Xet nghiem tiiy do tidu: Tim hieu sif bien ddi sd lUdng va hinh thai mau tffdng va phu'dng phSp nghien cffu: hoi cffu ket hijp tien ciru, mo ta, cat ngang dUdc thyc hien d giam tieu
Trang 1mg/ngay Tan suat sff dyng heroin hang ngay
eua benh nhan giam di rd ret: tru'dc dieu tri 1,24
lan/ngay; giai doan dd lieu 1,07 lan/ngay sau 7
ngay, 0,33 lan/ngay sau 30 ngay va sau 3 thang
dieu tri la 0,08 lan/ngay Ty te benh nhan dffdc
chuyen girl den cac dich vu y te khac nhff: Dieu
trj ARV la 44,5%, dieu tn nhiem triing cd hdi
30,8%, cung cap BKT sach 21,3%, tff van xet
nghiem HIV ty nguyen 8,3%, Oa sd benh nhan
dang dffdc dieu trj tai cac cd sd deu cho biet hp
benh nhan, thai dp bac sy lam viec, thai dp nhan
vien tff van cung nhff hai Idng vdi thai dp eiia cae
nhan vien cdng tac tai cd sd dieu trj Methadone
T A I L l g U T H A M KHAO
1 B$ Y te (2013), Bao cao ket qua hoat ddng
phong chdng HIV/AIDS 6 thang dau va phUOng
hffdng nhiem vu 6 thang cudi nam 2013
Bo Y te (2009), Bao cao ket qua trien khai thi
diem dieu tri nghien cac chat dang thuoc phien bang thuoc Methadone tai TP Hai Phong va TP,
Ho Chi Minh nam 2008, tr, 1- 9,
Bp Y te (2005), "Cac cong trinh nghien CLAJ khoa
hoc ve HIV/AIDS giai doan 2000-2005", Tap chi Y hoc thifc hanh nam 2006
Bp Y te (2007), Hu'dng dan xay di/ng khung cac
can thiep dPa tren hoat dong cua cac cd sd dieu tri Methadone ,yi5 Noi, tr, 5- 24
Bp Y te (2010), Hudng dan dieu tri thay the nghien cac chit dang thudc phien bang thuoc methadone, Ha Noi, tr, 3- 25
Trung tam phong chong HIV/AIDS Ha Npi (2013), Bao cao ket qua hoat dong phong chong
HIV/AIDS 5 thang dau va phUOng hUdng nhiem
vu 6 thang cuoi nam 2013,
Thu tu'dng Chinh phu (2012), Chien \Mc qudc
gia phong chdng HIV/AIDS d Viet Nam den nam
2020 va tam nhin 2030,
NGHIEN Ciru BIEN DOI SO LU'O'NG VA HINH THAI MAU TIEU CAU 6" BENH NHAN G I A M TIEU CAU JVlAU NGOAI VI
T 6 M TAT
Giam tieu cau thu'dng gap trong cac benh ly huyet
hpc cung nhU khong huyet hpc Xet nghiem tiiy do
tidu: Tim hieu sif bien ddi sd lUdng va hinh thai mau
tffdng va phu'dng phSp nghien cffu: hoi cffu ket
hijp tien ciru, mo ta, cat ngang dUdc thyc hien d
giam tieu a u mau ngoai vi ddn thuan hoac kem giam
cic BN nhom tuoi >45 tud'i, Xuat huyet giam tieu cau
vo c3n (ITP) la nguyen nhan pho bien nhat tiep theoja
glim sin tiiy, bach cau cap, 57,25% BN so lu'dng mau
tieu c3u trong tiiy binh thu'dng hoac giam nhffng hinh
thai vln binh thu'dng Trong 97/400 BN tang so lUdng
m§u ti^u d u vdi hinh thai dang non thi hau het la ITP
KSt lu^n: Tiiy do la xet nghiem quan trong de chan
do^n xac djnh nguyen nhan giam tieu cau
Titldida: Giam teu cau, Chpc hiit bjy xUOng (tiiy do)
• Khoa huyet hpc lam sang Benh vi$n TWQD108
Nguyen Thj Minh Phuong*
S U M M A R Y STUDY OF CHANGES I N NUMBER AND MORPHOLOGY OF THE MEGAKARYOCYTES I N PATIENT
W I T H THROMBOCYTOPENIA
Thrombocytopenia i5 commonly encountered in haematological and non-haematological disorders
diagnosis Objective: to analyse the changes in
number and morphology of the megakaryocytes in
patient with Thrombocytopenia, Patients and methods: This restrospective and prospective
cross-sectional study was carried out at 108 military central Mean age of patients was 53,2 years Maximum number of cases was seen in age group of above 45 the commonest cause followed by hypoplastic marrow, acute leukaemia respectively Most patients increased number of megacaryocyte with immature form is ITP
Conclusion: bone marrow aspiration is an important
diagnostic modality to determine the aetiology of thrombocytopenia
Keywords: Thrombocytopenia, bone marrow
aspiration
Trang 2I BAT VAN DE
Tieu cau (TC) ddng mpt vai trd quan trpng
trong ddng mau va cam mau khi thanh maeh bi
ton thffdng Giam so iffdng tieu cau
(thrombocytopenia) se tang nguy ed ehay mau
Giam TC thffdng gap trong thyc hanh lam sang
Mae dii ed rat nhieu nguyen nhan gay giam tieu
cau nhffng cd the chia ra lam 4 nhdm chinh: Suy
giam kha nang sinh tieu cau, tang hiiy TC hoac
tieu thu TC, giam TC do phan bd va mat mau Idn
(Levine, 2003) [4], Cac chf djnh tiiy do thffdng
dffdc dffa ra khi giam tieu cau khdng giai thfch
dydc hoac khi cd giam 3 ddng ngoai mau vl Bleu
hien lam sang thffdng gap d eac benh ly gay
giam TC la xanh xao, met mdi, laeh to, hach to,
sot, ehay mau, giam can, va gan to (Tariq et al,,
2010).Tham kham lam sang ky cang va xet
nghiem mau ngoai vi cd the giiip djnh hffdng
chan doan Tuy nhien xet nghiem tuy do la rat
can thiet gdp phan quan trpng khang djnh chan
doan Chpc hut tiiy xydng de lam tiiy dd la thii
thuat xam lan nhffng an toan dffdc thffc hien
thffdng quy trong eae benh vien de tim cac
nguyen nhan gay giam tieu eau (Egesie et al.,
2009) ngay ca trffdng hdp cd giam tieu cau nang
(Kibria et al., 2010) [2] Mue tieu eiia nghien cffu
nay la danh gia vai trd cua tiiy xffdng trong cac trffdng hdp giam tieu cau
II OOI TU'ONG VA PHt/CTNG PHAP NGHIEN OJM
2.1 Doi tu'dng nghien cu'u: 400BN giam
tieu cau mau ngoai vi dieu trj tai Benh vienTWQO
108 Loai trff cac trffdng hdp Iffdng dich hut tiiy xffdng khdng dii de dpc xet nghiem hoac tiiy kho khd hilt djch, benh nhan dang sff dung cae thuoc
cd kha nang gay giam tieu cau, BN ung thff dieu trj hda ehat hoac xa trj
2.2 Pliffdng pliap nghien cu'u: Hoi ciitj
ket hdp tien cffu, md ta cat ngang Chi tieu nghien cffu: Cac trieu chffng lam sang, xet nghiem mau ngoai vi va tuy do dypc phan ti'ch chi tiet Tieu cau dffdc coi la giam khi
sd Iffdng dffdi 150 G/L Cdng thffc mau dffdc
dem bang may tff dpng So Iffdng mau tieu can
binh thffdng (mdt mau tieu cau / 1 den 3 vi trffdng), tang (hdn hai mau tieu cau / 1 vi trffdng), giam (mpt mau tieu cau / 5 den 10 vi trffdng), Thay doi hinh thai ciia mau tieu cau la cac bien ddi dang non, loan san va nhan trd
Sd lieu nghien cffu dffdc xff ly bang phan mem SPSS 18.0
KET QUA
Bang 1: Dac diem chung cua cac BN nghien cffu
Tuoi
Gidi
<15 16-30 31-45 46-60
>60 Nam NO-Sot
Xuat huyet
Da xanii, niem mac ntidt
Gan to
Lach to
Hach to
Dau xu'dng
Cac trieu chCrnq khac
So lu'dng BN
6
45
72
140
137
251
149
134
235
290
92
106
65
47
82
Ty le %
1,5 11,25
18
35 34,25 62.8 37.3 33,5 58,75 72,5
23 26,5 16,25 11,8 20,5
400 BN giam tliu cau du tliu chuan d&dc chpn vao nghien c&V Tudi trung btnh ia 53,2 tuoi (14-94 tudi) Nhdm tudi th&dng gap nhit la >45 tudi (69,25%, trong sd 400 binh nhan) 62,8% la nam g'i& 37,3% la n&gidi vdi ty li nam:n&la 1,6:1 Trieu ch&ng lam sang th&dng gap nhit la da xanh, h^ mac nhdt (72.5%) sau do den xuit huyet da, niim mac hoac phu tang (58,75.0%), sdt (33,5%) w
Trang 3Bang 2: Xet nqhiem mau nqoai vi cua cac BN nqhien cu'u
Cac chi so mau ngoai vi
Hb rq/il
Tonq so iu'dnq bach cau (G/L)
So iydnq tuyet doi BC hat (G/L)
So iu'Onq tieu cau (G/i)
Hinh thai te bao
Hinh thai hong
cau
HC Binh thu'dng dang sac
HC Nho, nhu'dc sac HCto
Te bao bat thu'dng mau ngoai vi
Gia tri trunq binh (Mean ± SD)
106,46 ±27,16 19,45±41,77 7,78 ± 24,9 63,62±33,39
So lu'dng BN (n= 400), ty le («/o)
326 81,5%)
39 (9,75%)
35 (8,75%)
93 23.25%)
Kit qua cong th&c mau cua 100 BN giam TC thay so luang TC trung binh la 63,62±33,39 G/L, so luang BC trung binh 19,45±41,77 G/L va hong cau binh thu'dng, dang sac chiem 81.5%
Bang 3: Mat do te bao tuy xi/dnq d cac BN nqhien ciru
Sd tlTdng te bao tuy ( G / L )
So iu'dng binh thu'dng (30-100 G/L)
Tuy tang so luang te bao (>100 G/L)
Tuy qiam so lu'dnq te bao (<30 G/L)
Tong sd
Sd lu'dng BN
194
97
109
400
Ty le (%)
48,5%
24,25%
27,25
100
Ve mat do tebao aia tuy xUdng thay tiiy tang so IWdng tebao d 24,25% BN, so Iddng binh thudng d
•18,5% va giam d 2725%
Bang 4: So iu'dng mau tieu car
Chan doan
Bach cau lympho cap
Bach cau tuy cap
Giai doan cap ciJa bach cau tijy man
H6I chu'ng thu'c bao
Cu'dng lach
Giam san tuy
Xuat huyet giam tieu cau vo can (FTP)
Roi ioan sinh tuy
Thieu mau HC i<h6ng io
Di can ung thu vao tuy xUdng
Xdtuy
T3ng sinh ac ti'nh dong Piasmocyte
Xdgan
Nhiem trung
Tong sd
tuy XUdng d cac BN vdi
Sd lu'dn
Khong gap
7
24
0
0
0
21
0
0
0
0
0
0
0
0
52
:ac Chan doan khac nhau
3 Mau tieu cau ( n =
Binh thu'dng
4
2
3
5
2
21
22
4
5
0
0
7
11
10
96
Giam
9
27
2
3
1
43
0
11
28
13
3
5
2
3
150
400)
tang
0
0
1
3
6
0
67
4
4
12
2
1
2
0
102
Tong
50
20
53
6
11
9
85
89
19
37
25
5
13
15
13
400
Tyl?
(%)
5 13,25 1,5 2,75 2,25 21,75 22,25 4,75 9,25 6,25 1,25 3,25 3.75 3,25
100
K& qua tuy do cho thay ITP la pho bien nhat (89 BN, 22,25%) Nguyen nhan pho bien thd 2 la giam san tuy (85 BN 21,75%) sau dd la AML (53 BN, 13,25%) Thieu mau hdng cau khong to (9,25%), di cSn ung thd vao tuy xddng (6,25%), roi loan sinh tuy (4,75%), tang sinh ac tinh ddng piasmocyte
Trang 4Bang 5: Moi lien quan giffa so iffdng va hinh thai mau tieu cau d tiiy dd cac BN giam TC
Hinh thai
Khonq gap
Hinh thai roi ioan
Hinh thai binh thu'dnq
Dang te bao non
Tdng sd
Sd lu'dng
Khonq qap
52
0
0
0
52
Binh thu'dnq
0
12
84
0
96
Giam
0
5
145
0
150
Tang
0
5
0
97
102
Tong sd
52
22
229
97
400
Sdl&dng va hinh thai mau tiiu cau trong tuy do cd mdi liin quan vdi benh 229/400 BN chiim 57,25%
CO so l&dng mau tieu cau trong tuy binh thwdng hoac giam nh&ng hinh that van binh th&dng Co 97 tr&dng hdp co tang sd l&dng mau tieu cau vdi dang non hoac ch&a tr&dng thanh Trong so do hau het
la cac tr&dng hdp FTP Hinh thai Idi loan d&dc thiy trong tit ca cac tr&dng hdp rdi loan sinh tuy
IV BAN LU^N
Giam tieu eau thffdng gap trong cac rdi loan
huyet hpe khac nhau bao gom ed rdi loan sinh
tiiy hoae khdng ed rdi loan (MeKenzie, 1996) [5]
Mpt so benh huyet hpc ehi bieu hien giam tieu
eau ddn thuan hoac kem theo giam 2 ddng khac
Chpc hilt tuy xffdng de lam tiiy do la mdt xet
nghiem an toan va hffu leh nham xac djnh ehan
doan cudi cung [6] Trong nghien cffu eiia chung
tdi dp tudi hay gap nhat la >45 tudi (59,25%,
trong sd 400 BN) Trong mdt nghien cffu ciia
Muhury va es (2009), da sd eae BN dffdi 10 tudi
[6] Tudi trung binh trong nghien cffu ciia chiing
tdi la 53,25 tudi (62,8%) la nam gidi (37,3%) la
nff gidi vdi ty le nammff la 1,6:1 Trong nghien
cffu eiia Muhury va es giam TC thffdng gap d
nam hdn la nff d dp tuoi 10 nam dau tien [6]
Trong nghien cffu ciia chung tdi trong 400
BN giam tieu eau 8.6 % giam 3 ddng Nghien
cffu ciia Jha etal (2008) [l],Bashawri va cs
(2002), va Pudasaini va cs (2002) [7] ty le xet
nghiem tiiy do de danh gia giam 3 ddng lan Iffdt
la 17.34%, 11.9% and 50% ITP la phd bi§n
nhat thay d 89 BN (22,25%) Cac nghien effu
khae eae ty le nay lan Iffdt la 6.21%, 14.5%,
6,8% va 5% kibria va es 2010 [2]; Ahmad va cs
2011; Pudasaini va cs 2002;Knodke va es 2001)
[3], [7] Nguyen nhan phd' bien thff 2 gay giam
tieu eau la giam san tiiy (85/400 BN chiem
21,75%) sau dd la bach eau tiiy cap (53 BN,
13,25%) Trong 53 trffdng hdp AML, the phd
bien la AML-M2 (22 BN), sau do la AML-Ml (8
BN) va AML-M4 (7 BN) Tffdng tff nhff nghien
cffu cua chiing tdi thi bach cau cap cung la
nguyen nhan phd bien thff 3 gay giam tieu cau
trong nghien cffu ciia Savage va cs (1999) va
tffdng tff nhff nghien cffu ciia Varma va Dash
(1992) Cac nghien cffu khac (Egesie va cs 2009;
Gayathri va cs 2011; Jha va cs 2008; Kibria va cs 2010) eung thay baeh cau cap la benh mau ac tinh phd bien nhat va bach cau cap ddng tuy pho bien hdn ddng lympho Thieu mau hong cau khdng Id thay d 37 trffdng hdp (9,25%) Nghien cffu ciia chung toi thay bach cau cap la nguyen nhan thff 3 Niazi va cs (2004),Jha va cs (2008) Gayathri va cs (2011) thay thieu mau hong cau khdng Id la nguyen nhan phd bien thff 2 cdn d nghien cffu ciia ehung tdi la giam san tuy So sanh vdi nghien cffu eiia ehiing tdi thi thieu mau giam san tiiy gap lan Iffdt d 19%, 29% and 14% trong cac nghien cffu (Gayathri va cs 2011;Knodke va es 2001; Niazi va cs 2004) Chiing tdi cung gap tang sinh ac tinh piasmocyte nhffng vdi ty le thap (3,25 %) va rdi loan sinh tiiy (4,75%) Cac nghien effu khac nhff cua Kibria va
cs 2010; Laishram va cs 2008) thay t/ Ie da u tiiy xffdng tff 0.94% tdi 4.1% va rdi loan sinh tiiy tff 2% to 7.9% Ve so Iffdng va hinh thai mau tieu cau thi tang sd Iffdng va dang non dffdc thay trong hau het cae trffdng hdp FTP George va cs (1994) va Levine va es (1999) cung cho ket qua tffdng tff
V KET LUAN
Ciing vdi cac trieu chiffig lam sang thi xet nghiem tiiy do la mdt bffdc quan trpng de chan doan xac djnh cac benh ly huyet hpc cd giam tieu cau Xuat huyet giam tieu cau vd can la nguyen
nhan pho bien nhat gay giam tieu cau trong
nghien cffu ciia chung tdi 57,25% BN sd Iffdng
mau tieu cau trong tiiy binh thffdng ho3c giam
nhffng hinh thai van binh thffdng Trong sd 97
BN tang sd Iffdng mau tieu cau vdi hinh thai dang non thi hau het la cac trffdng hdp ITP Hinh thai
rdi loan dffde thay trong tat ea cac trffdng hdp roi
Trang 5TAI L I f U T H A M KHAO
1 Jha, A., Sayami, G., Adhikari, R C , Panta, D.,
Jha, R (2008) Bone marrow examination in cases
of pancytopenia 3 Nepal Med Assoc, 47, 12-17
2 Kibria, S G., Islam, M D U (2010)
Prevalence of Hematological Disorder: A Bone
MantJW Study of 177 Cases In a Private Hospital
at Fandpur Farldpur Med Coll J, S, 11-13
3 Knodke, K., Marwah, S (2001) Bone marrow
examination in cases of pancytopenia J Academy
QinMed,!, 55-59
4 Levine, F C (1999) "Idiopathic"
thrombocytopenia Arch Intern Med, 88, 701-728
I 13 Levine, S P (2003) Thrombocytopenia:
pathophysiology and classification In Greer 3P,
Foerster J, Lukens JN, et al (Eds.), Wintrobe's clinical hematology 11th ed (vol 2, pp
1530-1532) Philadelphia: Lippincott Williams & Wilkins MeKenzie S B (Ed.), (1996) Textbook of hematology, 2nd ed Painsylvania: Willaims& Wilkins
Muhury, M., Mathai, A M (2009)
Megakaryocytic alterations in thrombocytopenia: A
bone marrow aspirabon study Indian J PatholMlcrobioi, 52, 490^94
Pudasaini, S., Prasad, K B R (2002)
hematological disorder Journal of Pathology of Nepal, 2, 309-312
THirC TRANG AN TOAN VE SINH THITC PHAM TAI BEP AN TAP THE COA M O T "SO DOANH N G H I E P - T H A N H PHO HAI DiraNG NAM 2 0 1 3
TbM TAT
Nghien ciiff thUe trang An toan ve sinh thiTc pham
t?i cic bep 3n tap the (BATT) ciia doanh nghiep tren
dja ban thanh phd Hai DUdng , ket qua cho thay : Dien
tich phong che bien < lOOm^ chiem ty le nhieu nhat
(50%); di?n ti'ch phong an 200-500m^ chiem t / le
nhiSu nhat (45%); Cdn ed 44% BATT chUa dat yeu
ve CO sd ha tang; 20% BATT ngudi phuc vu (NPV)
khdng mang day dii bao hp lao dpng khi lam viec;
Tren cac mau xet nghiem deu thay co ty le nhiem vi
(Jyhp thu'c pham chin, ban tay NPV, Trong do ty le
nhiem VSV tren ban tay NPV la cao nhat: Coliform
(72,5%); E.coli (25,0%); S.aureus(32,0%)
SUMMARY
SAFETY S I T U A H O N I N FOOD HYGIENE AT
CANTEENS OF SEVERAL BUSINESSES
-H A I DUONG CITY I N 2 0 1 3
Research the current status of food safety and
hygiene in the canteens of businesses in Hai Duong city,
the results show that processing room area < lOOm^
area of 200 - 500 m^ accounting for the largest
preiportion (45%); there are 44% of the canteens is
' SdYte tinh Hal DuVng
" TnAlmg Cao dSng Y teHai Phdng
Dinh Huy Hung*, Vu Due Long** unsatisfactorily on administrative procedures; 17.5% is unsatisfactorily on infrastructure, 20% waiters do not carry adequate labor protection at work; 20% waiters do not use clean utensils when processing; In the specimens founded microorganism ratio on cooked food, containers of cooked food , hands of waiters In which the infection rates on the waiters' hands is the highest; Coliform (72.5%), E, coli (25,0%), S, aureus (32,0%),
I OAT VAN OE
An toan ve sinh thffc pham(ATVSTP) hien dang la mdi quan tam Idn ciia nhieu Qudc gia tren the gidi, Tren the gidi ffdc tfnh, hang nam cd khoang 3 - 5 ty ngu'di bj tieu ehay, ed 3 - 5 trieu ngLfdi tff vong, khoang 1.400 trieu Iffpt tre em/nam bi mac benh tieu chay ,trong sd dd 70
% nguyen nhan do an, udng thi/e pham bj d nhiem [ 5 ] , [ 6 ] Tai Viet Nam, sd trffdng hdp ngd ddc thffc pham cd xu hffdng ngay cang gia
t a n g [ l ] , Theo thdng ke chffa day du ciia cue ATVSTP trong cac nam 2007-2011, toan qudc da ghi nhan 927 vu NOTP vdi 30.733 ngu'di mac va
299 ngffdi chet Trung binh cd 185 vu/nam, trong
dd sd vu ngd ddc tai bep an tap the chiem tff 12,7 den 20,6% tong sd vu moi nam, Tuy nhien day chi la sd iieu thdng ke chu'a day du ,thffc te con sd ngd dpc thffe pham hang nam cdn eao hdn rat nhieu[2] Theo ffdc tinh eiia WHO, d Viet Nam con sd ngd dpc thffe pham hang nam khoang tren 8 trieu ngffdi [5] Hai Dffdng la mdt