makrocituli anemiebi

anemiis diagnostikisTvis aucilebeli laboratoriuli

monacemebi:

•hemoglobini

•hematokriti

•retikulocitebis raodenoba

•eriTrocitebis saerTo raodenoba

•e.w eriTrocituli indeqsebi:

MCV (mean corpuscular volume)
MCH (mean corpuscular hemoglobin)
MCHC(mean corpuscular hemoglobin
concentration)
 rogoria MCV?

normaSi
80-98 mkm 3 maRali
dabali >98 mkm 3
retikulocitebis raodenoba
< 80 mkm 3
dabali: retikulocitebi normaSi:
• renuli anemia; • B12 da folideficituti
dabali feritini:
•Aplastiuri anemia; anemiebi;
•rkinis deficiti
retikulocitebis raodenoba •alkoholuri daavadeba;
normaSi: •plazmocitoma
• anemia qr. daavade-bebis dros retikulocitebis raodenoba
retikulocitebis raodenoba momatebuli:
feritini normaSi/maRali:
momatebuli: •hemolizi
• anemia qr. daavade-bebis •regeneracia
•hemolizi;
dros;
•sisxldena
•Talasemia.
•regeneracia
 makrocituli anemiebi
ZiriTadi morfologiuri niSani - didi zomis
eriTrocitebi.

mizezebi

•daCqarebuli eriTropoezi (sisxlSi didi raodenobiTaa

didi zomis axalgazrda eriTrocitebi);

•eriTocitebis membranis farTobis gazrda plazmis

lipidebis xarjze;

•megaloblasturi eriTropoezi.
 megaloblasturi tipis eriTropoezis Sedegad
ganviTarebul anemiebi

• B12 deficituri anemia;

•foliumis mJ-is deficitiT gamowveuli

anemia;

•medikamenturi;
 B12 deficituri anemia

B12 adamianis organizmSi xvdeba sakvebis gziT.

kobalamins didi raodenobiT Seicavs cxoveluri warmoSobis produqtebi:

•zRvis produqtebi (moluskebi, Tevzi, xizilala)

•Roris/cxvris/qaTmis xorci;
•RviZli
•kvercxi
•rZis nawarmi
•dRiuri moTxovnileba 2 mkgr.
 vit. B12 fiziologia

•kuWSi vit. B12 ukavSirdeba cila R-s (Rapid

binder);
•cila/vit.-is kompleqsi gadadis 12-gojaSi;
•pankreasis fermentebi arRveven kavSirs;
•gaTavisuflebuli B12 ukavSirdeba kastlis
Sinagan faqtors (gamomuSavdeba kuWSi);
•Seiwovwba mlivi nawlavis distalur nawilSi;
•nawlavis ujredSi ukavSirdeba transkobalamins
•xvdeba sisxlSi, aqidan ki sxvadasxva
qsovilebsa da ujredebSi
 vit. B12 fiziologia

kobalamini adamianis ujredSi arsebuli 2 fermrntis umniSvnelovanesi

kofaqtoria:

•meTionin sinTaza
•meTilmalonin-koenzim A
kobalamini arsebobs 2 metabolurad aqtiuri formis saxiT:
•meTilkobalamini
•adenozilkobalamini.

adenozilkobalamini
nervul boWkoebSi mielinis normalur
metabolizms
uzrunvelyofs.
 vit. B12 fiziologia

meTilkobalamini
•akatalizebs homocisteinis meTioninad gardaqmnis process-aucilebeli
piroba foliumis mJavis aqtiur formaSi gadasayvanad, anu didi roli aqvs
dnm-is sinTezis procesSi.

•orive, foli da B12 deficituri anemiebis dros, plazmaSi homocisteinis

raodenoba momatebulia, rasac arteriuli da venuri Trombozebis
Camoyalibebis risk-faqtorad miiCneven.

•uzrunvelyofs sisxlmbadi sistemis ujredebis momwifebas, gamravlebas da

ganviTarebas, upiratesad zemoqmedebs wiTel Stoze;

• gavlena aqvs kuW-nawlavis epiTeliumze.

 B12 deficituri anemia – klinikuri diagnostika:

1) anemiuri sindromi;
2) specifiuri simptomebi
•nevrologiuri - xelebisa da fexebis fxana,
WianWvelebis cocvis SegrZneba; dambla,
koordinaciis darRveva, funikuluri mielozi,
polineiropaTia;
•fsiqologiuri - depresia, cnobierebis darRveva,
fsiqozi, Sizofrenia, demencia
 B12 deficituri anemia – klinikuri diagnostika:

•simptomebi kuW-nawlavis mxriv:

•priala, wiTeli ena, hunteris glositi
•muclis tkivilebi saWmlis monelebis darRveviT
(yabzoba/faRaraTi)

klasikuri niSnebi:
• makrocitozi;
• funikuluri
mielozi;
•Aatrofiuli glositi
laboratoriuli diagnostika

tipuri cvlilebebi:
• hiperqromia (Fi=1,3-1,5)
• MCV, MCHmomatebuli;
• retikulocitopenia
• makrocitebi;
• Trombocitopenia,leikopenia (mZime SemTxvevebSi)
aseve:
• Zvlis tvinis gamokvleva;
• vitamin 12-is raodenoba plazmaSi (<150pg/ml)
• Silingis testi
• ganavlis gamokvleva Wiebze
• autoantisxeulebi
• gastrofibroskopia
vit. B12 –is deficitis mizezebi:

•kvebiTi (iSviaTia, vegetarianelebSi)

•gazrdili moTxovnileba (xSiria nawlavuri parazitebiT invaziisas)

•nawlavis daavadebebi (kroni, celiakia, a.S)

•kaslis Sinagani faqtoris nakleboba (kuWis sruli rezeqciis dros;

perniciozuli anemiisas.)

B12-is deficiti iwvevs dnm-is sinTezis darRvevas- irRveva ujredebis gayofa, zrda ki ar iTrguneba. Sedegad – cota
raodenobis da makrocituli hiperqromuli eriTrocitebi .
 folideficituri anemia

gvexvdeba cxovelur produqtebsa da bostneulSi poliglutamatis

saxiT

•dRiuri moTxovnileba
daaxloebiT 50 mkgr/dReSi;
•organizmis sxvadasxva depoSi
inaxeba 5-20 mg-mde foliumis
mJava, aqedan naxevari -
RviZlis ujredebSi
 vit.BB9-is fiziologia

•organizmSi xvdeba alimenturi gziT

poliglutamatis saxiT;
•gardaiqmneba monoglutamatad
•Seiwoveba wvril nawlavSi;
•sisxlidan specifiuri gadamtaniT
aRweven ujredebSi

monawileobs
•nukleinis mJavebis sinTezSi;
•sisixlis wiTeli ujredebis produqciaSi;
•vitamin C da B12 Tan erTad proteinebis
monelebisa da utilizaciis procesSi
 Hfoliumis mJavis deficitis mizezebi

arasrulfasovani kveba (alkoholizmiT daavadebulebSi; TineijerebSi,

bavSvebSi
vitaminze gazrdili moTxovnileba
•orsuloba,
•bavSvebSi,
•avTvisebiani simsivneebi,
•gaZlierebuli hemopoezi (qronikuli hemolizuri anemia)

malabsorbcia
darRveuli metabolizmi
•dihidrofolatreduqtazas inhibitorebi
(metotreqsati, triamterini,
trimetoprimi)
•alkoholi
•fermentebis Tandayolili deficiti
(iSviaTi)
 foliumis mJavas deficiti/
klinikuri diagnostika

foliumis mJavas deficiti iwvevs nukleinis mJavebis sinTezis darRvevas. es

yvelaze metad Zvlis tvins azianebs - viTardeba megaloblasturi tipis
eriTropoezi.
foliumis mJavas mwvave deficiti viTardeba misi antagonistebis miRebis
Semdeg:
•madis dakargva,
•tkivili muclis areSi,
•gulisreva,
•diarea,
•wylulebi piris RruSi,
•wylulebi saylapavSi,
•kanis dazianeba,
•Tmis cvena
 foliumis mJavas qronikuli ukmarisobis gamovlinebebi

•anemiuri sindromi;
•depresia;
•kognituri funqciebis daqveiTeba;
•wylulebi enasa da piris RruSi;
•kidurebis mfaravi kanis muqi Seferiloba.

vit. B12 deficituri anemiisagan gansxvavebiT ar xasiaTdeba

nevrologiuri simptomatikiT
 Hfolideficituri anemiis diagnostikuri kriteriumebi

1)sisxlis saerTo analizi:

•hiperqromuli anemia;
•makrocitozi;
•neitrofilebis hipersegmentacia
•reikulocitopenia,
•Trombocitopenia, leikopenia
2)sisxlis Sratsa da eriTrocitebSi
foliumis mJavas raodenoba
Semcirebulia <2 ng/mL (4.5
nanomol/L)
3) arapirdapiri bilirubinis
raodenoba momatebulia (
hemolizis SemTxvevaSi)
diferencialuri diagnozi
 medikamenturi megaloblasturi anemia

gamoyofen megaloblasturi anemiis gamomwvev medikamentTa Semdeg

jgufebs:
1) dnm-is sinTezis pirdapiri inhibitorebi:
• purinebis analogebi (azatioprini; 6-merkaptopurini);
• antivirusuli agentebi (zidovudini (AZT);

2) foliumis antagonistebi –metotreqsati

(dihidrofolatreduqtazasinhibitori), pentamidini,
trimetoprimi, triamterini.

3) sxva – antikonvulsantebi (fenitoini,

pirimidoni, fenobarbitali)
გმადლობთ
ყურადღებისათვის!