻣﺎ ا ﻋ ﺮ ا ض ا ر ﺗ ﻔﺎ ع اﻟ ﺒ ﻮ ﺗ ﺎ ﺳ ﻴ ﻮ م ﺗ ﺸ ﻤ ﻞ‬
‫‪ ‬ﺿﻌﻒ اﻟﻌﻀﻼت‬
‫‪ ‬ﻏﻴﺎب اﺻﻮات اﻻﻣﻌﺎء ﻋﻨﺪ اﻟﻔﺤﺺ ﺑﺎﻟﺴﻤﺎﻋﺔ‬
‫‪ ‬ر ﺟ ﻔ ﺎ ن ﺑ ﻄ ﻴ ﻨﺎ ت ا ﻟ ﻘﻠ ﺐ‬
‫‪ ‬ا ﺳ ﺘ ﺮ ا ﺣ ﺔ ا ﻟ ﻘﻠ ﺐ‬
‫‪ ‬ﺗﺸ ﻮ ه ﻗ ﺮ آ ء ة ﺗ ﺨ ﻄ ﻴ ﻂ اﻟ ﻘ ﻠ ﺐ ﻣ ﺜ ﻞ ا ر ﺗ ﻔ ﺎ ع ﻣ ﻮ ﺟ ﻪ ‪ T‬و ﻃ ﻮ ل ا ﻟ ﻔ ﺘ ﺮ ة ﺑ ﻴ ﻦ ﻣ ﻮ ﺟ ﺘ ﻲ ‪P‬‬
‫‪and R‬‬

‫‪ Controversy: Immunomodulatory Effects of Transfusion‬‬

‫ﻫ ﺬ ة ا ﻟ ﺤ ﺎ ﻟ ﺔ ﻋ ﻨ ﺪ ﻧ ﻘ ﻞ ا ﻟ ﺪ م ا و ا ﺣ ﺪ ﻣ ﺸ ﺘ ﻘ ﺎ ﺗ ﺔ ﺗ ﺆد ي ا ﻟ ﻰ ﺗ ﻌ ﺪ ﻳ ﻞ ﻧ ﻈ ﺎ م ا ﻟ ﻤ ﻨ ﺎﻋ ﺔ ﻟ ﺪ ى ا ﻟ ﻤ ﺴ ﺘ ﻠ ﻢ ‪.‬‬
‫ﺣﺘﻰ اﻟﻠﺤﻈﺔ ﻟﻢ ﻳﺘﻢ ﻓﻬﻢ ﻫﺬة اﻻﻟﻴﺔ ﺑﺸﻜﻞ واﺿﺢ ﺗﻤﺎﻣﺎً‪.‬‬
‫ﻟ ﻜ ﻦ اﻟ ﺪ ر ا ﺳﺎ ت ﺗ ﺸ ﻴ ﺮ ا ﻟ ﻰ إ ن ﻋ ﻤﻠ ﻴﺎ ت اﻟ ﻨ ﻘ ﻞ ﺗ ﺆ ﺛ ﺮ ﻋﻠ ﻰ ا ﻟ ﺨ ﻼ ﻳﺎ ا ﻟ ﺘﺎ ﺋ ﻴ ﺔ‬
‫‪T-helper cells (Th1 and Th2 cells).‬‬
‫ﺣﻴﺚ ﺗﻜﻮن اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﺔ اﻟﻤﺴﺎﻋﺪة اﻻوﻟﻰ ﺑﺎﻓﺮاز ﻣﻮاد ﻣﻨﻬﺎ‬
‫‪ interferon-γ‬‬
‫‪ tumor necrosis‬‬
‫‪factor‬‬
‫)‪ interleukin-2 (IL-2‬‬
‫اﻟﺘﻲ ﺗﺤﻔﺰ ﺧﻼﻳﺎ اﻟﻤﺎﻛﺮوﻓﻴﺞ‬
‫ا ﻣ ﺎ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﺘ ﺎ ﺋ ﻴ ﺔ ا ﻟ ﻤﺴ ﺎﻋ ﺪ ة اﻟ ﺜ ﺎ ﻧ ﻴ ﺔ ﻓ ﺘ ﻔ ﺮ ز‬
‫‪ IL-4‬‬
‫‪ IL-5‬‬
‫ا ﻟ ﺘ ﻲ ﺗ ﺆ د ي ا ﻟ ﻰ ﺗ ﻔ ﻌ ﻴ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ اﻟ ﺒ ﺎ ﺋ ﻴ ﺔ و ﻗﺪ و ﺟﺪ ت اﻟ ﺪ ر ا ﺳﺎ ت ا ن ﻣ ﺠ ﻤ ﻞ ﻋ ﻤﻠ ﻴﺎ ت ﻧ ﻘ ﻞ ا ﻟﺪ م‬
‫ﺗ ﺆ د ي ا ﻟ ﻰ ﺗ ﺤ ﻔ ﻴ ﺰ ا ﻟ ﺨ ﻼ ﻳ ﺎ اﻟ ﺒ ﺎ ﺋ ﻴ ﺔ ﻋ ﻦ ﻃ ﺮ ﻳ ﻖ ﻫ ﺬ ا اﻟ ﻤ ﺴﺎ ر ‪ .‬و ﺑ ﺎﻟ ﺘ ﺎﻟ ﻲ ﺗ ﻘﻠ ﻴ ﻞ د و ر ا ﻟ ﺨ ﻼ ﻳﺎ‬
‫ا ﻟ ﺘﺎ ﺋ ﻴ ﺔ ا ﻟ ﻘﺎ ﺗﻠ ﺔ و ا ﻟ ﺨ ﻼﻳﺎ ا ﻟ ﻘﺎ ﺗﻠ ﺔ ا ﻟ ﻄ ﺒﻴ ﻌ ﻴ ﺔ‬
 ‫‪Infectious Transfusion Reactions‬‬
‫اﻻﺛﺎر اﻟﺠﺎﻧﺒﻴﺔ اﻟﻤﻌﺪﻳﺔ ﻟﻨﻘﻞ اﻟﺪم‬
‫ﺑﻌﺪ ان اﻛﻤﻠﻨﺎ اﻟﺘﻔﺎﻋﻼت اﻟﺠﺎﻧﺒﻴﺔ ﻏﻴﺮ اﻟﻤﻌﺪﻳﺔ ﻧﻜﻤﻞ ﻣﻌﻜﻢ اﻟﺘﻔﺎﻋﻼت اﻟﻤﻌﺪﻳﺔ او اﻟﻌﺪوى‬
‫ا ﻟ ﻨﺎ ﺗ ﺠ ﺔ ﻋ ﻦ ﻧ ﻘ ﻞ ا ﻟﺪ م ‪.‬‬
‫)‪ Transfusion-Transmitted Bacterial Infections (TTBI‬‬
‫و ﺗﻌﺘﺒﺮ اﻻﻣﺮاض اﻟﺒﻜﺘﻴﺮﻳﺔ واﺣﺪة ﻣﻦ اﻫﻢ ﻣﺼﺎدر اﻟﻌﺪوى اﻟﺘﻲ ﺗﻨﺘﻘﻞ ﻋﻦ ﻃﺮﻳﻖ اﻟﺪم و‬
‫ﻋ ﻠ ﻰ ا ﻟ ﺮﻏ ﻢ ﻣ ﻦ ا ﺧ ﺘ ﻴ ﺎ ر اﻟ ﻤ ﺘ ﺒ ﺮﻋ ﻴ ﻦ و ا ﻟ ﻔ ﺤ ﻮ ﺻ ﺎ ت ا ﻟ ﺼ ﺎ ر ﻣ ﺔ ‪ ،‬و ﺗ ﻘ ﻨ ﻴ ﺎ ت ﺟ ﻤ ﻊ و ﺧ ﺰ ن ا ﻟ ﺪ م‬
‫اﻟﺼﺎرﻣﺔ اﻻ إن ﻫﺬة اﻟﻤﺸﻜﻠﺔ ﻻ زاﻟﺖ ﻗﺎﺋﻤﺔ ﻓﻲ ﻣﻨﺘﺠﺎت اﻟﺪم و ﺑﺎﻟﺨﺼﻮص اﻟﺼﻔﺎﺋﺢ‬
‫اﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ‪ .‬اﻟ ﺮ ﻗ ﻢ ا ﻟﺪ ﻗ ﻴ ﻖ ﻋ ﻦ ﻫ ﺬ ة ا ﻟ ﺤﺎ ﻟ ﺔ ﻏ ﻴ ﺮ و ا ﺿ ﺢ و ﻋﻠ ﻰ ا ﻟ ﺮ ﻏ ﻢ ﻣ ﻦ ا ﻧ ﺨ ﻔﺎ ض ﻧ ﺴ ﺒ ﺘ ﻬ ﺎ ﻓ ﻲ‬
‫اﻟﻌﻘﻮد اﻟﺜﻼﺛﺔ اﻻﺧﻴﺮ اﻟﻤﺎﺿﻴﺔ ﻟﻜﻦ ﻫﺬا اﻻﻧﺨﻔﺎض ﻏﻴﺮ ﺣﻘﻴﻘﻲ و اﻧﻤﺎ ﺑﺴﺒﺐ ﻋﺪم ﺗﺴﺠﻴﻞ‬
‫اﻟﺤﺎﻻت و ﺗﺪوﻳﻨﻬﺎ و رﻓﻊ اﻻرﻗﺎم اﻟﻰ اﻟﺠﻬﺎت اﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﺒﺤﻮث ﻟﺬﻟﻚ ﻧﻼﺣﻆ اﻧﺨﻔﺎض ﻛﺎذب‬
‫ﻓ ﻲ اﻟ ﻨ ﺴ ﺒ ﺔ ا ﻟ ﺤ ﻘ ﻴ ﻘ ﻴ ﺔ ‪.‬‬
‫ﺗﻌ ﺮ ف ا ﻟﻤ ﻨ ﻈ ﻤ ﺎ ت ا ﻟ ﺨ ﺎ ﺻ ﺔ ﺑﻤ ﺠ ﺎ ل ﻧ ﻘ ﻞ ا ﻟ ﺪ م إ ن و ﺟ ﻮ د ا ﻟ ﺒ ﻜ ﺘ ﺮ ﻳ ﺎ ﻳ ﺠ ﺐ ا ن ﻳ ﺘ ﻢ ﺗ ﺤ ﺪ ﻳ ﺪ ة ﺑ ﺸ ﻜ ﻞ‬
‫دﻗﻴﻖ داﺧﻞ اﻟﻤﺴﺘﻠﻢ و ذﻟﻚ ﻣﻦ ﺧﻼل اﻟﺴﻴﺎﻗﺎت اﻟﺘﺎﻟﻴﺔ ‪-:‬‬
‫ﻓﺤﺺ ﻣﻜﻮﻧﺎت اﻟﺪم ﻗﺒﻞ اﻻﻋﻄﺎء و ﻋﻨﺪ ﺟﻤﻊ اﻟﺪم ﻣﻦ اﻟﻮاﻫﺐ ﻟﻠﺘﺄﻛﺪ ﻣﻦ ﺳﻼﻣﺘﻬﺎ‬
‫ﻳﺠﺐ اﻟﺘﺄﻛﺪ ﻣﻦ إن اﻟﻤﺮﻳﺾ ﻟﻢ ﻳﻜﻦ او ﻟﻢ ﻳﺘﻌﺮض ﻟﻼﺻﺎﺑﺔ ﺑﺎﻟﻌﺎﻣﻞ اﻟﻤﺮﺿﻲ اﻟﺤﺎﻟﻲ‬
‫اﻟﻤﻮﺟﻮد ﺑﻌﺪ اﻻﻋﻄﺎء ﺑﺸﻜﻞ ﺗﺎم و دﻗﻴﻖ‬

‫اﻻﻋﺮاض ﺗﻜﻮن ﺳﺮﻳﺮﻳﺔ او ﺷﺒﺔ ﺳﺮﻳﺮﻳﺔ او ﻗﺪ ﺗﻜﻮن ﻗﺎﺗﻠﺔ و ﻣﻤﻴﺘﻪ ﻛﺬﻟﻚ ﺗﺨﺘﻠﻒ ﺣﺴﺐ‬
‫ﻧﻮع ﻣﻨﺘﺞ اﻟﺪم ﻓﻤﺜﻼ ً ﻣﻨﺘﺞ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء ﻗﺪ ﻳﺤﺘﻮي ﻋﻠﻰ ‪ enterotoxin‬ﻧﺎﺗﺞ‬
‫ﻋﻦ اﻟﺒﻜﺘﺮﻳﺎ اﻟﺴﺎﻟﺒﺔ ﻣﻤﺎ ﻳﺆدي اﻟﻰ اﻃﻼق اﻟﻌﺪﻳﺪ ﻣﻦ اﻻوﺳﺎط اﻻﻟﺘﻬﺎﺑﻴﺔ و ﺗﻈﻬﺮ اﻻﻋﺮاض‬
‫ﻣﺜﻞ زﻳﺎدة درﺟﺔ اﻟﺤﺮارة ﻋﻦ ‪ 38‬درﺟﺔ ﺳﻴﻠﻴﻠﻴﺰﻳﺔ‪.‬‬
‫‪ Fever‬‬
‫‪ rigors‬‬
‫‪ hypotension‬‬
‫‪ tachycardia‬‬
‫‪ nausea‬‬
‫‪ vomiting‬‬
‫) ‪ Pain (back, abdominal, or infusion site‬‬
‫‪ respiratory complaints‬‬
‫‪ Septic shock‬‬
‫‪ acute kidney failure‬‬
‫‪ disseminated intravascular hemolysis‬‬
‫اﻣﺎ اﻻﻋﺮاض اﻟﺘﻲ ﺗﺼﺎﺣﺐ ﻧﻘﻞ اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﻳﺔ‬
‫ﻓﺎﻏﻠﺐ اﻟﺤﺎﻻت ﺗﻌﺎﻧﻲ ﻣﻦ‬
‫‪ Fever‬‬
‫‪ rigors‬‬
‫و اﻏﻠﺐ اﻻﺷﺨﺎص اﻟﺬﻳﻦ ﻳﻨﻘﻠﻮن اﻟﺼﻔﺎﺋﺢ ﻧﺠﺪ إن ﻟﺪﻳﻬﻢ ﻧﻘﺺ ﻓﻲ ﻋﺪد ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ‬
‫اﻟﺘﻲ ﺗﻌﺘﺒﺮ ﺣﺎﺟﺰ دﻓﺎﻋﻲ ﻣﻬﻢ ﻟﺬﻟﻚ ﻳﻌﺎﻧﻮن ﻣﻦ اﻻﺻﺎﺑﺎت اﻟﺒﻜﺘﻴﺮﻳﺔ اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﺣﺼﻮل‬
‫ﻫﺬة اﻻﻋﺮاض ‪ .‬و ﻓﻲ ﺣﺎل وﺟﻮد اﻋﺮاض اﺧﺮى ﻣﺜﻞ‬
‫‪ hypotension or respiratory symptoms‬‬
‫ﻳﺠﺐ وﺿﻊ اﻟﺤﺎﻻت اﻟﺘﺎﻟﻴﺔ ﻓﻲ ﻧﻈﺮ اﻻﻋﺘﺒﺎر‬
‫‪ TRALI and allergic anaphylactoid‬‬
 ‫اي ﺑﻤﻌﻨﻰ ﻳﺠﺐ ان ﻳﻜﻮن ﻫﻨﺎﻟﻚ ﻓﻬﺮس ﻣﺘﻜﺎﻣﻞ ﻋﻦ ﻫﺬة اﻟﺤﺎﻻت و ﻛﻴﻔﻴﺔ اﻟﺘﻤﻴﻴﺰ ﺑﻴﻨﻬﺎ‬
‫ﻣﻦ اﺟﻞ ﺳﺮﻋﺔ ﻋﻼج اﻟﺤﺎﻟﺔ و ﻣﻨﻊ اﻟﻤﻀﺎﻋﻔﺎت ‪.‬‬

‫اﻻﺣﻴﺎء اﻟﻤﺠﻬﺮﻳﺔ اﻟﺘﻲ ﺗﻨﺘﻘﻞ ﻋﻦ ﻃﺮﻳﻖ اﻟﺪم ﺗﺨﺘﻠﻒ ﻣﺎ ﺑﻴﻦ ﻣﻨﺘﺞ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء و‬
‫اﻟﺼﻔﺎﺋﺢ و ﻫﺬا ﻳﻌﻮد ﺑﺴﺒﺐ وﺟﻮد ﻇﺮوف ﺧﺰن ﻣﺨﺘﻠﻔﺔ ﺑﻴﻦ اﻻﺛﻨﻴﻦ ‪ .‬ﺣﻴﺚ إن اﻏﻠﺐ‬
‫اﻟﺒﻜﺘﺮﻳﺎ ﻻ ﺗﻨﻤﻮ ﺑﺪرﺟﺔ ﺣﺮارة اﻟﺜﻼﺟﺔ و اﻏﻠﺐ اﻟﻤﻨﺘﻘﻼت او اﻟﻤﻠﻮﺛﺎت ﻣﻊ ﻫﺬا اﻟﻨﻮع ﻫﻲ‬
‫اﻓﺮاد اﻟﻌﺎﺋﻠﺔ اﻟﻤﻌﻮﻳﺔ ‪ Enterobacteriaceae‬و اﻟﺘﻲ ﺗﻨﺘﺞ اﻟﺴﻤﻮم ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺣﺼﻮل‬
‫ﺻﺪ ﻣ ﺔ ا ﻟ ﺘ ﻬﺎ ﺑﻴ ﺔ ﺣﺎ دة ‪ .‬و ﻻ ﻳ ﺘ ﻢ ﻛ ﺸ ﻔ ﻬﺎ ﻓ ﻲ ا ﻟﺪ م ا ﻣ ﺎ ﺑ ﺴ ﺒ ﺐ ا ﻧﻬ ﺎ ﺗ ﻜ ﻮ ن ﺑ ﻜ ﺘ ﺮﻳﺎ ﻋ ﺎ ﺑ ﺮ ة ا و‬
‫ﻧﺘﻴﺠﺔ إن اﻟﻤﺮﻳﺾ ﻻ ﻳﻌﺎﻧﻲ ﻣﻦ اﻻﻋﺮاض وﻗﺖ اﻟﺘﺒﺮع‬
‫ﻋﻠﻰ اﻟﻨﻘﻴﺾ ﻣﻦ ذﻟﻚ ﻓﺈن اﻏﻠﺐ اﻟﻤﻨﺘﻘﻼت ﻣﻊ اﻟﺼﻔﺎﺋﺢ ﺗﻜﻮن ﺑﻜﺘﺮﻳﺎ ﻣﻮﺟﺒﺔ اﻟﺘﻲ ﺗﺴﺘﻮﻃﻦ‬
‫ا ﻟ ﺠ ﻠ ﺪ ﺑ ﺸ ﻜ ﻞ ﻃ ﺒ ﻴﻌ ﻲ و ﺗ ﻨ ﺘ ﻘ ﻞ ﻣ ﻊ ا ﻟ ﺪ م ﻋ ﻨ ﺪ ﺳ ﺤ ﺒ ﻪ ا و ا ﻟ ﺘ ﺒ ﺮ ع ﺑ ﻪ و ﻗ ﺪ ﺳ ﺠ ﻠ ﺖ ﺑ ﻜ ﺘ ﺮ ﻳ ﺎ‬
‫‪Staphylococcus aureus‬‬
‫اﻋﻠﻰ ﻣﻌﺪل وﻓﻴﺎت ﻓﻲ دراﺳﺔ ﻣﻦ ﻣﻦ ‪ 2011‬اﻟﻰ ﻋﺎم ‪ 2015‬ﻧﺘﻴﺠﺔ اﻧﺘﻘﺎﻟﻬﺎ ﻣﻊ اﻟﺼﻔﺎﺋﺢ‬
‫ا ﻟﺪ ﻣ ﻮ ﻳ ﺔ و ا ﺷ ﻬ ﺮ ا ﻧ ﻮ اع ا ﻟ ﺒ ﻜ ﺘ ﺮ ﻳﺎ ا ﻟ ﻤ ﻨ ﺘ ﻘﻠ ﻪ ﻣ ﻊ ﻣ ﻨ ﺘ ﺞ ﻛ ﺮ ﻳﺎ ت ا ﻟﺪ م ﻫ ﻲ‬
‫‪ Enterobacter cloacae‬‬
‫‪ Escherichia coli‬‬
‫‪ Klebsiella oxytoca‬‬
‫‪ Klebsiella pneumonia‬‬
‫‪ Pseudomonas aeruginosa‬‬
‫‪ Serratia marcescens‬‬
‫ا ﻣﺎ ا ﻟ ﺒ ﻜ ﺘ ﺮﻳﺎ ا ﻟ ﻤ ﻨﺘ ﻘﻠ ﺔ ﻣ ﻊ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ﻓﺎ ﺷ ﻬ ﺮ ﻫ ﺎ ﻣﺎ ﻳﻠ ﻲ‬
‫‪ Staphylococcus aureus‬‬
‫‪ Staphylococcus epidermidis‬‬
‫‪ Staphylococcus lugdunensis‬‬
‫و ﺗ ﺘﻤ ﻴ ﺰ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ ا ﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ﺑﻤ ﻌ ﺪ ل ﺗ ﻠ ﻮ ث ﻋ ﺎﻟ ﻲ ﺑ ﺎ ﻟ ﺒ ﻜ ﺘ ﺮ ﻳ ﺎ ﻟ ﺬ ﻟ ﻚ ﺗ ﻢ ا ﻟ ﺘ ﺮ ﻛ ﻴ ﺰ ﻋ ﻠ ﻴ ﻬ ﺎ ا ﺛ ﻨ ﺎ ء ﻋ ﻤ ﻠ ﻴ ﺎ ت‬
‫ﻧﻘﻠﻬﺎ اﻟﻰ اﻟﻤﺴﺘﻠﻤﻴﻦ و ﻣﻦ اﺟﻞ ﺗﻘﻠﻴﻞ ﺗﻠﻚ اﻟﺤﺎﻻت اﻟﻨﺎﺗﺠﻪ ﻣﻦ ﺗﻠﻮث اﻟﻌﻴﻨﺎت ﺗﻢ اﺗﺒﺎع‬
‫ﻋﺪة اﺳﺘﺮاﺗﻴﺠﻴﺎت ﻣﻨﻬﺎ ‪-:‬‬
‫‪ ‬اﻟﺸﺨﺺ اﻟﻤﻌﺮض ﻟﻼﺻﺎﺑﺎت اﻟﺒﻜﺘﻴﺮﻳﺔ ﻳﻜﻮن ﻣﻤﻨﻮع ﻋﻠﻴﺔ اﻟﺘﺒﺮع ﺑﺎﻟﺪم ﻟﻔﺘﺮة ﺗﻤﺘﺪ ‪6‬‬
‫ا ﺷ ﻬ ﺮ ﻣ ﺜ ﻞ ا ﻟ ﻌﺎ ﻣﻠ ﻴ ﻦ ﻓ ﻲ ﻣ ﺮ ا ﻛ ﺰ اﻟ ﺒ ﺤ ﻮ ث و ا ﻟ ﻤ ﺨ ﺘ ﺒ ﺮ ا ت ا ﻟ ﺒ ﻴ ﻮ ﻟ ﻮ ﺟ ﻴ ﺔ‬
‫‪ ‬اﻟﺸﺨﺺ اﻟﺬي ﺗﻌﺮض ﻟﻼﺻﺎﺑﺔ و ﺗﻢ ﺗﺸﺨﻴﺼﻪ ﺑﺸﻜﻞ ﻣﺆﻛﺪ ﻳﻤﻨﻊ ﻋﻠﻴﺔ اﻟﺘﺒﺮع ﺑﺎﻟﺪم‬
‫ﻟﻔﺘﺮة ﻻ ﺗﻘﻞ ﻋﻦ ‪ 6‬اﺷﻬﺮ ﺑﻌﺪ ﺷﻔﺎء اﻻﻋﺮاض‬
‫‪ ‬اﻟﺸﺨﺺ اﻟﺬي ﺗﻈﻬﺮ ﻋﻠﻴﺔ ﻋﻼﻣﺎت ﺗﺪل ﻋﻠﻰ وﺟﻮد اﻟﻌﺪوى اﻳﺎً ﻛﺎن ﻣﺴﺒﺒﻬﺎ ﻓﻴﺠﺐ‬
‫ﻋﺪم ﺗﺒﺮﻋﻪ ﺑﺎﻟﺪم ﺣﻔﺎﻇﺎً ﻋﻠﻰ ﺣﻴﺎة اﻻﺧﺮﻳﻦ‬
‫‪ ‬ﺗﻌ ﻘ ﻴ ﻢ ا ﻟ ﺠ ﻠ ﺪ ﺑ ﺸ ﻜ ﻞ ﺟ ﻴ ﺪ ﻗ ﺒ ﻞ ﺳ ﺤ ﺐ ا ﻟ ﻌ ﻴ ﻨ ﺎ ت ﻟ ﺘ ﻼ ﻓ ﻲ ﺗ ﻠ ﻮ ث ا ﻟ ﻤ ﻨ ﺘ ﺠ ﺎ ت ﺑ ﺎ ﻟ ﺒ ﻜ ﺘ ﺮ ﻳ ﺎ‬
‫‪ ‬ﻇ ﺮ و ف ا ﻟ ﺨ ﺰ ن ﻳ ﺠ ﺐ ا ن ﺗ ﻜ ﻮ ن ﺿ ﻤ ﻦ ا ﻟ ﻤ ﻌ ﺎ ﻳ ﻴ ﺮ ا ﻟﻤ ﻌ ﺘ ﻤ ﺪ ة و ﻳ ﻜ ﻮ ن ﺗ ﻄ ﺒ ﻴ ﻘ ﻬ ﺎ ﺑ ﺸ ﻜ ﻞ‬
‫ﺻﺎ ر م‬
‫‪ ‬ﺗﻢ اﺳﺘﺨﺪام ﺗﻘﻨﻴﺔ ﻓﻲ اﻟﻮﻻﻳﺎت اﻟﻤﺘﺤﺪة و ﻫﻲ اﺳﺘﺨﺪام ‪psoralen derivative‬‬
‫ﻛﻌﻼج ﻛﻴﻤﻮﺿﻮﺋﻲ ﻟﻠﻘﻀﺎء ﻋﻠﻰ اﻟﺒﻜﺘﺮﻳﺎ اﻟﺘﻲ ﺗﻨﺘﻘﻞ ﻣﻊ اﻟﺪم او اﺣﺪ ﻣﺸﺘﻘﺎﺗﺔ‬
‫‪ ‬ﻳ ﺠ ﺐ ﻣ ﺘﺎ ﺑ ﻌ ﺔ ا ﻟ ﻤ ﺮ ﺿ ﻰ ﺑ ﻌﺪ ا ﻋ ﻄ ﺎ ء اﻟ ﺪ م ﻟ ﻔ ﺘ ﺮ ة و ﻋ ﻤ ﻞ ﺟﺪ و ل ز ﻣ ﻨ ﻲ ﺑ ﺎﻟ ﻤ ﺮ ا ﺟ ﻌﺎ ت و‬
‫ﺗ ﺘ ﻮ ﻟ ﻰ ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ اﻟ ﺪ م و ﺿ ﻊ ﻫ ﺬ ا ا ﻟ ﺠ ﺪ و ل و ﻓ ﻖ اﻟ ﺴ ﻴ ﺎ ﻗ ﺎ ت ا ﻟ ﻤ ﻌﻤ ﻮ ل ﺑ ﻬ ﺎ‬
‫‪ ‬ﺗ ﺘ ﻮﻟ ﻰ ﻟ ﺠ ﻨ ﺔ ﺧ ﺪ ﻣ ﺎ ت ﻧ ﻘ ﻞ ا ﻟ ﺪ م ﻣ ﺮ ا ﻗ ﺒ ﺔ ﻋ ﻤ ﻠ ﻴ ﺎ ت ﺟﻤ ﻊ و ﺧ ﺰ ن و ا ﻋ ﻄ ﺎ ء ا ﻟ ﺪ م و‬
‫ﻣ ﺸﺘ ﻘ ﺎ ﺗ ﺔ و ا ﺗ ﺨﺎ ذ ﺗ ﺪ ا ﺑ ﻴ ﺮ ﺻﺎ ر ﻣ ﻪ ﻣ ﻦ ا ﺟ ﻞ ﻣ ﻨ ﻊ ﺗﻠ ﻮ ث و ﻫﺪ ر ا ﻟﺪ م و ﻣ ﺸ ﺘ ﻘﺎ ﺗ ﺔ‬
 ‫ﺑﻤﺎ إﻧﻨﺎ ﺗﻄﺮﻗﻨﺎ ﺧﻼل اﻟﺸﺮح اﻟﻰ ﻣﺼﻄﻠﺢ ﻓﺮط اﻟﺤﺴﺎﺳﻴﺔ ﻓﻲ اﻛﺜﺮ ﻣﻦ ﻣﻮﻗﻊ‬

‫ﺧﻼل اﻟﻔﺼﻮل ﻟﺬﻟﻚ ﻫﻨﺎ ﺳﻨﻮﺿﺢ اﻟﻜﺜﻴﺮ ﻣﻦ اﻟﻤﻔﺎﻫﻴﻢ اﻟﺨﺎﺻﺔ ﺑﻬﺬا اﻟﻤﺼﻄﻠﺢ‬

‫ﻟﺬ ﻟ ﻚ ﻻ ﺗ ﺘ ﻮ ﻗ ﻒ ﺣ ﺘ ﻰ ﺗ ﻜﻤ ﻞ ا ﻟﻤ ﺸ ﻮ ا ر‬

‫‪Hypersensitivity‬‬

‫ﻧﻔﺲ ردود اﻟﻔﻌﻞ اﻟﻤﻨﺎﻋﻴﺔ اﻟﺘﻲ ﺗﺤﻤﻴﻨﺎ ﻣﻦ اﻟﻌﺪوى ﻳﻤﻜﻦ أن ﺗﻠﺤﻖ ﺑﻨﺎ اﻟﻜﺜﻴﺮ ﻣﻦ اﻷﺿﺮار‬
‫ﻓﻲ ﺧﻼﻳﺎ ﺟﺴﻤﻨﺎ ‪ .‬ﺗﺴﺘﺨﺪم اﻻﺳﺘﺠﺎﺑﺔ اﻟﻤﻨﺎﻋﻴﺔ اﺳﺘﺮاﺗﻴﺠﻴﺎت ﻣﺘﻌﺪدة ﻟﻠﺤﺪ ﻣﻦ اﻷﺿﺮار‬
‫اﻟﺘﻲ ﺗﻠﺤﻖ ﺑﺨﻼﻳﺎ اﻟﺠﺴﻢ ﻋﻦ ﻃﺮﻳﻖ إﻳﻘﺎف اﻟﺮدود ﺑﻤﺠﺮد ازاﻟﺔ اﻟﻌﺎﻣﻞ اﻟﻤﺮﺿﻲ و ﻣﻦ ﺧﻼ‬
‫ل ﺗ ﺠ ﻨ ﺐ ا ﻟ ﺘ ﻔ ﺎ ﻋ ﻞ ﻣ ﻊ ﻣ ﺴ ﺘ ﻀ ﺪ ا ت اﻟ ﺠﺴ ﻢ ﻧ ﻔﺴ ﻪ و ﻣ ﻊ ذ ﻟ ﻚ ﻓ ﺈ ن ﻫ ﺬ ا اﻟ ﺘ ﻨ ﻈ ﻴ ﻢ ا ﻟ ﺪ ﻗ ﻴ ﻖ ﻣ ﻦ‬
‫اﻟﻤﻤﻜﻦ ان ﻳﻨﻬﺎر ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﻔﺎﻋﻼت ﻣﻨﺎﻋﻴﺔ ﺿﺎرة اﻛﺜﺮ ﻣﻤﺎ ﻫﻲ ﺣﺎﻣﻴﺔ ﻟﻠﺠﺴﻢ ‪.‬‬
‫ﺑﻌﺾ اﻻﺿﻄﺮاﺑﺎت اﻟﻤﻨﺎﻋﻴﺔ ﻧﺎﺗﺠﺔ ﻣﻦ ﻋﺪم اﻟﺘﺤﻤﻞ اﻟﻤﻨﺎﻋﻲ و ﺗﺆدي اﻟﻰ ﺣﺪوث اﻣﺮاض‬
‫اﻟﻤﻨﺎﻋﺔ اﻟﺬاﺗﻴﺔ ﻓﻲ ﺣﻴﻦ إن اﻟﺼﻨﻒ اﻻﺧﺮ ﻧﺎﺗﺞ ﻋﻦ ﻓﺮط ﻧﺸﺎط اﻟﻤﻨﺎﻋﺔ اﻟﻔﻄﺮﻳﺔ او‬
‫اﻟﻤﻜﺘﺴﺒﺔ ﺿﺪ اﻟﻤﺴﺘﻀﺪات اﻟﻐﻴﺮ ﻣﺜﻴﺮة ﻟﻠﻤﻨﺎﻋﺔ او ﺿﻌﻴﻔﺔ اﻻﺛﺎرة اﻟﻤﻨﺎﻋﻴﺔ ‪ .‬و ﻫﺬا اﻟﺤﺎﻟﺔ‬
‫ﺗﺴﻤﻰ ﻓﺮط اﻟﺘﺤﺴﺲ ‪ hypersensitivities‬و اﻟﺘﻲ ﺳﻨﺮﻛﺰ ﻋﻠﻴﻬﺎ ﺧﻼل ﻫﺬا اﻟﻤﻮﺿﻮع‬
‫ﻗ ﺴ ﻢ ﻋ ﻠ ﻤ ﺎ ء ا ﻟ ﻤ ﻨ ﺎ ﻋ ﺔ ﻓ ﺮ ط ا ﻟ ﺘ ﺤ ﺴ ﺲ ا ﻟ ﻰ ﻧ ﻮﻋ ﻴ ﻦ ﺣ ﺴ ﺐ و ﻗ ﺖ ﺗ ﻄ ﻮ ر ﻫ ﺎ‬
‫‪Immediate hypersensitivity‬‬
‫و اﻟﺘﻲ ﺗﻈﻬﺮ ﻋﻼﻣﺘﻬﺎ ﺧﻼل ﻓﺘﺮة ﻗﺼﻴﺮة ﺟﺪاً ﻗﺪ ﺗﻜﻮن دﻗﺎﺋﻖ او ﺳﺎﻋﺎت ﻗﻠﻴﻠﺔ‬
‫)‪delayed-type hypersensitivity (DTH‬‬
‫و اﻟﺘﻲ ﺗﻈﻬﺮ ﻋﻼﻣﺘﻬﺎ ﺧﻼل ﻓﺘﺮة ﺗﻤﺘﺪ ﻣﻦ ﻳﻮم اﻟﻰ ﺛﻼﺛﺔ اﻳﺎم‬
‫و ﺑ ﺸ ﻜ ﻞ ﻋ ﺎ م ﻓ ﺈ ن ﻓ ﺮ ط ا ﻟ ﺘ ﺤ ﺴ ﺲ ا ﻟ ﻔ ﻮ ر ي ﻳ ﻜ ﻮ ن ﻧ ﺎ ﺗ ﺞ ﻣ ﻦ ﺗ ﻔ ﺎﻋ ﻞ ا ﻟ ﻀ ﺪ ﺑ ﺎﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ا ﻣ ﺎ ﻓ ﺮ ط‬
‫ا ﻟ ﺘ ﺤ ﺴ ﺲ ا ﻟ ﻤ ﺘ ﺄ ﺧ ﺮ ﻓ ﻬ ﻮ ﻧ ﺎ ﺗ ﺞ ﻣ ﻦ ﺗ ﻔ ﺎﻋ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ اﻟ ﺘ ﺎ ﺋ ﻴ ﺔ‬

‫ﻗ ﺴ ﻢ اﻟ ﻌ ﻠ ﻤ ﺎ ء ﻓ ﺮ ط ا ﻟ ﺘ ﺤﺴ ﺲ اﻟ ﻰ ا ر ﺑ ﻊ ا ﻧ ﻮ اع اﻋ ﺘ ﻤ ﺎ د ا ً ﻋ ﻠ ﻰ ﻧ ﻮع ا ﻟ ﺨ ﻼ ﻳ ﺎ و اﻟ ﺠ ﺰ ﻳ ﺌ ﺎ ت ا ﻟ ﻤ ﻨ ﺎ ﻋ ﻴ ﺔ‬
‫اﻟﺘﻲ ﺗﺸﺘﺮك ﻓﻴﻬﺎ ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ ﻛﻴﻔﻴﺔ ﺗﻄﻮﻳﺮ ﺗﻠﻚ اﻻﺳﺘﺠﺎﺑﺔ‬
‫اﻟﻨﻮع اﻻول‬
‫ﻫﺬا اﻟﻨﻮع ﺗﺸﺘﺮك ﻓﻴﻪ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ‪ IgE‬اﻟﺘﻲ ﺗﺮﺗﺒﻂ ﺑﺎﻟﺨﻼﻳﺎ اﻟﻤﻨﺎﻋﻴﺔ و ﺑﺎﻟﺨﺼﻮص‬
‫‪mast cells or basophils‬‬
‫و ﺑﺎﻟﻨﺘﻴﺠﺔ اﻃﻼق اﻟﻌﺪﻳﺪ ﻣﻦ اﻻوﺳﺎط اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻﻋﺮاض ﻣﻌﻈﻤﻬﺎ ﻓﻲ‬
‫ا ﻟ ﺠ ﻬﺎ ز اﻟ ﺘ ﻨ ﻔ ﺴ ﻲ و ا ﻏﻠ ﺐ ﻫﺬ ا ا ﻟ ﻨ ﻮع ﻧﺎ ﺗ ﺞ ﻋ ﻦ ﺣ ﺒ ﻮ ب ا ﻟﻠ ﻘ ﺎ ح ‪ ،‬ا ﻟ ﻌ ﺚ ‪ ،‬ا ﻟ ﻐ ﺒﺎ ر و ﺣ ﺴ ﺎ ﺳ ﻴ ﺔ‬
‫ا ﻟ ﻄ ﻌﺎ م ﻣ ﺜ ﻞ اﻟ ﻤ ﺤ ﺎ ر و ا ﻟ ﻔ ﻮ ل اﻟ ﺴ ﻮ د ا ﻧ ﻲ‬

‫ا ﻟ ﻨ ﻮع ا ﻟ ﺜﺎ ﻧ ﻲ‬
‫و ﻫﺬا اﻟﻨﻮع ﻧﺎﺗﺞ ﻋﻦ ارﺗﺒﺎط اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻧﻮﻋﻲ ‪ IgM , IgG‬ﻣﻊ ﺧﻼﻳﺎ اﻟﺸﺨﺺ ﻧﻔﺴﻪ‬
‫ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﺪﻣﻴﺮ ﻫﺬة اﻟﺨﻼﻳﺎ ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ او ﻣﻦ ﺧﻼل ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ ‪ .‬و ﻣﻦ‬
‫اﺷﻬﺮ اﻻﻣﺜﻠﺔ ﻋﻠﻰ ﻫﺬة اﻟﺤﺎﻟﺔ ﻫﻲ ﻋﻤﻠﻴﺎت ﻧﻘﻞ اﻟﺪم ﻏﻴﺮ اﻟﻤﺘﻮاﻓﻖ ﺑﻴﻦ اﻟﻮاﻫﺐ و اﻟﻤﺴﺘﻠﻢ‬
‫و ﺧﺎﺻﺔ اﻻﺧﺘﻼف ﻓﻲ ﻧﻈﺎم ‪ABO‬‬

‫ا ﻟ ﻨ ﻮع ا ﻟ ﺜﺎ ﻟ ﺚ‬
‫ﻳ ﺘ ﻢ ا ﻟ ﺘ ﺮ ا ﺑ ﻂ ﺑ ﻴ ﻦ ا ﻟ ﻀ ﺪ و ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ و ذ ﻟ ﻚ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻜ ﻮ ﻳ ﻦ ﻣﻌ ﻘ ﺪ ﻣ ﻨ ﺎﻋ ﻲ ا ﻟ ﺬ ي ﻳ ﺘ ﺮ ﺳ ﺐ ﻓ ﻲ‬
‫اﻋﻀﺎء اﻟﺠﺴﻢ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ و اﻃﻼق اوﺳﺎط اﻏﻠﺒﻬﺎ ﻣﻦ ﺧﻼﻳﺎ اﻟﺪم‬
 ‫اﻟﺒﻴﺾ اﻟﺤﺒﻴﺒﻴﺔ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺣﺼﻮل اﻻﻟﺘﻬﺎب‬

‫ا ﻟ ﻨ ﻮع ا ﻟ ﺮ ا ﺑ ﻊ‬
‫و ﻫﻮ ﻧﺎﺗﺞ ﻣﻦ ﻓﺮط ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﺔ و اﺷﻬﺮ ﻣﺜﺎل ﻫﻮ اﻻﻣﺮاض اﻟﺠﻠﺪﻳﺔ او ﻣﻨﺎﻃﻖ‬
‫ا ﻟ ﺠ ﻠ ﺪ ا ﻟ ﺘ ﻲ ﺗ ﻜ ﻮ ن ﻣ ﻌ ﺮ ﺿ ﺔ ﻟ ﻠ ﺴﻤ ﻮ م اﻟ ﺘ ﻲ ﺗ ﺆ د ي ا ﻟ ﻰ ﻓ ﺮ ط ﺗ ﻔ ﻌ ﻴ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ اﻟ ﺘ ﺎ ﺋ ﻴ ﺔ‬

‫و ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ ﻫﺬا اﻟﺘﻘﺴﻴﻢ اﻟﻤﺒﺴﻂ اﻻ إن ﻓﺮط اﻟﺤﺴﺎﺳﻴﺔ ﻣﻮﺿﻮع ﺷﺎﺋﻚ و ﻣﻌﻘﺪ و‬
‫ﻳﺤﺘﺎج ﺗﻔﺎﺻﻴﻞ ﻛﺜﻴﺮة ﻣﻦ اﺟﻞ ﻓﻬﻢ اﻟﺤﺎﻻت اﻻرﺑﻌﺔ ﻛﺬﻟﻚ ﻛﻞ ﻗﺴﻢ ﻣﻦ ﻫﺬة اﻻﻧﻮاع ﻗﺪ‬
‫ﻳ ﺤ ﺘ ﻮ ي ﺗ ﻘ ﺴ ﻴ ﻤ ﺎ ت ﻓ ﺮﻋ ﻴ ﺔ ﺗ ﻀ ﻴ ﻒ اﻟ ﻜ ﺜ ﻴ ﺮ ﻣ ﻦ اﻟ ﺘ ﻌ ﻘ ﻴ ﺪ ﻋ ﻠ ﻰ ﻫ ﺬ ا ا ﻟ ﻤ ﻮ ﺿ ﻮ ع‬

‫اﻻوﺳﺎط اﻟﺘﻲ ﺗﻄﻠﻘﻬﺎ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ اﻟﺤﺒﻴﺒﻴﺔ و ﻣﻨﻬﺎ‬

‫ا ﻟﻬ ﺴ ﺘﺎ ﻣ ﻴ ﻦ‬
‫و ﻫﻮ ﻋﺒﺎرة ﻋﻦ ﻣﺮﻛﺐ ﻣﻮﺟﻮد ﻓﻲ ﺣﺒﻴﺒﺎت ‪ mast cell‬و اﻟﺬي ﻳﺘﻢ اﻃﻼﻗﺔ ﺑﻌﺪ ﺗﺤﻔﻴﺰ‬
‫ﻫﺬة اﻟﺨﻼﻳﺎ ﺧﻼل دﻗﺎﺋﻖ ‪ .‬و ﺗﻮﺟﺪ ارﺑﻊ اﻧﻮاع ﻣﻦ اﻟﻤﺴﺘﻘﺒﻼت اﻟﺨﺎﺻﺔ ﺑﻬﺬا اﻟﻨﻮع ﺗﺨﺘﻠﻒ‬
‫ﻓ ﻲ ﻣ ﻮ ا ﻗ ﻌ ﻬﺎ د ا ﺧ ﻞ ا ﻟ ﺠ ﺴ ﻢ‬
‫إن اﻏﻠﺐ ﺗﺄﺛﻴﺮات اﻟﻬﺴﺘﺎﻣﻴﻦ ﻧﺎﺗﺠﺔ ﻣﻦ ارﺗﺒﺎﻃﻪ ﻣﻊ اﻟﻤﺴﺘﻘﺒﻞ اﻻول ‪ H1 receptor‬و اﻟﺬي‬
‫ﻳﺆدي اﻟﻰ ﺗﻮﻟﻴﺪ ﻣﺠﻤﻮﻋﺔ ﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻟﺘﺄﺛﻴﺮات ﻫﻲ اﻟﺴﺒﺐ ﻓﻲ ﻇﻬﻮر اﻻﻋﺮاض ﻋﻠﻰ‬
‫اﻟ ﻤ ﺮ ﻳ ﺾ ﻣ ﻨ ﻬﺎ‬
‫‪ ‬ﺗﻘﻠﺺ اﻟﻌﻀﻼت ﻓﻲ اﻻﻣﻌﺎء و اﻟﻘﺼﺒﺎت اﻟﻬﻮاﺋﻴﺔ‬
‫‪ ‬زﻳﺎدة ﻧﻀﻮح اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ‬
‫‪ ‬زﻳﺎدة اﻓﺮاز اﻟﻤﺨﺎط ﻣﻦ ﺑﻄﺎﻧﺔ اﻻﻣﻌﺎء و اﻟﻘﺼﺒﺎت اﻟﻬﻮاﺋﻴﺔ‬
‫اﻣﺎ ﺗﻔﺎﻋﻞ اﻟﻬﺴﺘﺎﻣﻴﻦ ﻣﻊ اﻟﻤﺴﺘﻘﺒﻞ اﻟﺜﺎﻧﻲ ‪ H2 receptor‬ﻳﺆدي اﻟﻰ‬
‫‪ ‬زﻳﺎدة ﻧﻀﻮح اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ‬
‫‪ ‬ﺗﻮﺳﻊ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ‬
‫‪ ‬زﻳﺎدة اﻓﺮازات اﻟﻐﺪد ﺧﺎرﺟﻴﺔ اﻻﻓﺮاز ‪exocrine‬‬
‫‪ ‬ز ﻳ ﺎد ة ا ﻓ ﺮ ا ز ﺣ ﻤ ﺾ ا ﻟ ﻤ ﻌ ﺪ ة‬
‫‪ ‬ﻛﺬﻟﻚ ﻳﻘﻠﻞ اﻃﻼق ﺣﺒﻴﺒﺎت ‪ mast cells‬ﺑﺘﺄﺛﻴﺮ ﺳﻠﺒﻲ راﺟﻊ‬
‫اﻣﺎ ﺗﻔﺎﻋﻞ اﻟﻬﺴﺘﺎﻣﻴﻦ ﻣﻊ اﻟﻤﺴﺘﻘﺒﻞ اﻟﺮاﺑﻊ ‪ H4 receptor‬ﻳﺆدي اﻟﻰ‬
‫‪ ‬ﺟﺬب اﻟﺨﻼﻳﺎ اﻟﻰ ﻣﻮﻗﻊ اﻟﺘﺤﺴﺲ ﻣﻤﺎ ﻳﺰﻳﺪ اﻻﺿﺮار‬
‫ﺗﻔﺎﻋﻞ اﻟﻬﺴﺘﺎﻣﻴﻦ ﻣﻊ اﻟﻤﺴﺘﻘﺒﻞ اﻟﺜﺎﻟﺚ ‪ H3 receptor‬ﻳﺆدي اﻟﻰ‬
‫‪ ‬ﺗﻌ ﺪ ﻳ ﻞ ﻓ ﻌ ﺎ ﻟ ﻴ ﺔ ا ﻟ ﻨ ﻮ ا ﻗ ﻞ ا ﻟ ﻌ ﺼ ﺒ ﻴ ﺔ ا ﻟ ﻤ ﻮ ﺟ ﻮ د ه ﻓ ﻲ ا ﻟ ﺠ ﻬ ﺎ ز ا ﻟ ﻌ ﺼ ﺒ ﻲ ا ﻟ ﻤ ﺮ ﻛ ﺰ ي‬

‫ا ﻟ ﻠ ﻴ ﻜ ﻮ ﺗ ﺮ ﻳ ﻨ ﺎ ت و ا ﻟ ﺒ ﺮ و ﺳ ﺘ ﺎﻏ ﻼ ﻧ ﺪ ﻳ ﻨ ﺎ ت‬
‫ﻫﻲ اوﺳﺎط ﻓﻲ اﻟﻌﺎدة ﺗﻜﻮن ﻏﻴﺮ ﻣﺘﺸﻜﻠﺔ او ﻣﺘﻜﻮﻧﺔ ﺣﺘﻰ ﻳﺘﻢ اﻃﻼق اﻟﺤﺒﻴﺒﺎت ﻣﻦ‬
‫‪ Mast cells‬و ﻧﺘﻴﺠﺔ ﺗﺪﻣﻴﺮ اﻟﻐﺸﺎء اﻟﺒﻼزﻣﻲ ﻟﻠﺨﻼﻳﺎ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻ‬
‫ﻧﺰﻳﻤﺎت اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﺤﻮﻳﻞ اﻟﺪﻫﻮن اﻟﻔﻮﺳﻔﺎﺗﻴﺔ اﻟﻤﻮﺟﻮدة ﻓﻲ ﻫﺬا اﻟﻐﺸﺎء اﻟﻰ ﻫﺬة اﻻ‬
‫و ﺳﺎ ط ‪.‬‬
‫ﻓﻔﻲ ﺣﺎﻻت اﻟﺮﺑﻮ ﻓﻲ اﻟﺒﺪاﻳﺔ ﻳﺘﻢ اﻃﻼق اﻟﻬﺴﺘﺎﻣﻴﻦ و ﺑﻌﺪ ﻣﺮور ‪ 30‬اﻟﻰ ‪ 60‬ﺛﺎﻧﻴﺔ ﻳﺘﻢ‬
‫اﻃﻼق اﻟﻠﻴﻜﻮﺗﺮﻳﻨﺎت اﻟﺘﻲ ﺗﻜﻮن اﻗﻮى ب ‪ 1000‬ﻣﺮة ﻣﻦ اﻟﻬﺴﺘﺎﻣﻴﻦ ﻓﻲ ﺗﻘﻠﻴﺺ اﻟﻘﺼﺒﺎت‬
‫اﻟﻬﻮاﺋﻴﺔ و ﻛﺬﻟﻚ ﻳﺰﻳﺪ ﻣﻦ ﻧﻀﻮح اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ زﻳﺎدة اﻓﺮاز اﻟﻤﺨﺎط‬
‫) ا ﻟ ﻘ ﺸ ﻊ ( ﻣ ﻦ ﺑ ﻄﺎ ﻧ ﺔ ا ﻟ ﻘ ﺼ ﺒ ﺎ ت ا ﻟﻬ ﻮ ا ﺋ ﻴ ﺔ‬

‫ا ﻟ ﺴ ﺎ ﻳ ﺘ ﻮ ﻛ ﻴ ﻨ ﺎ ت و ا ﻟ ﺠ ﻮ اذ ب ا ﻟ ﻜ ﻴ ﻤ ﻴ ﺎ ﺋ ﻴ ﺔ‬
‫و ﺗ ﺘﻤ ﺜ ﻞ ﺑ ﻤ ﺠ ﻤ ﻮﻋ ﺔ ﻣ ﻦ ا ﻟ ﺮ ﺳ ﺎ ﺋ ﻞ ا ﻟ ﺘ ﻲ ﺗ ﺘ ﻮ ا ﺻ ﻞ ﺑ ﻮ ا ﺳ ﻄ ﺘ ﻬ ﺎ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﺨ ﻼ ﻳ ﺎ ﻣ ﻊ ﺑ ﻌ ﻀ ﻬ ﺎ ا ﻟ ﺒﻌ ﺾ‬
 ‫ﻣﺜﻞ‬
‫‪IL-4, IL-5, IL-8, IL-9, IL-13, GM-CSF, and TNF-α.‬‬
‫و اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ و ﺗﺠﻨﻴﺪ اﻟﺨﻼﻳﺎ اﻟﺤﻤﻀﻴﺔ و اﻟﻌﺪﻟﺔ ﻣﻦ اﺟﻞ ﺑﺪأ اﻻﻟﺘﻬﺎب‬
‫‪IL-4 and IL-13‬‬
‫ﻳ ﺰ ﻳ ﺪ ﻣ ﻦ ﺗ ﻔﻌ ﻴ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﺘ ﺎ ﺋ ﻴ ﺔ ا ﻟ ﻤ ﺴ ﺎﻋ ﺪ ة ا ﻟ ﺜ ﺎ ﻧ ﻴ ﺔ ا ﻟ ﺘ ﻲ ﺗ ﻌ ﻤ ﻞ ﻋ ﻠ ﻰ ﺗ ﻔ ﻌ ﻴ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﺒ ﺎ ﺋ ﻴ ﺔ و ﺑ‬
‫ﺎﻟﺘﺎﻟﻲ اﻧﺘﺎج اﻟﻤﺰﻳﺪ ﻣﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻧﻮع ‪ IgE‬ﻣﻤﺎ ﻳﺰﻳﺪ ﻣﻦ ﺳﻮء اﻟﺤﺎﻟﺔ ‪.‬‬
‫‪IL-5‬‬
‫ﻳﻌﻤﻞ ﻋﻠﻰ ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﺤﻤﻀﻴﺔ اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ زﻳﺎدة اﻻﻟﺘﻬﺎب ﻣﻦ ﺧﻼل اﻃﻼق‬
‫ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻوﺳﺎط اﻻﺧﺮى‬
‫‪IL-8‬‬
‫ﻳﻌﻤﻞ ﻋﻠﻰ زﻳﺎدة ﺗﺠﻨﻴﺪ اﻟﻤﺰﻳﺪ ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﻤﻨﺎﻋﻴﺔ اﻻﺧﺮى ﻣﻦ اﺟﻞ زﻳﺎدة اﻻﺳﺘﺠﺎﺑﺔ اﻻ‬
‫ﻟﺘﻬﺎﺑﻴﺔ ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ دورة اﻟﻜﺒﻴﺮ ﻓﻲ ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﺔ‬

‫‪TNF-α‬‬
‫ﻳﺆدي اﻟﻰ ﻣﺰﻳﺪ ﻣﻦ اﻻﻟﺘﻬﺎب و ﺑﺎﻟﺘﺎﻟﻲ ﺣﺼﻮل ﺻﺪﻣﺔ ﺗﺂﻗﻴﺔ ﺣﺎدة و اﺛﺎرﻫﺎ ﺗﺸﻤﻞ ﻣﺠﻤﻮﻋﺔ‬
‫ﻛ ﺒ ﻴ ﺮ ة ﻣ ﻦ ا ﺟ ﻬ ﺰ ة اﻟ ﺠﺴ ﻢ ) ﺻ ﺪ ﻣ ﺔ ﺟ ﻬ ﺎ ز ﻳ ﺔ (‬
‫‪GM-CSF‬‬
‫ﻳﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ اﻻﺳﻼف اﻟﻤﺴﺆوﻟﺔ ﻋﻦ اﻧﺘﺎج ﺧﻼﻳﺎ اﻟﺪم و ﺑﺎﻟﺨﺼﻮص اﻟﺨﻼﻳﺎ اﻟﺤﺒﻴﺒﻴﺔ و‬
‫ﺧﻼﻳﺎ اﻟﻤﻮﻧﻮﺳﺎﻳﺖ‬
‫‪Chemokines‬‬
‫و ﻫ ﻲ ﻣ ﺠ ﻤ ﻮﻋ ﺔ ﻛ ﺒ ﻴ ﺮ ة ﻣ ﻦ ا ﻟ ﻤ ﻮ ا د ا ﻟ ﺘ ﻲ ﺗ ﻌ ﻤ ﻞ ﻋ ﻠ ﻰ ﺟ ﺬ ب و ﺳ ﺤ ﺐ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ ا ﻟ ﻰ‬
‫ﻣ ﻮ ﻗ ﻊ ا ﻟ ﺘ ﺤ ﺴ ﺲ و ﺑﺎ ﻟ ﺘﺎ ﻟ ﻲ ﺗ ﻮ ﺳ ﻊ ا ﻃﺎ ر ا ﻟ ﺘ ﺤ ﺴ ﺲ‬

‫ﻓﺌﺎت ﻓﺮط اﻟﺘﺤﺴﺲ ﻣﻦ اﻟﻨﻮع اﻻول‬

‫ﻣﻤﻜﻦ ﺗﻜﻮن اﻻﺛﺎر ﻣﻮﺿﻌﻴﺔ ﻣﺜﻞ ارﺗﻔﺎع اﻟﺤﺮارة او اﻟﺘﻬﺎب اﻟﺠﻠﺪ او ﺟﻬﺎزﻳﺔ ﺗﻜﻮن ﻇﺮوف‬
‫اﺷﺪ و اﻛﺜﺮ ﺿﺮاوة و ﺗﻌﺘﻤﺪ اﻻﻋﺮاض ﻋﻠﻰ ﻋﺪة ﻋﻮاﻣﻞ ﻣﻨﻬﺎ‬
‫‪ ‬ﻃ ﺮ ق د ﺧ ﻮ ل اﻟ ﻌ ﺎ ﻣ ﻞ ا ﻟ ﻤ ﺤ ﻔ ﺰ ﻟﻠ ﺘ ﺤ ﺴ ﺲ‬
‫‪ ‬ﺗ ﺮﻛ ﻴ ﺰ ا ﻟ ﻌ ﺎ ﻣ ﻞ ا ﻟ ﻤ ﺤ ﻔ ﺰ ﻟ ﻠ ﺘ ﺤ ﺴ ﺲ‬
‫‪ ‬ﻓ ﺘ ﺮ ة ز ﻣ ﻦ ﺑ ﻘ ﺎ ء ا ﻟ ﻌ ﺎ ﻣ ﻞ ا ﻟ ﻤ ﺤ ﻔ ﺰ ﻟ ﻠ ﺘ ﺤﺴ ﺲ ﻓ ﻲ ا ﻟ ﺠ ﺴ ﻢ‬
‫‪ ‬ا ﻟ ﻌ ﻮ ا ﻣ ﻞ اﻟ ﻮ ر ا ﺛ ﻴ ﺔ ا ﻟ ﺨ ﺎ ﺻ ﺔ ﺑﺎ ﻟ ﻤ ﺮ ﻳ ﺾ‬

‫و ﻫﻨﺎ ﺳﻨﺘﻌﺮف ﻋﻠﻰ ﺑﻌﺾ اﻟﻔﺌﺎت اﻟﺨﺎﺻﺔ ﺑﻔﺮط اﻟﺘﺤﺴﺲ ﻣﻦ اﻟﻨﻮع اﻻول و اﻟﺘﻲ ﻣﻦ‬
‫ا ﻣ ﺜﻠ ﺘ ﻬﺎ‬
‫‪Systemic Anaphylaxis‬‬
‫و ﻫﻲ ﻗﺪ ﺗﻜﻮن ﻗﺎﺗﻠﺔ و ﺗﺤﺪث ﺧﻼل دﻗﺎﺋﻖ ﺑﻌﺪ اﻟﺘﻌﺮض ﻟﻠﻌﺎﻣﻞ اﻟﻤﺤﻔﺰ ﻟﻠﺘﺤﺴﺲ ‪ .‬و‬
‫ﺗﺤﺪث ﻋﻨﺪ دﺧﻮل ﻟﻠﻌﺎﻣﻞ اﻟﻤﺤﻔﺰ ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ اﻟﻰ اﻟﺪم او ﻋﻦ ﻃﺮﻳﻖ اﻣﺘﺼﺎﺻﺔ ﻓﻲ اﻻ‬
‫ﻣﻌﺎء او اﻟﺠﻠﺪ ‪ .‬اﻣﺎ اﻻﻋﺮاض ﻓﺘﺸﻤﻞ‬
‫‪ ‬ﻫ ﺒ ﻮ ط ا ﻟ ﻀﻐ ﻂ ﺑ ﺸ ﻜ ﻞ ﻣ ﻔ ﺎ ﺟ ﻰ ء‬
‫‪ ‬ﺗﻘﻠﺺ اﻟﻌﻀﻼت اﻟﻤﻠﺴﺎء‬
‫‪ ‬ا ﺧ ﺘ ﻨﺎ ق‬
‫‪ ‬ﺗﻐ ﻮ ط ) ا ﺳ ﻬ ﺎ ل (‬
‫‪ ‬ﺗﺒ ﻮ ل ﻗ ﺪ ﻳﻜ ﻮ ن ﻻ ار اد ي‬
‫ﻣﻤﻜﻦ ان ﻳﺆدي اﻻﺧﺘﻨﺎق اﻟﻰ اﻟﻤﻮت ﺧﻼل ‪ 2‬اﻟﻰ ‪ 4‬دﻗﺎﺋﻖ ﻣﻦ اﻟﺘﻌﺮض ﻟﻠﻌﺎﻣﻞ اﻟﻤﺤﻔﺰ‬
‫ﻟﻠﺘﺤﺴﺲ ﻧﺘﻴﺠﺔ ﻓﻘﺪان اﻻوﻛﺴﺠﻴﻦ‪ .‬و ﻛﻞ ﻫﺬة اﻻﻋﺮاض ﻧﺎﺗﺠﺔ ﻣﻦ زﻳﺎدة وﺟﻮد اﻟﻀﺪ ﻧﻮع‬
‫‪ IgE‬اﻟﺬي ﻳﺴﺒﺐ اﻃﻼق ﺣﺒﻴﺒﺎت ‪ mast cells‬و ﺑﺎﻟﺘﺎﻟﻲ ﻇﻬﻮر اﻻﻋﺮاض اﻟﻤﺬﻛﻮرة اﻟﺘﻲ‬
‫ﺗ ﻜ ﻮ ن ﺷ ﺪﻳﺪة‬

‫ا ﻟ ﻌ ﻮ ا ﻣ ﻞ اﻟ ﻤ ﺤ ﻔ ﺰ ة ﻟ ﻬ ﺬ ا ا ﻟ ﻨ ﻮ ع ﻣ ﻦ ا ﻟ ﺘ ﺤ ﺴ ﺲ ﺗ ﺸﻤ ﻞ‬
‫‪ venom from bee , wasp , hornet‬‬
‫‪ drugs such as penicillin, insulin‬‬
‫‪ antitoxins‬‬
‫‪ foods such as seafood and nuts‬‬
‫‪ latex‬‬
‫و ﻳﺤﺘﺎج ﻫﺬا اﻟﻨﻮع اﻟﻰ اﻟﻌﻼج ﺑﺴﺮﻋﺔ و ﻳﻌﺘﺒﺮ اﻻدرﻳﻨﺎﻟﻴﻦ ﻫﻮ اﻟﺨﻂ اﻻول ﻓﻲ اﻟﻌﻼج و‬
‫ﻳﻌﻤﻞ ﻋﻠﻰ اﺳﺘﺮﺧﺎء اﻟﻌﻀﻼت اﻟﻤﻠﺴﺎء و ﺗﻘﻠﻴﻞ ﻧﻀﻮﺣﻴﺔ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﻛﺬﻟﻚ ﻳﻌﺎﻛﺲ‬
‫اﻟﻬﺴﺘﺎﻣﻴﻦ و اﻟﻠﻴﻜﻮﺗﺮﻳﻨﺎت ﻓﻲ ﻋﻤﻠﺔ ‪ .‬و ﻳﺰﻳﺪ ﻣﻦ ﺿﺮﺑﺎت اﻟﻘﻠﺐ ﻣﻤﺎ ﻳﻤﻨﻊ ﺗﻠﻒ اﻻوﻋﻴﺔ‬
‫ا ﻟﺪ ﻣ ﻮﻳ ﺔ‬

‫‪Localized Hypersensitivity Reactions‬‬

‫و ﻫ ﻲ ﻓ ﺌ ﺔ ﺗ ﺘ ﻤ ﻴ ﺰ ﺑ ﻮ ﺟ ﻮ د ﺗ ﺤ ﺴ ﺲ ﻓ ﻲ ﻣ ﻨ ﻄ ﻘ ﺔ ﻣﻌ ﻴ ﻨ ﺔ ﻣ ﻦ ا ﻟ ﺠ ﺴ ﻢ و ﺑ ﺎ ﻟ ﺨ ﺼ ﻮ ص ﻓ ﻲ ا ﻟ ﺨ ﻼ ﻳ ﺎ‬
‫ا ﻟ ﻄ ﻼ ﺋ ﻴ ﺔ ا و ا ﻟ ﻤ ﺒ ﻄ ﻨ ﺔ ﻟ ﻠﻌ ﻀ ﻮ ا ﻟ ﻤ ﺘ ﺤ ﺴ ﺲ و ا ﻣ ﺎ ا ﻧ ﻮ اﻋ ﻬ ﺎ ﻓ ﺘ ﺸ ﻤ ﻞ‬
‫)‪ rhinitis (hay fever‬‬
‫‪ asthma‬‬
‫)‪ atopic dermatitis (eczema‬‬
‫)‪ urticaria (hives‬‬
‫)‪ angioedema (deep tissue swelling‬‬
‫‪ food allergies‬‬
‫و ﻛﻞ ﻫﺬة اﻟﺤﺎﻻت ﻧﺎﺗﺠﺔ ﺑﺴﺒﺐ‬
‫دﺧﻮل اﻟﻌﺎﻣﻞ اﻟﻤﺤﻔﺰ اﻟﺬي ﻳﺘﻢ ﺗﻤﻴﻴﺰة ﺑﻮاﺳﻄﺔ اﻟﻀﺪ ﻧﻮع ‪ IgE‬ﻋﻠﻰ إﻧﺔ ﻏﺮﻳﺐ ﻓﻴﻌﻤﻞ ﻫﺬا‬
‫اﻟﻀﺪ ﻋﻠﻰ اﻻرﺗﺒﺎط ﺑﻪ و ﺗﻔﻌﻴﻞ ﺧﻼﻳﺎ ‪ mast cells‬و ﺑﺎﻟﺘﺎﻟﻲ اﻃﻼق ﻣﺤﺘﻮﻳﺎت اﻟﺨﻠﻴﺔ اﻟﺘﻲ‬
‫ﺗﺸﻤﻞ اﻟﻬﺴﺘﺎﻣﻴﻦ و اﻟﻠﻴﻜﻮﺗﺮﻳﻨﺎت و ﺑﺎﻟﺘﺎﻟﻲ ﺣﺼﻮل اﻻﻋﺮاض اﻟﺘﻲ ﺗﺸﻤﻞ‬
‫‪ secretions in the eyes‬‬
‫‪ nasal passages‬‬
‫‪ Tearing‬‬
‫‪ runny nose‬‬
‫‪ sneezing‬‬
‫‪ coughing‬‬
‫و ﻫﻨﺎﻟﻚ ﺗﻔﺎﺻﻴﻞ ﻛﺜﻴﺮة ﻋﻦ ﻛﻞ ﺣﺎﻟﺔ ﻻ ﻳﺘﺴﻊ اﻟﻤﻘﺎل ﻟﺬﻛﺮﻫﺎ ﺟﻤﻴﻌﺎً ﻻن ﻣﻮﺿﻮﻋﻨﺎ ﻻ‬
‫ﻳﺨﺘﺺ ﺑﻬﺬة اﻟﺤﺎﻻت ﺑﺎﻟﺘﺤﺪﻳﺪ‬
 ‫اﻟﻌﻼﺟﺎت اﻟﺘﻲ ﺗﻘﻠﻞ و ﺗﻌﺎﻟﺞ ﻓﺮط اﻟﺘﺤﺴﺲ اﻟﻨﻮع اﻻول‬
‫‪Decongestants‬‬
‫ﻣﻀﺎدات اﻻﺣﺘﻘﺎن ﻣﺜﻞ‬
‫‪‬‬ ‫‪oxymetazoline‬‬
‫‪‬‬ ‫‪phenylephrine‬‬
‫‪‬‬ ‫‪pseudoephedrine‬‬
‫اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ازاﻟﺔ اﻻﺣﺘﻘﺎن ﻓﻲ اﻻﻧﻒ ﺑﺎﻟﺨﺼﻮص‬

‫‪antihistamines‬‬
‫ﻣ ﻀ ﺎ د ا ت ا ﻟ ﺘ ﺤﺴ ﺲ اﻟ ﺘ ﻲ ﻣ ﻦ ا ﺷ ﻬ ﺮ ﻫ ﺎ‬
‫‪‬‬ ‫‪chlorpheniramine‬‬
‫‪‬‬ ‫‪fexofenadine‬‬
‫‪‬‬ ‫‪loratadine‬‬
‫‪‬‬ ‫‪desloratadine‬‬

‫‪Leukotriene antagonists‬‬
‫ﻣ ﻀ ﺎ د ا ت ا ﻟﻠﻴ ﻜ ﻮ ﺗ ﺮﻳ ﻨﺎ ت و أ ﺷﻬ ﺮ ﻫﺎ‬
‫‪‬‬ ‫‪montelukast‬‬

‫‪corticosteroids‬‬
‫ا ﻟ ﺴﺘ ﻴ ﺮ وﻳ ﺪ ات ﻣﻨﻬ ﺎ‬
‫‪‬‬ ‫‪Dexamethasone‬‬
‫‪‬‬ ‫‪Betamethasone‬‬
‫‪‬‬ ‫‪Hydrocortisone‬‬
‫‪‬‬ ‫‪Prednisolone‬‬
‫‪‬‬ ‫‪Methylprednisolone‬‬
‫ا ﻣﺎ ا ﻟ ﻌ ﻼ ﺟﺎ ت ا ﻟ ﺘ ﻲ ﺗ ﺤﺪ ﻣ ﻦ ﺗ ﻄ ﻮ ر ا ﻟ ﺤ ﺎﻟ ﺔ ﻓﺎ ﺷ ﻬ ﺮ ﻫ ﺎ ﻫ ﻮ‬
‫‪Epinephrine‬‬
‫و ﻫﻨﺎﻟﻚ ﻋﻼﺟﺎت ﻣﻨﺎﻋﻴﺔ ﻣﺜﻞ‬
‫‪anti-IgE antibodies‬‬
‫و اﻟﺘﻲ ﺗﻤﻨﻊ اﻟﺘﺼﺎق ﻫﺬا اﻟﻀﺪ ﺑﺨﻼﻳﺎ ‪ mast cells‬و ﺑﺎﻟﺘﺎﻟﻲ ﺗﻤﻨﻊ اﻃﻼق ﻣﺤﺘﻮﻳﺎت‬
‫اﻟﺤﺒﻴﺒﺎت اﻟﻤﻮﺟﻮدة ﻓﻲ ﻫﺬة اﻟﺨﻼﻳﺎ و ﻣﻦ اﺷﻬﺮ ﻫﺬة اﻟﻌﻼﺟﺎت ﻫﻮ ‪omalizumab‬‬

‫‪Antibody-Mediated (Type II) Hypersensitivity‬‬

‫و ﻓﻲ ﻫﺬا اﻟﻨﻮع ﻣﻦ ﻓﺮط اﻟﺘﺤﺴﺲ ﻳﺘﻢ ﺗﺪﻣﻴﺮ اﻟﺨﻼﻳﺎ ﻣﻦ ﺧﻼل اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻣﻦ‬
‫ﻧﻮع ‪ IgG and IgM‬و ﻳﺘﻢ ﻫﺬا اﻟﺘﺪﻣﻴﺮ ﻋﻦ ﻃﺮﻳﻖ اﺳﺘﺨﺪام واﺣﺪة ﻣﻦ اﻻﺳﺘﺮاﺗﺠﻴﺎت‬
‫ا ﻟ ﺘﺎ ﻟ ﻴ ﺔ‬
‫‪ ‬ﺗﻌﻤﻞ ﺑﻌﺾ اﻻﺿﺪاد ﻋﻠﻰ ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ ) ﺗﺪﻣﻴﺮ ﻏﻴﺮ ﻣﺒﺎﺷﺮ (‬
‫‪ ‬ﺗﻘﻮم ﺑﻌﺾ اﻻﺿﺪاد ﺑﺎﻻرﺗﺒﺎط ﻣﻊ ﻣﺴﺘﻀﺪات اﻟﺨﻼﻳﺎ و ﻳﺮﺗﺒﻂ ﺟﺰء اﻟﻀﺪ اﻟﺤﺮ ﻣﻊ‬
‫ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ ا ﻟ ﺘ ﻲ ﺗﻌ ﻤ ﻞ ﻋ ﻠ ﻰ ﻗ ﺘ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟﻤ ﺮ ﺗ ﺒ ﻂ ﺑ ﻬ ﺎ ا ﻟ ﻀ ﺪ‬
‫‪ ‬ﺗﻘﻮم ﺑﻌﺾ اﻻﺿﺪاد ﺑﻌﻤﻞ ﺑﺘﺴﻬﻴﻞ ﻋﻤﻠﻴﺎت اﻻﻟﺘﻬﺎم اﻟﺨﻠﻮي او ﺗﺴﻤﻰ اﻟﻄﺎﻫﻴﺎت اﻟﺘﻲ‬
‫ﺗﺆدي اﻟﻰ اﺑﺘﻼع اﻟﺨﻠﻴﺔ و ﺗﺪﻣﻴﺮﻫﺎ ﻣﻦ ﺧﻼل اﻟﻬﻀﻢ داﺧﻞ ﺧﻼﻳﺎ اﻻﻟﺘﻬﺎم او ﺧﻼﻳﺎ‬
‫ا ﻟ ﺒﻠ ﻌ ﻤ ﺔ‬
 ‫و أﺷﻬﺮ ﻣﺜﺎل ﻋﻠﻰ ﻫﺬا اﻟﻨﻮع ﻫﻮ ﺗﺤﻠﻞ ﺧﻼﻳﺎ اﻟﺪم اﻟﻤﻨﻘﻮﻟﺔ اﻟﻰ اﻟﻤﺮﻳﺾ اﻟﺬي ﺳﻨﻘﻮم‬
‫ﺑﺸﺮﺣﻪ ﺑﺎﻟﺘﻔﺼﻴﻞ ﻓﻲ ﻫﺬا اﻟﻤﻘﻄﻊ اﻟﻜﺘﺎﺑﻲ ﺑﺎﻻﺿﺎﻓﺔ اﻟﻰ اﻣﺜﻠﺔ اﺧﺮى ﺳﻴﺘﻢ ﺷﺮﺣﻬﺎ ﺗﺒﺎﻋﺎ‬

‫‪Transfusion Reactions Are an Example of Type II Hypersensitivity‬‬

‫ﻋﻠﻰ ﺳﻄﺢ ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء ﺗﻮﺟﺪ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻟﺒﺮوﺗﻴﻨﺎت ‪ protein‬و اﻟﺴﻜﺮﻳﺎت‬
‫اﻟﺒﺮوﺗﻴﻨﻴﺔ ‪ glycoprotein‬و ﻫﺬة ﺗﺴﻤﻰ ﻣﺴﺘﻀﺪات و ﻫﻲ اﻟﺘﻲ ﺗﻤﻴﺰ ﻓﺼﺎﺋﻞ اﻟﺪم واﺣﺪة‬
‫ﻋﻦ اﻻﺧﺮى ﺣﺴﺐ ﻧﻈﺎم ‪ ABO‬ﻓﻠﻮ ﻛﺎﻧﺖ ﻛﺮﻳﺎت اﻟﺪم ﺗﺤﻤﻞ ﻣﺴﺘﻀﺪ ﻧﻮع ‪ a‬ﻓﺎﻟﻔﺼﻴﻠﺔ‬
‫ﺗ ﻜ ﻮ ن ‪ A‬ا ﻣﺎ ﻟ ﻮ ﻛﺎ ﻧ ﺖ ﺗ ﺤ ﻤ ﻞ ﻣ ﺴ ﺘ ﻀﺪ ﻧ ﻮع ‪ b‬ﺳ ﺘ ﻜ ﻮ ن ا ﻟ ﻔ ﺼ ﻴﻠ ﺔ ‪ B‬ا ﻣﺎ ا ذ ا ﻟ ﻢ ﺗ ﺤ ﻤ ﻞ ا ي ﻧ ﻮع‬
‫ﻣﻦ ﻫﺬة اﻟﻤﺴﺘﻀﺪات ﺗﺴﻤﻰ ‪ O‬و ﻳﻤﻜﻦ ان ﺗﻬﺐ اﻟﺪم ﻻي ﻣﻦ اﻟﻔﺼﺎﺋﻞ اﻻﺧﺮى !!!‬

‫ﻓ ﻴ ﻤ ﺎ ﺑ ﻌ ﺪ ﺗ ﻢ ا ﻛ ﺘﺸ ﺎ ف ﻣ ﺴ ﺘ ﻀ ﺪ ا ﺧ ﺮ ﻫ ﻮ ‪ H‬و ا ﻟ ﺬ ي ﺗ ﺴ ﺘ ﻨ ﺪ ﻋ ﻠ ﻰ ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ا ت ‪ a , b‬و ﻋ ﺪ م‬
‫وﺟﻮده ﻳﺴﺒﺐ ﺣﺪوث ﺣﺎﻟﺔ ﻧﺎدرة و ﻓﺼﻴﻠﺔ دم ﻧﺎدرة ﺗﺴﻤﻰ ‪Bombay blood group‬‬

‫وﺟﺪت اﻟﺪراﺳﺎت إن ﻫﻨﺎﻟﻚ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﺗﺘﻜﻮن ﻓﻲ اﻻﺷﺨﺎص ﻓﻠﻮ ﻛﺎن‬
‫اﻟﺸﺨﺺ ﻳﺤﻤﻞ ﻓﺼﻴﻠﺔ دم ‪ A‬ﻓﺈن اﻻﺿﺪاد اﻟﻤﺘﻜﻮﻧﺔ ﻫﻲ ‪ anti B‬و اﻟﻌﻜﺲ ﺻﺤﻴﺢ اﻣﺎ اذا‬
‫ﻛﺎﻧﺖ ﻓﺼﻴﻠﺔ اﻟﺪم ﻫﻲ ﻧﻮع ‪ O‬ﻓﺈن اﻟﺸﺨﺺ ﻳﺤﻤﻞ اﻟﻨﻮﻋﻴﻦ ﻣﻦ اﻻﺿﺪاد‬
‫‪Anti A‬‬
‫‪Anti B‬‬
‫وﻟﻮ ﻛﺎن ﻣﻦ ﻓﺼﻴﻠﺔ دم ‪ AB‬ﻓﺈﻧﺔ ﻳﺤﻤﻞ اﻟﻤﺴﺘﻀﺪات ‪ a,b‬و ﻻ ﻳﻮﺟﺪ ﻓﻲ دﻣﺔ اي ﻧﻮع ﻣﻦ‬
‫ا ﻟ ﻤ ﺴﺘ ﻀﺪ ات ‪ .‬و ﻫ ﻨ ﺎ ﺳ ﺆ ا ل ﻣﻬ ﻢ‬
‫ﻟﻤﺎذا ﺗﺘﻜﻮن اﻻﺿﺪاد ﺑﺼﻮرة ﻋﻜﺴﻴﺔ ﻳﻌﻨﻲ ﻟﻤﺎذا ﺗﺘﻜﻮن ﻋﻨﺪ اﻟﺸﺨﺺ اﻟﺤﺎﻣﻞ ﻟﻔﺼﻴﻠﺔ اﻟﺪم‬
‫‪ A‬اﺿﺪاد ﻣﻦ ﻧﻮع ‪ anti B‬و ﻻ ﺗﺘﻜﻮن ﻣﻦ ﻧﻮع ‪ anti A‬و ﻫﻮ ﺳﺆال ﻓﻲ ﻏﺎﻳﺔ اﻻﻫﻤﻴﺔ‬
‫ا ﻟ ﺠ ﻮ ا ب ﻳ ﻌ ﻮ د ا ﻟ ﻔ ﻀ ﻞ ﻓ ﻲ ذ ﻟ ﻚ ﺑ ﺴ ﺒ ﺐ ا ﻟ ﺘ ﺤ ﻤ ﻞ ا ﻟ ﻤ ﻨ ﺎﻋ ﻲ ا ﻟ ﺬ ا ﺗ ﻲ ﺣ ﻴ ﺚ ﻳﻌ ﻤ ﻞ ﻫ ﺬ ا ﻋ ﻠ ﻰ ﻛ ﺒ ﺢ ا ﻟ ﺨ‬
‫ﻼﻳﺎ اﻟﻤﻨﺎﻋﻴﺔ و ﻣﻨﻌﻬﺎ ﻣﻦ ﺗﻜﻮﻳﻦ اﻻﺿﺪاد ﻻﻧﻬﺎ ﻓﻴﻤﺎ ﻟﻮ ﺗﻜﻮﻧﺖ ﺳﺘﻬﺎﺟﻢ ﻛﺮﻳﺎت دم اﻟﺸﺨﺺ‬
‫ﻧ ﻔ ﺴ ﻪ و ﺑ ﺎﻟ ﺘ ﺎﻟ ﻲ ﺣ ﺪ و ث ا ﻣ ﺮ ا ض ا ﻟ ﻤ ﻨﺎ ﻋ ﺔ ا ﻟﺬ ا ﺗ ﻴ ﺔ ‪.‬‬
‫و ﻋﻨﺪ اﻟﺘﻌﺮض ﻟﻜﺎﺋﻦ ﻣﺠﻬﺮي ﻳﺜﻴﺮ اﻟﻤﻨﺎﻋﺔ ﺗﺘﻜﻮن اﻻﺿﺪاد اووﺗﻜﻮن ﻣﻮﺟﻮدة ﺑﺸﻜﻞ ﻃﺒﻴﻌﻲ‬
‫ﻣ ﻨ ﺬ ا ﻟ ﻮ ﻻ د ة ا ﻟ ﺘ ﻲ ﺗ ﻌ ﻤ ﻞ ﻋ ﻠ ﻰ ﻣ ﻬ ﺎ ﺟ ﻤ ﺔ ا ﻟﻤ ﺴ ﺘ ﻀ ﺪ ﻧ ﻮ ع ‪ b‬ﻓ ﻴ ﻤ ﺎ ﻟ ﻮ ﺗﻌ ﺮ ض ﻟ ﻪ ﺟ ﺴ ﻢ ا ﻟ ﺸ ﺨ ﺺ‬
‫ﺑ ﻌﺪ ﺗ ﻌ ﺮﻳ ﻔ ﺔ ﻛ ﺠ ﺴ ﻢ ﻏ ﺮﻳ ﺐ‬

‫ﻋﻨﺪ ﻧﻘﻞ دم ﻏﻴﺮ ﻣﺘﻮاﻓﻖ ﺣﺴﺐ ﻧﻈﺎم ‪ ABO‬ﻓﺈن ﻫﺬة اﻻﺿﺪاد ﺳﺘﺘﻔﺎﻋﻞ ﻣﻊ اﻟﻤﺴﺘﻀﺪات و‬
‫ﺑﺎﻟﺘﺎﻟﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﺪﻣﻴﺮ اﻟﺨﻼﻳﺎ اﻟﻤﻨﻘﻮﻟﺔ ﻣﺨﻠﻔﺔ وراﻫﺎ اﻟﻜﺜﻴﺮ ﻣﻦ اﻻﺿﺮار و ﻣﺆدﻳﺔ اﻟﻰ‬
‫ﻇﻬﻮر اﻻﻋﺮاض اﻟﺘﻲ ذﻛﺮﻧﺎﻫﺎ ﻓﻲ ﺑﺪاﻳﺔ اﻟﻜﺘﺎب و ﻫﺬا اﻟﺸﻲء ﻧﺎﺗﺞ ﻋﻦ ﺗﺤﻠﻞ ﻣﺒﺎﺷﺮ او ﻏﻴﺮ‬
‫ﻣ ﺒ ﺎ ﺷ ﺮ ﻳﻌ ﻨ ﻲ ﻋ ﻦ ﻃ ﺮ ﻳ ﻖ ﺗ ﻔ ﻌ ﻴ ﻞ ﻧ ﻈ ﺎ م ا ﻟ ﻤ ﺘ ﻤ ﻢ‬

‫ﻗﺪ ﻳ ﺤﺪ ث ا ﻟ ﺘ ﺤﻠ ﻞ ﻧ ﺘ ﻴ ﺠ ﺔ ﻋﺪ م ﺗ ﻮ ا ﻓ ﻖ ا ﻟﺪ م ﺑ ﻴ ﻦ ا ﻟ ﻮ ا ﻫ ﺐ و اﻟ ﻤ ﺴ ﺘﻠ ﻢ ﻧ ﺘ ﻴ ﺠ ﺔ ا ﻧ ﻈ ﻤ ﺔ ﻓ ﺼﺎ ﺋ ﻞ‬
‫اﻟﺪم اﻻﺧﺮى ﻣﺜﻞ ﻧﻈﺎم اﻟﻌﺎﻣﻞ اﻟﺮﻳﺴﻲ ﺣﻴﺚ إن ﻫﺬا اﻟﻨﻮع ﻳﺆدي اﻟﻰ ﺗﻜﻮﻳﻦ اﺿﺪاد ﻣﻨﺎﻋﻴﺔ‬
‫ﻧﻮع ‪ IgG‬اﻟﺘﻲ ﺗﺘﻄﻮر ﺧﻼل ‪ 2‬اﻟﻰ ‪ 6‬اﻳﺎم ﺑﻌﺪ ﻋﻤﻠﻴﺔ ﻧﻘﻠﺔ اﻟﺪم و ﻳﻜﻮن اﻟﺘﺤﻠﻞ ﺧﺎرج اﻻ‬
‫وﻋ ﻴ ﺔ ا ﻟ ﺪ ﻣ ﻮ ﻳ ﺔ ﻣ ﻤ ﺎ ﻳ ﺆد ي ا ﻟ ﻰ ا ﻟ ﻴ ﺮ ﻗ ﺎ ن و ﺗ ﻀ ﺨ ﻢ ا ﻟ ﻄ ﺤ ﺎ ل و ا ر ﺗ ﻔ ﺎ ع د ر ﺟ ﺔ ا ﻟ ﺤ ﺮ ا ر ة و ﻓ ﻘ ﺮ ا ﻟ ﺪ م‬
‫ا ﻟ ﺘﺪ رﻳ ﺠ ﻲ و ﻳ ﺘ ﻢ ﻋ ﻦ ﻃ ﺮﻳ ﻖ ا ﻟ ﻄ ﻬ ﻲ ا و ﻋ ﻦ ﻃ ﺮﻳ ﻖ ا ﻟ ﺒﻠ ﻌ ﻤ ﺔ‬
‫‪Hemolytic Disease of the Newborn Is Caused by Type II Reactions‬‬

‫ا ﻟ ﻔ ﺌ ﻪ ا ﻟ ﺜ ﺎ ﻧ ﻴ ﻪ ﻣ ﻦ ﻓ ﺮ ط ا ﻟ ﺤ ﺴ ﺎ ﺳ ﻴ ﻪ ا ﻟ ﻨ ﻮ ع ا ﻟ ﺜ ﺎ ﻧ ﻲ و ﻫ ﺬ ه ا ﻟ ﺤ ﺎ ﻟ ﻪ ﻧ ﺎ ﺗ ﺠ ﻪ ﻋ ﻦ و ﺟ ﻮ د ا ﺿ ﺪ ا د ﻣ ﻨ ﺎﻋ ﻴ ﻪ‬
‫ﺗﻌﻤﻞ ﻋﻠﻰ ﻣﻬﺎﺟﻤﻪ ﺧﻼﻳﺎ او ﻛﺮﻳﺎت دم اﻟﻄﻔﻞ ﻓﻲ داﺧﻞ اﻟﺮﺣﻢ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﺪﻣﻴﺮ ﺗﻠﻚ‬
‫اﻟﺨﻼﻳﺎ وﺑﺎﻟﺘﺎﻟﻲ ﻣﻮت اﻟﺠﻨﻴﻦ او اﻻﺟﻬﺎض وﻳﻜﻮن ﻧﻮع اﻻﺿﺪاد ﻣﻦ ﻧﻮع ‪IgG‬‬

‫ﻫﺬه اﻟﺤﺎﻟﻪ ﻧﺎﺗﺠﻪ ﻣﻦ اﺧﺘﻼف اﻟﻌﺎﻣﻞ اﻟﺮﻳﺴﻲ ﺑﻴﻦ اﻻم واﻟﻄﻔﻞ ﻧﺘﻴﺠﻪ اﻻﻟﻴﻼت ﺣﻴﺚ ﺗﻜﻮن‬
‫اﻻم ﻏﻴﺮ ﺣﺎوﻳﻪ ﻋﻠﻰ اﻟﻌﺎﻣﻞ اﻟﺮﺋﻴﺴﻲ او ان ﺗﺠﻲ او ﻣﺴﺘﻀﺪاﺗﻪ ﻓﻲ ﺣﻴﻦ ﻳﻜﻮن اﻟﻄﻔﻞ‬
‫ﺣ ﺎ و ي ﻋ ﻠ ﻰ ﻣﺴ ﺘ ﻀ ﺪ ا ت ا ﻟ ﻌ ﺎ ﻣ ﻞ ا ﻟ ﺮ ﺋ ﻴ ﺴ ﻲ ﻣ ﻤ ﺎ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻮ ﻟ ﻴ ﺪ ا ﺿ ﺪ ا د ﻣ ﻨ ﺎﻋ ﻴ ﻪ ﺗ ﻬ ﺎ ﺟ ﻢ ﺗ ﻠ ﻚ‬
‫ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ا ت و ﻫ ﺬ ا ﻳﻌ ﻨ ﻲ ﺗ ﻌ ﺮ ﻳ ﻒ ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ا ت ﻋ ﻠ ﻰ ا ﻧ ﻬ ﺎ ﺟ ﺴ ﻢ ﻏ ﺮ ﻳ ﺐ ﻣ ﻤ ﺎ ﻳ ﺜ ﻴ ﺮ ا ﻟ ﺠ ﻬ ﺎ ز ا ﻟ ﻤ ﻨ ﺎﻋ ﻲ‬
‫و ﻳﺴﺒﺐ ﺗﻜﻮﻳﻦ ﺗﻠﻚ اﻻﺿﺪاد ‪.‬‬

‫ﺗﻜﻮن اﻻﺿﺪاد ﻓﻲ اﻟﺒﺪاﻳﺔ ﻣﻦ ﻧﻮع ‪ IgM‬و اﻟﺘﻲ ﺳﺮﻋﺎن ﻣﺎ ﻳﺘﻢ ازاﻟﺘﻬﺎ ﻣﻦ اﻻوﻋﻴﺔ‬
‫اﻟﺪﻣﻮﻳﺔ و ﻻن ﻫﺬة اﻟﻨﻮع ﻣﻦ اﻻﺿﺪاد ﻻ ﻳﺴﺘﻄﻴﻊ ﻋﺒﻮر اﻟﻤﺸﻴﻤﺔ ﺑﺴﺒﺐ اﻟﻮزن اﻟﺠﺰﻳﺌﻲ‬
‫اﻟ ﻜ ﺒ ﻴ ﺮ ﻟ ﻪ ﻓ ﺈ ن و ﺟ ﻮ د ة ﻻ ﻳ ﻬﺪ د ﺣ ﻴﺎ ة ا ﻟ ﻄ ﻔ ﻞ ‪.‬‬

‫ﺗﺒﻘﻰ ﺧﻼﻳﺎ اﻟﺬاﻛﺮة اﻟﺘﻲ ﺗﻨﺘﺞ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻧﻮع ‪ IgG‬اﻟﺘﻲ ﺗﺴﺘﻄﻴﻊ ﻋﺒﻮر‬
‫اﻟﻤﺸﻴﻤﺔ و ﺗﺪﻣﻴﺮ ﺧﻼﻳﺎ دم اﻟﻄﻔﻞ ﻧﺘﻴﺠﺔ اﺧﺘﻼف اﻟﻤﺴﺘﻀﺪات ﺑﻴﻦ اﻻم و اﻟﻄﻔﻞ ﻣﻤﺎ ﻳﺆدي‬
‫اﻟﻰ ﺗﺠﻤﻊ ﺗﺠﻤﻊ اﻟﺒﻠﻴﺮوﺑﻴﻦ ﻓﻲ اﻟﻄﻔﻞ و ﻳﺴﺒﺐ ذﻟﻚ ﺗﺴﻤﻢ اﻟﻄﻔﻞ و ﻳﻤﻜﻦ اﺳﺘﺨﺪام اﻻ‬
‫ﺷ ﻌ ﺔ ﻓ ﻮ ق ا ﻟ ﺒ ﻨ ﻔ ﺴ ﺠ ﻴ ﺔ ﻣ ﻦ ا ﺟ ﻞ ﺧ ﻔ ﺾ ﺗ ﺮﻛ ﻴ ﺰ ا ﻟ ﺒ ﻠ ﻴ ﺮ و ﺑ ﻴ ﻦ ﻓ ﻲ ﺟ ﺴ ﻢ ا ﻟ ﻄ ﻔ ﻞ‬

‫اﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻼم ﻓﻴﺘﻢ اﻋﻄﺎء اﺑﺮة ﻣﻀﺎدة ﻟﻼﺟﺴﺎم اﻟﻤﻨﺎﻋﻴﺔ اﻟﻤﺘﻜﻮﻧﻪ ‪ anti D‬و اﻟﺘﻲ ﺗﻌﻤﻞ‬
‫ﻋﻠﻰ ازاﻟﺔ ﺧﻼﻳﺎ دم اﻟﻄﻔﻞ اﻟﺘﻲ ﺗﻌﺮض اﻟﻴﻬﺎ دم اﻻم ﻗﺒﻞ ان ﺗﺘﺤﻔﺰ اﻟﺨﻼﻳﺎ اﻟﺒﺎﺋﻴﺔ و ﺗﻨﺘﺞ‬
‫اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ‪.‬‬

‫و ﻳﺘﻢ ﺗﺸﺨﻴﺺ اﻟﺤﺎﻟﺔ ﻣﻦ ﺧﻼل اﻟﻜﺸﻒ ﻋﻦ وﺟﻮد اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻓﻲ ﻣﺼﻞ اﻻم و‬
‫ﻳﻌﺘﻤﺪ اﻟﻌﻼج ﻋﻠﻰ ﺷﺪة اﻟﺤﺎﻟﺔ و ﻛﻤﻴﺔ اﻻﺿﺪاد اﻟﻤﻮﺟﻮدة ﻓﻲ دم اﻻم ﻓﻠﻮ ﻛﺎﻧﺖ ﺣﺎدة‬
‫ﻣﻤﻜﻦ ﻧﻘﻞ اﻟﺪم اﻟﻰ اﻟﻄﻔﻞ و ﻫﻮ داﺧﻞ رﺣﻢ اﻻم او ﺑﻌﺪ اﻟﻮﻻدة ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ او ﻳﻤﻜﻦ‬
‫اﺳﺘﺒﺪال ﺑﻼزﻣﺎ اﻻم ﺑﺎﺧﺮى ﻣﻦ اﺟﻞ ﺗﻘﻠﻴﻞ ﺗﺮﻛﻴﺰ اﻻﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ ﻓﻲ ﺟﺴﻤﻬﺎ‬

‫و ﻣﻦ اﻟﻤﻤﻜﻦ ان ﻳﺆدي اﻻﺧﺘﻼف ﺣﺴﺐ ﻧﻈﺎم ‪ ABO‬اﻟﻰ ﺗﺸﻜﻴﻞ اﺿﺪاد ﻣﻨﺎﻋﻴﺔ ﻣﻦ ﻧﻮع‬
‫‪ IgG‬ﻓﻲ ﺣﺎل ﻛﺎﻧﺖ اﻻم ‪ O‬و اﻟﻄﻔﻞ ﻫﻮ ‪ A or B‬ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﻣﻬﺎﺟﻤﺔ ﺧﻼﻳﺎ اﻟﺪم ﻟﺪى‬
‫اﻟ ﻄ ﻔ ﻞ و ﺑﺎ ﻟ ﺘﺎ ﻟ ﻲ ﺣ ﺼ ﻮ ل ﻓ ﻘ ﺮ ا ﻟﺪ م ﻟ ﻜ ﻦ ﻳ ﻜ ﻮ ن ا ﻗ ﻞ ﺿ ﺮ ا و ة ﻓ ﻲ ﻫﺬ ة ا ﻟ ﺤﺎ ﻟ ﺔ‬
‫‪Hemolytic Anemia Can Be Drug Induced‬‬
‫ﺗﻤ ﺜ ﻞ ا ﻟ ﻔ ﺌ ﺔ ا ﻟ ﺜ ﺎ ﻟ ﺜ ﺔ ﻣ ﻦ ا ﻟ ﻨ ﻮع ا ﻟ ﺜ ﺎ ﻧ ﻲ ﻣ ﻦ ﻓ ﺮ ط ا ﻟ ﺘ ﺤ ﺴ ﺲ و ﺗﺸ ﻤ ﻞ ﻣ ﺠ ﻤ ﻮ ﻋ ﺔ ﻣ ﻦ اﻟ ﻌ ﻼ ﺟ ﺎ ت‬
‫ﻣﺜﻞ‬
‫‪ penicillin‬‬
‫‪ cephalosporins‬‬
‫‪ streptomycin‬‬
‫‪ Ibuprofen‬‬
‫‪ naproxen‬‬
‫و ا ﻟ ﺘ ﻲ ﺗ ﺮ ﺗ ﺒ ﻂ ﻣ ﻊ ﻏ ﺸ ﺎ ء ﻛ ﺮ ﻳ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء ﻣﻤ ﺎ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻐ ﻴ ﻴ ﺮ ﻓ ﻲ ﻣ ﺴ ﺘ ﻀ ﺪ ا ﺗ ﻬ ﺎ و ﻫ ﺬ ا‬
‫ﻳ ﺜ ﻴ ﺮ اﻟ ﺠ ﻬ ﺎ ز ا ﻟﻤ ﻨ ﺎﻋ ﻲ ﻣ ﻤ ﺎ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻜ ﻮ ﻳ ﻦ ا ﺿ ﺪ ا د ﻣ ﻨ ﺎﻋ ﻴ ﺔ ﺗ ﻬ ﺎ ﺟ ﻢ ﻛ ﺮ ﻳ ﺎ ت ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء و‬
‫ﺗﺴﺒﺐ ﺗﺪﻣﻴﺮﻫﺎ ‪ .‬و ﺗﺰول اﻟﺤﺎﻟﺔ ﻋﻨﺪ زوال اﻟﻤﺆﺛﺮ ) اﻟﻌﻼج ( و ﻗﺪ وﺟﺪت اﻟﺪراﺳﺎت إن‬
‫اﻟﺒﻨﺴﻠﻴﻦ ﻳﺆدي اﻟﻰ ﺟﻤﻴﻊ اﻧﻮاع ﻓﺮط اﻟﺘﺤﺴﺲ اﻻرﺑﻌﻪ و ﻟﻬﺬا ﻳﻌﺘﺒﺮ اﻻﺧﻄﺮ ﺑﻴﻦ ﻫﺬة‬
‫ا ﻟ ﻤ ﺠ ﻤ ﻮﻋ ﺔ و ﻳ ﺘ ﻢ ﺻ ﺮ ﻓ ﺔ و ﻓ ﻖ ﻣ ﺤ ﺎ ذ ﻳ ﺮ ﻋ ﺎ ﻟ ﻴ ﺔ ﺟ ﺪ ا ً‬
‫ﺗﺘﻤﻴﺰ اﻟﺤﺎﻟﺔ ﺑﻔﻘﺮ اﻟﺪم اﻟﺸﺪﻳﺪ و اﻟﻤﺘﻮﺳﻂ اﻟﺸﺪة او ﻗﺪ ﻳﻜﻮن ﺿﻌﻴﻒ ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت‬

‫‪Immune Complex–Mediated (Type III) Hypersensitivity‬‬

‫ا ﻟ ﻨ ﻮع ا ﻟ ﺜﺎ ﻟ ﺚ ﻣ ﻦ ﻓ ﺮ ط اﻟ ﺘ ﺤ ﺴ ﺲ‬
‫ﺗ ﻔ ﺎﻋ ﻞ ا ﻟ ﺠ ﺴ ﻢ ا ﻟﻤ ﻀ ﺎ د ﻣ ﻊ ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ﻳ ﻮ ﻟ ﺪ ﻣﻌ ﻘ ﺪ ا ت ﻣ ﻨ ﺎﻋ ﻴ ﺔ ‪ .‬ﺑ ﺸ ﻜ ﻞ ﻋ ﺎ م ‪ ،‬ﺗﻌ ﻤ ﻞ ا ﻟ ﻤ ﻌ ﻘ ﺪ ا ت‬
‫ا ﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ ﻋ ﻠ ﻰ ﺗ ﺴ ﻬ ﻴ ﻞ إ ز اﻟ ﺔ اﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ﺑ ﻮ ا ﺳ ﻄ ﺔ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﺒ ﻠ ﻌ ﻤ ﻴ ﺔ و ﺧ ﻼ ﻳ ﺎ ا ﻟ ﺪ م ا ﻟ ﺤ ﻤ ﺮ ا ء ‪ .‬و ﻟ ﻜ ﻦ‬
‫ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت ﻳﻜﻮن ﻫﻨﺎك أﻋﺪاد ﻛﺒﻴﺮة ﻣﻦ اﻟﻤﻌﻘﺪات اﻟﻤﻨﺎﻋﻴﺔ اﻟﺘﻲ ﺗﺆدي اﻟﻰ ﺗﻔﺎﻋﻼت‬
‫ﻓﺮط اﻟﺤﺴﺎﺳﻴﺔ ﻣﻦ اﻟﻨﻮع اﻟﺜﺎﻟﺚ و اﻟﺘﻲ ﺗﺪﻣﺮ اﻷﻧﺴﺠﺔ ‪ .‬ﺣﺠﻢ ﻓﺮط اﻟﺘﺤﺴﺲ ﻳﻌﺘﻤﺪ‬
‫ﻋﻠ ﻰ ﻋﺪ ة ﻋ ﻮ ا ﻣ ﻞ ﻫ ﻲ‬
‫‪ ‬ﺣ ﺠ ﻢ و ﻣ ﺴ ﺘ ﻮ ى ا ﻟﻤ ﻌ ﻘ ﺪ ا ت اﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ‬
‫‪ ‬ﻣ ﻜﺎ ن ﺗ ﻮ ا ﺟﺪ ﺗﻠ ﻚ اﻟ ﻤ ﻌ ﻘﺪ ا ت ا ﻟ ﻤ ﻨﺎ ﻋ ﻴ ﺔ‬
‫‪ ‬ﻗﺪ رة ﻧ ﻈﺎ م ا ﻟ ﺒﻠ ﻌ ﻤ ﺔ‬
‫‪ ‬ﻋ ﻮ ا ﻣ ﻞ ﺧ ﺎ ﺻ ﺔ ﺑ ﺎ ﻟ ﻤﺴ ﺘ ﻀ ﺪ ﻧ ﻔﺴ ﺔ ﻣ ﺜ ﻞ ﻗ ﺪ ر ﺗ ﺔ ﻋ ﻠ ﻰ ا ﻟ ﺘ ﻬ ﺮ ب ا ﻟ ﻤ ﻨ ﺎ ﻋ ﻲ‬

‫ﺗ ﺮ ﺳ ﺐ اﻟ ﻤ ﻌ ﻘﺪ ا ت ا ﻟ ﻤ ﻨﺎ ﻋ ﻴ ﺔ ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻔ ﻌ ﻴ ﻞ ﻧ ﻈ ﺎ م اﻟ ﻤ ﺘ ﻤ ﻢ ا ﻟﺬ ي ﺑﺪ و ر ة ﻳ ﻘ ﻮ م ﺑ ﺘ ﺤ ﻔ ﻴ ﺰ اﻟ ﺨ ﻼ ﻳ ﺎ و‬
‫إ ﺣﺪ ا ث ا ﺿ ﺮ ا ر ﻛ ﺒ ﻴ ﺮة ﻓ ﻲ ﻣ ﺨ ﺘﻠ ﻒ ا ﻧ ﺴ ﺠ ﺔ ا ﻟ ﺠ ﺴ ﻢ ‪.‬‬

‫ﺗﻜﻮﻳﻦ اﻟﻤﻌﻘﺪ اﻟﻤﻨﺎﻋﻴﺔ ﻳﺆدي اﻟﻰ ﺗﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﻤﻨﺎﻋﻴﺔ ﻣﻦ ﺧﻼل ارﺗﺒﺎط ﻃﺮف ‪ Fc‬اﻟﻰ‬
‫ﻣﺴﺘﻘﺒﻼﺗﺔ اﻟﻤﻮﺟﻮدة ﻋﻠﻰ ﺳﻄﺢ اﻟﺨﻼﻳﺎ ﻣﻤﺎ ﻳﺆدي اﻟﻰ اﻃﻼق ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻوﺳﺎط اﻟﺘﻲ‬
‫ﺗﺪﻣﺮ اﻟﺨﻼﻳﺎ او ﻣﻦ ﺧﻼل ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﺤﻠﻞ اﻟﺨﻼﻳﺎ ﺑﺸﻜﻞ ﻣﺒﺎﺷﺮ ‪.‬‬
‫ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت ﺿﻌﻒ ﻧﻈﺎم اﻟﺒﻠﻌﻤﺔ ﻓﻲ ازاﻟﺔ اﻟﻤﻌﻘﺪات اﻟﻤﻨﺎﻋﻴﺔ ﻳﺆدي اﻟﻰ ﺑﻘﺎء ﺗﻠﻚ‬
‫اﻟﻤﻌﻘﺪات اﻟﻤﻨﺎﻋﻴﺔ ﻓﻲ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ او ﻓﻲ اﻻﻋﻀﺎء و ﺑﺎﻟﺘﺎﻟﻲ ﻳﻨﺘﺞ ﻋﻨﻪ اﻟﻨﻮع اﻟﺜﺎﻟﺚ‬
‫ﻣﻦ ﻓﺮط اﻟﺘﺤﺴﺲ ‪ .‬و ﺗﺸﻤﻞ ﻫﺬة اﻟﺤﺎﻻت‬
‫‪ ‬وﺟﻮد اﻟﻤﺴﺘﻀﺪ اﻟﺬي ﻳﻜﻮن ﻗﺎدر ﻋﻠﻰ اﻧﺘﺎج ﺗﻔﺎﻋﻼت ﻣﻨﺎﻋﻴﺔ و ﺗﻜﻮﻳﻦ ﻣﻌﻘﺪات‬
‫ﻣ ﻨﺎ ﻋﻴ ﺔ ﻛ ﺜ ﻴ ﺮة‬
‫‪ ‬اﻟﻘﺪرة اﻟﻌﺎﻟﻴﺔ ﻟﻠﻤﺴﺘﻀﺪ ﻓﻲ ارﺗﺒﺎﻃﻪ ﻣﻊ اﻟﺨﻼﻳﺎ اﻟﻤﻮﺟﻮده ﻓﻲ اﻻﻋﻀﺎء‬
‫‪ ‬و ﺟ ﻮ د ﻣ ﺴ ﺘ ﻀ ﺪ ﻣ ﺸ ﺤ ﻮ ن ﺑ ﺸ ﻜ ﻞ ﻋ ﺎ ﻟ ﻲ ﻳ ﻌ ﻨ ﻲ ﻳ ﻤ ﻨ ﻊ ا ﻟ ﺨ ﻼ ﻳ ﺎ ﻣ ﻦ ا ﺑ ﺘ ﻼﻋ ﺔ‬
 ‫ﺧ ﻠ ﻞ ﻓ ﻲ ﻧ ﻈ ﺎ م ا ﻟ ﺒ ﻠﻌ ﻤ ﺔ ا ﻟ ﺨ ﺎ ص ﺑ ﺎ ﻟ ﻤ ﺮ ﻳ ﺾ‬ ‫‪‬‬

‫ﺑﻘﺎء اﻟﻤﻌﻘﺪ ﻓﻲ اﻻوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﻳﺆدي اﻟﻰ ارﺗﺒﺎﻃﻪ ﺑﺨﻼﻳﺎ‬

‫‪mast cells, neutrophils, and macrophages via Fc‬‬
‫ﻣﻤﺎ ﻳﺆدي اﻟﻰ اﻃﻼق ﻣﺠﻤﻮﻋﺔ ﻣﻦ‬
‫‪vasoactive mediators and inflammatory cytokines‬‬
‫و اﻟﺘﻲ ﺗﺘﻔﺎﻋﻞ ﻣﻊ اﻟﺒﻄﺎﻧﺔ اﻟﺪاﺧﻠﻴﺔ ﻟﻼوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ و ﺗﺴﺒﺐ زﻳﺎدة اﻟﻨﻀﻮح ﻓﺘﺨﺮج‬
‫اﻟﻤﻌﻘﺪات اﻟﻤﻨﺎﻋﻴﺔ ﻣﻦ اﻟﻮﻋﺎء اﻟﺪﻣﻮﻳﺔ ﻟﺘﺘﺮﺳﺐ ﻓﻲ اﻻﻋﻀﺎء و ﻫﻨﺎ ﻳﺘﻢ ﺗﻔﻌﻴﻞ ﻧﻈﺎم اﻟﻤﺘﻤﻢ‬
‫اﻟﺬي ﻳﺸﻤﻞ ‪ C3a and C5a‬و اﻟﺘﻲ ﺗﺠﺬب ﺧﻼﻳﺎ اﻟﺪم اﻟﻌﺪﻟﺔ و اﻟﻤﺎﻛﺮوﻓﻴﺞ ﻣﻤﺎ ﻳﺆدي اﻟﻰ‬
‫اﻟ ﺘ ﻬﺎ ب ا ﻛ ﺒ ﺮ‬

‫و ﻫﺬة اﻟﺨﻼﻳﺎ ﻋﻨﺪ ارﺗﺒﺎﻃﻬﺎ ﺑﻄﺮف اﻟﻀﺪ ﻳﺆدي ذﻟﻚ اﻟﻰ اﻃﻼق ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻻوﺳﺎط ﻣﻨﻬﺎ‬
‫‪chemokines and cytokines, prostaglandins, and proteases‬‬
‫و ﺗﻘﻮم ﻫﺬة اﻻوﺳﺎط و ﺧﺎﺻﺔ اﻻﺧﻴﺮ ﺑﺘﺪﻣﻴﺮ اﻟﺒﺮوﺗﻴﻨﺎت و ﺧﺎﺻﺔ ﻓﻲ اﻟﻐﻀﺎرﻳﻒ ﻋﻦ‬
‫ﻃ ﺮ ﻳ ﻖ ﺗ ﻮ ﻟ ﻴ ﺪ ا ﻟ ﺠ ﺬ و ر ا ﻟ ﺤ ﺮ ة ‪ .‬ﻛ ﺬ ﻟ ﻚ ﻣ ﻤ ﻜ ﻦ ا ن ﺗ ﺘ ﻔ ﺎ ﻋ ﻞ ا ﻟﻤ ﻌ ﻘ ﺪ ا ت اﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ ﻣ ﻊ ا ﻟ ﺼ ﻔ ﺎ ﺋ ﺢ‬
‫اﻟﺪﻣﻮﻳﺔ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﺨﺜﺮ اﻟﺪم و زﻳﺎدة اﻻﺿﺮار و ﺗﺴﻤﻰ اﻻﺿﺮار ﺑﺎﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻌﻀﻮ‬
‫ا ﻟﻤﺘ ﻀ ﺮر ﻣ ﺜ ﻞ‬
‫‪ vasculitis = inflammation of blood vessel‬‬
‫‪ glomerulonephritis inflammation of kidneys‬‬
‫‪ arthritis if it occurs in the joints.‬‬

‫‪Delayed-Type (Type IV) Hypersensitivity‬‬

‫و ﻫﻮ اﻟﻨﻮع اﻻﺧﻴﺮ ﻣﻦ ﻓﺮط اﻟﺘﺤﺴﺲ و ﺗﺴﻤﻰ أﻳﻀﺎً ﺑﻔﺮط اﻟﺘﺤﺴﺲ اﻟﻤﺘﺄﺧﺮ‬
‫)‪delayed-type hypersensitivity (DTH‬‬
‫و ﻫﻲ ﻓﺌﺔ ﺗﺸﺘﺮك ﻓﻴﻬﺎ اﻟﺨﻼﻳﺎ ﺑﺸﻜﻞ واﺿﺢ ﻓﻲ ﻓﺮط اﻟﺘﺤﺴﺲ ﻋﻠﻰ ﺧﻼف ﻣﺸﺎرﻛﺔ اﻻ‬
‫ﺿﺪاد اﻟﻤﻨﺎﻋﻴﺔ اﻟﺘﻲ ﺗﻜﻮن ﻣﻮﺟﻮدة ﻓﻲ اﻻﻧﻮاع اﻟﺜﻼﺛﺔ اﻟﺴﺎﺑﻘﺔ ‪ .‬ﺗﻢ اﻛﺘﺸﺎف ﻫﺬا اﻟﻨﻮع‬
‫ﺑ ﻮ ا ﺳ ﻄ ﺔ ﻋ ﺎ ﻟ ﻢ ا ﻟ ﺠ ﺮ ا ﺛ ﻴ ﻢ ر و ﺑ ﺮ ت ﻛ ﻮ خ ا ﻟﺬ ي ﻻ ﺣ ﻆ ﻋ ﻨﺪ ﺣ ﻘ ﻦ ﺑ ﻜ ﺘ ﺮ ﻳ ﺎ اﻟ ﺴ ﻞ ا ﻟ ﺮ ﺋ ﻮ ي ﺗ ﺤ ﺖ ا ﻟ ﺠﻠﺪ‬
‫ﻻ ﺗﻈﻬﺮ اﻟﻌﻼﻣﺎت اﻟﺪاﻟﺔ ﻋﻠﻰ ﻓﺮط اﻟﺘﺤﺴﺲ اﻻ ﺑﻌﺪ ﻣﺮور ‪ 1‬اﻟﻰ ‪ 2‬ﻳﻮم و ﻳﺘﻢ ﻫﺬا اﻟﻨﻮع‬
‫ﺑﺘﻔﻌﻴﻞ اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﺔ اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﺠﻨﻴﺪ ﺧﻼﻳﺎ اﻟﺪم اﻟﺒﻴﺾ اﻟﻌﺪﻟﺔ و اﻟﻤﺎﻛﺮوﻓﻴﺞ ﻣﻦ‬
‫اﺟﻞ ﺑﺪء اﻻﻟﺘﻬﺎب و ﻳﺒﺪأ اﻻﻟﺘﻬﺎب ﻓﻲ اﻟﻐﺎﻟﺐ ﻋﻠﻰ اﻟﺠﻠﺪ اوﻻ ‪dermatitis‬‬

‫ﻓﻲ اﻟﺒﺪاﻳﺔ ﻳﺠﺐ ﺗﺤﺴﺲ اﻟﻤﺴﺘﻀﺪ اﻟﻐﺮﻳﺐ و ﻳﺘﻢ ذﻟﻚ ﻣﻦ ﺧﻼل اﻻﻟﺘﻬﺎم‬
‫) ﺧﻼﻳﺎ اﻟﺒﻠﻌﻤﺔ ( اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﺪﻣﻴﺮ اﻟﺠﺴﻢ اﻟﻐﺮﻳﺐ و ﻋﺮض ﻣﺴﺘﻀﺪاﺗﻪ ﻋﻠﻰ ﻣﻌﻘﺪ‬
‫اﻟﺘﻮاﻓﻖ اﻟﻨﺴﻴﺠﻲ اﻟﺮﺋﻴﺴﻲ ‪ MCH‬و ذﻟﻚ ﺑﻌﺪ ﻧﻘﻠﺔ اﻟﻰ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﻳﺔ و اﻟﺠﻬﺎز اﻟﻠﻤﻔﺎوي‬
‫ﺛﻢ ﻳﺘﻢ اﻟﺘﻌﺮف ﻋﻠﻰ اﻟﻤﺴﺘﻀﺪ ﻣﻦ ﻗﺒﻞ اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﺔ اﻟﺘﻲ ﻓﻲ اﻟﻐﺎﻟﺐ ﺗﻜﻮن ‪ CD4+‬و‬
‫ﻛﺬﻟﻚ وﺟﺪت اﻟﺪراﺳﺎت ﺗﻮرط ﻟﺒﻌﺾ اﻟﺨﻼﻳﺎ ﻣﺜﻞ ‪ CD8+‬و اﻟﺨﻼﻳﺎ اﻟﺘﺎﺋﻴﺔ اﻟﻤﺴﺎﻋﺪة ‪ 17‬و‬
‫ﻳ ﺴ ﻤ ﻰ ﻫﺬ ا ا ﻟ ﻄ ﻮر ﺑ ﻄ ﻮر ا ﻟ ﺒﺪ ء ا و ﻃ ﻮر ا ﻟﺘ ﻌ ﺮ ف‬

‫ا ﻟ ﺘﻌ ﺮ ض ا ﻟ ﻰ ا ﻟ ﻤ ﺴ ﺘ ﻀ ﺪ ﻣ ﺮ ة ا ﺧ ﺮ ى ﻳ ﺆ د ي ا ﻟ ﻰ ﺗ ﻮ ﻟ ﻴ ﺪ ا ﺳ ﺘ ﺠ ﺎ ﺑ ﺔ و ﺗ ﺄ ﺛ ﻴ ﺮ ﻗ ﻮ ي‬
‫) اﻟ ﺘ ﺄ ﺛ ﻴ ﺮ ا ﻟ ﻤ ﺘ ﺄ ﺧ ﺮ ( و ﻳ ﺴ ﻤ ﻰ ﻫ ﺬ ا ﺑ ﻄ ﻮ ر اﻟ ﺘ ﺄ ﺛ ﻴ ﺮ ﺣ ﻴ ﺚ ﺗ ﺘ ﻔ ﻌ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﺘ ﺎ ﺋ ﻴ ﺔ ا ﻟ ﻤﺴ ﺎﻋ ﺪ ة ﻣ ﻦ‬
‫اﻟﻨﻮع اﻻول و ﺗﻘﻮم ﺑﺎﻓﺮاز ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻟﺴﺎﻳﺘﻮﻛﻴﻨﺎت ﻣﺜﻞ‬
‫)‪IFN-γ , TNF-α, and lymphotoxin-α (TNF-β‬‬
 ‫و اﻟﺘﻲ ﺗﻌﻤﻞ ﻣﻊ ﺑﻌﻀﻬﺎ ﻟﺘﺠﻨﻴﺪ ﺧﻼﻳﺎ اﻟﺒﻠﻌﻤﺔ و اﺷﻬﺮﻫﺎ اﻟﻤﺎﻛﺮوﻓﻴﺞ ﻣﻦ اﺟﻞ ﺑﺪء اﻟﺘﺄﺛﻴﺮ‬
‫اﻻﻟﺘﻬﺎﺑﻲ ‪ .‬و ﻓﻲ اﻟﻐﺎﻟﺐ ﻻ ﺗﻈﻬﺮ ﻋﻼﻣﺎت ﻓﺮط اﻟﺘﺤﺴﺲ اﻻ ﺑﻌﺪ ﻣﺮور ‪ 48‬اﻟﻰ‬
‫‪ 72‬ﺳﺎﻋﺔ ‪ .‬زﻳﺎدة ﻓﻌﺎﻟﻴﺔ ﺧﻼﻳﺎ اﻟﺒﻠﻌﻤﺔ ﻳﺆدي اﻟﻰ زﻳﺎدة اﻧﺘﺎج اﻻﻧﺰﻳﻤﺎت اﻟﺘﻲ ﻳﺘﻢ اﻃﻼﻗﻬﺎ‬
‫ﻓﻲ ﻣﺤﻴﻂ اﻻﺻﺎﺑﺔ ﻣﻤﺎ ﻳﺆدي اﻟﻰ ﺗﺪﻣﻴﺮ اﻟﺨﻼﻳﺎ اﻟﻤﺤﻴﻄﺔ و ﻛﺬﻟﻚ ﺗﺪﻣﻴﺮ اﻟﻌﺎﻣﻞ اﻟﻤﺮﺿﻲ‬
‫اﻟﻘﺎﺑﻊ وﺳﻂ اﻟﺨﻼﻳﺎ ‪ .‬ﺗﺴﺘﻄﻴﻊ ﺑﻜﺘﺮﻳﺎ اﻟﺴﻞ ان ﺗﻮﻗﻒ اﻻﻟﺘﺤﺎم ﻣﻊ اﻟﺠﺴﻤﺎت اﻟﺤﺎﻟﺔ و ﻟﺬﻟﻚ‬
‫ﻻ ﻳ ﻤ ﻜ ﻦ ا ن ﺗ ﻤ ﻮ ت ﺑ ﻞ ﺗ ﺒ ﻘ ﻰ ﻣ ﺴ ﺘ ﻤ ﺮ ة د ا ﺧ ﻞ ا ﻟ ﺨ ﻼ ﻳ ﺎ ا ﻟ ﻤ ﻨ ﺎﻋ ﻴ ﺔ و ﺗ ﻌ ﺘ ﺒ ﺮ و ا ﺣ ﺪ ة ﻣ ﻦ ا ﻫ ﻢ و‬
‫ﺳ ﺎ ﺋ ﻞ ا ﻟ ﺘ ﻬ ﺮ ب ﻣ ﻦ ا ﻟ ﺠ ﻬ ﺎ ز ا ﻟ ﻤ ﻨ ﺎﻋ ﻲ ‪ .‬ﻓ ﻲ ﺣ ﺎ ل ﻋ ﺪ م ﻗ ﺪ ر ة ا ﻟ ﺠ ﻬ ﺎ ز ا ﻟﻤ ﻨ ﺎﻋ ﻲ ﻋ ﻠ ﻰ ا ز ا ﻟ ﺔ ا ﻟﻌ ﺎ ﻣ ﻞ‬
‫ا ﻟ ﻤ ﺤ ﻔ ﺰ ﻳ ﺆد ي ﻫ ﺬ ا ا ﻟ ﻰ ﻇ ﻬ ﻮ ر ﻓ ﺮ ط ا ﻟ ﺘ ﺤ ﺴ ﺲ ا ﻟ ﻤ ﺘ ﺄ ﺧ ﺮ‬
1. What component is most frequently involved with transfusion-associated
sepsis?

a. Plasma
b. Packed red blood cells
c. Platelets
d. Whole blood

2. Fatal transfusion reactions are mostly caused by:

a. Serologic errors
b. Improper storage of blood
c. Clerical errors
d. Improper handling of the product

3. Early manifestation of an acute hemolytic transfusion reaction can be

confused with:

a. Allergic reaction
b. Febrile nonhemolytic reaction
c. Anaphylactic shock
d. Sepsis

4. Pain at infusion site and hypotension are observed with

what type of reaction?

a. Delayed hemolytic transfusion reaction

b. Acute hemolytic transfusion reaction
c. Allergic reaction
d. Febrile nonhemolytic reaction

5. Irradiation of blood is performed to prevent:

a. Febrile nonhemolytic transfusion reaction

b. Delayed hemolytic transfusion reaction
c. Transfusion-associated graft-versus-host disease
d. Transfusion-associated circulatory overload
6. The only presenting sign most often accompanying a delayed hemolytic
transfusion reaction is:

a. Renal failure
b. Unexplained decrease in hemoglobin
c. Active bleeding
d. Hives

7. Which transfusion reaction presents with fever, maculopapular rash,

watery diarrhea, abnormal liver function,and pancytopenia?

a. Transfusion-associated sepsis
b. Transfusion-related acute lung injury
c. Transfusion-associated graft-versus-host disease
d. Transfusion-associated allergic reaction

8. A suspected transfusion-related death must be reported to:

a. AABB
b. Federal and Drug Administration (FDA)
c. College of American Pathologists (CAP)
d. The Joint Commission (TJC)

9. Nonimmune hemolysis can be caused during transfusion by:

a. Use of small bore size needle

b. Use of an infusion pump
c. Improper use of a blood warmer
d. All of the above

10. Transfusion reactions are classified according to:

a. Signs or symptoms presenting during or after 24 hours

b. Immune or nonimmune
c. Infectious or noninfectious
d. All of the above
11. With febrile nonhemolytic transfusion reactions:
a. They are self-limited
b. Fever resolves within 2–3 hours
c. Treatment is required
d. a and b are correct
e. All of the above

12. Absolute IgA deficiency is a classic example of a severe allergic reaction.

A result indicating an absolute IgA deficiency is:

a. <0.05 mg/dL
b. <0.50 mg/dL
c. <0.50 gm/dL
d. <5 mg/dL

13. How are mild allergic transfusion reactions with isolated symptoms or
hives and urticaria treated?

a. Transfusion is stopped and transfusion reaction workup is initiated

b. Transfusion is stopped and antihistamines administrated; when
symptoms improve, transfusion is restarted
c. Stop transfusion and prepare washed red blood cells
d. Continue transfusion with a slower infusion rate

14. TRALI presents with the following symptoms:

a. Respiratory distress
b. Severe hypoxemia and hypotension
c. Fever
d. All of the above

15. Which of the following is characteristic of iron overload?

a. Delayed, nonimmune complication occurs
b. Chelating agents are used
c. Multiorgan damage may occur
d. All of the above
 ‫اﻟ ﻔﻬ ﺮ ﺳ ﺖ‬
 Recognition and Evaluation of Transfusion Reactions
 Alloimmunization to RBC Antigens
 Acute Hemolytic Transfusion Reaction (AHTR)
 Delayed Hemolytic and Serologic Transfusion Reaction ( DHTR )
 Transfusion-Related Acute Lung Injury (TRALI)
 Transfusion-Associated Circulatory Overload (TACO)
 Transfusion Associated Dyspnea (TAD)
 Hypotensive Transfusion Reaction
 Febrile Nonhemolytic Transfusion Reaction (FNHTR)
 Allergic Transfusion Reactions (ATRs)
 Adverse Reactions to Infusion of Plasma-Derived Products
 Transfusion-Associated Graft-Versus-Host Disease
 Post Transfusion Purpura
 Refractoriness to Platelet Transfusion and Alloimmunization
 Adverse Metabolic Effects of Transfusion
 Controversy: Immunomodulatory Effects of Transfusion
 Transfusion-Transmitted Bacterial Infections (TTBI)
 Hypersensitivity and types
 Molecules Responsible for Type I Hypersensitivity Symptoms
 Categories of Type I Hypersensitivity Reactions
 Drugs that reduce and limit the symptoms of allergic responses
 Antibody Mediated (Type II) Hypersensitivity
 Immune Complex Mediated (Type III) Hypersensitivity
 Delayed-Type (Type IV) Hypersensitivity
 Review questions