كتاب فقر الدم الطبعة الثالثة

‫ﻓﻘﺮ اﻟ ـ ـ ـﺪم‬ ‫ﺃﺳﺑﺎﺑﻪ‪ ،‬ﺃﻧﻭﺍﻋﻪ‪ ،‬ﻋﻼﺟﻪ‬

‫د‪ /‬أﻛ ـ ــﺮم اﻟﻬﻼﻟ ـ ــﻲ‬

‫ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻟﺛﺔ‬ ‫‪ 1435‬ﻫـ‪ 2014-‬ﻡ‬

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‫ﺑﺳﻡ ﷲ ﺍﻟﺭﺣﻣﻥ ﺍﻟﺭﺣﻳﻡ‬

‫ﻓﻘــــــﺭ ﺍﻟــــــﺩﻡ‬ ‫ﺃﺳﺑﺎﺑﻪ‪ ،‬ﺃﻧﻭﺍﻋﻪ‪ ،‬ﻋﻼﺟﻪ‬

‫ﻣﻘ ّﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ‬ ‫‪U‬‬

‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺃﻭ )ﺍﻷﻧﻳﻣﻳﺎ( ﻛﻠﻣﺔ ﺷﺎﺋﻌﺔ ﺑﻳﻥ ﺍﻟﻧﺎﺱ ﻭﻟﻛﻥ ﺍﻟﻛﺛﻳﺭﻳﻥ ﻻ ﻳﻌﺭﻓﻭﻥ ﻣﻌﻧﺎﻫﺎ ﺍﻟﺣﻘﻳﻘﻲ‪ ،‬ﻓﻣﻧﻬﻡ ﻣﻥ ﻳﻌﺗﻘﺩ‬ ‫ﺃﻧﻬﺎ ﺗﻌﻧﻲ ﻧﻘﺻﺎ ً ﻓﻲ ﺣﺟﻡ ﺍﻟﺩﻡ‪ ،‬ﻭﺃﻛﺛﺭﻫﻡ ﻳﻅﻥ ﺃﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻧﻭﻉ ﻭﺍﺣﺩ ﻭﻋﻼﺟﻪ ﻭﺍﺣﺩ‪ ،‬ﻫﻭ ﺍﻟﺣﺩﻳﺩ ﻭﺍﻟﻔﻳﺗﺎﻣﻳﻧﺎﺕ‪،‬‬ ‫ﺃﻭ ﻣﺎ ﻳﺳﻣﻰ )ﺍﻟﻣﻘﻭﻳﺎﺕ(‪ .‬ﻭﻧﺭﻯ ﺑﻌﺽ ﺍﻟﻧﺎﺱ ﻳﻣﺯﺝ ﺑﻳﻥ ﻣﻌﻧﻰ ﻓﻘﺭ ﺍﻟﺩﻡ ﻭ )ﺍﻟﺿﻌﻑ(‪ ...‬ﻭﻫﻛﺫﺍ‬ ‫ﻭﻗﺩ ﺭﺃﻳﺕ ﺃﻥ ﺇﺻﺩﺍﺭ ﻫﺫﺍ ﺍﻟﻛﺗﻳّﺏ ﻋﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻷﺷﺭﺡ ﺍﻟﻣﺭﺽ‪ ،‬ﻣﺑﻳّﻧﺎ ً ﺃﺳﺎﺑﻪ ﻭﺃﻧﻭﺍﻋﻪ ﻭﻋﻼﺝ ﻛﻝ ﻧﻭﻉ‬ ‫ﺑﺷﻛﻝ ﻣﺧﺗﺻﺭ ﺳﻳﻛﻭﻥ ﻣﻔﻳﺩﺍً‪.‬‬ ‫ﻭﻟﻣﺎ ﻛﺎﻥ ﻓﻬﻡ ﺍﻟﻣﻭﺿﻭﻉ ﻳﻧﺑﻐﻲ ﺃﻥ ﻳﺳﺑﻘﻪ ﻣﻘ ّﺩﻣﺎﺕ ﻋﻥ ﺗﺭﻛﻳﺏ ﺍﻟﺩﻡ ﻭﻣﻧﺷﺄ ﺧﻼﻳﺎﻩ ﻭﺗﺭﻛﻳﺏ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫)ﺧﺿﺎﺏ ﺍﻟﺩﻡ( ﻭﻭﻅﻳﻔﺗﻪ ﻓﻘﺩ ﻋﻣﺩﺕ ﺇﻟﻰ ﺷﺭﺡ ﻛﻝ ﺗﻠﻙ ﺍﻷﻣﻭﺭﻗﺑﻝ ﺍﻟﺩﺧﻭﻝ ﺇﻟﻰ ﻣﻭﺿﻭﻉ ﻓﻘﺭ ﺍﻟﺩﻡ‪.‬‬ ‫ﺃﺭﺟﻭ ﺃﻥ ﻳﻛﻭﻥ ﻫﺫﺍ ﺍﻟﻛﺭﺍﺱ ﺫﺍ ﻧﻔﻊ ﻟﺗﻌﺭﻳﻑ ﺍﻟﻘﺎﺭﺉ ﺑﻬﺫﺍ ﺍﻟﻣﺭﺽ ﺍﻟﻬﺎﻡ ﻭﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺗﺟ ّﻧﺑﻪ ﻭﺣﺳﻥ‬ ‫ﻋﻼﺟﻪ‪ .‬ﻭﻣﻥ ﷲ ﻭﺣﺩﻩ ﺍﻟﺗﻭﻓﻳﻕ‪.‬‬

‫ﺩ‪ .‬ﺃﻛﺭﻡ ﺍﻟﻬﻼﻟﻲ‬

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‫ﻣﻘ ّﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻧﻳﺔ‬ ‫‪U‬‬

‫ﺣﻣﺩ ہﻠﻟ ﺍﻟﺫﻱ ﻋﻠّﻡ ﺍﻹﻧﺳﺎﻥ ﻣﺎﻟﻡ ﻳﻌﻠﻡ‪ ،‬ﻭﺍﻟﺫﻱ ﻣﺎ ﺧﻠﻕ ﻣﻥ ﺩﺍ ٍء ﺇﻻ ﺟﻌﻝ ﻟﻪ ﺩﻭﺍءﺍً‪ ،‬ﻭﺑﻌﺩ‬ ‫ﻓﻬﺫﻩ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻧﻳﺔ ﻣﻥ ﻛﺗﺎﺏ )ﻓﻘﺭ ﺍﻟﺩﻡ( ﺃﻗ ّﺩﻣﻬﺎ ﻟﻠﻘﺎﺭﺉ ﺑﻌﺩ ﻣﺭﻭﺭ ﺃﺣﺩﻯ ﻋﺷﺭﺓ ﺳﻧﺔ ﻋﻠﻰ ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ‪،‬‬ ‫ﻭﻫﻲ ﺗﻣﺗﺎﺯ ﻋﻥ ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ ﺑﻣﺎ ﻳﻠﻲ‪:‬‬ ‫ ﺗﺛﺑﻳﺕ ﺍﻟﻣﺻﻁﻠﺣﺎﺕ ﺍﻟﻁﺑﻳﺔ ﺑﺣﺳﺏ ﺍﻟﻣﻌﺟﻡ ﺍﻟﻁﺑﻲ ﺍﻟﻣﻭﺣﺩ‪.‬‬‫ ﺗﺣﺳﻳﻥ ﻭﺯﻳﺎﺩﺓ ﺍﻟﺭﺳﻭﻡ ﺍﻟﺗﻭﺿﻳﺣﻳﺔ‪.‬‬‫ ﺇﺣﺩﺍﺙ ﺗﻐﻳﻳﺭﺍﺕ ﻣﺧﺗﻠﻔﺔ ﺗﺟﻌﻝ ﺍﻟﻣﺎﺩﺓ ﺃﺳﻬﻝ ﻋﻠﻰ ﺍﻟﻔﻬﻡ‪ ،‬ﻭﺫﻟﻙ ﺑﻧﺎء ﻋﻠﻰ ﻣﺎ ﻭﺭﺩﻧﻲ ﻣﻥ ﻣﻼﺣﻅﺎﺕ ﺑﻌﺽ‬‫ﺍﻟﻘﺎﺭﺋﻳﻥ‪.‬‬ ‫ ﺇﺿﺎﻓﺎﺕ ﺗﻁﻠﺑﺗﻬﺎ ﺍﻟﺗﻁﻭﺭﺍﺕ ﺍﻟﻌﻠﻣﻳﺔ ﺍﻟﺗﻲ ﺣﺻﻠﺕ ﺧﻼﻝ ﺍﻟﻌﻘﺩ ﺍﻟﻣﺎﺿﻲ‪.‬‬‫ ﻁﺑﻊ ﺍﻟﻛﺗﺎﺏ ﺑﺣﺟﻡ ﻭﺭﻕ ﺻﻐﻳﺭ ﻟﻳﺳﻬﻝ ﺗﺩﺍﻭﻟﻪ‪.‬‬‫ﺃﺭﺟﻭ ﺃﻥ ﻳﻛﻭﻥ ﻓﻲ ﺍﻟﻛﺗﺎﺏ ﻓﺎﺋﺩﺓ ﻋﻠﻣﻳﺔ ﻟﺩﻯ ﻋﺎﻣﺔ ﺍﻟﻧﺎﺱ‪ ،‬ﻣﻣﺎ ﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺗﺟﻧﺏ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﻓﻘﺭ ﺍﻟﺩﻡ‬ ‫ﻭﺍﻻﺳﺗﻔﺎﺩﺓ‪ ،‬ﻋﻥ ﻋﻠﻡ‪ ،‬ﻣﻥ ﻧﺻﺎﺋﺢ ﺍﻷﻁﺑﺎء ﻓﻲ ﻫﺫﺍ ﺍﻟﺧﺻﻭﺹ ﻭﺗﻳﺳﻳﺭ ﻋﻼﺟﻪ‪.‬‬ ‫ﻭﷲ ﺃﺳﺄﻝ ﺃﻥ ﻳﺯﻳﺩﻧﺎ ﻋﻠﻣﺎ ً‬ ‫ﺃﺧﻳﺭﺍًﻥ ﺃﻭﺩ ﺃﻥ ﺃﺷﻛﺭ ﻗﺳﻡ ﺍﻟﻌﻼﻗﺎﺕ ﺍﻟﻌﺎﻣﺔ ﻓﻲ ﻣﺅﺳﺳﺔ ﺣﻣﺩ ﺍﻟﻁﺑﻳﺔ ﺑﻘﻁﺭ ﻓﻲ ﺇﻋﺎﺩﺓ ﺭﺳﻡ ﺍﻟﺻﻭﺭ ﺑﺷﻛﻝ‬ ‫ﺃﺣﺳﻥ ﻭﺃﻭﺿﺢ‪ ،‬ﻭﺍﻟﺳﻳﺩﺓ ﺃﻣﻳﺭﺓ ﻁﺑﺎﺭﺓ ﻋﻠﻰ ﺇﻋﺎﺩﺓ ﻁﺑﺎﻋﺔ ﺍﻟﻛﺗﺎﺏ ﻋﻠﻰ ﺍﻟﻛﻣﺑﻳﻭﺗﺭ ﻗﺑﻝ ﺩﻓﻌﻪ ﺇﻟﻰ ﺍﻟﻣﻁﺑﻌﺔ‪.‬‬

‫ﺩ‪.‬ﺃﻛﺭﻡ ﺍﻟﻬﻼﻟﻲ‬

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‫ﻣﻘﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻟﺛﺔ‬

‫ﺑﺳﻡ ﷲ ﺍﻟﺭﺣﻣﻥ ﺍﻟﺭﺣﻳﻡ‬ ‫ﻣﺿﻰ ﺛﻣﺎﻧﻲ ﻋﺷﺭﺓ ﺳﻧﺔ ﻋﻠﻰ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻧﻳﺔ ﻣﻥ ﻛﺗﺎﺏ ﻓﻘﺭ ﺍﻟﺩﻡ‪ ،‬ﺗﻐﻳّﺭ ﻭﺗﻁﻭّ ﺭ ﺧﻼﻟﻬﺎ ﺍﻟﻌﻠﻡ ﻛﺛﻳﺭﺍً‪ .‬ﻭﻟﻣﺎ ﻛﺎﻥ‬ ‫ﺍﻟﻛﺗﺎﺏ ﻗﺩ ﻟﻘﻲ ﺗﺭﺣﻳﺑﺎ ً ﺟﻳّﺩﺍ ﻓﻘﺩ ﺍﺭﺗﺄﻳﺕ ﺇﺧﺭﺍﺝ ﻁﺑﻌﺔ ﺟﺩﻳﺩﺓ ﺗﻌﻛﺱ ﻫﺫﻩ ﺍﻟﺗﻁﻭّ ﺭﺍﺕ ﺍﻟﻌﻠﻣﻳﺔ‪ ،‬ﺇﺗﻣﺎﻣﺎ ً ﻟﻠﻔﺎﺋﺩﺓ‬ ‫ﺍﻟﻣﺭﺟﻭّ ﺓ ﻣﻧﻪ‪.‬‬ ‫ﺃﺭﻓﻘﺕ ﺑﺎﻟﻛﺗﺎﺏ ﺃﻁﻠﺱ ﺻﻭﺭ ﻟﻠﺧﻼﻳﺎ ﻭﺍﻷﻧﺳﺟﺔ ﺍﻟﻣﺫﻛﻭﺭﺓ‪ ،‬ﻛﻣﺎ ﺃﺿﻔﺕ ﻓﻲ ﺁﺧﺭ ﺍﻟﻛﺗﺎﺏ ﻣﻌﺟﻣﺎ ً ﺑﺎﻟﻣﺻﻁﻠﺣﺎﺕ‬ ‫ﺍﻟﺗﻲ ُﺫﻛﺭﺕ ﻓﻳﻪ ﻭﻗﺩ ﻭﺿﻌﺕ ﻛﻼًّ ﻣﻥ ﺗﻠﻙ ﺍﻟﻣﺻﻁﻠﺣﺎﺕ ﺩﺍﺧﻝ ﻗﻭﺳﻳﻥ ﻣﻥ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ] [ ﻋﻧﺩ ﻣﺭﻭﺭﻫﺎ ﻓﻲ ﻣﺗﻥ‬ ‫ﺍﻟﻛﺗﺎﺏ‪.‬‬ ‫ﺃﺭﺟﻭ ﷲ ﺃﻥ ﻳﺟﻌﻝ ﻓﻳﻪ ﺍﻟﻔﺎﺋﺩﺓ ﻭﻳﻘﺑﻝ ﻣﻧﻲ ﺍﻟﻌﻣﻝ ﺧﺎﻟﺻﺎ ً ﻟﻭﺟﻬﻪ ﺍﻟﻛﺭﻳﻡ‪.‬‬

‫ﺩ‪ .‬ﺃﻛﺭﻡ ﺍﻟﻬﻼﻟﻲ‬ ‫‪2014‬‬

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‫اﻟﻔﺼﻞ اﻷول‬

‫ﻣﻛـــــ ّﻭﻧﺎﺕ ﺍﻟــــــﺩﻡ‬ ‫ﺇﻥ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻳﺟﺭﻱ ﻓﻲ ﻋﺭﻭﻗﻧﺎ )ﺍﻟﺷﺭﺍﻳﻳﻥ ﻭﺍﻷﻭﺭﺩﺓ(‪ ،‬ﻭﺍﻟﺫﻱ ﻳﺿﺧﻪ ﺍﻟﻘﻠﺏ ﺑﺻﻭﺭﺓ ﺩﺍﺋﻣﻳﺔ ﻭﻣﻧﺗﻅﻣﺔ ﺇﻟﻰ ﻛﻝ ﺃﻧﺣﺎء ﺍﻟﺟﺳﻡ‪ ،‬ﻫﻭ‬ ‫ﺳﺎﺋﻝ ﺫﻭ ﺗﺭﻛﻳﺏ ﻣﻌﻘﺩ ﺟﺩﺍً ﻭﻭﻅﺎﺋﻑ ﻣﻧﻭﻋﺔ ﺟ ّﺩﺍً‪ ،‬ﻭﺑﻌﺽ ﻣﺭﻛﺑﺎﺗﻪ ﻏﻳﺭ ﻣﻔﻬﻭﻣﺔ ﺗﻣﺎﻣﺎ ً ﻟﺣﺩ ﺍﻵﻥ‪ .‬ﺍﻟﺩﻡ –ﻭﻛﻣﺎ ﻳﻌﻠﻡ ﺍﻟﻘﺎﺭﺉ‪ -‬ﺳﺎﺋﻝ‬ ‫ّ‬ ‫ﻳﺗﺧﺛﺭ )ﺃﻱ ﻳﺗﺣﻭﻝ ﺇﻟﻰ ﺣﺎﻟﺔ ﺻﻠﺑﺔ ﺟﻼﺗﻳﻧﻳﺔ( ﻓﻲ ﺩﺍﺧﻠﻬﺎ ﺇﻻ ﻓﻲ ﺣﺎﻻﺕ ﻣﺭﺿﻳﺔ ﺧﺎﺻﺔ‪.‬‬ ‫ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺩﺍﺧﻝ ﺍﻟﻌﺭﻭﻕ ﻭﻻ‬ ‫ﺍﻟﻣﺭﺿﻲ ﻳﺳﻣﻰ ]ﺍﻟﺗﺟﻠّﻁ[‪ .‬ﻛﻣﺎ ﺃﻥ ﺍﻟﺩﻡ ﻗﺎﺑﻝ ﻝ]ﺍﻟﺗﺧﺛﺭ[ ﺧﻼﻝ ﺩﻗﺎﺋﻕ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻧﺯﻑ )ﻟﺗﺳﺎﻋﺩ ﺍﻟﺧﺛﺭﺓ ﻋﻠﻰ ﻗﻁﻊ ﺫﻟﻙ‬ ‫ﻭﻫﺫﺍ ﺍﻟﺗﺣﻭّ ﻝ َ‬ ‫ً‬ ‫ﺍﻟﻧﺯﻑ(‪ ،‬ﺃﻭ ﻓﻲ ﺣﺎﻟﺔ ﺳﺣﺏ ﻋﻳﻧﺔ ﻣﻧﻪ ﻭﻭﺿﻌﻪ ﺧﺎﺭﺝ ﺍﻟﺟﺳﻡ )ﻓﻲ ﺃﻧﺑﻭﺏ ﺯﺟﺎﺟﻲ ﻣﺛﻼ(‪ .‬ﻳﻣﻛﻥ ﻣﻧﻊ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻟﺩﻯ ﻓﺻﺩﻩ ﻣﻥ‬ ‫ﺍﻟﺟﺳﻡ ﺇﺫﺍ ﺃﺿﻔﻧﺎ ﻟﻪ ﻓﻭﺭﺍً ﻣﻭﺍﺩ ﻣﻌﻳﻧﺔ ﺗﺳﺗﺄﺛﺭ ﺑﺑﻌﺽ ﻣﻛﻭﻧﺎﺗﻪ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻟﻠﺗﺧﺛﺭ )ﻣﺛﻝ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ(‪.‬‬ ‫ﻫﺫﺍ ﺍﻟﺩﻡ ﻳﺗﻛﻭّ ﻥ ﻓﻲ ﺣﺎﻟﺔ ﺳﻳﻭﻟﺗﻪ ﻣﻥ ﺳﺎﺋﻝ ﻟﻭﻧﻪ ﻣﺎﺋﻝ ﻟﻠﺻﻔﺭﺓ ﺍﻟﺧﻔﻳﻔﺔ ﻧﺳﻣّﻳﻪ ﺍﻟﺑﻼﺯﻣﺎ ﺃﻭ ]ﺍﻟﺳﺎﺋﻝ ﺍﻟﺻﻭﺭﻱ[‪ ،‬ﺗﺳﺑﺢ ﻓﻳﻪ ﺧﻼﻳﺎ ﻣﻥ‬ ‫ﺃﻧﻭﺍﻉ ﺛﻼﺛﺔ ﺭﺋﻳﺳﻳﺔ ﻫﻲ‪ :‬ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻭﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺑﻳﺿﺎء ﻭﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪ .‬ﻟﻛﻝ ﻣﻥ ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﻭﺍﺟﺑﺎﺗﻪ ﺍﻟﺗﻲ ﺗﺧﺗﻠﻑ ﻋﻥ‬ ‫ﺍﻷﺧﺭﻯ ﻛﻠّ ّﻳﺎ ً‪ ،‬ﻛﻣﺎ ﺃﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء ﻟﻳﺳﺕ ﻣﻥ ﻧﻭﻋﻳﺔ ﻭﺍﺣﺩﺓ‪ ،‬ﻭﻫﻲ ﻓﻲ ﺍﻟﺩﻡ ﺧﻣﺳﺔ ﺃﻧﻭﺍﻉ ﻟﻛﻝ ﻭﺍﺟﺑﻪ ﺍﻟﻣﺣﺩﺩ‪.‬‬ ‫‪U‬‬

‫اﻟﺒﻼزﻣﺎ وﻣﺼﻞ اﻟﺪم‪:‬‬

‫ﺇﻥ ﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ ] ﺍﻟﺳﺎﺋﻝ ﺍﻟﺻﻭﺭﻱ[ ﻟﻳﺱ ﻣﺣﻠﻭﻻً ﺑﺳﻳﻁﺎ ً ﺑﻝ ﻫﻭ ﺑﺎﻟﻎ ﺍﻟﺗﻌﻘﻳﺩ ﻭﺃﺳﺎﺳﻪ ﺍﻟﻣﺎء ﻭﻓﻳﻪ ﺍﻟﻣﺋﺎﺕ ﻣﻥ ﺍﻟﻣﻭﺍﺩ ﺍﻟﻣﺫﺍﺑﺔ ﻣﻥ‬ ‫ﻋﻧﺎﺻﺭ ﻓﻠﺯﻳﺔ ﻭﻻﻓﻠﺯﻳﺔ ﻭﻣﺭﻛﺑﺎﺕ ﻋﺿﻭﻳﺔ ﻭﻻﻋﺿﻭﻳﺔ‪ ،‬ﻭﻣﻧﻬﺎ ﺍﻟﻣﻌﻘﺩﺓ ﺍﻟﺗﺭﻛﻳﺏ ﻭﻣﻧﻬﺎ ﺍﻟﺑﺳﻳﻁﺔ ﻓﻲ ﺗﺭﻛﻳﺑﻬﺎ‪ ،‬ﻭﻛﻝ ﻫﺫﻩ ﻣﻭﺟﻭﺩﺓ‬ ‫ﺑﺗﺭﻛﻳﺯﺍﺕ ﻣﻧﻭّ ﻋﺔ ﻭﻟﻛﻧﻬﺎ ﺛﺎﺑﺗﺔ ﺿﻣﻥ ﺣﺩﻭﺩ ﺿﻳﻘﺔ ﻟﻛﻝ ﻣﻧﻬﺎ ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ‪ .‬ﺍﻷﻭﺯﺍﻥ ﺍﻟﺟﺯﻳﺋﻳﺔ ﻟﻬﺫﻩ ﺍﻟﻣﻭﺍﺩ ﻣﺗﻔﺎﻭﺗﺔ ﺟﺩﺍً‪،‬‬ ‫ﻓﻣﻧﻬﺎ ﺍﻟﺻﻐﻳﺭ ﻭﻣﻧﻬﺎ ﻣﺎ ﺗﻛﻭﻥ ﺟﺯﻳﺋﺗﻪ ﻛﺑﻳﺭﺓ ﺟ ّﺩﺍً‪ .‬ﺍﻟﺑﻌﺽ ﻣﻥ ﻫﺫﻩ ﺍﻟﻣﻛﻭّ ﻧﺎﺕ ﺗﻭﺟﺩ ﻓﻲ ﺑﻼﺯﻣﺎ ﺍﻟﺩﻡ ﻟﻠﻘﻳﺎﻡ ﺑﻭﻅﺎﺋﻔﻬﺎ ﻭﻫﻲ ﻓﻲ ﺍﻟﺩﻡ‪،‬‬ ‫ﺇﻻ ﺃﻥ ﺍﻟﻛﺛﻳﺭ ﻣﻧﻬﺎ ﻣﻭﺟﻭﺩ ﻓﻲ ﺍﻟﺩﻡ ﻓﻲ ﺣﺎﻟﺔ ﻋﺑﻭﺭ ﻣﻥ ﻋﺿﻭ ﻓﻲ ﺍﻟﺟﺳﻡ ﺇﻟﻰ ﺁﺧﺭ‪ .‬ﻓﻣﻧﻬﺎ ﻣﺎﻳﺄﺗﻲ ﻣﻥ ﺍﻷﻣﻌﺎء ﺍﻟﺗﻲ ﺍﻣﺗﺻﺗﻪ ﻣﻥ‬ ‫ﺍﻟﻁﻌﺎﻡ ﻭﻭﺟﻭﺩﻩ ﻓﻲ ﺍﻟﺩﻡ ﺇﻧﻣﺎ ﻫﻭ ﻟﻠﻌﺑﻭﺭ ﺇﻟﻰ ﺍﻟﻛﺑﺩ ﺍﻟﺫﻱ ﻳﺧﺯﻧﻪ ﺃﻭ ﻳﻐﻳّﺭ ﻣﻥ ﺗﺭﻛﻳﺑﻪ ﻟﻳﻘﻠﻝ ﻣﻥ ﺿﺭﺭﻩ ﻋﻠﻰ ﺍﻟﺟﺳﻡ‪ ،‬ﻭﻣﻧﻬﺎ ﻣﺎ ﻳﻔﺭﺯﻩ‬ ‫ﺃﺣﺩ ﺍﻷﻋﺿﺎء )ﻛﺎﻟﻐﺩّﺓ ﺍﻟﺩﺭﻗﻳﺔ ﻭﺍﻟﺑﻧﻛﺭﻳﺎﺱ( ﻭﻳﺣﻣﻠﻪ ﺍﻟﺩﻡ ﻟﻳﻭﺩﻋﻪ ﻟﺩﻯ ﻫﺫﺍ ﺍﻟﻌﺿﻭ ﺃﻭ ﺫﺍﻙ ﻣﻥ ﺍﻟﺟﺳﻡ ﻟﻳﻘﻭﻡ ﺑﻭﻅﻳﻔﺗﻪ ﻫﻧﺎﻙ‬ ‫ﻛﻬﺭﻣﻭﻥ ﺃﻭ ﻏﻳﺭﻩ ﻛﺫﻟﻙ ﻓﺈﻥ ﺑﻼﺯﻣﺎ ﺍﻟﺩﻡ ﺗﺣﻣﻝ ﻣﻭﺍﺩ ُﺗﻌ ّﺩ ﻣﻥ ﺍﻟﻔﺿﻼﺕ ﻓﺗﺄﺧﺫﻫﺎ ﺇﻟﻰ ﺍﻟﻛﺑﺩ ﺃﻭ ﺍﻟﻛﻠﻳﺗﻳﻥ ﻟﻠﺗﺧﻠﺹ ﻣﻧﻬﺎ‪.‬‬ ‫ﻓﻲ ﺑﻼﺯﻣﺎ ﺍﻟﺩﻡ ﺃﻳﺿﺎ ً ﺑﺭﻭﺗﻳﻧﺎﺕ ﻣﻧﻭّ ﻋﺔ ﺟﺩﺍً ﻭﻛﻠﻬﺎ ﺫﺍﺕ ﺃﻫﻣﻳﺔ ﻛﺑﺭﻯ ﻟﻠﺟﺳﻡ‪ .‬ﺃﻫﻡ ﺑﺭﻭﺗﻳﻥ ﻭﺃﻛﺛﺭﻫﺎ ﺗﺭﻛﻳﺯﺍً ﻓﻲ ﺍﻟﺩﻡ ﻫﻭ ﺍﻟﺯﻻﻝ‬ ‫]ﺃﻟﺑﻭﻣﻳﻥ[‪ .‬ﻭﻫﻧﺎﻙ ﺑﺭﻭﺗﻳﻧﺎﺕ ﺍﻟﻣﻧﺎﻋﺔ ﺃﻭ ﻣﺎ ﺗﺳﻣّﻰ ]ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ[‪ ،‬ﻭﻫﻲ ﻋﺎﺩﺓ ﻣﺿﺎﺩﺓ ﻟﻸﺟﺳﺎﻡ ﻭﺍﻟﺟﺯﻳﺋﺎﺕ ﺍﻟﻐﺭﻳﺑﺔ ﻭﺍﻟﺟﺭﺍﺛﻳﻡ‬ ‫ﺍﻟﺗﻲ ﺗﻐﺯﻭ ﺍﻟﺟﺳﻡ‪.‬‬ ‫ﺇﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺗﺣﻭﻱ‪ ،‬ﺿﻣﻥ ﻣﺎ ﺗﺣﻭﻱ‪ ،‬ﺑﺭﻭﺗﻳﻧﺎﺕ ﻣﻌ ّﻘﺩﺓ ﺗﺷ ّﻛﻝ ﻓﻳﻣﺎ ﺑﻳﻧﻬﺎ ﺳﻠﺳﻠﺔ ﻣﺗﻔﺎﻋﻼﺕ ﻛﻳﻣﻳﺎﻭﻳﺔ ﺗﺅﺩﻱ – ﻋﻧﺩ ﺍﻟﺣﺎﺟﺔ‪ -‬ﺇﻟﻰ‬ ‫ّ‬ ‫ﺗﺧﺛﺭ ﺍﻟﺑﻼﺯﻣﺎ ﻭﻣﻌﻬﺎ ﻛﻝ ﺍﻟﺩﻡ )ﺧﺎﺭﺝ ﺍﻟﺟﺳﻡ( ﺃﻭ ﺍﻟﺗﺟﻠّﻁ )ﺩﺍﺧﻝ ﺃﻭﻋﻳﺔ ﺍﻟﺩﻡ(‪ .‬ﻫﺫﻩ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﻧﻁﻠﻕ ﻋﻠﻳﻬﺎ ﺍﺳﻡ ]ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ[‪.‬‬ ‫ﺍﻟﺩﻡ ﺇﺫﺍ ّ‬ ‫ﺗﺧﺛﺭ ﻧﺟﺩﻩ ﻳﺗﺣﻭّ ﻝ ﺇﻟﻰ ﻛﺗﻠﺔ ﺟﻼﺗﻳﻧﻳﺔ ﻟﺩِﻧﺔ ﺃﻭﻝ ﺍﻷﻣﺭ‪ ،‬ﺛﻡ ﺇﺫﺍ ُﺗﺭﻙ ﻓﺗﺭﺓ ﻧﺻﻑ ﺳﺎﻋﺔ ﺃﻭ ﺃﻛﺛﺭﻧﺟﺩ ﺃﻥ ﺍﻟﻣﺎﺩﺓ ﺍﻟﺟﻼﺗﻳﻧﻳﺔ‬ ‫ﺗﻧﻛﻣﺵ ﺇﻟﻰ ﻛﺗﻠﺔ ﺣﻣﺭﺍء ﺩﺍﻛﻧﺔ ﻭﺗﺗﺭﻙ ﺧﺎﺭﺟﻬﺎ ﺳﺎﺋﻼً ﻳﻣﻳﻝ ﺇﻟﻰ ﺍﻟﺻﻔﺭﺓ ﺍﻟﺧﻔﻳﻔﺔ‪ .‬ﻫﺫﺍ ﺍﻟﺳﺎﺋﻝ ﻻ ﻳﺧﺗﻠﻑ ﻛﺛﻳﺭﺍً ﻓﻲ ﺷﻛﻠﻪ ﻭﻟﻭﻧﻪ ﻋﻥ‬ ‫ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﺗﻲ ﻧﺷﺄ ﻣﻧﻬﺎ ﻭﻟﻛﻧﻪ ﻳﻔﺗﻘﺭ ﺇﻟﻰ ﺍﻟﺑﻌﺽ ﻣﻥ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﺍﻟﺗﻲ ﺫﻛﺭﺗﻬﺎ ﺃﻋﻼﻩ‪ ،‬ﺣﻳﺙ ُﺗﺳﺗﻬﻠﻙ ﺧﻼﻝ ﻋﻣﻠﻳﺔ ﺗﺧﺛﺭ ﺍﻟﺩﻡ‪.‬‬ ‫ّ‬ ‫ﺍﻟﻣﺗﺧﺛﺭ ]ﺍﻟﻣﺻﻝ[‪ ،‬ﻭﻫﻭ –ﻛﻣﺎ ﺫﻛﺭﺕ‪ -‬ﻳﻁﺎﺑﻕ ﺍﻟﺑﻼﺯﻣﺎ ﻓﻲ ﺃﻛﺛﺭ ﺻﻔﺎﺗﻪ ﻭﺗﺭﺍﻛﻳﺑﻪ ﻟﻛﻧﻪ‬ ‫ﻳﺳﻣﻰ ﻫﺫﺍ ﺍﻟﺳﺎﺋﻝ ﺍﻟﺫﻱ ﻳﻧﻔﺻﻝ ﻋﻥ ﺍﻟﺩﻡ‬ ‫‪8‬‬

‫ﻏﻳﺭ ﻗﺎﺑﻝ ﻟﻠﺗﺧﺛﺭ ﺑﺳﺑﺏ ﻣﺎ ﺫﻛﺭﺕ ﻣﻥ ﻣﻥ ﺍﺳﺗﻧﻔﺎﺩ ﺑﻌﺽ ﺑﺭﻭﺗﻳﻧﺎﺕ ﺍﻟﺗﺧﺛﺭ ﻓﻳﻪ‪ .‬ﺃﻣﺎ ﺍﻟﺟﺯء ﺍﻟﺫﻱ ﻳﺗﻘﻠﺹ ﻭﻳﺗﺻﻠّﺏ ﻧﻭﻋﺎ ً ﻣﺎ ﻣﻥ ﺍﻟﺩﻡ‬ ‫ﺍﻟﻣﺗﺧﺛﺭ‪ ،‬ﺗﺎﺭﻛﺎ ً ﺍﻟﻣﺻﻝ ﻳﺧﺭﺝ ﺳﺎﺋﻼً ﻣﻧﻪ ﻓﻬﻭ ﻋﺑﺎﺭﺓ ﻋﻥ ﺷﺑﻛﺔ ﺧﻳﻭﻁ ]ﻓﺑﺭﻳﻥ ﺃﻭ ﻟﻳﻔﻳﻥ[ ﺍﻟﺩﻡ ﻣﻣﺳﻛﺔ ﻓﻲ ﺩﺍﺧﻠﻬﺎ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‬ ‫ﺍﻟﻣﺧﺗﻠﻔﺔ‪ .‬ﻫﺫﻩ ﺍﻟﺧﻳﻭﻁ ﺗﻛﻭﻧﺕ ﻛﻧﺗﻳﺟﺔ ﻧﻬﺎﺋﻳﺔ ﻟﻠﺗﻔﺎﻋﻼﺕ ﺍﻟﻣﺅﺩﻳﺔ ﺇﻟﻰ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻭﺗﺣﺗﻭﻱ ﺃﻭﻝ ﺍﻷﻣﺭ ﻛﻝ ﻣﻛﻭﻧﺎﺕ ﺍﻟﺩﻡ‪ ،‬ﺑﺧﻼﻳﺎﻩ‬ ‫ﻭﻣﺻﻠﻪ‪ ،‬ﺛﻡ ﺗﺗﻘﻠﺹ ﺍﻟﺧﻳﻭﻁ ﺑﻌﺩ ﻣﺩﺓ ﻓﺗﻌﺗﺻﺭ ﺍﻟﺧﻼﻳﺎ ﺩﺍﺧﻠﻬﺎ ﻭﺗﺳﻣﺢ ﻟﻠﻣﺻﻝ ﺑﺎﻟﻧﺿﻭﺡ ﺇﻟﻰ ﺧﺎﺭﺟﻬﺎ‪.‬‬ ‫ﻳﻭﺿﺢ ﺍﻟﺷﻛﻼﻥ )‪ 1‬ﻭ‪(2‬ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻭﺍﻧﻔﺻﺎﻝ ﺍﻟﻣﺻﻝ ﻋﻥ ﺧﺛﺭﺓ ﺍﻟﺩﻡ‪.‬‬ ‫ﻣﺻﻝ‬ ‫ﺍﻟﺩﻡ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪-1‬‬

‫ﺩﻡ ﻣﺿﻰ ﻋﻠﻰ ﺗﺧﺛﺭﻩ ﺳﺎﻋﺔ‬

‫ﺩﻡ ﺣﺩﻳﺙ ﺍﻟﺗﺧﺛﺭ‬

‫‪U‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -2‬ﺭﺳﻡ ﺗﻭﺿﻳﺣﻲ ﻳﺑ ّﻳﻥ ﻋﻣﻠﻳﺔ ﺗﻘﻠّﺹ ﺧﺛﺭﺓ ﺍﻟﺩﻡ ﻭﻧﺿﻭﺡ ﺍﻟﻣﺻﻝ‬

‫ﺧﻼﻳﺎ اﻟﺪم أو ﺣﺠﻴﺮاﺗﻪ‪:‬‬ ‫ﺃﻋﻭﺩ ﺍﻵﻥ ﺇﻟﻰ ﺍﻟﻣﻛﻭﻧﺎﺕ ﺍﻟﺧﻠﻭﻳﺔ ﻟﻠﺩﻡ ﻷﻋﻁﻲ ﻓﻛﺭﺓ ﻋﺎﻣﺔ ﻋﻥ ﺃﻧﻭﺍﻋﻬﺎ ﻭﻭﺍﺟﺑﺎﺗﻬﺎ‬ ‫‪U‬‬

‫ﺃﻭﻻً‪ -‬ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء‪:‬‬

‫ﻭﻫﻲ ﺍﻟﺗﻲ ﺗﺷ ّﻛﻝ ﻣﻌﻅﻡ ﺍﻟﺟﺯء ﺍﻟﺧﻠﻭﻱ ﻣﻥ ﺍﻟﺩﻡ ﻭﺗﻌﻁﻳﻪ ﻟﻭﻧﻪ ﺍﻷﺣﻣﺭ‪ ،‬ﻧﻅﺭﺍً ﻟﻌﺩﺩﻫﺎ ﺍﻟﻛﺑﻳﺭ ﻣﻘﺎﺭﻧﺔ ﻣﻊ ﺑﺎﻗﻲ ﺍﻟﺧﻼﻳﺎ ﻓﻳﻪ‪.‬‬ ‫ﻭﻟﻭﻧﻬﺎ ﺍﻷﺣﻣﺭ ﻫﻭ ﺑﺳﺑﺏ ﻣﺣﺗﻭﺍﻫﺎ ﻣﻥ ]ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﺃﻭ ﺧﺿﺎﺏ ﺍﻟﺩﻡ[‪ .‬ﻣﻌﺩّﻝ ﻗﻁﺭ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻁﺑﻳﻌﻳﺔ ‪ 8‬ﻣﺎﻳﻛﺭﻭﻣﺗﺭ‬ ‫ﻭﻟﻳﺱ ﻟﻬﺎ ﻧﻭﻯ‪ .‬ﺳﺄﺗﻛﻠﻡ ﻋﻥ ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﻓﻳﻣﺎ ﺑﻌﺩ ﺑﺎﻟﺗﻔﺻﻳﻝ‪ ،‬ﺣﻳﺙ ﺃﻧﻬﺎ ﺗﺷ ّﻛﻝ ﺍﻟﻣﻭﺿﻭﻉ ﺍﻟﺭﺋﻳﺳﻲ ﻟﻬﺫﺍ ﺍﻟﻛﺗﺎﺏ‪.‬‬

‫ﺛﺎﻧﻳﺎ ً‪ -‬ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺑﻳﺿﺎء‪:‬‬ ‫‪U‬‬

‫ﻭﻫﻲ‪ -‬ﻛﻣﺎ ﻭﺭﺩ ﺳﺎﺑﻘﺎ ً – ﻋﻠﻰ ﺃﻧﻭﺍﻉ ﺧﻣﺳﺔ ﺭﺋﻳﺳﻳﺔ ﺩﺍﺧﻝ ﺍﻟﺩﻡ‪ ،‬ﻭﻟﻛﻝ ﻭﻅﻳﻔﺗﻪ‪ .‬ﻑ]ﺍﻟﺧﻼﻳﺎ ﻣﺗﻌﺎﺩﻟﺔ ﺍﻟﺣﺑﻳﺑﺎﺕ ﻣﻔﺻﺻﺔ ﺍﻟﻧﻭﻯ[‬ ‫ﺗﻠﺗﻬﻡ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻐﺭﻳﺑﺔ ﺻﻐﻳﺭﺓ ﺍﻟﺣﺟﻡ‪ ،‬ﻣﺛﻝ ﻣﻌﻅﻡ ﺍﻟﺑﻛﺗﺭﻳﺎ‪ .‬ﻭ]ﺍﻟﺧﻼﻳﺎ ﺣﻣﺿﻳﺔ ﺍﻟﺣﺑﻳﺑﺎﺕ ﻣﻔﺻﺻﺔ ﺍﻟﻧﻭﻯ[ ﺗﻔﺭﺯ ﻣﻭﺍﺩ‬ ‫ﻛﻳﻣﻳﺎﻭﻳﺔ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺣﺳﺎﺳﻳﺔ‪ .‬ﻭﺍﻟﺧﻼﻳﺎ ﺍﻟﻘﺎﻋﺩﻳﺔ ﻣﻔﺻﺻﺔ ﺍﻟﻧﻭﻯ ﺗﻔﺭﺯ ﻣﻭﺍﺩ ﻛﻳﻣﻳﺎﻭﻳﺔ ﻛﺎﻟﻬﺳﺗﺎﻣﻳﻥ ﻭﻣﻭﺍﺩ ﺃﺧﺭﻯ‪ ،‬ﺑﺗﺣﻔﻳﺯ‬ ‫ﻣﻥ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺧﺎﺻﺔ ﺑﺎﻟﺣﺳﺎﺳﻳﺔ ﺗﺗﻭﺍﺟﺩ ﻋﻠﻰ ﺳﻁﻭﺡ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء‪ .‬ﻭ]ﺍﻟﺧﻼﻳﺎ ﻭﺣﻳﺩﺓ ﻓﺹ ﺍﻟﻧﻭﻯ[‬ ‫‪9‬‬

‫ﺗﻠﺗﻬﻡ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻐﺭﻳﺑﺔ ﺍﻷﻛﺑﺭ ﺣﺟﻣﺎ ً ﺃﻭ ﺍﻷﺻﻌﺏ ﻣﻥ ﺍﻟﺑﻛﺗﺭﻳﺎ‪ .‬ﺃﻣﺎ ]ﺍﻟﺧﻼﻳﺎ ﺍﻟﻠﻣﻔﻳﺔ[ ﻓﻭﺍﺟﺑﻬﺎ ﻣﺣﺎﺭﺑﺔ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻐﺭﻳﺑﺔ‬ ‫]ﺍﻟﻣﺳﺗﺿﺩّﺍﺕ[ ﺇﻣﺎ ﺏ]ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ[ ﺗﻔﺭﺯﻫﺎ ﻟﺗﻛﻭﻥ ﻣﺫﺍﺑﺔ ﻓﻲ ﻣﺻﻝ ﺍﻟﺩﻡ ﺃﻭ ﺑﻣﺿﺎﺩﺍﺕ ﺗﺣﻣﻠﻬﺎ ﺍﻟﺧﻼﻳﺎ ﻋﻠﻰ ﺳﻁﻭﺣﻬﺎ‪.‬‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء ﺃﻛﺑﺭ ﻗﻁﺭﺍً ﻣﻥ ﺍﻟﺣﻣﺭﺍء ﻋﺩﺍ ﻣﺟﻣﻭﻋﺔ ﺻﻐﻳﺭﺓ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻠﻣﻔﻳﺔ ﺍﻟﺗﻲ ﻳﻛﻭﻥ ﻗﻁﺭﻫﺎ ﻣﻣﺎﺛﻼً ﻟﻠﺧﻼﻳﺎ‬ ‫ﺍﻟﺣﻣﺭﺍء‪.‬‬

‫ﺛﺎﻟﺛﺎ ً‪ -‬ﺍﻟﺻُﻔﻳْﺣﺎﺕ‪:‬‬ ‫‪U‬‬

‫ﻭﻫﺫﻩ ﺧﻼﻳﺎ ﺻﻐﻳﺭﺓ ﻗﻁﺭﻫﺎ ﺃﺻﻐﺭ ﻣﻥ ﻗﻁﺭ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻛﺛﻳﺭﺍً ﻭﻟﻳﺱ ﻟﻬﺎ ﻧﻭﺍﺓ‪ .‬ﺗﺳﺎﻋﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻓﻲ ﺳﺩ ﺍﻟﺛﻐﺭﺍﺕ‬ ‫ﻓﻲ ]ﺍﻟﻌﺭﻭﻕ ﺍﻟﺷﻌﺭﻳﺔ ﺃﻭ ﺍﻟﺷﻌﻳﺭﺍﺕ ﺍﻟﺩﻣﻭﻳﺔ[ ﻭﻟﻬﺎ ﺩﻭﺭ ﻓﻲ ﻋﻣﻠﻳﺔ ﺗﺟﻠﻁ ﺃﻭ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻋﻣﻭﻣﺎ ً ﺳﻭﺍ ًء ﺩﺍﺧﻝ ﺍﻟﺟﺳﻡ ﺃﻭ ﺧﺎﺭﺟﻪ‬ ‫ﺃﻭ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺟﺭﻭﺡ ﻭﺗﺷ ّﻛﻝ‪ ،‬ﻣﻊ ﺧﻳﻭﻁ ﺍﻟﻠﻳﻔﻳﻥ‪ ،‬ﻫﻳﻛﻝ ﺍﻟﺟﻠﻁﺔ‪ ،‬ﻛﻣﺎ ﺗﺳﺎﻋﺩ ﻋﻠﻰ ﺗﻘﻠّﺹ ﺍﻟﺧﻳﻭﻁ‪ ،‬ﻭﻣﻥ ﺛ ّﻡ ﺗﻘﻠّﺹ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻭﺗﻘﻭﻳﺗﻬﺎ‪.‬‬ ‫‪U‬‬

‫أﺻﻞ ﺧﻼﻳﺎ اﻟﺪم وﻣﻮاﺿﻊ ﺗﺨﻠّﻘﻬﺎ‬ ‫ﺇﻥ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺑﺄﻧﻭﺍﻋﻬﺎ ﻟﻬﺎ ﺃﻋﻣﺎﺭ ﻣﺣﺩﺩﺓ ﺗﻘﺿﻳﻬﺎ ﻓﻲ ﺍﻟﺩﻡ ﻭﺑﻌﺩﻫﺎ ﻳﻘﻭﻡ ﺍﻟﺟﺳﻡ ﺑﺗﻬﺩﻳﻡ ﺗﻠﻙ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻌﻣّﺭﺓ ﻟﻳﺑﻧﻲ ﻏﻳﺭﻫﺎ‬ ‫ﺟﺩﻳﺩﺓ‪ .‬ﻓﻣﺗﻭﺳﻁ ﻋﻣﺭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺃﺭﺑﻌﺔ ﺷﻬﻭﺭ‪ .‬ﻭﻣﺗﻭﺳﻁ ﻋﻣﺭ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ‪ 12‬ﻳﻭﻣﺎ ً‪ .‬ﺃﻣﺎ ﺃﻋﻣﺎﺭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء‬ ‫ﻓﻳﺧﺗﻠﻑ ﻣﻥ ﻧﻭﻉ ﻵﺧﺭ ﻓﻣﻧﻬﺎ ﻣﺎ ﻳﻌﻳﺵ ﻳﻭﻣﻳﻥ ﺛﻡ ﻳﻧﺩﺛﺭ ﻭﻣﻧﻬﺎ ﻋﺩﺩ ﻗﻠﻳﻝ ﻳﺑﻘﻰ ﻟﻣﺩﺓ ﺳﻧﻳﻥ‪.‬‬

‫ﻟﻐﺭﺽ ﺗﺟﺩﻳﺩ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﻣﺳﺗﻬﻠﻛﺔ ﻓﺈﻥ ﻧﺳﻳﺟﺎ ً ﻣﺗﺧﺻﺻﺎ ً ﻭﺯﻧﻪ ﺣﻭﺍﻟﻲ ‪ 2‬ﻛﻳﻠﻭﻏﺭﺍﻡ ﻓﻲ ﺍﻟﺑﺎﻟﻐﻳﻥ ﻫﻭ ]ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ[ )ﺍﻧﻅﺭ‬ ‫ﺍﻷﻁﻠﺱ ﺍﻟﻣﺭﻓﻕ ﺑﺎﻟﻛﺗﺎﺏ( ﻳﻘﻭﻡ ﺑﻭﺍﺟﺏ ﺻﻧﻊ ﻣﻌﻅﻡ ﺃﻧﻭﺍﻉ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺑﻌﺩ ﻭﻻﺩﺓ ﺍﻟﻁﻔﻝ‪ .‬ﺃﻣﺎ ﻓﻲ ﺣﻳﺎﺓ ﺍﻟﺟﻧﻳﻥ ﻓﺈﻥ ﺃﻋﺿﺎء‬ ‫ﺃﺧﺭﻯ ﺗﺳﺑﻕ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻓﻲ ﻫﺫﺍ ﺍﻟﻌﻣﻝ‪ ،‬ﺃﻫﻣﻬﺎ ]ﺍﻟﻛﺑﺩ[ ﻭ]ﺍﻟﻁﺣﺎﻝ[‪ .‬ﻟﻛﻥ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ )ﺍﻟﺫﻱ ﻳﺑﺩﺃ ﻅﻬﻭﺭﻩ ﺧﻼﻝ ﺍﻟﺷﻬﺭ ﺍﻟﺭﺍﺑﻊ‬ ‫ﻣﻥ ﺍﻟﺣﻳﺎﺓ ﺍﻟﺭﺣﻣﻳﺔ( ﻳﺄﺧﺫ ﻫﺫﻩ ﺍﻟﻣﻬﻣﺔ ﺗﺩﺭﻳﺟﻳﺎ ً ﻣﻥ ﺍﻷﻋﺿﺎء ﺍﻷﺧﺭﻯ‪ ،‬ﺣﺗﻰ ﻳﺻﺑﺢ ﺍﻟﻧﺳﻳﺞ ﺍﻟﻭﺣﻳﺩ ﺗﻘﺭﻳﺑﺎ ً ﺍﻟﺫﻱ ﻳﻘﻭﻡ ﺑﺎﻟﻌﻣﻝ‬ ‫ﺍﻟﻣﺫﻛﻭﺭ ﻋﻧﺩ ﺧﺭﻭﺝ ﺍﻟﻁﻔﻝ ﻟﻠﺣﻳﺎﺓ‪.‬‬ ‫ﺇﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻠﻣﻔﻳﺔ ﻣﺳﺗﺛﻧﺎﺓ ﻣﻥ ﻫﺫﺍ ﺍﻟﻛﻼﻡ‪ ،‬ﺣﻳﺙ ﺃﻧﻬﺎ ُﺗﺻﻧﻊ ﻭ ُﺗﺟﺭﻯ ﻋﻠﻳﻬﺎ ﺗﻐﻳﻳﺭﺍﺕ ﻭﻅﻳﻔﻳﺔ ﻓﻲ ﺃﻋﺿﺎء ﺃﺧﺭﻯ‪ ،‬ﻭﺃﻫﻣﻬﺎ‬ ‫ﺍﻟﻁﺣﺎﻝ ﻭ]ﺍﻟﻐﺩﺓ ﺍﻟﺳﻌﺗﺭﻳﺔ[ ﻭ]ﺍﻟﻌﻘﺩ ﺍﻟﻠﻣﻔﻳﺔ[‪ ،‬ﻭﻻ ﻳُﺻﻧﻊ ﻣﻧﻬﺎ ﺃﻭ ﻳﺗﻭﺍﺟﺩ ﻓﻲ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺇﻻ ﻧﺳﺑﺔ ﻗﻠﻳﻠﺔ‪.‬‬ ‫ﻳﻣﺭ ﻛﻝ ﻧﻭﻉ ﻣﻥ ﺃﻧﻭﺍﻉ ﺧﻼﻳﺎ ﺍﻟﺩﻡ )ﺍﻟﺣﻣﺭﺍء ﻭﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﺍﻟﺑﻳﺿﺎء ﺑﺄﻧﻭﺍﻋﻬﺎ( ﺑﺄﺩﻭﺍﺭ ﺍﺳﺗﺣﺎﻟﺔ ﻭﺗﺧﻠّﻕ ﺗﺩﺭﻳﺟﻲ ﻟﻳﺻﻝ ﺇﻟﻰ‬ ‫ﻣﺭﺣﻠﺔ ﺍﻟﻧﺿﻭﺝ ﺍﻟﺗﻲ ﻳﻣﻛﻧﻬﺎ ﻓﻳﻬﺎ ﺃﺩﺍء ﻭﺍﺟﺑﻬﺎ ﺍﻟﺫﻱ ُﺧﻠﻘﺕ ﻟﻪ ﻓﻲ ﺍﻟﺩﻡ ﻭﺍﻷﻧﺳﺟﺔ‪ .‬ﻭ ﻻ ﻳﻣﻛﻧﻬﺎ –ﺇﻻ ﻓﻲ ﺣﺎﻻﺕ ﺍﺳﺗﺛﻧﺎﺋﻳﺔ‪-‬‬ ‫ﺍﻟﺻﺩﻭﺭ ﺇﻟﻰ ﺍﻟﺩﻡ ﻗﺑﻝ ﻭﺻﻭﻟﻬﺎ ﺇﻟﻰ ﻣﺭﺣﻠﺔ ﺍﻟﻧﺿﻭﺝ ﺗﻠﻙ‪.‬‬

‫ﻧﺧﺎﻉ ﺍﻟﻌﻅـــــــــﻡ‬ ‫‪U‬‬

‫ﻗﺩ ﻳﺣﺗﺎﺝ ﺍﻟﻁﺑﻳﺏ ﺇﻟﻰ ﻓﺣﺹ ﻋﻳّﻧﺔ ﻣﻥ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪ ،‬ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﻋﻳﻧﺔ ﺍﻟﺩﻡ‪ ،‬ﻓﻳﻠﺟﺄ ﺣﻳﻧﺋﺫ ﺇﻟﻰ ﺳﺣﺏ ﻋﻳﻧﺔ ﺻﻐﻳﺭﺓ ﻣﻥ‬ ‫ﺍﻟﻧﺧﺎﻉ‪ .‬ﺍﻟﻣﻭﺿﻊ ﺍﻟﻣﻔﺿﻝ ﻟﻠﺳﺣﺏ ﻫﻭﻣﺅﺧﺭﺓ ﻋﻅﻡ ﺍﻹﻟﻳﺔ ﻣﻥ ﺟﻬﺔ ﺍﻟﻌﺟُﺯ‪ .‬ﻓﻲ ﺍﻟﺑﺎﻟﻐﻳﻥ ﻳﻣﺛﻝ ﺍﻟﻌﻅﻡ ﺍﻟﻘﺹ ﻓﻲ ﺍﻟﺻﺩﺭ‬ ‫ﻣﻭﺿﻌﺎ ً ﺁﺧﺭ ﻟﻠﺳﺣﺏ ﻟﻛﻥ ﺍﻟﺳﺣﺏ ﻣﻥ ﻫﺫﺍ ﺍﻟﻌﻅﻡ ﺃﺻﺑﺢ ﺍﻵﻥ ﻧﺎﺩﺭﺍً‪ .‬ﻳﻣﻛﻥ ﺍﻟﻠﺟﻭء ﺇﻟﻰ ﻋﻅﺎﻡ ﺃﺧﺭﻯ ﻣﺛﻝ ﺣﺎﻓﺔ ﻋﻅﻡ ﺍﻟﺣﻭﺽ‬ ‫ﻭﺍﻟﻔﻘﺭﺍﺕ‪ .‬ﺃﻣﺎ ﺍﻟﻌﻅﺎﻡ ﺍﻟﻣﺳﺗﻁﻳﻠﺔ ﻓﻬﻲ ﺗﺣﻭﻱ ﻧﺧﺎﻋﺎ ً ﻏﻳﺭ ﻓﻌّﺎﻝ ]ﻧﺧﺎﻉ ﺃﺑﻳﺽ[ ﻋﻧﺩ ﺍﻟﺑﻠﻭﻍ‪ ،‬ﺑﻳﻧﻣﺎ ﺗﺣﻭﻱ ﺍﻟﻌﻅﺎﻡ ﺍﻟﻣﺫﻛﻭﺭﺓ‬ ‫ﺃﻋﻼﻩ ﻋﻠﻰ ]ﻧﺧﺎﻉ ﺃﺣﻣﺭ[‪ ،‬ﻭﻫﻭ ﺍﻟﻔﻌﺎﻝ ﻭﻫﻭ ﺍﻟﺫﻱ ﻳﺻﻠﺢ ﻟﻠﻔﺣﺹ‪.‬‬ ‫ّ‬ ‫ﺍﻟﻣﺳﻁﺣﺔ ﻣﻥ ﺍﻟﺟﺳﻡ ﻓﻲ ﺍﻟﺑﺎﻟﻐﻳﻥ ﻳﻛﻔﻲ ﻟﺳﺩ ﺣﺎﺟﺔ ﺃﺟﺳﺎﻣﻬﻡ ﻣﻥ‬ ‫ﺇﻥ ﺍﻟﻧﺧﺎﻉ ﺍﻷﺣﻣﺭ ﺍﻟﻣﻭﺟﻭﺩ ﻓﻲ ﺍﻟﻌﻅﺎﻡ ﺍﻟﻭﺳﻁﻰ ﻭﺍﻟﻌﻅﺎﻡ‬ ‫ﺧﻼﻳﺎ ﺍﻟﺩﻡ‪ ،‬ﺇﻻ ﺃﻥ ﺍﻟﻧﺧﺎﻉ ﺍﻷﺑﻳﺽ ﻳﻣﻛﻥ ﺃﻥ ﻳﺗﺣﻭﻝ ﺇﻟﻰ ﻧﺧﺎﻉ ﺃﺣﻣﺭ ﻓﻌّﺎﻝ ﻓﻲ ﺣﺎﻻﺕ ﺍﺷﺗﺩﺍﺩ ﺣﺎﺟﺔ ﺍﻟﺟﺳﻡ ﺇﻟﻰ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‬ ‫)ﺍﻟﺣﻣﺭﺍء ﻋﺎﺩﺓ(‪ ،‬ﻭﺳﻳﺭﺩ ﺫﻛﺭ ﻫﺫﺍ ﺍﻟﺗﻐﻳّﺭ ﻟﺩﻯ ﻣﻧﺎﻗﺷﺔ ﺗﻠﻙ ﺍﻟﺣﺎﻻﺕ‪.‬‬ ‫‪10‬‬

‫ﺍﻟﻛﺑﺩ ﻭﺍﻟﻁﺣﺎﻝ ﺍﻟﻠﺫﺍﻥ ﺗﻭ ّﻗﻔﺎ ﻋﻥ ﺇﻧﺗﺎﺝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﻋﻧﺩ ﻭﻻﺩﺓ ﺍﻟﻁﻔﻝ‪ ،‬ﺃﻭ ﺣﺗﻰ ﻗﺑﻝ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﻗﺩ ﻳﻌﻭﺩﺍﻥ ﻹﻧﺗﺎﺝ ﺗﻠﻙ ﺍﻟﺧﻼﻳﺎ ﻓﻲ‬ ‫ﺍﻟﺣﺎﻻﺕ ﺍﻻﺿﻁﺭﺍﺭﻳﺔ ﻋﻧﺩﻣﺎ ﺗﻘ ّﻝ ﻁﺎﻗﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺑﺳﺑﺏ ﺍﺣﺗﺷﺎﺋﻪ ﺃﻭ ﺍﺣﺗﻼﻟﻪ ﺑﻧﺳﻳﺞ ﻏﻳﺭ ﻁﺑﻳﻌﻲ‪ ،‬ﻓﻼ ﻳﺳﺗﻁﻳﻊ ﺗﺯﻭﻳﺩ‬ ‫ﺍﻟﺟﺳﻡ ﺑﺣﺎﺟﺗﻪ‪ .‬ﺳﻳﺭﺩ ﺫﻛﺭ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﺃﻳﺿﺎ ً ﻋﻧﺩ ﺷﺭﺡ ﺃﻧﻭﺍﻉ ﻣﻌﻳﻧﺔ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ‪.‬‬

‫‪U‬‬

‫ﺗﻔﺼﻴﻞ ﻋﻦ ﺧﻼﻳﺎ اﻟﺪم اﻟﺤﻤﺮاء‬ ‫ﺃﻋﻭﺩ ﺍﻵﻥ ﺇﻟﻰ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻟﻠﺗﺭﻛﻳﺯ ﻋﻠﻳﻬﺎ‪ ،‬ﻷﻥ ﺍﻟﻧﻘﺹ ﻓﻳﻬﺎ ﻫﻭ ﻓﻘﺭ ﺍﻟﺩﻡ‪ ،‬ﺍﻟﺫﻱ ﻫﻭ ﻣﻭﺿﻭﻉ ﺍﻟﻛﺗﺎﺏ‪.‬‬ ‫ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﺗﻛﻭﻥ ﻋﺩﻳﻣﺔ ﺍﻟﻧﻭﻯ ﻓﻲ ﺍﻟﻠﺑﺎﺋﻥ‪ ،‬ﻋﻧﺩ ﺧﺭﻭﺟﻬﺎ ﻧﺎﺿﺟﺔ ﻣﻥ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪ ،‬ﺑﻳﻧﻣﺎ ﺗﻛﻭﻥ ﻟﻬﺎ ﻧﻭﻯ ﻓﻲ ﺍﻟﻔﻘﺭﻳﺎﺕ‬ ‫ﺻﺎ ً ﻳﺷﺑﻪ ﺍﻟﻘﺭﺹ ﺍﻟﻣﺩﻭّ ﺭ‬ ‫ﺍﻷﺧﺭﻯ‪ ،‬ﻭﺗﺧﺗﻠﻑ ﺣﺟﻭﻣﻬﺎ ﻣﻥ ﺣﻳﻭﺍﻥ ﻵﺧﺭ ﺍﺧﺗﻼﻓﺎ ً ﺷﺎﺳﻌﺎ ً‪ .‬ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﺗﺄﺧﺫ ﻫﺫﻩ ﺍﻟﺧﻠﻳﺔ ﺷﻛﻼً ﺧﺎ ّ‬ ‫ﺫﺍ ﺍﻟﻭﺟﻬﻳﻥ ﺍﻟﻣﻘﻌّﺭﻳْﻥ‪ ،‬ﻭﺫﻟﻙ ﻋﻧﺩﻣﺎ ﻳﻛﺗﻣﻝ ﻧﺿﻭﺟﻬﺎ‪ ،‬ﻛﻣﺎ ﻳﺑﺩﻭ ﻓﻲ ﺍﻟﺷﻛﻝ ﺭﻗﻡ ‪.3‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -3‬ﻣﻘﻁﻊ ﺭﺃﺳﻲ ﻣﺎﺭ ﺑﻘﻁﺭ ﺧﻠﻳﺔ ﺣﻣﺭﺍء ﻁﺑﻳﻌﻳﺔ‬ ‫ﻗﻁﺭ ﺍﻟﺧﻠﻳﺔ ﻳﺗﺭﺍﻭﺡ ﺑﻳﻥ ‪ 7‬ﻭ ‪ 8,5‬ﻣﺎﻳﻛﺭﻭﻣﺗﺭ ﺣﻳﻥ ﺗﻛﻭﻥ ﻋﺎﻟﻘﺔ ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﺳﺎﺋﻠﺔ‪ .‬ﺃﻣﺎ ﺣﺟﻣﻬﺎ ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﺍﻟﺑﺎﻟﻎ ﻓﻳﺗﺭﺍﻭﺡ‬ ‫ﺑﻳﻥ ‪ 80‬ﻭ ‪ 93‬ﻓﻣﺗﻭﻟﺗﺭ‪.‬‬ ‫ﺇﻥ ﺃﻫﻡ ﻣﺎ ﺗﺣﺗﻭﻳﻪ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻫﻭ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﺣﻳﺙ ﻳﺷﻛﻝ ﺣﻭﺍﻟﻲ ﺛﻠﺙ ﻣﺣﺗﻭﻳﺎﺗﻬﺎ ﻣﻥ ﺣﻳﺙ ﺍﻟﻭﺯﻥ‪ ،‬ﻭﻓﻲ ﺍﻟﺧﻠﻳﺔ‬ ‫ﺍﻟﻁﺑﻳﻌﻳﺔ ﻳﻛﻭﻥ ﻭﺯﻧﻪ ﻣﻥ ‪ 26‬ﺇﻟﻰ ‪ 32‬ﻣﺎﻳﻛﺭﻭ‪-‬ﻣﺎﻳﻛﺭﻭ ﻏﺭﺍﻡ‪ .‬ﺇﺿﺎﻓﺔ ﻟﻠﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﺗﺣﻭﻱ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻋﻠﻰ ﺍﻟﻣﺎء‬ ‫ﻭﺍﻷﻣﻼﺡ ﻭﻗﻠﻳﻝ ﻣﻥ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﻏﻳﺭ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻛﺄﻳﺔ ﺧﻠﻳﺔ ﺃﺧﺭﻯ‪.‬‬ ‫ﻟﻠﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻧﺷﺎﻁ ﺣﻳﻭﻱ ﺇﻻ ﺃﻧﻪ ﻣﺣﺩﻭﺩ‪ .‬ﻭﻫﻲ ﻏﻳﺭ ﻗﺎﺑﻠﺔ ﻟﻼﻧﻘﺳﺎﻡ ﺑﺳﺑﺏ ﻓﻘﺩﺍﻥ ﺍﻟﻧﻭﺍﺓ ﻭﺍﻟﻌﻭﺍﻣﻝ ﺍﻷﺧﺭﻯ ﺍﻟﻼﺯﻣﺔ ﻟﺫﻟﻙ‪.‬‬ ‫ﻭﺑﻌﺑﺎﺭﺓ ﺃﺧﺭﻯ ﻓﺈﻥ ﻫﺫﻩ ﺍﻟﺧﻠﻳﺔ ﺗﻛﺭّﺱ ﺣﻳﺎﺗﻬﺎ ﻟﻧﻘﻝ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻣﻥ ﻣﻛﺎﻥ ﺇﻟﻰ ﺁﺧﺭ ﻓﻲ ﺍﻟﺟﺳﻡ‪ ،‬ﺿﻣﻥ ﺍﻟﺩﻡ ﻛﻠﻪ‪ ،‬ﻟﻳﻘﻭﻡ ﺑﺣﻣﻝ‬ ‫ﺍﻷﻭﻛﺳﺟﻳﻥ ﻣﻥ ﺍﻟﺭﺋﺗﻳﻥ ﺇﻟﻰ ﺃﻧﺳﺟﺔ ﺍﻟﺟﺳﻡ ﺍﻟﻣﺧﺗﻠﻔﺔ ﻭﻣﻥ ﻫﻧﺎﻙ ﻳﺄﺧﺫ ﺛﺎﻧﻲ ﺃﻭﻛﺳﻳﺩ ﺍﻟﻛﺎﺭﺑﻭﻥ ﺇﻟﻰ ﺍﻟﺭﺋﺗﻳﻥ ﻟﻠﺗﺧﻠﺹ ﻣﻧﻪ‪ .‬ﻋﺩﺍ‬ ‫ﻫﺫﻩ ﺍﻟﻣﻬﻣﺔ ﺍﻟﻛﺑﻳﺭﺓ ﻓﺈﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺗﻧ ّﻔﺫ ﺃﻋﻣﺎﻻً ﺣﻳﻭﻳﺔ ﺑﻧﻁﺎﻕ ﺿﻳّﻕ ﻟﻠﻣﺣﺎﻓﻅﺔ ﻋﻠﻳﻬﺎ‪ ،‬ﻭﻋﻠﻰ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻓﻲ ﺣﺎﻟﺔ‬ ‫ﺳﻠﻳﻣﺔ ﻭﻓﻌّﺎﻟﺔ ﻭﻳﻣﻧﻊ ﺗﻠﻑ ﺟﺩﺭﺍﻧﻬﺎ ﺭﻏﻡ ﻣﺎ ﺗﻣﺭ ﺑﻪ ﻣﻥ ﺻﺩﻣﺎﺕ ﻓﻲ ﺍﻟﺩﻭﺭﺓ ﺍﻟﺩﻣﻭﻳﺔ ﻭﻣﺎ ﺗﺗﻌﺭﺽ ﻟﻪ ﻣﻥ ﻅﺭﻭﻑ ﺷﺎﻗﺔ‬ ‫ﻛﻳﻣﻳﺎﻭﻳﺎ ً ﻭﻓﻳﺯﻳﺎﻭﻳﺎ ً‪ .‬ﻫﺫﻩ ﺍﻷﻋﻣﺎﻝ ﺍﻟﺣﻳﻭﻳﺔ ﺗﺣﺗﺎﺝ ﺑﺎﻟﺿﺭﻭﺭﺓ ﺇﻟﻰ ﺃﺩﻭﺍﺕ ﻛﻳﻣﻳﺎﻭﻳﺔ ﻓﻌّﺎﻟﺔ ﻙ ]ﺍﻷﻧﻅﻳﻣﺎﺕ ﺃﻭ ﺍﻟﺧﻣﺎﺋﺭﻭﻣﺳﺎﻋﺩﺍﺕ‬ ‫ﺍﻷﻧﻅﻳﻣﺎﺕ[ ﺗﻛﻭﻥ ﻣﺗﻭﻓﺭﺓ ﺑﺎﻟﻘﺩﺭ ﺍﻟﻣﻁﻠﻭﺏ ﻟﻠﻘﻳﺎﻡ ﺑﺄﻭﺩ ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻬﺎﻣﺔ‪ .‬ﻣﻘﺎﺩﻳﺭ ﻫﺫﻩ ﺍﻷﻧﻅﻳﻣﺎﺕ ﺗﻧﻘﺹ ﺗﺩﺭﻳﺟﻳﺎ ً ﻛﻠﻣﺎ ﺗ ّﻘﺩﻡ‬ ‫ﺍﻟﻌﻣﺭ ﺑﺎﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﺣﺗﻰ ﺗﺻﻝ ﻣﺳﺗﻭﻯ ﻣﻥ ﺍﻟﺗﺩﻧﻲ ﻻ ﺗﺳﺗﻁﻳﻊ ﻣﻌﻪ ﺍﻟﺧﻠﻳﺔ ﺃﻥ ﺗﺳﺗﻣﺭ ﺑﻧﺷﺎﻁﻬﺎ ﻓﻳﻧﻘﺿﻲ ﻋﻣﺭﻫﺎ ﺑﺄﻥ‬ ‫ﺗﻠﺗﻬﻣﻬﺎ ]ﺧﻼﻳﺎ ﻣﻠﺗﻬﻣﺔ[ ﺧﺎﺻﺔ ﻳﻭﺟﺩ ﺃﻛﺛﺭﻫﺎ ﻓﻲ ﻟﺏ ﺍﻟﻁﺣﺎﻝ‪ ،‬ﻭﻳﺗﻡ ﻫﺿﻣﻬﺎ ﻭﺇﻋﺎﺩﺓ ﺍﻻﺳﺗﻔﺎﺩﺓ ﻣﻥ ﻣﺭﻛﺑﺎﺗﻬﺎ ﺍﻷﺳﺎﺳﻳﺔ‪ .‬ﻭﻳﺗﻡ‬ ‫ﻛﺫﻟﻙ ﺗﺟﺯﺋﺔ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺇﻟﻰ ﺟﺯﻳﺋﺎﺕ ﺃﺳﺎﺳﻳﺔ ﻟﻳﻌﺎﺩ ﺍﺳﺗﻌﻣﺎﻝ ﺑﻌﺿﻬﺎ‪ .‬ﺳﺄﻋﻭﺩ ﻟﺗﻔﺻﻳﻝ ﻫﺫﺍ ﺍﻟﻣﻭﺿﻭﻉ ﻋﻧﺩ ﺍﻟﻛﻼﻡ‬ ‫ﻋﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪.‬‬ ‫‪11‬‬

‫ﻋﻣﺭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ ‫ﻣﻌﺩّﻝ ﺍﻟﻔﺗﺭﺓ ﺍﻟﺗﻲ ﺗﻌﻳﺷﻬﺎ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻣﻧﺫ ﺗﻘﺩﻳﻣﻬﺎ ﺇﻟﻰ ﻣﺟﺭﻯ ﺍﻟﺩﻡ ﻣﻥ ﻗ َﺑﻝ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻭﺣﺗﻰ ﺗﺣﻁﻳﻣﻬﺎ ﻭﺍﻧﺩﺛﺎﺭﻫﺎ ﻓﻲ‬ ‫ﺍﻟﻁﺣﺎﻝ ﻫﻭ ﺣﻭﺍﻟﻲ ‪ 120‬ﻳﻭﻣﺎ ً ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﺍﻟﻁﺑﻳﻌﻲ‪ .‬ﻭﻣﻌﻧﻰ ﻫﺫﺍ ﺃﻥ ﺣﻭﺍﻟﻰ ‪ 1‬ﻣﻥ ‪ 120‬ﻣﻥ ﺍﻟﻌﺩﺩ ﺍﻟﻛﻠﻲ ﻟﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء‬ ‫ّ‬ ‫ﻳﺗﺣﻁﻡ ﻳﻭﻣﻳﺎ ً ﻟﻳﺣﻝ ﻣﺣﻠﻪ ﻧﻔﺱ ﺍﻟﻣﻘﺩﺍﺭ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺩﻳﺩﺓ ﻳﺻﻧﻌﻬﺎ ﺍﻟﻧﺧﺎﻉ ﻟﻺﺑﻘﺎء ﻋﻠﻰ ﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﺛﺎﺑﺗﺎ ً ﺑﺻﻭﺭﺓ‬ ‫ﻓﻲ ﺍﻟﺟﺳﻡ‬ ‫ﻣﺩﻫﺷﺔ ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﺍﻟﺳﻭﻱ ﺍﻟﺫﻱ ﻳﻌﻳﺵ ﺣﻳﺎﺓ ﺍﻋﺗﻳﺎﺩﻳﺔ‪ .‬ﻟﻛﻥ ﺍﻟﻧﺧﺎﻉ ﻋﻧﺩﻩ ﺍﻟﻘﺎﺑﻠﻳﺔ ﻋﻠﻰ ﺭﻓﻊ ﻣﺳﺗﻭﻯ ﺇﻧﺗﺎﺟﻪ‪ ،‬ﺃﻭ ﺣﺗﻰ‬ ‫ﻣﺿﺎﻋﻔﺗﻪ‪ ،‬ﻋﻧﺩ ﺍﻟﺣﺎﺟﺔ ‪،‬ﻣﺛﻝ ﺣﺎﻻﺕ]ﺍﻟﻧﺯﻑ[ ﺃﻭ ]ﺍﻧﺣﻼﻝ ﺍﻟﺩﻡ[‪ ،‬ﻭﺫﻟﻙ ﺑﺯﻳﺎﺩﺓ ﺳﺭﻋﺔ ﺇﻧﺗﺎﺟﻪ ﻭﺗﻭﺳﻳﻊ ﺭﻗﻌﺗﻪ‪.‬‬

‫ﻫﻝ ﻣﻥ ﺍﻟﺿﺭﻭﺭﻱ ﻭﺟﻭﺩ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺩﺍﺧﻝ ﺍﻟﺧﻼﻳﺎ؟‬ ‫ﺇﺫﺍ ﻛﺎﻥ ﺃﻫﻡ ﻭﺍﺟﺏ ﻟﻠﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻫﻭ ﺣﻣﻝ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻠﻣﺎﺫﺍ ﻻ ﻳﻛﻭﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻁﻠﻳﻘﺎ ً ﻓﻲ ﺍﻟﺩﻡ‪ ،‬ﻭﻫﻝ ﻣﻥ‬ ‫ﺍﻟﺿﺭﻭﺭﻱ ﺍﺣﺗﻭﺍﺋﻪ ﺩﺍﺧﻝ ﺧﻼﻳﺎ ﺗﺣﻣﻠﻪ‪ .‬ﺍﻟﺣﻘﻳﻘﺔ ﺃﻥ ﻫﻧﺎﻙ ﺣﻳﻭﺍﻧﺎﺕ ﺩﻧﻳﺎ ﻟﻬﺎ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻁﻠﻳﻕ ﻣﺫﺍﺏ ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ﻭﻏﻳﺭ‬ ‫ﻣﺣﺻﻭﺭ ﻓﻲ ﺧﻼﻳﺎ‪ ،‬ﻟﻛﻥ ﺫﻟﻙ ﻻ ﻳﺗﻼءﻡ ﻣﻊ ﻁﺑﻳﻌﺔ ﺣﻳﺎﺓ ﺍﻷﺣﻳﺎء ﺍﻟﻌﻠﻳﺎ ﻭﺍﻹﻧﺳﺎﻥ‪ .‬ﻭﺇﺫﺍ ﺍﻓﺗﺭﺿﻧﺎ ﻭﺟﻭﺩ ﻧﻔﺱ ﻛﻣﻳﺔ ﻭﺗﺭﻛﻳﺯ‬ ‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺑﺎﻟﺩﻡ ﺍﻟﺑﺷﺭﻱ ﺑﺷﻛﻝ ﺳﺎﺋﻝ ﻭﻏﻳﺭ ﻣﺣﺻﻭﺭ ﺩﺍﺧﻝ ﺟﺩﺭﺍﻥ ﺍﻟﺧﻼﻳﺎ ﻓﺈﻥ ﻛﺛﺎﻓﺔ ﺍﻟﺩﻡ ﺳﺗﻛﻭﻥ ﻋﺎﻟﻳﺔ ﺇﻟﻰ ﺩﺭﺟﺔ ﻻ‬ ‫ﺗﺳﻣﺢ ﺑﺎﻟﺣﻳﺎﺓ‪ ،‬ﻛﻣﺎ ﺃﻥ ﻋﻣﻠﻳﺔ ﺗﺑﺎﺩﻝ ﺍﻷﻛﺳﺟﻳﻥ ﻭﺛﺎﻧﻲ ﺃﻛﺳﻳﺩ ﺍﻟﻛﺎﺭﺑﻭﻥ ﺑﻳﻥ ﺍﻟﺩﻡ ﻭﺍﻷﻧﺳﺟﺔ ﻭﺍﻟﺭﺋﺗﻳﻥ ﻟﻥ ﺗﻛﻭﻥ ﻛﻔﻭءﺓ‪ .‬ﺇﺿﺎﻓﺔ‬ ‫ﺇﻟﻰ ﻛﻝ ﻫﺫﺍ ﻓﺈﻥ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺳ ُﺗﻔﻘﺩ ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﻛﻠﻳﺗﻳﻥ ﻓﻲ ﺍﻟﺑﻭﻝ ﻷﻥ ﺣﺟﻡ ﺟﺯﻳﺋﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻫﻭ ﺻﻐﻳﺭ‬ ‫ﻧﺳﺑﻳﺎ ً‪ .‬ﺇﻥ ﺧﺭﻭﺝ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺑﻭﻝ ﺳﻭﻑ ﻳﺳﺑﺏ‪ ،‬ﺇﺿﺎﻓﺔ ﻟﺧﺳﺎﺭﺓ ﺍﻟﺟﺳﻡ ﻟﻠﺑﺭﻭﺗﻳﻥ ﻧﻔﺳﻪ ﻭﻣﺎ ﻳﺣﻭﻳﻪ ﻣﻥ‬ ‫ﺫﺭﺍﺕ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﺇﻟﻰ ﺍﻧﺳﺩﺍﺩ ﺍﻟﻣﺟﺎﺭﻱ ﺍﻟﺿﻳّﻘﺔ ﻟﻠﻛﻠﻳﺗﻳﻥ‪ .‬ﺇﻥ ﻫﺫﺍ ﻳﺣﺩﺙ ﺃﺣﻳﺎﻧﺎ ً ﻟﺩﻯ ﺍﻧﺣﻼﻝ ﻋﺩﺩ ﺿﺧﻡ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻓﻲ‬ ‫ﺣﺎﻻﺕ ﻣﺭﺿﻳﺔ ﺧﺎﺻﺔ‪ ،‬ﺣﻳﺙ ﺗﺗﺣﺭﺭ ﻛﻣﻳﺔ ﻛﺑﻳﺭﺓ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﺳﺭﻋﺎﻥ ﻣﺎ ﺗﻅﻬﺭ ﻓﻲ ﺍﻟﺑﻭﻝ‪،‬ﻭﻗﺩ ﻳﺅﺩﻱ ﺍﻷﻣﺭ ﻛﺫﻟﻙ ﺇﻟﻰ‬ ‫ﺗﻭﻗﻑ ﻋﻣﻝ ﺍﻟﻛﻠﻳﺗﻳﻥ‪.‬‬

‫ﺗﻐﻳّﺭ ﺷﻛﻝ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء‪ ،‬ﻛﻣﺎ ﺫﻛﺭﺕ ﻣﻥ ﻗﺑﻝ‪ ،‬ﻟﻬﺎ ﺷﻛﻝ ﺛﺎﺑﺕ ﻓﻲ ﺍﻷﺣﻭﺍﻝ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﻛﻧﻬﺎ ﻟﻳﺳﺕ ﺟﺳﻣﺎ ً ﺻﻠﺑﺎ ً ﺑﻣﻌﻧﻰ ﺍﻟﻛﻠﻣﺔ ﺑﻝ‬ ‫ّ‬ ‫ﻭﻣﻁﺎﻁﺔ ﻭﻗﺎﺑﻠﺔ ﻟﻼﻧﺿﻐﺎﻁ ﺑﺳﻬﻭﻟﺔ‪ ،‬ﺛﻡ ﺍﻟﻌﻭﺩﺓ ﺇﻟﻰ ﺷﻛﻠﻬﺎ ﺍﻷﺻﻠﻲ‪ .‬ﻭﻛﻣﺛﺎﻝ ﻳﺣﺩﺙ ﻓﻲ ﻛﻝ ﻭﻗﺕ‪ ،‬ﺗﻧﻁﻭﻱ ﺍﻟﺧﻠﻳﺔ‬ ‫ﻫﻲ ﻟﺩﻧﺔ‬ ‫ﺍﻟﺣﻣﺭﺍء ﻟﺗﻣﺭ ﺧﻼﻝ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺷﻌﺭﻳﺔ‪ ،‬ﻭﻗﺩ ﻣ ّﺭ ﺃﻥ ﻣﻌﺩّﻝ ﻗﻁﺭ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ‪ 7,5‬ﻣﺎﻳﻛﺭﻭﻣﺗﺭ‪ ،‬ﺑﻳﻧﻣﺎ ﻗﻁﺭ ﺍﻟﺷﻌﻳﺭﺓ ﺍﻟﺩﻣﻭﻳﺔ‬ ‫ﻻ ﻳﺯﻳﺩ ﻋﻥ ‪ 3‬ﻣﺎﻳﻛﺭﻭﻣﺗﺭ‪.‬‬ ‫ﺇﻻ ﺃﻥ ﺗﻐﻳّﺭ ﺍﻟﺷﻛﻝ ﺍﻟﻁﺑﻳﻌﻲ ﻟﻠﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‪ ،‬ﺑﻌﺿﻬﺎ ﺃﻭ ﻣﻌﻅﻣﻬﺎ‪ ،‬ﺑﺻﻭﺭﺓ ﺩﺍﺋﻣﺔ ﻫﻭ ﺗﺷﻭّ ﻩ ﻳﺩﻝ ﻋﻠﻰ ﻣﺭﺽ ﻣﻥ‬ ‫ﺍﻷﻣﺭﺍﺽ‪ .‬ﺳﻳﺭﺩ ﺗﻔﺻﻳﻝ ﺫﻟﻙ ﻓﻳﻣﺎ ﺑﻌﺩ‪.‬‬ ‫‪U‬‬

‫اﻟﻬﻴﻤـ ـ ــﻮﻏﻠﻮﺑﻴﻦ‬ ‫ﺗﺭﻛﻳﺑــــــــــﻪ )ﺷﻛﻝ ‪(4‬‬

‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻫﻭ ﻧﻭﻉ ﺧﺎﺹ ﻣﻥ ﺃﻧﻭﺍﻉ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ‪ ،‬ﻭﺯﻧﻪ ﺍﻟﺟﺯﻳﺋﻲ )‪ (64,450‬ﺩﺍﻟﺗﻭﻥ ﻭﺗﺗﻛﻭّ ﻥ ﺟﺯﻳﺋﺗﻪ ﻣﻥ ﺃﺭﺑﻊ ﺳﻼﺳﻝ‬ ‫ﻣﻥ ]ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ[ ﻋﻠﻰ ﺷﻛﻝ ﺯﻭﺟﻳﻥ‪ :‬ﺍﻟﺯﻭﺝ ﺍﻷﻭﻝ ﻳﺳﻣّﻰ ﺳﻠﺳﻠﺔ )ﺃ( ﻭﺍﻟﺯﻭﺝ ﺍﻟﺛﺎﻧﻲ ﻳﺳﻣّﻰ ﺳﻠﺳﻠﺔ )ﺏ( ﻟﺩﻯ ﺍﻹﻧﺳﺎﻥ‬ ‫ﺍﻟﺑﺎﻟﻎ‪ ،‬ﺣﻳﺙ ﻳﺳﻣّﻰ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺫﻱ ﻳﺣﺗﻭﻳﻬﺎ ]ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﺃ[‪ .‬ﻭﺗﺣﻝ ﺳﻠﺳﻠﺔ ﻣﺧﺗﻠﻔﺔ ﻗﻠﻳﻼً ﻣﺣﻝ ﺳﻠﺳﻠﺔ ﺏ‪ ،‬ﺍﺳﻣﻬﺎ ]ﺳﻠﺳﻠﺔ‬ ‫ﺝ[ ﻓﻲ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻷﻁﻔﺎﻝ ﺣﺩﻳﺛﻲ ﺍﻟﻭﻻﺩﺓ )ﻭﻓﻲ ﺍﻷﺷﻬﺭ ﺍﻟﻘﻠﻳﻠﺔ ﻗﺑﻝ ﺍﻟﻭﻻﺩﺓ(‪ ،‬ﻭﺍﻟﺫﻱ ﻳﺳﻣﻰ ]ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﻑ[‪ .‬ﻛﻣﺎ ﺗﻭﺟﺩ‬ ‫ﻓﻲ ﻛﻝ ﺍﻷﻋﻣﺎﺭ ﻣﻥ ﺑﻌﺩ ﺍﻟﻁﻔﻭﻟﺔ ﺍﻟﻣﺑ ّﻛﺭﺓ ﻧﺳﺑﺔ ﺿﺋﻳﻠﺔ ﻣﻥ ]ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﺃ‪ [2‬ﺗﺣﺗﻭﻱ ﻋﻠﻰ ﺯﻭﺝ ﻣﻥ ﺳﻠﺳﻠﺔ ﺃ ﻭﺯﻭﺝ ﻣﻥ‬ ‫]ﺳﻠﺳﻠﺔ ﺩ[ )ﺑﺩﻝ ﺏ ﻭ ﺝ( ﻣﻥ ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ‪ .‬ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﺃ‪ 2‬ﻳﺗﻭﺍﺟﺩ ﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ ﺑﻧﺳﺑﺔ ﺃﻗﻝ ﻣﻥ ‪ %1‬ﻭﺗﺯﺩﺍﺩ ﺗﺭﻳﺟﻳﺎ ً‬ ‫ﺑﻌﺩﻫﺎ ﻟﺗﺻﻝ ﺣﻭﺍﻟﻲ ‪ %2,5‬ﻭﺗﻘﻑ ﻫﻧﺎﻙ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻁﺑﻳﻌﻳﺔ‪.‬‬ ‫‪12‬‬

‫ﺗﺭﺗﺑﻁ ﺑﻛﻝ ﺳﻠﺳﻠﺔ ﻣﻥ ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ ﺣﻠﻘﺔ ﺭﺑﺎﻋﻳﺔ ﻣﻥ ]ﺍﻟﻘﻭﺍﻋﺩ ﺍﻟﻧﺎﻳﺗﺭﻭﺟﻳﻧﻳﺔ[ ﺗﺳﻣﻰ ﻛﻳﻣﻳﺎﻭﻳﺎ ً ]ﺑﻭﺭﻓﻳﺭﻳﻥ[ ﺗﺗﺻﻝ ﺑﻬﺎ‬ ‫ﺫﺭﺓ ﻭﺍﺣﺩﺓ ﻣﻥ ]ﺍﻟﺣﺩﻳﺩﻭﺯ[‪ .‬ﻳﻣﻛﻥ ﻟﻛﻝ ﺫﺭﺓ ﺣﺩﻳﺩ ﺃﻥ ﺗﺭﺗﺑﻁ ﺑﺫﺭﺓ ﺃﻭﻛﺳﺟﻳﻥ ﻭﺍﺣﺩﺓ‪ .‬ﻭﻋﻠﻰ ﻫﺫﺍ ﺍﻷﺳﺎﺱ ﺗﺷﻣﻝ ﺍﻟﺟﺯﻳﺋﺔ‬ ‫ﺍﻟﻭﺍﺣﺩﺓ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻋﻠﻰ‪:‬‬ ‫‪ -1‬ﺃﺭﺑﻊ ﺳﻼﺳﻝ ﺃﻣﻳﻧﻳﺔ‬ ‫‪ -2‬ﺃﺭﺑﻊ ﺣﻠﻘﺎﺕ ﺭﺑﺎﻋﻳﺔ ﻣﻥ ﺍﻟﻘﻭﺍﻋﺩ ﺍﻟﻧﺎﻳﺗﺭﻭﺟﻳﻧﻳﺔ )ﺑﻭﺭﻓﻳﺭﻳﻥ(‬ ‫‪ - 3‬ﺃﺭﺑﻊ ﺫﺭﺍﺕ ﺣﺩﻳﺩ ﻋﻠﻰ ﺷﻛﻝ ﺣﺩﻳﺩﻭﺯ‬ ‫ﻭﺗﺳﺗﻁﻳﻊ ﺍﻟﺟﺯﻳﺋﺔ ﺍﻟﻭﺍﺣﺩﺓ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺣﻣﻝ ﺃﺭﺑﻊ ﺫﺭﺍﺕ ﻣﻥ ﺍﻷﻛﺳﺟﻳﻥ‪.‬‬ ‫‪1‬‬

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‫‪2‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -4‬ﺍﻷﺟﺯﺍء ﺍﻟﺛﻼﺛﺔ ﺍﻟﺭﺋﻳﺳﻳﺔ ﻟﺟﺯﻳﺋﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫‪-1‬ﺳﻠﺳﻠﺔ ﺃﺣﻣﺎﺽ ﺃﻣﻳﻧﻳﺔ‬ ‫‪U‬‬

‫‪ -2‬ﺣﻠﻘﺔ ﻗﻭﺍﻋﺩ ﻧﺎﻳﺗﺭﻭﺟﻳﻥ )ﺑﻭﺭﻓﺭﻳﻥ(‬

‫‪-3‬ﺫﺭﺓ ﺣﺩﻳﺩ‬

‫ﺻﻧﻊ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﻫﺩﻣﻬﺎ‪:‬‬

‫ﺇﻥ ﺍﻟﺧﻠﻳﺔ ﺍﻟﻣﻭﻟﺩﺓ ﻟﻠﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ]ﺃﺭﻭﻣﺔ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء[‪ ،‬ﻭﻫﻲ ﻧﻭﻉ ﻣﻥ ]ﺍﻷﺭﻭﻣﺎﺕ[ ﺗﻭﻟﺩ ﻛﻝ ﻣﻧﻬﺎ ﻧﻭﻋﺎ ً ﻣﻥ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‬ ‫ﺩﺍﺧﻝ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪ ،‬ﺗﺣﺗﺎﺝ ﺇﻟﻰ ﻣﻭﺍﺩ ﺃﻭﻟﻳﺔ ﻣﻧﻭّ ﻋﺔ ﻟﺗﺻﻧﻊ ﻣﻧﻬﺎ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻭﺑﻌﺩ ﺍﻧﻘﺳﺎﻣﺎﺕ ﻣﺗﻌﺩﺩﺓ ﻭﺗﻐﻳﻳﺭﺍﺕ‬ ‫ﻣﺗﺗﺎﻟﻳﺔ ﻓﻲ ﺗﺭﻛﻳﺑﻬﺎ ﻳﻛﺗﻣﻝ ﻣﺣﺗﻭﺍﻫﺎ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ .‬ﺑﺫﻟﻙ ﻳﻛﻭﻥ ﻗﺩ ﺍﻛﺗﻣﻝ ﻧﺿﻭﺝ ﺍﻟﺧﻠﻳﺔ ﻭﺃﺻﺑﺣﺕ ﺟﺎﻫﺯﺓ ﻟﻠﺧﺭﻭﺝ ﻣﻥ‬ ‫ﺍﻟﻧﺧﺎﻉ ﺇﻟﻰ ﺍﻟﺩﻡ‪ ،‬ﻓﺗﻔﻘﺩ ﻧﻭﺍﺗﻬﺎ ﻟﺗﺻﺑﺢ ﺧﻠﻳﺔ ﺣﻣﺭﺍء ﻭﻳﺩﻓﻊ ﺑﻬﺎ ﺍﻟﻧﺧﺎﻉ ﺇﻟﻰ ﻣﺟﺭﻯ ﺍﻟﺩﻡ‪ .‬ﺗﺣﺻﻝ ﺍﻷﺭﻭﻣﺔ ﻋﻠﻰ ﺍﻟﻣﻭﺍﺩ ﺍﻟﻼﺯﻣﺔ‬ ‫ﻟﺻﻧﻊ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻣﻥ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻳﻧﻘﻠﻬﺎ ﺇﻟﻰ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻣﻥ ﻣﺧﺎﺯﻧﻬﺎ ﻓﻲ ﺍﻟﺟﺳﻡ‪ .‬ﻣﻥ ﺍﻟﻧﺎﺣﻳﺔ ﺍﻷﺧﺭﻯ‪ ،‬ﻓﺈﻥ ﺗﺣﻁﻳﻡ ﺍﻟﺧﻠﻳﺔ‬ ‫ﺍﻟﺣﻣﺭﺍء ﻟﺩﻯ ﺍﻧﺗﻬﺎء ﻋﻣﺭﻫﺎ )ﻭﺫﻟﻙ ﻓﻲ ﺍﻟﻁﺣﺎﻝ ﻋﺎﺩﺓ( ﻳﺗﺑﻌﻪ ﺗﻔﻛﻳﻙ ﻛﻝ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﻣﻭﺟﻭﺩﺓ ﺩﺍﺧﻠﻬﺎ ﺇﻟﻰ ﻣﻭﺍﺩﻫﺎ‬ ‫ﺍﻷﻭﻟﻳﺔ‪ .‬ﻓﺎﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ ﺗﺫﻫﺏ ﺇﻟﻰ ﺍﻟﺩﻡ ﻟﻳﻌﺎﺩ ﺍﺳﺗﻌﻣﺎﻟﻬﺎ ﻓﻲ ﺃﻱ ﻣﻛﺎﻥ ﻳﺣﺗﺎﺟﻪ ﺍﻟﺟﺳﻡ )ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺃﻭ ﺃﻱ ﻣﻛﺎﻥ ﻏﻳﺭﻩ(‪.‬‬ ‫ﺍﻟﺣﺩﻳﺩ ﻳﺫﻫﺏ ﺇﻟﻰ ﺍﻟﺩﻡ ﺃﻳﺿﺎ ً ﻟﻳﺣﻣﻠﻪ ﺇﻟﻰ ﺣﻳﺙ ﻳﺣﺗﺎﺟﻪ ﺍﻟﺟﺳﻡ ) ﻟﺻﻧﻊ ﺟﺯﻳﺋﺔ ﺟﺩﻳﺩﺓ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺃﻭ ﺃﻳﺔ ﺟﺯﻳﺋﺔ ﺃﺧﺭﻯ‬ ‫ﻳﺩﺧﻝ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺗﺭﻛﻳﺑﻬﺎ(‪ ،‬ﺃﻭ ﻟﻳُﺧﺯﻥ )ﻓﻲ ﺍﻟﻛﺑﺩ ﻋﺎﺩﺓ( ﺣﺗﻰ ﻳﻛﻭﻥ ﺍﺣﺗﻳﺎﻁﻳﺎ ً ﻭ ﻳﺳﺗﻌﻣﻝ ﻋﻧﺩ ﺍﻟﺣﺎﺟﺔ‪ .‬ﺃﻣﺎ ﺍﻟﺣﻠﻘﺔ ﺍﻟﺭﺑﺎﻋﻳﺔ ﻣﻥ‬ ‫‪13‬‬

‫ﺍﻟﻘﻭﺍﻋﺩ ﺍﻟﻧﺎﻳﺗﺭﻭﺟﻳﻧﻳﺔ )ﺍﻟﺑﻭﺭﻓﻳﺭﻳﻥ( ﻓﻳﺟﺭﻱ ﻓﺗﺣﻬﺎ ﻟﺗﺻﺑﺢ ﺳﻠﺳﻠﺔ ﺭﺑﺎﻋﻳﺔ ﻫﻲ ﻣﺎﺩﺓ ]ﺍﻟﺻﻔﺭﺍء[ ﺃﻭ ﺍﻟﺑﻠﺭﻭﺑﻳﻥ )ﺷﻛﻝ ﺭﻗﻡ ‪(5‬‬ ‫ﻭﻳﻧﻘﻠﻬﺎ ﺍﻟﺩﻡ ﺇﻟﻰ ﺍﻟﻛﺑﺩ ﻟﺗﻘﻭﻡ ﺧﻼﻳﺎﻩ ﺑﺈﺟﺭﺍء ﺗﻐﻳﻳﺭﺍﺕ ﻓﻲ ﺗﺭﻛﻳﺑﻬﺎ ﺛﻡ ﻳﻔﺭﺯﻫﺎ ﺇﻟﻰ ]ﺍﻟﻣﺭﺍﺭﺓ[ ﺍﻟﺗﻲ ﺗﻘﻭﻡ ﺑﺗﺭﻛﻳﺯﻫﺎ ﺛﻡ ﺇﻓﺭﺍﺯﻫﺎ‬ ‫ﺇﻟﻰ ﺍﻷﻣﻌﺎء ﻟﺗﺳﺎﻋﺩ ﻫﻧﺎﻙ ﻋﻠﻰ ﻫﺿﻡ ﻭﺍﻣﺗﺻﺎﺹ ﺍﻟﻣﻭﺍﺩ ﺍﻟﺩﻫﻧﻳﺔ ﻓﻲ ﺍﻟﻁﻌﺎﻡ‪.‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -5‬ﺟﺯﻳﺋﺔ ﺍﻟﺑﻠﺭﻭﺑﻳﻥ‬

‫ﻫﺫﺍ ﺍﻟﺷﺭﺡ ﺍﻟﻣﻭﺟﺯ ﻋﻥ ﻣﺂﻝ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻳﻌﻁﻲ ﻓﻛﺭﺓ ﻋﻥ ﺃﻥ ﺍﻟﺟﺳﻡ ُﺧﻠﻕ ﻟﻳﻌﻣﻝ ﻭﻓﻕ ﺍﻗﺗﺻﺎﺩ ّ‬ ‫ﻣﻧﻅﻡ ﻭﺩﻗﻳﻕ‬ ‫ﻟﻳﺳﺗﻔﻳﺩ ﻣﻥ ﻛﻝ ﺟﺯﻳﺋﺔ ﻭﺫﺭﺓ ﻋﻧﺩﻩ ﺇﻟﻰ ﺃﻗﺻﻰ ﺣﺩ ﻣﻣﻛﻥ‪.‬‬

‫ﺍﻟﺣــــﺩﻳﺩ‬ ‫ﺇﻻ ﺃﻥ ﻣﺎ ﺫﻛﺭﺗﻪ ﻓﻲ ﺍﻟﻔﻘﺭﺓ ﺃﻋﻼﻩ ﻻ ﻳﻌﻧﻲ ﺃﻥ ﻫﺫﻩ ﺍﻟﺟﺯﻳﺋﺎﺕ ﻻ ﻳُﻔﻘﺩ ﻣﻧﻬﺎ ﺷﻲء ﺃﺑﺩﺍً‪ ،‬ﻓﺑﻌﺽ ﺫﺭﺍﺕ ﺍﻟﺣﺩﻳﺩ ُﺗﻔﻘﺩ ﻳﻭﻣﻳﺎ ً ﺿﻣﻥ‬ ‫ّ‬ ‫ﺍﻟﻣﺑﻁﻧﺔ ﻟﻸﻣﻌﺎء ﺍﻟﺗﻲ ﺗﺗﺳﺎﻗﻁ ﻣﻥ ﺳﻁﺢ ﺍﻷﻣﻌﺎء ﺍﻟﺩﺍﺧﻠﻲ‪.‬‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺗﻘﺭّﻧﺔ ﺍﻟﺗﻲ ﺗﺗﺳﺎﻗﻁ ﻣﻥ ﺳﻁﺢ ﺍﻟﺟﻠﺩ ﻭﻛﺫﻟﻙ ﺿﻣﻥ ﺍﻟﺧﻼﻳﺎ‬ ‫ُﺗﻔﻘﺩ ﺑﻌﺽ ﺫﺭﺍﺕ ﺍﻟﺣﺩﻳﺩ ﻣﻊ ﺍﻹﻓﺭﺍﺯﺍﺕ ﺍﻟﻣﺧﺗﻠﻔﺔ ﺃﻳﺿﺎ ً‪ .‬ﻫﺫﺍ ﻁﺑﻌﺎ ً ﻋﺩﺍ ﻣﺎ ﻳُﻔﻘﺩ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻣﻊ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻳُﻧﺯﻑ ﻷﻱ ﺳﺑﺏ‪.‬‬ ‫ﻓﻲ ﺍﻟﺟﺳﻡ ﻣﺧﺯﻭﻥ ﻣﻥ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﺃﻛﺛﺭﻩ ﻓﻲ ﺍﻟﻛﺑﺩ )ﺣﻭﺍﻟﻲ ‪ 500‬ﻣﻠﻐﺭﺍﻡ ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﺍﻟﺑﺎﻟﻎ ﺍﻟﻁﺑﻳﻌﻲ(‪ .‬ﺃﻣﺎ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺍﻟﺗﻲ ﺗﻧﺣﻝ ﻳﻭﻣﻳﺎ ً ﻓﺈﻥ ﻣﺣﺗﻭﺍﻫﺎ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻻ ﻳُﻔﻘﺩ ﺑﻝ ﻳُﻌﺎﺩ ﺍﺳﺗﻌﻣﺎﻟﻪ ﺃﻭ ﻳُﺧﺯﻥ‪ ،‬ﻭﻟﻭﻻ ﺫﻟﻙ ﻟﻛﺎﻧﺕ ﺧﺳﺎﺭﺓ ﺍﻟﺟﺳﻡ ﻛﺑﻳﺭﺓ‬ ‫ﻭﺗﻌﻭﻳﺿﻬﺎ ﻣﺳﺗﺣﻳﻼً‪ .‬ﺇﻥ ﺗﻌﻭﻳﺽ ﻛﻝ ﻣﺎ ﻗﺩ ﻳﺧﺳﺭﻩ ﺍﻟﺟﺳﻡ ﺇﻟﻰ ﺍﻟﺧﺎﺭﺝ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻳﺄﺗﻲ – ﺑﻁﺑﻳﻌﺔ ﺍﻟﺣﺎﻝ‪ -‬ﻣﻥ ﺍﻟﻁﻌﺎﻡ ﺍﻟﺫﻱ‬ ‫ﻧﺗﻧﺎﻭﻟﻪ‪ .‬ﻭﺇﺫﺍ ﻛﺎﻥ ﻓﻲ ﺍﻟﻁﻌﺎﻡ ﺯﻳﺎﺩﺓ ﻋﻥ ﺣﺎﺟﺔ ﺍﻟﺟﺳﻡ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻓﺈﻥ ﺍﻷﻣﻌﺎء ﻻ ﺗﻣﺗﺹ ﺇﻻ ﺣﺎﺟﺗﻪ‪ ،‬ﻭﺫﻟﻙ ﺿﻣﻥ ﻋﻣﻠﻳﺔ ﺩﻗﻳﻘﺔ‬ ‫ﺟﺩﺍً ﻭﻣﺳﻳﻁﺭﺍً ﻋﻠﻳﻬﺎ )ﺇﻻ ﻓﻲ ﺣﺎﻻﺕ ﻣﺭﺿﻳﺔ ﺧﺎﺻﺔ ﻭﻧﺎﺩﺭﺓ ﺃﻭ ﺑﺎﻟﺗﺳﻣﻡ ﺑﺗﻧﺎﻭﻝ ﻛﻣﻳﺎﺕ ﻛﺑﻳﺭﺓ ﻣﻥ ﺣﺑﻭﺏ ﺍﻟﺣﺩﻳﺩ(‪ ،‬ﻷﻥ ﻭﺟﻭﺩ‬ ‫ﺯﻳﺎﺩﺓ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﺟﺳﻡ ﻣﺿ ّﺭ ﻟﻪ‪ .‬ﺃﻣﺎ ﺇﺫﺍ ﺣﺻﻝ ﻧﻘﺹ ﻓﻲ ﻣﺣﺗﻭﻯ ﺍﻟﺟﺳﻡ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻭﺍﺳ ُﺗﻧﻔﺩ ﺍﻟﻣﺧﺯﻭﻥ ﺍﻻﺣﺗﻳﺎﻁﻲ ﺗﻣﺎﻣﺎ ً‬ ‫ﻓﺈﻥ ﺫﻟﻙ ﻳﺅﺩﻱ ﺇﻟﻰ ﻓﻘﺭ ﻓﻲ ﺍﻟﺩﻡ‪ ،‬ﻛﻣﺎ ﺳﻳﺭﺩ ﺗﻔﺻﻳﻠﻪ ﻓﻳﻣﺎ ﺑﻌﺩ‪.‬‬

‫ﺍﻟﻣﻭﺍﺩ ﺍﻷﺧﺭﻯ ﺍﻟﻣﺳﺎﻋﺩﺓ ﻓﻲ ﺻﻧﻊ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺇﻥ ﻋﻣﻠﻳﺔ ﺻﻧﻊ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻭﺗﻧﺿﻳﺟﻬﺎ ﻭﺻﻧﻊ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺩﺍﺧﻠﻬﺎ ﺗﺣﺗﺎﺝ ﺇﻟﻰ ﺍﻟﻣﻭﺍﺩ ﺍﻷﻭﻟﻳﺔ ﺍﻟﺗﻲ ﺫﻛﺭﺗﻬﺎ ﺳﺎﺑﻘﺎً‪،‬‬ ‫ﻛﻣﺎ ﺃﻥ ﻫﻧﺎﻙ ﻋﻭﺍﻣﻝ ﺃﺧﺭﻯ ﻣﺳﺎﻋﺩﺓ ﻳﺣﺗﺎﺟﻬﺎ ﺍﻟﺟﺳﻡ ﺑﻛﻣﻳﺎﺕ ﻣﺣﺩﺩﺓ ﻟﺻﻧﻊ ﺍﻟﺧﻼﻳﺎ ﻭﻧﺿﺟﻬﺎ‪ ،‬ﻣﻧﻬﺎ ﻋﻠﻰ ﺳﺑﻳﻝ ﺍﻟﻣﺛﺎﻝ‬ ‫]ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪] ،[12‬ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ[ ﻭﻫﻭ ﻣﻥ ﻓﻳﺗﺎﻣﻳﻧﺎﺕ ﻣﺟﻣﻭﻋﺔ ﺏ‪ ،‬ﻭ]ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ ،[6‬ﻭﻛﺫﻟﻙ ﺑﻌﺽ ﺍﻟﻬﺭﻣﻭﻧﺎﺕ ﻣﺛﻝ ]‬ ‫ﻫﻭﺭﻣﻭﻥ ﻣﻭﻟﺩ ﺍﻟﺣﻣﺭﺍء[ ﻭﻛﻣﻳﺎﺕ ﺿﺋﻳﻠﺔ ﻣﻥ ﺍﻟﻧﺣﺎﺱ‪.‬‬

‫‪14‬‬

‫ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻫﻭ ﻟﻳﺱ ﻓﻘﻁ ﻣﻭﻁﻧﺎ ً ﻟﺻﻧﻊ ﻭﻧﺿﺞ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﻭﺇﻧﻣﺎ ﺗﻔﺭﺯ ﺑﻌﺽ ﺧﻼﻳﺎﻩ ﺍﻟﺳﺎﻧﺩﺓ ]ﻣﻔﻌّﻼﺕ ﺧﻠﻭﻳﺔ[ ﻭ]ﻋﻭﺍﻣﻝ‬ ‫ﻣﺎﺑﻳﻥ ﺍﻟﺧﻠﻭﻳﺔ[ ﻟﺗﻘﻭﻡ ﺑﺩﻭﺭ ﺭﺋﻳﺱ ﻓﻲ ﺗﻧﺿﻳﺞ ﺍﻟﺧﻼﻳﺎ ﺧﻁﻭﺓ ﺧﻁﻭﺓ ﺣﺗﻰ ﺗﺻﻝ ﺇﻯ ﺍﻟﻣﺭﺍﺣﻝ ﺍﻟﻧﻬﺎﺋﻳﺔ ﻟ ُﺗﺳﻠّﻡ ﺇﻟﻰ ﺍﻟﺩﻡ‪.‬‬

‫ﺍﻟﺣﺩﻭﺩ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺩﻡ‬ ‫ﻳﺧﺗﻠﻑ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﻛﻝ ‪ 100‬ﺳﻡ‪) 3‬ﺃﻭ ﻟﺗﺭ( ﻣﻥ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺑﺎﺧﺗﻼﻑ ﻋﻣﺭ ﺍﻟﻔﺭﺩ ﻭﻛﺫﻟﻙ ﺑﺎﺧﺗﻼﻑ‬ ‫ﺍﻟﺟﻧﺱ ﺑﻌﺩ ﺍﻟﺑﻠﻭﻍ‪ .‬ﺍﻟﺟﺩﻭﻝ ﺭﻗﻡ ‪ 1‬ﻳﺑﻳﻥ ﺍﻟﺣﺩﻭﺩ ﺍﻟﺩﻧﻳﺎ ﻭﺍﻟﻌﻠﻳﺎ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﻘﺑﻭﻟﺔ ﻟﺩﻯ ﺃﻛﺛﺭ ﺍﻷﻁﺑﺎء‪.‬‬ ‫‪U‬‬

‫ﺟﺩﻭﻝ ﺭﻗﻡ‪1-‬‬ ‫ﺗﺮﻛﻴﺰ اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ﻓﻲ اﻟﺪم ﻓﻲ اﻟﺤﺎﻟﺔ اﻟﻄﺒﻴﻌﻴﺔ‬

‫ﻋﻣﺭ ﺍﻹﻧﺳـــــﺎﻥ ﻭﺟﻧﺳﻪ‬

‫ﺍﻟﺣﺩﻭﺩ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻏﻡ‪/‬ﺩﻝ*‬

‫ﺍﻟﻁﻔﻝ ﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ‬

‫‪19,5 -14,5‬‬

‫ﺍﻟﻁﻔﻝ ﻓﻲ ﺍﻷﻳﺎﻡ ﺍﻷﻭﻟﻰ ﻣﻥ ﻋﻣﺭﻩ‬

‫‪18 -13‬‬

‫ﺍﻟﻁﻔﻝ ﻋﻣﺭ ‪ 3‬ﺷﻬﻭﺭ‬

‫‪12,5-10‬‬

‫ﺍﻟﻁﻔﻝ ﻣﻥ ‪ 3‬ﺷﻬﻭﺭ ﺇﻟﻰ ﺳﻧﺔ ﻣﻥ ﺍﻟﻌﻣﺭ‬

‫‪13 -10,5‬‬

‫ﺍﻟﻁﻔﻝ ﻣﻥ ﺳﻧﺔ ﺇﻟﻰ ‪ 5‬ﺳﻧﻭﺍﺕ ﻣﻥ ﺍﻟﻌﻣﺭ‬

‫‪14 -11‬‬

‫ﺍﻟﻁﻔﻝ ﻣﻥ ‪ 5‬ﺳﻧﻭﺍﺕ ﺇﻟﻰ ‪ 12‬ﺳﻧﺔ ﻣﻥ ﺍﻟﻌﻣﺭ‬

‫‪14,5 -11,5‬‬

‫ﺍﻟﺫﻛﻭﺭ ﺑﻌﺩ ﻋﻣﺭ ‪ 12‬ﺳﻧﺔ‬

‫‪17,5 -13‬‬

‫ﺍﻹﻧﺎﺙ ﺑﻌﺩ ﻋﻣﺭ ‪ 12‬ﺳﻧﺔ‬

‫‪16,5 -12‬‬

‫*ﻏﻢ‪/‬دل أي ﺑﺎﻟﻐﺮاﻣﺎت ﻓﻲ ﻛﻞ دﺳﻲ ﻟﻴﺘﺮ أو ‪ 100‬ﺳﻢ‪ 3‬ﻣﻦ اﻟﺪم وﻳﻤﻜﻦ ﺿﺮب اﻟﺮﻗﻢ ﻓﻲ ‪ 10‬ﻟﻴﺼﺒﺢ اﻟﺘﺮﻛﻴﺰ ﺑﺎﻟﻐﺮاﻣﺎت‬ ‫ﻟﻜﻞ ﻟﺘﺮ ﻣﻦ اﻟﺪم‪.‬‬ ‫ﻣﻼﺣﻅﺔ‪ :‬ﻛﺎﻧﺕ ﻧﺗﻳﺟﺔ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺩﻡ ُﺗﻌﻁﻰ ﺳﺎﺑﻘﺎ ً ﻋﻠﻰ ﺷﻛﻝ ﻧﺳﺑﺔ ﻣﺋﻭﻳﺔ‪ ،‬ﻭﻟﻛﻥ ﺍﻟﺗﻌﺑﻳﺭ ﻋﻧﻬﺎ ﺑﺎﻟﻐﺭﺍﻡ ﻓﻲ‬ ‫ﻛﻝ ﺩﺳﻲ ﻟﺗﺭ ﺃﻭ ﺍﻟﻐﺭﺍﻡ ﻓﻲ ﻛﻝ ﻟﺗﺭ ﻫﻭ ﺍﻟﻣﻌﻣﻭﻝ ﺑﻪ ﻏﺎﻟﺑﺎ ً ﺍﻵﻥ ﻭﻫﻭ ﺍﻷﺩﻕ‪ .‬ﻓﻔﻲ ﺣﺎﻟﺔ ﺍﻟﻧﺳﺑﺔ ﺍﻟﻣﺋﻭﻳﺔ ﻳﺟﺏ ﺍﻻﺗﻔﺎﻕ ﻋﻠﻰ‬ ‫ﺍﻟﺭﻗﻡ ﺍﻟﺫﻱ ﻳﻣﺛﻝ ‪ %100‬ﻭﻫﻭ ﺃﻣﺭ ﻓﻳﻪ ﺧﻼﻑ‪ .‬ﺇﺫﺍ ﺃﺭﺩﺕ ﺗﺣﻭﻳﻝ ﻧﺗﻳﺟﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺇﻟﻰ ﻧﺳﺑﺔ ﻣﺋﻭﻳﺔ ﺗﻘﺳّﻡ ﺍﻟﻧﺗﻳﺟﺔ‬ ‫ﻋﻠﻰ ‪) 14,8‬ﻭﻫﻭ ﺭﻗﻡ ﺭﺑﻣﺎ ﻳﻣﺛﻝ ‪ (%100‬ﻭﺗﺿﺭﺏ ﺍﻟﻧﺎﺗﺞ ﻓﻲ ﻣﺎﺋﺔ‪ .‬ﻓﻣﺛﻼً‪ ،‬ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺗﺭﻛﻳﺯ ‪ّ 11,5‬‬ ‫ﻳﻣﺛﻝ‬ ‫‪.%77,7‬‬

‫ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺟﻧﻳﻥ ﻭﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ‪:‬‬ ‫ُﻼﺣﻅ ﻣﻥ ﺟﺩﻭﻝ ﺭﻗﻡ ‪ 1‬ﺃﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻋﺎﻟﻲ ﺍﻟﺗﺭﻛﻳﺯ ﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ )ﻭﻛﺫﻟﻙ ﻳﻛﻭﻥ ﻗﺑﻠﻬﺎ(‪ ،‬ﻭﺍﻟﺳﺑﺏ‪ ،‬ﻛﻣﺎ ﻫﻭ ﻣﻌﻠﻭﻡ‪،‬‬ ‫ﻳ َ‬ ‫ﺃﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻳﺄﺧﺫ ﺍﻷﻭﻛﺳﺟﻳﻥ ﻣﻥ ﺍﻟﻣﺷﻳﻣﺔ )ﺍﻟﺗﻲ ﺗﺄﺧﺫﻩ ﻣﻥ ﺩﻡ ﺍﻷﻡ( ﺇﻟﻰ ﺃﻧﺳﺟﺔ ﺍﻟﺟﻧﻳﻥ‪ .‬ﻭﻟﻣﺎ ﻛﺎﻥ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ‬

‫‪15‬‬

‫ﻋﺎﻝ‬ ‫ﺍﻷﻭﻛﺳﺟﻳﻥ ﻣﻥ ﺍﻷﻡ ﺃﺻﻌﺏ ﻣﻥ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻳﻪ ﻣﻥ ﻫﻭﺍء ﺍﻟﺭﺋﺗﻳﻥ )ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ( ﻓﻘﺩ ﺻﺎﺭ ﺿﺭﻭﺭﻳﺎ ً ﻭﺟﻭﺩ ﺗﺭﻛﻳﺯ ٍ‬ ‫ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺩﻡ ﺍﻟﺟﻧﻳﻥ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﻛﻣﻳﺔ ﺍﻷﻛﺳﺟﻳﻥ ﺍﻟﻣﻁﻠﻭﺑﺔ‪.‬‬ ‫ﺃﻣﺎ ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ ﻋﻧﺩﻣﺎ ﻳﺑﺩﺃ ﺍﻟﻁﻔﻝ ﺑﺎﻟﺗﻧﻔﺱ ﺍﻟﺭﺋﻭﻱ ﻓﺈﻧﻪ ﻳﺣﺻﻝ ﻋﻠﻰ ﺍﻷﻭﻛﺳﺟﻳﻥ ﺑﺳﻬﻭﻟﺔ ﻭﻳﺄﺧﺫ ﻛﻔﺎﻳﺗﻪ ﻣﻧﻪ ﻓﻼ ﻳﻌﻭﺩ‬ ‫ﺩﺍﻉ ﻟﻠﺗﺭﻛﻳﺯ ﺍﻟﻌﺎﻟﻲ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺫﻱ ﻛﺎﻥ ﻣﻭﺟﻭﺩﺍً ﻗﺑﻝ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﻓﻳﺑﺩﺃ ﺍﻟﺟﺳﻡ ﺑﻬﺩﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﺯﺍﺋﺩﺓ‪.‬‬ ‫ﻫﻧﺎﻙ ٍ‬ ‫ﻫﺫﺍ ﺍﻟﻬﺩﻡ ﻟﻠﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻳﺅﺩﻱ ﺑﺎﻟﻁﺑﻊ ﺇﻟﻰ ﺗﻔﻛﻳﻙ ﻣﺎ ﺑﻬﺎ ﻣﻥ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﻣﻥ ﺛ ّﻡ ﺗﻭﻟﻳﺩ ﻛﻣﻳﺎﺕ ﻛﺑﻳﺭﺓ ﻣﻥ ﻣﺎﺩﺓ‬ ‫ﺍﻟﺻﻔﺭﺍء‪ .‬ﻭﻟﻣﺎ ﻛﺎﻥ ﺍﻟﻛﺑﺩ ﻏﻳﺭ ﻣﻛﺗﻣﻝ ﺍﻟﻔﻌﺎﻟﻳﺔ ﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ ﻓﺈﻥ ﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء ﺗﺗﻛﺩّﺱ ﻓﻲ ﺍﻟﺩﻡ ﻭﻳﺭﺗﻔﻊ ﺗﺭﻛﻳﺯﻫﺎ‬ ‫ﻭﺗﺗﺭﺳﺏ ﻓﻲ ﺍﻷﻧﺳﺟﺔ‪ ،‬ﻓﻳﺑﺩﻭ ﺍﻟﻁﻔﻝ ﺃﺻﻔﺭ ﺍﻟﻠﻭﻥ‪ ،‬ﻭﻳﻅﻬﺭ ﻫﺫﺍ ﺍﻟﺻﻔﺎﺭ ﺟﻠ ّﻳﺎ ً ﻓﻲ ﻗﺯﺣﻳﺔ ﺍﻟﻌﻳﻧﻳﻥ‪ .‬ﻫﺫﺍ ﻫﻭ ]ﺍﻟﻳﺭﻗﺎﻥ[ ﺃﻭ‬ ‫ﺍﻻﺻﻔﺭﺍﺭ ﺍﻟﻁﺑﻳﻌﻲ ﻟﺩﻯ ﺣﺩﻳﺛﻲ ﺍﻟﻭﻻﺩﺓ‪ .‬ﺗﺧﺗﻠﻑ ﺷﺩﺓ ﻫﺫﺍ ﺍﻟﻳﺭﻗﺎﻥ ﺑﻳﻥ ﻭﻟﻳﺩ ﻭﺁﺧﺭ ﺣﺳﺏ ﻓﻌّﺎﻟﻳﺔ ﺍﻟﻛﺑﺩ‪.‬‬ ‫ﻣﺭﺿﻳﺔ ﻭﺷﺩﻳﺩﺓ ﻟﺩﻯ ﺑﻌﺽ ﺣﺩﻳﺛﻲ ﺍﻟﻭﻻﺩﺓ ﺑﺳﺑﺏ ﺃﻧﻭﺍﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺳﻳﺭﺩ ﺫﻛﺭﻫﺎ ﻓﻳﻣﺎ ﺑﻌﺩ ﻓﻲ‬ ‫ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﻳﺭﻗﺎﻥ َ‬ ‫ﺍﻟﻛﺗﺎﺏ‪.‬‬ ‫ﻭﺑﻣﻧﺎﺳﺑﺔ ﺫﻛﺭ ﺣﺩﻳﺛﻲ ﺍﻟﻭﻻﺩﺓ ﻭﺳﺑﺏ ﺯﻳﺎﺩﺓ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺩﻣﻬﻡ‪ ،‬ﺃﻗﻭﻝ ﺇﻥ ﺃﻱ ﺇﻧﺳﺎﻥ‪ ،‬ﻓﻲ ﺃﻱ ﻋﻣﺭ‪ ،‬ﻻ ﻳﺻﻝ ﺇﻟﻰ‬ ‫ﺃﻧﺳﺟﺗﺔ ﺟﺳﻣﻪ ﻛﻣﻳﺔ ﻛﺎﻓﻳﺔ ﻣﻥ ﺍﻷﻭﻛﺳﺟﻳﻥ )ﻷﺳﺑﺎﺏ ﻣﺗﻌﺩﺩﺓ ﻟﻬﺎ ﻋﻼﻗﺔ ﺑﻌﻣﻝ ﺍﻟﻘﻠﺏ ﺃﻭ ﺍﻟﺭﺋﺗﻳﻥ ﺃﻭ ﺗﺭﻛﻳﺏ ﺍﻟﺩﻡ ﻧﻔﺳﻪ ﺃﻭ‬ ‫ﺍﻻﺭﺗﻔﺎﻉ ﻋﻥ ﻣﺳﺗﻭﻯ ﺳﻁﺢ ﺍﻟﺑﺣﺭ( ﻧﺟﺩ ﻋﻧﺩﻩ ﺍﺭﺗﻔﺎﻋﺎ ً ﻓﻲ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻋﻥ ﺍﻟﺣﺩ ﺍﻟﻁﺑﻳﻌﻲ ﻓﻲ ﻋﻣﺭﻩ ﻟﺗﻌﻭﻳﺽ‬ ‫ﺫﻟﻙ ﺍﻟﻧﻘﺹ ﻭﺳﺩ ﺣﺎﺟﺔ ﺍﻷﻧﺳﺟﺔ ﻣﻥ ﺍﻷﻭﻛﺳﺟﻳﻥ‪.‬‬

‫‪16‬‬

‫اﻟﻔﺼﻞ اﻟﺜﺎﻧﻲ‬

‫ﻓﻘﺭ ﺍﻟـــــــــﺩﻡ‬ ‫‪U‬‬

‫ﻣﻧﺎﻗﺷﺔ ﻋﺎﻣــــــﺔ‬ ‫ﺗﻌﺭﻳﻑ ]ﻓﻘﺭ ﺍﻟﺩﻡ[‪:‬‬

‫ﻫﻭ ﺍﻟﻧﻘﺹ ﻓﻲ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺩﻡ ﻋﻥ ﺍﻟﺣﺩ ﺍﻷﺩﻧﻰ ﺍﻟﻣﻘﺭﺭ ﻟﻌﻣﺭ ﺍﻟﻔﺭﺩ ﻭﺟﻧﺳﻪ‪ ،‬ﻣﻊ ﻣﺎ ﻳﺗﺑﻌﻪ ﻣﻥ ﺃﻋﺭﺍﺽ‬ ‫ﻭﻋﻼﻣﺎﺕ ﺳﺭﻳﺭﻳﺔ‪.‬‬

‫ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻣﺎﺕ ﺍﻟﺳﺭﻳﺭﻳﺔ ﻟﻔﻘﺭ ﺍﻟﺩﻡ‪:‬‬ ‫ﺍ‪.‬ﻫﻧﺎﻙ ]ﺃﻋﺭﺍﺽ[ ﻭ]ﻋﻼﻣﺎﺕ[ ﻟﻔﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻳﺣﺻﻝ ﺑﺻﻭﺭﺓ ﺗﺩﺭﻳﺟﻳﺔ ﻟﺩﻯ ﺍﻟﻣﺭﻳﺽ ]ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻣﺯﻣﻥ[‪ ،‬ﻭﻫﻭ ﺍﻟﻧﻭﻉ‬ ‫ﺍﻟﻐﺎﻟﺏ ﻣﻥ ﺍﻟﻣﺭﺽ‪ ،‬ﻭﺗﺷﻣﻝ‬ ‫ﺍﻟﺷﺣﻭﺏ ﻓﻲ ﺍﻟﻭﺟﻪ ﻭﺍﻟﺟﻠﺩ ﻋﻣﻭﻣﺎ ً ﻭﻓﻲ ﺍﻷﻏﺷﻳﺔ ﺍﻟﻣﺑﻁﻧﺔ ﻟﻸﺟﻔﺎﻥ ﻭﺍﻟﻔﻡ‪.‬‬‫ﺍﻟﺷﻌﻭﺭ ﺑﺎﻟﺧﻣﻭﻝ ﻷﺑﺳﻁ ﺃﻧﻭﺍﻉ ﺍﻟﺟﻬﺩ‬‫ﺗﺳﺎﺭﻉ ﺩﻗﺎﺕ ﺍﻟﻘﻠﺏ ﺑﻌﺩ ﺟﻬﺩ ﺍﻋﺗﻳﺎﺩﻱ ﻣﺛﻝ ﺻﻌﻭﺩ ﺳﻠّﻡ‬‫ﺍﻟﺷﻌﻭﺭ ﺑﺩﻭﺍﺭﻋﻧﺩ ﺍﻟﻧﻬﻭﺽ ﻣﻥ ﻭﺿﻊ ﺍﻻﺿﻁﺟﺎﻉ ﺃﻭ ﺍﻟﺟﻠﻭﺱ‬‫ﻛﻝ ﻫﺫﻩ ﺍﻷﻋﺭﺍﺽ ﺗﺄﺗﻲ ﻣﻥ ﻗﻠﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻭﻣﻥ ﺛﻡ ﺍﻷﻭﻛﺳﺟﻳﻥ ﺍﻟﺫﻱ ﻳﺻﻝ ﻟﻸﻧﺳﺟﺔ ﻋﻣﻭﻣﺎً‪ ،‬ﻭﺍﻟﻣﺦ ﺑﺻﻭﺭﺓ ﺧﺎﺻﺔ‪.‬‬ ‫ﻫﻧﺎ ﺃﺭﻳﺩ ﺃﻥ ﺃﺑﺩﻱ ﻣﻼﺣﻅﺎﺕ ﻋﻠﻰ ﻣﻭﺿﻭﻉ ﺍﻟﺷﺣﻭﺏ‪ ،‬ﺍﻟﺫﻱ ﻫﻭ ﺃﺑﺳﻁ ﻭﺃﻅﻬﺭ ﻋﻼﻣﺎﺕ ﻓﻘﺭ ﺍﻟﺩﻡ ﻓﺄﻗﻭﻝ ﺇﻥ ﻫﺫﺍ ﺍﻟﺷﺣﻭﺏ‬ ‫ﻳﺻﻌﺏ ﺃﺣﻳﺎﻧﺎ ً ﺇﻗﺭﺍﺭﻩ ﻣﻥ ﻭﺟﻪ ﺍﻹﻧﺳﺎﻥ‪ ،‬ﻓﻣﻥ ﺍﻟﻧﺎﺱ ﻣﻥ ﻳﻛﻭﻥ ﻟﻭﻥ ﻭﺟﻬﻪ ﺷﺎﺣﺑﺎ ً ﺑﺻﻭﺭﺓ ﻁﺑﻳﻌﻳﺔ ﺩﻭﻥ ﻭﺟﻭﺩ ﻓﻘﺭ ﺩﻡ‪ ،‬ﻛﻣﺎ‬ ‫ﻳﻅﻬﺭ ﻣﻥ ﺍﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ ﺍﻟﻣﺗﻛﺭﺭ‪ .‬ﻛﻣﺎ ﺃﻥ ﺍﻟﻭﺟﻪ ﻫﻭ ﻣﺭﺁﺓ ﻋﻭﺍﻁﻑ ﺍﻹﻧﺳﺎﻥ‪ ،‬ﻓﻘﺩ ﻳﺣﻣ ّﺭ ﻋﻧﺩ ﺍﻟﺷﻌﻭﺭ ﺑﺎﻟﺧﺟﻝ ﺃﻭ‬ ‫ﺍﻻﺿﻁﺭﺍﺏ‪ ،‬ﻛﻣﺎ ﻗﺩ ﻳﺷﺣﺏ ﻋﻧﺩ ﺍﻟﺷﻌﻭﺭ ﺑﺎﻷﻟﻡ ﺃﻭ ﺍﻟﺧﻭﻑ‪ .‬ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻷﺣﻭﺍﻝ ﻳﻛﻭﻥ ﻟﻭﻥ ﺍﻟﻭﺟﻪ ﺧﺎﺩﻋﺎُ‪ ،‬ﻟﺫﺍ ﺗﺭﻯ ﺍﻟﻁﺑﻳﺏ‬ ‫ﻳﻠﺟﺄ ﺇﻟﻰ ﻓﺣﺹ ﺟﻔﻥ ﺍﻟﻌﻳﻥ ﻣﻥ ﺍﻟﺩﺍﺧﻝ ﺃﻭ ﺍﻟﻠﺳﺎﻥ ﺃﻭ ﻟﻭﻥ ﺍﻟﺟﻠﺩ ﻓﻲ ﺧﻠﻔﻳﺔ ﺃﻅﺎﻓﺭ ﺍﻟﻳﺩ ﺃﻭ ﻏﻳﺭﻫﺎ ﻣﻥ ﺍﻷﻣﺎﻛﻥ ﻟﻠﺗﺄﻛﺩ ﻣﻥ‬ ‫ﺍﻟﺷﺣﻭﺏ‪ .‬ﻭﻣﻊ ﺫﻟﻙ‪ ،‬ﻓﻬﻧﺎﻙ ﺃﺷﺧﺎﺹ ﻳﺷﻙ ﺍﻟﻁﺑﻳﺏ ﺍﻟﻔﺎﺣﺹ ﺑﺈﺻﺎﺑﺗﻬﻡ ﺑﻔﻘﺭ ﺍﻟﺩﻡ ﺍﻋﺗﻣﺎﺩﺍً ﻋﻠﻰ ﻫﺫﺍ ﺍﻟﺷﺣﻭﺏ ﺛﻡ ﻻ ﻳﺛﺑﺕ‬ ‫ﺍﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ ﺍﻟﻣﺿﺑﻭﻁ ﺻﺣﺔ ﺍﻟﺷﻙ‪.‬‬ ‫ﺏ‪ -‬ﺃﻣﺎ ﻓﻲ ﺣﺎﻟﺔ ﺣﺻﻭﻝ ﻧﺯﻑ ﺷﺩﻳﺩ ﻭﺣﺎﺩ ﻓﺎﻷﻋﺭﺍﺽ ﺗﻧﺷﺄ ﻣﻥ ﻗﻠﺔ ﺍﻟﺩﻡ ﺍﻟﻭﺍﺻﻝ ﻟﻸﻧﺳﺟﺔ ﺇﺿﺎﻓﺔ ﻻﻧﺧﻔﺎﺽ ﺿﻐﻅ ﺍﻟﺩﻡ‪.‬‬ ‫ﺃﻫﻡ ﻫﺫﻩ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺗﻌﺭّﻕ ﻭﺍﻟﺷﺣﻭﺏ ﺍﻟﻣﻔﺎﺟﺊ ﻭﺍﻟﺗﺳﺎﺭﻉ ﻓﻲ ﺿﺭﺑﺎﺕ ﺍﻟﻘﻠﺏ ﻭﺭﺑﻣﺎ ﻓﻘﺩﺍﻥ ﺍﻟﻭﻋﻲ ﺗﺩﺭﻳﺟﻳﺎ ً‪ .‬ﺇﺫﺍ ﻛﺎﻥ ﻓﻘﺩﺍﻥ‬ ‫ﺍﻟﺩﻡ ﺇﻟﻰ ﺧﺎﺭﺝ ﺍﻟﺟﺳﻡ ﻓﺈﻥ ﺍﻟﻣﺭﻳﺽ ﻭﻣﻥ ﺣﻭﻟﻪ ﻳﻛﻭﻧﻭﻥ ﻋﺎﺭﻓﻳﻥ ﺫﻟﻙ‪ ،‬ﻭﻫﺫﺍ ﻣﺎ ﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺗﺷﺧﻳﺹ ﺳﺑﺏ ﻣﺎﻳﺣﺻﻝ‪.‬‬ ‫ﺝ‪ -‬ﻫﻧﺎﻙ ﻋﻼﻣﺎﺕ ﺃﺧﺭﻯ ﻗﺩ ﻧﺟﺩﻫﺎ ﻓﻲ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﻓﻘﺭ ﺍﻟﺩﻡ ﺩﻭﻥ ﻏﻳﺭﻫﺎ‪ ،‬ﻛﻣﺎ ﺃﻧﻬﺎ ﻟﻳﺳﺕ ﻋﻼﻣﺎﺕ ﺧﺎﺻﺔ ﺑﻔﻘﺭ ﺍﻟﺩﻡ ﻭ ﻗﺩ‬ ‫ﺗﻛﻭﻥ ﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺣﺎﻻﺕ ﻣﺭﺿﻳﺔ ﺃﺧﺭﻯ‪ .‬ﻣﻥ ﻫﺫﻩ ﺍﻟﻌﻼﻣﺎﺕ ]ﺗﺿﺧﻡ ﺍﻟﻁﺣﺎﻝ[ ﻭﺍﻟﻳﺭﻗﺎﻥ ﻭ]ﻋﺟﺯ ﺍﻟﻘﻠﺏ[‪ .‬ﻫﺫﻩ ﺍﻟﻌﻼﻣﺔ‬ ‫ﺍﻷﺧﻳﺭﺓ ﻗﺩ ﺗﺣﺩﺙ ﻓﻲ ﺣﺎﻻﺕ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺷﺩﻳﺩ ﺟﺩﺍً ﺑﻌﺩ ﻓﺗﺭﺓ ﻣﻥ ﺍﻟﺯﻣﻥ‪.‬‬ ‫ﺩ‪ -‬ﻣﻥ ﺍﻟﻣﻔﻳﺩ ﺃﻥ ﻧﺫﻛﺭ ﻫﻧﺎ ﺃﻥ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺩﺍﺧﻠﺔ ﺿﻣﻥ ﺍﻟﺗﻌﺭﻳﻑ ﺃﻋﻼﻩ ﻗﺩ ﻳﺻﺎﺣﺑﻬﺎ ﻧﻘﺹ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء ﺃﻭ‬ ‫ﺍﻟﺻﻔﻳْﺣﺎﺕ ﺃﻭ ﻛﻠﻳﻬﻣﺎ ﻭﻣﺎ ﻳﻧﺗﺞ ﻋﻥ ﺫﻟﻙ ﻣﻥ ﻣﺿﺎﻋﻔﺎﺕ ﻛﺎﻹﻟﺗﻬﺎﺑﺎﺕ ﺍﻟﺟﺭﺛﻭﻣﻳﺔ ﺍﻟﺣﺎﺩﺓ ﻭﺍﻟﻧﺯﻑ ﻓﻲ ﺍﻟﺟﻠﺩ ﻭﻏﻳﺭﻩ ﻛﺎﻷﻧﻑ ﺃﻭ‬

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‫ﺍﻷﺳﻧﺎﻥ‪ ،‬ﻭﻏﻳﺭ ﺫﻟﻙ‪ .‬ﺇﻥ ﻫﺫﻩ ﺍﻟﻌﻼﻣﺎﺕ ﻫﻲ ﻟﻳﺳﺕ ﻣﻥ ﻋﻼﻣﺎﺕ ﻓﻘﺭ ﺍﻟﺩﻡ ﺑﺎﻟﻣﻌﻧﻰ ﺍﻟﺩﻗﻳﻕ ﻭﻟﻛﻧﻬﺎ ﻋﻼﻣﺎﺕ ﺗﻌﻭﺩ ﻟﻣﺿﺎﻋﻔﺎﺕ‬ ‫ﺃﻧﻭﺍﻉ ﺧﺎﺻﺔ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺗﻧﻘﺹ ﻓﻳﻬﺎ ﺧﻼﻳﺎ ﺃﺧﺭﻯ ﻏﻳﺭ ﺍﻟﺣﻣﺭﺍء‪ ،‬ﻛﻣﺎ ﺫﻛﺭﺕ‪.‬‬

‫ﺍﻟﻛﺷﻑ ﻋﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻣﺧﺑﺭﻳﺎ ً‪:‬‬ ‫ﻳُﻛﺷﻑ ﻋﻥ ﻭﺟﻭﺩ ﻓﻘﺭ ﺍﻟﺩﻡ ﺑﺎﻟﻣﺧﺗﺑﺭ ﺑﺈﺟﺭﺍء ﻓﺣﺹ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺩﻡ ﺃﻭﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺃﻭ ﻧﺳﺑﺔ ]ﺍﻟﺧﻼﻳﺎ‬ ‫ﺍﻟﺣﻣﺭﺍء ﺍﻟﻣﺭﺻﻭﺻﺔ[ ﺇﻟﻰ ﺣﺟﻡ ﺍﻟﺩﻡ ﻛﻠﻪ‪ .‬ﻭﺍﻷﻓﺿﻝ ﺇﺟﺭﺍء ﺍﻟﻔﺣﻭﺹ ﺍﻟﺛﻼﺛﺔ ﺟﻣﻳﻌﺎً‪ ،‬ﻭﻫﻭ ﻣﺎ ﺃﺻﺑﺢ ﺍﻵﻥ ﻳُﻌﻣﻝ ﺑﺻﻭﺭﺓ‬ ‫ﺭﻭﺗﻳﻧﻳﺔ ﺑﺎﺳﺗﺧﺩﺍﻡ ﺍﻷﺟﻬﺯﺓ ﺍﻷﻟﻛﺗﺭﻭﻧﻳﺔ ﻓﻲ ﺍﻟﻣﺧﺎﺑﺭ‪ .‬ﻭﺣﻳﻧﻣﺎ ﻳُﺭﺍﺩ ﺇﺟﺭﺍء ﻫﺫﻩ ﺍﻟﻔﺣﻭﺹ ﻓﺈﻥ ﻋﻳّﻧﺔ ﺻﻐﻳﺭﺓ ﻣﻥ ﺍﻟﺩﻡ ُﺗﻔﺻﺩ ﻣﻥ‬ ‫ﺍﻟﻭﺭﻳﺩ ﺃﻭ ﻣﻥ ﻭﺧﺯﺓ ﻓﻲ ﻧﻬﺎﻳﺔ ﺍﻹﺻﺑﻊ ﺗﻛﻔﻲ ﻟﻠﻔﺣﺹ‪ .‬ﺇﻧﻧﺎ ﻧﻔﺗﺭﺽ )ﻭﻫﺫﺍ ﺍﻻﻓﺗﺭﺍﺽ ﺻﺣﻳﺢ ﻋﺎﺩﺓ( ﺃﻥ ﺍﻟﻧﻣﻭﺫﺝ ﺍﻟﺫﻱ‬ ‫ﻧﻔﺣﺻﻪ ّ‬ ‫ﻳﻣﺛﻝ ﺍﻟﺩﻡ ﻛﻠﻪ ﻓﻲ ﺍﻟﺟﺳﻡ )ﻭﺍﻟﺫﻱ ﻳﺑﻠﻎ ﺣﺟﻣﻪ ‪ 5-4‬ﺃﻟﺗﺎﺭ ﻓﻲ ﺍﻟﺑﺎﻟﻐﻳﻥ(‪ .‬ﻟﺫﻟﻙ ﻓﺈﻥ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﻧﻣﻭﺫﺝ ﺃﻭ‬ ‫ﺍﻟﻌﻳّﻧﺔ ﻫﻭ ﻧﻔﺱ ﺗﺭﻛﻳﺯﻩ ﻓﻲ ﺍﻟﺩﻡ ﻛﻛﻝ‪ .‬ﻭﻟﻛﻥ ﻳﺟﺏ ﺃﻥ ﻧﺗﺫ ّﻛﺭ ﺑﻌﺽ ﺍﻟﻣﻼﺣﻅﺎﺕ ﺣﻭﻝ ﻧﺗﺎﺋﺞ ﻓﺣﻭﺹ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺗﻲ‬ ‫ُﺗﺟﺭﻯ ﻓﻲ ﺍﻟﻣﺧﺗﺑﺭﺍﺕ‪:‬‬ ‫ﺍ‪-‬ﺍﻟﺩﻡ‪ -‬ﻛﻣﺎ ﺷﺭﺣﺕ ﺳﺎﺑﻘﺎ ً‪ -‬ﻳﺗﻛﻭﻥ ﻣﻥ ﺟﺯﺋﻳْﻥ ﺃﺣﺩﻫﻣﺎ ﺍﻟﺣﺟﻳﺭﺍﺕ ﺃﻭ ﺍﻟﺧﻼﻳﺎ ﻭﺍﻵﺧﺭ ﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ‪ ،‬ﻭﺍﻟﻧﻘﺹ ﻓﻲ ﺗﺭﻛﻳﺯ‬ ‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻳﻌﻧﻲ – ﻓﻲ ﺃﻛﺛﺭﺍﻟﺣﺎﻻﺕ‪ -‬ﻧﻘﺻﺎ ً ﻓﻲ ﺍﻟﺣﺟﻡ ﺍﻟﻌﺎﻡ ﻟﻠﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻣﻊ ﺑﻘﺎء ﺍﻟﺣﺟﻡ ﺍﻟﻛﻠﻲ ﻟﻠﺩﻡ ﺛﺎﺑﺗﺎً‪ ،‬ﻛﻣﺎ‬ ‫ﻳﻭﺿﺣﻪ ﺍﻟﺷﻛﻝ ﺭﻗﻡ ‪ ،6‬ﻟﻛﻥ ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﻗﺩ ﻻ ﻳﻌﺑّﺭ ﻓﻳﻬﺎ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻋﻥ ﺣﻘﻳﻘﺔ ﻛﻣﻳﺔ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ ‫ﻭﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺫﻱ ﺗﺣﻭﻳﻪ‪ ،‬ﻛﻣﺎ ﻳﺣﺩﺙ ﻣﺑﺎﺷﺭﺓ ﺑﻌﺩ ﺍﻟﻧﺯﻑ ﺍﻟﺷﺩﻳﺩ‪ .‬ﺇﻥ ﺍﻟﻧﺯﻑ ﻳﻌﻧﻲ ﺧﺳﺎﺭﺓ ﻓﻲ ﻛﻝ ﻣﻛﻭّ ﻧﺎﺕ ﺍﻟﺩﻡ )ﺧﻼﻳﺎ‬ ‫ﻭﺑﻼﺯﻣﺎ(‪ ،‬ﻭﻟﺫﻟﻙ ﻓﺈﻥ ﺍﻟﺣﺟﻡ ﺍﻟﻛﻠﻲ ﻟﻠﺩﻡ ﻳﻧﻘﺹ ﺑﻌﺩ ﺍﻟﻧﺯﻑ‪ ،‬ﻭﻟﻛﻥ ﻧﺳﺑﺔ ﺍﻟﺧﻼﻳﺎ ﺇﻟﻰ ﺍﻟﺑﻼﺯﻣﺎ ﺗﺑﻘﻰ ﻛﻣﺎ ﻛﺎﻧﺕ ﻗﺑﻝ ﺍﻟﻧﺯﻑ ﻓﻲ‬ ‫ﺍﻟﺩﻡ ﻛﻛﻝ ﻭﻓﻲ ﺍﻟﻌﻳﻧﺔ ﺍﻟﺻﻐﻳﺭﺓ ﺍﻟﺗﻲ ﺗﺅﺧﺫ ﻟﻐﺭﺽ ﺍﻟﻔﺣﺹ )ﻭﺍﻟﺗﻲ ّ‬ ‫ﺗﻣﺛﻝ ﺍﻟﺩﻡ ﻛﻛﻝ(‪ .‬ﻟﻛﻥ ﺑﻣﺭﻭﺭ ﺳﺎﻋﺎﺕ ﻳﺑﺩﺃ ﺍﻟﺟﺳﻡ‬ ‫ﺑﺗﻌﻭﻳﺽ ﺣﺟﻡ ﺍﻟﺩﻡ ﺍﻟﻣﻔﻘﻭﺩ ﺑﺈﺿﺎﻓﺔ ﺳﻭﺍﺋﻝ ﺇﻟﻰ ﺍﻟﺩﻡ ُﺗﺳﺣﺏ ﻣﻥ ﺍﻷﻧﺳﺟﺔ‪ .‬ﻫﺫﻩ ﺍﻟﺳﻭﺍﺋﻝ ﻁﺑﻌﺎ ً ﻻ ﺗﺣﺗﻭﻱ ﻋﻠﻰ ﺧﻼﻳﺎ ﺣﻣﺭﺍء‪.‬‬ ‫ﺑﺫﻟﻙ ﻳﻌﻭﺩ ﺍﻟﺣﺟﻡ ﺍﻟﻛﻠﻲ ﻟﻠﺩﻡ ﻛﻣﺎ ﻛﺎﻥ ﻗﺑﻝ ﺍﻟﻧﺯﻑ ﻟﻛﻥ ﻧﺳﺑﺔ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺇﻟﻰ ﺍﻟﺣﺟﻡ ﺍﻟﻛﻠﻲ ﻟﻠﺩﻡ‪ ،‬ﻭﻛﺫﻟﻙ ﺗﺭﻛﻳﺯ‬ ‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻳﺻﺑﺢ ﺃﻗﻝ ﻣﻣﺎ ﻛﺎﻥ ﻋﻠﻳﻪ ﻗﺑﻝ ﺍﻟﻧﺯﻑ‪ .‬ﻓﺈﺫﺍ ﺃﺧﺫﺕ ﻋﻳّﻧﺔ ﺑﻌﺩ ﻫﺫﻩ ﺍﻟﺳﺎﻋﺎﺕ ﻓﺳﺗﻌﻛﺱ ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺣﻘﻳﻘﻲ‬ ‫ﻟﻠﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺑﻌﺩ ﺍﻟﻧﺯﻑ‪.‬‬

‫ﺑﻼﺯﻣﺎ‬

‫ﺑﻼﺯﻣﺎ‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﺣﺎﻟﺔ ﻓﻘﺭ ﺩﻡ‬

‫ﺣﺎﻟﺔ ﻁﺑﻳﻌﻳﺔ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -6‬ﺍﻟﻔﺭﻕ ﺑﻳﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻣﺯﻣﻥ ﻭﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ‬

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‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻣﻔﻘﻭﺩﺓ ﻓﻲ ﺍﻟﻧﺯﻑ ﻳﻌﻭّ ﺿﻬﺎ ﺍﻟﺟﺳﻡ )ﻣﻥ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ( ﺗﻌﻭﻳﺿﺎ ً ﺗﺎﻣﺎ ً ﺑﺎﻟﺗﺩﺭﻳﺞ ﻋﻠﻰ ﻣﺩﻯ ﺃﺳﺑﻭﻋﻳﻥ ﺃﻭ ﺃﻛﺛﺭ‬ ‫)ﺍﻧﻅﺭ ﺍﻟﺷﻛﻝ ﺭﻗﻡ ‪.(7‬‬ ‫ﺑﻼﺯﻣﺎ‬

‫ﺑﻼﺯﻣﺎ‬ ‫ﺑﻼﺯﻣﺎ‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﻗﺑﻝ ﺍﻟﻧﺯﻑ‬ ‫)ﻁﺑﻳﻌﻲ(‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﺑﻌﺩ ﺍﻟﻧﺯﻑ‬ ‫ﻣﺑﺎﺷﺭﺓ‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﺑﻌﺩ ﺍﻟﻧﺯﻑ‬ ‫ﺑﻳﻭﻡ ﻭﺍﺣﺩ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -7‬ﺍﻟﺗﻐﻳﻳﺭﺍﺕ ﺍﻟﺗﻲ ﺗﺣﺩﺙ ﻓﻲ ﺍﻟﺩﻡ ﺑﻌﺩ ﺍﻟﻧﺯﻑ ﺍﻟﺣﺎﺩ‬

‫ﻫﺫﺍ ﺍﻟﺷﺭﺡ ﺣﻭﻝ ﺗﻌﻭﻳﺽ ﺍﻟﺩﻡ ﺍﻟﻣﻔﻘﻭﺩ ﻧﺯﻓﺎ ً ﻳﻧﻁﺑﻕ ﺇﺫﺍ ﻟﻡ ﻳُﻧﻘﻝ ﻟﻠﻣﺭﻳﺽ ﺩﻡ ﺑﺳﺑﺏ ﺍﻟﻧﺯﻑ‪ .‬ﻛﺛﻳﺭ ﻣﻥ ﺣﺎﻻﺕ ﺍﻟﻧﺯﻑ ﺍﻟﺷﺩﻳﺩ‬ ‫ُﺗﻌﺎﻟﺞ ﺑﺎﻟﻣﺳﺗﺷﻔﻳﺎﺕ ﺑﻧﻘﻝ ﺍﻟﺩﻡ‪ .‬ﻳﻛﻭﻥ ﺍﻟﺩﻡ ﺍﻟﻣﻧﻘﻭﻝ ﻋﺎﺩﺓ ﺧﻼﻳﺎ ﺣﻣﺭﺍء ﻣﺭ ّﻛﺯﺓ )ﺃﻱ ﻣﺳﺣﻭﺑﺎ ً ﻣﻧﻬﺎ ﻣﻌﻅﻡ ﺍﻟﺑﻼﺯﻣﺎ(‪ ،‬ﺭﻏﻡ ﺃﻥ‬ ‫ﺍﻟﻣﺭﻳﺽ ﻓﻘﺩ ﻣﻥ ﻛﻝ ﺃﻧﻭﺍﻉ ﺍﻟﺧﻼﻳﺎ ﻭﺑﻼﺯﻣﺎ ﺃﻳﺿﺎً‪ ،‬ﻭﺫﻟﻙ ﻷﻥ ﺗﻌﻭﻳﺽ ﺍﻟﺑﻼﺯﻣﺎ ﻭﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء ﻳﺗﻭﻟّﻰ ﺃﻣﺭﻩ ﺍﻟﺟﺳﻡ ﻭﻳﻧﺟﺯﻩ‬ ‫ﺧﻼﻝ ﺳﺎﻋﺎﺕ‪.‬ﻳﺟﺩﺭ ﺑﺎﻟﺫﻛﺭ ﺃﻧﻪ ﻋﻧﺩ ﻋﺩﻡ ﺗﻭ ّﻓﺭﺍﻟﺩﻡ ﺑﺎﻟﺳﺭﻋﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻋﻧﺩ ﺍﻟﻧﺯﻑ ﻓﺈﻥ ﺍﻷﻁﺑﺎء ﻳﻧﻘﻠﻭﻥ ﻟﻠﻣﺭﻳﺽ ﺳﻭﺍﺋﻝ‬ ‫ﺑﺎﻟﻭﺭﻳﺩ )ﺑﻼﺯﻣﺎ ﺃﻭ ﻣﺣﺎﻟﻳﻝ ﻣﻠﺣﻳﺔ ﺃﻭ ﻣﺣﺎﻟﻳﻝ ﺳﻛﺭﻳﺔ ﻭﻣﻠﺣﻳﺔ( ﻹﻛﻣﺎﻝ ﺣﺟﻡ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻧﻘﺹ ﺑﺎﻟﻧﺯﻑ‪ ،‬ﻷﻥ ﻧﻘﺹ ﺣﺟﻡ ﺍﻟﺩﻡ‬ ‫ﻳﺅﺩﻱ ﻟﻬﺑﻭﻁ ﺍﻟﺿﻐﻁ ﻭﺍﻧﻬﻳﺎﺭ ﺟﻬﺎﺯ ﺍﻟﺩﻭﺭﺍﻥ ]ﺍﻟﺻﺩﻣﺔ ﺍﻟﺩﻭﺭﺍﻧﻳﺔ[ ﺃﻭ ﺣﺗﻰ ﺍﻟﻣﻭﺕ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻧﺯﻓﻳﺔ ﺍﻟﺷﺩﻳﺩﺓ‪ .‬ﻫﺫﻩ ﺍﻟﺳﻭﺍﺋﻝ‬ ‫– ﺑﻁﺑﻳﻌﺔ ﺍﻟﺣﺎﻝ‪ -‬ﻻ ﺗﺣﻭﻱ ﺧﻼﻳﺎ ﺣﻣﺭﺍء ﻭ ﻳﺣﺻﻝ ﻓﻘﺭ ﺩﻡ ﺑﻌﺩ ﺇﻋﻁﺎﺋﻬﺎ ﻟﻠﻣﺭﻳﺽ ﺑﻌﺩ ﺍﻟﻧﺯﻑ‪ .‬ﻭﺣﻳﻧﻣﺎ ﻳﺗﻭﻓﺭ ﺍﻟﺩﻡ ﻓﻬﻭ‬ ‫ﺍﻟﻌﻼﺝ ﺍﻷﻫﻡ ﻟﺣﺎﻻﺕ ﺍﻟﻧﺯﻑ‪.‬‬ ‫ﺏ‪ -‬ﻫﻧﺎﻙ ﺣﺎﻟﺔ ﺃﺧﺭﻯ ﻫﻲ ﺣﺎﻟﺔ ﺍﻟﺣﻣﻝ ﺑﻳﻥ ﺍﻟﺷﻬﺭﻳﻥ ﺍﻟﺭﺍﺑﻊ ﻭﺍﻟﺛﺎﻣﻥ ﻗﺩ ﻳﻛﻭﻥ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﻣﺣﺳﻭﺏ ﻣﺧﺑﺭﻳﺎ ً ﻓﻳﻬﺎ‬ ‫ﻏﻳﺭ ﻣﻌﺑّﺭ ﺗﻌﺑﻳﺭﺍً ﻭﺍﻗﻌﻳﺎ ً ﻋﻥ ﺍﻟﻛﻣﻳﺔ ﺍﻟﻛﻠﻳّﺔ ﻟﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻓﻲ ﺍﻟﺟﺳﻡ ﻋﻣﻭﻣﺎً‪ ،‬ﻷﻥ ﺣﺟﻡ ﺑﻼﺯﻣﺎ ﺍﻟﺩﻡ ﻓﻲ ﺗﻠﻙ ﺍﻟﻔﺗﺭﺓ ﻣﻥ‬ ‫ﺍﻟﺣﻣﻝ ﻳﺯﻳﺩ ﻋﻠﻰ ﺣﺟﻣﻪ ﻓﻲ ﻏﻳﺭﻫﺎ ﻓﻳﺳﺑﺏ ﻧﻘﺻﺎ ً ﻓﻲ ﻧﺳﺑﺔ ﺍﻟﺧﻼﻳﺎ ﺇﻟﻰ ﺣﺟﻡ ﺍﻟﺑﻼﺯﻣﺎ ﻭﺣﺟﻡ ﺍﻟﺩﻡ ﻋﻣﻭﻣﺎً‪ ،‬ﺃﻱ ﺃﻥ ﻫﻧﺎﻙ‬ ‫ﺗﺧﻔﻳﻔﺎ ً ﻟﻠﺧﻼﻳﺎ ﻭﻟﻳﺱ ﻧﻘﺻﺎ ً ﻓﻳﻬﺎ‪ .‬ﺇﺫﺍ ﻓﺣﺻﻧﺎ ﻋﻳّﻧﺔ ﻣﻥ ﻫﺫﺍ ﺍﻟﺩﻡ ﺃﻅﻬﺭ ﻧﻘﺻﺎ ً ﻓﻲ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻛﻣﺎ ﻳﻭﺿﺣﻪ ﺍﻟﺷﻛﻝ‬ ‫ﺭﻗﻡ ‪ .8‬ﻟﻛﻥ ﻳﺟﺏ ﺃﻥ ﻧﺗﺫ ّﻛﺭ ﺃﻥ ﻓﻘﺭ ﺩﻡ ﺣﻘﻳﻘﻲ ﻣﻥ ﺃﻧﻭﺍﻉ ﻣﺧﺗﻠﻔﺔ‪ ،‬ﻳﻣﻛﻥ ﺃﻥ ﺗﺣﺻﻝ ﺧﻼﻝ ﻓﺗﺭﺓ ﺍﻟﺣﻣﻝ‪ ،‬ﻓﺎﻧﺧﻔﺎﺽ‬ ‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺇﻟﻰ ﺃﻗﻝ ﻣﻥ ‪ 10.5‬ﻏﻡ‪/‬ﺩﻝ ﻗﺩ ﻳﻌﻧﻲ ﻭﺟﻭﺩ ﺃﺳﺑﺎﺏ ﺃﺧﺭﻯ‪ ،‬ﻏﻳﺭ ﺗﺧﻔﻳﻑ ﺍﻟﺩﻡ ﺍﻟﻣﺫﻛﻭﺭ ﺃﻋﻼﻩ‪ ،‬ﺃﻭ ﺑﻌﺑﺎﺭﺓ ﺃﺧﺭﻯ‬ ‫ﻗﺩ ﻳﻌﻧﻲ ﻧﻘﺻﺎ ً ﺣﻘﻳﻘﻳﺎ ً ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‪ ،‬ﻭﻟﻳﺱ ﺗﺧﻔﻳﻔﺎ ً ﻟﻬﺎ ﻓﻘﻁ ﻭﺃﻥ ﻧﻘﺹ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺣﻘﻳﻘﻲ ﻭﻟﻳﺱ ﻧﺎﺗﺟﺎ ً ﻋﻥ ﺯﻳﺎﺩﺓ‬ ‫ﺣﺟﻡ ﺍﻟﺑﻼﺯﻣﺎ‪.‬‬

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‫ﺑﻼﺯﻣﺎ‬ ‫ﺑﻼﺯﻣﺎ‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬

‫ﻗﺑﻝ ﺍﻟﺣﻣﻝ‬

‫ﺧﻼﻝ ﺍﻟﺣﻣﻝ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -8‬ﺣﺎﻟﺔ ﺗﺧﻔﻳﻑ ﺍﻟﺩﻡ ﺃﺛﻧﺎء ﺍﻟﺣﻣﻝ‬ ‫ﺝ‪ -‬ﻓﻲ ﻣﻘﺎﺑﻝ ﺫﻟﻙ‪ ،‬ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﻳﻔﻘﺩ ﻓﻳﻬﺎ ﺍﻹﻧﺳﺎﻥ ﺳﻭﺍﺋﻝ ﻛﺛﻳﺭﺓ ﺇﻣﺎ ﻋﻠﻰ ﺷﻛﻝ ﺑﻼﺯﻣﺎ ﻛﺎﻣﻠﺔ ﺍﻟﺗﺭﻛﻳﺏ )ﻛﻣﺎ ﻓﻲ ﺣﺎﻟﺔ‬ ‫ﺍﻟﺣﺭﻭﻕ ﺍﻟﻭﺍﺳﻌﺔ( ﺃﻭ ﻋﻠﻰ ﺷﻛﻝ ﻣﺎء ﻭﺃﻣﻼﺡ )ﻛﻣﺎ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺣﻣﻰ ﻭﺃﺛﻧﺎء ﺍﻟﺻﻳﻑ ﺍﻟﺣﺎﺭ ﺃﻭ ﻓﻲ ﺣﻼﺕ ﺍﻟﺗﻘﻳﺅ ﺍﻟﻣﺳﺗﻣﺭ‬ ‫ﻑ ﻳﻧﻘﺹ ﺣﺟﻡ ﺍﻟﺑﻼﺯﻣﺎ ﻣﻊ ﺑﻘﺎء ﺣﺟﻡ ﺍﻟﺧﻼﻳﺎ ﺛﺎﺑﺗﺎ ُ ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺭﻛﻳﺯ ﺍﻟﺩﻡ‪.‬‬ ‫ﻭﺍﻹﺳﻬﺎﻝ ﺍﻟﺷﺩﻳﺩ(‪ .‬ﻓﺈﺫﺍ ﻟﻡ ﺗﻌﻭﱠ ﺽ ﺑﺷﻛﻝ ﻛﺎ ٍ‬ ‫ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﻋﻣﻭﻣﺎ ً ﺗﻭﺻﻑ ﺏ]ﺍﻟﺟﻔﺎﻑ[‪.‬‬ ‫ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﺇﺫﺍ ﺃﺧﺫﻧﺎ ﻋﻳّﻧﺔ ﺩﻡ ﻣﻥ ﺍﻟﻣﺭﻳﺽ ﻭﻗﺳﻧﺎ ﻓﻳﻬﺎ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﺳﺗﻛﻭﻥ ﺍﻟﻧﺗﻳﺟﺔ ﺃﻋﻠﻰ ﻣﻣﻝ ﻟﺩﻯ‬ ‫ﺍﻟﻣﺭﻳﺽ ﻓﻌﻼً ﻟﻭ ﻛﺎﻥ ﺣﺟﻡ ﺍﻟﺑﻼﺯﻣﺎ ﻁﺑﻳﻌﻳﺎ ُ ﻭﻟﻡ ﻳﻛﻥ ﻟﺩﻳﻪ ﻧﻘﺹ ﺳﻭﺍﺋﻝ‪ .‬ﻓﻣﻥ ﻛﺎﻥ ﻟﺩﻳﻪ ﺑﺎﻷﺻﻝ ﻓﻘﺭ ﺩﻡ ﻗﺩ ﻳﻌﻁﻲ ﻓﺣﺹ ﺩﻣﻪ‬ ‫ﻧﺗﻳﺟﺔ ﻁﺑﻳﻌﻳﺔ‪ ،‬ﻭﻣﻥ ﻛﺎﻥ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻋﻧﺩﻩ ﻗﺑﻝ ﺍﻟﺟﻔﺎﻑ ﻁﺑﻳﻌﻳﺎ ً ﻓﻘﺩ ﻳﻌﻁﻲ ﺗﺣﻠﻳﻝ ﺩﻣﻪ ﻧﺗﻳﺟﺔ ﺃﻋﻠﻰ ﻣﻥ ﺍﻟﻁﺑﻳﻌﻲ‪ ،‬ﻛﻣﺎ‬ ‫ﻳﻭﺿﺣﻪ ﺍﻟﺷﻛﻝ ﺭﻗﻡ ‪ .9‬ﻭﺇﺫﺍ ﺗﻡ ﺗﺻﺣﻳﺢ ﺟﻔﺎﻑ ﺟﺳﻡ ﺍﻟﻣﺭﻳﺽ ﺑﺈﻋﻁﺎﺋﻪ ﺍﻟﺳﻭﺍﺋﻝ ﺍﻟﻣﻁﻠﻭﺑﺔ ﺗﺭﺟﻊ ﻧﺗﺎﺋﺞ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺇﻟﻰ‬ ‫ﺣﻘﻳﻘﺗﻬﺎ‪.‬‬

‫ﺑﻼﺯﻣﺎ‬ ‫ﺑﻼﺯﻣﺎ‬ ‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬ ‫ﺣﺎﻟﺔ ﻁﺑﻳﻌﻳﺔ‬

‫ﺧﻼﻳﺎ‬ ‫ﺣﻣﺭﺍء‬ ‫ﺣﺎﻟﺔ ﺗﺭﻛﻳﺯ ﺍﻟﺩﻡ )ﻓﻘﺩﺍﻥ ﺳﻭﺍﺋﻝ(‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -9‬ﺣﺎﻟﺔ ﺗﺭﻛﻳﺯ ﺍﻟﺩﻡ ﻣﻘﺎﺭﻧﺔ ﺑﺎﻟﻭﺿﻊ ﺍﻟﻁﺑﻳﻌﻲ‬ ‫‪20‬‬

‫ﻭﺑﻌﺩ ﺫﻛﺭ ﻫﺫﻩ ﺍﻷﻣﺛﻠﺔ ﻣﻥ ﺣﺎﻻﺕ ﻻ ﺗﺗﻁﺎﺑﻕ ﻓﻳﻬﺎ ﻧﺗﻳﺟﺔ ﻓﺣﺹ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻓﻲ ﺍﻟﻣﺧﺗﺑﺭ ﻣﻊ ﺣﻘﻳﻘﺔ ﺣﺟﻡ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺃﻭ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﻲ ﺍﻟﺟﺳﻡ ﻛﻛﻝ ﺃﻋﻭﺩ ﺇﻟﻰ ﺣﺎﻻﺕ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺣﻘﻳﻘﻲ ﻭﺍﻟﺗﻲ ﺗﻛﻭﻥ ﻓﻳﻬﺎ ﻧﺗﻳﺟﺔ ﻓﺣﺹ ﺍﻟﺩﻡ ﻣﻣﺛﻼً‬ ‫ﺃﻣﻳﻧﺎ ً ﻟﻭﺿﻊ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻓﻲ ﺍﻟﺩﻭﺭﺓ ﺍﻟﺩﻣﻭﻳﺔ‪.‬‬

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‫اﻟﻔﺼﻞ اﻟﺜﺎﻟﺚ‬ ‫‪U‬‬

‫ﺗﺻﻧﻳﻑ ﻓﻘﺭ ﺍﻟﺩﻡ‬ ‫ﺃﻧﻭﺍﻉ ﻓﻘﺭ ﺍﻟﺩﻡ‬ ‫‪U‬‬

‫ﻻﺣﻕ ﻟﻧﺯﻑ ﺣﺎﺩ‬

‫ﻧﻘﺹ ﻋﻭﺍﻣﻝ‬

‫ﺛﺎﻧﻭﻱ‬

‫ﺍﻧﺣﻼﻟﻲ‬

‫ﻧﻘﺹ ﺇﻧﺗﺎﺝ‬

‫ﺃﺧﺭﻯ‬

‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺇﻣﺎ ﺃﻥ ﻳﻛﻭﻥ ﻣﻛﺗﺳﺑﺎً‪ ،‬ﺃﻱ ﺃﻧﻪ ﻳﺣﺩﺙ ﻧﺗﻳﺟﺔ ﺃﺳﺑﺎﺏ ﻏﻳﺭ ﻣﻭﺭﻭﺛﺔ ﻭﻅﺭﻭﻑ ﺗﺣﺻﻝ ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﺃﻭ ﺃﺣﻳﺎﻧﺎ ً ﺧﻼﻝ ﺍﻟﺣﻣﻝ‪،‬‬ ‫ﺃﻭ ﻳﻛﻭﻥ ﻭﺭﺍﺛﻳﺎ ً ﻧﺗﻳﺟﺔ ﻋﻭﺍﻣﻝ ﻳﺭﺛﻬﺎ ﺍﻹﻧﺳﺎﻥ ﻋﻥ ﺃﺑﻭﻳﻪ‪ .‬ﻟﻛﻥ ﺑﻌﺹ ﺃﻧﻭﺍﻉ ﻓﻘﺭ ﺍﻟﺩﻡ ﻟﻬﺎ ﺃﺳﺎﺱ ﻭﺭﺍﺛﻲ ﻻ ﻳﺳﺑﺏ ﺿﺭﺭﺍً ﺇﻻ ﺑﻭﺟﻭﺩ‬ ‫ﻋﻭﺍﻣﻝ ﺇﺿﺎﻓﻳﺔ ﻣﻛﺗﺳﺑﺔ‪ ،‬ﻛﻣﺎ ﺳﻧﺭﻯ ﻓﻳﻣﺎ ﺑﻌﺩ‪ .‬ﺳﺄﺷﺭﺡ ﻛﻝ ﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺣﺳﺏ ﺍﻟﺗﻘﺳﻳﻡ ﺍﻟﻭﺍﺭﺩ ﺃﻋﻼﻩ‪ ،‬ﺫﺍﻛﺭﺍً ﻣﺎ ﻛﺎﻥ ﻣﻧﻬﺎ‬ ‫ﻭﺭﺍﺛﻳﺎ ً ﻋﻧﺩ ﺷﺭﺡ ﻛﻝ ﻧﻭﻉ ‪.‬‬

‫‪-1‬ﻓﻘﺮ اﻟﺪم اﻟﻨﺎﺷﺊ ﻋﻦ ﻧﺰف ﺣﺎد ﺷﺪﻳﺪ‬ ‫‪U‬‬

‫ﺳﺑﻕ ﺍﻟﺗﻁﺭّﻕ ﺇﻟﻰ ﻫﺫﺍ ﺍﻟﻣﻭﺿﻭﻉ ﺣﻳﺙ ﻗﻠﺕ ﺇﻥ ﻣﺛﻝ ﻫﺫﺍ ﺍﻟﻧﺯﻑ ﻳﺳﺑﺏ ﻓﻘﺭ ﺩﻡ ﻳﻛﻭﻥ ﻣﻭ ّﻗﺗﺎ ً ﺑﺳﺑﺏ ﺗﻌﻭﻳﺽ ﺍﻟﺟﺳﻡ ﻋﻥ ﺍﻟﺩﻡ ﺍﻟﻣﻔﻘﻭﺩ‬ ‫ﺑﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ ﺃﻭﻻً ﺛﻡ ﺑﺎﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺗﺩﺭﻳﺟﻳﺎ ً ﻓﻲ ﺍﻷﺷﺧﺎﺹ ﺍﻟﺫﻳﻥ ﻟﻳﺱ ﻟﺩﻳﻬﻡ ﻧﻘﺹ ﻓﻲ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻷﺳﺎﺳﻳﺔ ﻟﺻﻧﻊ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‬ ‫)ﻛﺎﻟﺣﺩﻳﺩ(‪ ،‬ﺑﺣﻳﺙ ﻳﻛﺗﻣﻝ ﺍﻟﺗﻌﻭﻳﺽ ﻓﻲ ﻣﺩﺓ ﻻ ﺗﺗﺟﺎﻭﺯ ﺍﻟﺷﻬﺭ‪.‬‬ ‫ﻳﻌﺗﺑﺭ ﺍﻟﻛﺛﻳﺭﻭﻥ ﻣﻥ ﺍﻟﻧﺎﺱ ﺃﻥ ﺍﻟﺗﺑﺭّﻉ ﺑﻭﺣﺩﺓ ﺩﻡ ﻫﻭ ﺑﻣﺛﺎﺑﺔ ﻧﺯﻑ ﺣﺎﺩ ﻭﺷﺩﻳﺩ ﺣﻳﺙ ﻳُﻔﺻﺩ ﻣﻥ ﺍﻟﻣﺗﺑﺭﻉ ﺣﺟﻡ ‪ 450‬ﻣﻠﻳﻠﺗﺭ‪ .‬ﻟﺗﻭﺿﻳﺢ‬ ‫ﺍﻟﻔﺭﻕ ﺑﻳﻥ ﺍﻟﺣﺩﺛﻳﻥ ﺃﺑﻳّﻥ ﻣﺎ ﻳﻠﻲ ﻟﻳﺅﺧﺫ ﺑﺎﻻﻋﺗﺑﺎﺭ‪:‬‬ ‫ﺍﻟﺣﺟﻡ ﺍﻟﻣﺫﻛﻭﺭ ﻟﻣﻘﺩﺍﺭ ﺍﻟﺗﺑﺭّﻉ ﻳﻣﺛﻝ ‪ %10‬ﻓﻘﻁ ﻣﻥ ﺍﻟﺣﺟﻡ ﺍﻟﻛﻠﻲ ﻟﺩﻡ ﺍﻹﻧﺳﺎﻥ ﺍﻟﺑﺎﻟﻎ‪.‬‬‫ﻻ ﻳُﻘﺑﻝ ﺍﻟﻣﺭء )ﺭﺟﻼً ﻛﺎﻥ ﺃﻭ ﺍﻣﺭﺃﺓ( ﻟﻠﺗﺑﺭﻉ ﺣﺗﻰ ﻳﺛﺑﺕ ﺃﻥ ﻧﺳﺑﺔ ﺍﻟﻬﻳﻭﻏﻠﻭﺑﻳﻥ ﻋﻧﺩﻩ ﺟﻳّﺩﺓ ﺑﺣﻳﺙ ﺗﺗﺭﻙ ﻭﺭﺍءﻫﺎ ﺑﻌﺩ ﺍﻟﺗﺑﺭﻉ ﺗﺭﻛﻳﺯﺍً‬‫ﻫﻭ ﺿﻣﻥ ﺍﻟﻁﺑﻳﻌﻲ ﺍﻟﻣﻘﺑﻭﻝ‪ .‬ﻓﻣﺛﻼً‪ ،‬ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻟﺩﻯ ﺍﻟﻣﺗﺑﺭﻉ ‪ 14‬ﻏﺭﺍﻡ ﻟﻛﻝ ﺩﺳﻳﻠﺗﺭ ﻓﻳﻛﻭﻥ ﻗﺩ ﻧﻘﺹ ﺇﻟﻰ ‪ 126‬ﻓﻲ‬ ‫ﺍﻟﻳﻭﻡ ﺍﻟﺗﺎﻟﻲ ﻟﻠﺗﺑﺭّﻉ‪ .‬ﻛﻣﺎ ﻳﻭﺟﱠ ﻪ ﻟﻠﻣﺗﺑﺭﻉ ﺃﺳﺋﻠﺔ ﻟﺗﺑ ّﻳﻥ ﺍﺣﺗﻣﺎﻝ ﻋﺩﻡ ﺗﺣﻣّﻠﻪ ﻟﻠﺗﺑﺭﻉ ﻭﻳﺅﺧﺫ ﺭﺃﻱ ﻁﺑﻳﺏ ﺑﻧﻙ ﺍﻟﺩﻡ ﺇﺫﺍ ﻛﺎﻥ ﻫﻧﺎﻙ ﺷﻙ‪.‬‬ ‫ﺍﻟﺗﺑﺭّﻉ ﻳﺗﻡ ﺗﺣﺕ ﺇﺷﺭﺍﻑ ﻓﻧﻲ ﻭﻁﺑﻲ ﻛﺎﻣﻝ ﺑﺣﻳﺙ ﻳﻣﻛﻥ ﺇﻳﻘﺎﻓﻪ ﺣﺎﻟﻣﺎ ﺗﻅﻬﺭ ﺃﻱ ﻋﻼﻣﺎﺕ ﺗﺄﺛﺭ ﻟﺩﻯ ﺍﻟﻣﺗﺑﺭّ ﻉ‪ ،‬ﻣﺛﻝ ﺍﻟﺗﻌﺭﻕ ﻭﻫﺑﻭﻁ‬‫ﺿﻐﻁ ﺍﻟﺩﻡ‪.‬‬ ‫ﻻ ﻳُﺳﻣﺢ ﻟﻠﻣﺗﺑﺭّ ﻉ ﺑﺗﻛﺭﺍﺭ ﺍﻟﺗﺑﺭّﻉ ﺇﻻ ﺑﻌﺩ ﻣﺭﻭﺭ ﻓﺗﺭﺓ ﻛﺎﻓﻳﺔ ﻟﻳﻌﻭّ ﺽ ﺧﻼﻟﻬﺎ ﻣﺎ ﻓﻘﺩ ﻣﻥ ﺍﻟﺩﻡ‪.‬‬‫ﺇﺫﺍ ﺗﺑﻳّﻥ ﻟﻁﺑﻳﺏ ﺑﻧﻙ ﺍﻟﺩﻡ ﺃﻥ ﺍﻟﻣﺗﺑﺭّﻉ ﻟﻡ ﻳﺳﺗﻁﻊ ﺗﻌﻭﻳﺽ ﻣﺎ ﻓﻘﺩ ﻓﻲ ﺍﻟﺗﺑﺭّﻉ ﺍﻟﻔﺎﺋﺕ ﻓﻠﻥ ﻳُﺳﻣﺢ ﻟﻪ ﺑﺎﻟﺗﺑﺭﻉ ﺑﻝ ﻳُﻌﻁﻰ ﺍﻷﺩﻭﻳﺔ‬‫ﺍﻟﻼﺯﻣﺔ ﻟﺗﻌﻳﻧﻪ ﻋﻠﻰ ﺭﻓﻊ ﻣﺳﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻭﺍﻟﺫﻱ ﻟﻡ ﻳﺭﺗﻔﻊ ﺑﺳﺑﺏ ﻭﺟﻭﺩ ﻧﻘﺹ ﻟﺩﻯ ﺍﻟﻣﺗﺑﺭﻉ ﻓﻲ ﺃﺣﺩ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻼﺯﻣﺔ‬ ‫ﻟﺻﻧﻊ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ ،‬ﻭﻳﻛﻭﻥ ﺫﻟﻙ ﺍﻟﻌﺎﻣﻝ ﻫﻭ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺃﻏﻠﺏ ﺍﻷﺣﻳﺎﻥ‪.‬‬ ‫ﺇﺫﺍً‪ ،‬ﻓﻔﻘﺩﺍﻥ ﺩﻡ ﺑﺎﻟﻧﺯﻑ ﻟﻣﺭﺓ ﻭﺍﺣﺩﺓ‪ -‬ﻭﻣﻬﻣﺎ ﻛﺎﻧﺕ ﺍﻟﻛﻣﻳﺔ ﺍﻟﻣﻔﻘﻭﺩﺓ‪ -‬ﻻ ﻳﺅﺩﻯ ﻏﺎﻟﺑﺎ ً ﻋﻠﻰ ﺍﻟﻣﺩﻯ ﺍﻟﺑﻌﻳﺩ ﺇﻟﻰ ﺍﻹﺻﺎﺑﺔ ﺑﻔﻘﺭ ﺍﻟﺩﻡ ﺇﺫﺍ‬ ‫ﻧﺟﺎ ﺍﻟﻣﺭء ﻣﻥ ﺍﻟﻣﻭﺕ ﺑﺳﺑﺏ ﺍﻟﻧﺯﻑ ﺍﻟﺣﺎﺩ ﺍﻟﺫﻱ ﻗﺩ ﻳﻘﺗﻠﻪ ﺑﺳﺑﺏ ﻫﺑﻭﻁ ﺿﻐﻁ ﺍﻟﺩﻡ ﻭﺍﻟﻧﻘﺻﺎﻥ ﺍﻟﺣﺎﺩ ﻓﻲ ﺍﻷﻭﻛﺳﺟﻳﻥ ﺍﻟﻭﺍﺻﻝ ﺇﻟﻰ‬ ‫ﺍﻟﺩﻣﺎﻍ‪ .‬ﺃﻣﺎ ﺇﺫﺍ ﺗﻛﺭﺭ ﻓﻘﺩﺍﻥ ﺍﻟﺩﻡ ﻛﺛﻳﺭﺍً‪ ،‬ﻭﺑﺄﻭﻗﺎﺕ ﻣﺗﻘﺎﺭﺑﺔ ﻓﺈﻥ ﺍﻷﻣﺭ ﺳﻳﺧﺗﻠﻑ‪ ،‬ﻭﺳﻳﺭﺩ ﺫﻛﺭ ﺫﻟﻙ ﻓﻳﻣﺎ ﺑﻌﺩ‪.‬‬

‫‪22‬‬

‫‪U‬‬

‫‪-2‬ﻓﻘﺮ اﻟﺪم اﻟﻨﺎﺗﺞ ﻋﻦ ﻧﻘﺺ ﺑﻌﺾ اﻟﻌﻮاﻣﻞ اﻟﻼزﻣﺔ ﻟﺼﻨﻊ اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ أو ﺧﻼﻳﺎ اﻟﺪم اﻟﺤﻤﺮاء‬

‫ﺃ‪-‬ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‬ ‫‪U‬‬

‫ﺇﻥ ﻋﻧﺻﺭ ﺍﻟﺣﺩﻳﺩ ﻫﻭ ﺃﻫﻡ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻼﺯﻣﺔ ﻟﺻﻧﻊ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﺣﻳﺙ ﻳﺷﻛﻝ ﺍﻟﻧﻘﺹ ﻓﻳﻪ ﺃﻫﻡ ﺃﺳﺑﺎﺏ ﻓﻘﺭ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﻌﺎﻟﻡ ﻛﻠﻪ‪ .‬ﻭﻳﺳﻣﻰ ﻓﻘﺭ‬ ‫ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ]ﻓﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ[‪.‬‬ ‫ﻭﻣﻥ ﺃﻫﻡ ﺍﻟﻣﺻﺎﺩﺭ ﺍﻟﻐﺫﺍﺋﻳﺔ ﻟﻠﺣﺩﻳﺩ ﺍﻟﻛﻠﻰ ﻭﺍﻟﻛﺑﺩ ﻭﺍﻟﻠﺣﻡ ﺍﻷﺣﻣﺭ ﻭﺍﻟﺳﺑﺎﻧﺦ‪ .‬ﺃﺩﻧﺎﻩ ﺟﺩﻭﻝ ﺑﻣﺣﺗﻭﻯ ﺃﻫﻡ ﺍﻷﻏﺫﻳﺔ ﻣﻥ ﺍﻟﺣﺩﻳﺩ‪:‬‬ ‫ﺟﺩﻭﻝ ﺭﻗﻡ ‪ 2-‬ﺗﻭﺍﺟﺩ ﻋﻧﺻﺭ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻷﻁﻌﻣﺔ‪:‬‬ ‫ﻣﺤﺘﻮﻳﺎت اﻷﻏﺬﻳﺔ ﻣﻦ ﻋﻨﺼﺮ اﻟﺤﺪﻳﺪ ﺑﺎﻟﻨﺴﺒﺔ إﻟﻰ ‪ 100‬ﻏﺮام ﻣﻦ وزن اﻟﻤﺎدة‬ ‫ﺍﻟﻤﺎﺩﺓ ﺍﻟﻐﺬﺍﺋﻴﺔ‬

‫ﺗﺮﻛﻴﺰ ﺍﻟﺤﺪﻳﺪ‬ ‫ﻓﻴﻬﺎ)ﻣﻠﻐﻢ‪ 100/‬ﻏﻢ(‬ ‫‪0,3‬‬

‫ﺍﻟﺘﻤﻮﺭ ﺍﻟﻄﺮﻳﺔ )ﺑﺪﻭﻥ ﻧﻮﻯ(‬

‫ﺍﻟﻜﺮﻳﻤﺔ‬

‫‪0,1‬‬

‫ﺍﻟﺘﻤﻮﺭ ﺍﻟﺠﺎﻓﺔ )ﺑﺪﻭﻥ ﻧﻮﻯ(‬

‫ﺍﻟﺰﺑﺪﺓ‬

‫‪0,2‬‬

‫ﺍﻟﺤﻤﺺ ﺍﻟﺠﺎﻑ‬

‫ﺍﻟﺤﻠﻴﺐ ﺍﻟﺒﻘﺮﻱ‬

‫‪0,1‬‬

‫ﺍﻟﺴﺒﺎﻧﺦ‬

‫ﺍﻟﺒﻴﺾ )ﺑﺠﻤﻊ ﺟﺰﺋﻴﻪ(‬

‫‪2,5‬‬

‫ﺍﻟﻄﻤﺎﻁﻢ‬

‫ﻟﺤﻢ ﺍﻟﺒﻘﺮ‬

‫‪3,2 – 2,6‬‬

‫ﺍﻟﺠﺰﺭ‬

‫ﻟﺤﻢ ﺍﻟﻐﻨﻢ‬

‫‪2,6 – 2,2‬‬

‫ﺍﻟﺒﻄﺎﻁﺎ‬

‫ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ‬

‫‪4‬‬

‫ﻁﺤﻴﻦ ﺍﻟﺤﻨﻄﺔ ﻣﻊ ﺍﻟﺨﻤﻴﺮﺓ‬

‫ﺍﻟﻜﺒﺪ‬

‫‪10‬‬

‫ﺍﻟﺘﻔﺎﺡ‬

‫ﺍﻟﺠﺒﻦ‬

‫ﻛﻠﻰ ﺍﻟﺒﻘﺮ‬ ‫ﻟﺤﻢ ﺍﻟﺪﺟﺎﺝ‬ ‫ﺍﻷﺳﻤﺎﻙ‬ ‫ﺍﻟﺒﻘﻮﻝ ﺍﻟﺨﻀﺮﺍء‬ ‫ﺍﻟﺒﻘﻮﻝ ﺍﻟﺠﺎﻓﺔ‬ ‫ﺍﻟﻤﻠﻔﻮﻑ )ﻟﻬّﺎﻧﺔ(‬ ‫ﺍﻟﺰﻫﺮﺓ )ﻗﺮﻧﺒﻴﻂ(‬

‫ﺍﻟﻤﺎﺩﺓ ﺍﻟﻐﺬﺍﺋﻴﺔ‬

‫ﺍﻟﻤﺸﻤﺶ ﺍﻟﻤﺠﻔﻒ‬

‫‪15‬‬

‫ﺍﻟﻤﻮﺯ‬

‫‪3,2‬‬

‫ﺍﻟﺒﺮﺗﻘﺎﻝ‬

‫‪1,5 – 0,9‬‬

‫ﺍﻹﺟﺎﺹ‬

‫‪1,1‬‬

‫ﺍﻟﺰﻳﻮﺕ ﺍﻟﻨﺒﺎﺗﻴﺔ‬

‫‪7‬‬

‫ﺍﻟﺴﻜﺮ‬

‫‪0,7‬‬

‫ﺍﻟﺒﺼﻞ‬

‫‪0,6‬‬

‫ﺗﺮﻛﻴﺰ ﺍﻟﺤﺪﻳﺪ ﻓﻴﻬﺎ‬ ‫)ﻣﻠﻐﻢ‪ 100/‬ﻏﻢ(‬ ‫‪0,3‬‬ ‫‪1,3‬‬ ‫‪5‬‬ ‫‪3‬‬ ‫‪0,5‬‬ ‫‪0,6‬‬ ‫‪0,8‬‬ ‫‪5‬‬ ‫‪0,3‬‬ ‫‪4,5‬‬ ‫‪0,5‬‬ ‫‪0,3‬‬ ‫‪0,2‬‬ ‫ﺻﻔﺮ‬ ‫ﺻﻔﺮ‬ ‫‪0,4‬‬

‫ﺣﺎﺟﺔ ﺍﻹﻧﺳﺎﻥ ﺍﻟﻳﻭﻣﻳﺔ ﻟﻠﺣﺩﻳﺩ‪:‬‬ ‫‪U‬‬

‫ﺇﻥ ﺍﻟﺭﺟﻝ ﺍﻟﻌﺎﺩﻱ ﺍﻟﺫﻱ ﻻ ﻳﻧﺯﻑ ﻷﻱ ﺳﺑﺏ ﻳﺣﺗﺎﺝ ﻳﻭﻣﻳﺎ ً ﺇﻟﻰ ﺣﻭﺍﻟﻲ ﻣﻠﻠﻳﻐﺭﺍﻡ ﻭﺍﺣﺩ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻓﻘﻁ‪ .‬ﺍﻟﻣﺭﺃﺓ ﺗﺣﺗﺎﺝ ﺇﻟﻰ ﺿﻌﻑ‬ ‫ﺗﻠﻙ ﺍﻟﻛﻣﻳﺔ ﺑﺳﺑﺏ ﻧﺯﻑ ﺍﻟﺩﻭﺭﺓ ﺍﻟﺷﻬﺭﻳﺔ‪ .‬ﺍﻷﻁﻔﺎﻝ ﻳﺣﺗﺎﺟﻭﻥ ﺇﻟﻰ ﻛﻣﻳﺔ ﺃﻛﺑﺭ‪ ،‬ﻧﺳﺑﺔ ﺇﻟﻰ ﻭﺯﻧﻬﻡ‪ ،‬ﺑﺳﺑﺏ ﻧﻣﻭّ ﻫﻡ ﺍﻟﻣﺳﺗﻣﺭ‪ .‬ﻓﻬﻡ‬ ‫ﻳﺣﺗﺎﺟﻭﻥ ﺇﻟﻰ ﺇﺿﺎﻓﺔ ﺧﻼﻳﺎ ﺟﺩﻳﺩﺓ‪ ،‬ﻭﻣﻧﻬﺎ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء‪ .‬ﻛﻣﺎ ﺃﻥ ﻣﺧﺯﻥ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﻁﻔﻝ ﻳﺟﺏ ﺃﻥ ﻳﺗﻭﺳﻊ ﺑﺻﻭﺭﺓ ﻣﺳﺗﻣﺭﺓ‬ ‫ﻟﻳﺗﻣﺎﺷﻰ ﻣﻊ ﻧﻣﻭ ﺍﻟﺟﺳﻡ ّ‬ ‫ﻭﺍﻁﺭﺍﺩ ﺯﻳﺎﺩﺓ ﺣﺎﺟﺗﻪ‪ .‬ﻟﺫﺍ‪ ،‬ﻓﺎﻷﻁﻔﺎﻝ ﻗﺩ ﻳﺣﺗﺎﺟﻭﻥ ﺇﻟﻰ ‪ 3‬ﻣﻠﻐﻡ ﺑﺎﻟﻳﻭﻡ ﻟﻣﻧﻊ ﺣﺻﻭﻝ ﻧﻘﺹ ﻓﻲ ﺍﻟﺣﺩﻳﺩ‬ ‫ﺧﺎﻝ ﻭﻳﺅﺩﻱ ﺇﻟﻰ ﻅﻬﻭﺭ ﻓﻘﺭ ﺩﻡ ﻧﻘﺹ‬ ‫ﻋﻧﺩﻫﻡ‪ .‬ﺍﻟﻁﻔﻝ ﺍﻟﻣﻭﻟﻭﺩ ﻗﺑﻝ ﺍﻛﺗﻣﺎﻝ ﻣﺩﺓ ﺍﻟﺣﻣﻝ )ﺍﻟﺧﺩﻳﺞ( ﻳﻛﻭﻥ ﻣﺧﺯﻥ ﺍﻟﺣﺩﻳﺩ ﻋﻧﺩﻩ ﺷﺑﻪ ٍ‬ ‫ﺍﻟﺣﺩﻳﺩ ﻣﺎ ﻟﻡ ﻳُﻌﺟﱠ ﻝ ﺑﺗﺯﻭﻳﺩﻩ ﺑﺎﻟﺣﺩﻳﺩ‪.‬‬

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‫ﻫﺫﻩ ﺍﻟﺣﺎﺟﺔ ﺍﻟﻳﻭﻣﻳﺔ ﻟﻺﻧﺳﺎﻥ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻫﻲ ﺑﺳﺑﺏ ﻓﻘﺩﺍﻥ ﻛﻣﻳﺎﺕ ﺑﺳﻳﻁﺔ ﻣﻧﻪ‪ ،‬ﻭﺑﺻﻭﺭﺓ ﻣﺳﺗﻣﺭﺓ‪ ،‬ﺿﻣﻥ ﺧﻼﻳﺎ ﺍﻟﺟﻠﺩ ﻭﺍﻷﻣﻌﺎء‬ ‫ﺍﻟﻣﺗﺳﺎﻗﻁﺔ ﻭﻓﻲ ﺍﻹﻓﺭﺍﺯﺍﺕ ﺍﻟﻣﺧﺗﻠﻔﺔ‪ .‬ﻳﻌﻭّ ﺽ ﺍﻹﻧﺳﺎﻥ ﺫﻟﻙ ﻳﻭﻣﻳﺎ ً ﺑﺎﻟﻣﻘﺎﺩﻳﺭ ﺍﻟﺗﻲ ﺗﻣﺗﺻّﻬﺎ ﺍﻷﻣﻌﺎء ﻣﻥ ﺍﻷﻁﻌﻣﺔ ﺍﻟﻣﺧﺗﻠﻔﺔ‪.‬‬

‫ﺍﻣﺗﺻﺎﺹ ﺍﻷﻣﻌﺎء ﻟﻠﺣﺩﻳﺩ‪:‬‬ ‫ﺇﻥ ﺍﻷﻣﻌﺎء ﻻ ﺗﻣﺗﺹ ﻛﻝ ﺍﻟﺣﺩﻳﺩ ﺍﻟﻣﺗﻭﻓﺭ ﻓﻲ ﺍﻟﻁﻌﺎﻡ ﻭﺇﻧﻣﺎ ﺗﻣﺗﺹ ﻧﺳﺑﺔ ﻻ ﺗﺗﺟﺎﻭﺯ‪ %30‬ﻣﻧﻪ‪ ،‬ﻭﻫﺫﻩ ﺍﻟﻧﺳﺑﺔ ﺗﻘﻝ ﻛﺛﻳﺭﺍً ﻓﻲ ﺣﺎﻻﺕ‬ ‫ﻗﻠﺔ ﺍﻟﺣﺎﺟﺔ ﻟﻠﺣﺩﻳﺩ‪ ،‬ﻛﻣﺎ ﺗﺯﺩﺍﺩ ﻣﻊ ﺯﻳﺎﺩﺓ ﺍﻟﺣﺎﺟﺔ ﺇﻟﻳﻪ ﻓﻲ ﺍﻟﺟﺳﻡ )ﻛﻣﺎ ﻳﺣﺩﺙ ﺑﻌﺩ ﺍﻟﻧﺯﻑ ﻣﺛﻼً(‪.‬‬ ‫ﻭﻫﻧﺎﻙ ﻋﻣﻠﻳﺔ ﺳﻳﻁﺭﺓ ﻋﻠﻰ ﺍﻻﻣﺗﺻﺎﺹ ﻫﻲ ﺣ ّﻘﺎ ً ﻣﻥ ﺁﻳﺎﺕ ﷲ ﺍﻟﻌﻅﻣﻰ ﻳﺷﺗﺭﻙ ﻓﻳﻬﺎ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ ﻣﻥ ﺧﻼﻳﺎ ﺟﺩﺍﺭ ﺍﻷﻣﻌﺎء‬ ‫ﻭﺍﻟﺩﻡ ﻭﺍﻟﻛﺑﺩ ﻭﻏﻳﺭﻫﺎ‪ ،‬ﻛﻠﻬﺎ ﺗﻌﻣﻝ ﺑﺗﻧﺳﻳﻕ ﻭﺩﻗﺔ ﻛﺎﻣﻠﻳْﻥ ﻟﺋﻼ ﻳﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﺟﺳﻡ ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ‪ ،‬ﻭﻟﺋﻼ ﺗﺯﺩﺍﺩ ﻛﻣﻳﺗﻪ ﻓﻲ‬ ‫ﺍﻟﺟﺳﻡ‪ ،‬ﺣﻳﺙ ﺃﻥ ﻓﻲ ﻛﻼ ﺍﻟﺣﺎﻟﺗﻳْﻥ ﺿﺭﺭﺍ‪ .‬ﻭﻟﻭ ﺩﺧﻝ ﻣﻥ ﺍﻷﻣﻌﺎء ﻛﻝ ﻳﻭﻡ ﻛﻣﻳﺔ ﺃﻛﺑﺭ ﺑﻧﺳﺑﺔ ﻗﻠﻳﻠﺔ ﻣﻣﺎ ﻳﺣﺗﺎﺝ ﺍﻟﺟﺳﻡ ﻟﺗﺭﺍﻛﻡ ﺍﻟﺣﺩﻳﺩ‬ ‫ﻭﺃﺩﻯ ﺑﻌﺩ ﻣﺭﻭﺭ ﺳﻧﻳﻥ ﻁﻭﻳﻠﺔ ﺇﻟﻰ ﺩﻣﺎﺭ ﻟﺧﻼﻳﺎ ﺍﻟﻛﺑﺩ ﻭﺍﻟﺑﻧﻛﺭﻳﺎﺱ ﻭﺍﻟﻘﻠﺏ‪ .‬ﻭﻫﻧﺎﻙ ﻣﺭﺽ ﻭﺭﺍﺛﻲ ﻳﺗﺻﻑ ﺑﻬﺫﻩ ﺍﻟﺻﻔﺔ ﻫﻭ ]ﻣﺭﺽ‬ ‫ﺯﻳﺎﺩﺓ ﺻﺑﻐﺔ ﺍﻟﺩﻡ ﺍﻟﻭﺭﺍﺛﻲ[‪.‬‬ ‫ﻛﻣﺎ ﺃﻥ ﻧﻭﻉ ﺍﻟﻣﺭ ّﻛﺑﺎﺕ ﺍﻟﻐﺫﺍﺋﻳﺔ ﺍﻟﺗﻲ ﻳﺩﺧﻝ ﻓﻳﻬﺎ ﺍﻟﺣﺩﻳﺩ ﻟﻪ ﺗﺄﺛﻳﺭ ﻋﻠﻰ ﺳﺭﻋﺔ ﺍﻣﺗﺻﺎﺻﻪ‪ ،‬ﻓﺎﻣﺗﺻﺎﺹ ﺍﻟﺣﺩﻳﺩ ﻣﻥ ﺍﻟﻣﺭ ّﻛﺑﺎﺕ‬ ‫ﺍﻟﻼﻋﺿﻭﻳﺔ ﺃﺳﻬﻝ ﻣﻧﻪ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻣﺭ ّﻛﺑﺎﺕ ﺍﻟﻌﺿﻭﻳﺔ‪ .‬ﻭﻫﻧﺎﻙ ﻣﻭﺍﺩ ﺃﺧﺭﻯ ﻗﺩ ﺗﻛﻭﻥ ﻓﻲ ﺍﻟﻐﺫﺍء ﺗﺅﺛﺭ ﻋﻠﻰ ﺍﻻﻣﺗﺻﺎﺹ‪ ،‬ﻭﺗﺅﺛﺭ‬ ‫ﺍﻟﺣﻣﻭﺿﺔ ﻋﻠﻰ ﺍﻻﻣﺗﺻﺎﺹ ﺇﻳﺟﺎﺑﺎ ً‪ .‬ﻭﻓﻲ ﺣﺎﻝ ﺗﻧﺎﻭﻝ ﺍﻟﺣﺩﻳﺩ ﻋﻠﻰ ﺷﻛﻝ ﻋﻘﺎﺭ ﻓﺈﻥ ﻧﺳﺑﺔ ﻣﺣﺩﻭﺩﺓ ﻣﻧﻪ ﻳﺟﺭﻱ ﺍﻣﺗﺻﺎﺻﻬﺎ ﻣﻥ‬ ‫ّ‬ ‫ﻭﻳﺅﺛﺭ ﻋﻠﻰ ﻟﻭﻧﻪ ﻟﻳﺟﻌﻠﻪ ﺃﺳﻭﺩﺍ‪.‬‬ ‫ﺍﻷﻣﻌﺎء‪ ،‬ﺗﺗﻧﺎﺳﺏ ﻣﻊ ﺣﺎﺟﺔ ﺍﻟﺟﺳﻡ‪ ،‬ﻭﻣﺎ ﻳﺗﺑﻘﻰ ﻳﺧﺭﺝ ﻓﻲ ﺍﻟﺑﺭﺍﺯ‬ ‫ﻓﻲ ﺣﺎﻟﺔ ﺃﺧﺫ ﺣ ّﺑﺎﺕ ﺍﻟﺣﺩﻳﺩ ﺑﻛﻣ ّﻳﺎﺕ ﻛﺑﻳﺭﺓ ﺟﺩّﺍ ) ﺧﻁﺄ ً ﺃﻭ ﻗﺻﺩﺍً( ﻓﺈﻥ ﺍﻟﺳﻳﻁﺭﺓ ﻋﻠﻰ ﺍﻻﻣﺗﺻﺎﺹ ُﺗﻔ َﻘﺩ ﻭﺗﺩﺧﻝ ﻛﻣﻳﺎﺕ ﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ‬ ‫ﺗﺳﻣﻡ ﺑﺎﻟﺣﺩﻳﺩ‪.‬‬

‫ﺃﺳﺑﺎﺏ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪:‬‬ ‫ﻟﻳﺱ ﻣﻥ ﺍﻟﺻﻌﺏ ﻋﻠﻰ ﺍﻟﻘﺎﺭﺉ ﺃﻥ ﻳﺗﺻﻭﺭ ﺑﻌﺩ ﺍﻟﻣﻧﺎﻗﺷﺔ ﺃﻋﻼﻩ ﺍﻷﺳﺑﺎﺏ ﺍﻟﺗﻲ ﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﺟﺳﻡ‪ .‬ﺇﻥ ﺃﻱ ﺷﺧﺹ‬ ‫ﻟﻳﺱ ﺑﻣﻘﺩﻭﺭﻩ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ ﻣﺗﻁﻠﺑﺎﺗﻪ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻣﻥ ﻏﺫﺍﺋﻪ ﺑﻣﺎ ﻳﻌﺎﺩﻝ ﻣﺎ ﻳﻔﻘﺩﻩ ﺳﻭﻑ ﻳﻧﺗﻬﻲ ﺑﻪ ﺍﻷﻣﺭ ﺇﻟﻰ ﺍﺳﺗﻧﻔﺎﺩ ﻣﺧﺯﻭﻧﻪ ﻣﻥ‬ ‫ﺍﻟﺣﺩﻳﺩ ﻭﺇﺻﺎﺑﺗﻪ ﺑﻔﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪ .‬ﻭﻳﻣﻛﻧﻧﺎ ﺗﺻﻭﺭ ﺍﻷﻣﺭ ﻋﻠﻰ ﺷﻛﻝ ﻣﻳﺯﺍﻥ ﻣﺩﻓﻭﻋﺎﺕ ﻳﺻﺎﺏ ﺑﺎﻟﻌﺟﺯ ﺇﻣﺎ ﻟﻘﻠﺔ ﺍﻟﺩﺧﻝ ﺃﻭ‬ ‫ﺯﻳﺎﺩﺓ ﺍﻟﻣﺻﺭﻭﻑ‪ .‬ﻭﺇﻟﻳﻙ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻣﻬﻣﺔ ﺍﻟﺗﻲ ﻳﺣﺩﺙ ﻓﻳﻬﺎ ﻓﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﺑﺳﺑﺏ ﻭﺟﻭﺩ ﺣﺎﻟﺔ ﻭﺍﺣﺩﺓ‪ ،‬ﺃﻭ ﺃﻛﺛﺭ‪ ،‬ﻟﺩﻯ‬ ‫ﺍﻟﺷﺧﺹ‪.‬‬ ‫ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﻐﺫﺍء ﺑﺳﺑﺏ ﻧﻭﻋﻳﺔ ﺍﻟﻐﺫﺍء ﺍﻟﺫﻱ ﻳﺅﻛﻝ ﻭﻓﻳﻪ ﻗﻠﻳﻝ ﻣﻥ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﺃﻭ ﻟﻳﺱ ﻓﻳﻪ ﺣﺩﻳﺩ‪.‬‬ ‫ﺯﻳﺎﺩﺓ ﺍﻟﺣﺎﺟﺔ ﺇﻟﻰ ﺍﻟﺣﺩﻳﺩ ﺑﺳﺑﺏ ﺍﻟﻧﻣﻭ ﻓﻲ ﺍﻷﻁﻔﺎﻝ ﻣﻊ ﻗﻠﺔ ﻣﺎﻳﺣﺻﻠﻭﻥ ﻋﻠﻳﻪ ﻣﻥ ﺍﻟﻐﺫﺍء‪ ،‬ﺧﺻﻭﺻﺎ ً ﺇﺫﺍ ﺍﻗﺗﺻﺭ ﻋﻠﻰ ﺍﻟﺣﻠﻳﺏ‬ ‫ﺑﻌﺩ ﺍﻟﺷﻬﺭ ﺍﻟﺳﺎﺩﺱ ﻣﻥ ﺍﻟﻌﻣﺭ‪.‬‬ ‫ﺍﻟﺣﻣﻝ ﻭﺍﻟﺭﺿﺎﻋﺔ ﻓﻲ ﺍﻟﻣﺭﺃﺓ‪ ،‬ﺑﺳﺑﺏ ﺣﺎﺟﺔ ﺍﻟﺟﻧﻳﻥ ﺇﻟﻰ ﺍﻟﺣﺩﻳﺩ ﻷﻏﺭﺍﺽ ﺍﻟﻧﻣﻭ ﻭﺍﻟﺧﺯﻥ‪ ،‬ﻭﻫﻭ ﻣﺎ ﻳﺄﺧﺫﻩ ﻣﻥ ﺃﻣﻪ‪ .‬ﺇﺫﺍ ﺗﻛﺭﺭ‬ ‫ﻑ ﻓﻲ ﻏﺫﺍﺋﻬﺎ‪.‬‬ ‫ﺍﻟﺣﻣﻝ ﻓﻲ ﻓﺗﺭﺍﺕ ﻣﺗﻘﺎﺭﺑﺔ ﺯﺍﺩﺕ ﺍﻟﺣﺎﺟﺔ‪ ،‬ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻟﺩﻯ ﺍﻷﻡ ﺇﺫﺍ ﻟﻡ ﻳﺗﻭﻓﺭ ﻣﻧﻪ ﻣﻘﺩﺍﺭ ﻛﺎ ٍ‬ ‫ﻓﻘﺩﺍﻥ ﺍﻟﺩﻡ ﺍﻟﻣﺗﻛﺭﺭ‪ ،‬ﻛﻣﺎ ﻳﺣﺻﻝ ﻓﻲ ﺇﺻﺎﺑﺔ ﺍﻟﺷﺧﺹ ﺑﺩﻳﺩﺍﻥ ﺍﻷﻧﻛﻠﺳﺗﻭﻣﺎ ﻭﺍﻟﺑﻠﻬﺎﺭﺳﻳﺎ ﺃﻭ ﻛﻣﺎ ﻳﺣﺻﻝ ﻓﻲ ﺍﻟﻧﺯﻑ ﺍﻟﻣﺯﻣﻥ ﻣﻥ‬ ‫ﻗﺭﺣﺔ ﺍﻟﻣﻌﺩﺓ ﻭﺍﻻﺛﻧﻲ ﻋﺷﺭﻱ ﻭﺗﻘﺭّﺣﺎﺕ ﺍﻟﻘﻭﻟﻭﻥ ﻭﺣﺻﺎﺓ ﺍﻟﻛﻠﻳﺔ ﻭﺍﻟﺑﻭﺍﺳﻳﺭ‪ ،‬ﻭﻏﻳﺭﻫﺎ ﻣﻥ ﺍﻟﻌﻠﻝ ﺍﻟﻣﺅﺩﻳﺔ ﻟﻠﻧﺯﻑ ﺍﻟﻣﺗﻛﺭﺭ‪.‬‬ ‫ﻗﻠﺔ ﺍﻻﻣﺗﺻﺎﺹ ﻣﻥ ﺍﻷﻣﻌﺎء ﺭﻏﻡ ﺗﻭﻓﺭ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﻐﺫﺍء‪ .‬ﻳﺣﺻﻝ ﻫﺫﺍ ﻓﻲ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺎﻹﺳﻬﺎﻝ ﺍﻟﻣﺗﻛﺭﺭ ﻭﻓﻲ ﺃﻣﺭﺍﺽ ﺳﻭء‬ ‫ﺍﻻﻣﺗﺻﺎﺹ ﺍﻟﻣﻌﻭﻳﺔ‪ .‬ﻫﺫﻩ ﺍﻹﺻﺎﺑﺎﺕ ﻗﺩ ﺗﻛﻭﻥ ﻣﺻﺣﻭﺑﺔ ﺑﻔﻘﺩﺍﻥ ﻛﻣﻳﺎﺕ ﺑﺳﻳﻁﺔ ﻣﻥ ﺍﻟﺩﻡ ﺑﺻﻭﺭﺓ ﻣﺗﻛﺭﺭﺓ‪ ،‬ﺇﺿﺎﻓﺔ ﻟﻧﻘﺹ‬ ‫ﺍﻣﺗﺻﺎﺹ ﺍﻟﺣﺩﻳﺩ‪.‬‬ ‫‪24‬‬

‫ﺃﻛﺭﺭ ﻫﻧﺎ ﺃﻧﻪ ﻟﻳﺱ ﻛﻝ ﻣﻥ ﻳﻔﻘﺩ ﺩﻣﺎ ً ﻭﻻ ﻛﻝ ﻁﻔﻝ ﻳﻧﻣﻭ ﺃﻭ ﺍﻣﺭﺃﺓ ﺗﺣﻣﻝ ﺟﻧﻳﻧﺎ ً ﻳﺻﺎﺑﻭﻥ ﺑﻔﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻭﺇﻧﻣﺎ ﻳﺗﻭﻗﻑ ﺍﻷﻣﺭ‬ ‫ﻋﻠﻰ ﺍﻟﻘﺩﺭﺓ ﺃﻭ ﺍﻟﻔﺷﻝ ﻓﻲ ﺗﻌﻭﻳﺽ ﺍﻟﻛﻣﻳﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻣﻥ ﺍﻟﻁﻌﺎﻡ‪.‬‬ ‫ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻣﺎﺕ ﺍﻟﺧﺎﺻﺔ ﺑﻔﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪:‬‬ ‫ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻣﺎﺕ ﺍﻟﻌﺎﻣﺔ ﻟﻔﻘﺭ ﺍﻟﺩﻡ )ﺻﻔﺣﺔ ‪ (16‬ﻓﺈﻥ ﻓﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻗﺩ ﺗﻛﻭﻥ ﻟﻪ ﺃﻋﺭﺍﺽ ﺧﺎﺻﺔ ﺑﻪ‪ ،‬ﻣﻧﻬﺎ‬ ‫ﻣﺎﻫﻭ ﻋﺎﺋﺩ ﺇﻟﻰ ﺍﻟﺣﺎﻟﺔ ﺍﻷﺻﻠﻳﺔ ﺍﻟﻣﺳﺑﺑﺔ ﻟﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﻣﺛﻝ ﻋﻼﻣﺎﺕ ﺳﻭء ﺍﻻﻣﺗﺻﺎﺹ ﻭﻋﻼﻣﺎﺕ ﺍﻟﻧﺯﻑ ﺍﻟﻣﺗﻛﺭﺭ )ﻛﺎﺳﻭﺩﺍﺩ ﻟﻭﻥ‬ ‫ﺍﻟﺑﺭﺍﺯ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﻧﺯﻑ ﻣﻥ ﺍﻟﻣﻌﺩﺓ ﻭﺍﻷﻣﻌﺎء(‪ .‬ﻛﺫﻟﻙ ﻳﺟﺏ ﺃﻥ ﺃﺫﻛﺭ ﻫﻧﺎ ﺃﻥ ﺍﻟﺣﺩﻳﺩ ﻳﺩﺧﻝ ﻓﻲ ﺗﺭﻛﻳﺏ ﺍﻟﻛﺛﻳﺭ ﻣﻥ ﺍﻹﻧﻅﻳﻣﺎﺕ‬ ‫ﺍﻟﻬﺎﻣﺔ ﺍﻟﺗﻲ ﻟﻬﺎ ﺩﻭﺭ ﻓﻲ ﻧﺷﺎﻁ ﺍﻹﻧﺳﺎﻥ‪ ،‬ﻓﺎﻟﻧﻘﺹ ﻓﻳﻪ ﻳﺅﺛﺭ ﻋﻠﻰ ﺍﻟﻧﺷﺎﻁ ﻣﺛﻠﻣﺎ ﻳﺅﺛﺭ ﻋﻠﻰ ﻣﺳﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ .‬ﻭﻳﻌﺗﺑﺭ ﺍﻟﺧﻣﻭﻝ‬ ‫ﺍﻟﻌﺎﻡ ﻣﻥ ﻋﻼﻣﺎﺕ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪ .‬ﺍﻟﻛﺛﻳﺭ ﻣﻥ ﺍﻟﻣﺭﺿﻰ ﻳﻼﺣﻅ ﺗﺣﺳﻥ ﻧﺷﺎﻁﻪ ﻟﺩﻯ ﺍﻟﺑﺩء ﺑﺗﻧﺎﻭﻝ ﺍﻟﺣﺩﻳﺩ ﻛﻌﻼﺝ ﻟﻔﻘﺭ ﺍﻟﺩﻡ ﻭﻗﺑﻝ ﻅﻬﻭﺭ‬ ‫ﺃﻱ ﺍﺭﺗﻔﺎﻉ ﻓﻲ ﻧﺳﺑﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪.‬‬

‫ﺍﻟﻌﻼﻣﺎﺕ ﺍﻟﻣﺧﺑﺭﻳﺔ ﻟﻔﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪:‬‬ ‫ﺃﻭﻝ ﻣﺎﻳﺟﺏ ﺗﺄﻛﻳﺩﻩ ﻁﺑﻌﺎ ً ﻫﻭ ﻧﻘﺹ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ )ﺃﻱ ﻭﺟﻭﺩ ﻓﻘﺭ ﺍﻟﺩﻡ(‪ .‬ﻳﺗﺻﻑ ﻓﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﺑﺻﻐﺭ ﺣﺟﻭﻡ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‬ ‫ﺍﻟﺣﻣﺭﺍء‪ .‬ﻭﻣﻥ ﺧﻼﻝ ﺍﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ ﻳﺛﺑﺕ – ﻋﺎﺩﺓ – ﺍﻧﺧﻔﺎﺽ ]ﻣﻌﺩﻝ ﺣﺟﻡ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء[ ﻋﻥ ﺍﻟﺭﻗﻡ ﺍﻟﻁﺑﻳﻌﻲ ﺍﻟﺫﻱ ﻫﻭ ﻣﻥ‬ ‫‪ 80‬ﺇﻟﻰ ‪] 94‬ﻓﻣﺗﻭﻟﺗﺭ[‪ .‬ﻛﺫﻟﻙ ﻓﺈﻥ ﻣﺣﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻟﻛﻝ ﺧﻠﻳﺔ ﻳﻛﻭﻥ ﺃﻗﻝ ﻣﻥ ﺍﻟﻁﺑﻳﻌﻲ ﻑ]ﻣﻌﺩﻝ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫ﺍﻟﺧﻠﻭﻱ[ ﻳﻧﻘﺹ ﻋﻥ ﺍﻟﺣﺩ ﺍﻷﺩﻧﻰ ﺍﻟﻁﺑﻳﻌﻲ ﻭﻫﻭ ‪ .%32‬ﻭﻳﻧﻘﺹ ]ﻣﺣﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺧﻠﻭﻱ[ ﺗﺣﺕ ﺍﻟﺣﺩ ﺍﻷﺩﻧﻰ ﺍﻟﺫﻱ ﻫﻭ ‪26‬‬ ‫ﻣﺎﻳﻛﺭﻭ‪-‬ﻣﺎﻳﻛﺭﻭ ﻏﺭﺍﻡ ﻓﻲ ﺍﻟﺧﻠﻳﺔ ﺍﻟﻭﺍﺣﺩﺓ‪ .‬ﺍﻟﻣﺧﺗﺑﺭ ﻳﻘﻭﻡ ﺃﻳﺿﺎ ً ﺑﻔﺣﺹ ﺃﺷﻛﺎﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻓﻲ ﻣﺳﺣﺔ ﺩﻡ ﻣﺻﺑﻭﻏﺔ ﺣﻳﺙ ﻳﻛﻭﻥ‬ ‫ﻫﻧﺎﻙ ﺑﻌﺽ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺷﻭﻫﺔ ﻭﻳﺗﻡ ﺍﻟﺗﺄﻛﺩ ﺧﻼﻝ ﻓﺣﺹ ﺍﻟﻣﺳﺣﺔ ﺍﻟﻣﺻﺑﻭﻏﺔ ﻣﻥ ﺻﻐﺭ ﺍﻟﺣﺟﻡ ﻭﻧﻘﺹ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺩﺍﺧﻝ ﺍﻟﺧﻼﻳﺎ‬ ‫ﺣﻳﺙ ﺗﺑﺩﻭ ﺍﻟﺧﻼﻳﺎ ﺑﺎﻫﺗﺔ ﺍﻟﻠﻭﻥ‪.‬‬

‫ﺍﻟﻭﻗﺎﻳﺔ ﻭﺍﻟﻌﻼﺝ ﻣﻥ ﻓﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪:‬‬ ‫ﺇﻥ ﺍﻟﻭﻗﺎﻳﺔ ﻣﻥ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻳﻛﻭﻥ ﺑﺗﻧﺎﻭﻝ ﺍﻷﻁﻌﻣﺔ ﺍﻟﺗﻲ ﺗﺣﺗﻭﻱ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻣﺎ ﻳﺳﺩ ﺍﻟﺣﺎﺟﺔ ﺍﻟﻳﻭﻣﻳﺔ ﻟﻠﺷﺧﺹ‪ .‬ﻭﻟﻣﺎ ﻟﻡ‬ ‫ﻳﻛﻥ ﺑﻣﻘﺩﻭﺭ ﻛﻝ ﺷﺧﺹ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ ﺍﻟﻣﻁﻠﻭﺏ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻋﻥ ﻁﺭﻳﻕ ﻏﺫﺍء ﻣﺗﻛﺎﻣﻝ ﻓﺈﻥ ﺑﻌﺽ ﺍﻷﻓﺭﺍﺩ ﺍﻟﺫﻳﻥ ﺗﺷﺗﺩ ﺣﺎﺟﺗﻬﻡ‬ ‫ﻟﻠﺣﺩﻳﺩ ﻷﻱ ﺳﺑﺏ ﻣﻥ ﺍﻷﺳﺑﺎﺏ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺳﺎﺑﻘﺎ ً ﻳﻣﻛﻥ ﺇﻋﻁﺎﺅﻫﻡ ﺍﻟﺣﺩﻳﺩ ﻋﻠﻰ ﺷﻛﻝ ﺣﺑﻭﺏ ﻛﻭﻗﺎﻳﺔ ﻟﻬﻡ ﻗﺑﻝ ﺣﺻﻭﻝ ﻓﻘﺭ ﺍﻟﺩﻡ ﻓﻌﻼً‪،‬‬ ‫ﻣﻊ ﺍﻟﺗﺄﻛﺩ ﻣﻥ ﻣﺳﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺑﻳﻥ ﻣﺩﺓ ﻭﺃﺧﺭﻯ‪ .‬ﻛﻣﺎ ﺃﻥ ﺍﻟﻣﺻﺎﺏ ﺑﻔﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻳﻌﻁﻰ ﺍﻟﺣﺩﻳﺩ ﻛﻌﻼﺝ‪ ،‬ﻋﻠﻰ ﺃﻥ‬ ‫ﻳﺛﺑﺕ ﻭﺟﻭﺩ ﻓﻘﺭ ﺍﻟﺩﻡ ﻭﻧﻭﻋﻪ ﺑﺎﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ‪.‬‬ ‫ﺇﻥ ﻣﺭ ّﻛﺏ ﻛﺑﺭﻳﺗﺎﺕ ﺍﻟﺣﺩﻳﺩﻭﺯ ﻫﻭ ﻣﻥ ﺃﺑﺳﻁ ﻭﺃﻧﺟﺢ ﺍﻟﻣﺭ ّﻛﺑﺎﺕ ﺍﻟﺗﻲ ﺗﻌﻁﻰ ﻟﻠﻣﺭﻳﺽ ﺍﻟﻣﺻﺎﺏ ﺑﻔﻘﺭ ﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﻭﻳﻌﻁﻰ ﻋﺎﺩﺓ‬ ‫ﻋﻠﻰ ﺷﻛﻝ ﺣﺑﻭﺏ‪ ،‬ﻛﻣﺎ ﻳﻭﺟﺩ ﻣﻧﻪ ﻣﺣﻠﻭﻝ ﻟﻠﺻﻐﺎﺭ ﻭﻗﻁﺭﺍﺕ ﺃﻳﺿﺎ ً‪ .‬ﺗﻭﺟﺩ ﺃﻳﺿﺎ ً ﻣﺭﻛﺑﺎﺕ ﺣﺩﻳﺩ ﻟﻠﺣﻘﻥ ﺑﺎﻟﻭﺭﻳﺩ ﺃﻭﺑﺎﻟﻌﺿﻠﺔ‪ ،‬ﻭﺣﺳﺏ‬ ‫ﺗﻌﻠﻳﻣﺎﺕ ﺍﻟﻁﺑﻳﺏ‪ .‬ﻫﺫﻩ ﺗﻭﺻﻑ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺷﻙ ﺑﻭﺟﻭﺩ ﺧﻠﻝ ﻓﻲ ﺍﻻﻣﺗﺻﺎﺹ ﺃﻭ ﻟﺭﻓﻊ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﻧﺎﻗﺹ ﻛﺛﻳﺭﺍً ﺑﺳﺭﻋﺔ ﻣﻊ‬ ‫ﻣﻝء ﻣﺧﺎﺯﻥ ﺍﻟﺣﺩﻳﺩ ﺃﻭ ﺇﺫﺍ ﻛﺎﻧﺕ ﺣﺑﺎﺕ ﺍﻟﺣﺩﻳﺩ ﺗﺳﺑﺏ ﻣﺷﺎﻛﻝ ﻓﻲ ﺍﻟﻣﻌﺩﺓ ﻻ ﻳﺣﺗﻣﻠﻬﺎ ﺍﻟﻣﺭﻳﺽ‪ .‬ﺇﺫﺍ ﺃﻋﻁﻲ ﺍﻟﺣﺩﻳﺩ ﺑﺎﻟﺯﺭﻕ )ﺑﺎﻟﻌﺿﻠﺔ‬ ‫ﺃﻭ ﺍﻟﻭﺭﻳﺩ( ﻓﺑﻁﺑﻳﻌﺔ ﺍﻟﺣﺎﻝ ﺳﺗﺩﺧﻝ ﺍﻟﻛﻣﻳﺔ ﻛﻠﻬﺎ ﺇﻟﻰ ﺍﻟﺟﺳﻡ ﺳﻭﺍ ًء ﻛﺎﻥ ﻣﺣﺗﺎﺟﺎ ً ﺇﻟﻳﻬﺎ ﺃﻡ ﻻ‪ ،‬ﻭﻳﺻﻌﺏ ﺍﻟﺗﺧﻠﺹ ﻣﻧﻬﺎ ﺇﺫﺍ ﻟﻡ ﻳﻛﻥ‬ ‫ﺑﺣﺎﺟﺔ ﺇﻟﻳﻬﺎ‪ ،‬ﻭﻗﺩ ﺗﺳﺑﺏ ﺿﺭﺭﺍً ﻓﻲ ﻫﺫﻩ ﺍﻟﺣﺎﻟﺔ‪.‬‬ ‫ﺑﻌﺩ ﺇﻋﻁﺎء ﺍﻟﻌﻼﺝ ﻳﺟﺏ ﺗﺗﺑﻊ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻣﺧﺑﺭﻳﺎ ً ﻟﻠﺗﺄﻛﺩ ﻣﻥ ﺍﻟﻣﻔﻌﻭﻝ‪.‬‬ ‫ﺃﻧﺑّﻪ ﻫﻧﺎ ﻣﺭﺓ ﺃﺧﺭﻯ ﺃﻥ ﺍﻟﺣﺩﻳﺩ‪ ،‬ﺳﻭﺍء ﻛﺎﻥ ﻋﻠﻰ ﺷﻛﻝ ﺣﺑﻭﺏ ﺃﻭ ﻣﺣﻠﻭﻝ‪ ،‬ﻫﻭ ﻣﻥ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺧﻁﺭﺓ ﺍﻟﺗﻲ ﻻ ﻳﺟﻭﺯ ﺗﻧﺎﻭﻟﻬﺎ ﺑﺩﻭﻥ‬ ‫ﻧﺻﺢ ﺍﻟﻁﺑﻳﺏ ﻭﺍﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ ﺍﻟﻣﻧﺎﺳﺏ‪ ،‬ﺣﺗﻰ ﻟﻭ ﺍﻋﺗﻘﺩ ﺍﻟﻣﺭﻳﺽ ﺃﻥ ﻟﺩﻳﻪ ﺃﻋﺭﺍﺽ ﻓﻘﺭ ﺩﻡ‪ ،‬ﻓﻘﺩ ﻳﻛﻭﻥ ﻓﻘﺭ ﺍﻟﺩﻡ – ﺇﻥ ﻭﺟﺩ‬ ‫ﻓﻌﻼً‪ -‬ﻏﻳﺭ ﻣﺗﺳﺑﺏ ﻋﻥ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﺃﺻﻼً‪ .‬ﻛﺛﻳﺭ ﻣﻥ ﺍﻟﻧﺎﺱ ﻳﻅﻥ ﺃﻥ ﺍﻟﺣﺩﻳﺩ )ﻣﻘﻭّ ﻱ( ﻟﻠﺟﺳﻡ ﻭﺗﻧﺎﻭﻟﻪ ﻧﺎﻓﻊ ﻓﻲ ﻛﻝ ﺍﻷﺣﻭﺍﻝ‪.‬‬ ‫ﻭﺍﻟﺣﻘﻳﻘﺔ ﻫﻲ ﺃﻥ ﻭﺟﻭﺩ ﻣﻘﺩﺍﺭ ﺯﺍﺋﺩ ﻣﻥ ﺍﻟﺣﺩﻳﺩ ﻓﻲ ﺍﻟﺟﺳﻡ ﻓﻳﻪ ﺿﺭﺭ‪ .‬ﻭﻓﻲ ﺣﺎﻻﺕ ﺯﻳﺎﺩﺓ ﺍﻟﺣﺩﻳﺩ ﺑﺷﻛﻝ ﻛﺑﻳﺭ ﻓﻲ ﺍﻟﺟﺳﻡ ﻓﺈﻥ ﺍﻷﻁﺑﺎء‬ ‫‪25‬‬

‫ﻳﻌﻁﻭﻥ ﺍﻟﻣﺭﻳﺽ ﻋﻘﺎﺭﺍﺕ ﺗﻧﺯﻉ ﺍﻟﺣﺩﻳﺩ ﻟﻠﺗﺧﻠﺹ ﻣﻧﻪ ﻓﻲ ﺍﻟﺑﻭﻝ‪ .‬ﻫﺫﺍ ﻳﺣﺻﻝ ﻣﺛﻼً ﻋﻧﺩ ﺍﻟﻣﺭﺿﻰ ﺑﻔﻘﺭ ﺩﻡ ﻭﺭﺍﺛﻲ ﻭﻳُﻧﻘﻝ ﻟﻬﻡ ﺍﻟﺩﻡ‬ ‫ﺑﺻﻭﺭﺓ ﻣﺗﻛﺭﺭﺓ‪.‬‬ ‫ﻛﻣﺎ ﺃﺭﺟﻭ ﺃﻥ ﺃﻧﺑﻪ ﺍﻟﻘﺎﺭﻱء ﺇﻟﻰ ﺧﻁﻭﺭﺓ ﻭﺟﻭﺩ ﺃﻗﺭﺍﺹ ﻭﺷﺭﺍﺏ ﺍﻟﺣﺩﻳﺩ ﺑﻣﺗﻧﺎﻭﻝ ﺃﻳﺩﻱ ﺍﻷﻁﻔﺎﻝ‪ ،‬ﺣﻳﺙ ﺃﻥ ﺗﻧﺎﻭﻝ ﺑﺿﻌﺔ ﺃﻗﺭﺍﺹ‬ ‫ﻣﻧﻪ ﺩﻓﻌﺔ ﻭﺍﺣﺩﺓ ﻳﺳﺑﺏ ﺗﺳﻣﻣﺎ ً ﺣﺎ ّﺩﺍً‪ ،‬ﻭﺭﺑﻣﺎ ﻗﺎﺗﻼً‪ ،‬ﻓﻲ ﺍﻟﻁﻔﻝ ﻷﻥ ﺍﻟﻛﻣﻳﺎﺕ ﺍﻟﻛﺑﻳﺭﺓ ﻣﻧﻪ ﻻ ﺗﺧﺿﻊ ﻟﻧﻅﺎﻡ ﺍﻟﺳﻳﻁﺭﺓ ﻋﻠﻰ ﺍﻻﻣﺗﺻﺎﺹ‬ ‫ﺍﻟﺫﻱ ﺫﻛﺭﺗﻪ ﺁﻧﻔﺎ ً‪ .‬ﻭﻣﻥ ﺍﻟﺟﺩﻳﺭ ﺑﺎﻟﺫﻛﺭ ﺃﻥ ﺍﻷﻗﺭﺍﺹ ﻗﺩ ﺗﻛﻭﻥ ﻣﻐﻁﺎﺓ ﺑﺎﻟﺳ ّﻛﺭ ﻣﻣﺎ ﻳﺟﻌﻝ ﺍﻟﻁﻔﻝ ﺭﺍﻏﺑﺎ ً ﻓﻲ ﺗﻧﺎﻭﻝ ﻋﺩﺩ ﻛﺑﻳﺭ ﻣﻧﻬﺎ‪.‬‬ ‫ﻣﻥ ﻣﺗﻁﻠﺑﺎﺕ ﻋﻼﺝ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭﺍﻟﺩﻡ ﺍﻟﺑﺣﺙ ﻋﻥ ﺍﻟﻣﻭﺍﻁﻥ ﺍﻟﻣﺣﺗﻣﻠﺔ ﻟﻠﻧﺯﻑ ﻭﺍﻟﻔﺣﺹ ﻋﻥ ﺍﻟﺩﻳﺩﺍﻥ‪ ،‬ﻻ ﺳﻳّﻣﺎ ﻋﻧﺩ ﺍﻟﻘﺭﻭﻳﻳﻥ‪،‬‬ ‫ﻟﻠﻘﺿﺎء ﻋﻠﻰ ﺍﻟﻣﺳﺑّﺏ‪ ،‬ﺣﻳﺙ ﺃﻥ ﺇﻋﻁﺎء ﺍﻟﺣﺩﻳﺩ ﻣﻊ ﺍﺳﺗﻣﺭﺍﺭ ﻓﻘﺩﺍﻥ ﺍﻟﺩﻡ ﻷﺣﺩ ﺍﻟﺳﺑﺑﻳﻥ ﻻ ﻳﺣﻝ ﻣﺷﻛﻠﺔ ﻓﻘﺭ ﺍﻟﺩﻡ‪.‬‬ ‫‪U‬‬

‫ﺏ‪-‬ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻭﻓﻳﺗﺎﻣﻳﻥ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ‪:‬‬

‫ﺇﻥ ﻫﺫﻳْﻥ ﺍﻟﻣﺭﻛﺑﻳﻥ‪ ،‬ﻭﻛﻣﺎ ﺫﻛﺭﺕ ﺳﺎﺑﻘﺎ ً‪ ،‬ﺿﺭﻭﺭﻳﺎﻥ ﻟﻧﻣﻭ ﻭﺍﻧﻘﺳﺎﻡ ﺧﻼﻳﺎ ﺍﻟﺟﺳﻡ ﻋﻣﻭﻣﺎ ً ﻟﺗﺗﻛﺎﺛﺭ‪ ،‬ﻟﻛﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺗﻲ ﺗﺗﺻﻑ ﺑﺳﺭﻋﺔ‬ ‫ﻋﺎﻟﻳﺔ ﻣﻥ ﺍﻻﻧﻘﺳﺎﻡ – ﻣﺛﻝ ﺧﻼﻳﺎ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪ -‬ﺗﺣﺗﺎﺟﻬﻣﺎ ﺃﻛﺛﺭ ﻣﻥ ﻏﻳﺭﻫﺎ‪ .‬ﻭﻓﻲ ﺣﺎﻟﺔ ﻧﻘﺹ ﺃﻱ ﻣﻧﻬﻣﺎ ﻓﺈﻥ ﻓﻘﺭ ﺩﻡ ﻣﻥ ﻧﻭﻉ ﺧﺎﺹ‬ ‫ﻳﻧﺗﺞ ﻋﻥ ﺫﻟﻙ‪ ،‬ﻭﻓﻳﻪ ﺗﻛﻭﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء )ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ( ﻭﺍﻟﺑﻳﺿﺎء ﻭﺍﻟﺻُﻔﻳﺣﺎﺕ ﻛﻠﻬﺎ ﻧﺎﻗﺻﺔ‪ .‬ﻟﻛﻥ ﻧﻘﺹ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻫﻭ‬ ‫ﺃﻫﻡ ﻣﻅﺎﻫﺭ ﻫﺫﺍ ﺍﻟﻣﺭﺽ‪ .‬ﺗﻛﻭﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻛﺑﻳﺭﺓ ﺍﻟﺣﺟﻡ ﻟﻛﻥ ﺍﻟﻧﻘﺹ ﺍﻟﺷﺩﻳﺩ ﻓﻲ ﻋﺩﺩﻫﺎ ﻫﻭ ﺍﻟﺫﻱ ﻳﺅﺩﻱ ﺇﻟﻰ ﻓﻘﺭ ﺍﻟﺩﻡ‪ .‬ﻟﺫﻟﻙ‬ ‫ﻳﺳﻣﻰ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ]ﻓﻘﺭ ﺍﻟﺩﻡ ﻛﺑﻳﺭ ﺍﻟﺧﻼﻳﺎ[‪.‬‬

‫ﻣﺻﺎﺩﺭ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻭﺍﻟﺣﺎﺟﺔ ﺇﻟﻳﻪ‪:‬‬ ‫ﺇﻥ ﻫﺫﺍ ﺍﻟﻌﻧﺻﺭ ﺍﻟﻐﺫﺍﺋﻲ ﺷﺩﻳﺩ ﺍﻷﻫﻣﻳﺔ ﻭﻳﺗﻭﻓﺭ ﻋﺎﺩﺓ ﻓﻲ ﺍﻷﻁﻌﻣﺔ ﺣﻳﻭﺍﻧﻳﺔ ﺍﻟﻣﻧﺷﺄ ﻭﺃﻫﻣﻬﺎ ﺍﻟﻛﺑﺩ ﻭﺍﻟﻠﺣﻭﻡ‪ ،‬ﻭﻛﺫﻟﻙ ﺑﻌﺽ ﺍﻷﻁﻌﻣﺔ‬ ‫ﺍﻟﻧﺑﺎﺗﻳﺔ‪ .‬ﻳﺣﺗﺎﺝ ﺍﻹﻧﺳﺎﻥ ﻣﻥ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﺇﻟﻰ ﻣﺎﻳﻛﺭﻭﻏﺭﺍﻡ ﻭﺍﺣﺩ )ﻭﺍﺣﺩ ﻣﻥ ﻣﻠﻳﻭﻥ ﻣﻥ ﺍﻟﻐﺭﺍﻡ( ﻳﻭﻣﻳﺎ ً‪ .‬ﺗﻣﺗﺹ ﺍﻷﻣﻌﺎء ﻫﺫﺍ‬ ‫ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺑﻭﺟﻭﺩ ﻋﻧﺻﺭ ﺁﺧﺭ‪ ،‬ﻳﺳﻣﻰ ]ﺍﻟﻌﺎﻣﻝ ﺍﻟﺩﺍﺧﻠﻲ[ ﻷﻧﻪ ﻻ ﻳﺄﺗﻲ ﻣﻥ ﺍﻟﻐﺫﺍء ﺑﻝ ﻳﻔﺭﺯﻩ ﺟﺩﺍﺭ ﺍﻟﻣﻌﺩﺓ‪ .‬ﻫﺫﺍ ﺍﻟﻌﺎﻣﻝ ﻳﺣﻣﻝ‬ ‫ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻣﻥ ﺍﻟﻣﻌﺩﺓ ﻭﺣﺗﻰ ﺍﻟﻧﺻﻑ ﺍﻟﺛﺎﻧﻲ ﻣﻥ ﺍﻷﻣﻌﺎء ﺍﻟﺩﻗﻳﻘﺔ ﺣﻳﺙ ﻳﺟﺭﻱ ﺍﻣﺗﺻﺎﺻﻪ‪ .‬ﺇﻥ ﺍﻟﻌﺎﻣﻝ ﺍﻟﺩﺍﺧﻠﻲ ﻳﺣﺎﻓﻅ ﻋﻠﻰ ﺟﺯﻳﺋﺎﺕ‬ ‫ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻣﻥ ﺍﻟﻔﻘﺩﺍﻥ ﺑﺳﺑﺏ ﺍﻟﺻﻐﺭ ﺍﻟﻣﺗﻧﺎﻫﻲ ﻟﻛﻣﻳﺗﻪ ﻓﻲ ﺍﻟﻐﺫﺍء‪ .‬ﻳﺫﻫﺏ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺑﻌﺩ ﺍﻣﺗﺻﺎﺻﻪ ﺇﻟﻰ ﺍﻟﻛﺑﺩ ﻟﺧﺯﻧﻪ‪ .‬ﺇﻥ ﺍﻟﻣﺧﺯﻥ ﻓﻲ‬ ‫ﺍﻟﻛﺑﺩ ﻣﻥ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻟﺩﻯ ﺍﻹﻧﺳﺎﻥ ﺍﻟﻁﺑﻳﻌﻲ‪ ،‬ﺭﻏﻡ ﻗﻠﺗﻪ‪ ،‬ﻳﻛﻔﻲ ﻟﺳﺩ ﺣﺎﺟﺔ ﺍﻟﺟﺳﻡ ﻟﺳﻧﻭﺍﺕ ﻋﺩﻳﺩﺓ‪ ،‬ﺣﺗﻰ ﻟﻭ ﻟﻡ ﻳﺣﺻﻝ ﻋﻠﻰ ﺃﻱ ﺷﻲء‬ ‫ﻣﻥ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺧﻼﻟﻬﺎ‪ .‬ﻟﺫﺍ ﻓﺈﻥ ﺍﻹﻧﺳﺎﻥ ﺍﻟﺫﻱ ﻳﺣﺻﻝ ﻟﺩﻳﻪ ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻻ ﺑ ّﺩ ﺃﻥ ﻳﻛﻭﻥ ﻗﺩ ﺣُﺭﻡ ﻣﻥ ﺗﻧﺎﻭﻟﻪ ﺃﻭ ﺍﻣﺗﺻﺎﺻﻪ‬ ‫ﺳﻧﻳﻥ ﻁﻭﻳﻠﺔ‪.‬‬

‫ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪:12‬‬ ‫ﻳﺣﺻﻝ ﻫﺫﺍ ﺍﻟﻧﻘﺹ ﻓﻲ ﺣﺎﻟﺔ ﺗﺳﻣﻰ ]ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺧﺑﻳﺙ[ ﺍﻟﺫﻱ ﻳﻧﺗﺞ ﻋﻥ ﻧﻘﺹ ﺃﻭ ﺗﻭﻗﻑ ﺇﻧﺗﺎﺝ ﺍﻟﻌﺎﻣﻝ ﺍﻟﺩﺍﺧﻠﻲ ﻣﻥ ﺍﻟﻣﻌﺩﺓ ﺑﺳﺑﺏ‬ ‫ﻳﻌﻭﺽ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ‬ ‫ﺿﻣﻭﺭ ﺍﻟﻐﺷﺎء ﺍﻟﻣﺧﺎﻁﻲ ﻟﻠﻣﻌﺩﺓ‪ .‬ﻛﺫﻟﻙ ﻳﺣﺻﻝ ﺍﻟﻣﺭﺽ ﺑﻌﺩ ﺳﻧﻳﻥ ﻣﻥ ﺭﻓﻊ ﻣﻌﻅﻡ ﺃﻭ ﻛﻝ ﺍﻟﻣﻌﺩﺓ ﺟﺭﺍﺣﻳﺎً‪ ،‬ﺇﺫﺍ ﻟﻡ ﱠ‬ ‫ﺑﺎﻟﺯﺭﻕ‪ ،‬ﻭﻗﺩ ﻳﺣﺻﻝ ﻧﺗﻳﺟﺔ ﺭﻓﻊ ﺍﻟﻧﺻﻑ ﺍﻟﺛﺎﻧﻲ ﻣﻥ ﺍﻷﻣﻌﺎء ﺍﻟﺩﻗﻳﻘﺔ ﺟﺭﺍﺣﻳﺎً‪ ،‬ﻭﻛﺫﻟﻙ ﻓﻲ ﺣﺎﻻﺕ ﻣﻌﻳّﻧﺔ ﻣﻥ ﺃﻣﺭﺍﺽ ﺍﻷﻣﻌﺎء ﺗﺳﺑﺏ‬ ‫ﺳﻭء ﺍﻣﺗﺻﺎﺹ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ‪.‬‬ ‫ﻭﺗﻭﺟﺩ ﺃﺳﺑﺎﺏ ﺃﺧﺭﻯ ﻧﺎﺩﺭﺓ ﻟﻠﻧﻘﺹ‪ ،‬ﻭﺭﺍﺛﻳﺔ ﺍﻟﻣﻧﺷﺄ ﺳﺑﺑﻬﺎ ﻟﻳﺱ ﺍﻟﻧﻘﺹ ﻓﻲ ﺗﻧﺎﻭﻝ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻭﻻ ﻓﻲ ﺍﻣﺗﺻﺎﺻﻪ ﻭﺇﻧﻣﺎ ﻭﺟﻭﺩ ﺧﻠﻝ‬ ‫ﻓﻲ ﺍﻟﺗﻔﺎﻋﻼﺕ ﺍﻟﺗﻲ ﻳﺩﺧﻝ ﻓﻳﻬﺎ ﻷﺩﺍء ﻣﻬﻣﺗﻪ ﻓﻲ ﺑﻧﺎء ﺍﻟﺧﻼﻳﺎ ﻭﺍﻧﻘﺳﺎﻣﻬﺎ‪.‬‬

‫ﻣﺻﺎﺩﺭ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ ﻭﺍﻟﺣﺎﺟﺔ ﺇﻟﻳﻪ‪:‬‬ ‫ﻫﺫﺍ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻳﻭﺟﺩ ﻓﻲ ﻣﺻﺎﺩﺭ ﻧﺑﺎﺗﻳﺔ ﻭﺣﻳﻭﺍﻧﻳﺔ‪ ،‬ﻭﺗﺷﻛﻝ ﺍﻟﺧﺿﺭﺍﻭﺍﺕ ﺍﻟﻌﺎﺩﻳﺔ ﺍﻟﺗﻲ ﻧﺄﻛﻠﻬﺎ ﻛﻝ ﻳﻭﻡ ﻣﺻﺩﺭﺍً ﺃﺳﺎﺳﻳﺎ ً ﻟﻪ‪ ،‬ﻭﻟﻛﻥ ﻏﻠﻲ‬ ‫ﺍﻟﺧﺿﺭﺍﻭﺍﺕ ﻳﺗﻠﻑ ﺍﻟﻣﺭ ّﻛﺏ ﻭﻳﺣﺭﻡ ﺍﻟﺟﺳﻡ ﻣﻥ ﻓﺎﺋﺩﺗﻪ‪.‬‬ ‫‪26‬‬

‫ﻳﺣﺗﺎﺝ ﺍﻹﻧﺳﺎﻥ ﺇﻟﻰ ‪ 50‬ﻣﺎﻳﻛﺭﻭﻏﺭﺍﻡ ﻣﻧﻪ ﻳﻭﻣﻳﺎ ً‪ .‬ﻭﺗﻭﺻﻲ ﻣﻧﻅﻣﺔ ﺍﻟﺻﺣﺔ ﺍﻟﻌﺎﻟﻣﻳﺔ ﺑﺄﺧﺫ ﺃﻛﺛﺭ ﻣﻥ ﻫﺫﻩ ﺍﻟﻛﻣﻳﺔ ﻳﻭﻣﻳﺎً‪ ،‬ﺗﻔﺎﺩﻳﺎ ً‬ ‫ﻟﺣﺻﻭﻝ ﻧﻘﺹ‪ ،‬ﻻ ﺳﻳّﻣﺎ ﻟﺩﻯ ﺍﻟﺣﻭﺍﻣﻝ ﻭﺍﻷﻁﻔﺎﻝ‪.‬‬ ‫ﺍﻣﺗﺻﺎﺹ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ ﻣﻥ ﺍﻷﻣﻌﺎء ﻻ ﻳﺣﺗﺎﺝ ﺇﻟﻰ ﻋﺎﻣﻝ ﺩﺍﺧﻠﻲ‪ ،‬ﻟﻛﻥ ﺍﻟﻣﺧﺯﻭﻥ ﻣﻧﻪ )ﻓﻲ ﺍﻟﻛﺑﺩ ﻭﻏﻳﺭﻩ( ﻻ ﻳﻛﻔﻲ ﺇﻻ ﻷﺷﻬﺭ‪.‬‬ ‫ﻟﺫﻟﻙ ﻓﺈﻥ ﺣﺻﻭﻝ ﻧﻘﺹ ﻓﻲ ﻫﺫﺍ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺃﻣﺭ ﺃﻛﺛﺭ ﺍﺣﺗﻣﺎﻻً ﻣﻥ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻋﻧﺩ ﺍﺷﺗﺩﺍﺩ ﺍﻟﺣﺎﺟﺔ ﺇﻟﻳﻪ ﺃﻭ ﻗﻠﺔ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻳﻪ ﻣﻥ‬ ‫ﺍﻟﻐﺫﺍء‪.‬‬

‫ﻧﻘﺹ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ‪:‬‬ ‫ﻳﺣﺻﻝ ﻧﻘﺹ ﻓﻲ ﻫﺫﺍ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻓﻲ ﻛﺛﻳﺭ ﻣﻥ ﺣﺎﻻﺕ ﺳﻭء ﺍﻻﻣﺗﺻﺎﺹ‪ ،‬ﻛﻣﺎ ﻳﺣﺻﻝ ﻧﺗﻳﺟﺔ ﺳﻭء ﺍﻟﺗﻐﺫﻳﺔ‪ ،‬ﻻ ﺳﻳّﻣﺎ ﻓﻲ‬ ‫ﺍﻟﻧﺳﺎءﺍﻟﺣﻭﺍﻣﻝ ﻭﺧﺻﻭﺻﺎ ً ﺇﺫﺍ ﺗﻛﺭﺭ ﺍﻟﺣﻣﻝ ﻓﻲ ﺃﻭﻗﺎﺕ ﻣﺗﻘﺎﺭﺑﺔ‪ .‬ﻭﻗﺩ ﻳﺣﺻﻝ ﺍﻟﻧﻘﺹ ﻓﻲ ﺍﻷﻁﻔﺎﻝ ﺍﻟﺭﺿّﻊ ﻭﺳﺭﻳﻌﻲ ﺍﻟﻧﻣﻭ ﺇﺫﺍ ﻛﺎﻥ‬ ‫ﻏﺫﺍﺅﻫﻡ ﻏﻳﺭ ﻣﺗﻛﺎﻣﻝ ﻭﻻ ﻳﺯﻭّ ﺩﻫﻡ ﺑﻣﺎ ﻳﺳﺩ ﺣﺎﺟﺗﻬﻡ ﻣﻥ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ‪.‬‬

‫ﺍﻟﻭﻗﺎﻳﺔ ﻭﺍﻟﻌﻼﺝ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻛﺑﻳﺭ ﺍﻟﺧﻼﻳﺎ‪:‬‬ ‫ﺗﻛﻭﻥ ﺍﻟﻭﻗﺎﻳﺔ ﺍﻟﺻﺣﻳﺣﺔ ﺑﺗﻧﺎﻭﻝ ﺍﻷﻏﺫﻳﺔ ﺍﻟﺗﻲ ﺗﺣﺗﻭﻱ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻭﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ‪ ،‬ﺇﻥ ﺗﻭﻓﺭﺕ‪ .‬ﻭﻟﻛﻥ ﺑﻌﺽ ﺍﻟﻧﺎﺱ ﻳﺣﺗﺎﺟﻭﻥ‬ ‫ﺇﻟﻰ ﻭﻗﺎﻳﺔ ﻣﺿﻣﻭﻧﺔ ﺃﻛﺛﺭ ﺑﺗﻧﺎﻭﻝ ﺣﺑﻭﺏ ﺃﻭ ﺣﻘﻥ ﻣﻧﻬﺎ‪ .‬ﺃﻫﻡ ﺍﻟﺣﺎﻻﺕ ﺍﻟﺗﻲ ﻳُﻌﻁﻰ ﻓﻳﻬﺎ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ ﻭﻗﺎﺋﻳﺎ ً ﻫﻲ ﺣﺎﻻﺕ ﺍﻟﺣﻣﻝ‬ ‫ﺍﻟﻣﺗﻛﺭﺭ ﻭﺳﻭء ﺍﻻﻣﺗﺻﺎﺹ ﻭﺍﻹﺳﻬﺎﻝ ﺍﻟﻣﺯﻣﻥ ﺃﻭ ﺍﻟﻣﺗﻛﺭﺭ‪ .‬ﺑﺎﻟﻧﺳﺑﺔ ﺇﻟﻰ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻓﺈﻧﻪ ﻳﻌﻁﻰ ﻟﻠﻭﻗﺎﻳﺔ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻛﺑﻳﺭ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺑﻌﺩ ﻋﻣﻠﻳﺎﺕ ﻗﺹ ﻛﻝ ﺃﻭ ﻗﺳﻡ ﻛﺑﻳﺭ ﻣﻥ ﺍﻟﻣﻌﺩﺓ ﻭﺍﻷﻣﻌﺎء ﺍﻟﺩﻗﻳﻘﺔ ﻭﻓﻲ ﺣﺎﻻﺕ ﺳﻭء ﺍﻟﺗﻐﺫﻳﺔ‪.‬‬ ‫ﺃﻣﺎ ﻋﻼﺝ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻓﻳﻛﻭﻥ )ﺑﻌﺩ ﺍﻟﺗﺄﻛﺩ ﻣﻥ ﻧﻭﻋﻪ ﻭﻣﻥ ﻧﻘﺹ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺍﻟﻣﺳﺑﺏ ﻟﻪ( ﺑﺈﻋﻁﺎء ﺣﺑﻭﺏ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺃﻭ‬ ‫ﺣﻘﻧﻪ‪ .‬ﻭﻓﻲ ﺣﺎﻟﺔ ﻛﻭﻥ ﺳﺑﺏ ﺍﻟﻧﻘﺹ ﺳﻭء ﺍﻻﻣﺗﺻﺎﺹ ﻳﻛﻭﻥ ﺇﻋﻁﺎء ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺑﺎﻟﺣﻘﻥ ﺇﻟﺯﺍﻣﻳﺎ ً‪.‬‬

‫ﺝ‪ -‬ﻓﻘﺭ ﺩﻡ ﻧﺎﺷﺊ ﻋﻥ ﻧﻘﺹ ﻣﺯﺩﻭﺝ ﻓﻲ ﺍﻟﺣﺩﻳﺩ ﻭﺃﺣﺩ ﺍﻟﻔﻳﺗﺎﻣﻳﻧ ْﻳﻥ ﻓﻲ ﺏ ﺃﻋﻼﻩ‪:‬‬ ‫‪U‬‬

‫ﺍﻟﻣﻌﺗﺎﺩ ﺃﻥ ﻳﻛﻭﻥ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﺍﻟﻧﺎﻗﺹ ﻣﻊ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻫﻭ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ‪ .‬ﺗﻛﻭﻥ ﺍﻟﻌﻼﻣﺎﺕ ﺍﻟﻣﺧﺑﺭﻳﺔ ﻣﺷﺗﺭﻛﺔ ﻣﻥ ﺍﻟﻧﻭﻋﻳﻥ‪ .‬ﻧﺟﺩ‬ ‫ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻓﻲ ﺍﻷﻁﻔﺎﻝ ﻧﺗﻳﺟﺔ ﺳﻭء ﺍﻟﺗﻐﺫﻳﺔ ﻭﻓﻲ ﺍﻟﻧﺳﺎء ﺑﻌﺩ ﺍﻟﺣﻣﻝ ﺍﻟﻣﺗﻛﺭﺭ ﻭﻓﻲ ﺑﻌﺽ ﺣﺎﻻﺕ ﺳﻭء ﺍﻻﻣﺗﺻﺎﺹ‪.‬‬ ‫ﻣﻌﺩﻝ ﺣﺟﻡ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻓﺩ ﻳﻛﻭﻥ ﺿﻣﻥ ﺍﻟﻁﺑﻳﻌﻲ ﺃﻭ ﺧﺎﺭﺝ ﺣﺩﻭﺩ ﺍﻟﻁﺑﻳﻌﻲ ﺑﻘﻠﻳﻝ‪ ،‬ﺗﺑﻌﺎ ﻷﻱ ﻣﻥ ﺍﻟﻌﻧﺻﺭﻳﻥ ﻧﻘﺻﻪ ﺃﺷﺩ‪.‬‬

‫ﺩ‪ -‬ﻓﻘﺭ ﺩﻡ ﻧﺎﺷﺊ ﻋﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺃﺧﺭﻯ‪:‬‬ ‫‪U‬‬

‫ﻳﻧﺷﺄ ﻓﻘﺭ ﺍﻟﺩﻡ ﻧﺗﻳﺟﺔ ﻟﻧﻘﺹ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﻋﻣﻭﻣﺎً‪ ،‬ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻧﻘﺹ ﺷﺩﻳﺩﺍً‪ .‬ﺇﻥ ﻫﺫﺍ ﺍﻟﻧﻘﺹ ﻏﺎﻟﺑﺎ ً ﻣﺎ ﻳﻛﻭﻥ ﻣﺻﺣﻭﺑﺎ ً ﺑﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ ﻣﻣﺎ‬ ‫ﻳﺅﺩﻱ ﺇﻟﻰ ﻣﺿﺎﻋﻔﺔ ﺷﺩﺓ ﻓﻘﺭ ﺍﻟﺩﻡ‪.‬‬ ‫ﻳﻭﺟﺩ ﻓﻘﺭ ﺩﻡ ﺳﺑﺑﻪ ﻧﻘﺹ ﺷﺩﻳﺩ ﻓﻲ ]ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ [6‬ﺑﺳﺑﺏ ﻧﻘﺻﻪ ﻓﻲ ﺍﻟﻁﻌﺎﻡ ﺃﻭ ﺑﺳﺑﺏ ﺗﻧﺎﻭﻝ ﺑﻌﺽ ﻣﺿﺎﺩﺍﺕ ﺟﺭﺛﻭﻣﺔ ﺍﻟﺳﻝ‪.‬‬ ‫ﻧﻘﺹ ﺍﻟﻧﺣﺎﺱ ﻳﺳﺑﺏ ﻓﻘﺭ ﺩﻡ ﺻﻐﻳﺭ ﺍﻟﺧﻠﻳﺔ ﻳﺷﺑﻪ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‪.‬‬ ‫ﻧﻘﺹ ﺑﻌﺽ ﺍﻟﻬﻭﺭﻣﻭﻧﺎﺕ ﻣﺛﻝ ﻫﻭﺭﻣﻭﻥ ﺍﻟﺩﺭﻗﻳﺔ ﻭﻫﻭﺭﻣﻭﻥ ﺍﻟﻛﻅﺭﻳﺔ‪.‬‬ ‫ﻛﻝ ﻫﺫﻩ ﺣﺎﻻﺕ ﻧﺎﺩﺭﺓ ﺑﺎﻟﻣﻘﺎﺭﻧﺔ ﻣﻊ ﺗﻠﻙ ﺍﻟﻣﺫﻛﻭﺭﺓ ﻓﻲ ﺃ ﻭ ﺏ ﻭ ﺝ‪.‬‬ ‫ﻫﺫﻩ ﺍﻷﻧﻭﺍﻉ ﺗﺯﻭﻝ ﺑﻣﺟﺭﺩ ﻋﻼﺝ ﺍﻟﻧﻘﺹ ﺍﻟﻣﺳﺑﺏ ﻟﻬﺎ‪.‬‬

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‫‪U‬‬

‫‪ -3‬ﻓﻘﺮ اﻟﺪم اﻻﻧﺤﻼﻟﻲ‬

‫ﻭﻧﻌﻧﻲ ﺑﻪ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﺃﺳﺎﺳﺎ ً ﻋﻥ ﺍﻧﺣﻼﻝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻗﺑﻝ ﺍﻧﺗﻬﺎء ﻋﻣﺭﻫﺎ ﺍﻟﻁﺑﻳﻌﻲ‪ ،‬ﺃﻱ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻗﺻﺭ ﻓﻲ ﻋﻣﺭﻫﺎ‪.‬‬ ‫ﺳﺑﻕ ﺃﻥ ﺫﻛﺭﺕ ﺃﻥ ﻣﻌﺩﻝ ﺍﻟﻌﻣﺭ ﺍﻟﻁﺑﻳﻌﻲ ﻟﻠﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻫﻭ ﺣﻭﺍﻟﻲ ‪ 120‬ﻳﻭﻣﺎ ً‪ .‬ﺇﺫﺍ ﻧﻘﺹ ﺍﻟﻌﻣﺭ ﻋﻥ ﺫﻟﻙ ﻓﺈﻥ ﺍﻟﻧﺧﺎﻉ ﺍﻷﺣﻣﺭ‬ ‫ﻟﻠﻌﻅﺎﻡ )ﻭﺍﻟﺫﻱ ﻳﻛﻭﻥ ﻧﺷﻁﺎ ً ﻓﻲ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ( ﻳﺯﻳﺩ ﻣﻥ ﺇﻧﺗﺎﺟﻪ ﻟﻠﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻟﻳﻌﻭﺽ ﺍﻟﻧﻘﺹ‪ ،‬ﻭﻗﺩ ﺗﺗﻭﺳﻊ ﺭﻗﻌﺗﻪ ﻟﺗﺷﻣﻝ ﻣﻧﺎﻁﻕ‬ ‫ﺍﻟﻧﺧﺎﻉ ﺍﻷﺑﻳﺽ‪ .‬ﻓﻣﺛﻼً‪ ،‬ﺇﺫﺍ ﻗﺻﺭ ﻋﻣﺭ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻟﻳﺻﺑﺢ ‪ 60‬ﻳﻭﻣﺎ ً ﻓﺈﻥ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻳﺣﺗﺎﺝ ﺇﻟﻰ ﺯﻳﺎﺩﺓ ﺇﻧﺗﺎﺟﻪ ﺇﻟﻰ ﺍﻟﺿﻌﻑ‪.‬‬ ‫ﻭﻗﺩ ﻳﻧﺟﺢ ﻓﻲ ﺫﻟﻙ‪ ،‬ﺑﺣﻳﺙ ﻻ ﻳﺗﺳﺑﺏ ﻗﺻﺭ ﻋﻣﺭ ﺍﻟﺧﻼﻳﺎ ﻓﻲ ﺣﺻﻭﻝ ﻓﻘﺭ ﺩﻡ‪ .‬ﻟﻛﻥ ﻗﺎﺑﻠﻳﺔ ﺍﻟﻧﺧﺎﻉ ﻋﻠﻰ ﺍﻟﺗﻌﻭﻳﺽ ﻣﺣﺩﻭﺩﺓ ﻟﻬﺫﺍ ﻓﻘﺩ‬ ‫ﻳﺣﺻﻝ ﻓﻘﺭ ﺩﻡ ﺇﺫﺍ ﻣﺎ ﺍﻧﺧﻔﺽ ﻣﻌﺩﻝ ﻋﻣﺭ ﺍﻟﺧﻠﻳﺔ ﺇﻟﻰ ‪ 40-20‬ﻳﻭﻣﺎ ً‪ .‬ﻳﻣﻛﻥ ﺣﺳﺎﺏ ﻣﻌﺩّﻝ ﻋﻣﺭ ﺍﻟﺧﻼﻳﺎ ﺑﺎﺳﺗﻌﻣﺎﻝ ﻓﺣﻭﺹ ﺗﺩﺧﻝ‬ ‫ﻓﻳﻬﺎ ]ﺍﻟﻧﻅﺎﺋﺭ ﺍﻟﻣﺷﻌﺔ[ ﻟﻠﻛﺭﻭﻡ ﺑﻌﺩ ﻭﺳﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺑﻬﺎ‪ ،‬ﻟﻛﻥ ﻫﺫﻩ ﺍﻟﻔﺣﻭﺹ ﻧﺎﺩﺭﺍً ﻣﺎ ﺗﺳﺗﻌﻣﻝ ﻓﻲ ﺍﻟﺗﺷﺧﻳﺹ‪ ،‬ﺣﻳﺙ ﻳﻌﺗﻣﺩ‬ ‫ﺍﻟﻁﺑﻳﺏ ﻋﻠﻰ ﻓﺣﻭﺹ ﺃﺧﺭﻯ ﻹﺛﺑﺎﺕ ﻭﺟﻭﺩ ﻓﻘﺭ ﺩﻡ ﺍﻧﺣﻼﻟﻲ ﻭﻛﺫﻟﻙ ﻟﺗﻘﺭﻳﺭ ﻣﺩﻯ ﺷﺩﺓ ﺍﻻﻧﺣﻼﻝ‪.‬‬ ‫ﻣﻥ ﺍﻟﻧﺗﺎﺋﺞ ﺍﻟﻣﺧﺑﺭﻳﺔ ﺍﻟﺗﻲ ﻳﺳﺗﺩﻝ ﺍﻟﻁﺑﻳﺏ ﺑﻬﺎ ﻹﺛﺑﺎﺕ ﻭﺟﻭﺩ ﺍﻧﺣﻼﻝ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‪ ،‬ﺃﻭ ﻟﺗﻘﻳﻳﻡ ﺷﺩﺓ ﺫﻟﻙ ﺍﻻﻧﺣﻼﻝ ﻫﻭ ﻭﺟﻭﺩ‬ ‫ﺧﻼﻳﺎ ﺣﻣﺭﺍء ﻏﻳﺭ ﻧﺎﺿﺟﺔ ﺗﻣﺎﻣﺎ ً ﺑﺄﻋﺩﺍﺩ ﻛﺑﻳﺭﺓ ﻓﻲ ﺍﻟﺩﻡ )ﻭ ﺗﺷﺎﻫﺩ ﻟﺩﻯ ﻓﺣﺹ ﻣﺳﺣﺔ ﺍﻟﺩﻡ( ﻭﻣﻧﻬﺎ ]ﺍﻟﺧﻼﻳﺎ ﺍﻟﺷﺑﻛﻳﺔ[ ﻭﺍﻟﺧﻼﻳﺎ‬ ‫ﺍﻟﺣﻣﺭﺍء ﺫﻭﺍﺕ ﺍﻟﻧﻭﻯ‪ ،‬ﻭﻭﺟﻭﺩﻫﻣﺎ ﺩﻟﻳﻝ ﻋﻠﻰ ﻭﻗﻭﻉ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺗﺣﺕ ﺿﻐﻁ ﺍﻟﺟﺳﻡ ﺍﻟﺫﻱ ﻳﺣﺗﺎﺝ ﻻﻧﺗﺎﺝ ﺳﺭﻳﻊ ﻟﻠﺗﻌﻭﻳﺽ ﻋﻥ ﻓﻘﺭ‬ ‫ﺍﻟﺩﻡ‪ .‬ﻓﻲ ﺍﻷﺣﻭﺍﻝ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻻ ﺗﻭﺟﺩ ﺧﻼﻳﺎ ﺫﻭﺍﺕ ﻧﻭﻯ ﻓﻲ ﺍﻟﺩﻡ ﻭﺗﻭﺟﺩ ﺧﻼﻳﺎ ﺷﺑﻛﻳﺔ ﺑﺄﻋﺩﺍﺩ ﻻ ﺗﺗﺟﺎﻭﺯ‪ %1,5‬ﻣﻥ ﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ‬ ‫ﺍﻟﺣﻣﺭﺍء‪ .‬ﺍﻟﺧﻼﻳﺎ ﺍﻟﺷﺑﻛﻳﺔ ﻓﻳﻬﺎ ﺷﺑﻛﺔ ﻣﻥ ﺍﻟﺣﻣﺽ ﺍﻟﻧﻭﻭﻱ‪ ،‬ﻭﺍﻟﺫﻱ ﻳﺧﺗﻔﻲ ﺑﻌﺩ ﺃﻥ ﺗﻧﺿﺞ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺗﻣﺎﻣﺎ ً‪.‬‬ ‫ﺇﺫﺍ ﻟﺟﺄ ﺍﻟﻁﺑﻳﺏ ﻟﻔﺣﺹ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻓﻲ ﺣﺎﻻﺕ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﻓﺳﻳﺛﺑﺕ ﺯﻳﺎﺩﺓ ﻧﺷﺎﻁﻪ ﻓﻲ ﺇﻧﺗﺎﺝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻭﺯﻳﺎﺩﺓ‬ ‫ﻣﻭﻟﺩﺍﺗﻬﺎ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻷﺭﻭﻣﻳﺔ ﺍﻟﺣﻣﺭﺍء‪.‬‬ ‫ﻟﻣﺎ ﻛﺎﻧﺕ ﺍﻟﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء ﺍﻟﺗﻲ ﺫﻛﺭﺗﻬﺎ ﺳﺎﺑﻘﺎ ً ﻫﻲ ﻣﻥ ﻧﺗﺎﺝ ﺗﺣﻁﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻭﻣﺎ ﻓﻳﻬﺎ ﻣﻥ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﺈﻥ ﺗﺭﻛﻳﺯﻫﺎ ﻳﺯﺩﺍﺩ‬ ‫ﻓﻲ ﺍﻟﺩﻡ ﻓﻲ ﻓﻘﺭ ﺩﻡ ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ‪.‬‬ ‫ﻳﺷﻣﻝ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺃﻧﻭﺍﻋﺎ ً ﻋﺩﻳﺩﺓ ﻭﻣﺧﺗﻠﻔﺔ ﻋﻥ ﺑﻌﺿﻬﺎ‪ ،‬ﺗﺑﻌﺎ ً ﻟﺳﺑﺏ ﺍﻻﻧﺣﻼﻝ ﻏﻳﺭ ﺍﻟﻁﺑﻳﻌﻲ‪ ،‬ﻭ ﻻ ﻳﺟﻣﻌﻬﺎ ﻣﻊ ﺑﻌﺿﻬﺎ ﺳﻭﻯ‬ ‫ﻭﺟﻭﺩ ﻓﻘﺭ ﺍﻟﺩﻡ ﻭﻛﻭﻧﻪ ﻧﺎﺗﺟﺎ ً ﺑﺎﻷﺳﺎﺱ ﻋﻥ ﻗﺻﺭ ﻋﻣﺭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻭﺃﺩﻧﺎﻩ ﻣﺧﻁﻁ ﻣﺑﺳﻁ ﻟﺗﺻﻧﻳﻑ ﻫﺫﻩ ﺍﻷﻧﻭﺍﻉ ﻭﺃﺳﺑﺎﺑﻬﺎ‪:‬‬

‫ﻓﻘﺮ اﻟﺪم اﻻﻧﺤﻼﻟـ ـ ـ ــﻲ‬

‫‪U‬‬

‫ﺑﺄﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ‬

‫ﻣﻛﺗﺳﺏ‬

‫ﺑﻣﻭﺍﺩ ﻛﻳﻣﻳﺎﻭﻳﺔ‬

‫ﻣﻭﺭﻭﺙ‬ ‫‪U‬‬

‫‪U‬‬

‫ﺑﺄﺳﺑﺎﺏ ﺃﺧﺭﻯ‬

‫ﺧﻠﻝ ﺟﺩﺍﺭﻱ‬

‫ﺧﻠﻝ ﻓﻲ ﺗﺭﻛﻳﺏ‬

‫ﻧﻘﺹ ﺃﻧﻅﻳﻣﺎﺕ‬

‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺃﻭ ﺇﻧﺗﺎﺟﻪ‬

‫ﺃ‪ -‬ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻣﻭﺭﻭﺙ‬ ‫‪U‬‬

‫ﻭﻫﻭ ﻣﺎﺗﺳﺑﺏ ﻋﻥ ]ﻣﻭﺭّﺙ[ ﻏﻳﺭ ﻁﺑﻳﻌﻲ ﻋﻥ ﺃﺣﺩ ﺍﻟﻭﺍﻟﺩﻳﻥ ﺃﻭ ﻛﻠﻳﻬﻣﺎ ﻳﺳﺑﺏ ﺗﻐﻳﻳﺭﺍً ﻓﻲ ﺗﺭﻛﻳﺏ ﻭﺑﻧﻳﺔ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء ﻳﺅﺩﻱ ﺇﻟﻰ‬ ‫ﺍﻧﺣﻼﻟﻬﺎ ﺑﺳﺭﻋﺔ ﻏﻳﺭ ﻁﺑﻳﻌﻳﺔ‪ .‬ﺗﻘﻊ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻓﻲ ﺛﻼﺙ ﻣﺟﻣﻭﻋﺎﺕ ﺭﺋﻳﺳﻳﺔ‪:‬‬ ‫‪28‬‬

‫ﺃﻭﻻً‪ :‬ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﻣﺗﺳﺑﺑﺔ ﻋﻥ ﻭﺟﻭﺩ ﺧﻠﻝ ﻓﻲ ﺟﺩﺍﺭ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء‪:‬‬ ‫‪U‬‬

‫ﺍﻟﺧﻠﻝ ﻳﻛﻭﻥ ﻓﻲ ﺍﻟﺗﺭﻛﻳﺏ ﺍﻟﺧﻭﻳﻁﻲ ﺍﻟﺑﺎﻟﻎ ﺍﻟﺩﻗﺔ ﻓﻲ ﺟﺩﺍﺭ ﺍﻟﺧﻠﻳﺔ )ﺍﻟﺷﻛﻝ ‪ (10‬ﻭﺍﻟﺫﻱ ﻳﺣﺎﻓﻅ ﻋﻠﻰ ﺍﻟﺷﻛﻝ ﺍﻟﺗﻘﻠﻳﺩﻱ ﻟﻠﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء‬ ‫)ﺃﻱ ﺍﻟﺷﻛﻝ ﺍﻟﻘﺭﺻﻲ ﺍﻟﻣﻘﻌّﺭ ﺍﻟﻭﺟﻬﻳﻥ(‪ .‬ﻳﻧﺗﺞ ﻋﻥ ﻫﺫﺍ ﺍﻟﺧﻠﻝ ﺗﺣﻭّ ﻝ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء‪ ،‬ﺑﻌﺩ ﺍﻛﺗﻣﺎﻝ ﺗﻛﻭّ ﻧﻬﺎ ﻭﻧﺯﻭﻟﻬﺎ ﺇﻟﻰ ﻣﺟﺭﻯ ﺍﻟﺩﻡ‪،‬‬ ‫ﺗﺩﺭﻳﺟﻳﺎ ً ﺇﻟﻰ ﺷﻛﻝ ﻛﺭﻭﻱ ﺑﺗﺣﺩّﺏ ﻭﺟﻬﻲ ﺍﻟﻘﺭﺹ‪ .‬ﻛﻣﺎ ﺃﻥ ﺍﻟﺧﻠﻳﺔ ﺗﻔﻘﺩ ﺑﻌﺿﺎ ً ﻣﻥ ﺗﺭﺍﻛﻳﺏ ﺍﻟﺟﺩﺍﺭ‪ ،‬ﻋﻠﻰ ﺷﻛﻝ ﻗﻁﻊ ﺻﻐﻳﺭﺓ‪ ،‬ﻳﻭﻣﺎ ً‬ ‫ﺑﻌﺩ ﺁﺧﺭ‪ .‬ﺑﺫﻟﻙ ﺗﺻﻐﺭ ﻣﺳﺎﺣﺔ ﺍﻟﺟﺩﺍﺭ ﺑﺎﻟﻧﺳﺑﺔ ﺇﻟﻰ ﺍﻟﻣﺣﺗﻭﻳﺎﺕ ﺍﻟﺧﻠﻭﻳﺔ ﻭﺗﺗﺣﻭﻝ ﺍﻟﺧﻠﻳﺔ ﺗﺩﺭﻳﺟﻳﺎ ً ﺇﻟﻰ ]ﺧﻠﻳﺔ ﻛﺭﻭﻳﺔ[‪ ،‬ﺑﺎﻋﺗﺑﺎﺭ ﺃﻥ‬ ‫ﺍﻟﻛﺭﺓ ﻫﻲ ﺍﻟﺷﻛﻝ ﺍﻟﻬﻧﺩﺳﻲ ﺍﻟﺫﻱ ﻳﻣﻠﻙ ﺃﺻﻐﺭ ﻣﺳﺎﺣﺔ ﺳﻁﺣﻳﺔ ﻧﺳﺑﺔ ﺇﻟﻰ ﺣﺟﻣﻪ‪.‬‬ ‫ﺇﻥ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﺗﻭﺍﺟﻪ ﻣﺷﺎﻛﻝ ﺧﻼﻝ ﻣﺳﻳﺭﺗﻬﺎ ﻓﻲ ﺍﻟﺩﻡ‪ ،‬ﻓﻬﻲ ﺃﻭﻻً ﺗﻣﺗﻠﺊ ﺑﺎﻟﻣﺎء ﻭﺍﻟﺻﻭﺩﻳﻭﻡ ﻭﻻ ﺗﺳﺗﻁﻳﻊ ﺍﻟﺛﻐﻭﺭ ﺍﻟﻔﻌﺎﻟﺔ ﻓﻲ‬ ‫ﺟﺩﺍﺭﻫﺎ ﺇﺧﺭﺍﺝ ﺍﻟﻛﻣﻳﺎﺕ ﺍﻟﺯﺍﺋﺩﺓ ﻣﻧﻬﻣﺎ‪ ،‬ﻛﻣﺎ ﺃﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻠﺗﻬﻣﺔ ﻓﻲ ﻟﺏ ﺍﻟﻁﺣﺎﻝ ﻻ ﺗﺳﻣﺢ ﻟﻬﺎ ﺑﺎﻟﻣﺭﻭﺭ ﺑﺳﻬﻭﻟﺔ ﻭﺗﺣﻁﻣﻬﺎ ﻗﺑﻝ ﺃﻥ‬ ‫ﺗﻛﻣﻝ ﺍﻟﻌﻣﺭ ﺍﻻﻋﺗﻳﺎﺩﻱ ﻟﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻭﻳﻧﺗﺞ ﻋﻥ ﺫﻟﻙ ﻓﻘﺭ ﺍﻟﺩﻡ‪ .‬ﻟﺫﻟﻙ ﻓﺈﻥ ﺇﺟﺭﺍء ﻋﻣﻠﻳﺔ ﺍﺳﺗﺋﺻﺎﻝ ﺍﻟﻁﺣﺎﻝ ﻳﺅﺩﻱ ﺇﻟﻰ ﻧﻘﺹ‬ ‫ﺍﻻﻧﺣﻼﻝ ﺑﺷﻛﻝ ﻭﺍﺿﺢ‪ ،‬ﻭﻗﺩ ﻳُﻧﻬﻲ ﻓﻘﺭ ﺍﻟﺩﻡ ﻧﻬﺎﺋﻳﺎً‪ ،‬ﺩﻭﻥ ﺃﻥ ﺗﺧﺗﻔﻲ ﺍﻷﺷﻛﺎﻝ ﺍﻟﻣﻛﻭّ ﺭﺓ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻣﻥ ﺩﻡ ﺍﻟﻣﺭﻳﺽ‪.‬‬ ‫ﺗﺣﺕ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﺗﺩﺧﻝ ﺃﻳﺿﺎ ً ﺣﺎﻟﺔ ]ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﻭﻳﺔ[‪ ،‬ﺣﻳﺙ ﺗﻛﻭﻥ ﻛﻝ ﺃﻭ ﺃﻛﺛﺭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺑﻳﺿﻭﻳﺔ ﺍﻟﺷﻛﻝ ﺃﻭﻣﺳﺗﻁﻳﻠﺔ‪.‬‬ ‫ﻫﺫﻩ ﺍﻟﺣﺎﻟﺔ ﻧﺎﺩﺭﺍً ﻣﺎ ﺗﺅﺩﻱ ﺇﻟﻰ ﺍﻧﺣﻼﻝ ﻓﻌّﺎﻝ ﻭﻓﻘﺭ ﺩﻡ‪ .‬ﺳﺑﺏ ﺍﻟﺗﺷﻭﻩ ﻓﻲ ﺍﻟﺷﻛﻝ ﻫﻭ ﻧﻘﺹ ﺃﻭ ﺗﻐﻳّﺭ ﻓﻲ ﺗﺭﻛﻳﺏ ﺑﻌﺽ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ‬ ‫ﺍﻟﺗﻲ ﺗﺷ ّﻛﻝ ﻫﻳﻛﻝ ﺍﻟﺟﺩﺍﺭ ﺍﻟﺧﻠﻭﻱ‪ ،‬ﻛﺎ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻛﺭﻭﻳﺔ‪ ،‬ﻟﻛﻥ ﺍﻟﺗﻐﻳﻳﺭﺍﺕ ﺗﺧﺗﻠﻑ ﻓﻲ ﺍﻟﺣﺎﻟﺗﻳﻥ‪.‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -10‬ﺍﻟﻐﺷﺎء ﺍﻟﺩﻫﻧﻲ ﻟﺧﻠﻳﺔ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻭﺧﻳﻭﻁ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﺍﻟﺛﺑﺗﺔ ﻟﻪ‬ ‫‪U‬‬

‫ﺛﺎﻧﻳﺎ ً‪ :‬ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﻣﺗﺳﺑﺑﺔ ﻋﻥ ﺣﺩﻭﺙ ﺧﻠﻝ ﺗﺭﻛﻳﺑﻲ ﺃﻭ ﺇﻧﺗﺎﺟﻲ ﻓﻲ ﺟﺯﻳﺋﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪:‬‬

‫ﻣﺛﻝ ﻫﺫﺍ ﺍﻟﺧﻠﻝ ﻗﺩ ﻻ ﻳﺳﺑﺏ ﻣﺷﻛﻠﺔ ﻭﻻ ﻳﻧﺗﺞ ﻋﻧﻪ ﻓﻘﺭ ﺩﻡ ﻓﻲ ﺃﻛﺛﺭ ﺍﻷﺣﻳﺎﻥ‪ ،‬ﺇﻻ ﺃﻥ ﺃﻗﻠﻳﺔ ﻣﺣﺩﻭﺩﺓ ﻣﻥ ﺃﻧﻭﺍﻉ ﻫﺫﺍ ﺍﻟﺧﻠﻝ ﺗﺳﺑﺏ‬ ‫ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺑﺳﺭﻋﺔ ﻭﻳﻧﺗﺞ ﻋﻥ ﺫﻟﻙ ﻓﻘﺭ ﺩﻡ ﺗﺗﻧﺎﺳﺏ ﺷﺩّﺗﻪ ﻣﻊ ﻧﻭﻉ ﺍﻟﺧﻠﻝ ﻭﺩﺭﺟﺗﻪ ]ﻧﻘﻲ ﺃﻭ ﻫﺟﻳﻧﻲ[‪ .‬ﻣﻥ ﺃﻫﻡ ﺃﻣﺭﺍﺽ‬ ‫ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻧﺗﺷﺎﺭﺍً ﻓﻲ ﺍﻟﻌﺎﻟﻡ ﻣﺭﺽ ]ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻣﻧﺟﻠﻲ[‪ ،‬ﻭﻗﺩ ﺳﻣّﻲ ﺑﻬﺫﺍ ﺍﻻﺳﻡ ﻷﻥ ﺑﻌﺽ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺗﻛﻭﻥ ﻣﺷﻭّ ﻫﺔ‬ ‫ﻋﻠﻰ ﺷﻛﻝ ﻣﻧﺟﻝ ﺃﻭ ﻣﺳﺗﻁﻳﻠﺔ ﺑﻧﻬﺎﻳﺎﺕ ﻣﺩﺑﺑﺔ )ﺍﻧﻅﺭ ﺻﻭﺭﺍﻷﻁﻠﺱ(‪ .‬ﺃﻛﺛﺭ ﺃﻧﻭﺍﻉ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﺗﻛﻭﻥ ﻣﺗﺳﺑﺑﺔ ﻋﻥ ﺍﺳﺗﺑﺩﺍﻝ‬ ‫]ﺣﺎﻣﺽ ﺃﻣﻳﻧﻲ[ ﻭﺍﺣﺩ ﻓﻲ ﺇﺣﺩﻯ ﺳﻼﺳﻝ ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ ﺍﻷﺭﺑﻌﺔ ﺑﺣﺎﻣﺽ ﺃﻣﻳﻧﻲ ﺁﺧﺭ‪.‬‬ ‫ً‬ ‫ﻭﻫﻧﺎﻙ ﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﻳﻧﺿﻭﻱ ﺗﺣﺕ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻻ ﻳﺣﺗﻭﻱ ﻓﻲ ﺗﺭﻛﻳﺑﻪ ﺗﻐﻳﻳﺭﺍ ﻓﻲ ﺃﻱ ﻣﻥ ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ ﺑﻝ‬ ‫ﻳﺳﺑﺑﻪ ﻧﻘﺹ ‪ ،‬ﺗﺎﻡ ﺃﻭ ﻏﻳﺭ ﺗﺎﻡ‪ ،‬ﻓﻲ ﻗﺎﺑﻠﻳﺔ ﺍﻟﺧﻠﻳﺔ ﺍﻷﺭﻭﻣﻳﺔ ﺍﻟﻣﻭﻟﺩﺓ ﻟﻠﺣﻣﺭﺍء ﻋﻠﻰ ﺇﻧﺗﺎﺝ ﺃﺣﺩ ﺍﻟﻧﻭﻋﻳﻥ ﻣﻥ ﺳﻼﺳﻝ ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ‬ ‫)ﺃ ﺃﻭ ﺏ( ﻟﺗﻛﻭﻳﻥ ﺟﺯﻳﺋﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ .‬ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻳﺳﻣﻰ ]ﻓﻘﺭ ﺩﻡ ﺍﻟﺑﺣﺭ ﺍﻟﻣﺗﻭﺳﻁ[ ﺃﻭ ﺍﻟﺛﺎﻻﺳﻳﻣﻳﺎ‪ ،‬ﻻﻧﺷﺎﺭ ﻧﻭﻉ ﻣﻬﻡ‬ ‫ﻣﻧﻪ ﻓﻲ ﺍﻟﻣﻧﻁﻘﺔ ﺍﻟﻣﺣﻳﻁﺔ ﺑﻬﺫﺍ ﺍﻟﺑﺣﺭ‪ .‬ﺗﻛﻭﻥ ﺷﺩﺓ ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻣﺗﻔﺎﻭﺗﺔ ﻣﻥ ﺍﻟﺑﺳﻳﻁﺔ ﺟ ّﺩﺍً ﺇﻟﻰ ﺍﻟﺩﺭﺟﺔ ﺍﻟﺗﻲ ﻻ ﺗﺳﻣﺢ ﺑﺎﻟﻌﻳﺵ ﺑﻌﺩ‬ ‫ﺍﻟﻭﻻﺩﺓ ﺃﺻﻼً‪ .‬ﺇﺫﺍ ﻛﺎﻧﺕ ﺍﻟﺻﻌﻭﺑﺔ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻫﻲ ﻓﻲ ﺇﻧﺗﺎﺝ ﺳﻠﺳﻠﺔ ﺏ ﻳﺳﻣﻰ ﺍﻟﻣﺭﺽ ﺛﺎﻻﺳﻳﻣﻳﺎ ﺏ )ﺑﻳﺗﺎ( ﻭﺇﺫﺍ ﻛﺎﻧﺕ ﺍﻟﺻﻌﻭﺑﺔ ﻓﻲ‬ ‫ﺇﻧﺗﺎﺝ ﺳﻠﺳﻠﺔ ﺃ ﻳﺳﻣﻰ ﺛﺎﻻﺳﻳﻣﻳﺎ ﺃ )ﺃﻟﻔﺎ(‪.‬‬ ‫ً‬ ‫ﺛﺎﻻﺳﻳﻣﻳﺎ ﻧﻭﻉ ﺏ ﻫﻲ ﺍﻷﺷﺩ ﺍﻧﺗﺷﺎﺭﺍً ﻓﻲ ﻣﻧﻁﻘﺔ ﺍﻟﺑﺣﺭ ﺍﻟﻣﺗﻭﺳﻁ ﻭﺗﺗﺳﻡ ﺑﻔﻘﺭ ﺩﻡ ﺷﺩﻳﺩ ﺟﺩﺍ ﻭﺗﺿﺧﻡ ﺍﻟﻁﺣﺎﻝ ﻭﺍﻟﻛﺑﺩ‪.‬‬ ‫ﻳﻣﻛﻥ ﺍﻟﻛﺷﻑ ﻓﻲ ﺍﻟﻣﺧﺗﺑﺭ ﻋﻥ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻏﻳﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ )ﺃﻱ ﺍﻟﺗﻲ ﺗﺧﺗﻠﻑ ﺗﺭﻛﻳﺑﺎ ً ﻋﻥ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺃ( ﺑﺎﺳﺗﻌﻣﺎﻝ‬ ‫ﻁﺭﻳﻘﺔ ]ﺍﻟﺗﺟﺯﺋﺔ ﺍﻟﻛﻬﺭﺑﺎﺋﻳﺔ ﻟﻠﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ[‪ ،‬ﺣﻳﺙ ﻳﺅﺩﻱ ﺗﻐﻳﻳﺭ ﺗﺭﻛﻳﺑﻬﺎ ﺇﻟﻰ ﺗﻐﻳّﺭ ﺍﻟﺷﺣﻧﺔ ﺍﻟﻛﻬﺭﺑﺎﺋﻳﺔ ﻟﻧﻠﻙ ﺍﻟﺟﺯﻳﺋﺎﺕ‪ .‬ﺗﻐﻳﻳﺭ ﺍﻟﺷﺣﻧﺔ‬ ‫‪29‬‬

‫ﻳﺳﺑﺏ ﺗﻐﻳﻳﺭ ﺳﺭﻋﺔ ﺍﻧﺗﻘﺎﻟﻬﺎ ﻣﻥ ﻗﻁﺏ ﺇﻯ ﺁﺧﺭ ﻓﻲ ﺟﻬﺎﺯ ]ﺍﻟﺭﺣﻼﻥ ﺍﻟﻛﻬﺭﺑﺎﺋﻲ[‪ .‬ﺑﻬﺫﻩ ﺍﻟﻌﻣﻠﻳﺔ ﺗﻧﻔﺻﻝ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫ﺍﻟﻣﺧﺗﻠﻔﺔ ﻋﻥ ﺑﻌﺿﻬﺎ ﻭﻳﻣﻛﻥ ﺗﻣﻳﻳﺯﻫﺎ ﻓﻲ ﺍﻟﻣﺧﺗﺑﺭ‪.‬‬ ‫ﺫﻛﺭﺕ ﺣﻳﻥ ﺍﻟﻛﻼﻡ ﻋﻥ ﺍﻟﺗﺭﻛﻳﺏ ﺍﻟﻁﺑﻳﻌﻲ ﻟﺟﺯﻳﺋﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺃﻥ ﻫﻧﺎﻙ ﻧﻭﻉ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﺃ ﺍﻟﻁﺑﻳﻌﻲ ﻓﻲ ﺍﻟﺑﺎﻟﻐﻳﻥ ﻭﻧﻭﻉ‬ ‫ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﻑ ﺍﻟﻁﺑﻳﻌﻲ ﻓﻲ ﺍﻟﺟﻧﻳﻥ ﻭﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ‪ .‬ﻫﺫﺍ ﺍﻷﺧﻳﺭ ﻳﺧﺗﻔﻲ ﺗﻘﺭﻳﺑﺎ ً ﺑﻌﺩ ﺳﺗﺔ ﺷﻬﻭﺭ ﻣﻥ ﺍﻟﻭﻻﺩﺓ ﻟﻳﺣﻝ ﻣﺣﻠﻪ‬ ‫ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ -‬ﺃ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻁﺑﻳﻌﻳﺔ‪ .‬ﺃﻣﺎ ﻓﻲ ﻓﻘﺭ ﺩﻡ ﺍﻟﺑﺣﺭ ﺍﻟﻣﺗﻭﺳﻁ ﻓﻘﺩ ﺗﺑﻘﻰ ﻧﺳﺑﺔ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪-‬ﻑ ﻋﺎﻟﻳﺔ ﺑﻌﺩ ﺫﻟﻙ ﺍﻟﻌﻣﺭ‪،‬‬ ‫ﻭﻛﺫﻟﻙ ﻓﻘﺩ ﺗﻛﻭﻥ ﻧﺳﺑﺔ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪-‬ﺃ‪)2-‬ﺍﻧﻅﺭ ﺹ ‪ (12‬ﻋﺎﻟﻳﺔ‪ ،‬ﻭﺫﻟﻙ ﻧﺗﻳﺟﺔ ﺍﻟﺻﻌﻭﺑﺔ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻓﻲ ﺇﻧﺗﺎﺝ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪-‬ﺃ‪.‬‬ ‫ﻓﻲ ﺣﺎﻻﺕ ﺃﺧﺭﻯ ﻣﻥ ﻓﻘﺭ ﺩﻡ ﺍﻟﺑﺣﺭ ﺍﻟﻣﺗﻭﺳﻁ ﺗﻧﻌﻛﺱ ﺍﻵﻳﺔ ﻭﻳﻛﻭﻥ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪-‬ﺃ‪ 2‬ﺃﻗﻝ ﻣﻥ ﺍﻟﻁﺑﻳﻌﻲ ﻧﺗﻳﺟﺔ ﺍﻟﺻﻌﻭﺑﺔ ﻓﻲ ﺇﻧﺗﺎﺟﻪ‪.‬‬ ‫ﻋﻼﺝ ﻫﺫﻩ ﺍﻷﻧﻭﺍﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﻳﻧﺣﺻﺭ ﻓﻲ ﺍﻟﻭﻗﺕ ﺍﻟﺣﺎﺿﺭ ﺑﻧﻘﻝ ﺩﻡ ﻟﻠﻣﺭﺿﻰ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﻔﻘﺭ ﺩﻡ ﺷﺩﻳﺩ‪ .‬ﻛﺫﻟﻙ ﻳﻣﻛﻥ‬ ‫ﺇﺟﺭﺍء ﻋﻣﻠﻳﺔ ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺇﺫﺍ ﻭُ ﺟﺩ ﺍﻟﻣﺗﺑﺭﻉ ﺍﻟﻣﻁﺎﺑﻕ ﻟﻠﻣﺭﻳﺽ‪.‬‬ ‫‪U‬‬

‫ﺛﺎﻟﺛﺎ ً‪ -‬ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﻣﺗﺳﺑﺑﺔ ﻋﻥ ﻧﻘﺹ ﺇﻧﻅﻳﻣﺎﺕ ﻣﻌﻳﻧﺔ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‪:‬‬

‫ﺃﻫﻡ ﻧﻭﻉ ﻓﻲ ﺍﻟﻣﺟﻣﻭﻋﺔ‪ ،‬ﻭﺃﻛﺛﺭﻫﺎ ﺍﻧﺗﺷﺎﺭﺍً ﻓﻲ ﺍﻟﺷﺭﻕ ﺍﻷﻭﺳﻁ ﻭﻓﻲ ﺍﻟﻌﺎﻟﻡ ﻫﻭ ﺍﻟﻣﺭﺽ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﻧﻘﺹ ﻓﻲ ﺍﻟﻛﻣﻳﺔ ﺃﻭ ﺍﻟﻔﻌﺎﻟﻳﺔ‬ ‫ﻝ]ﺇﻧﻅﻳﻡ ﺍﻟﺫﻱ ﻳﻘﻭﻡ ﺑﻧﺯﻉ ﺍﻟﻬﺎﻳﺩﺭﻭﺟﻳﻥ ﻣﻥ ﻓﻭﺳﻔﺎﺕ‪-6-‬ﻏﻠﻭﻛﻭﺯ[ )ﺍﻧﻅﺭ ﺍﻟﺷﻛﻝ ‪.(11‬‬ ‫ً‬ ‫ً‬ ‫ﻫﺫﺍ ﺍﻟﻧﻘﺹ ﻓﻲ ﺑﻌﺽ ﺃﻧﻭﺍﻋﻪ ﻗﺩ ﻳﺳﺑﺏ ﺍﻧﺣﻼﻻً ﺩﺍﺋﻣﺎ ً ﻣﻧﺫ ﺍﻟﻭﻻﺩﺓ ﻣﻊ ﻓﻘﺭ ﺩﻡ ﻣﺳﺗﻣﺭ‪ .‬ﻟﻛﻥ ﺃﻧﻭﺍﻋﺎ ﺃﺧﺭﻯ ﻣﻧﻪ ﻻ ﺗﺳﺑﺏ ﺍﻧﺣﻼﻻ ﻓﻲ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺇﻻ ﻋﻧﺩ ﺗﻧﺎﻭﻝ ﺃﺩﻭﻳﺔ ﻣﻌﻳّﻧﺔ ﻣﺅﻛﺳِ ﺩﺓ )ﺟﺩﻭﻝ ﺭﻗﻡ‪ (3-‬ﺃﻭ ﻋﻧﺩ ﺗﻧﺎﻭﻝ ﺍﻟﻔﻭﻝ )ﺍﻟﺑﺎﻗﻼء(‪ ،‬ﻛﻣﺎﻳﺣﺩﺙ ﻏﺎﻟﺑﺎ ً ﻋﻧﺩ‬ ‫ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺎﻟﻧﻘﺹ ﻣﻥ ﺍﻟﻌﺭﺏ‪ .‬ﺑﻣﺟ ّﺭﺩ ﺗﻧﺎﻭﻝ ﻛﻣﻳﺔ ﻣﻥ ﻫﺫﻩ ﺍﻷﺩﻭﻳﺔ ﺃﻭ ﻣﻥ ﺍﻟﻔﻭﻝ )ﻋﻧﺩ ﺍﻷﻁﻔﺎﻝ ﻋﺎﺩﺓ( ﻳﺣﺩﺙ ﺍﻧﺣﻼﻝ ﻓﻲ ﻋﺩﺩ‬ ‫ﻫﺎﺋﻝ ﻣﻥ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻭﻫﻲ ﺩﺍﺧﻝ ﺃﻭﻋﻳﺔ ﺍﻟﺩﻡ ﻭﻳﺗﺣﺭﺭ ﻣﻧﻬﺎ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻓﺗﺧﺭﺝ ﻣﻧﻪ ﻛﻣﻳﺔ ﻛﺑﻳﺭﺓ ﻓﻲ ﺍﻟﺑﻭﻝ‪ ،‬ﺍﻟﺫﻱ ﻳﺻﺑﺢ‬ ‫ﺃﺣﻣﺭ ﺍﻟﻠﻭﻥ‪ ،‬ﻛﻣﺎﻳﺣﺩﺙ ﻫﺑﻭﻁ ﺳﺭﻳﻊ ﻓﻲ ﺿﻐﻁ ﺍﻟﺩﻡ ﻭﺍﻟﺩﻭﺭﺓ ﺍﻟﺩﻣﻭﻳﺔ )ﺻﺩﻣﺔ ﺩﻭﺭﺍﻧﻳﺔ( ﻭﻗﺩ ﻳﺅﺩﻱ ﺇﻟﻰ ﺍﻟﻣﻭﺕ‪ .‬ﺇﺫﺍ ﻧﺟﺎ ﺍﻟﻁﻔﻝ ﻣﻥ‬ ‫ﺍﻟﻣﻭﺕ ﺑﻌﺩ ﻧﻭﺑﺔ ﺍﻻﻧﺣﻼﻝ ﻓﺈﻧﻪ ﻳﻌﺎﻧﻲ ﺑﻌﺩﻫﺎ ﻣﻥ ﻓﻘﺭ ﺩﻡ ﺷﺩﻳﺩ ﻭﻳﺭﻗﺎﻥ‪ .‬ﺳﺑﺏ ﺍﻟﻳﺭﻗﺎﻥ ﻫﻭ ﺗﺣﻁﻡ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺗﻲ ﻟﻡ‬ ‫ﺗﺧﺭﺝ ﻓﻲ ﺍﻟﺑﻭﻝ‪ .‬ﺇﻥ ﻫﺫﻩ ﺍﻟﺣﺳﺎﺳﻳﺔ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻧﺣﻭ ﺍﻟﻔﻭﻝ ﺗﻣﻳﻝ ﺇﻟﻰ ﺍﻟﻧﻘﺻﺎﻥ ﺑﻌﺩ ﻧﻣﻭ ﺍﻟﻁﻔﻝ ﻭﻳﻭﺍﺟﻬﻬﺎ ﺍﻟﻣﺭﻳﺽ ﻋﺎﺩﺓ‬ ‫ﻓﻲ ﺃﻭﻝ ﻋﺎﻡ ﻣﻥ ﻋﻣﺭﻩ ﺣﻳﻧﻣﺎ ﻳﺑﺩﺃ ﺑﺗﻧﺎﻭﻝ ﺍﻟﻁﻌﺎﻡ ﻭﻓﻳﻪ ﺍﻟﻔﻭﻝ‪ .‬ﻳُﻌﺗ َﻘﺩ ﺃﻥ ﺍﺳﺗﻧﺷﺎﻕ ﺯﻫﻭﺭ ﺍﻟﻔﻭﻝ ﻓﻲ ﺣﻘﻭﻝ ﺍﻟﺯﺭﺍﻋﺔ ﻗﺩ ﻳﺅﺩﻱ ﺇﻟﻰ‬ ‫ﻧﻭﺑﺔ ﺍﻧﺣﻼﻝ ﺃﻳﺿﺎ ً‪.‬‬ ‫ﺇﻥ ﺍﻟﻣﺭﺿﻰ ﺑﻬﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﺍﻟﻣﺭﺽ ﺍﻟﻭﺭﺍﺛﻲ ﻫﻡ ﻋﺎﺩﺓ ﻣﻥ ﺍﻟﺫﻛﻭﺭ ﻷﻥ ﻣﻭﺭﺙ ﺍﻷﻧﻅﻳﻡ ﻣﺣﻣﻭﻝ ﻋﻠﻰ ]ﺻﺑﻐﻳﺔ ﺍﻟﺟﻧﺱ[ ﺃﻭ‬ ‫ﻛﺭﻭﻣﻭﺳﻭﻡ ﺃﻛﺱ‪ .‬ﻭﻟﻛﻥ ﺫﻟﻙ ﻻ ﻳﻣﻧﻊ ﻣﻥ ﺇﺻﺎﺑﺔ ﺍﻹﻧﺎﺙ ﺃﻳﺿﺎ ً ﺇﺫﺍ ﻭﺭﺛﺕ ﺍﻟﺑﻧﺕ ﺍﻟﻣﺭﺽ ﻣﻥ ﺃﺑﻭﻳﻬﺎ‪ .‬ﻳﺟﺩﺭ ﺍﻹﺷﺎﺭﺓ ﻫﻧﺎ ﺇﻟﻰ ﺃﻥ‬ ‫ﺍﻧﺣﻼﻻً ﺑﺳﻳﻁﺎ ً ﺃﻭ ﻣﺗﻭﺳﻁﺎ ً ﻗﺩ ﻳﺣﺻﻝ ﻟﺩﻯ ﻫﺅﻻء ﺍﻟﻣﺭﺿﻰ ﻋﻧﺩ ﺇﺻﺎﺑﺗﻬﻡ ﺑﻣﺧﺗﻠﻑ ﺃﻧﻭﺍﻉ ﺍﻟﺣﻣﻳﺎﺕ‪ ،‬ﺣﺗﻰ ﺑﺩﻭﻥ ﺗﻧﺎﻭﻝ ﻋﻘﺎﺭﺍﺕ ﺃﻭ‬ ‫ﻓﻭﻝ‪.‬‬ ‫ﻓﻭﺳﻔﺎﺕ‪-6-‬ﻛﻠﻭﻛﻭﺯ‬

‫‪G6PD‬‬

‫ﻓﻭﺳﻔﺎﺕ‪-6-‬ﻛﻠﻭﻛﻭﻧﺎﺕ‬

‫ﺫﺭﺗﺎ ﻫﺎﻳﺩﺭﻭﺟﻳﻥ‬ ‫‪U‬‬

‫ﺷﻛﻝ ﺭﻗﻡ‪- 11-‬ﻣﻭﻗﻊ ﻋﻣﻝ ﺇﻧﻅﻳﻡ ﺳﺎﻟﺏ ﺍﻟﻬﺎﻳﺭﻭﺟﻳﻥ ﻣﻥ ﻓﻭﺳﻔﺎﺕ‪-6-‬ﻛﻠﻭﻛﻭﺯ‬ ‫‪U‬‬

‫ﺍﻟﺟﺩﻭﻝ ﺭﻗﻡ ‪ 3‬ﻳﺣﻭﻱ ﺑﻌﺿﺎ ً ﻣﻥ ﺍﻷﺩﻭﻳﺔ ﺍﻟﻣﻬﻣﺔ ﺍﻟﺗﻲ ﺗﺳﺑﺏ ﺍﻧﺣﻼﻻً ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻟﺩﻯ ﺑﻌﺽ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺎﻟﻣﺭﺽ)‬ ‫ﺧﺻﻭﺻﺎ ً ﻟﺩﻯ ﺍﻟﻌﻧﺻﺭ ﺍﻟﺯﻧﺟﻲ ﻣﻧﻬﻡ(‬

‫ﺟﺩﻭﻝ ﺭﻗﻡ ‪3‬‬ ‫ﺑﻌﺽ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺗﻲ ﻗﺩ ﺗﺳﺑﺏ ﺍﻧﺣﻼﻻً ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻟﺩﻯ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﻧﻘﺹ ﺇﻧﻅﻳﻡ ‪G6PD‬‬

‫ﺑﺭﻳﻣﺎﻛﻭﻳﻥ‬ ‫ﻛﻧﻳﻥ‬

‫ﻋﻘﺎﺭﺍﺕ ﺃﺧﺭﻯ‬

‫ﻋﻘﺎﺭﺍﺕ ﻣﺿﺎﺩﺓ ﻟﻠﻣﻼﺭﻳﺎ‬

‫ﺍﻟﺳﻠﻔﻭﻧﺎﺕ‬ ‫ﻧﺎﻳﺗﺭﻭﻓﻳﻭﺭﺍﻧﺗﻭﻳﻥ)ﻓﻳﻭﺭﺍﺩﺍﻧﺗﻳﻥ(‬ ‫‪30‬‬

‫ﺑﺎﻣﺎﻛﻭﻳﻥ‬ ‫ﺑﻧﺗﺎﻛﻭﻳﻥ‬

‫ﺃﺳﻳﺗﺎﻧﻳﻠﻳﻥ‬ ‫ﺍﻟﻣﺛﻠﻳﻥ ﺍﻷﺯﺭﻕ‬ ‫ﺣﺎﻣﺽ ﻧﺎﻟﻳﺩﻛﺳﻳﻙ‬ ‫ﻧﻔﺛﺎﻟﻳﻥ )ﻗﺎﺗﻝ ﺍﻟﻌﺙ(‬ ‫ﻓﻧﻳﻝ ﻫﺎﻳﺩﺭﺍﺯﻳﻥ‬ ‫ﺍﻟﺗﻭﻟﻭﻳﺩﻳﻥ ﺍﻷﺯﺭﻕ‬ ‫ﻧﺎﻳﺗﺭﻭﺗﻭﻟﻭﻳﻥ‬

‫ﻋﻘﺎﺭﺍﺕ ﺍﻟﺳﻠﻔﺎ‬

‫ﺳﻠﻔﺎﻧﻳﻼﻣﺎﻳﺩ‬ ‫ﺳﻠﻔﺎﺳﻳﺗﺎﻣﺎﻳﺩ‬ ‫ﺳﻠﻔﺎ ﻣﻳﺛﺎﻛﺳﺎﺯﻭﻝ‬

‫ﺏ‪ -‬ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻣﻛﺗﺳﺏ‬ ‫‪U‬‬

‫ﺇﻥ ﺃﻫﻡ ﺃﻧﻭﺍﻉ ﺍﻻﻧﺣﻼﻝ ﺍﻟﻣﻛﺗﺳﺑﺔ ﻫﻲ ﻣﺎ ﻧﺗﺞ ﻋﻥ ]ﻣﺿﺎﺩﺍﺕ[ ﻟﻠﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻭﻫﺫﺍ ﻣﺎ ﺳﺄﺗﻛﻠﻡ ﻋﻧﻪ ﺑﺗﻔﺻﻳﻝ ﺃﻛﺑﺭ ﻧﻅﺭﺍً ﻷﻫﻣﻳﺗﻪ‬ ‫ﻭﻷﻥ ﺍﻟﻛﺛﻳﺭﻳﻥ ﻣﻥ ﺍﻟﻧﺎﺱ ﻳﺳﻣﻌﻭﻥ ﻋﻧﻪ ﻭﻳﺷﻐﻝ ﺑﺎﻟﻬﻡ‪.‬‬

‫ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻟﺭﺋﻳﺳﻳﺔ ﻭﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻬﺎ‪:‬‬ ‫‪U‬‬

‫ﺗﺣﻣﻝ ﻛﻝ ﺧﻠﻳﺔ ﺣﻣﺭﺍء )ﻭﺍﻟﺧﻼﻳﺎ ﺍﻷﺧﺭﻯ ﻓﻲ ﺍﻟﺟﺳﻡ( ﻋﻠﻰ ﺳﻁﺣﻬﺎ ]ﻣﺳﺗﺿﺩﺍﺕ[ ﺗﺧﺗﻠﻑ ﻣﻥ ﺷﺧﺹ ﻵﺧﺭ‪ ،‬ﻭﻳﻘﺳﻡ ﺍﻟﻧﺎﺱ ﻋﻠﻰ‬ ‫ﺃﺳﺎﺳﻬﺎ ﺇﻟﻰ ﻣﺟﻣﻭﻋﺎﺕ ﺗﺳﻣﻰ]ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ[‬ ‫ﺃﻫﻡ ﻫﺫﻩ ﺍﻟﻔﺻﺎﺋﻝ ﻁﺑﻳﺎ ً ﻫﻲ ﻣﺟﻣﻭﻋﺔ ‪ ABO‬ﺍﻟﺗﻲ ﻳُﻘﺳﻡ ﺍﻟﻧﺎﺱ ﻋﻠﻰ ﺃﺳﺎﺳﻬﺎ ﺇﻟﻰ ﺃﺭﺑﻌﺔ ﺃﻗﺳﺎﻡ‪ ،‬ﻭﻓﺻﻳﻠﺔ ‪ ، Rh‬ﺍﻟﺗﻲ ﻳُﻘﺳﻡ ﺍﻟﻧﺎﺱ ﻋﻠﻰ‬ ‫ﺃﺳﺎﺳﻬﺎ ﺇﻟﻰ ﺻﻧﻔﻳﻥ ﺭﺋﻳﺳﻳﻳﻥ )ﺍﻧﻅﺭ ﺍﻟﺟﺩﻭﻝ ﺭﻗﻡ ‪ .(4‬ﻓﻲ ﺣﺎﻟﺔ ﻓﺻﺎﺋﻝ ‪ ABO‬ﻓﺈﻥ ﻛﻝ ﺇﻧﺳﺎﻥ‪ ،‬ﻋﺩﺍ ﺣﺩﻳﺛﻲ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﻳﻭﺟﺩ ﻓﻲ ﺩﻣﻪ‬ ‫ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟﻠﻔﺻﻳﻠﺔ ﺍﻟﻣﻐﺎﻳﺭﺓ ﻟﻔﺻﻳﻠﺗﻪ‪ ،‬ﻛﻣﺎ ﺗﺭﻯ ﻓﻲ ﺍﻟﺟﺩﻭﻝ‪ .‬ﻫﺫﻩ ﺍﻷﺿﺩﺍﺩ ﺗﻭﺟﺩ ﺑﺷﻛﻝ ﻁﺑﻳﻌﻲ‪ .‬ﺃﻣﺎ ﺑﺎﻟﻧﺳﺑﺔ ﻟﻣﺟﻣﻭﻋﺔ ‪Rh‬‬ ‫ﻓﺈﻥ ﺍﻟﻧﻭﻉ ﺍﻟﻣﻭﺟﺏ ﻻ ﻳﻭﺟﺩ ﻓﻲ ﺩﻣﻪ ﺃﺿﺩﺍﺩ ﻟﻠﻔﺻﻳﻠﺔ ﻭﺍﻟﻧﻭﻉ ﺍﻟﺳﺎﻟﺏ ﻳﻣﻛﻥ ﺃﻥ ﻳﻭﻟﺩ ﺃﺟﺳﺎﻣﺎ ً ﻣﺿﺎﺩﺓ ﻓﻲ ﺣﺎﻟﺔ ﺩﺧﻭﻝ ﺧﻼﻳﺎ ﻣﻭﺟﺑﺔ‬ ‫ﺇﻟﻰ ﺩﻣﻪ ﻭﻫﺫﻩ ﺗﺳﻣّﻰ ]ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻣﻭﻟّﺩﺓ[ ﺃﻱ ﺃﻧﻬﺎ ﻟﻳﺳﺕ ﻁﺑﻳﻌﻳﺔ ﻓﻲ ﻧﺷﺄﺗﻬﺎ ﻭﻟﻡ ﺗﻛﻥ ﻣﻭﺟﻭﺩﺓ ﻗﺑﻝ ﺩﺧﻭﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻭﺟﺑﺔ ﺇﻟﻰ‬ ‫ﺩﻡ ﺫﻟﻙ ﺍﻟﻔﺭﺩ‪.‬‬ ‫ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﻣﺭﺿﻳﺔ ﺧﺎﺻﺔ‪ ،‬ﺳﻳﺭﺩ ﺫﻛﺭﻫﺎ ﻓﻳﻣﺎ ﺑﻌﺩ‪ ،‬ﻳﻣﻛﻥ ﺃﻥ ﺗﻭﺟﺩ ﻓﻳﻬﺎ ﻣﺿﺎﺩّﺍﺕ ﻟﻧﻔﺱ ﺍﻟﻔﺻﺎﺋﻝ ﺍﻟﺗﻲ ﺗﺣﻣﻠﻬﺎ ﺧﻼﻳﺎ ﺍﻟﻣﺭﻳﺽ‬ ‫ﻑ‪ .‬ﻭﻫﺫﻩ ﻫﻲ ﺍﻟﻣﺿﺎﺩّﺍﺕ ﺍﻟﺫﺍﺗﻳﺔ‪.‬‬ ‫ﻭﻳﺻﻧﻌﻬﺎ ﺍﻟﺟﺳﻡ ﻧﻔﺳﻪ ﻓﺗﻌﻣﻝ ﻋﻠﻰ ﺗﺣﻁﻳﻡ ﺧﻼﻳﺎﻩ ﺇﺫﺍ ﻛﺎﻧﺕ ﻓﻌّﺎﻟﺔ ﺑﺷﻛﻝ ﻛﺎ ٍ‬

‫ﺟﺩﻭﻝ ﺭﻗﻡ ‪4‬‬ ‫ﻓﺻﻳﻠﺔ ﺍﻟﺩﻡ‬

‫)ﻣﺳﺗﺿﺩّﺍﺕ ﻋﻠﻰ ﺳﻁﺢ ﺍﻟﺧﻠﻳﺔ(‬

‫ﻣﺟﻣﻭﻋﺔ ‪ABO‬‬ ‫‪A .1‬‬ ‫‪B .2‬‬ ‫‪O .3‬‬ ‫‪AB .4‬‬ ‫ﻣﺟﻣﻭﻋﺔ ‪Rh‬‬ ‫‪Rh (+)- D .1‬‬ ‫‪Rh (-)- d .2‬‬

‫ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻟﻣﻬﻣﺔ ﻣﻊ ﻣﺿﺎ ّﺩﺍﺗﻬﺎ‬ ‫ﺍﻟﻣﺿﺎ ّﺩﺍﺕ‬

‫)ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻓﻲ ﻣﺻﻝ ﺍﻟﺩﻡ(‬

‫ﻣﻼﺣﻅــــــــــﺎﺕ‬

‫ﻫﺫﻩ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻣﻭﺟﻭﺩﺓ ﺑﺷﻛﻝ ﻁﺑﻳﻌﻲ‪ .‬ﻻﺣﻅ ﺃﻧﻬﺎ ﻻ‬ ‫ﺗﺿﺎ ّﺩ ﻓﺻﻳﻠﺔ ﺍﻟﻔﺭﺩ ﺍﻟﺗﻲ ﻳﺣﻣﻠﻬﺎ‪ ،‬ﺃﻱ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﻣﻳﺯﺓ ﻋﻠﻰ‬ ‫ﺳﻁﺢ ﺧﻼﻳﺎﻩ‪.‬‬

‫ﺿﺩ ‪A‬‬ ‫ﺿﺩ ‪B‬‬ ‫ﺿﺩ ‪ A‬ﻭﺿﺩ ‪B‬‬ ‫ﻻﻳﻭﺟﺩ‬

‫‪ .1‬ﻫﻧﺎﻙ ﻓﺻﺎﺋﻝ ﺃﺧﺭﻯ ﺃﻗﻝ ﺃﻫﻣﻳﺔ ﺿﻣﻥ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ‬ ‫‪ .2‬ﻳﻣﻛﻥ ﺃﻥ ﺗﺗﻛﻭّ ﻥ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩّﺓ )ﻣﻭﻟّﺩﺓ( ﻓﻲ ﺣﺎﻟﺔ ﺩﺧﻭﻝ‬ ‫ﺧﻼﻳﺎ ﻣﻭﺟﺑﺔ ﺇﻟﻰ ﺩﻡ ﺍﻟﻔﺭﺩ ﺍﻟﺫﻱ ﺧﻼﻳﺎﻩ ﺳﺎﻟﺑﺔ‪ ،‬ﻭﺣﻳﻧﺋﺫ ﻻ‬ ‫ّ‬ ‫ﺗﺅﺛﺭ ﻫﺫﻩ ﺍﻷﺟﺳﺎﻡ ﺇﻻ ﻋﻠﻰ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺩﺧﻳﻠﺔ‬

‫ﻻ ﺗﻭﺟﺩ‬ ‫ﻻ ﺗﻭﺟﺩ‬

‫ﻣﺟﻣﻭﻋﺔ ‪ABO‬‬ ‫‪U‬‬

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‫ﻫﺫﻩ ﻫﻲ ﺃﻫﻡ ﻣﺟﻣﻭﻋﺎﺕ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺑﻼ ﻣﻧﺎﺯﻉ ﻭﻳﻭﺟﺩ ﻓﻳﻬﺎ ﺑﻌﺽ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻣﺫﻛﻭﺭﺓ ﻓﻲ ﺟﺩﻭﻝ ‪ ،4‬ﻭﻫﻲ ﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﻧﺷﺄ‬ ‫ﻭﻻ ﺗﻌﻣﻝ ﺿﺩ ﻓﺻﻳﻠﺔ ﺩﻡ ﺍﻟﻔﺭﺩ ﺍﻟﺫﻱ ﺗﺗﻭﺍﺟﺩ ﻓﻳﻪ‪ ،‬ﻟﻛﻥ ﺇﺫﺍ ﺣﺻﻝ ﺃﻥ ﺩﺧﻠﺕ ﺧﻼﻳﺎ ﺗﺣﻣﻝ ﻓﺻﻳﻠﺔ ﺩﻡ ﻣﻐﺎﻳﺭﺓ ﻟﻔﺻﻳﻠﺔ ﺩﻡ ﺫﻟﻙ ﺍﻟﻔﺭﺩ‬ ‫ﻓﺈﻧﻬﺎ ﺗﺗﺣﻁﻡ ﺑﺳﺭﻋﺔ ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎ ّﺩﺓ ﺍﻟﻣﻭﺟﻭﺩﺓ ﺑﺷﻛﻝ ﻁﺑﻳﻌﻲ‪ ،‬ﻛﻣﺎ ﺃﻥ ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﺗﺣﻔﺯ ﺍﻟﺟﺳﻡ ﺑﺩﺧﻭﻟﻬﺎ ﻓﻳﻪ ﻋﻠﻰ ﺗﻭﻟﻳﺩ ﺃﺟﺳﺎﻡ‬ ‫ﻣﺿﺎﺩﺓ ﺇﺿﺎﻓﻳﺔ )ﻣﻭﻟّﺩﺓ(‪ ،‬ﻭﻫﺫﻩ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﻭﻟﺩﺓ ﻫﻲ ﺃﺧﻁﺭ ﻋﻠﻰ ﺍﻟﺧﻼﻳﺎ‪ ،‬ﻭﺟﺯﻳﺋﺎﺗﻬﺎ ﺃﺻﻐﺭ ﻭﺯﻧﺎ ً ﻭﺣﺟﻣﺎ ً ﻣﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‬ ‫ﺍﻟﻁﺑﻳﻌﻳﺔ )ﺿﺩ ‪ A‬ﺃﻭﺿﺩ ‪.( B‬‬ ‫ﻣﻥ ﺍﻟﻣﻣﻛﻥ ﻋﻧﺩ ﺍﻟﺿﺭﻭﺭﺓ ﺇﻋﻁﺎء ﺩﻡ ﻣﻥ ﻓﺻﻳﻠﺔ ‪ O‬ﺇﻟﻰ ﺇﻧﺳﺎﻥ ﻣﻥ ﺃﻱ ﻣﻥ ﺍﻟﻔﺻﺎﺋﻝ ﺍﻟﺛﻼﺙ ﺍﻷﺧﺭﻯ ﺑﺩﻭﻥ ﺍﻻﻫﺗﻣﺎﻡ ﺑﺎﻟﺗﻧﺎﻗﺽ‪،‬‬ ‫ﻷﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻋﻧﺩﻫﻡ ﻟﻳﺳﺕ ﻣﺿﺎﺩﺓ ﻟﻔﺻﻳﻠﺔ ‪ ،O‬ﻛﻣﺎ ﺃﻥ ﺍﻟﻣﺭﻳﺽ ﻣﻥ ﻓﺻﻳﻠﺔ ‪ AB‬ﻻ ﻳﻭﺟﺩ ﻓﻲ ﺩﻣﻪ ﺃﺟﺳﺎﻡ‬ ‫ﻣﺿﺎﺩﺓ ﻝ ‪A‬ﺃﻭ ‪ B‬ﻟﺫﻟﻙ ﻓﺈﻥ ﻧﻘﻝ ﺩﻡ ﺇﻟﻳﻪ ﻣﻥ ﻓﺻﻳﻠﺔ ‪ A‬ﺃﻭ ‪ B‬ﺃﻭ ‪ AB‬ﺃﻭ ‪ O‬ﻻ ﻳﺅﺩﻱ ﺇﻟﻰ ﺣﺻﻭﻝ ﺗﻔﺎﻋﻝ ﻣﻊ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ‪ .‬ﺇﻟﻳﻙ‬ ‫ﻣﺛﻼً ﻋﻠﻰ ﺗﺣﻁﻳﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‪ ،‬ﺿﻣﻥ ﻣﺟﻣﻭﻋﺔ ‪: ABO‬‬ ‫ﺇﺫﺍ ﺃﻋﻁﻳﻧﺎ ﻟﻣﺭﻳﺽ ﻓﺻﻳﻠﺗﻪ ‪ A‬ﺩﻣﺎ ً ﻓﺻﻳﻠﺗﻪ ‪ B‬ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﺧﻁﺄ ﻓﺈﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻝ ‪) B‬ﺿﺩ ‪ (B‬ﺍﻟﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺩﻡ ﺍﻟﻣﺭﻳﺽ‬ ‫ﺳﺗﺣﻁﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻌﻁﺎﺓ ﻭﺑﺩﻭﻥ ﺗﺄﺧﻳﺭ )ﺍﻧﻅﺭ ﺷﻛﻝ ﺭﻗﻡ ‪ .(12‬ﺃﻣﺎ ﻣﺿﺎﺩﺍﺕ ‪ A‬ﺍﻟﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺑﻼﺯﻣﺎ ﺍﻟﺩﻡ ﺍﻟﻣﻌﻁﻰ ﻓﺈﻧﻬﺎ ﺗﺗﺧﻔﻑ‬ ‫ﻛﺛﻳﺭﺍً ﻣﻊ ﺩﻡ ﺍﻟﻣﺭﻳﺽ ﻭﻳﺻﺑﺢ ﺗﺄﺛﻳﺭﻫﺎ ﺿﻌﻳﻔﺎ ً ﺟﺩﺍً ﺃﻭ ﻣﻌﺩﻭﻣﺎً‪ ،‬ﺧﺻﻭﺻﺎ ً ﺃﻥ ﺍﻟﻣﻣﺎﺭﺳﺔ ﺍﻟﻐﺎﻟﺑﺔ ﺍﻵﻥ ﻫﻭ ﺇﻋﻁﺎء ﺧﻼﻳﺎ ﺣﻣﺭﺍء‬ ‫ﻣﺭ ّﻛﺯﺓ )ﻣﺳﺣﻭﺏ ﻣﻧﻬﺎ ﻣﻌﻅﻡ ﺍﻟﺑﻼﺯﻣﺎ(‪ .‬ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻌﻁﺎﺓ )‪ (B‬ﺳﺗﺣﻔﺯ ﻣﻥ ﺟﺎﻧﺑﻬﺎ ﺟﺳﻡ ﺍﻟﻣﺭﻳﺽ ﻟﺗﻭﻟﻳﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻝ ‪ B‬ﺟﺩﻳﺩﺓ‬ ‫)ﻣﻭﻟّﺩﺓ( ﺧﻼﻝ ﺃﻳﺎﻡ‪.‬‬ ‫‪U‬‬

‫ﻣﺟﻣﻭﻋﺔ ‪Rh‬‬

‫ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻫﻲ ﻟﻳﺳﺕ ﺑﺎﻟﺑﺳﺎﻁﺔ ﺍﻟﻣﺫﻛﻭﺭﺓ ﻓﻲ ﺍﻟﺟﺩﻭﻝ ﻭﻳﺩﺧﻝ ﺗﺣﺗﻬﺎ ﻓﺻﺎﺋﻝ ﺃﺧﺭﻯ ﻗﺩ ﻳﺅﺩﻱ ﺫﻛﺭﻫﺎ ﺇﻟﻰ ﺗﻌﻘﻳﺩ ﺍﻷﻣﺭ ﻋﻠﻰ‬ ‫ﺍﻟﻘﺎﺭﺉ‪.‬ﻻ ﺗﻭﺟﺩ ﻟﻬﺫﻩ ﺍﻟﻔﺻﺎﺋﻝ ﺃﻳﺔ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ‪ .‬ﻭﻟﻛﻥ ﻫﻧﺎ ﺃﻳﺿﺎ ً ﻗﺩ ﺗﺗﻭﻟﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺇﺫﺍ ﺩﺧﻠﺕ ﺧﻼﻳﺎ ﻣﻥ‬ ‫ﻧﻭﻉ ﻣﻭﺟﺏ ﻷﻱ ﻣﻥ ﺍﻟﻔﺻﺎﺋﻝ ﺇﻟﻰ ﺩﻡ ﺇﻧﺳﺎﻥ ﻓﺻﻳﻠﺗﻪ ﺳﻠﺑﻳﺔ )ﻭ ﻟﻳﺱ ﺗﻭﻟﺩ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻫﻧﺎ ﺷﻳﺋﺎ ً ﺣﺗﻣﻳﺎ ً(‪ .‬ﺃﻣﺎ ﺇﺫﺍ ﺩﺧﻠﺕ ﺧﻼﻳﺎ‬ ‫ﺳﺎﻟﺑﺔ ﺍﻟﻔﺻﻳﻠﺔ ﺇﻟﻰ ﺩﻡ ﺇﻧﺳﺎﻥ ﻓﺻﻳﻠﺗﻪ ﻣﻭﺟﺑﺔ ﻓﺈﻧﻬﺎ ﻻ ﺗﺳﺗﻁﻳﻊ ﺗﻭﻟﻳﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻓﻲ ﺩﻣﻪ‪ .‬ﻭﺑﻬﺫﺍ ﺗﻛﻭﻥ ﻛﻝ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻓﻲ‬ ‫ﺣﺎﻟﺔ ﻓﺻﻳﻠﺔ ‪ Rh‬ﻣﻭﻟﺩﺓ‪.‬‬ ‫‪U‬‬

‫ﻣﺟﻣﻭﻋﺎﺕ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻷﺧﺭﻯ‪:‬‬

‫ﻳﻭﺟﺩ ﻋﺩﺩ ﻛﺑﻳﺭ ﻣﻥ ﻣﺟﻣﻭﻋﺎﺕ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﻏﻳﺭ ‪ ABO‬ﻭ ‪ Rh‬ﻭﻫﻲ ﺃﻗﻝ ﺃﻫﻣﻳﺔ ﻣﻧﻬﺎ ﻁﺑﻳﺎً‪ ،‬ﻭﺇﻥ ﻛﺎﻧﺕ ﺗﺅﺩﻱ ﺇﻟﻰ ﺣﺻﻭﻝ ﻣﺷﺎﻛﻝ‬ ‫ﻟﺩﻯ ﻧﻘﻝ ﺍﻟﺩﻡ‪ ،‬ﻻ ﺳﻳﻣﺎ ﺇﺫﺍ ﺗﻛﺭﺭ ﺍﻟﻧﻘﻝ ﻛﺛﻳﺭﺍً‪ .‬ﻳﺳﺗﻔﺎﺩ ﻣﻥ ﺑﻌﺽ ﻫﺫﻩ ﺍﻟﻔﺻﺎﺋﻝ ﻓﻲ ﺍﻟﻁﺏ ﺍﻟﺷﺭﻋﻲ ﺧﺻﻭﺻﺎ ً ﻓﻲ ﺇﺛﺑﺎﺕ ﺍﻟﺑﻧﻭﺓ ﺃﻭ‬ ‫ﻧﻔﻳﻬﺎ‪ ،‬ﻭﺇﻥ ﻛﺎﻧﺕ ﺍﻵﻥ ﺃﻗﻝ ﺃﻫﻣﻳﺔ ﺑﺳﺑﺏ ﻅﻬﻭﺭ ﻁﺭﻕ ﻣﺧﺑﺭﻳﺔ ﺗﻌﺗﻣﺩ ﻋﻠﻰ ]ﺍﻟﺣﻣﺽ ﺍﻟﻧﻭﻭﻱ[‪ .‬ﺃﻫﻡ ﺍﻟﻔﺻﺎﺋﻝ ﻓﻲ ﻫﺫﺍ ﺍﻟﻣﺿﻣﺎﺭ‬ ‫ﻣﺟﻣﻭﻋﺔ‪. MNSs‬‬ ‫ﻛﺫﻟﻙ ﺍﺳﺗﻔﺎﺩ ﻋﻠﻡ ﺍﻷﺟﻧﺎﺱ ﻭﺃﺻﻭﻝ ﺍﻟﺷﻌﻭﺏ ﻣﻥ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ‪.‬‬ ‫ﻭﺃﻣﺛﻠﺔ ﺃﺧﺭﻯ ﻋﻠﻰ ﻫﺫﻩ ﺍﻟﻔﺻﺎﺋﻝ ﻣﺟﻣﻭﻋﺔ ‪ Lewis‬ﻭ ﻣﺟﻣﻭﻋﺔ ‪ Kidd‬ﻭﻣﺟﻣﻭﻋﺔ ‪.Kell‬‬

‫ﺃﻭﻻً‪-‬ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻬﺎ‪:‬‬ ‫‪U‬‬

‫ﻣﺗﻰ ﺗﻛﻭﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻠﻔﺻﺎﺋﻝ ﺳﺑﺑﺎ ً ﻓﻲ ﺍﻧﺣﻼﻝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء؟‬ ‫ﻻ ﻳﻣﻛﻥ ﺃﻥ ﻳﺣﺩﺙ ﺍﻧﺣﻼﻝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﻣﻥ ﻓﻌﻝ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺇﻻ ﺇﺫﺍ ﻛﺎﻧﺕ ﺗﻠﻙ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻣﻭﺟﻬﺔ ﺿﺩ ﺍﻟﻣﺳﺗﺿﺩّﺍﺕ‬ ‫)ﻓﺻﻳﻠﺔ ﺍﻟﺩﻡ( ﺍﻟﻣﺣﻣﻭﻟﺔ ﻋﻠﻰ ﺳﻁﻭﺡ ﺗﻠﻙ ﺍﻟﺧﻼﻳﺎ‪ .‬ﻓﻭﺟﻭﺩ ﺿﺩ ‪ A‬ﻓﻲ ﺩﻡ ﺇﻧﺳﺎﻥ ﻣﻥ ﻓﺻﻳﻠﺔ ‪) B‬ﻛﻣﺎ ﻫﻲ ﺍﻟﺣﺎﻝ ﺍﻟﻁﺑﻳﻌﻳﺔ( ﻻ ﻳﺅﺩﻱ‬ ‫ﺇﻟﻰ ﻣﺷﻛﻠﺔ‪ ،‬ﻭﻟﻛﻥ ﺇﺫﺍ ﺃﻋﻁﻲ ﻫﺫﺍ ﺍﻟﻣﺭﻳﺽ ﺩﻣﺎ ً ﻣﻥ ﻓﺻﻳﻠﺔ ‪) A‬ﺑﻁﺭﻳﻕ ﺍﻟﺧﻁﺄ ً( ﻓﺈﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺩﺧﻳﻠﺔ ﺗﺗﺣﻁﻡ ﺑﺳﺭﻋﺔ ﺑﻔﻌﻝ ﺃﺿﺩﺍﺩ‬ ‫‪ A‬ﺍﻟﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺩﻡ ﺍﻟﻣﺭﻳﺽ )ﺍﻧﻅﺭ ﺍﻟﺷﻛﻝ ﺭﻗﻡ ‪.(12‬‬

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‫ﺩﻡ ﻓﺻﻳﻠﺔ ‪B‬‬

‫ﺇﻧﺳﺎﻥ ﻣﻥ ﻓﺻﻳﻠﺔ ‪A‬‬ ‫‪A‬‬

‫‪B‬‬

‫ﺩﻡ ﻓﺻﻳﻠﺔ ‪A‬‬

‫‪A‬‬

‫‪A‬‬

‫ﺇﻧﺳﺎﻥ ﻣﻥ ﻓﺻﻳﻠﺔ ‪B‬‬ ‫‪B‬‬

‫‪B‬‬

‫‪B‬‬

‫‪A‬‬

‫ﺿﺩ‬ ‫‪B‬‬

‫ﺿﺩ‬ ‫‪A‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -12‬ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ ﻟﺩﻯ ﺇﻋﻁﺎﺋﻬﺎ ﻟﺷﺧﺹ ﺫﻱ ﻓﺻﻳﻠﺔ ﻣﻐﺎﻳﺭﺓ‬ ‫ﻛﻣﺎ ﺃﻥ ﺇﻋﻁﺎء ﺩﻡ ﻓﺻﻳﻠﺗﻪ ‪ Rh+‬ﺇﻟﻰ ﻣﺭﻳﺽ ﻣﻥ ﻓﺻﻳﻠﺔ ‪ Rh-‬ﻻ ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺣﻁﻳﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻌﻁﺎﺓ ﺃﻭﻝ ﺍﻷﻣﺭ ﻧﻅﺭﺍً ﻻﻧﻌﺩﺍﻡ‬ ‫ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻬﺎ ﺑﺷﻛﻝ ﻁﺑﻳﻌﻲ‪ .‬ﻟﻛﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻧﻘﻭﻟﺔ ﺗﺣﻔﺯ ﺍﻟﺟﺳﻡ )ﻓﻲ ﺃﻛﺛﺭ ﺍﻟﻧﺎﺱ( ﻟﺗﻭﻟﻳﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟﻬﺎ )ﺿﺩ ‪،(D‬‬ ‫ﻭﻫﺫﻩ ﺗﻅﻬﺭ‪-‬ﺇﻥ ﻅﻬﺭﺕ‪ -‬ﺑﻌﺩ ﺃﻳﺎﻡ )ﺃﻛﺛﺭ ﻣﻥ ‪ 10‬ﺃﻳﺎﻡ ﻋﺎﺩﺓ( ﻭﺣﻳﻧﺋﺫ ﺗﺑﺩﺃ ﺑﺗﺣﻁﻳﻡ ﻣﺎ ﺗﺑﻘﻰ ﻓﻲ ﺍﻟﺩﻡ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺩﺧﻳﻠﺔ )ﻣﻥ ﻓﺻﻳﻠﺔ‬ ‫‪ .(Rh+‬ﻟﻛﻥ ﺇﺫﺍ ﺣﺩﺙ ﺃﻥ ﺃُﻋﻁﻲ ﺍﻟﻣﺭﻳﺽ ﻧﻔﺳﻪ ﺩﻣﺎ ً ﻣﻥ ﻓﺻﻳﻠﺔ ‪ Rh+‬ﻣﺭﺓ ﺃﺧﺭﻯ ﻓﺈﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﺗﻲ ﺗﻛﻭﻧﺕ ﻣﻥ ﻧﻘﻝ ﺍﻟﺩﻡ‬ ‫ﺍﻷﻭﻝ ﺗﻛﻭﻥ ﻣﻭﺟﻭﺩﺓ‪ ،‬ﻭﺗﺯﺩﺍﺩ ﻗﻭﺓ ﺑﺳﺭﻋﺔ ﺑﻌﺩ ﺍﻟﻧﻘﻝ ﺍﻟﺛﺎﻧﻲ ﻓﺗﺳﺑﺏ ﺍﻧﺣﻼﻻً ﺁﻧﻳﺎ ً ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺩﺧﻳﻠﺔ‪.‬‬ ‫ﻓﻳﻣﺎ ﺳﺑﻕ ﺗﻛﻠﻣﺕ ﻋﻥ ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﻧﺷﺄ ﺃﻭ ﺍﻟﻣﻭﻟﺩﺓ ﻧﺗﻳﺟﺔ ﺇﻋﻁﺎء ﺩﻡ ﻣﻥ‬ ‫ﻓﺻﻳﻠﺔ ﻣﻐﺎﻳﺭﺓ ﺧﻁﺄ ً‪ .‬ﻟﻛﻥ ﻫﻧﺎﻙ ﺣﺎﻟﺗﻳﻥ ﺗﺳﺑﺑﺎﻥ ﺍﻧﺣﻼﻻً ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻠﻔﺻﺎﺋﻝ ﺩﻭﻥ ﺃﻥ ﻳُﻧﻘﻝ ﻟﻠﺷﺧﺹ ﺩﻡ‪ ،‬ﻭﻫﻣﺎ ]ﺍﻧﺣﻼﻝ ﺩﻡ‬ ‫ﺍﻟﻭﻟﻳﺩ[ ﻭﺍﻧﺣﻼﻝ ﺑﺎﻷﺟﺳﺎﻡ ]ﺫﺍﺗﻳﺔ ﺍﻟﺿﺩ[‬

‫ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‪:‬‬ ‫‪U‬‬

‫ﺇﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﻧﺷﺄ ﺫﺍﺕ ﻭﺯﻥ ﺟﺯﻳﺋﻲ ﻛﺑﻳﺭ )ﻳﻘﺭﺏ ﻣﻥ ﻣﻠﻳﻭﻥ ﺩﺍﻟﺗﻭﻥ( ﻭﻫﺫﺍ ﻳﻣﻧﻌﻬﺎ ﻣﻥ ﻋﺑﻭﺭ ﺣﺎﺟﺯ ﺍﻟﻣﺷﻳﻣﺔ‬ ‫ﺍﻟﺫﻱ ﻳﻔﺻﻝ ﺩﻡ ﺍﻷﻡ ﻋﻥ ﺩﻡ ﺍﻟﺟﻧﻳﻥ‪ .‬ﻫﺫﻩ ﺍﻟﺣﻘﻳﻘﺔ ﻫﻲ ﻋﺎﻣﻝ ﻭﻗﺎﺋﻲ ﻫﺎﻡ ﻟﻠﺟﻧﻳﻥ‪ ،‬ﺣﻳﺙ ﺃﻥ ﻓﺻﻳﻠﺔ ﺩﻡ ﺍﻷﻡ ﻛﺛﻳﺭﺍً ﻣﺎﺗﻛﻭﻥ ﻣﻐﺎﻳﺭﺓ‬ ‫ﻟﻔﺻﻳﻠﺔ ﺩﻡ ﺍﻟﺟﻧﻳﻥ‪ ،‬ﻧﺗﻳﺟﺔ ﻻﺧﺗﻼﻑ ﺍﻟﻔﺻﻳﻠﺔ ﺑﻳﻥ ﺍﻷﻡ ﻭﺍﻷﺏ‪ .‬ﻓﺈﺫﺍ ﻛﺎﻧﺕ ﻓﺻﻳﻠﺔ ﺩﻡ ﺍﻷﻡ ‪ O‬ﻭﺍﻟﺟﻧﻳﻥ ‪ B‬ﻣﺛﻼً ﻓﺈﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‬ ‫ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﺩﻯ ﺍﻷﻡ )ﻭﻣﻧﻬﺎ ﺿﺩ ‪( B‬ﻟﻭ ﻋﺑﺭﺕ ﺍﻟﻣﺷﻳﻣﺔ ﻟﺣﻁﻣﺕ ﻛﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻟﻠﺟﻧﻳﻥ‪ ،‬ﻭﻟﻛﻧﻬﺎ –ﻛﻣﺎ ﺫﻛﺭﺕ‪ -‬ﻻ ﺗﻌﺑﺭ ﻟﻛﺑﺭ‬ ‫ﻭﺯﻧﻬﺎ ﺍﻟﺟﺯﻳﺋﻲ‪ ،‬ﻭﻻ ﺗﻛﻭﻥ ﺳﺑﺑﺎ ً ﻟﺣﺩﻭﺙ ﺃﻱ ﺿﺭﺭ ﻟﻠﺟﻧﻳﻥ‪.‬‬ ‫ﺃﻣﺎ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻣﻭﻟﺩﺓ )ﺃﻱ ﺍﻟﻧﺎﺷﺋﺔ ﻋﻥ ]ﺗﺣﻔﻳﺯ[ ﺑﺧﻼﻳﺎ ﻣﻐﺎﻳﺭﺓ( ﻓﻬﻲ ﺫﺍﺕ ﻭﺯﻥ ﺟﺯﻳﺋﻲ ﺻﻐﻳﺭ ﻧﺳﺑﻳﺎ ً )ﺣﻭﺍﻟﻲ ‪ 180‬ﺃﻟﻑ‬ ‫ﺩﺍﻟﺗﻭﻥ( ﻭﺑﺫﻟﻠﻙ ﺗﺗﻣﻛﻥ ﻣﻥ ﻋﺑﻭﺭ ﺍﻟﺣﺎﺟﺯ ﺍﻟﻣﺷﻳﻣﻲ ﺑﺣﺭﻳﺔ ﻟﺗﺻﻝ ﺇﻟﻰ ﺧﻼﻳﺎ ﺍﻟﺟﻧﻳﻥ ﻭﺗﺅﺩﻱ ﺇﻟﻰ ﺍﻧﺣﻼﻟﻬﺎ‪ ،‬ﺇﺫﺍ ﻛﺎﻧﺕ ﻣﺿﺎﺩﺓ‬ ‫ﻟﻔﺻﻳﻠﺗﻬﺎ‪ .‬ﻫﺫﺍ ﺍﻻﻧﺣﻼﻝ ﻫﻭ ﺍﻟﻣﺭﺽ ﺍﻟﻣﺳﻣﻰ ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ‪ ،‬ﺣﻳﺙ ﻳﻭﻟﺩ ﺍﻟﻁﻔﻝ ﺑﻔﻘﺭ ﺩﻡ ﻭﻳﺭﻗﺎﻥ ﻭﺍﻷﺧﻳﺭ ﻳﺯﺩﺍﺩ ﺑﻣﺭﻭﺭ‬ ‫ﺍﻟﺳﺎﻋﺎﺕ ﺑﺳﺑﺏ ﻋﺟﺯ ﻛﺑﺩ ﺍﻟﻁﻔﻝ ﺣﺩﻳﺙ ﺍﻟﻭﻻﺩﺓ ﻋﻥ ﺍﻟﺗﺧﻠﺹ ﻣﻥ ﻛﻣﻳﺔ ﺍﻟﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء ﺍﻟﻣﻭﻟﺩﺓ ﻋﻥ ﺍﻻﻧﺣﻼﻝ‪ .‬ﺇﺫﺍ ﻭﺻﻝ ﺗﺭﻛﻳﺯ‬ ‫ﺍﻟﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء ﺇﻟﻰ ‪ 18‬ﻣﻠﻐﻡ ﻓﻲ ﻛﻝ ﺩﺳﻳﻠﺗﺭ )‪ 100‬ﺳﻡ‪) ، (3‬ﻭﻫﺫﺍ ﻳﻌﺎﺩﻝ ‪ 200‬ﻣﺎﻳﻛﺭﻭﻣﻭﻝ ﻟﻛﻝ ﻟﺗﺭ( ﻣﻥ ﻣﺻﻝ ﺍﻟﺩﻡ ﺃﻭ ﺃﻛﺛﺭ‬ ‫ﻓﺈﻧﻬﺎ ﻗﺩ ﺗﺗﺭﺳﺏ ﻓﻲ ﺑﻌﺽ ﺃﺟﺯﺍء ﻣﺦ ﺍﻟﻁﻔﻝ ﻣﺳﺑﺑﺔ ﺍﻟﻭﻓﺎﺓ ﺃﻭ ﺗﺎﺭﻛﺔ ﺗﺷﻧﺟﺎ ً ﺩﺍﺋﻣﺎ ً ﺇﺫﺍ ﻋﺎﺵ ﺍﻟﻁﻔﻝ‪ .‬ﻟﺫﻟﻙ ﻳﻌﻣﺩ ﺍﻷﻁﺑﺎء ﺇﻟﻰ ﺗﺑﺩﻳﻝ‬ ‫ﺑﻌﺽ ﺩﻡ ﺍﻟﻁﻔﻝ ﻗﺑﻝ ﺍﻟﻭﺻﻭﻝ ﺇﻟﻰ ﻫﺫﺍ ﺍﻟﺣﺩ ﺍﻟﻌﺎﻟﻲ ﻣﻥ ﺍﻟﻳﺭﻗﺎﻥ‪.‬‬ ‫‪U‬‬

‫ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ ﻧﺗﻳﺟﺔ ﻟﻠﺗﻧﺎﻗﺽ ﻓﻲ ﻓﺻﻳﻠﺔ ‪ Rh‬ﻣﻊ ﺃﻣﻪ‬

‫ﺇﻥ ﺃﺧﻁﺭ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺿﻣﻥ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ ﺍﻻﻧﺣﻼﻝ ﻫﻲ )ﺿﺩ ‪ ( D‬ﻓﻲ ﻣﺟﻣﻭﻋﺔ ‪ .Rh‬ﻳﻣﺛﻝ ﺍﻟﺷﻛﻝ ﺭﻗﻡ ‪13‬‬ ‫ﺗﺻﻭﻳﺭﺍً ﻟﻸﺣﺩﺍﺙ ﺍﻟﺗﻲ ﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ ﺫﻟﻙ‪.‬‬

‫‪33‬‬

‫ﺍﻷﺏ‬

‫ﺍﻷﻡ‬

‫‪D‬‬

‫‪d‬‬

‫ﺻﻔﺔ ﻣﺗﻐﻠﺑﺔ‬

‫ﺻﻔﺔ ﻣﺗﻧﺣﻳﺔ‬ ‫ﻻﺗﻭﺟﺩ ﺃﺟﺳﺎﻡ‬ ‫ﻣﺿﺎﺩﺓ‪.‬‬

‫ﺍﻟﺟﻧﻳﻥ ﺍﻷﻭﻝ‬

‫ﺍﻟﺣﻣـــــــﻝ ﺍﻷﻭﻝ‬ ‫‪U‬‬

‫‪U‬‬

‫ﺍﻟﺟﻧﻳﻥ ﺍﻷﻭﻝ‬

‫ﺃﻭ‬

‫‪ d‬ﺃﻭ‬

‫‪D‬‬

‫ﻻ ﺗﺣﺻﻝ ﻣﺷﻛﻠﺔ ﺍﻧﺣﻼﻝ ﺃﻭ‬ ‫ﺗﻭﻟﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ‬

‫ﺍﻟﺣﻣــــــﻝ ﺍﻟﺛﺎﻧﻲ‬ ‫‪U‬‬

‫‪U‬‬

‫ﻋﺑﻭﺭ ﺧﻼﻳﺎ ﺣﻣﺭﺍء ﻣﻥ ﺩﻡ ﺍﻟﺟﻧﻳﻥ ﺇﻟﻰ ﺩﻡ ﺍﻷﻡ‬ ‫ﻓﻲ ﺍﻷﻳﺎﻡ ﺍﻷﺧﻳﺭﺓ ﻣﻥ ﺍﻟﺣﻣﻝ ﺃﻭ ﺧﻼﻝ ﺍﻟﻭﻻﺩﺓ‬

‫ﺍﻷﻡ ﻗﺩ ﺗﻭﻟّﺩ ﺃﺟﺳﺎﻣﺎ ً ﻣﺿﺎﺩﺓ ﻝ ‪D‬‬ ‫ﺧﻼﻝ ﺃﻳﺎﻡ ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ ﻻ ﻳﺗﺄﺛﺭ ﺑﻬﺎ ﺍﻟﺟﻧﻳﻥ ﺍﻷﻭﻝ‬ ‫ﺗﻛﻭﻧﻬﺎ‬ ‫ﻷﻧﻪ ﻭُ ﻟﺩ ﻗﺑﻝ ّ‬

‫ﺍﻟﺟﻧﻳﻥ ﺍﻟﺛﺎﻧﻲ‬

‫‪d‬‬

‫ﺃﻭ‬

‫ﺍﻟﺟﻧﻳﻥ ﺍﻟﺛﺎﻧﻲ‬

‫‪D‬‬

‫ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ‬ ‫ﺗﻌﺑﺭ ﺇﻟﻰ ﺩﻣﻪ ﻣﻥ ﺍﻷﻡ‬

‫ﻻ ﺗﺗﺄﺛﺭ ﺧﻼﻳﺎ ﺍﻟﺟﻧﻳﻥ ﺑﺎﻷﺟﺳﺎﻡ‬ ‫ﺍﻟﻣﺿﺎﺩﺓ ﻷﻥ ﺍﻟﺧﻼﻳﺎ ﺳﺎﻟﺑﺔ‬ ‫•‬ ‫•‬ ‫•‬

‫ﻭﻓﺎﺓ ﺍﻟﺟﻧﻳﻥ ﺩﺍﺧﻝ ﺍﻟﺭﺣﻡ ﺃﻭ‬ ‫ﻭﻻﺩﺓ ﻁﻔﻝ ﻋﻧﺩﻩ ﻓﻘﺭ ﺩﻡ ﺷﺩﻳﺩ ﻭﻳﺭﻗﺎﻥ ‪....‬ﺃﻭ‬ ‫ﻭﻻﺩﺓ ﻁﻔﻝ ﻣﻊ ﻓﻘﺭ ﺩﻡ ﺑﺳﻳﻁ‬

‫ﻳﺣﺻﻝ ﺍﻧﺣﻼﻝ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻳﺗﻧﺎﺳﺏ ﻣﻊ ﺗﺭﻛﻳﺯ ﻭﻗﻭﺓ ﺍﻷﺟﺳﺎﻡ‬ ‫ﺍﻟﻣﺿﺎﺩﺓ )ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ(‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -13‬ﺍﺣﺗﻣﺎﻻﺕ ﻣﺎ ﻳﺣﺻﻝ ﻟﻠﺟﻧﻳﻥ ﻓﻲ ﺣﺎﻟﺔ ﺍﺧﺗﻼﻑ ﻓﺻﻳﻠﺔ ‪ Rh‬ﺑﻳﻥ ﺍﻟﺯﻭﺟﻳﻥ‬

‫ﻣﻼﺣﻅﺎﺕ‪:‬‬ ‫‪ .1‬ﻳﺟﺏ ﻣﻼﺣﻅﺔ ﺃﻥ ﻟﻳﺱ ﻛﻝ ﻁﻔﻝ ﻳﻭﻟﺩ ﻷﺏ ﻣﻥ ﻓﺻﻳﻠﺔ )‪ Rh+‬ﺃﻭ ‪ ( D‬ﻭﺃﻡ ﻣﻥ ﻓﺻﻳﻠﺔ )‪ Rh-‬ﺃﻭ ‪ (d‬ﺳﺗﻛﻭﻥ ﻓﺻﻳﻠﺔ ﺩﻣﻪ‬ ‫)‪ ،(Rh+‬ﺣﻳﺙ ﺃﻥ ﺍﻟﻣﻭﺟﺏ ﺻﻔﺔ ﻣﺗﻐﻠﺑﺔ ﻭﺍﻟﺳﺎﻟﺏ ﺻﻔﺔ ﻣﺗﻧﺣﻳﺔ‪ ،‬ﻷﻥ ﺍﻷﺏ ﺍﻟﻣﻭﺟﺏ ﻗﺩ ﻳﻛﻭﻥ ﻫﺟﻳﻧﺎ ً ﻓﻳﻛﻭﻥ ﺍﺣﺗﻣﺎﻝ ﺃﻥ‬ ‫ﻳُﺭﺯﻕ ﺑﻁﻔﻝ ﺳﺎﻟﺏ ﺍﻟﻔﺻﻳﻠﺔ ﺃﻭ ﻁﻔﻝ ﻣﻭﺟﺏ ﺍﻟﻔﺻﻳﻠﺔ ﻛﻼﻫﻣﺎ ﻭﺍﺭﺩ‪ .‬ﻳﺗﺿﺢ ﺫﻟﻙ ﻣﻥ ﺷﻛﻝ ﺭﻗﻡ ‪.14‬‬

‫‪34‬‬

‫ﺍﻻﺣﺗﻣﺎﻝ ﺍﻷﻭﻝ‪ :‬ﺍﻷﺏ ﻧﻘﻲ‬ ‫‪U‬‬

‫‪U‬‬

‫‪U‬‬

‫ﺍﻷﻁﻔﺎﻝ ﻛﻠﻬﻡ ‪Rh‬ﻣﻭﺟﺏ‪ -‬ﻫﺟﻳﻧﻲ‬ ‫‪U‬‬

‫ﺍﻻﺣﺗﻣﺎﻝ ﺍﻟﺛﺎﻧﻲ‪ :‬ﺍﻷﺏ ﻫﺟﻳﻧﻲ‬ ‫‪U‬‬

‫‪U‬‬

‫‪U‬‬

‫ﺍﻷﻡ ‪Rh‬ﺳﺎﻟﺑﺔ )ﻧﻘﻲ ﺑﺎﻟﺿﺭﻭﺭﺓ(‬ ‫‪U‬‬

‫‪d‬‬

‫‪d‬‬

‫‪D‬‬

‫‪Dd‬‬

‫‪Dd‬‬

‫‪Dd‬‬

‫ﺍﻷﻡ ‪Rh‬ﺳﺎﻟﺑﺔ )ﻧﻘﻲ ﺑﺎﻟﺿﺭﻭﺭﺓ(‬ ‫‪d‬‬

‫ﺍﻷﻁﻔﺎﻝ ‪ %50‬ﺳﺎﻟﺏ ﻭ ‪ %50‬ﻣﻭﺟﺏ‬ ‫ﻫﺟﻳﻧﻲ‬

‫‪U‬‬

‫ﺍﻷﺏ ‪Rh‬ﻣﻭﺟﺏ‪ -‬ﻧﻘﻲ‬

‫‪Dd‬‬

‫‪U‬‬

‫‪U‬‬

‫‪Dd‬‬

‫ﺍﻷﺏ ‪ Rh‬ﻣﻭﺟﺏ‪ -‬ﻫﺟﻳﻧﻲ‬

‫‪d‬‬

‫‪d‬‬

‫‪dd‬‬

‫‪D‬‬

‫‪dd‬‬

‫‪D‬‬

‫‪Dd‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -14‬ﻭﺭﺍﺛﺔ ﻓﺻﻳﻠﺔ ‪ Rh‬ﺣﻳﻧﻣﺎ ﺗﻛﻭﻥ ﺍﻷﻡ ﺳﺎﻟﺑﺔ ﻭﺍﻷﺏ ﻣﻭﺟﺑﺎ ً‬

‫‪.2‬‬

‫‪.3‬‬ ‫‪.4‬‬

‫‪.5‬‬ ‫‪.6‬‬

‫‪.7‬‬

‫ﺇﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻌﺎﺑﺭﺓ ﻣﻥ ﺍﻟﻁﻔﻝ ﺍﻟﻣﻭﺟﺏ ﺍﻟﻔﺻﻳﻠﺔ ﺇﻟﻰ ﺩﻡ ﺃﻣﻪ ﺍﻟﺳﺎﻟﺑﺔ ﺍﻟﻔﺻﻳﻠﺔ ﻻ ﻳُﺷﺗﺭﻁ ﺃﻥ ﺗﻭﻟّﺩ ﻓﻲ ﺍﻷﻡ ﺃﺟﺳﺎﻣﺎ ً‬ ‫ﻣﺿﺎﺩﺓ ﺇﻻ ﺭﺑﻣﺎ ﺑﻌﺩ ﺗﻛﺭﺭ ﺍﻟﺣﻣﻝ‪ .‬ﺇﻥ ﺗﻛﻭّ ﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺃﻭ ﻋﺩﻣﻪ ﻳﻌﺗﻣﺩ ﻋﻠﻰ ﻋﻭﺍﻣﻝ ﻋﺩﺓ‪ ،‬ﻣﻧﻬﺎ ﻁﺑﻳﻌﺔ ﺍﻟﺟﻬﺎﺯ‬ ‫ﺍﻟﻣﻧﺎﻋﻲ ﻟﻸﻡ ﻭﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻌﺎﺑﺭﺓ ﻭﻗﻭﺓ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﻣﻳﺯﺓ)ﺍﻟﻣﺳﺗﺿﺩﺍﺕ( ﻣﻥ ﻧﻭﻉ ‪ D‬ﻋﻠﻰ ﺳﻁﻭﺡ ﺍﻟﺧﻼﻳﺎ ﻋﻧﺩ ﺍﻟﺟﻧﻳﻥ‪.‬‬ ‫ﻳﺟﺏ ﻓﻲ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﻓﺣﺹ ﺩﻡ ﺍﻷﻡ ﻟﻠﺗﺄﻛﺩ ﻣﻥ ﻭﺟﻭﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻭﻛﺫﻟﻙ ﺗﺭﻛﻳﺯﻫﺎ‪ ،‬ﺇﻥ ﻭﺟﺩﺕ‪ ،‬ﺛﻡ ﻣﺗﺎﺑﻌﺔ ﺍﻟﺗﺭﻛﻳﺯ‬ ‫ﺇﻟﻰ ﻧﻬﺎﻳﺔ ﺍﻟﺣﻣﻝ‪.‬‬ ‫ﻳﻣﻛﻥ ﺇﺯﺍﻟﺔ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻌﺎﺑﺭﺓ ﻣﻥ ﺍﻟﺟﻧﻳﻥ ﺇﻟﻰ ﺩﻡ ﺃﻣﻪ ﺑﺈﻋﻁﺎء ﺍﻷﻡ ﺣﻘﻧﺔ ﻣﺻﻝ ﻣﺿﺎﺩ ﻟﺧﻼﻳﺎ ‪ Rh+‬ﻣﺑﺎﺷﺭﺓ ﺑﻌﺩ‬ ‫ﺍﻟﻭﻻﺩﺓ )ﺧﻼﻝ ‪ 36‬ﺳﺎﻋﺔ ﺑﻌﺩﻫﺎ( ﻭﺑﺫﻟﻙ ﻳﻣﻧﻊ ﺗﺣﻔﻳﺯ ﺟﺳﻣﻬﺎ ﻟﺗﻭﻟﻳﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻭﻳُﻣﻧﻊ ﺍﻟﺿﺭﺭ ﻋﻥ ﺍﻟﻁﻔﻝ ﺍﻟﻣﻘﺑﻝ‪.‬‬ ‫ﻗﺩ ﺗﻛﻭﻥ ﺍﻷﻡ‪ ،‬ﻓﻲ ﺣﺎﻻﺕ ﻧﺎﺩﺭﺓ‪ ،‬ﺣﺎﻣﻠﺔ ﻷﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟـ‪ D‬ﻗﺑﻝ ﺣﺻﻭﻝ ﺃﻭﻝ ﺣﻣﻝ‪ ،‬ﻭﺫﻟﻙ ﻧﺗﻳﺟﺔ ﺗﺣﻔﻳﺯ ﺑﺈﻋﻁﺎء ﺩﻡ ﻣﻥ‬ ‫ﻧﻭﻉ ‪ Rh+‬ﻗﺑﻝ ﺫﻟﻙ ﺍﻟﺣﻣﻝ ﺧﻁﺄ ً‪ .‬ﺑﺫﻟﻙ ﻓﻘﺩ ﻳﺻﺎﺏ ﺃﻭﻝ ﺟﻧﻳﻥ ﺑﺎﻧﺣﻼﻝ ﻧﺗﻳﺟﺔ ﺗﻠﻙ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺑﻌﺩ ﻋﺑﻭﺭﻫﺎ ﻣﻥ‬ ‫ﺍﻷﻡ‪ ،‬ﺇﺫﺍ ﻛﺎﻧﺕ ﻓﺻﻳﻠﺔ ﺍﻟﺟﻧﻳﻥ ﻣﻭﺟﺑﺔ‪.‬‬ ‫ﻗﺩ ﻳﺗﺄﺛﺭ ﺍﻟﻁﻔﻝ ﺍﻟﺛﺎﻧﻲ ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﺗﻲ ﺗﻭﻟﺩﺕ ﻋﻥ ﺍﻟﺣﻣﻝ ﺍﻷﻭﻝ ﺛﻡ ﻳﺄﺗﻲ ﺑﻌﺩﻩ ﻁﻔﻝ ﺛﺎﻟﺙ ﺃﻭ ﺭﺍﺑﻊ ﻣﻥ ﻓﺻﻳﻠﺔ‬ ‫‪ Rh‬ﺃﻱ ‪ d‬ﺑﺳﺑﺏ ﻛﻭﻥ ﺍﻷﺏ ﻫﺟﻳﻧﻳﺎ ً‪.‬ﻭﻁﺑﻌﺎ ً ﻓﺈﻥ ﻁﻔﻼً ﻛﻬﺫﺍ ﻟﻥ ﻳﺻﺎﺏ ﺑﺄﻱ ﺿﺭﺭ‪.‬‬‫ﺇﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﺗﻲ ﺗﺗﻭﻟﺩ ﻧﺗﻳﺟﺔ ﺍﻟﺗﺣﻔﻳﺯ ﺑﺎﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻌﺎﺑﺭﺓ ﻣﻥ ﺍﻟﺟﻧﻳﻥ ﺇﻟﻰ ﺍﻷﻡ ﻳﺗﻭﻗﻑ ﺗﻭﻟّﺩﻫﺎ ﺑﻌﺩ ﻭﻻﺩﺓ‬ ‫ﺍﻟﺟﻧﻳﻥ ﺑﺄﺳﺎﺑﻳﻊ ﻧﺗﻳﺟﺔ ﻻﻧﺗﻬﺎء ﻋﻣﺭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺫﻛﻭﺭﺓ ﻭﺍﺧﺗﻔﺎﺋﻬﺎ‪ .‬ﻫﺫﻩ ﺍﻟﻣﺿﺎﺩﺍﺕ ﻳﺑﺩﺃ ﺗﺭﻛﻳﺯﻫﺎ ﺑﺎﻟﺗﻧﺎﻗﺹ ﺗﺩﺭﻳﺟﻳﺎ ً ﻓﻲ‬ ‫ﻣﺻﻝ ﺍﻷﻡ‪ .‬ﻟﺫﺍ ﻓﺈﻥ ﺇﻁﺎﻟﺔ ﺍﻟﻣﺩﺓ ﺑﻳﻥ ﺣﻣﻝ ﻭﺁﺧﺭ ﻫﻭ ﻓﻲ ﻣﺻﻠﺣﺔ ﺍﻟﺟﻧﻳﻥ ﺍﻟﻣﻘﺑﻝ ﻓﻲ ﻫﺫﻩ ﺍﻷﺣﻭﺍﻝ‪.‬‬ ‫ﺇﺫﺍ ﻛﺎﻥ ﻫﻧﺎﻙ ﺗﻧﺎﻗﺽ ﻓﻲ ﻓﺻﻳﻠﺔ ‪ ABO‬ﺑﻳﻥ ﺍﻟﺟﻧﻳﻥ ﻭﺃﻣﻪ ﻣﻊ ﻭﺟﻭﺩ ﺗﻧﺎﻗﺽ ‪ Rh‬ﻓﺈﻥ ﺍﺣﺗﻣﺎﻝ ﺗﻭﻟّﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟـ ‪D‬‬ ‫ﻳﻛﻭﻥ ﺃﻗﻝ ﺑﺳﺑﺏ ﺳﺭﻋﺔ ﺗﺣﻁﻳﻡ ﺧﻼﻳﺎ ﺍﻟﺟﻧﻳﻥ ﺍﻟﻌﺎﺑﺭﺓ ﺇﻟﻰ ﺩﻡ ﺃﻣﻪ ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟـ ‪ ABO‬ﺍﻟﻣﻭﺟﻭﺩﺓ ﻋﻧﺩﻫﺎ ﺑﺷﻛﻝ‬ ‫ﻁﺑﻳﻌﻲ‪.‬‬ ‫‪35‬‬

‫ً‬ ‫ﻧﺗﻳﺟﺔ ﻟﺗﻧﺎﻗﺽ ﻓﺻﻳﻠﺔ ﺩﻡ ﻏﻳﺭ ‪: Rh‬‬ ‫ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ‬ ‫‪U‬‬

‫ﺇﻥ ﺗﻧﺎﻗﺽ ﺍﻷﺑﻭﻳﻥ ﻓﻲ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﻣﻥ ﻏﻳﺭ ﻣﺟﻣﻭﻋﺔ ‪ Rh‬ﻗﺩ ﻳﺳﺑﺏ ﺣﺎﻻﺕ ﺍﻧﺣﻼﻝ ﻣﻣﺎﺛﻠﺔ‪ ،‬ﻟﻛﻧﻬﺎ ﻓﻲ ﺍﻷﻏﻠﺏ ﺗﻛﻭﻥ ﺃﻗﻝ‬ ‫ﺧﻁﻭﺭﺓ ﻣﻣﺎ ﺗﺳﺑﺑﻪ ﺣﺎﻟﺔ ﺗﻧﺎﻗﺽ ‪ D‬ﻓﻲ ﻣﺟﻣﻭﻋﺔ ‪ . Rh‬ﻫﻧﺎﻙ ﻭﺍﺣﺩ ﻣﻥ ﺍﺣﺗﻣﺎﻟﻳْﻥ ﻣﺧﺗﻠﻔﻳْﻥ ﻟﺣﺻﻭﻝ ﺍﻻﻧﺣﻼﻝ‪.‬‬ ‫ﺃ‪ -‬ﺍﻻﻧﺣﻼﻝ ﺑﺳﺑﺏ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻣﻭﻟّﺩﺓ ﻟﻔﺻﺎﺋﻝ ﻣﺟﻣﻭﻋﺔ ‪ABO‬‬ ‫)ﺃﻱ ﺿﺩ ‪ A‬ﺃﻭ ﺿﺩ ‪ .( B‬ﻭﻗﺩ ﺫﻛﺭﺕ ﺳﺎﺑﻘﺎ ً ﺃﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﻧﺷﺄ ﻓﻲ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻫﻲ ﺫﺍﺕ ﻭﺯﻥ‬ ‫ﺟﺯﻳﺋﻲ ﻛﺑﻳﺭ ﻓﻼ ﻳﺳﻌﻬﺎ ﻋﺑﻭﺭ ﺣﺎﺟﺯ ﺍﻟﻣﺷﻳﻣﺔ ﻣﻥ ﺍﻷﻡ ﺇﻟﻰ ﺍﻟﺟﻧﻳﻥ‪ ،‬ﺇﻻ ﺃﻥ ﺗﺣﻔﻳﺯ ﺍﻷﻡ ﺑﺈﻋﻁﺎﺋﻬﺎ ﺩﻣﺎ ً ﺫﺍ ﻓﺻﻳﻠﺔ ﻣﻐﺎﻳﺭﺓ‬ ‫ﻟﻔﺻﻳﻠﺗﻬﺎ ﺃﻭ ﺑﻌﺑﻭﺭ ﺧﻼﻳﺎ ﻣﻥ ﺍﻟﻁﻔﻝ ﺍﻷﻭﻝ ﺫﺍﺕ ﻓﺻﻳﻠﺔ ﻣﻧﺎﻗﺿﺔ ﻟﻔﺻﻳﻠﺔ ﺩﻡ ﺍﻷﻡ ﻗﺩ ﻳﻭﻟﺩ ﺃﺟﺳﺎﻣﺎ ً ﻣﺿﺎﺩﺓ ﺫﺍﺕ ﻭﺯﻥ‬ ‫ﺟﺯﻳﺋﻲ ﺻﻐﻳﺭ ﻳﺗﻳﺢ ﻟﻬﺎ‪ ،‬ﻋﻧﺩﻣﺎ ﺗﺣﻣﻝ ﺍﻷﻡ ﻣﺳﺗﻘﺑﻼً‪ ،‬ﺃﻥ ﺗﻌﺑﺭ ﺍﻟﻣﺷﻳﻣﺔ ﺇﻟﻰ ﺩﻡ ﺍﻟﺟﻧﻳﻥ‪ ،‬ﻭﻗﺩ ﺗﺳﺑﺏ ﺍﻧﺣﻼﻻً ﻓﻲ ﺧﻼﻳﺎﻩ ﺇﺫﺍ‬ ‫ﻛﺎﻧﺕ ﻓﺻﻳﻠﺔ ﺩﻣﻪ ﻣﻧﺎﺳﺑﺔ ﻟﺗﺄﺛﻳﺭ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‪.‬‬

‫ﻣﺛﺎﻝ‪:‬‬

‫ﻓﺻﻳﻠﺔ ﺧﻼﻳﺎﻫﺎ ‪ O‬ﻓﻲ ﻣﺻﻝ ﺩﻣﻬﺎ‪ :‬ﺿﺩ ‪ A‬ﻭﺿﺩ ‪B‬‬ ‫‪ .1‬ﺍﻣﺭﺃﺓ ﻣﻥ ﻓﺻﻳﻠﺔ ‪O‬‬ ‫‪ .2‬ﺃﻋﻁﻳﺕ ﺧﻼﻳﺎ ﺩﻡ ﻣﻥ ﻓﺻﻳﻠﺔ ‪ A‬ﺧﻁﺄ‪ً.‬‬ ‫‪ .3‬ﺗﻛﻭّ ﻧﺕ ﻟﺩﻳﻬﺎ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻣﻭﻟﺩﺓ ﻓﻲ ﺍﻟﻣﺻﻝ ) ﺿﺩ ‪( A‬‬ ‫‪ .4‬ﺣﻣﻠﺕ ﺑﺟﻧﻳﻥ ﻣﻥ ﻓﺻﻳﻠﺔ ‪A‬‬ ‫‪ .5‬ﻋﺑﺭﺕ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻣﻭﻟﺩﺓ ﻣﻥ ﺩﻡ ﺍﻷﻡ ﺇﻟﻰ ﺩﻡ ﺍﻟﺟﻧﻳﻥ ﻓﺳﺑﺑﺕ ﺍﻧﺣﻼﻻً ﻓﻲ ﺧﻼﻳﺎﻩ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺇﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻣﻭﻟﺩﺓ ﻳﻣﻛﻥ ﺃﻥ ﺗﻧﺷﺄ ﺃﻳﺿﺎ ً ﻣﻥ ﻋﺑﻭﺭ ﺧﻼﻳﺎ ﺍﻟﺟﻧﻳﻥ ﺍﻷﻭﻝ ﺇﻟﻰ ﺩﻡ ﺍﻷﻡ ﺇﺫﺍ ﻛﺎﻥ ﻫﻧﺎﻙ ﺗﻧﺎﻗﺽ‬ ‫ﻓﺻﻳﻠﺔ ﺩﻡ ﺑﻳﻧﻬﻣﺎ ﻭﻫﺫﻩ ﺍﻷﺟﺳﺎﻡ ﻗﺩ ﺗﺅﺛﺭ ﻋﻠﻰ ﺍﻟﻁﻔﻝ ﺍﻟﺛﺎﻧﻲ‪ .‬ﻛﺫﻟﻙ ﻓﻘﺩ ﻟﻭﺣﻅ ﺗﻛﻭّ ﻥ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟـ‪ A‬ﺃﻭ ‪ B‬ﻓﻲ‬ ‫ﺃﺷﺧﺎﺹ ﻣﻥ ﻓﺻﻳﻠﺔ ‪ O‬ﺩﻭﻥ ﺃﻥ ﻳﻛﻭﻧﻭﺍ ﺃﺧﺫﻭﺍ ﺩﻣﺎ ً ﻣﻥ ﺗﻠﻙ ﺍﻟﻔﺻﺎﺋﻝ ﺃﺻﻼً‪ ،‬ﻭﻳﻌﺯﻯ ﺗﻭﻟّﺩ ﺗﻠﻙ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺇﻟﻰ‬ ‫ﻭﺟﻭﺩ ﻣﺣ ّﻔﺯﺍﺕ )ﺃﺟﺳﺎﻡ ﻣﻣﻳﱢﺯﺓ( ﻣﺷﺎﺑﻬﺔ ﻟـ‪ A‬ﺃﻭ‪ B‬ﻓﻲ ﺍﻟﻁﺑﻳﻌﺔ ﺑﻛﺛﺭﺓ‪ ،‬ﻭﻣﺛﺎﻝ ﺫﻟﻙ ﻭﺟﻭﺩﻫﺎ ﻓﻲ ﺃﻣﺻﺎﻝ ﺑﻌﺽ ﺍﻟﺧﻳﻭﻝ‬ ‫ﺍﻟﺗﻲ ﻗﺩ ﺗﺳﺗﻌﻣﻝ ﻟﻠﺗﻁﻌﻳﻡ ﺍﻟﻣﻧﺎﻋﻲ ﻣﺛﻝ ﺍﻟﻣﺻﻝ ﺍﻟﻣﺿﺎﺩ ﻟﻠﻛﺯﺍﺯ ﻭﺍﻟﻣﺻﻝ ﺍﻟﻣﺿﺎﺩ ﻟﻠﺧﻧﺎﻕ ﻭﻏﻳﺭﻫﺎ‪.‬‬ ‫‪U‬‬

‫‪U‬‬

‫‪U‬‬

‫‪U‬‬

‫‪U‬‬

‫ﺏ‪ -‬ﺍﻻﻧﺣﻼﻝ ﺑﺳﺑﺏ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟﻔﺻﺎﺋﻝ ﺍﻟﻣﺟﻣﻭﻋﺎﺕ ﺍﻷﺧﺭﻯ‪:‬‬ ‫‪U‬‬

‫)ﻣﺛﻝ ﻣﺟﻣﻭﻋﺎﺕ ‪ Kidd‬ﻭ‪ Duffy‬ﻭ ‪ ( Kell‬ﻭﻛﺫﻟﻙ ﺍﻟﻔﺻﺎﺋﻝ ﺍﻟﻔﺭﻋﻳﺔ ﺍﻟﺗﺎﺑﻌﺔ ﻟﻣﺟﻣﻭﻋﺔ ‪ Rh‬ﻏﻳﺭ ﻓﺻﻳﻠﺔ ‪.(c,e,C,E) D‬‬ ‫ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﻳﻛﻭﻥ ﺗﺳﻠﺳﻝ ﺍﻷﺣﺩﺍﺙ ﻣﻣﺎﺛﻼً ﻟﺣﺎﻟﺔ ﺍﻟﺗﻧﺎﻗﺽ ﻓﻲ ﻓﺻﻳﻠﺔ ‪ D‬ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻋﻼﻩ‪ ،‬ﺣﻳﺙ ﺃﻥ ﻫﺫﻩ‬ ‫ﺍﻟﻔﺻﺎﺋﻝ ﺟﻣﻳﻌﻬﺎ ﻟﻳﺱ ﻟﻬﺎ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﻧﺷﺄ‪ ،‬ﻭﺇﺫﺍ ﻭﺟﺩﺕ ﻟﻬﺎ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻣﻭﻟّﺩﺓ ﻓﺈﻧﻬﺎ ﺗﺳﺗﻁﻳﻊ ﻋﺑﻭﺭ‬ ‫ﺍﻟﻣﺷﻳﻣﺔ‪ .‬ﻟﻛﻥ ﻳﺟﺏ ﻣﻼﺣﻅﺔ ﺃﻥ ﺍﻟﻣﺳﺗﺿﺩﺍﺕ ﻟﻣﻌﻅﻡ ﻫﺫﻩ ﺍﻟﻔﺻﺎﺋﻝ ﻫﻲ ﺿﻌﻳﻔﺔ ﺟﺩﺍً ﻧﺳﺑﺔ ﺇﻟﻰ ﻣﺟﻣﻭﻋﺔ ‪ ABO‬ﻭﻓﺻﻳﻠﺔ‬ ‫‪ ، D‬ﻟﺫﺍ ﻓﺈﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﻭﻟﺩﺓ‪ ،‬ﻭﻣﻥ ﺛ ّﻡ ﺍﻧﺣﻼﻝ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﺟﻧﻳﻥ‪ ،‬ﺗﻛﻭﻥ ﺿﻌﻳﻔﺔ ﻋﺎﺩﺓ ﻭﻻ ﺗﺳﺑﺏ ﻣﺷﻛﻠﺔ ﺇﻻ ﻓﻲ ﺣﺎﻻﺕ‬ ‫ﻧﺎﺩﺭﺓ‪.‬‬ ‫ﻳﻛﻭﻥ ﻋﻼﺝ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺑﺎﻟﻭﻟﻳﺩ ﺑﺗﺑﺩﻳﻝ ﺩﻣﻪ ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ ﻟﺗﺧﻠﻳﺻﻪ ﻣﻥ ﺍﻟﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء ﺍﻟﺯﺍﺋﺩﺓ ﻭﺇﻋﻁﺎﺋﻪ ﺩﻣﺎ ً‬ ‫ﻣﻁﺎﺑﻘﺎً‪ ،‬ﻭﺫﻟﻙ ﺇﺫﺍ ﻛﺎﻥ ﺍﻻﻧﺣﻼﻝ ﺷﺩﻳﺩﺍً ﻭﺳﺑﺏ ﻧﻘﺻﺎ ً ﺷﺩﻳﺩﺍً ﻓﻲ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﺍﺭﺗﻔﺎﻋﺎ ً ﺯﺍﺋﺩﺍً ﻓﻲ ﺍﻟﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء‪ .‬ﺇﻥ‬ ‫ﺗﻌﺭﺽ ﺍﻟﻁﻔﻝ ﻟﺿﻭء ﺍﻟﺷﻣﺱ ﻏﻳﺭ ﺍﻟﻣﺑﺎﺷﺭ ﺃﻭ ﻟﻸﺷﻌﺔ ﻓﻭﻕ ﺍﻟﺑﻧﻔﺳﺟﻳﺔ ﻳﺳﺎﻋﺩ ﺃﻳﺿﺎ ً ﻓﻲ ﺧﻔﺽ ﺗﺭﻛﻳﺯ ﺍﻟﻣﺎﺩﺓ ﺍﻟﺻﻔﺭﺍء‬ ‫ﻓﻲ ﺍﻟﺩﻡ‪ .‬ﻭﻗﺩ ﺃﺻﺑﺢ ﻣﻣﻛﻧﺎ ً ﻧﻘﻝ ﺩﻡ ﻟﻠﺟﻧﻳﻥ ﻭﻫﻭ ﻓﻲ ﺍﻟﺭﺣﻡ ﺑﺯﺭﻗﻪ ﻓﻲ ﺟﻭﻑ ﺑﻁﻥ ﺍﻟﺟﻧﻳﻥ‪ ،‬ﻭﺫﻟﻙ ﻟﺭﻓﻊ ﻧﺳﺑﺔ‬ ‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﺗﺟﻧﺏ ﻣﻭﺕ ﺍﻟﻁﻔﻝ ﺩﺍﺧﻝ ﺍﻟﺭﺣﻡ ﻧﺗﻳﺟﺔ ﻋﺟﺯ ﻗﻠﺑﻪ‪ ،‬ﺍﻟﻣﺗﺳﺑﺏ ﻣﻥ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﻣﻧﺧﻔﺽ‪ .‬ﺍﻟﺩﻡ ﺍﻟﻣﻧﻘﻭﻝ‬ ‫ﻓﻲ ﻫﺫﻩ ﺍﻟﺣﺎﻟﺔ ﻳﻛﻭﻥ ﻣﻁﺎﺑﻘﺎ ً ﻟﺩﻡ ﺍﻷﻡ ﻭﻻ ﻳﺗﺄﺛﺭ ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﻌﺎﺑﺭﺓ ﻣﻧﻬﺎ‪.‬‬ ‫‪U‬‬

‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺫﺍﺗﻳﺔ )ﺫﺍﺗﻳﺔ ﺍﻟﺿﺩ(‪:‬‬

‫ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﺍﻻﻧﺣﻼﻝ ﻳﻧﺗﺞ ﻋﻥ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟﻭﺍﺣﺩﺓ ﻣﻥ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﻳﻛﻭﻧﻬﺎ ﺍﻟﺟﺳﻡ ﺿﺩ ﺧﻼﻳﺎﻩ‪ .‬ﺇﻥ ﺍﻹﻧﺳﺎﻥ ﺍﻟﺳﻭﻱ ﻻ ﻳﻭﻟﺩ‬ ‫ﺃﺟﺳﺎﻣﺎ ً ﻣﺿﺎﺩﺓ ﻟﻔﺻﺎﺋﻝ ﺗﺣﻣﻠﻬﺎ ﺧﻼﻳﺎﻩ‪ ،‬ﻭﺍﻟﺣﺎﻟﺔ ﺍﻟﺗﻲ ﻧﺗﻛﻠﻡ ﻋﻧﻬﺎ ﻫﻲ ﺣﺎﻟﺔ ﻣﺭﺿﻳﺔ ﻳﺗﺣﻭّ ﻝ ﻓﻳﻬﺎ ﺍﻟﺟﻬﺎﺯ ﺍﻟﻣﻧﺎﻋﺔ ﻟﻠﺟﺳﻡ ﺿﺩ ﺧﻼﻳﺎﻩ‬ ‫ّ‬ ‫ﺗﺣﻁﻡ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء )ﻭﺭﺑﻣﺎ ﻏﻳﺭﻫﺎ(‪ .‬ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﺗﺳﻣﻰ ]ﺃﻣﺭﺍﺽ ﺍﻟﻣﻧﺎﻋﺔ ﺫﺍﺗﻳﺔ ﺍﻟﺿﺩ[‪.‬‬ ‫ﻧﻔﺳﻬﺎ ﻟﻳﻭﻟﺩ ﺃﺟﺳﺎﻣﺎ ً ﻣﺿﺎﺩﺓ‬ ‫‪36‬‬

‫ﺇﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﺍﻟﺫﺍﺗﻳﺔ ﻟﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﺗﺗﻭﻟﺩ ﺃﺣﻳﺎﻧﺎ ً ﻓﻲ ﺑﻌﺽ ﺍﻷﻣﺭﺍﺽ ﻣﺛﻝ]ﺍﻟﺳﺭﻁﺎﻥ ﺍﻟﻠﻣﻔﺎﻭﻱ[ ﻭ]ﻣﺭﺽ ﺍﻟﺫﺋﺏ‬ ‫ﺍﻻﺣﻣﺭﺍﺭﻱ[ ﺃﻭ ﻧﺗﻳﺟﺔ ﺗﻧﺎﻭﻝ ﻋﻘﺎﺭﺍﺕ ﻣﻌﻳﻧﺔ ﻓﻲ ﺑﻌﺽ ﺍﻷﻓﺭﺍﺩ‪ ،‬ﺃﻭ ﺗﺗﻭﻟﺩ ﺑﺩﻭﻥ ﺳﺑﺏ ﻅﺎﻫﺭ ﻣﻥ ﻣﺭﺽ ﺃﻭ ﻋﻘﺎﺭ‪.‬‬ ‫ﻋﻼﺝ ﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻳﻛﻭﻥ ﺑﺎﻟﻌﻘﺎﺭﺍﺕ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻠﻣﻧﺎﻋﺔ ﻭﺍﻟﺗﻲ ﺗﻘﻠﻝ ﻣﻥ ﺇﻧﺗﺎﺝ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‪ ،‬ﻭﺑﻧﻘﻝ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﺣﺎﻻﺕ‬ ‫ﺍﻻﺿﻁﺭﺍﺭﻳﺔ ﺟﺩﺍً ﺣﻳﻧﻣﺎ ﻳﻬﺑﻁ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻛﺛﻳﺭﺍً‪ .‬ﻣﻥ ﺍﻟﻣﻔﻳﺩ ﺃﻥ ﻧﺫﻛﺭ ﺃﻥ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ ﺩﻡ ﻣﻁﺎﺑﻕ ﺗﻣﺎﻣﺎ ً ﻟﺩﻡ ﺍﻟﻣﺭﻳﺽ‬ ‫ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﻫﻭ ﺃﻣﺭ ﺻﻌﺏ ﺟﺩﺍً‪.‬‬

‫ﻓﻘﺭ ﺩﻡ ﺍﻧﺣﻼﻟﻲ ﻧﺎﺷﺊ ﻋﻥ ﺃﺳﺑﺎﺏ ﺃﺧﺭﻯ‪:‬‬ ‫‪U‬‬

‫ﺃﻫﻡ ﻫﺫﻩ ﺍﻷﺳﺑﺎﺏ ﻫﻲ ﺍﻟﻣﻼﺭﻳﺎ ﺍﻟﺗﻲ ﺗﺗﺣﻁﻡ ﻓﻳﻬﺎ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺑﺳﺑﺏ ﻁﻔﻳﻠﻲ ﺍﻟﻣﻼﺭﻳﺎ ﺍﻟﺫﻱ ﻳﻌﻳﺵ ﻓﻳﻬﺎ ﻟﺩﻯ ﺍﻧﻘﺳﺎﻡ ﺍﻟﻁﻔﻳﻠﻲ‪ .‬ﻗﺩ‬ ‫ﻳﻛﻭﻥ ﻓﻘﺭﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻟﻣﻼﺭﻳﺎ ﺷﺩﻳﺩﺍً ﻓﻲ ﺑﻌﺽ ﺍﻟﻣﺭﺿﻰ ﺍﻟﺫﻳﻥ ﻳﻐﺯﻭ ﺩﻣﺎءﻫﻡ ﻋﺩﺩ ﻫﺎﺋﻝ ﻣﻥ ﻁﻔﻳﻠﻲ ﺍﻟﻣﻼﺭﻳﺎ‪ ،‬ﻻ ﺳﻳّﻣﺎ ﻣﻥ ﻧﻭﻉ‬ ‫ﻓﺎﻟﺳﻳﺑﺎﺭﻡ‪.‬‬ ‫ً‬ ‫ﺗﻭﺟﺩ ﺃﻳﺿﺎ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﺍﻟﺑﻛﺗﺭﻳﺎ ﺍﻟﺗﻲ ﺗﻌﻳﺵ ﻓﻲ ﺍﻟﺩﻡ ﻭﺗﺣﻁﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‪.‬‬ ‫ﻫﻧﺎﻙ ﺃﻧﻭﺍﻉ ﺃﺧﺭﻯ ﻣﻛﺗﺳﺑﺔ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ‪ ،‬ﻣﻧﻬﺎ ﻣﺎ ﻳﻛﻭﻥ ﻧﺗﻳﺟﺔ ﺗﻧﺎﻭﻝ ﺑﻌﺽ ﺍﻷﺩﻭﻳﺔ ﺃﻭﺍﻟﻣﻭﺍﺩ ﺍﻟﻛﻳﻣﻳﺎﻭﻳﺔ ﺍﻟﻣﺅﻛﺳِ ﺩﺓ )ﻋﻥ‬ ‫ﻁﺭﻳﻕ ﺍﻟﺧﻁﺄ(‪ .‬ﻓﻣﺛﻼً ﻣﺎﺩﺓ ﺍﻟﻧﻔﺛﺎﻟﻳﻥ ﻭﺣﺎﻣﺽ ﺍﻟﻔﻳﻧﻭﻝ )ﺃﺳﺩﻓﻧﻳﻙ( ﺗﺳﺑﺑﺎﻥ ﺍﻧﺣﻼﻻً ﺷﺩﻳﺩﺍً ﻭﺣﺎﺩﺍً ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻗﺩ ﻳﺅﺩﻱ ﺇﻟﻰ‬ ‫ﺍﻟﻣﻭﺕ‪.‬‬ ‫ﻫﻧﺎﻙ ﺃﻧﻭﺍﻉ ﻣﻥ ﻫﺫﺍ ﺍﻻﻧﺣﻼﻝ ﻳﻧﺷﺄ ﻣﻥ ﺃﺳﺑﺎﺏ ﻣﺟﻬﻭﻟﺔ ﻭﺗﺻﺑﺢ ﻓﻳﻪ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺷﺩﻳﺩﺓ ﺍﻟﺣﺳﺎﺳﻳﺔ ﻟﺑﻌﺽ ]ﻣﺗﻣﻣﺎﺕ ﺍﻷﺟﺳﺎﻡ‬ ‫ﺍﻟﻣﺿﺎﺩﺓ[ ﻭﻳﻛﻭﻥ ﺍﻻﻧﺣﻼﻝ ﻋﻠﻰ ﺃﺷﺩّﻩ ﺃﺛﻧﺎء ﺍﻟﻠﻳﻝ ﻭﻗﺩ ﻳﺄﺗﻲ ﺑﻧﻭﺑﺎﺕ ﺷﺩﻳﺩﺓ ﺇﻟﻰ ﺩﺭﺟﺔ ﻳﻅﻬﺭ ﻓﻳﻬﺎ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﻣﺗﺣﺭﺭ ﻧﺗﻳﺟﺔ‬ ‫ﺍﻟﺗﺣﻠﻝ‪ ،‬ﻓﻲ ﺍﻟﺑﻭﻝ‪ .‬ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻳﺳﻣﻰ ]ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺑﻭﻝ ﺍﻟﻣﺳﺎﺋﻲ ﺍﻟﻣﺗﻧﺎﻭﺏ[‬ ‫ﻛﺫﻟﻙ ﻳﺻﺣﺏ ﻓﻘﺭ ﺩﻡ ﺍﻧﺣﻼﻟﻲ ﺣﺎﻻﺕ ﻣﻥ ﺍﻟﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ ﺗﺳﺑﺑﻬﺎ ﺳﺭﻁﺎﻧﺎﺕ ﻭﺍﺳﻌﺔ ﺍﻻﻧﺗﺷﺎﺭ ﺃﻭ ﺣﺎﻻﺕ ﻣﻧﺎﻋﻳﺔ‪ .‬ﻓﻲ ﻫﺫﻩ‬ ‫ﺍﻟﺣﻼﺕ ﻧﺟﺩ ﻓﻲ ﻣﺳﺣﺔ ﺍﻟﺩﻡ ﺧﻼﻳﺎ ﺣﻣﺭﺍء ﻣﻧﺷﻁﺭﺓ‪ ،‬ﻭﻛﺫﻟﻙ ﻧﺟﺩ ﻧﻘﺻﺎ ً ﻓﻲ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻓﻲ ﻋﻭﺍﻣﻝ ﺗﺧﺛﺭ ﺍﻟﺩﻡ‪.‬‬

‫‪] -4‬ﻓﻘﺮ اﻟﺪم اﻟﺜﺎﻧﻮي[‬ ‫ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻫﻭ ﻧﻭﻉ ﺷﺎﺋﻊ ﺟﺩﺍً ﻟﻛﻧﻪ ﻻ ﻳﺗﺻﺩّﺭ ﺗﺻﻧﻳﻑ ﻓﻘﺭ ﺍﻟﺩﻡ ﻷﻧﻪ ﻳﺣﺩﺙ ﻛﻧﺗﻳﺟﺔ ﺛﺎﻧﻭﻳﺔ ﻷﻣﺭﺍﺽ ﺃﺧﺭﻯ ﻭﻳﺯﻭﻝ‬ ‫ﺑﺯﻭﺍﻟﻬﺎ‪ .‬ﺃﻫﻡ ﺍﻷﻣﺭﺍﺽ ﺍﻟﺗﻲ ﺗﺳﺑﺏ ﻓﻘﺭ ﺩﻡ ﺛﺎﻧﻭﻳﺎ ً ﻫﻲ‪:‬‬ ‫ﺃ‪ -‬ﺍﻻﻟﺗﻬﺎﺑﺎﺕ ﺍﻟﺟﺭﺛﻭﻣﻳﺔ ﻭﺍﻟﺣ ّﻣﻳﺎﺕ ﻋﻣﻭﻣﺎ ً‪-‬‬ ‫ﺇﺫﺍ ﺩﺍﻣﺕ ﻣﺛﻝ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻷﻛﺛﺭ ﻣﻥ ﺃﺳﺑﻭﻉ ﻓﺈﻥ ﻓﻘﺭ ﺩﻡ ﻳﻧﺷﺄ ﺑﺻﻭﺭﺓ ﺗﺩﺭﻳﺟﻳﺔ ﻟﺩﻯ ﺍﻟﻣﺭﻳﺽ ﻭﻳﺳﺗﻣﺭ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫ﺑﺎﻻﻧﺧﻔﺎﺽ ﺣﺗﻰ ﻳﺻﻝ ﺇﻟﻰ ﻣﺳﺗﻭﻯ ﻣﺗﻭﺳﻁ ﻣﻥ ﺍﻟﺗﺩﻧﻲ ﻓﻳﺗﻭ ّﻗﻑ‪ .‬ﺇﻥ ﻋﻼﺝ ﺍﻟﻣﺭﺽ ﺍﻷﺻﻠﻲ ﺑﺎﻟﻣﺿﺎﺩّﺍﺕ ﺍﻟﺣﻳﻭﻳﺔ ﺃﻭ ﺑﺎﻹﺯﺍﻟﺔ‬ ‫ﺍﻟﺟﺭﺍﺣﻳﺔ ﻳﺅﺩﻱ ﺇﻟﻰ ﺍﻧﺗﻌﺎﺵ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺗﺩﺭﻳﺟﻳﺎ ً‪ .‬ﻭﻗﺩ ﻳﺣﺗﺎﺝ ﺍﻟﻣﺭﻳﺽ ﺇﻟﻰ ﺑﻌﺽ ﺍﻟﻣﻧﺷﻁﺎﺕ ﻟﻣﺳﺎﻋﺩﺗﻪ ﻓﻲ ﺍﺳﺗﻌﺎﺩﺓ‬ ‫ﺻﺣﺗﻪ ﺍﻟﺳﺎﺑﻘﺔ ﻭﺭﻓﻊ ﻧﺳﺑﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺑﺳﺭﻋﺔ‪.‬‬ ‫ﺇﻥ ﺍﻟﺟﺳﻡ ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﻳﺣﻭّ ﻝ ﻣﺎ ﻋﻧﺩﻩ ﻣﻥ ﻣﻭﺍﺩ ﺑﻧﺎء ﺃﻭﻟﻳﺔ ﻣﻥ ﻋﻣﻠﻳﺔ ﺻﻧﻊ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺇﻟﻰ ﺻﻧﻊ ﺧﻼﻳﺎ ﻣﻥ‬ ‫ﻧﻭﻉ ﺁﺧﺭ ﻟﺗﺭﻣﻳﻡ ﺍﻟﻣﻧﻬﺩﻡ ﻣﻥ ﺍﻷﻧﺳﺟﺔ ﻭﻣﺣﺎﺭﺑﺔ ﺍﻟﺟﺭﺍﺛﻳﻡ ﻭﻏﻳﺭ ﺫﻟﻙ‪ ،‬ﻛﻣﺎ ﻳﻘﻭﻡ ﺑﺣﺟﺯ ﺍﻟﺣﺩﻳﺩ ﻋﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻟﻳﻘﻠﻝ‬ ‫ﻋﺩﺩﻫﺎ ﻭﻟﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺻﻧﻊ ﺍﻟﺧﻼﻳﺎ ﺍﻷﺧﺭﻯ ﺍﻟﻣﺫﻛﻭﺭﺓ‪.‬‬ ‫ﺏ‪] -‬ﻋﺟﺯ ﺍﻟﻛﻠﻳﺗﻳﻥ ﺍﻟﻣﺯﻣﻥ[‪-‬‬ ‫ﺃﻭ ﺍﻟﻔﺷﻝ ﺍﻟﻛﻠﻭﻱ ﻳﻛﻭﻥ ﻣﺻﺣﻭﺑﺎ ً ﺩﻭﻣﺎ ً ﺑﻔﻘﺭ ﺩﻡ ﺛﺎﻧﻭﻱ ﻗﺩ ﻳﻛﻭﻥ ﺷﺩﻳﺩﺍً‪ .‬ﻟﻬﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺳﺑﺑﺎﻥ‪ .‬ﺍﻷﻭﻝ‪ ،‬ﻭﺍﻷﻫﻡ ﻫﻭ‬ ‫ﻧﻘﺹ ﻫﻭﺭﻣﻭﻥ ﻣﻧﺗﺞ ﺍﻟﺣﻣﺭﺍء ﺍﻟﺗﻲ ﺗﻘﻭﻡ ﺃﻧﺳﺟﺔ ﺍﻟﻛﻠﻳﺔ ﺑﺈﻓﺭﺍﺯﻩ ﻭﺗﻧﺷﻳﻁﻪ ﻛﻠﻣﺎ ﻧﻘﺹ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺑﺎﻟﺩﻡ‪ .‬ﻳﺅﺛﺭﻧﻘﺹ‬ ‫ﺍﻟﻬﻭﺭﻣﻭﻥ ﺑﺩﻭﺭﻩ ﻋﻠﻰ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻟﻳﻘﻠﻝ ﻣﻥ ﺍﻧﺗﺎﺝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ‪ .‬ﺍﻟﺛﺎﻧﻲ ﻭﺟﻭﺩ ﻛﻣﻳﺎﺕ ﻣﺭﺗﻔﻌﺔ ﻓﻲ ﺍﻟﺩﻡ ﻣﻥ ﺍﻟﻣﻭﺍﺩ‬ ‫ﺍﻟﺿﺎﺭﺓ ﺍﻟﺗﻲ ﻳﺗﺧﻠﺹ ﻣﻧﻬﺎ ﺍﻟﺟﺳﻡ ﺍﻟﻁﺑﻳﻌﻲ ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﻛﻠﻳﺗﻳﻥ‪ .‬ﻭﻗﺩ ﻳﺅﺩﻱ ﺍﻟﻣﻔﻌﻭﻝ ﺍﻟﺗﺳﻣﻣﻲ ﻟﺑﻌﺽ ﻫﺫﻩ ﺍﻟﻣﻭﺍﺩ ﺇﻟﻰ ﻫﺑﻭﻁ‬ ‫ﻧﺷﺎﻁ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪.‬‬ ‫‪U‬‬

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‫‪U‬‬

‫‪U‬‬

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‫ﻗﺩ ﻳﺣﺗﺎﺝ ﺍﻟﻣﺭﻳﺽ ﺇﻟﻰ ﻧﻘﻝ ﺩﻡ‪ ،‬ﻭﺭﺑﻣﺎ ﺑﺻﻭﺭﺓ ﻣﺗﻛﺭﺭﺓ‪ ،‬ﺇﺫﺍ ﺗﺭﺩّﻯ ﻣﺳﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻛﺛﻳﺭﺍً‪ .‬ﻓﻲ ﻛﻝ ﺍﻷﺣﻭﺍﻝ ﻳﻬﺗﻡ‬ ‫ﺍﻟﻁﺑﻳﺏ ﺑﻌﻼﺝ ﺍﻟﺣﺎﻟﺔ ﺍﻷﺻﻠﻳﺔ ﻭﻣﺿﺎﻋﻔﺎﺗﻬﺎ ﻭﻳﻌﺗﺑﺭ ﻣﻭﺿﻭﻉ ﻓﻘﺭ ﺍﻟﺩﻡ ﺃﻣﺭﺍً ﺛﺎﻧﻭﻳﺎ ً ﻳﺗﺣﺳﻥ ﺑﻣﺟﺭﺩ ﺯﻭﺍﻝ ﻣﺭﺽ ﺍﻟﻛﻠﻰ‪ ،‬ﺇﺫﺍ‬ ‫ﻛﺎﻥ ﺫﻟﻙ ﻣﻣﻛﻧﺎ ً‪.‬‬ ‫ﻭﻗﺩ ﺃﺻﺑﺢ ﺍﻵﻥ ﻫﻭﺭﻣﻭﻥ ﻣﻧﺗﺞ ﺍﻟﺣﻣﺭﺍء ﻣﺗﻭﻓﺭﺍً ﻛﻌﻘﺎﺭ ﺑﻔﺿﻝ ]ﻫﻧﺩﺳﺔ ﺍﻟﻣﻭﺭّﺛﺎﺕ[ ﻭﺃﺻﺑﺢ ﻳﺳﺗﻌﻣﻝ ﻁﺑﻳﺎ ً ﻟﺭﻓﻊ ﻣﺳﺗﻭﻯ‬ ‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻭﻳﺳﺎﻋﺩ ﻓﻲ ﺭﻓﻊ ﺍﻟﻣﺳﺗﻭﻯ ﻓﻲ ﻛﺛﻳﺭ ﻣﻥ ﺍﻟﺣﺎﻻﺕ‪.‬‬ ‫ﺇﻥ ﻋﻣﻠﻳﺔ ]ﻏﺳﻳﻝ ﺍﻟﻛﻠﻰ[‪ ،‬ﺇﺫﺍ ﺃﺟﺭﻳﺕ ﺑﺷﻛﻝ ﻓﻌّﺎﻝ ﻭﻣﻧﺗﻅﻡ‪ ،‬ﺗﺳﺎﻋﺩ ﻫﻲ ﺍﻷﺧﺭﻯ ﻓﻲ ﺗﺣﺳﻥ ﻛﻝ ﻋﻼﻣﺎﺕ ﻭﺃﻋﺭﺍﺽ ﻓﺷﻝ‬ ‫ﺍﻟﻛﻠﻰ‪ ،‬ﻭﻣﻧﻬﺎ ﻓﻘﺭ ﺍﻟﺩﻡ‪ .‬ﻛﻣﺎ ﺃﻥ ﺯﺭﺍﻋﺔ ﻛﻠﻳﺔ ﻟﻠﻣﺭﻳﺽ ﻭﺳﻳﻠﺔ ﻓﻌﺎﻟﺔ ﻓﻲ ﻣﻌﻅﻡ ﺍﻷﺣﻳﺎﻥ ﻓﻲ ﺷﻔﺎء ﺍﻟﻣﺭﺽ ﻭﻛﻝ ﻣﺎﻳﻧﺗﺞ ﻋﻧﻪ‪.‬‬ ‫ﺝ‪ -‬ﺣﺎﻻﺕ ﺍﻟﺳﺭﻁﺎﻥ‪-‬‬ ‫ﺇﻥ ﺍﻟﺳﺭﻁﺎﻥ ﺑﺄﻧﻭﺍﻋﻪ‪ ،‬ﻭﻣﻬﻣﺎ ﻛﺎﻥ ﺍﻟﻧﺳﻳﺞ ﺍﻟﺫﻱ ﻳﻧﺷﺄ ﻣﻧﻪ‪ ،‬ﻣﺭﺽ ﻋﺎﻡ ﻳﺅﺛﺭ ﻋﻠﻰ ﺍﻷﻋﻣﺎﻝ ﺍﻟﺣﻳﻭﻳﺔ ﻟﻠﺟﺳﻡ‪ .‬ﻟﺫﻟﻙ‪ ،‬ﻓﻼ ﻋﺟﺏ‬ ‫ﺃﻥ ﻳﻧﺷﺄ ﻓﻘﺭ ﺩﻡ ﺛﺎﻧﻭﻱ ﻓﻲ ﺃﻧﻭﺍﻉ ﻛﺛﻳﺭﺓ ﻣﻧﻪ‪ .‬ﻳﻌﺯﻯ ﻫﺫﺍ ﺍﻷﻣﺭ ﻋﺎﺩﺓ ﺇﻟﻰ ﺍﻟﺳﺭﻁﺎﻥ ﻧﻔﺳﻪ ﻛﻣﺭﺽ ﻭﻟﻛﻥ ﻫﻧﺎﻙ ﻣﻼﺣﻅﺎﺕ ﻳﺟﺏ‬ ‫ﺫﻛﺭﻫﺎ ﻋﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﺳﺭﻁﺎﻥ‪:‬‬ ‫ﺍﻷﻭﻟﻰ‪ :‬ﺃﻥ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﺍﻟﺳﺭﻁﺎﻥ‪ ،‬ﻻ ﺳﻳّﻣﺎ ﻣﺎ ﻛﺎﻥ ﻣﻧﻬﺎ ﻓﻲ ﺍﻟﻘﺳﻡ ﺍﻷﻭﻝ ﻣﻥ ﺍﻷﻣﻌﺎء ﺍﻟﻐﻠﻳﻅﺔ ﺃﻭ ﺍﻟﻣﺳﺗﻘﻳﻡ ﺃﻭ ﺍﻟﻣﻌﺩﺓ ﻛﺛﻳﺭﺍً ﻣﺎ‬ ‫ﺗﺗﻘﺭّﺡ ﻓﺗﻧﺯﻑ ﺑﺻﻭﺭﺓ ﻣﺯﻣﻧﺔ‪ ،‬ﻭﻫﺫﺍ ﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺿﺎﻋﻑ ﻓﻘﺭ ﺍﻟﺩﻡ ﻭﺗﻌﺩﺩ ﺃﺳﺑﺎﺑﻪ‪.‬‬ ‫ﺍﻟﺛﺎﻧﻳﺔ‪ :‬ﺃﻥ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﺍﻟﺳﺭﻁﺎﻥ ﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ ﻣﺿﺎﻋﻔﺎﺕ ﺃﺧﺭﻯ ﻛﺎﻹﻟﺗﻬﺎﺑﺎﺕ ﺍﻟﺟﺭﺛﻭﻣﻳﺔ ﻓﻲ ﻧﻔﺱ ﺍﻟﻭﺭﻡ ﺑﺳﺑﺏ ﺍﻟﺗﻘﺭﺡ‪،‬‬ ‫ﻛﻣﺎ ﻳﺣﺻﻝ ﻓﻲ ﺳﺭﻁﺎﻥ ﺍﻷﻣﻌﺎء‪ ،‬ﺃﻭ ﻓﻲ ﺃﺟﺯﺍء ﻣﺟﺎﻭﺭﺓ ﻛﻣﺎ ﻳﺣﺩﺙ ﻓﻲ ﺳﺭﻁﺎﻥ ﺍﻟﺭﺋﺔ ﺍﻟﺫﻱ ﻗﺩ ﻳﺳﺑﺏ ﺍﻧﺳﺩﺍﺩﺍً ﻓﻲ ﻗﺻﺑﺔ‬ ‫ﻫﻭﺍﺋﻳﺔ ﺃﻭ ﺃﻛﺛﺭ ﻣﻊ ﺗﺟﻣّﻊ ﻗﻳﺢ ﻓﻳﻣﺎ ﻭﺭﺍء ﺍﻻﻧﺳﺩﺍﺩ‪ .‬ﻫﺫﻩ ﺍﻟﺗﻘﻳﺣﺎﺕ ﺗﺅﺩﻱ ﺇﻟﻰ ﻫﺑﻭﻁ ﻓﻲ ﺗﺭﻛﻳﺯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪.‬‬ ‫ﺍﻟﺛﺎﻟﺛﺔ‪ :‬ﺃﻥ ﺍﻟﺳﺭﻁﺎﻥ ﺇﺫﺍ ﻣﺎ ﺍﻧﺗﺷﺭ ﻓﻘﺩ ﻳﻛﻭﻥ ﻣﻥ ﺿﻣﻥ ﺍﻷﺟﺯﺍء ﺍﻟﺗﻲ ﻳﺳﺗﻘﺭ ﻓﻳﻬﺎ ﻫﻭ ﺍﻟﻧﺧﺎﻉ ﺍﻷﺣﻣﺭ ﻟﻠﻌﻅﻡ‪ ،‬ﻣﻣﺎ ﻳﻘﻠﻝ ﻣﻥ‬ ‫ﻣﺳﺎﺣﺔ ﺍﻟﻧﺧﺎﻉ ﺍﻟﻔﻌﺎﻝ‪ ،‬ﻭﺑﺩﻭﺭﻩ ﻳﺯﻳﺩ ﻣﻥ ﻣﺳﺗﻭﻯ ﻓﻘﺭ ﺍﻟﺩﻡ‪ .‬ﺃﻫﻡ ﻣﺛﺎﻝ ﻋﻠﻰ ﻫﺫﺍ ﺍﻷﻣﺭ ﻫﻭ ﺳﺭﻁﺎﻥ ﺍﻟﺩﻡ‪ ،‬ﺣﻳﺙ ﺃﻥ ﻫﺫﺍ ﺍﻟﻧﻭﻉ‬ ‫ﻣﻥ ﺍﻟﺳﺭﻁﺎﻥ ﻳﻧﺷﺄ ﺃﺻﻼً ﻓﻲ ﺍﻟﻧﺧﺎﻉ ﻭﻳﻧﺗﺷﺭ ﻓﻳﻪ ﻣﻥ ﺍﻟﺑﺩﺍﻳﺔ ﻭﻳﺗﻭﺳﻊ ﺩﺍﺧﻠﻪ ﺣﺗﻰ ﻳﺗﻡ ﺍﺣﺗﻼﻝ ﻛﻝ ﺍﻟﻧﺧﺎﻉ ﺃﻭ ﻣﻌﻅﻣﻪ ﺑﺎﻟﺧﻼﻳﺎ‬ ‫ﺍﻟﺳﺭﻁﺎﻧﻳﺔ ﺍﻟﺗﻲ ﻻ ﺗﻧﺗﺞ ﺧﻼﻳﺎ ﺩﻡ ﺣﻣﺭﺍء ﻭﻻ ﺻﻔﻳﺣﺎﺕ ﻭﻻ ﺧﻼﻳﺎ ﺑﻳﺿﺎء ﻁﺑﻳﻌﻳﺔ ﻓﻳﺣﺻﻝ ﻧﻘﺹ ﻓﻳﻬﺎ ﺟﻣﻳﻌﺎ ً‪.‬‬ ‫ﺩ‪ -‬ﻧﻘﺹ ﺍﻟﻬﻭﺭﻣﻭﻧﺎﺕ‪-‬‬ ‫ﻻ ﺳﻳﻣﺎ ﻧﻘﺹ ﻫﻭﺭﻣﻭﻥ ﻗﺷﺭﺓ ]ﺍﻟﻐﺩﺓ ﺍﻟﻛﻅﺭﻳﺔ[ ﺃﻱ ]ﺍﻟﻛﻭﺭﺗﻳﺯﻭﻝ[ ﻭﻫﻭﺭﻣﻭﻥ ﺍﻟﺩﺭﻗﻳﺔ‪ .‬ﻫﺫﺍ ﺍﻟﻧﻘﺹ ﻳﺅﺩﻱ ﺇﻟﻰ ﻓﻘﺭ ﺩﻡ ﺧﻔﻳﻑ‬ ‫ﺃﻭ ﻣﺗﻭﺳﻁ ﺍﻟﺷﺩﺓ‪.‬‬ ‫ﻫـ‪ -‬ﺃﻣﺭﺍﺽ ﺍﻟﻛﺑﺩ ﺍﻟﻣﺯﻣﻧﺔ‪-‬‬ ‫ﻭﺑﺎﻟﺫﺍﺕ ﺍﻟﻣﺭﺽ ﺍﻟﻣﺳﻣﻰ ]ﺗﺷﻣّﻊ ﺍﻟﻛﺑﺩ[ ﻓﻬﻭ ﻳﺳﺑﺏ ﻓﻘﺭﺩﻡ ﻭﺗﻛﻭﻥ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﻓﻲ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻛﺑﻳﺭﺓ‬ ‫ﺍﻟﺣﺟﻡ ﻗﻠﻳﻼً‪.‬‬ ‫ﻭ‪] -‬ﺃﻣﺭﺍﺽ ﺍﻷﻧﺳﺟﺔ ﺍﻟﺭﺍﺑﻁﺔ[ ﺍﻟﻣﻧﺎﻋﻳﺔ‪-‬‬ ‫ﻣﺛﻝ ﻣﺭﺽ ﺍﻟﺫﺋﺏ ﺍﻻﺣﻣﺭﺍﺭﻱ ﺍﻟﻣﻧﺗﺷﺭ ﻭﻣﺭﺽ]ﺷﺑﻳﻪ ﺍﻟﺭﺛﻳﺔ ﺍﻟﻣﻔﺻﻠﻲ[‪ .‬ﺗﻛﻭﻥ ﻫﺫﻩ ﻋﺎﺩﺓ ﻣﺻﺣﻭﺑﺔ ﺑﻔﻘﺭ ﺩﻡ ﺑﺳﻳﻁ ﺃﻭ‬ ‫ﻣﺗﻭﺳﻁ‪ ،‬ﻭﻗﺩ ﻳﺻﺑﺢ ﺷﺩﻳﺩﺍً ﺇﺫﺍ ﺣﺻﻝ ﺍﻧﺣﻼﻝ ﻓﻲ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ﺑﺄﺟﺳﺎﻡ ﺫﺍﺗﻳﺔ ﺍﻟﺿﺩ )ﺍﻧﻅﺭ ﻣﻭﺿﻭﻉ ﻓﻘﺭ ﺍﻟﺩﻡ‬ ‫ﺍﻻﻧﺣﻼﻟﻲ(‪.‬‬ ‫‪U‬‬

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‫‪U‬‬

‫‪-5‬ﻓﻘﺮ اﻟﺪم اﻟﻨﺎﺗﺞ ﻋﻦ ]ﻗـﻠﺔ اﻹﻧﺘﺎج ﻓﻲ ﻧﺨﺎع اﻟﻌﻈﻢ[‬ ‫ﺫﻛﺭﺕ ﺳﺎﺑﻘﺎ ً ﺃﻥ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻳﻧﺗﺞ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﻛﻠﻬﺎ‪ .‬ﻭﺑﺗﺄﺛﻳﺭ ﻣﻥ ﺿﻭﺍﺑﻁ ﻫﻭﺭﻣﻭﻧﻳﺔ ﻓﺈﻥ ﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺗﻲ ُﺗﻧ َﺗﺞ ﻳﻭﻣﻳﺎ ً ﻳﻌﺎﺩﻝ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻧﺩﺛﺭﺓ ﺗﻘﺭﻳﺑﺎً‪ ،‬ﺑﺣﻳﺙ ﻳﺑﻘﻰ ﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء )ﻭﻣﻥ ﺛﻡ ﻧﺳﺑﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ( ﺛﺎﺑﺗﺎ ً ﺗﻘﺭﻳﺑﺎ ً ﻋﻧﺩ ﺛﺑﻭﺕ ﺍﻟﻅﺭﻭﻑ‬ ‫ﺍﻟﻣﺣﻳﻁﺔ‪ .‬ﻭﻳُﻔﺗﺭﺽ ﻓﻲ ﺍﻟﻧﺧﺎﻉ ﺍﻟﻁﺑﻳﻌﻲ ﺃﻥ ﻳﺳﺗﺟﻳﺏ ﺑﺳﺭﻋﺔ ﻷﻱ ﻓﻘﺭ ﺩﻡ ﺣﺎﺻﻝ‪ ،‬ﻣﻥ ﻧﺯﻑ ﺃﻭ ﺍﻧﺣﻼﻝ‪ ،‬ﺑﺯﻳﺎﺩﺓ ﺇﻧﺗﺎﺟﻪ ﻭﺫﻟﻙ‬ ‫ﺑﺯﻳﺎﺩﺓ ﺭﻗﻌﺗﻪ ﻭﺍﻻﺳﺭﺍﻉ ﻓﻲ ﺍﻧﻘﺳﺎﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺗﻭﻟﺩﺓ ﻓﻳﻪ‪ ،‬ﻋﻠﻰ ﺃﻥ ﺗﺗﻭﻓﺭ ﻟﻠﻧﺧﺎﻉ ﻛﻝ ﺍﻟﻣﻭﺍﺩ ﺍﻟﺑﻧﺎﺋﻳﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ‪.‬‬ ‫ً‬ ‫ً‬ ‫ﻟﻛﻥ ﻫﻧﺎﻙ ﺃﻧﻭﺍﻋﺎ ً ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺗﺗﺳﺑﺏ ﻋﻥ ﻧﻘﺹ ﺍﻹﻧﺗﺎﺝ ﻓﻲ ﺍﻟﻧﺧﺎﻉ ﻛﺳﺑﺏ ﺃﺳﺎﺳﻲ‪ .‬ﻓﺈﺫﺍ ﻛﺎﻥ ﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻧﺩﺛﺭﺓ ﻳﻭﻣﻳﺎ ﺛﺎﺑﺗﺎ ﻭﻻ‬ ‫ﻳﺯﻳﺩ ﻋﻥ ﺍﻟﻌﺩﺩ ﺍﻟﻁﺑﻳﻌﻲ )ﺃﻱ ﻻ ﻳﻭﺟﺩ ﺍﻧﺣﻼﻝ ﻓﻲ ﺍﻟﺧﻼﻳﺎ( ﻭﺍﻹﻧﺗﺎﺝ ﺃﻗﻝ ﻣﻥ ﺍﻟﻁﺑﻳﻌﻲ ﻓﺈﻥ ﻋﺩﺩ ﺍﻟﺧﻼﻳﺎ ﻓﻲ ﺍﻟﺩﻡ ﻳﺄﺧﺫ ﺑﺎﻟﺗﻧﺎﻗﺹ‬ ‫ﺗﺩﺭﻳﺟﻳﺎ ً ﺣﺗﻰ ﻳﺻﻝ ﺇﻟﻰ ﻣﺳﺗﻭﻳﺎﺕ ﻗﺩ ﺗﻛﻭﻥ ﻣﺗﺩﻧﻳﺔ ﺟﺩﺍً‪ .‬ﺇﻥ ﻣﺛﻝ ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻳﻛﻭﻥ ﻋﺎﺩﺓ ﺷﺎﻣﻼً ﻓﻲ ﺍﻟﻧﺧﺎﻉ ﺑﺣﻳﺙ ﻳﺅﺩﻱ ﺇﻟﻰ‬ ‫ﻧﻘﺹ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء )ﻓﻘﺭ ﺩﻡ( ﻭﻣﻌﻬﺎ ﺍﻟﺑﻳﺿﺎء ﺑﺄﻧﻭﺍﻋﻬﺎ ﻭﺍﻟﺻﻔﻳﺣﺎﺕ‪ ،‬ﻟﺫﻟﻙ ﻧﺭﻯ ﺍﻟﻣﺭﻳﺽ ﻳﻌﺭﺽ ﻧﻔﺳﻪ ﻋﻠﻰ ﺍﻟﻁﺑﻳﺏ‬ ‫‪38‬‬

‫ﺑﺳﺑﺏ ﻋﻼﻣﺎﺕ ﺃﻭ ﺃﻋﺭﺍﺽ ﻟﻬﺎ ﻋﻼﻗﺔ ﺑﻔﻘﺭ ﺍﻟﺩﻡ ﺃﻭ ﺑﺳﺑﺏ ﻧﺯﻑ ﺗﺣﺕ ﺍﻟﺟﻠﺩ )ﻛﺩﻣﺎﺕ( ﺃﻭ ﻧﺯﻑ ﻣﻥ ﺍﻟﻠﺛﺔ ﺃﻭ ﺍﻷﻧﻑ ﺃﻭ ﺍﻟﻣﻬﺑﻝ‪،‬‬ ‫ﻭﻛﻝ ﺗﻠﻙ ﺍﻷﻧﻭﺍﻉ ﻣﻥ ﺍﻟﻧﺯﻑ ﺳﺑﺑﻬﺎ ﻧﻘﺹ ﺍﻟﺻﻔﻳﺣﺎﺕ‪ .‬ﺃﻭ ﻗﺩ ﻳﺎﺗﻲ ﺑﺳﺑﺏ ﺍﻟﺣﻣﻰ ﻭﺍﻟﺗﻘﻳﺣﺎﺕ ﻟﻧﻘﺹ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء‪.‬‬ ‫ﻧﺎﺩﺭﺍً ﻣﺎ ﻳﻛﻭﻥ ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻭﻻﺩﻱ ﺍﻟﻣﻧﺷﺄ ﻭﻟﻛﻥ ﺍﻟﻌﺎﺩﺓ ﺃﻥ ﻳﺣﺻﻝ ﻣﻥ ﺃﺳﺑﺎﺏ ﻣﻛﺗﺳﺑﺔ ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ ﻭﻓﻲ ﺃﻱ ﻋﻣﺭ‪.‬ﻣﻥ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ‬ ‫ﻣﺎﻳﻛﻭﻥ ﺳﺑﺑﻬﺎ ﻣﺟﻬﻭﻻً ﻭﻻ ﻳﺗﻭﺻﻝ ﺇﻟﻳﻪ ﺍﻟﻁﺑﻳﺏ ﻣﻥ ﺍﺳﺗﻘﺻﺎء ﺗﺄﺭﻳﺦ ﺣﻳﺎﺓ ﺍﻟﻣﺭﻳﺽ‪ ،‬ﻟﻛﻥ ﻫﻧﺎﻙ ﺑﻌﺽ ﺍﻟﻌﻘﺎﺭﺍﺕ ﺍﻟﺗﻲ ﺗﺳﺑﺏ‬ ‫ﺍﻟﻣﺭﺽ ﻓﻲ ﺃﻓﺭﺍﺩ ﺩﻭﻥ ﻏﻳﺭﻫﻡ ﺑﺳﺑﺏ ﺭﺩّﺓ ﻓﻌﻝ ﻓﻲ ﺃﺟﺳﺎﻣﻬﻡ ﺗﺟﺎﻩ ﺍﻟﻌﻘﺎﺭ‪ ،‬ﻛﻣﺎ ﻳﺣﺻﻝ ﻣﻥ ]ﺍﻟﻣﺿﺎﺩ ﺍﻟﺣﻳﺎﺗﻲ[ )ﻛﻠﻭﺭﺍﻣﻔﻧﻳﻛﻭﻝ( ﺃﻭ‬ ‫ﻏﻳﺭﻩ ﻣﻥ ﺍﻷﺩﻭﻳﺔ‪ .‬ﻛﻣﺎ ﺃﻥ ﺃﻛﺛﺭ ﺍﻷﺩﻭﻳﺔ ﺍﻟﻣﺳﺗﻌﻣﻠﺔ ﻓﻲ ﻋﻼﺝ ﺍﻟﺳﺭﻁﺎﻧﺎﺕ ]ﺍﻟﻌﻼﺝ ﺍﻟﻛﻳﻣﻳﺎﻭﻱ[ ﺗﺅﺩﻱ ﺇﻟﻰ ﻗﻣﻊ ﻧﺷﺎﻁ ﺍﻟﻧﺧﺎﻉ‬ ‫ﺍﻷﺣﻣﺭ ﺑﻛﻝ ﺃﺟﺯﺍﺋﻪ‪ .‬ﻳﺣﺩﺙ ﺍﻟﺷﻲء ﻧﻔﺳﻪ ﻋﻧﺩ ﻋﻼﺝ ﺍﻟﺳﺭﻁﺎﻥ ﺑﺎﻹﺷﻌﺎﻉ ﺍﻟﻌﻣﻳﻕ ﻭﺍﻟﻌﻧﺎﺻﺭ ﺍﻟﻣﺷﻌﺔ‪.‬‬ ‫ﻻ ﻳُﺷﺗﺭﻁ ﺃﻥ ﻳﻌﻭﺩ ﺍﻟﻧﺧﺎﻉ ﺇﻟﻰ ﻧﺷﺎﻁﻪ ﺍﻟﻌﺎﺩﻱ ﻋﻧﺩ ﺇﻗﺻﺎء ﺍﻟﻌﺎﻣﻝ ﺍﻟﻣﺳﺑﺏ‪ ،‬ﻛﻣﺎ ﺃﻥ ﺍﻟﻌﺎﻣﻝ ﺍﻟﻣﺳﺑﺏ‪ ،‬ﻣﻥ ﻋﻘﺎﺭ ﺃﻭ ﻏﻳﺭﻩ ﻗﺩ ﻳﻛﻭﻥ‬ ‫ﻣﺟﻬﻭﻻً ﺃﺻﻼً‪ ،‬ﻭﻟﻛﻥ ﻁﺑﻌﺎ ً ﻳﺟﺏ ﺇﻳﻘﺎﻑ ﺃﻱ ﻋﻘﺎﺭ ﻛﺎﻥ ﻳﺗﻧﺎﻭﻟﻪ ﺍﻟﻣﺭﻳﺽ ﺑﻌﺩ ﺗﺷﺧﻳﺹ ﻫﺫﺍ ﺍﻟﻧﻭﻉ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻭﺇﺑﺩﺍﻟﻪ ﺑﻐﻳﺭﻩ‪ ،‬ﺣﻳﺙ‬ ‫ﻗﺩ ﻳﻛﻭﻥ ﻣﺳﺑﺑﺎ ً ﻟﻠﻣﺭﺽ ﻓﻲ ﻣﺭﻳﺽ ﻣﻌﻳّﻥ ﺭﻏﻡ ﺃﻧﻪ ﻣﻥ ﻏﻳﺭ ﺍﻟﻣﻌﺭﻭﻑ ﻋﻧﻪ ﻣﺛﻝ ﻫﺫﺍ ﺍﻟﻣﻔﻌﻭﻝ ﺍﻟﺳﻲء ﻓﻲ ﻣﺭﺿﻰ ﺁﺧﺭﻳﻥ‪ .‬ﺇﻥ‬ ‫ﺍﻟﻌﻘﺎﺭﺍﺕ ﺍﻟﻛﻳﻣﻳﺎﻭﻳﺔ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻠﺳﺭﻁﺎﻥ ﻳﺫﻫﺏ ﻣﻔﻌﻭﻟﻬﺎ ﻋﻧﺩ ﺇﻳﻘﺎﻓﻬﺎ‪ ،‬ﻛﻘﺎﻋﺩﺓ ﻋﺎﻣﺔ‪.‬‬ ‫ً‬ ‫ﻳﻌﻣﺩ ﺍﻟﻁﺑﻳﺏ ﺇﻟﻰ ﻧﻘﻝ ﺩﻡ ﻟﻠﻣﺭﻳﺽ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻬﺑﻭﻁ ﺍﻟﺷﺩﻳﺩ ﻟﻠﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‪ُ .‬ﺗﻌﻁﻰ ﺑﻌﺽ ﺍﻟﻬﻭﺭﻣﻭﻧﺎﺕ ﺍﻟﻣﻧﺷﻁﺔ‪ ،‬ﺍﻟﺗﻲ ﻗﻠﻳﻼ ﻣﺎ‬ ‫ﺗﻛﻭﻥ ﺫﺍﺕ ﻓﺎﺋﺩﺓ‪.‬‬ ‫ً‬ ‫ً‬ ‫ً‬ ‫ﺑﻌﺽ ﺍﻟﺣﺎﻻﺕ ﺗﺗﺣﺳﻥ ﺗﻠﻘﺎﺋﻳﺎ ﺑﺎﻟﺗﺩﺭﻳﺞ ﻭﻳﺳﺗﻌﻳﺩ ﺍﻟﻣﺭﺽ ﻋﺎﻓﻳﺗﻪ ﻭﺑﻌﺽ ﺍﻟﺣﺎﻻﺕ ﺗﺄﺧﺫ ﻭﻗﺗﺎ ﻁﻭﻳﻼ )ﻳﺻﻝ ﺇﻟﻰ ﻋﺩﺓ ﺳﻧﻭﺍﺕ( ﻟﻳﻌﻭﺩ‬ ‫ﺗﺩﺭﻳﺟﻳﺎ ً ﺇﻟﻰ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ‪ .‬ﻗﺩ ﻳﻣﻭﺕ ﺍﻟﻣﺭﻳﺽ ﺧﻼﻝ ﻓﺗﺭﺓ ﺍﻟﻣﺭﺽ ﻣﻥ ﻧﺯﻑ ﺣﺎﺩ ﺃﻭ ﺗﻘﻳّﺣﺎﺕ ﺟﺭﺛﻭﻣﻳﺔ ﺃﻭ ﻣﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺷﺩﻳﺩ‪.‬‬ ‫ﺃﺣﻳﺎﻧﺎ ً ﻗﻠﻳﻠﺔ ﻳﻧﻘﻠﺏ ﺍﻟﻣﺭﺽ ﺇﻟﻰ ﻓﻘﺭ ﺩﻡ ﺍﻧﺣﻼﻟﻲ ﺃﻭ ﺇﻟﻰ ﺳﺭﻁﺎﻥ ﺩﻡ ﺣﺎﺩ‪.‬‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ ﻣﻥ ﻫﺫﺍ ﺍﻟﻧﻭﻉ‪ ،‬ﺇﺫﺍ ﻟﻡ ﺗﻧﻔﻊ ﻣﻌﻪ ﺍﻟﻣﻧﺷﻁﺎﺕ ﻭﻁﺎﻝ ﺑﻘﺎﺅﻩ ﻛﺛﻳﺭﺍً ﻣﺎ ﻳُﻌﺎﻟَﺞ ﺑﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺃﻭ ]ﺧﻠﻳﺔ ﺍﻟﺩﻡ ﺍﻟﺟﺫﻋﻳﺔ[‪.‬‬

‫‪ -6‬أﻧﻮاع ﻓﻘﺮ اﻟﺪم اﻷﺧﺮى‬ ‫‪U‬‬

‫ﻗﺩ ﻳﺣﺩﺙ ﻓﻘﺭ ﺩﻡ ﻣﻥ ﺃﺳﺑﺎﺏ ﺃﺧﺭﻯ ﻣﺗﻔﺭﻗﺔ ﻻ ﺗﺩﺧﻝ ﺿﻣﻥ ﺍﻷﻧﻭﺍﻉ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻋﻼﻩ‪ .‬ﻣﻥ ﺫﻟﻙ –ﻣﺛﻼً – ﺣﺻﻭﻝ ﻓﻘﺭ ﺩﻡ )ﻗﺩ ﻳﻛﻭﻥ‬ ‫ﻣﺻﺣﻭﺑﺎ ً ﺑﻧﻘﺹ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء ﻭﺍﻟﺻﻔﻳﺣﺎﺕ( ﺑﺳﺑﺏ ﺍﻟﻁﺣﺎﻝ ﺍﻟﺫﻱ ﻗﺩ ﻳﻛﻭﻥ ﻣﺗﺿﺧﻣﺎ ً ﻗﻠﻳﻼً ﺃﻭ ﻛﺛﻳﺭﺍً ﻷﺳﺑﺎﺏ ﻻ ﻋﻼﻗﺔ ﻟﻬﺎ‬ ‫ﺑﺎﻟﺩﻡ‪.‬‬ ‫ﻳﻧﺷﺄ ﻓﻘﺭ ﺍﻟﺩﻡ ﻣﻥ ﺍﺣﺗﺷﺎء ﺍﻟﻧﺧﺎﻉ ﺍﻷﺣﻣﺭ ﺑﺄﻧﻭﺍﻉ ﻣﺧﺗﻠﻔﺔ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻐﺭﻳﺑﺔ ﻋﻧﻪ‪ ،‬ﻣﻧﻬﺎ ﻣﺎ ﻫﻭ ﺳﺭﻁﺎﻧﻲ ﻣﻧﺗﺷﺭ ﺇﻟﻰ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫ﻣﻥ ﺃﻣﺎﻛﻥ ﺃﺧﺭﻯ ﻓﻲ ﺍﻟﺟﺳﻡ‪ ،‬ﻭﻣﻧﻬﺎ ﻣﺎﻫﻭ ﻏﻳﺭ ﺳﺭﻁﺎﻧﻲ )ﻛﺎﻟﺧﻼﻳﺎ ﺍﻟﻣﻠﺗﻬﻣﺔ ﺍﻟﻣﺣﻣّﻠﺔ ﺑﺄﻧﻭﺍﻉ ﻣﻌﻳﻧﺔ ﻣﻥ ﺍﻟﺩﻫﻭﻥ ﺗﺗﻛﺩّﺱ ﻓﻲ ﺍﻟﺟﺳﻡ‬ ‫ﺑﺳﺑﺏ ﻧﻘﺹ ﻭﺭﺍﺛﻲ ﻓﻲ ﺇﻧﻅﻳﻣﺎﺕ ﻛﻳﻣﻳﺎﻭﻳﺔ ﻣﻌﻳﻧﺔ ﺫﺍﺕ ﻋﻼﻗﺔ ﺑﺗﻠﻙ ﺍﻟﺩﻫﻭﻥ( ﻭﻏﻳﺭﻫﺎ ﻣﻥ ﺍﻟﺧﻼﻳﺎ‪.‬‬ ‫ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﺍﻟﺗﻬﺎﺑﺎﺕ ﻣﺯﻣﻧﺔ )ﻛﺎﻟﺗﺩ ّﺭﻥ( ﺗﺗﺳﺑﺏ ﻓﻲ ﺗﻭﺍﺟﺩ ﺩﺭﻧﺎﺕ ﻓﻲ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻭﺗﺅﺩﻱ ﻟﻧﻔﺱ ﺍﻟﻧﺗﻳﺟﺔ ﺇﺫﺍ ﻛﺎﻥ ﺍﻻﺣﺗﺷﺎء ﺷﺩﻳﺩﺍ‪ً.‬‬

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‫‪U‬‬

‫ﻧﺑﺫﺓ ﻋﻥ ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻭﺧﻠﻳﺔ ﺍﻟﺩﻡ ﺍﻟﺟﺫﻋﻳﺔ‬

‫ﻓﻲ ﺍﻟﺭﺑﻊ ﺍﻷﺧﻳﺭ ﻣﻥ ﺍﻟﻘﺭﻥ ﺍﻟﻣﺎﺿﻲ ﺩﺧﻠﺕ ]ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ[ ﺇﻟﻰ ﺍﻟﻁﺏ ﺍﻟﻌﻼﺟﻲ ﻛﺄﺳﻠﻭﺏ ﻣﺗﻁﻭّ ﺭ ﻣﻥ ﺍﻟﻌﻼﺝ ﻭﻷﻏﺭﺍﺽ‬ ‫ﻣﺗﻌﺩﺩﺓ‪ ،‬ﺛﻡ ﺑﻌﺩﻫﺎ ﺗﺑﻳّﻥ ﺃﻥ ﺍﻟﺧﻠﻳﺔ ﺍﻟﻣﻬﻣﺔ ﻓﻲ ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻫﻲ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺟﺫﻋﻳﺔ ﺍﻟﺗﻲ ﺗﻧﺗﺞ ﻛﻝ ﺃﻧﻭﺍﻉ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﻧﺧﺎﻉ‪.‬‬ ‫ﺛﻡ ﻭُ ﺟﺩﺕ ﻫﺫﻩ ﺍﻟﺧﻠﻳﺔ ﻓﻲ ﺍﻟﺩﻡ ﺑﺄﻋﺩﺍﺩ ﺻﻐﻳﺭﺓ ﺟ ّﺩﺍً‪ .‬ﺑﻌﺩ ﺫﻟﻙ ﺍﺳﺗﻌﻣﻠﺕ ﺃﺟﻬﺯﺓ ﻣﺗﻁﻭﺭﺓ ﻟﻔﺻﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء ﻭﺣﻳﺩﺓ ﻓﺹ ﺍﻟﻧﻭﻯ‬ ‫)ﻭﻣﻥ ﺿﻣﻧﻬﺎ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺟﺫﻋﻳﺔ( ﻣﻥ ﺍﻟﺩﻡ ﻭﺑﺄﻋﺩﺍﺩ ﺗﺟﻌﻠﻬﺎ ﻛﺎﻓﻳﺔ ﻟﻠﺯﺭﺍﻋﺔ ﻭﺃﺻﺑﺣﺕ ﺑﺎﻟﺗﺩﺭﻳﺞ ﺗﺣﻝ ﻣﺣﻝ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻷﻏﺭﺍﺽ‬ ‫ﺍﻟﺯﺭﺍﻋﺔ‪.‬‬ ‫ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ )ﺃﻭ ﺧﻠﻳﺔ ﺍﻟﺩﻡ ﺍﻟﺟﺫﻋﻳﺔ( ﺗﺅﺧﺫ ﻣﻥ ﺃﺣﺩ ﺇﺧﻭﺓ ﺍﻟﻣﺭﻳﺽ ﺃﻭ ﺃﻗﺭﺑﺎﺋﻪ ﺍﻟﻣﻁﺎﺑﻘﻳﻥ ﻟﻪ ﻓﻲ ]ﺍﻟﻔﺻﺎﺋﻝ ﺍﻟﻧﺳﺟﻳﺔ[ )ﻭﻫﻲ ﻏﻳﺭ‬ ‫ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ(‪ .‬ﺃﺣﻳﺎﻧﺎ ً ﻳﺅﺧﺫ ﻣﻥ ﺷﺧﺹ ﻏﻳﺭ ﻗﺭﻳﺏ‪ ،‬ﺇﺫﺍ ﺛﺑﺗﺕ ﻣﻁﺎﺑﻘﺗﻪ ﻟﻠﻣﺭﻳﺽ ﺑﺎﻟﻔﺻﺎﺋﻝ ﺍﻟﻧﺳﺟﻳﺔ ﻭﺗﻌﺫﺭ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ ﻗﺭﻳﺏ‬ ‫ﻣﻁﺎﺑﻕ‪ .‬ﻛﻣﺎ ﺃﻥ ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﻳﺅﺧﺫ ﻓﻳﻬﺎ ﺍﻟﻧﺧﺎﻉ‪ ،‬ﺃﻭ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺟﺫﻋﻳﺔ ﺍﻟﻣﺭﻛﺯﺓ‪ ،‬ﻣﻥ ﺍﻟﻣﺭﻳﺽ ﻧﻔﺳﻪ ﻭﻳﺣﻔﻅ ﻣﺟﻣّﺩﺍً ﻟﻳُﺯﺭﻉ ﻓﻲ‬ ‫ﻭﻗﺕ ﻻﺣﻕ )ﺍﻧﻅﺭ ﺍﻟﺷﻛﻝ ‪ 15‬ﻭﺍﻟﺷﻛﻝ ‪.(16‬‬ ‫ﻭُ ﺟﺩ ﺑﻌﺩ ﺫﻟﻙ ﺃﻥ ﺩﻡ ﺍﻟﺣﺑﻝ ﺍﻟﺳﺭﻱ ﻳﺣﻭﻱ ﻋﺩﺩﺍً ﺟﻳّﺩﺍً ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﺍﻟﻧﺷﻁﺔ ﻓﺄﺿﻳﻑ ﻫﺫﺍ ﺍﻟﻣﺻﺩﺭ ﺇﻟﻰ ﺍﻟﻣﺻﺩﺭﻳﻥ ﺍﻵﺧﺭﻳْﻥ‬ ‫ﻟﻠﺧﻠﻳﺔ ﺍﻟﺟﺫﻋﻳﺔ‪.‬‬ ‫ﻳﺗﻡ ﺃﻭﻻً ﺍﻟﻘﺿﺎء ﺍﻟﺗﺎﻡ ﻋﻠﻰ ﻧﺧﺎﻉ ﻋﻅﻡ ﺍﻟﻣﺭﻳﺽ ﺑﺎﻟﻌﻘﺎﺭﺍﺕ ﺍﻟﻛﻳﻣﻳﺎﻭﻳﺔ‪ ،‬ﻣﻊ ﺃﻭ ﺑﺩﻭﻥ ﺇﺷﻌﺎﻉ ﻟﻛﺎﻣﻝ ﺍﻟﺟﺳﻡ‪ .‬ﺍﻷﺧﻳﺭ ﻫﻭ ﻟﻠﻘﺿﺎء‬ ‫ﻋﻠﻰ ﺍﻟﺟﻬﺎﺯ ﺍﻟﻣﻧﺎﻋﻲ ﻟﻠﻣﺭﻳﺽ ﺣﺗﻰ ﻻ ﻳﻠﻔﻅ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﺍﻟﻣﺯﺭﻭﻋﺔ‪.‬‬ ‫ﻳﻌﻁﻰ ﺍﻟﻧﺧﺎﻉ‪ ،‬ﺃﻭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ‪ ،‬ﻣﻥ ﺃﻱ ﻣﻥ ﺍﻟﻣﺻﺎﺩﺭ ﺟﺎءﺕ‪ ،‬ﻟﻠﻣﺭﻳﺽ ﺑﺎﻟﻭﺭﻳﺩ ﻭﺗﺫﻫﺏ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﻟﺗﺳﺗﻘﺭ ﻓﻲ ﺩﺍﺧﻝ‬ ‫ﻋﻅﺎﻡ ﺍﻟﻣﺭﻳﺽ ﻟﺗﺑﻧﻲ ﻧﺧﺎﻋﺎ ً ﺟﺩﻳﺩﺍً ﻳﺣﻣﻝ ﻛﻝ ﺑﺻﻣﺎﺕ ﺍﻟﻣﺗﺑﺭﻉ‪.‬‬

‫ﺍﻻﺣﺗﻣﺎﻝ ﺍﻷﻭﻝ‬ ‫‪U‬‬

‫ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ )ﺃﻭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ(‬ ‫ﺯﺭﻉ ﻧﺧﺎﻉ‬ ‫ﻣﻥ ﺷﺧﺹ‬ ‫ﺁﺧﺭ‬

‫ﻋﻼﺝ ﺑﺎﻟﻛﻳﻣﻳﺎﻭﻳﺎﺕ ﻭ ﺍﻹﺷﻌﺎﻉ‬ ‫ﻣﻭﺕ ﺧﻼﻳﺎ‬ ‫ﺍﻟﻧﺧﺎﻉ ﺑﻣﺎ‬ ‫ﻓﻳﻬﺎ ﻣﻥ‬ ‫ﻣﺭﺽ‬

‫ﻧﺧﺎﻉ ﻓﻳﻪ‬ ‫ﺳﺭﻁﺎﻥ ﺃﻭ‬ ‫ﻣﺭﺽ ﺁﺧﺭ‬

‫ﻧﺧﺎﻉ ﺟﺩﻳﺩ‬ ‫ﻁﺑﻳﻌﻲ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -15‬ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻣﻥ ﻣﺗﺑﺭﻉ ﻁﺑﻳﻌﻲ ﺇﻟﻰ ﺍﻟﻣﺭﻳﺽ‬ ‫‪U‬‬

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‫ﺍﻻﺣﺗﻣﺎﻝ ﺍﻟﺛﺎﻧﻲ‬ ‫‪U‬‬

‫ﺳﺣﺏ ﻧﺧﺎﻉ ﻭﺣﻔﻅﻪ‬ ‫ﻣﺟﻣﺩﺍً‬

‫ﻣﻭﺕ ﺧﻼﻳﺎ‬ ‫ﺍﻟﻧﺧﺎﻉ‬

‫ﻧﺧﺎﻉ ﻁﺑﻳﻌﻲ‬

‫ﻧﺧﺎﻉ ﻁﺑﻳﻌﻲ‬ ‫ﻛﻳﻣﻳﺎﻭﻳﺎﺕ ﺷﺩﻳﺩﺓ ﻭﺇﺷﻌﺎﻉ ﻟﻘﺗﻝ ﺍﻟﺳﺭﻁﺎﻥ‪ ،‬ﺗﺅﺛﺭ ﻋﻠﻰ ﺍﻟﻧﺧﺎﻉ ﺃﻳﺿﺎ ً‬

‫ﺳﺭﻁﺎﻥ‬ ‫ﺧﺎﺭﺝ‬ ‫ﻧﺧﺎﻉ‬ ‫ﺍﻟﻌﻅﻡ‬

‫ﺯﺭﻉ‬ ‫ﺍﻟﻧﺧﺎﻉ‬ ‫ﺍﻟﻣﺣﻔﻭﻅ‬

‫ﻧﺧﺎﻉ ﺟﺩﻳﺩ ﻁﺑﻳﻌﻲ‬

‫ﺳﺭﻁﺎﻥ‬ ‫ﺧﺎﺭﺝ‬ ‫ﻧﺧﺎﻉ‬ ‫ﺍﻟﻌﻅﻡ‬

‫ﺍﺧﺗﻔﺎء‬ ‫ﺍﻟﺳﺭﻁﺎﻥ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪ -16‬ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺃﻭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﻣﻥ ﺍﻟﻣﺭﻳﺽ ﺇﻟﻰ ﻧﻔﺳﻪ‬ ‫‪U‬‬

‫ﺇﻥ ﻋﻣﻠﻳﺔ ﺯﺭﻉ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺃﻭ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﻫﻲ ﻋﻣﻠﻳﺔ ﺻﻌﺑﺔ ﻋﻠﻰ ﺍﻟﻣﺭﻳﺽ ﻭﻋﻠﻰ ﺍﻟﻁﺑﻳﺏ ﻭﻋﻠﻰ ﺍﻟﻣﻣ ّﺭﺽ‪ .‬ﻓﺎﻟﻣﺭﻳﺽ ﻳﻣﺭ‬ ‫ﺑﻣﺭﺍﺣﻝ ﺧﻁﺭﺓ ﻭﻳﺣﺗﺎﺝ ﺇﻟﻰ ﺭﻋﺎﻳﺔ ﻣﺭ ّﻛﺯﺓ ﻭﻋﺯﻝ ﻟﻔﺗﺭﺓ ﺃﺳﺎﺑﻳﻊ ﺣﺗﻰ ﻳﺗﻡ ﺍﻧﺯﺭﺍﻉ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﻟﺗﻌﻳﺩ ﺇﻧﺷﺎء ﻧﺧﺎﻉ ﻋﻅﻡ ﻓﻲ‬ ‫ﻣﺣﻝ ﺍﻟﻧﺧﺎﻉ ﺍﻟﺫﻱ ﻗُﺿﻲ ﻋﻠﻳﻪ ﻣﺳﺑﻘﺎ ً ﻭﻳﻘﻭﻡ ﻫﺫﺍ ﺍﻟﻧﺧﺎﻉ )ﻭﺍﻟﺫﻱ ﻳﺷﺑﻪ ﻧﺧﺎﻉ ﺍﻟﻣﺗﺑﺭﻉ( ﺑﺈﻧﺗﺎﺝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺑﺄﻧﻭﺍﻋﻬﺎ ﻭﺑﻛﻣﻳﺎﺕ ﺟﻳّﺩﺓ‪.‬‬ ‫ﺇﻥ ﻫﺫﻩ ﺍﻟﻌﻣﻠﻳﺔ ﻣﺣﺎﻁﺔ ﺑﺄﺧﻁﺎﺭ ﺍﻟﻔﺷﻝ ﺇﺫﺍ ﻟﻔﻅ ﺟﺳﻡ ﺍﻟﻣﺭﻳﺽ ﺍﻟﻧﺧﺎﻉ ﺍﻟﻣﺯﺭﻭﻉ‪ ،‬ﺃﻭ ﺇﺫﺍ ﻗﺎﻣﺕ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﻧﺎﻋﻳﺔ ﻓﻲ ﺍﻟﻧﺧﺎﻉ‬ ‫ﺍﻟﻣﺯﺭﻭﻉ )ﺃﻭ ﻓﻲ ﻣﺭ ّﻛﺯ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺫﻋﻳﺔ ﻣﻥ ﺍﻟﺩﻡ( ﺑﺎﻟﺗﻛﺎﺛﺭ ﺛﻡ ﻫﺎﺟﻣﺕ ﺧﻼﻳﺎ ﺍﻟﺟﺳﻡ ﺍﻟﻣﺯﺭﻭﻋﺔ ﻓﻳﻪ‪ .‬ﻭﻣﻊ ﻛﻝ ﺗﻠﻙ ﺍﻟﻣﺷﺎﻛﻝ‬ ‫)ﻭﻏﻳﺭﻫﺎ ﺍﻟﻛﺛﻳﺭ( ﻓﺈﻥ ﻧﺟﺎﺡ ﻋﻣﻠﻳﺔ ﺍﻟﺯﺭﺍﻋﺔ ﻳﻛﻭﻥ ﺗﺄﺛﻳﺭﻩ ﻋﻅﻳﻣﺎ ً ﻓﻘﺩ ﻳﺗﺧﻠﺹ ﺍﻟﻣﺭﻳﺽ ﻣﻥ ﺳﺭﻁﺎﻥ ﻋﻧﺩﻩ‪ ،‬ﻭﻗﺩ ﻳﻧﺗﻬﻲ ﻧﻘﺹ ﻓﻲ‬ ‫ﺍﻟﻣﻧﺎﻋﺔ ﺃﻭ ﻓﻲ ﻓﺷﻝ ﻓﻲ ﺍﻟﻧﺧﺎﻉ ﻭﻳﺗﻌﻭﺽ ﺑﻧﺧﺎﻉ ﺻﺣﻲ ﻭ ُﺗﻛﺗﺏ ﻟﻠﻣﺭﻳﺽ ﺣﻳﺎﺓ ﺟﺩﻳﺩﺓ‪.‬‬

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‫ﻣﻌﺟﻡ ﺍﻟﻣﺻﻁﻠﺣﺎﺕ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻲ ﺍﻟﻛﺗﺎﺏ ﺣﺳﺏ ﺗﺳﻠﺳﻝ ﻭﺭﻭﺩﻫﺎ‬ ‫اﻟﻤﺼﻄﻠﺢ اﻟﻌﺮﺑﻲ‬ ‫ﺗﺟﻠّﻁ ﺩﻣﻭﻱ‬ ‫ﺍﻟﺳﺎﺋﻝ ﺍﻟﺻﻭﺭﻱ‬ ‫ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩّﺓ‬ ‫ﺧﻳﻁﻳﻥ ﺃﻭ ﻓﺑﺭﻳﻥ‬ ‫ﺧﺿﺎﺏ‪ ،‬ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫ﻣﺗﻌﺎﺩﻟﺔ ﺍﻟﺣﺑﻳﺑﺎﺕ‪ ،‬ﻣﺗﻌﺩﺩﺓ‬ ‫ﻓﺻﻭﺹ ﺍﻟﻧﻭﺍﺓ‬ ‫ﻗﺎﻋﺩﻳﺔ ﺍﻟﺣﺑﻳﺑﺎﺕ‪ ،‬ﻣﺗﻌﺩﺩﺓ‬ ‫ﻓﺻﻭﺹ ﺍﻟﻧﻭﺍﺓ‬ ‫ﺧﻠﻳﺔ ﻟﻣﻔﻳﺔ‬ ‫ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺍﻷﺣﻣﺭ‬ ‫ﺍﻟﻛﺑﺩ‬ ‫ﺍﻟﻐﺩّﺓ ﺍﻟﺳﻌﺗﺭﻳّﺔ‬ ‫ﺍﻷﻧﻅﻳﻣﺎﺕ ﺃﻭ ﺍﻟﺧﻣﺎﺋﺭ‬ ‫ﺧﻼﻳﺎ ﻣﻠﺗﻬﻣﺔ‬ ‫ﺍﻧﺣﻼﻝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‬ ‫ﺳﻠﺳﻠﺔ ﺃ‬ ‫ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺃ‬ ‫ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﻑ‬ ‫ﺳﻠﺳﻠﺔ ﺩ‬ ‫ﺑﻭﺭﻓﻳﺭﻳﻥ‬ ‫ﺃﺭﻭﻣﺔ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺍﻟﺻﻔﺭﺍء‬ ‫ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪12‬‬ ‫ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪6‬‬ ‫ﻣﻔﻌّﻼﺕ ﺧﻠﻭﻳﺔ‬ ‫ﻳﺭﻗﺎﻥ‬ ‫َ‬ ‫ﺍﻟﻌﻼﻣﺎﺕ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻣﺯﻣﻥ‬ ‫ﺻﺩﻣﺔ ﺩﻭﺭﺍﻧﻳﺔ‬

‫ﻣﺭﺽ ﺯﻳﺎﺩﺓ ﺻﺑﻐﺔ ﺍﻟﺩﻡ‬ ‫ﺍﻟﻭﺭﺍﺛﻲ‬

‫ﻣﻌﺩّﻝ ﺣﺟﻡ ﺍﻟﺧﻠﻳﺔ‬ ‫ﺍﻟﺣﻣﺭﺍء‬ ‫ﻣﻌﺩّﻝ ﺗﺭﻛﻳﺯ‬

‫اﻟﻤﺼﻄﻠﺢ اﻟﻌﺮﺑﻲ‬ ‫ّ‬ ‫ﺗﺧﺛﺭ ﺍﻟﺩﻡ‬ ‫ﺃﻟﺑﻭﻣﻳﻥ‪ ،‬ﺯﻻﻝ‬ ‫ﻣﺻﻝ ﺍﻟﺩﻡ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺑﻳﺿﺎء‬

‫‪/‬‬ ‫ﻣﺎﻳﻘـﺎﺑﻠﻪ ﻓﻲ اﻟﻠﻐﺔ اﻹﻧﻜﻠﻴﺰﻳﺔ‬ ‫‪/ Thrombosis‬‬ ‫‪/ Plasma‬‬ ‫‪/ Antibodies‬‬ ‫‪Fibrin‬‬ ‫‪Hemoglobin‬‬ ‫ﺣﻣﺿﻳﺔ ﺍﻟﺣﺑﻳﺑﺎﺕ‪ ،‬ﻣﺗﻌﺩﺩﺓ‬ ‫‪Neutrophil‬‬ ‫ﻓﺻﻭﺹ ﺍﻟﻧﻭﺍﺓ‬ ‫‪Granulocyte‬‬ ‫ﻭﺣﻳﺩﺓ ﻓﺹ ﺍﻟﻧﻭﻯ‬ ‫‪Basophil Granulocyte‬‬ ‫ﻣﺳﺗﺿﺩّﺍﺕ‬ ‫ﺷﻌﻳﺭﺍﺕ ﺩﻣﻭﻳﺔ‪ ،‬ﻋﺭﻭﻕ‬ ‫ﺷﻌﺭﻳﺔ‬ ‫ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﺍﻷﺑﻳﺽ‬ ‫ﺍﻟﻁﺣﺎﻝ‬ ‫ﺍﻟﻌﻘﺩ ﺍﻟﻠﻣﻔﻳﺔ‬ ‫ﻣﺳﺎﻋﺩﺍﺕ ﺍﻷﻧﻅﻳﻣﺎﺕ‬ ‫ﻧﺯﻑ ﺍﻟﺩﻡ‬ ‫ﺍﻷﺣﻣﺎﺽ ﺍﻷﻣﻳﻧﻳﺔ‬ ‫ﺳﻠﺳﻠﺔ ﺏ‬ ‫ﺳﻠﺳﻠﺔ ﺝ‬ ‫ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺃ‪2‬‬ ‫ﻗﺎﻋﺩﺓ ﻧﺎﻳﺗﺭﻭﺟﻳﻧﻳﺔ‬ ‫ﺣﺩﻳﺩﻭﺯ‬

‫‪Lymphocyte‬‬ ‫‪Blood Platelets‬‬ ‫‪Red Bone Marrow‬‬ ‫‪Liver‬‬ ‫‪Thymus‬‬ ‫‪Enzymes‬‬ ‫‪Phagocytes‬‬ ‫‪Hemolysis‬‬ ‫‪α polypeptide chain‬‬ ‫‪Hemoglobin A‬‬ ‫‪Hemoglobin F‬‬ ‫‪λ polypeptide chain‬‬ ‫‪Porphyrin‬‬ ‫‪Erythroblast‬‬ ‫‪Bilirubin‬‬ ‫‪Vitamin B12‬‬ ‫‪Vitamin B6‬‬ ‫‪Cytokines‬‬ ‫‪Jaundice‬‬ ‫‪Signs‬‬ ‫‪Chronic anemia‬‬

‫ﺍﻷﺭﻭﻣﺎﺕ‪ ،‬ﺍﻟﺧﻼﻳﺎ ﺍﻷﺭﻭﻣﻳﺔ‬

‫ﺍﻟﻣﺭﺍﺭﺓ‬ ‫ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ‬ ‫ﻫﻭﺭﻣﻭﻥ ﻣﻭﻟّﺩ ﺍﻟﺣﻣﺭﺍء‬ ‫ﻋﻭﺍﻣﻝ ﻣﺎﺑﻳﻥ ﺍﻟﺧﻼﻳﺎ‬ ‫ﺍﻷﻋﺭﺍﺽ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ‬

‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺍﻟﻣﺭﺻﻭﺻﺔ‬

‫‪Circulatory shock‬‬ ‫‪Hereditary‬‬ ‫‪hemachromatosis‬‬

‫‪Mean Cell Volume‬‬ ‫)‪(MCV‬‬ ‫‪Mean Cell Hemoglobin‬‬

‫‪Monocyte‬‬ ‫‪Antigens‬‬ ‫‪Blood Capillaries‬‬ ‫‪White Bone Marrow‬‬ ‫‪Spleen‬‬ ‫‪Lymph Nodes‬‬ ‫‪Co-enzymes‬‬ ‫‪Bleeding‬‬ ‫‪Amino Acids‬‬ ‫‪β polypeptide chain‬‬ ‫‪γ polypeptide chain‬‬ ‫‪Hemoglobin A2‬‬ ‫‪Nitrogen Base‬‬ ‫‪Ferrous‬‬ ‫‪Blast cells‬‬ ‫‪Gall Bladder‬‬ ‫‪Folic Acid‬‬ ‫‪Erythropoietin‬‬ ‫‪Interleukins‬‬ ‫‪Symptoms‬‬ ‫‪Anemia‬‬

‫‪Packed red cell volume‬‬ ‫)‪(PCV), or hematocrit (HCT‬‬

‫ﺍﻟﺟﻔﺎﻑ‬ ‫ﻛﺑﺭﻳﺗﺎﺕ ﺍﻟﺣﺩﻳﺩﻭﺯ‬

‫‪Dehydration‬‬ ‫‪Ferrous Sulphate, FeSO4‬‬

‫ﻓﻣﺗﻭﻟﺗﺭ‬

‫‪Femto liter (1 of million‬‬ ‫)‪million of a liter‬‬ ‫‪Mean Cell Hemoglobin‬‬

‫ﻣﺣﺗﻭﻯ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫‪42‬‬

‫ﻣﺎ ﻳﻘـﺎﺑﻠﻪ ﻓﻲ اﻟﻠﻐﺔ اﻹﻧﻜﻠﻴﺰﻳﺔ‬ ‫‪Clotting‬‬ ‫‪Albumin‬‬ ‫‪Serum‬‬ ‫)‪Red Blood cells (RBCs‬‬ ‫)‪White Blood cells (WBCs‬‬ ‫‪Eosinophil Granulocyte‬‬

‫)‪concentration (MCHC‬‬ ‫‪Macrocytic Anemia‬‬ ‫‪Pernicious Anemia‬‬ ‫‪Radio-isotopes‬‬ ‫‪Spherocyte‬‬ ‫‪Ovalocyte‬‬ ‫‪Sickle Cell Anemia‬‬ ‫‪Gene‬‬

‫ﻣﻭﺭّﺙ ﻫﺟﻳﻧﻳﻲ‬ ‫ﺃﻧﻅﻳﻡ ﻧﺯﻉ ﺍﻟﻬﺎﻳﺩﺭﻭﺟﻳﻥ‬ ‫ﻣﻥ ﻓﻭﺳﻔﺎﺕ‪-6-‬ﻏﻠﻭﻛﻭﺯ‬

‫‪Heterozygous‬‬ ‫‪Glucose-6-Phosphate‬‬ ‫)‪Dehydrogenase (G6PD‬‬

‫ﺍﻟﺧﻠﻭﻱ‬ ‫ﺍﻟﻌﺎﻣﻝ ﺍﻟﺩﺍﺧﻠﻲ‬ ‫ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪6‬‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺷﺑﻛﻳﺔ‬ ‫ﻣﺭﺽ ﺍﻟﺗﺷﻭﻩ ﺍﻟﻛﺭﻭﻱ‬ ‫ﻣﺭﺽ ﺍﻟﺗﺷﻭﻩ ﺍﻟﺑﻳﺿﻭﻱ‬ ‫ﺣﺎﻣﺽ ﺃﻣﻳﻧﻲ‬ ‫ﻓﻘﺭ ﺩﻡ ﺍﻟﺑﺣﺭ ﺍﻟﻣﺗﻭﺳﻁ‬ ‫)ﺛﺎﻻﺳﻳﻣﻳﺎ(‬ ‫ﻣﻭﺭّﺙ ﻧﻘﻲ‬

‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺧﻠﻭﻱ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ ﻛﺑﻳﺭ ﺍﻟﺧﻼﻳﺎ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺧﺑﻳﺙ‬ ‫ﺍﻟﻧﻅﺎﺋﺭ ﺍﻟﻣﺷﻌّﺔ‬ ‫ﺧﻠﻳﺔ ﻛﺭﻭﻳﺔ‬ ‫ﺧﻠﻳﺔ ﺑﻳﺿﻭﻳﺔ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻣﻧﺟﻠﻲ‬ ‫ﻣﻭﺭّ ﺙ‬

‫ﺻﺑﻐﻳﺔ ﺍﻟﺟﻧﺱ‬ ‫ﻧﻭﺑﺎﺕ ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ ﺍﻟﺑﻭﻝ‬ ‫ﺍﻟﻣﺳﺎﺋﻲ‬ ‫ﻣﺳﺗﺿﺩّﺍﺕ‬ ‫ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻣﻭﻟﺩﺓ‬ ‫ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ‬ ‫ﻣﺭﺽ ﺍﻟﺫﺋﺏ ﺍﻻﺣﻣﺭﺍﺭﻱ‬ ‫ﻋﺟﺯ ﺍﻟﻛﻠﻳﺗﻳﻥ ﺍﻟﻣﺯﻣﻥ‬ ‫ﻏﺳﻳﻝ ﺍﻟﻛﻠﻰ‬ ‫ﺍﻟﻛﻭﺭﺗﻳﺯﻭﻝ‬

‫‪Sex (X) chromosome‬‬ ‫‪Paroxysmal Nocturnal‬‬ ‫)‪Hemoglobinuria (PNH‬‬ ‫‪Antigens‬‬ ‫‪Immune Antibodies‬‬ ‫‪Hemolytic Disease of‬‬ ‫‪the Newborn‬‬ ‫‪Auto-immune Diseases‬‬ ‫‪Lupus Erythematosus‬‬ ‫‪Chronic Renal Failure‬‬ ‫‪Renal Dialysis‬‬ ‫‪Cortisol‬‬

‫ﻣﺗﻣﻣﺎﺕ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‬

‫ﺃﻣﺭﺍﺽ ﺍﻷﻧﺳﺟﺔ ﺍﻟﺭﺍﺑﻁﺔ‬

‫‪Collagen Diseases‬‬

‫ﺃﻣﺭﺍﺽ ﺍﻟﻣﻧﺎﻋﺔ ﺫﺍﺗﻳﺔ ﺍﻟﺿﺩ‬

‫ﻗﻠﺔ ﺍﻹﻧﺗﺎﺝ ﻓﻲ ﻧﺧﺎﻉ‬ ‫ﺍﻟﻌﻅﻡ‬ ‫ﺍﻟﻌﻼﺝ ﺍﻟﻛﻳﻣﻳﺎﻭﻱ‬

‫ﺍﻟﺗﺟﺯﺋﺔ ﺍﻟﻛﻬﺭﺑﺎﺋﻳﺔ‬ ‫ﻟﻠﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ )ﺍﻟﺭﺣﻼﻥ‬ ‫ﺍﻟﻛﻬﺭﺑﺎﺋﻲ(‬

‫ﺍﻟﻣﺿﺎﺩﺍﺕ‪ ،‬ﺍﻷﺟﺳﺎﻡ‬ ‫ﺍﻟﻣﺿﺎﺩﺓ‬ ‫ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ‬ ‫ﺃﺟﺳﺎﻡ ﺫﺍﺗﻳﺔ ﺍﻟﺿﺩ‬ ‫ﺗﺣﻔﻳﺯ‬

‫‪Aplastic Anemia‬‬ ‫‪Chemotherapy‬‬

‫‪43‬‬

‫)‪(MCH‬‬ ‫‪Internal Factor‬‬ ‫)‪Vitamin B6 (Pyridoxine‬‬ ‫‪Reticulocytes‬‬ ‫‪Spherocytosis‬‬ ‫‪Ovalocytosis‬‬ ‫‪Amino Acid‬‬ ‫‪Thalassemia‬‬ ‫‪Homozygous‬‬ ‫‪Hemoglobin‬‬ ‫‪Electrophoresis‬‬ ‫‪Complement‬‬ ‫‪Antibodies‬‬ ‫‪Blood Groups‬‬ ‫‪Auto antibodies‬‬ ‫‪Immunization‬‬

‫ﺍﻟﺳﺭﻁﺎﻥ ﺍﻟﻠﻣﻔﺎﻭﻱ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺛﺎﻧﻭﻱ‬ ‫ﻫﻧﺩﺳﺔ ﺍﻟﻣﻭﺭّﺛﺎﺕ‬ ‫ﺍﻟﻐﺩﺓ ﺍﻟﻛﻅﺭﻳﺔ‬ ‫ﺗﺷﻣّﻊ ﺍﻟﻛﺑﺩ‬

‫‪Lymphoma‬‬ ‫‪Secondary Anemia‬‬ ‫‪Genetic Engineering‬‬ ‫‪Adrenal Gland‬‬ ‫‪Liver Cirrhosis‬‬

‫ﻣﺭﺽ ﺷﺑﻳﻪ ﺍﻟﺭﺛﻳﺔ‬ ‫ﺍﻟﻣﻔﺻﻠﻲ‬ ‫ﺍﻟﻣﺿﺎﺩ ﺍﻟﺣﻳﺎﺗﻲ‬

‫‪Rheumatoid Arthritis‬‬ ‫‪Antibiotic‬‬

‫ﺧﻠﻳﺔ ﺟﺫﻋﻳﺔ‬

‫‪Stem Cell‬‬

‫ﻣﺭﺍﺟـــــﻊ ﺍﻟﻛﺗﺎﺏ‬ U

‫ ﻣﻧﻅﻣﺔ‬.‫ ﻣﺣﻣﺩ ﻫﻳﺛﻡ ﺍﻟﺧﻳﺎﻁ‬-2006 ‫ ﻋﺭﺑﻲ –ﺍﻟﻁﺑﻌﺔ ﺍﻟﺭﺍﺑﻌﺔ‬،‫ ﺇﻧﻛﻠﻳﺯﻱ‬:‫• ﺍﻟﻣﻌﺟﻡ ﺍﻟﻁﺑﻲ ﺍﻟﻣﻭﺣﺩ‬ .‫ ﻣﻛﺗﺑﺔ ﻟﺑﻧﺎﻥ ﻧﺎﺷﺭﻭﻥ‬.‫ ﺍﻟﻣﻛﺗﺏ ﺍﻹﻗﻠﻳﻣﻲ ﻟﺷﺭﻕ ﺍﻟﻣﺗﻭﺳﻁ‬:‫ﺍﻟﺻﺣﺔ ﺍﻟﻌﺎﻟﻣﻳﺔ‬ * Barbara Bain. (Ed.), Blood Cells. A Practical Guide. IB Lippincott Co. Philadelphia , 1989 * Cant AJ, Galloway A and Jackson G. Practical Haemopoietic Stem Cell Transplantation. 2007. Blackwell Publishing. * Dacie JV & Lewis SM. Practical Haematology. Ninth Edition, 2001, Churchil Livingstone. * Hollannd B, Unwin ID & Buss DH. The Composition of Foods, Fruits & Nuts.

The Royal Society of Chemistry, Cambridge, UK. 1992 * Lee GR, Bithell TC, Foerster J, Athens JW & Lukens JN- in Wintrobe, Clinical Hematology, 9th Edition 1993. Lee & Febiger. * Miale,JB. Laboratory Medicine-Haematology. 5th edition, 1977. CB Mosby Company. * Mollison PL. Blood Transfusion in Clinical Medicine. 6th Edition, 1979.

Blackwell Scientific Publications. * Rodak BF, Fristima GA and Keohane EM.(ED.) Hematology, Clinical Principles and Application. 4th edition 2011. Elsevier Saunders. * Rossi EC, Simon TL & Moss GS (Ed.) Principles of Transfusion Medicine, 1991.

Williams & Wilkins. * Swedish National Institute for Public Health Bulletin. 1967 * Thomas L. (Ed). Clinical Laboratory Diagnostics. 1st English Edition 1998. TH Books.

44

* WHO Requirements of Ascorbic Acid, Vitamin D, Vitamin B12 & Iron. WHO Technical report, 1970.

-

45

‫‪U‬‬

‫ﻓﻬﺭﺳﺕ ﺍﻟﻛﺗﺎﺏ‬

‫ﺍﻟﻣﻭﺿﻭﻉ‬ ‫‪U‬‬

‫ﺍﻟﺻﻔﺣﺔ‬ ‫‪U‬‬

‫‪U‬‬

‫ﻣﻘﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ‬

‫‪2‬‬

‫ﻣﻘﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻧﻳﺔ‬

‫‪4‬‬

‫ﻣﻘﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻟﺛﺔ‬

‫‪6‬‬

‫ﺍﻟﻔﺻﻝ ﺍﻷﻭﻝ‬ ‫ﻣﻛﻭﻧﺎﺕ ﺍﻟﺩﻡ‬

‫‪8‬‬

‫ﺍﻟﺑﻼﺯﻣﺎ ﻭﻣﺻﻝ ﺍﻟﺩﻡ‬

‫‪8‬‬

‫ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺃﻭ ﺣﺟﻳﺭﺍﺗﻪ‬

‫‪9‬‬

‫ﺃﺻﻝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﻭﻣﻭﺍﺿﻊ ﺗﺧﻠّﻘﻬﺎ‬

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‫ﺗﻔﺻﻳﻝ ﻋﻥ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء‬

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‫ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬

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‫ﺍﻟﻔﺻﻝ ﺍﻟﺛﺎﻧﻲ‬ ‫ﻓﻘﺭ ﺍﻟﺩﻡ‪ -‬ﻣﻧﺎﻗﺷﺔ ﻋﺎﻣﺔ‬

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‫ﺍﻟﻛﺷﻑ ﻋﻥ ﻓﻘﺭ ﺍﻟﺩﻡ ﻣﺧﺑﺭﻳﺎ ً‬

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‫ﺍﻟﻔﺻﻝ ﺍﻟﺛﺎﻟﺙ‬ ‫ﺗﺻﻧﻳﻑ ﻓﻘﺭ ﺍﻟﺩﻡ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﻧﺯﻑ ﺣﺎﺩ ﺷﺩﻳﺩ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‬

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‫ﺃﺳﺑﺎﺏ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‬

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‫ﺍﻟﻭﻗﺎﻳﺔ ﻭﺍﻟﻌﻼﺝ ﻟﻔﻘﺭﺩﻡ ﻧﻘﺹ ﺍﻟﺣﺩﻳﺩ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﺏ‪ 12‬ﻭﻓﻳﺗﺎﻣﻳﻥ ﺣﺎﻣﺽ ﻓﻭﻟﻳﻙ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﻧﻘﺹ ﻣﺯﺩﻭﺝ‬

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‫ﻓﻘﺭ ﺩﻡ ﻧﺎﺷﺊ ﻋﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺃﺧﺭﻯ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻣﻭﺭﻭﺙ‬

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‫ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﻣﺗﺳﺑﺑﺔ ﻋﻥ ﻭﺟﻭﺩ ﺧﻠﻝ ﻓﻲ ﺟﺩﺍﺭ ﺍﻟﺧﻠﻳﺔ ﺍﻟﺣﻣﺭﺍء‬

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‫ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﻣﺗﺳﺑﺑﺔ ﻋﻥ ﻭﺟﻭﺩ ﺧﻠﻝ ﺗﺭﻛﻳﺑﻲ ﺃﻭ ﺇﻧﺗﺎﺟﻲ ﻓﻲ ﺟﺯﻳﺋﺔ ﺍﻟﻬﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬

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‫ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﻣﺗﺳﺑﺑﺔ ﻋﻥ ﻧﻘﺹ ﺇﻧﻅﻳﻣﺎﺕ ﻣﻌﻳّﻧﺔ ﻓﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻣﻛﺗﺳﺏ‬

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‫ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻟﺭﺋﻳﺳﻳﺔ ﻭﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻬﺎ‬

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‫ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻬﺎ‬

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‫ﺍﻧﺣﻼﻝ ﺩﻡ ﺍﻟﻭﻟﻳﺩ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺫﺍﺗﻳﺔ‬

‫‪37‬‬

‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻻﻧﺣﻼﻟﻲ ﺍﻟﻧﺎﺷﺊ ﻋﻥ ﺃﺳﺑﺎﺏ ﺃﺧﺭﻯ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﺛﺎﻧﻭﻱ‬

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‫ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﻧﻘﺹ ﺍﻹﻧﺗﺎﺝ ﻓﻲ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬

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‫ﺃﻧﻭﺍﻉ ﻓﻘﺭ ﺍﻟﺩﻡ ﺍﻷﺧﺭﻯ‬

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‫ﻧﺑﺫﺓ ﻋﻥ ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻭﺧﻠﻳﺔ ﺍﻟﺩﻡ ﺍﻟﺟﺫﻋﻳﺔ‬

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‫ﻣﻌﺟﻡ ﺍﻟﻣﺻﻁﻠﺣﺎﺕ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻲ ﺍﻟﻛﺗﺎﺏ‬

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‫ﻣﺭﺍﺟﻊ ﺍﻟﻛﺗﺎﺏ‬

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