كتاب تخثر الدم الطبعة الثانية

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‫ﺗﺧﺛﺭ ﺍﻟﺩﻡ‬

‫ﺃﻣﺮﺍﺽ ﻓﺮﻁ ﺍﻟﻨﺰﻑ‬ ‫ﻭﺃﻣﺮﺍﺽ ﻓﺮﻁ ﺍﻟﺘﺨﺜّﺮ‬

‫د‪.‬أﻛ ــﺮم اﻟﻬﻼﻟﻲ‬

‫اﻟﻄﺒﻌﺔ اﻟﺜﺎﻧﻴﺔ‪2014 -‬‬ ‫‪U‬‬

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‫ﺑﺳﻡ ﷲ ﺍﻟﺭﺣﻣﻥ ﺍﻟﺭﺣـــﻳﻡ‬

‫ﻣﻘــــ ّﺪﻣﺔ ﺍﻟﻄﺒﻌﺔ ﺍﻷﻭﻟﻰ‬ ‫ﻭﺗﻛﺭﻡ ﻋﻠﻰ ﺍﻹﻧﺳﺎﻥ ﻓﺄﺣﺎﻁﻪ ﺑﻣﺎ ﺷﺎء ﻣﻥ ﻋﻠﻣﻪ‪ ،‬ﻭﺑﻌﺩ…‪.‬‬ ‫ﺃﺣﻣﺩ ﷲ ﺍﻟﺫﻱ ﺃﺣﺎﻁ ﻋﻠﻣﻪ ﺑﻛﻝ ﺷﻲء‬ ‫ّ‬ ‫ﻓﻬ��ﺫﺍ ﻛﺗ ّﻳ��ﺏ ﺟﺩﻳ��ﺩ ﺃﻗ ّﺩﻣ �ﻪ ﻟﻠﻘ��ﺎﺭﺉ ﺍﻟﻌﺭﺑ��ﻲ‪ ،‬ﺑﻌ��ﺩ ﻛﺗ��ﺎﺏ ﻓﻘ��ﺭ ﺍﻟ��ﺩﻡ ﺛ � ّﻡ ﻛﺗ��ﺎﺏ ﺳ��ﺭﻁﺎﻥ ﺍﻟ��ﺩﻡ‪،‬ﻟﺗﻛﻭّ ﻥ ﻓﻳﻣ��ﺎ ﺑﻳﻧﻬ��ﺎ‬ ‫ﻣﺟﻣﻭﻋﺔ ﻣﻔﻳﺩﺓ‪-‬ﺑﺈﺫﻥ ﷲ‪-‬ﻋﻥ ﺍﻟﺩﻡ ﻭﺃﻣﺭﺍﺿﻪ‪.‬‬ ‫ﺇﻥ ﻣﻭﺿﻭﻉ ﺗﺧ ّﺛﺭ )ﺃﻭ ﺗﺟﻠّﻁ( ﺍﻟﺩﻡ ﻳﻬ ّﻡ ﺍﻟﻛﺛﻳﺭ ﻣﻥ ﺍﻟﻧﺎﺱ‪ ،‬ﻣﻥ ﻣﺭﺿﻰ ﻭﺫﻭﻱ ﻣﺭﺿﻰ ﻭﻣﻥ ﺃﻁﺑﺎء ﻭﻏﻳﺭﻫﻡ‬ ‫ﻣ��ﻥ ﺍﻟﻌ��ﺎﻣﻠﻳﻥ ﻓ��ﻲ ﺣﻘ��ﻝ ﺍﻟﻁ��ﺏ‪ ،‬ﻛﻣ��ﺎ ﺃﻥ ﺍﻹﺣﺎﻁ��ﺔ ﺑ��ﻪ ﻳﻌ��ﺩّ ﻣ��ﻥ ﺍﻟﻣﻌﻠﻭﻣ��ﺎﺕ ﺍﻟﻌﺎﻣ��ﺔ ﺍﻟﻣﻔﻳ��ﺩﺓ ﻟﻛ��ﻝ ﻣﺛﻘ��ﻑ ﻓ��ﻲ‬ ‫ﻋﺻﺭﻧﺎ ﺍﻟﺣﺎﺿﺭ‪.‬‬ ‫ﺇﻥ ﺃﺷﻬﺭ ﺃﻣﺭﺍﺽ ﺍﻟﻧﺯﻑ ﻫﻭ ) ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ( ﺃﻭ ﻓﺭﻁ ﺍﻟﻧﺯﻑ‪ ،‬ﻭﺃﺷﻬﺭ ﺃﻣ�ﺭﺍﺽ ﺍﻟﺗﺧﺛ�ﺭ ﻫ�ﻭ ﻣ�ﺭﺽ‬ ‫ﺍﻧﺳــــﺩﺍﺩ ﺷــﺭﺍﻳﻳﻥ ﺍﻟﻘﻠﺏ ) ﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﺗﺎﺟﻳﺔ( ﺑﺎﻟﺧﺛﺭﺓ ﺃﻭ ﺍﻟﺟﻠﻁﺔ ﺍﻟﺩﻣﻭﻳﺔ‪ ،‬ﻭﻟﺩﻯ ﻋﺎﻣﺔ ﺍﻟﻘﺭﺍء ﻣﻌﻠﻭﻣﺎﺕ‬ ‫ﻣﺗﺑﺎﻳﻧﺔ ﺍﻟﻭﺿﻭﺡ ﻋﻥ ﻣﺟﻣﻝ ﺃﻣﺭﺍﺽ ﺍﻟﻧ�ﺯﻑ ﻭﺃﻣ�ﺭﺍﺽ ﺍﻟﺗﺧﺛ�ﺭ ﻭﻋﻣﻠﻳ�ﺔ ﺗﺳ�ﻳﻳﻝ ﺍﻟ�ﺩﻡ ﺑﺎﻟﻌﻘ�ﺎﺭﺍﺕ ﺍﻟﻣﺧﺗﻠﻔ�ﺔ‬ ‫ﻛﻭﻗﺎﻳﺔ ﻣﻥ ﺃﻭ ﻋﻼﺝ ﻷﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻣﻭﺟ ﻪ ‪ ،‬ﺑﺄﺳﻠﻭﺑﻪ ﻭﻧﻭﻋ ّﻳ�ﺔ ﻣﻌﻠﻭﻣﺎﺗ�ﻪ‪ ،‬ﻟﻠﻣ�ﺭﻳﺽ ﺍﻟﻣﺛﻘ�ﻑ ﺍﻟ�ﺫﻱ ﻳﺭﻏ�ﺏ ﻓ�ﻲ ﺍﻻﺳ�ﺗﺯﺍﺩﺓ‬ ‫ﻫﺫﺍ ﺍﻟﻛﺗﻳﺏ‬ ‫ّ‬ ‫ﻣﻥ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻋﻥ ﻣﺭﺿﻪ‪ ،‬ﻭ ﻛﺫﻟﻙ ﻟﺫﻭﻱ ﺍﻟﻣﺭﺿﻰ ﻭﻟﻠﻣﺷﺗﻐﻠﻳﻥ ﺑﺎﻟﻌﻧﺎﻳﺔ ﺑﻬ�ﺅﻻء ﺍﻟﻣﺭﺿ�ﻰ ﻣ�ﻥ ﺍﻟﻌ�ﺎﻣﻠﻳﻥ‬ ‫ﻓﻲ ﺍﻟﺣﻘﻝ ﺍﻟﻁﺑﻲ ﻣﻥ ﻣﻣﺭﺿﻳﻥ ﻭﻓﻧﻳﻳﻥ ﻭﺃﻁﺑﺎء ﻋﻣﻭﻣﻳﻳﻥ‪.‬‬ ‫ﻭﻗﺩ ﻭﺿﻌﺕ ﻓﻲ ﺁﺧﺭ ﺍﻟﻛﺗ�ﺎﺏ ﻣﻌﺟﻣ�ﺎ ً ﺑﺎﻟﻣﺻ�ﻁﻠﺣﺎﺕ ﺑﺎﻟﻌﺭﺑﻳ�ﺔ ﻭﺍﻹﻧﻛﻠﻳﺯﻳ�ﺔ ﻟﻔﺎﺋ�ﺩﺓ ﺍﻟﻌ�ﺎﺭﻓﻳﻥ ﺑﺎﻟﻠﻐ�ﺔ‬ ‫ﺍﻟﻁﺑﻳﺔ‪.‬‬ ‫ﷲ ﺃﺭﺟﻭ ﺃﻥ ﻳﻧﻔﻊ ﺑﺎﻟﻛﺗﺎﺏ‪ ،‬ﻭﺫﻟﻙ ﻏﺎﻳﺗﻲ ﺑﻌﺩ ﺭﺿﺎﻩ ﺗﻌﺎﻟﻰ‪.‬‬

‫ﺃﻛﺭﻡ ﺍﻟﻬﻼﻟﻲ ‪1423‬ﻫـ‪ 2002-‬ﻡ‬

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‫ﻣﻘﺪّﻣﺔ اﻟﻄﺒﻌﺔ اﻟﺜﺎﻧﻴﺔ‬ ‫ﺣﻣﺩ ہﻠﻟ ﺍﻟﺫﻱ ﻋﻠﻡ ﺑﺎﻟﻘﻠﻡ‪ ،‬ﻋﻠّﻡ ﺍﻹﻧﺳﺎﻥ ﻣﺎﻟﻡ ﻳﻌﻠﻡ‪ ،‬ﻭﺑﻌﺩ‬ ‫ﻓﻬﺫﻩ ﻫﻲ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻧﻳﺔ ﻣﻥ ﻛﺗﺎﺏ ﺗﺧ ّﺛﺭ ﺍﻟﺩﻡ ﺗﺄﺗﻲ ﺑﻌﺩ ﻣﺭﻭﺭ ‪ 12‬ﻋﺎﻣﺎ ً ﻋﻠﻰ ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ‪ ،‬ﻣﺯﻳﺩﺓ ﻭ‬ ‫ﻣﻧﻘﺣﺔ ﺑﻣﺎ ﺍﺳﺗﺟ ّﺩ ﻣﻥ ﺗﻁﻭﺭ ﻓﻲ ﻣﺟﺎﻝ ﻫﺫﺍ ﺍﻻﺧﺗﺻﺎﺹ‪.‬‬ ‫ﺃﺭﺟﻭ ﷲ ﺃﻥ ﻳﻧﻔﻊ ﺑﻣﺎ ﻓﻳﻬﺎ ﻭﺃﺭﺟﻭﻩ –ﺳﺑﺣﺎﻧﻪ ﻭﺗﻌﺎﻟﻰ‪ -‬ﺃﻥ ﻳﺯﻳﺩﻧﺎ ﻋﻠﻣﺎ ً ﻭﻳﻌﻠﻣﻧﺎ ﻣﻥ ﻋﻠﻣﻪ ﺍﻟﻣﺯﻳﺩ‪.‬‬

‫ﺃﻛﺭﻡ ﺍﻟﻬﻼﻟﻲ‪ 1435 -‬ﻫـ‪ 2014 -‬ﻡ‬

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‫ﺍﻟﻔﺼﻞ ﺍﻷﻭﻝ‬ ‫ﺑﺣﺙ ﻋﺎﻡ‬ ‫ﺣﻭﻝ‬

‫ﻅﺎﻫﺮﺓ ﺗﺨﺜﺮ ﺍﻟﺪﻡ ﻭﻋﻤﻠﻴّﺔ ﻗﻄﻊ ﺍﻟﻨﺰﻑ‬ ‫ﻓﻲ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻄﺒﻴﻌﻴّﺔ‬

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‫ﺍﻟﺪﻡ ﺳﺎﺋـﻼ ً‬ ‫ﻗﺑﻝ ﺃﻥ ﻧﺩﺧﻝ ﺇﻟﻰ ﻣﻭﺿ�ﻭﻉ ّ‬ ‫ﺗﺧﺛ�ﺭ ﺍﻟ�ﺩﻡ ﻳﺟ�ﺏ ﺃﻥ ﻧﺗﻌ�ﺭّﻑ ﻋﻠ�ﻰ ﺍﻟ�ﺩﻡ ﻓ�ﻲ ﺣﺎﻟﺗ�ﻪ ﺍﻟﺳ�ﺎﺋﻠﺔ‪ ،‬ﻭﻫ�ﻲ‬ ‫ﺣﺎﻟﺗﻪ ﺍﻟﻁﺑﻳﻌﻳّﺔ‪ ،‬ﻓﺎﻟﺩﻡ ﺩﺍﺧﻝ ﺍﻟﻌﺭﻭﻕ ﻫﻭ ﺳﺎﺋﻝ ﺃﺣﻣﺭ ﺍﻟﻠﻭﻥ‪ .‬ﻭﻣﻌﻧﻰ ّ‬ ‫ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻫ�ﻭ ﺗﺣ�ﻭّ ﻝ ﺫﻟ�ﻙ‬ ‫ﺍﻟﺳﺎﺋﻝ ﺇﻟﻰ ﺣﺎﻟﺔ ﻏﻳﺭ ﺳﺎﺋﻠﺔ ﺃﻭ ﺟﻼﺗﻳﻧﻳ�ﺔ‪ ،‬ﺑﺣﻳ�ﺙ ﻳﺗﻭﻗّ�ﻑ ﺳ�ﻳﻼﻧﻪ ﻓ�ﻲ ﺍﻟﻌ�ﺭﻭﻕ ﺃﻭ ﺇﻟ�ﻰ ﺍﻟﺧ�ﺎﺭﺝ‬ ‫ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺟﺭﻭﺡ ﻭﺍﻟﻧﺯﻑ‪.‬‬

‫ﻣﻜ ّﻮﻧﺎﺕ ﺍﻟﺪﻡ ﺍﻟﺮﺋﻴﺴﻴّﺔ‬ ‫ﺍﻟﺩﻡ‪ -‬ﻛﻣﺎ ﻫﻭ ﻣﻌﻠﻭﻡ‪ -‬ﻣﻛﻭّ ﻥ ﻣﻥ ﺧﻼﻳﺎ ﺗﺳﺑﺢ ﻓﻲ ﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ‪.‬‬

‫ﻭﺍﻟﺨﻼﻳﺎ ﺃﻧﻮﺍﻋﻬﺎ ﺛﻼﺛﺔ‪:‬‬ ‫ﺍﻟﺣﻣ��ـﺭﺍء ‪ :‬ﻭﻫ��ﻲ ﺃﻛﺛ��ﺭ ﺍﻟﺧ��ـﻼﻳﺎ ﻋ��ﺩﺩﺍً ﻭﺗﺣﻣـ��ـﻝ ﺧﺿــ��ـﺎﺏ ﺍﻟ��ﺩﻡ ) ﻫﻳﻣﻭﻏﻠ��ﻭﺑﻳﻥ ﺍﻟ��ﺩﻡ( ﻭﺍﻟ��ﺫﻱ‬ ‫ﻳﻌﻁﻲ ﻟﻠﺩﻡ ﻟﻭﻧﻪ ﺍﻷﺣﻣﺭ‪.‬‬ ‫ﺍﻟﺑﻳﺿﺎء ‪ :‬ﻭﻫﻲ ﺍﻷﻗﻝ ﻋﺩﺩﺍً ﻣ�ﻥ ﺍﻷﻧ�ﻭﺍﻉ ﺍﻟﺛﻼﺛ�ﺔ ﻭﺣﺟ�ﻡ ﺍﻟﻭﺍﺣ�ﺩﺓ ﻣﻧﻬ�ﺎ ﺃﻛﺑ�ﺭ ﻣ�ﻥ ﺃﻧ�ﻭﺍﻉ ﺍﻟﺧﻼﻳ�ﺎ‬ ‫ﺍﻷﺧ�ﺭﻯ‪ .‬ﺃﻣ��ﺎ ﻭﻅﺎﺋﻔﻬ��ﺎ ﻓﺗﻘﺗﺻ��ﺭ ﻋﻠ�ﻰ ﻣﻘﺎﻭﻣ��ﺔ ﻭﺗ��ﺩﻣﻳﺭ ﺍﻷﺟﺳ��ﺎﻡ ﻭﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﻐﺭﻳﺑ��ﺔ ﺍﻟﺗ��ﻲ ﺗ��ﺩﺧﻝ‬ ‫ﺍﻟﺟﺳﻡ‪ ،‬ﻭﻫﻲ ﺗﺷ ّﻛﻝ ﺃﻫﻡ ﻋﻭﺍﻣﻝ ﺍﻟﺩﻓﺎﻉ ﻭﺍﻟﻣﻧﺎﻋﺔ ﻓﻲ ﺍﻟﺟﺳﻡ ﻭﻟﻬﺎ ﺃﻧﻭﺍﻉ ﻓﺭﻋﻳّﺔ ﻣﺗﻌﺩﺩﺓ‪.‬‬ ‫ﺍﻟﺻﻔﻳﺣﺎﺕ ‪ :‬ﻭﻋﺩﺩﻫﺎ ﻣﺗﻭﺳﻁ ﺑﻳﻥ ﺍﻟﻧﻭﻋﻳﻥ ﺍﻵﺧﺭﻳﻥ ﻭﺣﺟﻡ ﺍﻟﺻﻔﻳﺣﺔ ﺍﻟﻭﺍﺣﺩﺓ ﻫﻭ ﺍﻷﺻﻐﺭ ﺑ�ﻳﻥ‬ ‫ﺍﻵﻧﻭﺍﻉ ﺍﻟﺛﻼﺛﺔ‪.‬‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛ�ﺭ ﻭﺇﻳﻘ�ﺎﻑ‬ ‫ﻭﻟﻠﺻﻔﻳﺣﺎﺕ‪ ،‬ﺧﻼﻓﺎ ً ﻟﻠﻧﻭﻋﻳﻥ ﺍﻵﺧﺭﻳﻥ ﻣﻥ ﺍﻟﺧﻼﻳﺎ‪ ،‬ﺃﺩﻭﺍﺭ ﺗﻘﻭﻡ ﺑﻬ�ﺎ ﻓ�ﻲ ﻋﻣﻠﻳّ�ﺔ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﺍﻟﻧﺯﻳﻑ ﺗﺟﺩﻫﺎ ﻣﻔﺻّﻠﺔ ﻋﻧﺩ ﺍﻟﺣﺩﻳﺙ ﻋﻥ‬

‫ﺃﻣّﺎ ﺍﻟﺑﻼﺯﻣﺎ‪،‬‬ ‫ﻓﻬﻲ ﺍﻟﺳﺎﺋﻝ ﺍﻟﻣﺎﺋﻝ ﻟﻠﺻﻔﺭﺓ ﻗﻠ�ﻳﻼً ﻭﺍﻟ�ﺫﻱ ﻳﺷ� ّﻛﻝ ﺃﻛﺛ�ﺭ ﻣ�ﻥ ‪ %50‬ﻣ�ﻥ ﺣﺟ�ﻡ ﺍﻟ�ﺩﻡ ﻭ ﺗﺳ�ﺑﺢ ﻓﻳ�ﻪ‬ ‫ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺑﺄﻧﻭﺍﻋﻪ ﺍﻟﺛﻼﺛﺔ‪.‬‬ ‫ﺗﺭﻛﻳ��ﺏ ﺍﻟﺑﻼﺯﻣ��ﺎ ﺃﺳﺎﺳ��ﻪ ﺍﻟﻣ��ﺎء ﻭﻓﻳ��ﻪ ﺃﻧ��ﻭﺍﻉ ﻣﺧﺗﻠﻔ��ﺔ ﻣ��ﻥ ﺍﻟﻣ��ﻭﺍﺩ ﺍﻟﻣﺫﺍﺑ��ﺔ ﺃﻭ ﺍﻟﻣﺳ��ﺗﺣﻠﺑﺔ ﺳ��ﻳﺄﺗﻲ‬ ‫ﺫﻛﺭﻫﺎ ﻓﻳﻣﺎ ﺑﻌﺩ‪.‬‬

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‫ﺇﻥ ﻅﺎﻫﺭﺓ ّ‬ ‫ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻫﻲ ﺑﺎﻷﺻﻝ ﺗﺣﻭّ ﻝ ﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ ﺇﻟﻰ ﺍﻟﺣﺎﻟﺔ ﻏﻳﺭ ﺍﻟﺳﺎﺋﻠﺔ ﺃﻭ ﺍﻟﺟﻼﺗﻳﻧﻳّ�ﺔ‪،‬‬ ‫ﺣﻳ��ﺙ ﺃﻥ ﺧﻼﻳ��ﺎ ﺍﻟ��ﺩﻡ ﻫ��ﻲ ﺑﺎﻷﺻ��ﻝ ﻏﻳ��ﺭ ﺳ��ﺎﺋﻠﺔ ﻁﺑﻌ �ﺎ ً‪ .‬ﺇﻻ ّ ﺃﻥ ﺃﺣ��ﺩ ﺃﻧ��ﻭﺍﻉ ﺧﻼﻳ��ﺎ ﺍﻟ��ﺩﻡ‪ -‬ﻭﻫ��ﻲ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﻛﻣ��ﺎ ﺳ��ﻳﺭﺩ ﺗﻔﺻ��ﻳﻠﻪ ﻓﻳﻣ��ﺎ ﺑﻌ��ﺩ‪ ،‬ﻭﻟﻛﻧﻬ��ﺎ ﻟﻳﺳ��ﺕ ﺟ��ﺯءﺍً‬ ‫ﺍﻟﺻ��ﻔﻳﺣﺎﺕ‪ -‬ﺗﺷ��ﺎﺭﻙ ﻓ��ﻲ ﻋﻣﻠ ّﻳ��ﺔ‬ ‫ّ‬ ‫ً‬ ‫ﺑﺩﺍﻳﺔ‪.‬‬ ‫ﻳﺗﺧﺛﺭ ﻣﻥ ﺍﻟﺩﻡ‪ ،‬ﻓﺎﻟﺧﻼﻳﺎ ﻟﻳﺳﺕ ﺳﺎﺋﻠﺔ‬ ‫ّ‬ ‫ﻣﻛﻭﻧﺎﺕ ﺍﻟﺑﻼﺯﻣﺎ‪:‬‬ ‫ﻗﺑﻝ ﺃﻥ ﺃﺩﺧﻝ ﻓﻲ ﻣﻭﺿﻭﻉ ﻅﺎﻫﺭﺓ‬ ‫ﺍﻟﺗﺧﺛﺭ ﻳﺟﺏ ﺃﻥ ﺃﺷﺭﺡ ﻟﻠﻘﺎﺭﺉ ّ‬ ‫ﺣﺟ��ﻡ ﺑﻼﺯﻣ��ﺎ ﺍﻟ��ﺩﻡ ﺃﻛﺛ��ﺭ ﻣ��ﻥ ‪ %50‬ﻣ��ﻥ ﺣﺟ��ﻡ ﺍﻟ��ﺩﻡ ﺍﻟﻛﻠّ��ﻲ‪ ،‬ﻭﻳﺻ��ﻝ ﺇﻟ��ﻰ ﺃﻛﺛ��ﺭ ﻣ��ﻥ ‪ %60‬ﻓ��ﻲ‬ ‫ﺍﻟﻧﺳﺎء ﻭﺍﻷﻁﻔﺎﻝ‪.‬‬ ‫ﺃﺳﺎﺱ ﺍﻟﺑﻼﺯﻣﺎ ﻫﻭ ﺍﻟﻣﺎء ﻭﻳﺷ ّﻛﻝ ﻣﻌﻅﻡ ﺍﻟﺑﻼﺯﻣﺎ ﻭﺯﻧﺎ ً ﻭﺣﺟﻣﺎ ً‪ .‬ﺇﺿﺎﻓ ّﺔ ﺇﻟ�ﻰ ﺍﻟﻣ�ﺎء‪ ،‬ﺗﻭﺟ�ﺩ ﻣ�ﻭﺍﺩ‬ ‫ﻣﺫﺍﺑ��ﺔ ﻭﺃﺧ��ﺭﻯ ﻣﺳ��ﺗﺣﻠﺑﺔ ‪ ،‬ﺃﻱ ﺗﻛ��ﻭﻥ ﻋﻠ��ﻰ ﺷ��ﻛﻝ ﺩﻗ��ﺎﺋﻕ ﺻ��ﻐﻳﺭﺓ ﻻ ﺗﻧﻔﺻ��ﻝ ﻋ��ﻥ ﺍﻟﺑﻼﺯﻣ��ﺎ ﻓ��ﻲ‬ ‫ﺣﺎﻟﺔ ﺭﻛﻭﺩﻫﺎ‪.‬‬

‫‪.1‬ﺍﻟﻣﻭﺍﺩ ﺍﻟﻣﺫﺍﺑﺔ ‪:‬‬ ‫ﺍ��ـ ﻣ��ﻭﺍﺩ ﻏﻳ��ﺭ ﻋﺿ��ﻭ ّﻳ ﺔ ﺃﻭ ﺃﻣ��ﻼﺡ ﻣﻭﺟ��ﻭﺩﺓ ﺑﻛﻣﻳّ��ﺎﺕ ﻛﺑﻳ��ﺭﺓ ﻧﺳ��ﺑ ّﻳﺎ ً ﻛﺎﻟﺻ��ﻭﺩﻳﻭﻡ ﻭﺍﻟﺑﻭﺗﺎﺳ��ﻳﻭﻡ‬ ‫ﻭﺍﻟﻛﺎﻟﺳﻳﻭﻡ ﻭﺍﻟﻣﻐﻧﻳﺳﻳﻭﻡ ﻭﺍﻟﻬﺎﻳﺩﺭﻭﺟﻳﻥ ﻭﻫﻲ ﺁﻳﻭﻧﺎﺕ ﻣﻭﺟﺑﺔ ﺍﻟﺷﺣﻧﺔ‪ ،‬ﻭﺍﻟﻔﻭﺳ�ﻔﺎﺕ ﻭﺍﻟﻛﺑﺭﻳﺗ�ﺎﺕ‬ ‫ﻭﺍﻟﻧﺗ���ﺭﺍﺕ ﻭﺍﻷﻭﻛﺳ���ﺟﻳﻥ ﻭﻫ���ﻲ ﺁﻳﻭﻧ���ﺎﺕ ﺳ���ﺎﻟﺑﺔ ﺍﻟﺷ���ﺣﻧﺔ‪ ،‬ﻭﻣ���ﻭﺍﺩ ﺃﺧ���ﺭﻯ ﻣﻭﺟ���ﻭﺩﺓ ﺑﻛﻣ ّﻳ���ﺎﺕ‬ ‫ﻭﺗﺭﻛﻳﺯﺍﺕ ﺻﻐﻳﺭﺓ ﺟ ّﺩﺍً ﻛﺎﻟﺣﺩﻳﺩ ﻭﺍﻟﻧﺣﺎﺱ ﻭﺍﻟﺯﻧﻙ ﻭﺍﻟﻛﻭﺑﺎﻟﺕ ﻭﻏﻳﺭﻫﺎ ﻣﻭﺍﺩ ﻛﺛﻳﺭﺓ‪.‬‬ ‫ﺏ ـ ﻣ��ﻭﺍﺩ ﻋﺿ��ﻭ ّﻳ ﺔ ﻣ��ﻥ ﺟﺯﻳﺋ��ﺎﺕ ﺻ��ﻐﻳﺭﺓ ﻛﺎﻟﺳ � ّﻛﺭﻳﺎﺕ ﻭﻣﻠ��ﺢ ﺍﻟﻳﻭﺭﻳ��ﺎ )ﺍﻟﺑ��ﻭﻟﻳﻥ( ﻭﺣ��ﺎﻣﺽ‬ ‫ﺍﻟﻳﻭﺭﻳﻙ ‪ ،‬ﻭﺟﺯﻳﺋﺎﺕ ﻛﺑﻳﺭﺓ ﻛﺎﻟﺑﺭﻭﺗﻳﻧﺎﺕ ‪ ،‬ﻭﺃﻫﻣّﻬ�ﺎ ﺍﻟ�ﺯﻻﻝ )ﺃﻟﺑ�ﻭﻣﻳﻥ( ﻭﺍﻟﻐﻠﻭﺑُﻠﻳﻧ�ﺎﺕ ﺑﺄﻧﻭﺍﻋﻬ�ﺎ‪،‬‬ ‫ﺳ���ﻭﺍء ﻣﻧﻬ���ﺎ ﺍﻟﺧ���ﺎﺹ ﺑﺎﻟﻣﻧﺎﻋ���ﺔ ) ﺍﻷﺟﺳ���ﺎﻡ ﺍﻟﻣﺿ���ﺎ ّﺩﺓ( ﺃﻭ ﺍﻹﻧﻅﻳﻣ���ﺎﺕ ﺍﻟﺗ���ﻲ ﺗﺳ���ﻳﻁﺭ ﻋﻠ���ﻰ‬ ‫ﺍﻻﺳ��ﺗﻘﻼﺑﺎﺕ ﻭﺍﻟﺗﻔ��ﺎﻋﻼﺕ ﺍﻟﻛﻳﻣﻳﺎﺋ ّﻳ��ﺔ‪ ،‬ﻭﻣﻧﻬ��ﺎ ﺃﻳﺿ �ﺎ ً ﺍﻟﺑﺭﻭﺗﻳﻧ��ﺎﺕ ﺍﻟﺧﺎﺻ��ﺔ ﺑ� ّ‬ ‫�ﺎﻟﺗﺧﺛﺭ)ﻭ ﻣﻌﻅﻣﻬ��ﺎ‬ ‫ﺇﻧﻅﻳﻣﺎﺕ(‪ .‬ﻭﻫﻧﺎﻙ ﺃﻳﺿﺎ ً ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﺍﻟﺣﺎﻣﻠﺔ ﻟﻠﺩﻫﻭﻥ ) ﻭﺍﻟﺗﻲ ﺗﺳﺎﻋﺩ ﻋﻠﻰ ﻧﻘﻝ ﺍﻟﺩﻫﻭﻥ ﺍﻟﺗ�ﻲ ﻻ‬ ‫ﺗﺫﻭﺏ ﻓﻲ ﺍﻟﻣﺎء ﺍﻟﺫﻱ ﻫﻭ ﺃﺳﺎﺱ ﺍﻟﺑﻼﺯﻣﺎ(‬

‫‪2‬ـ ﺍﻟﻣﻭﺍﺩ ﻏﻳﺭ ﺍﻟﻣﺫﺍﺑﺔ ‪:‬‬ ‫ﻭﻫﻲ ﺍﻟﺩﻫﻭﻥ ﺍﻟﺗﻲ ﺗﻌﺑﺭ ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ﺑﻌ�ﺩ ﺍﻣﺗﺻﺎﺻ�ﻬﺎ ﻣ�ﻥ ﺍﻷﻣﻌ�ﺎء ﻋﻠ�ﻰ ﺷ�ﻛﻝ ﺩﻗ�ﺎﺋﻕ ﺻ�ﻐﻳﺭﺓ‬ ‫ﺑﺣﻳﺙ ﻳﺻﻌﺏ ﺍﻧﻔﺻ�ﺎﻟﻬﺎ ﻋ�ﻥ ﺍﻟﺑﻼﺯﻣ�ﺎ ﺗﻣﺎﻣ�ﺎ ً ﻛﺎﻟ�ﺩﻫﻥ ﺍﻟﻣﻭﺟ�ﻭﺩ ﻓ�ﻲ ﺍﻟﺣﻠﻳ�ﺏ ﺍﻟﻣﺗﺟ�ﺎﻧﺱ‪ ،‬ﻭﻟ�ﻭﻻ‬ ‫ﺻﻐﺭ ﺩﻗﺎﺋﻘﻬﺎ ﻻﻧﻔﺻﻠﺕ ﺑﺳﻬﻭﻟﺔ ﻣﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺎﺋﻳّﺔ‪.‬‬

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‫ﺇﺿﺎﻓﺔ ﻟﻠﻣﻭﺍﺩ ﺍﻟﻣﺫﻛﻭﺭﺓ‪ ،‬ﺗﻭﺟﺩ ﺍﻟﻣﺋﺎﺕ ‪ ،‬ﺑﻝ ﺍﻵﻻﻑ ﻣﻥ ﺍﻟﻣﻭﺍﺩ ﺍﻟﺗ�ﻲ ﺗﻣ�ﺭ ﻣ�ﻥ ﻣﻛ�ﺎﻥ ﺇﻟ�ﻰ ﺁﺧ�ﺭ‬ ‫ﻓﻲ ﺍﻟﺟﺳﻡ ﻋﺑﺭ ﺍﻟﺑﻼﺯﻣﺎ‪ ،‬ﻷﻥّ ﺍﻟﺑﻼﺯﻣﺎ )ﺃﻭ ﺍﻟﺩﻡ ﻛﻠﻪ( ﺗﻣﺷﻲ ﻓﻲ ﺍﻟﻌ�ﺭﻭﻕ ﻛﺎﻟﺳ�ﻳﺎﺭﺓ ﺍﻟﺗ�ﻲ ﺗﺟ�ﺊ‬ ‫ﻭﺗﺭﻭﺡ ﻣﻥ ﻣﻛﺎﻥ ﺇﻟ�ﻰ ﺁﺧ�ﺭ ﺣﺎﻣﻠ�ﺔ ﻣ�ﻭﺍﺩ ﻣﺧﺗﻠﻔ�ﺔ‪ .‬ﻓﺎﻷﺩﻭﻳ�ﺔ ﺍﻟﺗ�ﻲ ﻧﺗﻧﺎﻭﻟﻬ�ﺎ ﺑ�ﺎﻟﻔﻡ ﺃﻭ ﺍﻟﺣﻘ�ﻥ ﺗﻣ�ﺭ‬ ‫ﺑﺎﻟﺑﻼﺯﻣﺎ ﻟﻠﻭﺻﻭﻝ ﺇﻟﻰ ﺃﺟﺯﺍء ﺍﻟﺟﺳﻡ ﺍﻟﻣﺧﺗﻠﻔﺔ‪ ،‬ﻭﺍﻷﻏﺫﻳﺔ ﺍﻟﺗﻲ ﺗﻣﺗﺻّﻬﺎ ﺍﻷﻣﻌﺎء‪ ،‬ﻭﺍﻟﻔﻳﺗﺎﻣﻳﻧﺎﺕ‪،‬‬ ‫ﻭﺣﺗ��ﻰ ﺍﻟﺳ��ﻣﻭﻡ ﺍﻟﺗ��ﻲ ﻗ��ﺩ ﻳﺗﻧﺎﻭﻟﻬ��ﺎ ﺍﻹﻧﺳ��ﺎﻥ‪ ،‬ﻛﻠّﻬ��ﺎ ﺗﻣ��ﺭ ﻣﺣﻣﻭﻟ��ﺔ ﻓ��ﻲ ﺍﻟﺑﻼﺯﻣ��ﺎ ﺇﻟ��ﻰ ﺣﻳ��ﺙ ﻳﻛ��ﻭﻥ‬ ‫ﺗﺄﺛﻳﺭﻫﺎ ﻓﻲ ﺃﻗﺳﺎﻡ ﺍﻟﺟﺳﻡ ﺍﻟﻣﺧﺗﻠﻔﺔ‪.‬‬ ‫ﻣﺎ ﻳﻬﻣّﻧﺎ ﻓﻲ ﻫﺫﺍ ﺍﻟﻛﺗﺎﺏ ﻣﻥ ﻣﻛﻭّ ﻧﺎﺕ ﺍﻟﺑﻼﺯﻣﺎ ﻫﻲ ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﺍﻟﺧﺎﺻﺔ ﺑﺎﻟ ّ‬ ‫ﺗﺧﺛﺭ ﻭ ﻣ�ﺎ ﻟ�ﻪ ﺗ�ﺄﺛﻳﺭ‬ ‫ّ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛﺭ ﻭﺍﻟﺧﻁﻭﺍﺕ ﺍﻟﻣﻭﺻﻠﺔ ﺇﻟﻳﻬ�ﺎ‬ ‫ﺍﻟﺗﺧﺛﺭ ﻣﻥ ﺍﻟﻣﻭﺍﺩ ﺍﻷﺧﺭﻯ‪ .‬ﻭﺳﻧﺄﺗﻲ ﻋﻠﻰ ﻅﺎﻫﺭﺓ‬ ‫ﻓﻲ ﻋﻣﻠﻳّﺔ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛ�ﺭ‬ ‫ﺑﺎﻟﺗﻔﺻﻳﻝ‪ .‬ﻟﻛﻥ ﻗﺑﻝ ﺍﻟﺑﺩء ﺑﺫﻟﻙ ﺃﺭﻳﺩ ﺃﻥ ﺃﻧﺑّﻪ ﺍﻟﻘﺎﺭﺉ ﺇﻟﻰ ﻣﺳﺄﻟﺔ ﻣﻬﻣّﺔ‪ ،‬ﻭﻫ�ﻲ ﺃﻥّ ﻋﻣﻠﻳّ�ﺔ‬ ‫ﻫﻲ ﻋﻣﻠﻳّﺔ ﻁﺑﻳﻌﻳّﺔ ُﺧﻠﻘﺕ ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﻭﺍﻟﺣﻳﻭﺍﻥ ـ ﻭﺣﺗﻰ ﺑﻌﺽ ﺍﻟﻧﺑﺎﺗﺎﺕ ـ ﻹﻳﻘﺎﻑ ﻧ�ﺯﻑ ﺍﻟ�ﺩﻡ ‪،‬‬ ‫ﺃﻭ ﺍﻟﻌﺻ���ﺎﺭﺍﺕ ﻓ���ﻲ ﺍﻟﻧﺑ���ﺎﺕ‪ ،‬ﺍﻟ���ﺫﻱ ﻳﺣﻣ���ﻝ ﻋﻧﺎﺻ���ﺭ ﺣﻳﻭ ّﻳ���ﺔ‪ ،‬ﻭﺑﻧﻘﺻ���ﻪ ﺍﻟﺷ���ﺩﻳﺩ ﺗﺻ���ﺑﺢ ﺍﻟﺣﻳ���ﺎﺓ‬ ‫ﻣﺳﺗﺣﻳﻠﺔ‪ ،‬ﻻﺳﻳّﻣﺎ ﺇﺫﺍ ﺣﺻﻝ ﺍﻟﻧﻘﺹ ﻓﻲ ﺍﻟﺣﺟﻡ ﻓﻲ ﻓﺗﺭﺓ ﻭﺟﻳﺯﺓ ﻛﻣﺎ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﻧﺯﻑ ﺍﻟﺷ�ﺩﻳﺩ‪.‬‬ ‫ﻓﺎﻷﺻﻝ ﻫﻭ ﺃﻥ ﺍﻟﻧﺯﻑ ـ ﻧﺗﻳﺟﺔ ﻟﺟﺭﺡ ﻣﺛﻼً ـ ﻳﻛﻭﻥ ﻫﻭ ﻧﻔﺳﻪ ﺍﻟﻌﺎﻣ�ﻝ ﺍﻟ�ﺫﻱ ﻳﺑ�ﺩﺃ ﺃﻭﻟ�ﻰ ﺧﻁ�ﻭﺍﺕ‬ ‫ﺍﻟﺗﺧﺛﺭ‪ .‬ﻓﺎﻟﺟﺳﻡ ﺑﻭﺿﻌﻪ ﺍﻟﻁﺑﻳﻌﻲ ﻻ ﻳﺣﺗﺎﺝ ّ‬ ‫ّ‬ ‫ﻟﺗﺧﺛﺭ ﺍﻟﺩﻡ‪ ،‬ﺑﻝ ﺇ ّﻧﻪ ﻳﺣﺎﻭﻝ ﻣﻧﻌ�ﻪ‪ ،‬ﻟﻛ�ﻥّ ﺑ�ﺩء ﺍﻟﻧ�ﺯﻑ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛﺭ ﻟﻐﺭﺽ ﻣﻧﻊ ﺍﺳﺗﻣﺭﺍﺭ ﺍﻟﻧﺯﻑ‪.‬‬ ‫ﻟﺳﺑﺏ ﻣﺎ ﻫﻭ ﻣﻔﺗﺎﺡ ﻋﻣﻠﻳّﺔ‬ ‫ﺇﻥ ﻋﻣﻠﻳّﺔ ﺇﻳﻘﺎﻑ ﺍﻟﻧﺯﻑ ﺗﺣﻣﻝ ﻓﻲ ﻁﻳّﺎﺗﻬﺎ ﺁﻳﺎﺕ ﻣﻌﺟﺯﺍﺕ ﺣﻘّ�ﺎً‪ ،‬ﻛﻣ�ﺎ ﺳ�ﻳﺭﻯ ﺍﻟﻘ�ﺎﺭﺉ ﻣ�ﻥ ﺧ�ﻼﻝ‬ ‫ﻣﺭﻭﺭﻧﺎ ﺑﻣﺭﺍﺣﻝ ﺍﻟﻌﻣﻠﻳّﺔ‪.‬‬

‫ﻋﻣﻠ ّﻳﺔ ﻗﻁﻊ ﺍﻟﻧﺯﻑ‬ ‫ﺣﺗﻰ ﺗﻛﻭﻥ ﻫﻧﺎﻙ ﻋﻣﻠﻳّﺔ ﻗﻁﻊ ﻟﻠﻧﺯﻑ ﻓﻼﺑ ّﺩ ﺃﻥ ﻳﻛﻭﻥ ﻫﻧﺎﻙ ﻧﺯﻑ ﺃﻭﻻً‪.‬‬ ‫ﺇﻥ ﺣﺻﻭﻝ ﻧﺯﻑ ﻳﺄﺗﻲ ﻣﻥ ﺣﺻﻭﻝ ﺷ ّﺩﺓ ﻋﻠﻰ ﻣﻭﺿﻊ ﻓﻲ ﺍﻟﺟﺳﻡ ﺑﺂﻟﺔ ﺣﺎ ّﺩﺓ ) ﻛﻣﺎ ﻓ�ﻲ ﺍﻟﺟﺭﺍﺣ�ﺔ‬ ‫ﻭﻏﻳﺭﻫ��ﺎ( ﺃﻭ ﺑﺂﻟ��ﺔ ﺻ��ﻠﺑﺔ ﻏﻳ��ﺭ ﺣ��ﺎ ّﺩﺓ‪ .‬ﻭﻫﻧ��ﺎﻙ ﺣ��ﺎﻻﺕ ﻣﺭﺿ�ﻳّﺔ ﻳﺣﺻ��ﻝ ﻓﻳﻬ��ﺎ ﺍﻟﻧ��ﺯﻑ ﺩﻭﻥ ﺷ� ّﺩﺓ‬ ‫ﻣﺳ��ﺑﻘﺔ‪ ،‬ﻟﻛﻧﻧ�ﻲ ﻓ��ﻲ ﻫ��ﺫﺍ ﺍﻟﻔﺻ��ﻝ ﺃﺗﻛﻠّ�ﻡ ﻋ��ﻥ ﺍﻹﻧﺳ��ﺎﻥ ﺍﻟﻁﺑﻳﻌ��ﻲ ﻭﻟ��ﻳﺱ ﻋ��ﻥ ﺍﻟﻣﺻ��ﺎﺑﻳﻥ ﺑ��ﺄﻣﺭﺍﺽ‬ ‫ﻧﺯﻓﻳّﺔ‪.‬‬

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‫ﺇﻥ ﺍﻟﺷﺩﺓ ﻧﻔﺳ�ﻬﺎ ـ ﻭﺍﻟﺗ�ﻲ ﺗ�ﺅ ّﺩﻱ ﻟﻠﻧ�ﺯﻑ ـ ﺗﺣﻔّ�ﺯ ﻓ�ﻲ ﻧﻔ�ﺱ ﺍﻟﻭﻗ�ﺕ ﺗﻐﻳﻳ�ﺭﺍﺕ ﻣﻌﻳّﻧ�ﺔ ﻫ�ﺩﻓﻬﺎ ﻭﻗ�ﻑ‬ ‫ﺍﻟﻧﺯﻑ ) ﺍﻧﻅﺭ ﺍﻵﺷﻛﺎﻝ ‪ 1‬ﻭ ‪ 2‬ﻭ ‪.(3‬‬

‫ﻓﺎﻋﻼﺕ ﻛﻳﻣﺎﻭﻳﺔ ﺗﻔﺭﺯ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺗﻬﺩﻣﺔ ﺗﺅﺛﺭ ﻋﻠﻰ ﺍﻟﺷﺭﺍﻳﻳﻥ‬ ‫ﺍﻟﺻﻐﻳﺭﺓ ﺍﻟﻣﺅﺩﻳﺔ ﺇﻟﻰ ﻣﻭﻗﻊ ﺍﻟﻧﺯﻑ ﻭﺗﺳﺑﺏ ﺗﻘﻠﺹ ﺗﻠﻙ ﺍﻟﺷﺭﺍﻳﻳﻥ‬ ‫ﻭﻧﻘﺹ ﺍﻟﺩﻡ ﺍﻟﻭﺍﺻﻝ ﺇﻟﻰ ﺍﻟﻣﻭﻗﻊ‬ ‫ﻋﺻﺎﺭﺓ ﺧﻠﻭ ّﻳ ﺔ ﻧﺎﺗﺟﺔ ﻋﻥ ﺍﻟﻧﺳﻳﺞ ﺍﻟﻣﺗﻬﺩﻡ ﺑﺳﺑﺏ ﺍﻟﺷﺩﺓ‬

‫ﺷﺪة ﺧﺎرﺟﻴﺔ ﻋﻠﻰ ﻣﻮﺿﻊ‬ ‫ﻓﻲ اﻟﺠﺴﻢ ـ ﺗﺆدي إﻟﻰ‬

‫ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﺗﺻﺑﺢ ﺑﺗﻣﺎﺱ ﻣﻊ ﺍﻷﻧﺳﺟﺔ ﺧﺎﺭﺝ ﺍﻟﻌﺭﻭﻕ )ﺍﻟ ُﻛﻼﺟﻳﻥ(‬ ‫ﺷﺊ ﻣﻥ ﺍﻟﺩﻡ ﻳﺧﺭﺝ ﻣﻥ ﺍﻟﻌﺭﻭﻕ ﻓﻳﺻﺑﺢ ﺑﺗﻣﺎﺱ ﻣﻊ ﺍﻷﻧﺳﺟﺔ ﺧﺎﺭﺟﻬﺎ )ﺍﻟ ُﻛﻼﺟﻳﻥ(‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪1‬‬ ‫ﺍﻷﺣﺩﺍﺙ ﺍﻷﻭﻟ ّﻳ ﺔ ﺍﻷﺭﺑﻌﺔ ﺍﻟﻧﺎﺗﺟﺔ ﻋﻥ ﺍﻟﺷﺩﺓ ﻭﺍﻟﻧﺯﻑ‬

‫ﻭﺗﻔﺻﻳﻝ ﺍﻷﺣﺩﺍﺙ ﺍﻷﺭﺑﻌﺔ ﻛﻣﺎ ﻳﻠﻲ‪:‬‬ ‫ﺛﻭﺍﻥ ﻣﻥ ﺣﺻﻭﻝ ﺍﻟﺷ� ّﺩﺓ‪ .‬ﺇﻥّ ﻣﻔﻌ�ﻭﻝ ﺗﻘﻠّ�ﺹ‬ ‫‪ .1‬ﻋﻣﻠ ّﻳ ﺔ ﺗﻘﻠّﺹ ﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﻣﻭﺿﻌﻳّﺔ ﺗﺑﺩﺃ ﺧﻼﻝ‬ ‫ٍ‬

‫ﺍﻟﺷﺭﺍﻳﻳﻥ ﻭﺗﺿﻳّﻘﻬﺎ ﻣﻔﻌﻭﻝ ﻣﺑﺎﺷﺭ ﻭﻭﺍﺿﺢ ﻓﻲ ﻣﺣﺎﻭﻟﺔ ﻭﻗﻑ ﺍﻟﻧﺯﻑ‪ .‬ﻋﻠﻣﺎ ً ﺃﻥّ ﻫﺫﺍ ﺍﻟﺗﻘﻠّﺹ‬

‫ﻳﻧﻘﻠﺏ ﻓﻳﻣﺎ ﺑﻌﺩ ﺇﻟﻰ ﺗﻣ ّﺩﺩ ﻭﺗﻭﺳّﻊ ﺣﻳﻧﻣﺎ ﻳﻘﻑ ﺍﻟﻧﺯﻑ ﺗﻣﺎﻣﺎً‪ ،‬ﻭﺫﻟﻙ ﻟﺟﻠ�ﺏ ﺩﻡ ﺃﻛﺛ�ﺭ ﻟﻠﻣﺳ�ﺎﻋﺩﺓ‬ ‫ﻓﻲ ﺇﺻﻼﺡ ﺍﻟﺗﻠﻑ ﺑﻭﺍﺳﻁﺔ ﺧﻼﻳﺎ ﺍﻟ�ﺩﻡ ﺍﻟﺑﻳﺿ�ﺎء ﻭﻣﺧﺗﻠ�ﻑ ﺍﻟﻔ�ﺎﻋﻼﺕ ﺍﻟﺧﻠﻭﻳّ�ﺔ ﻭﻣ�ﻭﺍﺩ ﺍﻟﺑﻧ�ﺎء‬ ‫ﺍﻟﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺍﻟﺩﻡ‪.‬‬ ‫‪ .2‬ﺃﻣّﺎ ﺍﻟﺣﺩﺙ ﺍﻟﺛﺎﻧﻲ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻟﺷ� ّﺩﺓ ﻭ ﺗﻠ�ﻑ ﺍﻷﻧﺳ�ﺟﺔ ﻓﻬ�ﻭ ﻅﻬ�ﻭﺭ ﺍﻟﻌﺻ�ﺎﺭﺍﺕ ﺍﻟﺧﻠﻭﻳّ�ﺔ ﻣ�ﻥ‬ ‫ﺍﻟﺧﻼﻳ��ﺎ ﺍﻟﻣﻬ ّﺩﻣ��ﺔ‪ ،‬ﻭﻫ��ﺫﻩ ﺗ��ﺅ ّﺩﻱ ﺇﻟ��ﻰ ﺗﻔﻌﻳ��ﻝ ﻋﻣﻠ ّﻳ��ﺔ ﺍﻟﺗﺧ ّﺛ��ﺭ ﺑﺎﻟﺗ��ﺄﺛﻳﺭ ﺍﻟﺧ��ﺎﺭﺟﻲ‪ ،‬ﻛﻣ��ﺎ ﻓ��ﻲ‬ ‫ﺍﻟﺷ��ﻛﻠﻳﻥ ) ‪ 2‬ﻭ ‪ .(5‬ﻫ��ﺫﻩ ﺍﻟﻌﻣﻠ ّﻳ��ﺔ ﺗﺳ��ﺗﻐﺭﻕ ﻣ��ﻥ ‪ 10‬ﺇﻟ��ﻰ ‪ 20‬ﺛﺎﻧﻳ��ﺔ ﻟﻠﻭﺻ��ﻭﻝ ﺇﻟ��ﻰ ﻣﺭﺣﻠ��ﺔ‬ ‫ﺍﻟﺧﺛﺭﺓ‪.‬‬

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‫ﺷ ّﺪة ﺧﺎرﺟﻴّﺔ‬

‫ﻋﺼﺎرة ﻧﺴﺠﻴّﺔ ﻣﻦ‬ ‫اﳋﻼﻳﺎ اﳌﻬ ّﺪﻣﺔ‬

‫ﺍﻟﺗﺣﺎﻡ ﻣﻊ ﺍﻟﻌﺎﻣﻝ ﺍﻟﺧﺛﺭﻱ‬ ‫ﺍﻟﺳﺎﺑﻊ ﻭﺗﻔﻌﻳﻠﻪ‬

‫ﺗﺨﺜّﺮ اﻟﺪم ﺑﺎﻟﺘﺄﺛﻴﺮ‬ ‫اﻟﺨﺎرﺟﻲ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪2‬‬ ‫ﺍﻟﺣﺩﺙ ﺍﻟﺛﺎﻧﻲ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻟﺷﺩﺓ‬

‫‪ .3‬ﺍﻟﺣ��ﺩﺙ ﺍﻟﺛﺎﻟ��ﺙ‪ :‬ﻫ��ﻭ ﺍﻟ��ﺫﻱ ﻳﺑ��ﺩﺃ ﺑﺗﻣ��ﺎﺱ ﺻ��ﻔﻳﺣﺎﺕ ﺍﻟ��ﺩﻡ ﻣ��ﻊ ﺍﻟ ُﻛﻼﺟ��ﻳﻥ )ﺍﻟﻣِﻐ��ﺭﺍء( ﻭﻫ��ﻭ ﻣ��ﻥ‬ ‫ﺍﻵﻧﺳﺟﺔ ﺍﻟﻠﻳﻔﻳﺔ ﺍﻟﺭﺍﺑﻁﺔ‪ ،‬ﻭﻋﻣﻭﻡ ﺍﻟﻧﺳ�ﻳﺞ ﺧ�ﺎﺭﺝ ﺃﻭﻋﻳ�ﺔ ﺍﻟ�ﺩﻡ‪ .‬ﺇﻥ ﻫ�ﺫﻩ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻻ ﺗ�ﺄﺗﻲ‬ ‫ﺑﺎﻟﺗﻣ�ﺎﺱ ﻣ�ﻊ ﺗﻠ��ﻙ ﺍﻷﻧﺳ�ﺟﺔ ﺇﻻّ ﻋﻧ�ﺩ ﺣﺻ��ﻭﻝ ﻓ�ﺗﺢ ﻓ�ﻲ ﺍﻷﻭﻋﻳ��ﺔ‪ ،‬ﺃﻱ ﺣﺻ�ﻭﻝ ﻧ�ﺯﻑ ﻭﺷ� ّﺩﺓ‪.‬‬ ‫ﻭﻳﺑﻳّﻥ ﺍﻟﺷﻛﻝ ‪ 3‬ﻣﺎ ﻳﺣﺩﺙ ﻟﻠﺻ�ﻔﻳﺣﺎﺕ ﻋﻧ�ﺩ ﺣﺻ�ﻭﻝ ﺍﻟﺗﻣ�ﺎﺱ‪ ،‬ﺃﻱ ﺍﻻﻟﺗﺻ�ﺎﻕ ﺑ�ﺎﻟ ُﻛﻼﺟﻳﻥ ﺛ�ﻡ‬ ‫ﺗﺭﺍﻛﻣﻬﺎ ﻋﻠﻰ ﺑﻌﺿﻬﺎ‪ .‬ﻭﻫﺫﻩ ﺍﻟﻌﻣﻠﻳّﺔ ﺗﺳﺗﻐﺭﻕ ﻣﻥ ‪ 10‬ﺇﻟﻰ ‪ 15‬ﺛﺎﻧﻳﺔ ﻟﺗﺗﻡ‪.‬‬ ‫ﻧﺰف دم‬

‫ﺷ ّﺪة ﺧﺎرﺟﻴّﺔ‬ ‫ﻫﺬﻩ اﻟﺘﺠﻤﻌﺎت ﺗﺸ ّﻜﻞ ﻛﺘﻼً ﺗﺴﺎﻋﺪ ﻋﻠﻰ‬ ‫ﺳﺪ اﻟﺜﻐﺮات اﻟﺼﻐﲑة ﰲ اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳّﺔ‬

‫ﺻﻔﻴﺤﺎت ﰲ اﻟﺪم اﻟﺴﺎﺋﻞ‬ ‫ﻧﺘﻴﺠﺔ اﻟﻨﺰف‬ ‫ﻋﺎﻣﻞ ﻓﻮن وﻟﱪاﻧﺪ ﻣﻦ‬ ‫اﻟﺒﻼزﻣﺎ‬ ‫ﲤﺎس ﻣﻊ اﻟ ُﻜﻼﺟﲔ‬

‫ﺗﺘﺠﻤﻊ ﻣﻼﻳﲔ اﻟﺼﻔﺎﺋﺢ‬ ‫ّ‬

‫ﺗﻠﺘﺼﻖ اﻟﺼﻔﻴﺤﺎت ﺑﺎﻟﻜٌﻼﺟﲔ‬

‫ﻋﻠﻰ ﺑﻌﻀﻬﺎ ﺑﻌﺪ اﻟﺘﺼﺎق‬ ‫اﻷﻓﻮاج اﻷوﱃ ﻣﻨﻬﺎ ﻋﻠﻰ‬ ‫ﺳﻄﺢ اﻟ ُﻜﻼﺟﲔ‬

‫ﺑﺄﻋﺪاد ﻛﺒﲑة‬ ‫ﺷﻛﻝ ﺭﻗﻡ ‪3‬‬ ‫ﺍﻟﺣﺩﺙ ﺍﻟﺛﺎﻟﺙ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻟﺷ ّﺩ ﺓ‬

‫ّ‬ ‫ﺍﻟﺗﺧﺛ�ﺭ‪ ،‬ﻣ�ﻊ ﺍﻟ ُﻛﻼﺟ��ﻳﻥ‬ ‫‪ .4‬ﺍﻟﺣ�ﺩﺙ ﺍﻟﺭﺍﺑ�ﻊ‪ :‬ﻫ�ﻭ ﺍﻟ�ﺫﻱ ﻳﺑ�ﺩﺃ ﺑﺗﻣ�ﺎﺱ ﺑﻼﺯﻣ��ﺎ ﺍﻟ�ﺩﻡ‪ ،‬ﻭﻓﻳﻬ�ﺎ ﻋﻭﺍﻣ�ﻝ‬ ‫ﻭﻋﻣ��ﻭﻡ ﺍﻟﻧﺳ��ﻳﺞ ﺍﻟﻭﺍﻗ��ﻊ ﺧ��ﺎﺭﺝ ﺃﻭﻋﻳ��ﺔ ﺍﻟ��ﺩﻡ‪ ،‬ﺫﻟ��ﻙ ﺍﻟﺗﻣ��ﺎﺱ ﺍﻟ��ﺫﻱ ﻻ ﻳﺣﺻ��ﻝ ﻓ��ﻲ ﺍﻟﺣﺎﻟ��ﺔ‬ ‫‪9‬‬

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‫ﺍﻟﻁﺑﻳﻌﻳﺔ‪ .‬ﺇﻥ ﻫﺫﺍ ﺍﻟﺗﻣﺎﺱ ) ﺗﺄﺛﻳﺭﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﺩﺍﺧﻠﻳ ﺔ( ﻳ�ﺅ ّﺩﻱ ﺇﻟ�ﻰ ﺣﺻ�ﻭﻝ ﺍﻟﺧﺛ�ﺭﺓ ﺍﻟﺭﺋﻳﺳ�ﻳﺔ‬ ‫ﻟﻠﺩﻡ ﻧﺗﻳﺟﺔ ﻟﻠﺗﻔﺎﻋﻼﺕ ﺍﻟﻣﺗﺳﻠﺳﻠﺔ ﺍﻟﺗﻲ ﺗﺟﺩﻫﺎ ﻣﺧﺗﺻ�ﺭﺓ ﻓ�ﻲ ﺍﻟﺷ�ﻛﻝ ‪ 4‬ﻭﻣﻔﺻّ�ﻠﺔ ﻓ�ﻲ ﺍﻟﺷ�ﻛﻝ‬ ‫‪ .6‬ﻭﻫﺫﻩ ﺍﻟﻌﻣﻠﻳّﺔ ﺗﺄﺧﺫ ﺩﻗﺎﺋﻕ ﻟﺗﺗﻡ )‪ 10-2‬ﺩﻗﺎﺋﻕ(‪.‬‬ ‫ﻋﻠﻰ ﺍﻟﻘﺎﺭﺉ ﺃﻻّ ﻳﺗﺻﻭّ ﺭ ﺃﻥ ﻛﻼًّ ﻣ�ﻥ ﺍﻷﺣ�ﺩﺍﺙ ﺍﻷﺭﺑﻌ�ﺔ ﻫ�ﻭ ﻅ�ﺎﻫﺭﺓ ﻣﺳ�ﺗﻘﻠّﺔ ﺗﻣﺎﻣ�ﺎ ً ﻭﻣﻧﻔﺻ�ﻠﺔ ‪،‬‬ ‫ﻓﻛﻠﻬﺎ ﻣﺣﺎﻭﻻﺕ ﻟﻭﻗﻑ ﺍﻟﻧﺯﻑ ﻋﻠﻰ ﺟﺑﻬﺎﺕ ﻣﺗﻌﺩﺩﺓ ﺗﺟﺭﻱ ﻣﻌﺎ ً ﻭﺗﺗﺩﺍﺧﻝ ﻣﻊ ﺑﻌﺿﻬﺎ‪.‬‬ ‫ﺷﺊ ﻣﻦ ﺑﻼزﻣﺎ اﻟﺪم ﻳﺄﺗﻲ‬

‫ﻧﺰف دم‬

‫ﺷ ّﺪة ﺧﺎرﺟﻴّﺔ‬

‫ﺗﺨﺜّﺮ اﻟﺪم‬

‫ﺑﺘﻤﺎس ﻣﻊ اﻷﻧﺴﺠﺔ‬

‫) اﻟ ُﻜﻼﺟﻴﻦ( ﺧﺎرج اﻷوﻋﻴﺔ‬ ‫اﻟﺪﻣﻮﻳﺔ ﻧﺘﻴﺠﺔ ﻟﻠﺸﺪة‬

‫ﻫﺬا اﻟﺘﻤﺎس ﻳﺆ ّدي إﻟﻰ ﺗﻔﻌﻴﻞ‬

‫ﺗﻔﻌﻴﻞ ﻋﻮاﻣﻞ‬

‫اﻟﻌﻮاﻣﻞ اﻷوﻟﻰ ﻓﻲ ﺳﻠﺴﻠﺔ اﻟﺘﺨﺜّﺮ‬ ‫) ﻋﻮاﻣﻞ اﻟﺘﻤﺎس(‬

‫أﺧﺮى ﺑﻌﺪﻫﺎ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪4‬‬ ‫ﺍﻟﺣﺩﺙ ﺍﻟﺭﺍﺑﻊ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺍﻟﺷﺩّ ﺓ‬

‫ﻋﺼﺎرة ﻧﺴﺠﻴّﺔ ﻧﺎﲡﺔ‬ ‫ﻦ ﻬﺗ ّﺪم ﺧﻼﻳﺎ‬ ‫ﻋﺎﻣﻝ ‪ 7‬ﻓ ّﻌﺎﻝ‪ +‬ﺇﻧﻅﻳﻣﺎﺕ ﻣﻥ ﺍﻟﻌﺻﺎﺭﺓ‬ ‫ﻓﻌﺎﻝ‬ ‫ﻋﺎﻣﻝ ‪ّ 5‬‬

‫ﻋﺎﻣﻝ ‪7‬‬ ‫ﻋﺎﻣﻝ ‪10‬‬

‫ﻋﺎﻣﻝ ‪ 10‬ﻓ ّﻌﺎﻝ‬ ‫ﺑﺎﻗﻲ ﺍﻟﺧﻁﻭﺍﺕ ﻛﻣﺎ ﻓﻲ ﺍﻟﺷﻛﻝ ‪6‬‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪5‬‬ ‫ﺗﻔﺻﻳﻝ ﻋﻣﻠ ّﻳ ﺔ ﺍﻟﺗﺧ ّﺛﺭ ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﻌﺻﺎﺭﺓ ﺍﻟﻧﺳﺟ ّﻳ ﺔ‬

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‫ﻋﺎﻣﻝ ‪12‬‬

‫ﺗﻤﺎس ﺑﺎﻟﻜﻮﻻﺟﻴﻦ‬

‫ﻋﺎﻣﻝ ‪ 12‬ﻓﻌّﺎﻝ‬

‫ﻋﺎﻣﻝ ‪11‬‬ ‫ﻋﺎﻣﻝ‪5‬‬ ‫ﻋﺎﻣﻝ ‪ 5‬ﻓﻌّﺎﻝ‬

‫ﻋﺎﻣﻝ ‪ 11‬ﻓﻌّﺎﻝ‬ ‫ﻋﺎﻣﻝ ‪9‬‬

‫ﻋﺎﻣﻝ ‪ 9‬ﻓﻌّﺎﻝ‬

‫ﻋﺎﻣﻝ ‪8‬‬

‫ﻋﺎﻣﻝ ‪10‬‬

‫ﻋﺎﻣﻝ ‪ 8‬ﻓﻌّﺎﻝ‬

‫ﻋﺎﻣﻝ ‪ 10‬ﻓﻌّﺎﻝ‬ ‫ﻋﺎﻣﻝ ‪ 2‬ﻓﻌّﺎﻝ)ﺧﺛﺭﻳﻥ(‬ ‫ﻋﺎﻣﻝ ‪)2‬ﻣﻭﻟّﺩ ﺍﻟﺧﺛﺭﻳﻥ(‬ ‫ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ )ﺧﻳﻭﻁ ﻣﻔﺭﺩﺓ(‬ ‫ﻋﺎﻣﻝ ‪13‬‬

‫ﻟﻳﻔﻳﻥ)ﺧﻳﻭﻁ ﻣﺯﺩﻭﺟﺔ(‬ ‫ﻋﺎﻣﻝ ‪ 13‬ﻓﻌّﺎﻝ‬ ‫ﻟﻳﻔﻳﻥ ﻣﺛ ﱠﺑﺕ‬ ‫)ﺧﺛﺭﺓ ﺍﻟﺩﻡ(‬ ‫ﺷﻛﻝ ﺭﻗﻡ ‪6‬‬ ‫ﻋﻣﻠ ّﻳ ﺔ ﺗﺧ ّﺛﺭ ﺍﻟﺩﻡ ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﺗﻣﺎﺱ‬ ‫)ﺗﺄﺛﻳﺭ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﺩﺍﺧﻠﻳ ﺔ(‬

‫ﻁﺑﻳﻌﺔ ﻋﻭﺍﻣﻝ ﺗﺧ ّﺛﺭ ﺍﻟﺩﻡ ﻭﻁﺭﻳﻘﺔ ﺗﻔﺎﻋﻠﻬﺎ‬ ‫‪ .1‬ﺇﻥّ ﻋﻭﺍﻣﻝ ّ‬ ‫ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻓﻲ ﻣﻌﻅﻣﻬﺎ)ﻋﺩﺍ ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ ﺃﻭﺍﻟﻌﺎﻣﻝ ﺍﻷﻭﻝ (ﻫ�ﻲ ﺇﻧﻅﻳﻣ�ﺎﺕ‪ ،‬ﻟﻛ ّﻧﻬ�ﺎ‬ ‫ﺗﺟﺭﻱ ﻓ�ﻲ ﺍﻟ�ﺩﻡ‪ ،‬ﻛﺟ�ﺯء ﻣ�ﻥ ﺍﻟﺑﻼﺯﻣ�ﺎ‪ ،‬ﺑﺄﺷ�ﻛﺎﻝ ﻏﻳ�ﺭ ﻓﻌّﺎﻟ�ﺔ‪ ،‬ﻭﻛ�ﻝ ﻣﻧﻬ�ﺎ ﻳﺣﺗ�ﺎﺝ ﺇﻟ�ﻰ ﺗﻔﻌﻳ�ﻝ‬ ‫ﺍﻟﻌﺎﻣ��ﻝ ﺍﻟﺳ��ﺎﺑﻕ ﻟ��ﻪ ﻟﻳ��ﺅﺛﺭ ﻋﻠﻳ��ﻪ ﻭ ﻳﻔﻌّﻠ��ﻪ‪ .‬ﻓﺎﻟﻌﻣﻠ ّﻳ��ﺔ ﺇﺫﺍً ﻫ��ﻲ ﺗﻔﻌ��ﻳﻼﺕ ﻣﺗﺗﺎﻟﻳ��ﺔ ﺗﺑ��ﺩﺃ ﺑﺎﻟﺣ��ﺩﺙ‬ ‫ﺍﻷﻭّ ﻝ ) ﺍﻟﺗﻣ��ﺎﺱّ ﺑ��ﺎﻟﻁﺭﻳﻕ ﺍﻟ��ﺩﺍﺧﻠﻲ ﺃﻭ ﺑ��ﺎﻟﻁﺭﻳﻕ ﺍﻟﺧ��ﺎﺭﺟﻲ ﺑﻭﺍﺳ��ﻁﺔ ﺍﻟﻌﺻ��ﺎﺭﺍﺕ ﺍﻟﺧﻠﻭ ّﻳ��ﺔ(‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻟﺗﺗﻭﺍﻟﻰ ﺧﻁﻭﺍﺗﻬﺎ ﻭﺣﺗﻰ ﺍﻟﻧﻬﺎﻳﺔ‪ ،‬ﺃﻱ‬ ‫‪ .2‬ﺇﻥ ﻛﻝ ﺟﺯﻳﺋﺔ ﻣﻥ ﻫﺫﻩ ﺍﻟﻌﻭﺍﻣﻝ‪ ،‬ﻟﺩﻯ ﺗﻔﻌﻳﻠﻬﺎ‪ّ ،‬‬ ‫ﺗﺅﺛﺭ ﻋﻠﻰ ﺃﻛﺛﺭ ﻣﻥ ﺟﺯﻳﺋﺔ ﻣﻥ ﺍﻟﻌﺎﻣﻝ ﺍﻟ�ﺫﻱ‬ ‫ﻳﻠﻳ��ﻪ ﻭﺗ��ﺅ ّﺩﻱ ﺇﻟ��ﻰ ﺗﻔﻌﻳﻠﻬ��ﺎ‪ .‬ﻭﻫﻛ��ﺫﺍ ﻓ��ﺈﻥ ﻋ��ﺩﺩ ﺍﻟﺟﺯﻳﺋ��ﺎﺕ ﻳﺗﺿ��ﺎﻋﻑ ﻋ � ّﺩﺓ ﻣ � ّﺭﺍﺕ ﺍﺑﺗ��ﺩءﺍً ﻣ��ﻥ‬

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‫ﺍﻟﺧﻁﻭﺓ ﺍﻷﻭﻟﻰ ﺇﻟﻰ ﺍﻟﺧﻁﻭﺓ ﺍﻟﻧﻬﺎﺋﻳّﺔ‪ .‬ﻭﺑﺳﺑﺏ ﺍﺳﺗﻣﺭﺍﺭ ﺗﻛﺎﺛﺭ ﺍﻟﺟﺯﻳﺋﺎﺕ ﺍﻟﻣﺷﻣﻭﻟﺔ ﺑﺎﻟﺗﻔﻌﻳ�ﻝ‬ ‫ﻓﺈﻥ ﺍﻟﺧﻁﻭﺍﺕ ﺍﻷﺧﻳﺭﺓ ﺗﺳﻳﺭ ﺑﺷﻛﻝ ﺃﺳﺭﻉ ﻣﻥ ﺍﻟﺧﻁﻭﺍﺕ ﺍﻻﺑﺗﺩﺍﺋﻳّﺔ‪.‬‬ ‫‪ .3‬ﺇﻥ ﺍﻟﺧﻁﻭﺍﺕ ﻛﻠّﻬﺎ‪ ،‬ﺳﻭﺍ ًء ﻓﻲ ﻁﺭﻳ�ﻕ ﺍﻟﺗ�ﺄﺛﻳﺭ ﺍﻟ�ﺩﺍﺧﻠﻲ ﺃﻭ ﺍﻟﺧ�ﺎﺭﺟﻲ‪ ،‬ﺇ ّﻧﻣ�ﺎ ﻫ�ﺩﻓﻬﺎ ﺍﻟﻭﺻ�ﻭﻝ‬ ‫ﺇﻟﻰ ﺗﻔﻌﻳﻝ ﺁﺧﺭ ﻋﺎﻣﻝ‪ ،‬ﻭﻫﻭ ﺇﻧﻅﻳﻡ ﺷﺩﻳﺩ ﺍﻟﻔ ّﻌﺎﻟﻳّﺔ ﺍﺳ�ﻣﻪ ﺍﻟﺧﺛ�ﺭﻳﻥ‪ .‬ﻭﻫ�ﻭ ﻓ�ﻲ ﺍﻟﺣﻘﻳﻘ�ﺔ ﻣﺷ�ﺎﺑﻪ‬ ‫ﺟ ّﺩﺍً ﻟﺳﻡ ﺑﻌﺽ ﺍﻷﻓﺎﻋﻲ ﺍﻟﺫﻱ ﻳﺳﺑّﺏ ّ‬ ‫ﺗﺧﺛﺭﺍً ﻓﻭﺭ ّﻳﺎ ً ﻟﺩﻡ ﺍﻹﻧﺳﺎﻥ ﺃﻭ ﺍﻟﺣﻳﻭﺍﻥ ﺍﻟﺫﻱ ﺗﻠﺩﻏﻪ ﺗﻠ�ﻙ‬ ‫ﺍﻷﻓﺎﻋﻲ ﻭﺑﻣﺟﺭّﺩ ﺩﺧﻭﻝ ﻛﻣﻳّﺔ ﺻﻐﻳﺭﺓ ﻣﻧﻪ ﻓﻲ ﺩﻡ ﺍﻟﻣﻠﺩﻭﻍ‪ .‬ﻫ�ﺫﺍ ﺍﻹﻧﻅ�ﻳﻡ‪ ،‬ﺍﻟﺧﺛ�ﺭﻳﻥ‪ ،‬ﻳ�ﺅ ّﺩﻱ‬ ‫ﺑﺎﻵﺧﺭ ﺇﻟﻰ ﺗﺣﻭﻳﻝ ﺍﻟﺧﻳﻭﻁ ﺍﻷﺣﺎﺩﻳّﺔ ﻣﻥ ﺑﺭﻭﺗﻳﻥ ﻣﻭﺟﻭﺩ ﻓﻲ ﺍﻟﺩﻡ ﻭﻳﺳﺭﻱ ﻓﻲ ﺣﺎﻟ�ﺔ ﺳ�ﺎﺋﻠﺔ‪،‬‬ ‫ﻳﺣﻭّ ﻟﻬﺎ ﺇﻟﻰ ﺣﺯﻣﺔ ﺧﻳﻭﻁ ﻏﻳﺭ ﺳﺎﺋﻠﺔ‪ ،‬ﻭﻫﺫﺍ ﻳﺳﺑّﺏ ّ‬ ‫ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻛﻠّﻪ‪.‬‬ ‫‪ .4‬ﺍﻟﺷﻛﻝ ‪ 7‬ﻳﺑﻳّﻥ ﺑﺻ�ﻭﺭﺓ ﺗﺧﻁﻳﻁﻳّ�ﺔ ﻣ�ﺎ ﻳﺣﺻ�ﻝ ﻟﻠﺧﻳ�ﻭﻁ ﺍﻷﺣﺎﺩﻳّ�ﺔ )ﻣﻭﻟّ�ﺩ ﺍﻟﻠﻳﻔ�ﻳﻥ( ﻟﺗﺗــ�ـﺣﻭّ ﻝ‬ ‫ﺇﻟﻰ ﺧﻳﻭﻁ ﻣﺯﺩﻭﺟﺔ ﻭﺣﺯﻡ ﻣﺗﻌ ّﺩﺩﺓ )ﺍﻟﻠﻳﻔﻳﻥ(‪.‬‬ ‫ﺗﻛﻭﻥ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻛﻳﻔ ّﻳ ﺔ ّ‬ ‫ﺑﺎﻟﺷﺭﺡ ﺍﻟﺳﺎﺑﻕ ﺗﺑﻳّﻥ ﻟﻧﺎ ﻛﻳﻑ ﺗﺗﻛﻭّ ﻥ ﺍﻟﺧﻳﻭﻁ ﻏﻳﺭ ﺍﻟﺫﺍﺋﺑﺔ) ﺍﻟﻠﻳﻔﻳﻥ( ﻣﻥ ﺍﻟﺧﻳﻭﻁ ﺍﻟﻣﻔﺭﺩﺓ ﺍﻟﺫﺍﺋﺑ�ﺔ‬ ‫ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ) ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ( ﻭﺗﻧﻔﺻﻝ ﻋﻥ ﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ‪ ،‬ﻭﻟﻛﻥ ﻣ�ﻥ ﻳ�ﺭﻯ ﺍﻟ�ﺩﻡ ّ‬ ‫ﻳﺗﺧﺛ�ﺭ ﻳﺟ�ﺩ ﺃﻥ‬ ‫ﻛ��ﻝ ﺍﻟﺳ��ﺎﺋﻝ‪ ،‬ﺑﻣ��ﺎ ﻓﻳ��ﻪ ﺍﻟﺧﻼﻳ��ﺎ ﺍﻟﺣﻣ��ﺭ ﺍﻟﺗ��ﻲ ﺗﺿ��ﻔﻲ ﻋﻠ��ﻰ ﺍﻟ��ﺩﻡ ﻟﻭﻧ��ﻪ ﺍﻷﺣﻣ��ﺭ‪ ،‬ﻳﺗﺣ��ﻭّ ﻝ ﺇﻟ��ﻰ ﻛﺗﻠ��ﺔ‬ ‫ﺟﻼﺗﻳﻧﻳّﺔ ﻏﻳﺭ ﺳﺎﺋﻠﺔ‪ ،‬ﻓﻛﻳﻑ ﻳﺣﺻﻝ ﺫﻟﻙ؟‬ ‫ﺧﻳﻭﻁ‬ ‫ﺃﺣﺎﺩﻳّﺔ‬ ‫ﺫﺍﺋﺑﺔ‬ ‫ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ‬ ‫ﺍﻟﺧﺛﺭﻳﻥ ﺍﻟﻔ ّﻌﺎﻝ ﻳﻘﻭﻡ ﺑﺑﺗﺭ ﻗﻁﻌﺔ‬ ‫ﻣﻥ ﻛﻝ ّ ﺧﻳﻁ‪ ،‬ﻭﺑﺫﻟﻙ ُﺗﻛﺷﻑ ﻧﻬﺎﻳﺎﺕ‬ ‫ﺟﺩﻳﺩﺓ ﻟﻠﺧﻳﻭﻁ ﺗﺗﺄﻟّﻑ ﻣﻊ ﺑﻌﺿﻬﺎ‬ ‫ﻭﺗﺅ ّﺩﻱ ﺇﻟﻰ ﺍﻟﺗﺻﺎﻗﻬﺎ ﻋﻠﻰ ﺷﻛﻝ ﺧﻳﻁ ﺳﻣﻳﻙ‬ ‫ﻏﻳﺭ ﺫﺍﺋﺏ‪.‬‬

‫ﻟﻳﻔﻳﻥ‬ ‫ﺷﻛﻝ ﺭﻗﻡ ‪7‬‬ ‫ﺗﻛﻭﻥ ﺍﻟﻠﻳﻔﻳﻥ ﻣﻥ ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ‬ ‫ّ‬

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‫ﺇﻥ ﺗﺣﻭّ ﻝ ﺍﻟﺧﻳﻭﻁ ﺍﻟﻣﻔﺭﺩﺓ ﺍﻟﺫﺍﺋﺑﺔ )ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ( ﺇﻟﻰ ﺣﺯﻣﺎﺕ ﺍﻟﻠﻳﻔﻳﻥ ﻣ�ﺎ ﻫ�ﻭ ﺇﻻّ ﻋﻣﻠﻳّ�ﺔ ﺗﺷ�ﻛﻳﻝ‬ ‫ﻫﻳﻛﻝ ﺍﻟﺧﺛﺭﺓ‪ ،‬ﻭﺍﻟﺧﺛﺭﺓ ﺑﻛﺎﻣﻠﻬﺎ ﺗﺗﻛﻭّ ﻥ ﺑﺎﻟﺧﻁﻭﺍﺕ ﺍﻟﺛﻼﺙ ﺍﻟﺗﺎﻟﻳﺔ‪:‬‬ ‫‪ .1‬ﺗﺣﻭّ ﻝ ﺧﻳﻭﻁ ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ ﺇﻟﻰ ﻟﻳﻔﻳﻥ ﻏﻳﺭ ﺫﺍﺋﺏ‪.‬‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛ�ﺭ ﻗ�ﺩ ﺗﻣﺳ�ﻙ‬ ‫‪ .2‬ﺍﻟﺗﺻﺎﻕ ﻧﻬﺎﻳﺎﺕ ﻫﺫﻩ ﺍﻟﺧﻳﻭﻁ ﺑﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪ .‬ﻓﻛﻝ ﺻﻔﻳﺣﺔ ﺩﻡ ﻓﻲ ﻣﻭﻗ�ﻊ‬ ‫ﺑﻧﻬﺎﻳ��ﺎﺕ ﺧﻳ��ﻭﻁ ﻛﺛﻳ��ﺭﺓ ﻣ��ﻥ ﺍﻟﻠﻳﻔ��ﻳﻥ‪ .‬ﻭﻳﻛ��ﻭﻥ ﺫﻟ��ﻙ ّ‬ ‫ﺑﺗﺧﺛ��ﺭ ﻣﻭﻟ��ﺩﺍﺕ ﺍﻟﻠﻳﻔ��ﻳﻥ ﺍﻟﻣﻭﺟ��ﻭﺩﺓ ﻋﻠ��ﻰ‬ ‫ﺳﻁﻭﺡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﺍﺗﺻﺎﻟﻬﺎ ﻣﻊ ﺗﻠﻙ ﺍﻟﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ‪.‬‬ ‫‪ .3‬ﺗﺗﻛﻭّ ﻥ ﺑﺫﻟﻙ ﺷﺑﻛﺔ ﻣﻥ ﺧﻳﻭﻁ ُﻋ َﻘﺩﻫﺎ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪ ،‬ﻭﺧ�ﻼﻝ ﺗﻛ�ﻭّ ﻥ ﺍﻟﺷ�ﺑﻛﺔ ﺗﻧﺣ�ﺑﺱ ﺩﺍﺧﻠﻬ�ﺎ‬ ‫ﻛﻝ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﻣﻭﺟﻭﺩﺓ ﻓﻲ ﺍﻟﻣﻧﻁﻘﺔ‪ ،‬ﺣﻳ�ﺙ ﻻ ﺗﻌﻁﻳﻬ�ﺎ ﺍﻟﺷ�ﺑﻛﺔ ﺍﻟﻣﺣﺑﻭﻛ�ﺔ ﻁﺭﻳﻘ�ﺎ ً ﻟﻠﺧ�ﺭﻭﺝ‬ ‫ﻣﻥ ﺣﺑﺎﺋﻠﻬﺎ‪ .‬ﻛﺫﻟﻙ ﻓﺈﻥ ﻛﻝ ﺳﺎﺋﻝ ﺍﻟﺑﻼﺯﻣﺎ ﺑﻣﺎ ﻓﻳﻪ ﻣﻥ ﻣ�ﺎء ﻭﺑﺭﻭﺗﻳﻧ�ﺎﺕ ﻳﻧﺣ�ﺑﺱ ﻫ�ﻭ ﺍﻵﺧﺭ�ـ‬ ‫ﻓﻲ ﺃﻭّ ﻝ ﺍﻷﻣﺭـ ﺩﺍﺧﻝ ﺍﻟﺧﺛﺭﺓ‪ .‬ﻭﻓﻲ ﻫﺫﺍ ﺍﻷﻣﺭ ﺣﻛﻣﺔ ﻛﺑﻳﺭﺓ‪ .‬ﻓﻠﻭ ﺗﺻﻭّ ﺭﻧﺎ ﺧﻳﻭﻁ ﺍﻟﻠﻳﻔﻳﻥ ﻓﻲ‬ ‫ﻣﻛﺎﻥ ﻣﺎ‪ ،‬ﻛﺟﺭﺡ ﻣﺛﻼً‪ ،‬ﻟﻭ ﺗﺻﻭّ ﺭﻧﺎﻫﺎ ﻋﻣﻠﺕ ﺧﺛﺭﺓ ﻟﻭﺣﺩﻫﺎ ﻓ�ﺈﻥ ﺣﺟﻣﻬ�ﺎ ﻟ�ﻥ ﻳﺗﺟ�ﺎﻭﺯ ﺭﺃﺱ‬ ‫ﺩﺑّﻭﺱ ﺇﺫﺍ ﺗﺷ ّﻛﻠﺕ ﻣﻥ ﺩﻡ ﺣﺟﻣﻪ ‪ 100‬ﺳﻡ‪ ،3‬ﻓﻛﻳ�ﻑ ﻳﻣﻛ�ﻥ ﻟﺗﻠ�ﻙ ﺍﻟﺧﺛ�ﺭﺓ ﺍﻟﺻ�ﻐﻳﺭﺓ ﺃﻥ ﺗﺳ� ّﺩ‬ ‫ﺟﺭﺣﺎ ً ﺗﺳﺑﺏ ﻓﻲ ﻣﺛﻝ ﺫﻟ�ﻙ ﺍﻟﻧ�ﺯﻑ؟ ﺇﺫﺍً‪ ،‬ﻓﺎﻟﺧﻼﻳ�ﺎ ﻭﺍﻟﺑﻼﺯﻣ�ﺎ ﺗﻌﻁ�ﻲ ﻟﺷ�ﺑﻛﺔ ﺍﻟﺧﻳ�ﻭﻁ ﺍﻟﺣﺟ�ﻡ‬ ‫ﺍﻟﻬﺎﺋﻝ ﺍﻟﺫﻱ ﻧﺭﺍﻩ ﻓﻲ ﺍﻟﺧﺛﺭﺓ‪ .‬ﺍﻧﻅﺭ ﺍﻟﺷﻛﻝ ‪:8‬‬ ‫ﺧﻳﻭﻁ ﺍﻟﻠﻳﻔﻳﻥ‬

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‫ﺧﻼﻳﺎ‬ ‫ﺑﻳﺿﺎء‬

‫ﺧﻼﻳﺎ ﺣﻣﺭﺍء‬ ‫ﺷﻛﻝ ﺭﻗﻡ ‪8‬‬ ‫ﺭﺳﻡ ﺗﺧﻁﻳﻁﻲ ﻟ ﻘﻁﻌﺔ ﻣﻥ ﻫﻳﻛﻝ ﺍﻟﺧﺛﺭﺓ ﻭﻣﺣﺗﻭﻳﺎﺗﻬﺎ‬

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‫ﻭﺍﻟﺣﻘﻳﻘﺔ‪ ،‬ﻓﺈﻥ ﻛﻝ ‪100‬ﺳﻡ‪ 3‬ﻣﻥ ﺍﻟﺩﻡ ﺗﺣﻭﻱ ﺃﻗ� ّﻝ ﻣ�ﻥ ﺭﺑ�ﻊ ﻏ�ﺭﺍﻡ ﻣ�ﻥ ﺍﻟﻠﻳﻔ�ﻳﻥ ﺃﻭ ﻣﻭﻟّ�ﺩ ﺍﻟﻠﻳﻔ�ﻳﻥ‪،‬‬ ‫ﻓﻠﻭ ﺍﺟﺗﻣﻌﺕ ﻛﻠّﻬﺎ ﻭﻋﻣﻠﺕ ﺷﺑﻛﺔ ﻟﻭﺣﺩﻫﺎ ﺩﻭﻥ ﻣﺣﺗﻭﻳﺎﺕ ﻟﻛﺎﻧﺕ ﺷﻳﺋﺎ ً ﺗﺎﻓﻬﺎ ً ﻭﺿﻌﻳﻔﺎ ً‪.‬‬ ‫ﻭﻅﻳﻔﺔ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﻓﻲ ﻋﻣﻠ ّﻳﺔ ﺍﻟﺗﺧ ّﺛﺭ ﻭﻭﻗﻑ ﺍﻟﻧﺯﻑ‬

‫ﻳﺗﺑﻳّﻥ ﻟﻠﻘﺎﺭﺉ ﻣﻥ ﺗﺭﻛﻳﺑﺔ ﺍﻟﺧﺛﺭﺓ ﺍﻟﺗ�ﻲ ﺷ�ﺭﺣﺗﻬﺎ ﺃﻋ�ﻼﻩ ﺍﻟ�ﺩﻭﺭ ﺍﻟﺛ�ﺎﻧﻲ ﻣ�ﻥ ﺃﺩﻭﺍﺭ ﺻ�ﻔﻳﺣﺎﺕ ﺍﻟ�ﺩﻡ‬ ‫ﻓﻲ ﻋﻣﻠﻳّﺔ ﻗﻁﻊ ﺍﻟﻧﺯﻑ‪ ،‬ﻓﻬﻲ ﺗﻛﻭّ ﻥ ﻣﺭﺗﻛﺯﺍﺕ ﺗﺳﺗﻧﺩ ﺇﻟﻳﻬﺎ ﻭﺗﺗﺛﺑّﺕ ﺑﻬﺎ ﺧﻳﻭﻁ ﺍﻟﺧﺛﺭﺓ‪.‬‬ ‫ﻭﻗﺩ ﺫﻛﺭﺕ ﺳﺎﺑﻘﺎ ً ﺍﻟ�ﺩﻭﺭ ﺍﻵﻭّ ﻝ ﻟﻠﺻ�ﻔﻳﺣﺎﺕ ﻣ�ﻥ ﺧ�ﻼﻝ ﺍﻟﺣ�ﺩﺙ ﺍﻟﺛ�ﺎﻧﻲ ﺍﻟﻧ�ﺎﺗﺞ ﻋ�ﻥ ﺍﻟﺷ� ّﺩﺓ‪ ،‬ﻭﻫ�ﻭ‬ ‫ﺗﻛ��ﻭﻳﻥ ﺗﺟﻣّﻌ��ﺎﺕ ﻣﻧﻬ��ﺎ ﺗﺳ� ّﺩ ﺍﻷﻭﻋﻳ��ﺔ ﺍﻟﺻ��ﻐﻳﺭﺓ ﺍﻟﻧﺎﺯﻓ��ﺔ‪ .‬ﻭﺫﻟ��ﻙ ﺍﻟ��ﺩﻭﺭ ﻟ��ﻳﺱ ﺟ��ﺯءﺍً ﻣ��ﻥ ﺗﻛ��ﻭﻳﻥ‬ ‫ﺍﻟﺧﺛﺭﺓ ﻭﻟﻛ ّﻧﻪ ﻳﺳﺎﻋﺩ ﻓﻲ ﻭﻗﻑ ﺍﻟﻧﺯﻑ ﺑﻁﺭﻳﻘﺔ ﺗﺧﺗﺹ ﺑﻬﺎ ﺍﻟﺻﻔﻳﺣﺎﺕ‪.‬‬ ‫ﻫﻧﺎﻙ ﺩﻭﺭ ﺛﺎﻟﺙ ﻟﻠﺻﻔﻳﺣﺎﺕ ﻓﻲ ﻋﻣﻠﻳّﺔ ﻗﻁﻊ ﺍﻟﻧﺯﻑ ﻭﻫﻭ ﻓﻲ ﻣﺟ�ﺎﻝ ﺗﻛ�ﻭﻳﻥ ﺍﻟﺧﺛ�ﺭﺓ……ﻓﻌﻠ�ﻰ‬ ‫ﺳﻁﻭﺡ ﺟﺩﺭﺍﻥ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺗﻭﺟﺩ ﺩﻫﻭﻥ ﻓﻭﺳﻔﺎﺗﻳّﺔ ﺟﺯﻳﺋﺎﺗﻬﺎ ﻛﺑﻳﺭﺓ ﻭﺗﻛﻭّ ﻥ ﺍﻟﺟﺯء ﺍﻟﺭﺋﻳﺳ�ﻲ ﻣ�ﻥ‬ ‫ﺳﻁﺢ ﺍﻟﺧﻼﻳﺎ‪ .‬ﺇﻥ ﻫﺫﻩ ﺍﻟﺩﻫﻭﻥ ﺍﻟﻔﻭﺳﻔﺎﺗﻳّﺔ ﺗﺷ� ّﻛﻝ ﻗﻭﺍﻋ�ﺩ ﺛﺎﺑﺗ�ﺔ ﺗﻠﺗﻘ�ﻲ ﻋﻠﻳﻬ�ﺎ ﺍﻟﻛﺛﻳ�ﺭ ﻣ�ﻥ ﻋﻭﺍﻣ�ﻝ‬ ‫ﺍ ّ‬ ‫ﻟﺗﺧﺛﺭ ﻟﻳﺗﻡ ﺍﻟﺗﻔﺎﻋﻝ ﺑﻳﻧﻬﺎ ﺑﺷﻛﻝ ﺃﻛﻔﺄ ﻭﺃﺳﺭﻉ‪ .‬ﻓﻠﻭ ﻛﺎﻧﺕ ﺟﺯﻳﺋﺎﺕ ﺗﻠﻙ ﺍﻟﻌﻭﺍﻣﻝ ﺗﺳﺑﺢ ﺳ�ﺎﺋﺑﺔ ﻓ�ﻲ‬ ‫ﺍﻟﺑﻼﺯﻣ��ﺎ ﻓ��ﺈﻥ ﺃﻣ��ﺭ ﺗﻼﻗ��ﻲ ﺗﻠ��ﻙ ﺍﻟﺟﺯﻳﺋ��ﺎﺕ ﻣ��ﻊ ﺑﻌﺿ��ﻬﺎ ﻭﻓ��ﻲ ﺍﻟﺗﺳﻠﺳ��ﻝ ﺍﻟﺻ��ﺣﻳﺢ ﺳ��ﻳﻌﺗﻣﺩ ﻋﻠ��ﻰ‬ ‫ﺍﻟﺻ��ﺩﻓﺔ ﻭﺗﻛ��ﻭﻥ ﺍﻟﺗﻔ��ﺎﻋﻼﺕ ﺑﻁﻳﺋ��ﺔ‪ .‬ﻭﻟ ّﻣ��ﺎ ﻛﺎﻧ��ﺕ ﺻ��ﻔﻳﺣﺎﺕ ﺍﻟ��ﺩﻡ ﺗﺗﺛ ّﺑ��ﺕ ﻋﻠ��ﻰ ﺍﻟ ُﻛﻼﺟ��ﻳﻥ ﻟ��ﺩﻯ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛ��ﺭ ﺗﺳ��ﺗﻘﺭ ﻋﻠ��ﻰ ﺳ��ﻁﻭﺣﻬﺎ‬ ‫ﺣﺻ��ﻭﻝ ﺍﻟﺟ��ﺭﺡ ﻭﺗﺟﺗﻣ��ﻊ ﺑﺄﻋ��ﺩﺍﺩ ﻫﺎﺋﻠ��ﺔ ﻫﻧ��ﺎﻙ‪ ،‬ﻓ��ﺈﻥ ﻋﻭﺍﻣ��ﻝ‬ ‫ﻭﺗﺗﻔﺎﻋﻝ ﺑﺳﻬﻭﻟﺔ ﻟﺗﻘﺎﺭﺑﻬﺎ ﻣﻊ ﺑﻌﺿﻬﺎ ﻭﺭﻛﻭﻧﻬﺎ ﺇﻟﻰ ﺳ�ﻁﻭﺡ ﺛﺎﺑﺗ�ﺔ ﺑ�ﺩﻻً ﻣ�ﻥ ﺳ�ﺑﺎﺣﺗﻬﺎ ﻓ�ﻲ ﺳ�ﺎﺋﻝ‬ ‫ﻣﺗﺣﺭّﻙ‪.‬‬ ‫ﻫﻧﺎ ﻳﺗﺑﺎﺩﺭ ﺳﺅﺍﻝ‪:‬‬ ‫ﺇﺫﺍ ﻛﺎﻧ��ﺕ ﺟﻣﻳ��ﻊ ﺍﻷﺣ��ﺩﺍﺙ ﺍﻟﺗ��ﻲ ﺫﻛﺭﻧﺎﻫ��ﺎ ﺗﻧ��ﺗﺞ ﻋ��ﻥ ﺍﻟﺷ � ّﺩﺓ ﻭﻋ��ﻥ ﺗﻬ � ّﺩﻡ ﺍﻟﺧﻼﻳ��ﺎ ﻓ��ﻲ ﺍﻟﻣﻧﻁﻘ��ﺔ‬ ‫ﺍﻟﻣﺗﻌ ّﺭﺿﺔ ﻟﻠﺷ ّﺩﺓ ﻓﻣﺎﺫﺍ ﻳﺣﺩﺙ ﺇﺫﺍ ﻓﺻﺩﻧﺎ ﻋﻳّﻧﺔ ﺩﻡ‪ ،‬ﺃﻭ ﻛﻳﺱ ﺩﻡ‪ ،‬ﻣﻥ ﺍﻹﻧﺳﺎﻥ ﺑﺩﻭﻥ ﺷ� ّﺩﺓ ُﺗ�ﺫﻛﺭ‪،‬‬ ‫ﻭﺑﺩﻭﻥ ﺃﻥ ﻳﺗﻌﺭّﺽ ﺍﻟﺩﻡ ﺇﻟﻰ ﻋﺻﺎﺭﺓ ﺧﻼﻳﺎ ﻣﻬ ّﺩﻣﺔ ﺃﻭ ُﻛﻼﺟﻳﻥ ﻭﺍﻗ�ﻊ ﺧ�ﺎﺭﺝ ﺍﻷﻭﻋﻳ�ﺔ ﺍﻟﺩﻣﻭﻳّ�ﺔ؟‬ ‫ّ‬ ‫ﻳﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻟﺔ ﻭﻫﻭ ﻳﻣ�ﺭ ﻣﺑﺎﺷ�ﺭﺓ ﻣ�ﻥ ﺍﻟﻭﺭﻳ�ﺩ ﺇﻟ�ﻰ ﺍﻟﻣﺣﻘﻧ�ﺔ ﺃﻭ ﺍﻷﻧﺑﻭﺑ�ﺔ ﺃﻭ‬ ‫ﻫﻝ‬ ‫ﺍﻟﻛﻳﺱ؟‬ ‫ﻭﺍﻟﺟﻭﺍﺏ ﻫﻭ‪ :‬ﻧﻌﻡ ّ‬ ‫ﻳﺗﺧﺛﺭ‪ .‬ﻭﺇﻟﻳﻙ ﺍﻟﺗﻔﺳﻳﺭ‪:‬‬

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‫ﻓﺎﻟﺩﻡ ﻓﻲ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻟﺔ ّ‬ ‫ﻳﺗﺧﺛﺭ ﻭﻟﻛﻥ ﻟﻳﺱ ﺑﺗﺄﺛﻳﺭ ﺧﺎﺭﺟﻲ )ﺃﻱ ﻋﺻﺎﺭﺓ ﺍﻷﻧﺳﺟﺔ( ﻭﻟﻛ�ﻥ ﺑﻔﻌ�ﻝ‬ ‫ﺩﺍﺧﻠ��ﻲ ﻣ��ﻥ ﺫﺍﺕ ﻣﻛﻭّ ﻧﺎﺗ��ﻪ‪ ،‬ﻭﻳﺑ��ﺩﺃ ﺫﻟ��ﻙ ﺑﺧﻁ��ﻭﺓ )ﺍﻟ ّﺗﻣ��ﺎﺱ(‪ .‬ﻭﻟﻛ��ﻥ ﺍﻟﺗﻣ��ﺎﺱّ ﻫﻧ��ﺎ ﻫ��ﻭ ﻟ��ﻳﺱ ﻣ��ﻊ‬ ‫ﺍﻟ ُﻛﻼﺟﻳﻥ ﺃﻭ ﺃﻧﺳﺟﺔ ﺍﻟﺟﺳ�ﻡ ﺍﻟﻭﺍﻗﻌ�ﺔ ﺧ�ﺎﺭﺝ ﺍﻷﻭﻋﻳ�ﺔ‪ ،‬ﺑ�ﻝ ﻣ�ﻊ ﺍﻷﺳ�ﻁﺢ ﺍﻟﻣﺧﺗﻠﻔ�ﺔ ﺍﻟﺗ�ﻲ ﻳﻼﻣﺳ�ﻬﺎ‬ ‫ﻛﺣﺩﻳﺩ ﺍﻹﺑﺭﺓ ﻭﺍﻟﺯﺟﺎﺝ ﺃﻭ ﺍﻟﺧﺷﺏ ﺃﻭ ﺍﻷﺭﺽ )ﺇﺫﺍ ﺍﻧﺳﻛﺏ ﺍﻟﺩﻡ ﻋﻠﻰ ﺍﻷﺭﺽ(‪ .‬ﻭﻣ�ﻥ ﻫﻧ�ﺎ ﻓ�ﺈﻥ‬ ‫ﺍﻟﺩﻡ ﺍﻟﻣﺳﻔﻭﺡ ﻣﻥ ﺍﻟﺟ�ﺭﺡ ﻋﻠ�ﻰ ﺍﻷﺭﺽ ﺃﻭ ﺍﻟﺳ�ﻁﻭﺡ ﺍﻷﺧ�ﺭﻯ ّ‬ ‫ﻳﺗﺧﺛ�ﺭ ﺑﻌ�ﺩ ﺩﻗ�ﺎﺋﻕ‪ .‬ﻭﻛ�ﺫﻟﻙ ﻓ�ﺈﻥ‬ ‫ﺍﻟﺩﻡ ﺍﻟﻣﻔﺻﻭﺩ ﺑﺎﻟﻣﺣﻘﻧﺔ ﻟﻔﺣﻭﺹ ﺍﻟﻣﺧﺗﺑﺭ‪ ،‬ﻟﻭ ﺗﺭﻛﻧﺎﻩ ﻣ�ﻥ ﻏﻳ�ﺭ ﺇﺿ�ﺎﻓﺔ ﻣ�ﻭﺍﺩ ﻣﻌﻳﻧ�ﺔ ﺗﺳ�ﻠﺏ ﻣﻧ�ﻪ‬ ‫ﺍﻟﻛﺎﻟﺳﻳﻭﻡ )ﺍﻧﻅﺭ ﺍﻟﻔﻘﺭﺓ ﺍﻟﻣﻘﺑﻠ�ﺔ( ّ‬ ‫ﻟﺗﺧﺛ�ﺭ ﺧ�ﻼﻝ ﺩﻗ�ﺎﺋﻕ‪ .‬ﻟﻛ�ﻥ ﻳﺟ�ﺏ ﺃﻥ ﻧﻌﻠ�ﻡ ﺃﻥ ﺳ�ﻁﻭﺣﺎ ً ﻣﻌﻳﻧ�ﺔ‪،‬‬ ‫ﻛﺎﻟﺑﻼﺳ��ﺗﻳﻙ ﻭﺍﻟﺳ��ﻁﻭﺡ ﺍﻟﻣﺩﻫﻭﻧ��ﺔ ﺑ��ﺎﻟﺯﻳﻭﺕ‪ ،‬ﻻ ﺗﻌﻁ��ﻲ ﻧﻔ��ﺱ ﺍﻟﺗﻔﻌﻳ��ﻝ ﺍﻟ��ﺫﻱ ﻳﻌﻁﻳ��ﻪ ﺍﻟﺣﺩﻳ��ﺩ ﻭ‬ ‫ﺍﻟﺯﺟﺎﺝ ﻭﺍﻟﺧﺷﺏ ﻭﺍﻷﺭﺽ ﻟﻌﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻋﻧﺩ ﺗﻣﺎﺳﻬﺎ ﻣ�ﻊ ﺍﻟ�ﺩﻡ‪ .‬ﻟ�ﺫﻟﻙ ﻓﺎﻟ�ﺩﻡ ﻳﺄﺧ�ﺫ ﻭﻗﺗ�ﺎ ُ ﺃﻁ�ﻭﻝ‬ ‫ﻟﻳﺗﺧﺛﺭ ﻋﻧﺩ ﺗﻣﺎﺳﻪ ﻣﻊ ﺍﻟﺳﻁﻭﺡ ﺍﻷﻭﻟﻰ‪ ،‬ﻛﻣﺎ ﺍﻟﺣﺎﻟﺔ ﻓﻲ ﺍﻷﻧﺎﺑﻳﺏ ﺍﻟﺑﻼﺳﺗﻳﻛﻳﺔ‪.‬‬ ‫ﺁﻳﻭﻥ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ ﻭﺗﺧﺛﺭ ﺍﻟﺩﻡ‬ ‫ﺇﻥ ﻣﻌﻅ��ﻡ ﺧﻁ��ﻭﺍﺕ ﻋﻣﻠﻳ��ﺔ ﺍﻟﺗﺧﺛ��ﺭ ﺗﺣﺗ��ﺎﺝ ﺇﻟ��ﻰ ﻋﻧﺻ��ﺭ ﺍﻟﻛﺎﻟﺳ��ﻳﻭﻡ ﻋﻠ��ﻰ ﺷ��ﻛﻝ ﺁﻳ��ﻭﻥ ﻟﺗ��ﺗﻡ‪ .‬ﻟﻛ��ﻥ‬ ‫ﺍﻟﻛﻣﻳﺔ ﺍﻟﻣﻭﺟﻭﺩﺓ ﻣﻧﻪ ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ﺯﺍﺋﺩﺓ ﻋﻥ ﺣﺎﺟﺔ ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛ�ﺭ ﻭﻻ ﺗﺗ�ﺄﺛﺭ ﻫ�ﺫﻩ ﺍﻟﻌﻣﻠﻳ�ﺔ ﺣﺗ�ﻰ‬ ‫ﻓﻲ ﺃﺷﺩ ﺣﺎﻻﺕ ﻧﻘﺹ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ ﻟﺩﻯ ﺍﻟﻣﺭﺿﻰ‪.‬‬ ‫ﻭﺣﻳﻧﻣ��ﺎ ُﺗﻔﺻ��ﺩ ﻋﻳّﻧ��ﺎﺕ ﺍﻟ��ﺩﻡ ﻣ��ﻥ ﺍﻟﻣﺭﺿ��ﻰ ﻹﺟ��ﺭﺍء ﻓﺣ��ﻭﺹ ﺍﻟﺗﺧﺛ��ﺭ ﻋﻠﻳﻬ��ﺎ ﻳﺿ��ﺎﻑ ﺇﻟﻳﻬ��ﺎ ﻣ��ﻥ‬ ‫ﺍﻟﺑﺩﺍﻳﺔ ﻛﻣﻳﺔ ﻣﻥ ﺇﺣﺩﻯ ﺍﻟﻣﻭﺍﺩ ﺍﻟﺗﻲ ﺗﻣﻧﻊ ﺗﺧﺛﺭ ﺍﻟﻌﻳﻧﺔ ﺑﻭﺍﺳﻁﺔ ﺳﻠﺏ ﻛﻝ ﺁﻳﻭﻧ�ﺎﺕ ﺍﻟﻛﺎﻟﺳ�ﻳﻭﻡ ﻣ�ﻥ‬ ‫ﺍﻟﺑﻼﺯﻣ�ﺎ‪ .‬ﺇﻥ ﻣﻧ��ﻊ ﺍﻟﺗﺧﺛ��ﺭ ﻫﻧ��ﺎ ﻫ��ﻭ ﻹﺑﻘ��ﺎء ﺍﻟ�ﺩﻡ ﺳ��ﺎﺋﻼً ﻭ ﺍﻟﺳ��ﻣﺎﺡ ﺑﻔﺻ��ﻝ ﺍﻟﺑﻼﺯﻣ��ﺎ ﻣﻧ��ﻪ ﻭﺇﺑﻘﺎﺋﻬ��ﺎ‬ ‫ﺳ��ﺎﺋﻠﺔ ﻟﺣ��ﻳﻥ ﺇﺟ��ﺭﺍء ﺍﻟﻔﺣ��ﺹ ﻋﻠﻳﻬ��ﺎ‪ .‬ﻭﻋﻧ��ﺩﻣﺎ ُﺗﺟ��ﺭﻯ ﻓﺣ �ﻭﺹ ﺍﻟﺗﺧﺛﺭﻋﻠ��ﻰ ﺍﻟﺑﻼﺯﻣ��ﺎ ﺑ��ﺎﻟﻣﺧﺗﺑﺭ‬ ‫ﻳﺿﺎﻑ ﺇﻟﻳﻬﺎ ﺍﻟﻛﺎﻟﺳ�ﻳﻭﻡ ﺑﻛﻣﻳ�ﺔ ﺗﺗﻐﻠ�ﺏ ﻋﻠ�ﻰ ﻓﻌ�ﻝ ﺍﻟﻣ�ﺎﺩﺓ ﺍﻟﻣﺎﻧﻌ�ﺔ ﻟﻠﺗﺧﺛ�ﺭ ﻓﻳ�ﺗﻡ ﺍﻟﺗﺧﺛ�ﺭ ﻭ ﻳﺣﺳ�ﺏ‬ ‫ﺍﻟﻭﻗﺕ ﺍﻟﻼﺯﻡ ﻟﺫﻟﻙ‪.‬‬ ‫ﻛﺫﻟﻙ ﻓﺈﻥ ﺍﻟ�ﺩﻡ ﺍﻟ�ﺫﻱ ﻳﺗﺑ�ﺭﻉ ﺑ�ﻪ ﺍﻹﻧﺳ�ﺎﻥ ﻟﺑﻧ�ﻙ ﺍﻟ�ﺩﻡ ﻳ�ﺩﺧﻝ ﺇﻟ�ﻰ ﻛ�ﻳﺱ ﺍﻟﺗﺑ�ﺭﻉ ﻟﻳﺟ�ﺩ ﻓﻳ�ﻪ ﺳ�ﺎﺋﻼً‬ ‫ﻳﺣﻭﻱ ﺇﺣﺩﻯ ﻫﺫﻩ ﺍﻟﻣﻭﺍﺩ ﺍﻟﺗﻲ ﺗﺣﺭﻡ ﺑﻼﺯﻣﺎ ﺍﻟﺩﻡ ﻣﻥ ﻛ�ﻝ ﺁﻳﻭﻧ�ﺎﺕ ﺍﻟﻛﺎﻟﺳ�ﻳﻭﻡ ﻓ�ﻭﺭﺍً ﻭﺑ�ﺫﻟﻙ ﻳﺑﻘ�ﻰ‬ ‫ﺍﻟﺩﻡ ﺳﺎﺋﻼً ﺧﻼﻝ ﻓﺗﺭﺓ ﺧﺯﻧﻪ ﻓﻲ ﺑﻧﻙ ﺍﻟﺩﻡ‪.‬‬

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‫ﺍﻟﻣﻭﺍﻧﻊ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﻠﺗﺧﺛﺭ‬ ‫ﻓﻲ ﻧﻔﺱ ﺑﻼﺯﻣﺎ ﺍﻟ�ﺩﻡ‪ ،‬ﻭﺍﻟﺗ�ﻲ ﺗﺣ�ﻭﻱ ﻛ�ﻝ ﺍﻟﻌﻭﺍﻣ�ﻝ ﺍﻟﻼﺯﻣ�ﺔ ﻟﺗﺧﺛ�ﺭ ﺍﻟ�ﺩﻡ‪ ،‬ﺗﻭﺟ�ﺩ ﻋﻭﺍﻣ�ﻝ ﺃﺧ�ﺭﻯ‬ ‫ﺗﺣﺎﻭﻝ ﻣﻧﻊ ﺍﻟﺗﺧﺛﺭ! ﻓﻠﻡ ﺫﻟﻙ؟ ﻭﻣﺎ ﻫﻲ ﺍﻟﺣﻛﻣﺔ؟ ﻭ ﻛﻳ�ﻑ ﻳﻣﻛ�ﻥ ﺃﻥ ﻳﺟﺗﻣ�ﻊ ﺍﻟﻧﻘﻳﺿ�ﺎﻥ ﻓ�ﻲ ﻣﻛ�ﺎﻥ‬ ‫ﻭﺍﺣﺩ؟ ﻭﻣﻥ ﻣﻧﻬﻣﺎ ﻳﺗﻐﻠّﺏ؟‬ ‫ﻟﻧﺑﺩﺃ ﺑﺑﻳﺎﻥ ﺃﻧﻭﺍﻉ ﻣﺿﺎ ّﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻭﻁﺭﻳﻘﺔ ﻋﻣﻝ ﻛﻝ ﻣﻧﻬﺎ‪:‬‬ ‫‪ .1‬ﻫﻧﺎﻙ ﻣﺿﺎ ّﺩ ﻟﻌﺎﻣﻝ ‪ 2‬ﺍﻟﻔﻌّﺎﻝ ) ﺍﻟﺧﺛﺭﻳﻥ(‪.‬‬ ‫‪ .2‬ﻫﻧﺎﻙ ﻋﺎﻣﻝ ﻣﺿﺎ ّﺩ ﻟﻌﺻﺎﺭﺓ ﺍﻷﻧﺳﺟﺔ‪.‬‬ ‫‪ .3‬ﻫﻧﺎﻙ ﻣﺿﺎ ّﺩ ﻟﻌﺎﻣﻝ ‪ 8‬ﻭﻋﺎﻣ�ﻝ ‪ 5‬ﺍﻟﻔﻌّ�ﺎﻟَﻳﻥ )ﻣﺿ�ﺎ ّﺩ ﻭﺍﺣ�ﺩ ﻟﻛﻠﻳﻬﻣ�ﺎ ﻣﻌ�ﺎ ً( ﻭﻳﺳ�ﻣّﻰ ﺑ�ﺭﻭﺗﻳﻥ ﺝ‬ ‫ﻭﻳﺳﺎﻋﺩﻩ ﺑﺭﻭﺗﻳﻥ ﺁﺧﺭ ﻫﻭ ﺑﺭﻭﺗﻳﻥ ﺍﺱ‪.‬‬ ‫‪ .4‬ﻫﻧﺎﻙ ﻣﺿﺎ ّﺩ ﺗﺧﺛ�ﺭ ﻣﺛﺑّ�ﺕ ﻓ�ﻲ ﺟ�ﺩﺭﺍﻥ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﻣﺑﻁﻧ�ﺔ ﻟﻸﻭﻋﻳ�ﺔ ﺍﻟﺩﻣﻭﻳ�ﺔ ﻭﺍﺳ�ﻣﻪ ) ﺍﻟﻌﺎﻣ�ﻝ‬ ‫ﺍﻟﻣﻛﻳّﻑ ﻟﻠﺧﺛﺭﺓ(‪.‬‬ ‫‪ .5‬ﻭﻫﻧﺎﻙ ﻣﺿﺎ ّﺩﺍﺕ ﺗﺧﺛﺭ ﺃﺧﺭﻯ ﺃﻗﻝ ﺃﻫﻣﻳﺔ‪.‬‬ ‫ﻫ�ﺫﻩ ﺍﻟﻌﻭﺍﻣ�ﻝ ﻣﻭﺟ�ﻭﺩﺓ ﻓ�ﻲ ﺍﻟﺑﻼﺯﻣ�ﺎ ﻓ�ﻲ ﻛ��ﻝ ﺃﻧﺣ�ﺎء ﺍﻟﺟﺳ�ﻡ‪ ،‬ﻋ�ﺩﺍ ﺍﻟﻌﺎﻣ�ﻝ ﺍﻟﻣﻛﻳّ�ﻑ ﻟﻠﺧﺛ�ﺭﺓ ﻓﻬ��ﻭ‬ ‫ﻣﻭﺟﻭﺩ ﻓﻲ ﺟﺩﺭﺍﻥ ﻛﻝ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﺑﻛﻝ ﺣﺟﻭﻣﻬﺎ‪ .‬ﺇﻥ ﺳ�ﺑﺏ ﻭﺟ�ﻭﺩ ﻛ�ﻝ ﻫ�ﺫﻩ ﺍﻟﻌﻭﺍﻣ�ﻝ ﻫ�ﻭ‬ ‫ﻟﻳﺱ ﻟﻣﻧﻊ ﺣﺻﻭﻝ ﺍﻟﺗﺧﺛﺭ ﻟﺩﻯ ﻭﻗﻭﻉ ﺍﻟﺷ�ﺩﺓ ﺃﻭ ﺍﻟﻧ�ﺯﻑ‪ ،‬ﺑ�ﻝ ﻫ�ﻭ ﻟﻣﻧ�ﻊ ﺗﻁ�ﻭﺭ ﻋﻣﻠﻳ�ﺔ ﺗﻔﻌﻳ�ﻝ ﺃﻱّ‬ ‫ﻣﻥ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﻗﺩ ﺗﺣﺻﻝ ﻓﻲ ﺍﻷﻭﺿﺎﻉ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻧﺗﻳﺟﺔ ﻟﺗﻬﺩﻡ ﺧﻼﻳ�ﺎ ﻗﻠﻳﻠ�ﺔ ﻣﺣ�ﺩﻭﺩﺓ ) ﻭﻫ�ﻭ‬ ‫ﻣﺎﻳﺣﺻ��ﻝ ﻛﺛﻳ��ﺭﺍً ﻭﻻ ﻳﺣﺗ��ﺎﺝ ﺇﻟ��ﻰ ﺗﺧﺛ��ﺭ ﺍﻟ �ﺩﻡ(‪ ،‬ﺃﻭ ﺩﺧ��ﻭﻝ ﻋﺻ��ﺎﺭﺍﺕ ﺃﻧﺳ��ﺟﺔ ﺑﺳ��ﺑﺏ ﺍﻟﺗﻬﺎﺑ��ﺎﺕ‬ ‫ﻣﻭﺿﻌﻳّﺔ ﻭﺣﻭﺍﺩﺙ ﺃﺧﺭﻯ ‪ ،‬ﻭﻛﻠﻬﺎ ﻻﺗﻘﺗﺿﻲ ﺣﺻﻭﻝ ﺗﺧﺛﺭ ﺩﻡ ﻣﻭﺿﻌ ّﻳﺎ ً‪ .‬ﻭﻟﻣﺎ ﻛﺎﻥ ﺍﻟﺗﻔﻌﻳﻝ ﻓ�ﻲ‬ ‫ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﺧﻔﻳﻔﺎ ً ﻭﺿﻌﻳﻔﺎ ً ﻭﻣﺣﺩﻭﺩﺍً ﻓﺈﻥ ﻋﻭﺍﻣﻝ ﻣﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺑﻁﺎﻗﺗﻬﺎ ﺍﻟﻣﺣ�ﺩﻭﺩﺓ‬ ‫ﺗﻧﺟﺢ ﻓﻲ ﻣﻧﻊ ﺣﺻﻭﻝ ﺗﺧﺛﺭ ﺩﺍﺧﻝ ﺍﻷﻭﻋﻳﺔ ﻭﻳﻌﻣﻝ ﻛﻝ ﻣﻧﻬﺎ ﻟﻣﻧﻊ ﻣﺭﺣﻠ�ﺔ ﻣﻌﻳّﻧ�ﺔ ﻣ�ﻥ ﺍﻟﻭﺻ�ﻭﻝ‬ ‫ﺇﻟﻰ ﺗﻔﻌﻳﻝ ﻣﺎ ﺑﻌﺩﻫﺎ‪ .‬ﻭﺑ�ﺫﻟﻙ ﻳﻛ�ﻭﻥ ﺍﻟﺟﺳ�ﻡ ﻣﺣﻣﻳّ�ﺎ ً ﻣ�ﻥ ﺣﺻ�ﻭﻝ ﺣ�ﻭﺍﺩﺙ ﺗﺧﺛ�ﺭ ﺩﺍﺧﻠﻳ�ﺔ ﺑﺻ�ﻭﺭﺓ‬ ‫ﻏﻳﺭ ﻣﻘﺻﻭﺩﺓ ﻭﻻ ﻣﻔﻳﺩﺓ ﻟﻠﺟﺳﻡ ﻓﻲ ﺗﻠﻙ ﺍﻟﻅﺭﻭﻑ ) ﺣﻳﺙ ﻻ ﻳﻭﺟﺩ ﻧﺯﻑ ﻳﺣﺗﺎﺝ ﻟﻣﺎ ﻳﻭﻗﻔﻪ(‪.‬‬ ‫ﻳﺟﺏ ﺃﻥ ﻧﻼﺣﻅ ﺃﻥ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻣﺎﻧﻌﺔ ﻟﻠﺗﺧﺛ�ﺭ ﻣﻭﺟ�ﻭﺩﺓ ﺑﺗﺭﻛﻳ�ﺯ ﺑﺳ�ﻳﻁ ﻓ�ﻲ ﻛ�ﻝ ﻧﻘﻁ�ﺔ ﻓ�ﻲ ﺍﻟﺟﺳ�ﻡ‬ ‫ﻳﺗﻧﺎﺳﺏ ﻣﻊ ﻣﺛﻝ ﻫ�ﺫﻩ ﺍﻻﺣﺗﻣ�ﺎﻻﺕ ﻟﺗﺧﺛ�ﺭ ﻣﻭﺿ�ﻌﻲ ﺑﺳ�ﻳﻁ ﻟﺗﻘ�ﻭﻡ ﺑﻣﻧﻌ�ﻪ‪ .‬ﻛﻣ�ﺎ ﻳﺟ�ﺩﺭ ﺃﻥ ﻧﻼﺣ�ﻅ‬ ‫ﺍﻟﺣﻛﻣﺔ ﻣﻥ ﻭﺟﻭﺩ ﻣﺎﻧﻊ ﺗﺧﺛﺭ ﺛﺎﺑﺕ ﻓﻲ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﻣﺑﻁﻧ�ﺔ ﺍﻟﺳ�ﻠﻳﻣﺔ‪ ،‬ﻓﻬ�ﺫﺍ ﺍﻟﻌﺎﻣ�ﻝ ﻳﻔﻌّ�ﻝ ﺍﻟﺑ�ﺭﻭﺗﻳﻥ‬

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‫ﺝ ﺍﻟﻣﺎﻧﻊ ﻟﻠﺗﺧﺛﺭ ﻛﻣ�ﺎ ﻳﺛ�ﺑّﻁ ﺍﻟﺧﺛ�ﺭﻳﻥ ﻭﺑ�ﺫﻟﻙ ﻳﻣﻧ�ﻊ ﺍﺳ�ﺗﻣﺭﺍﺭ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ ﻓ�ﻲ ﺍﻟﻣﻭﺍﺿ�ﻊ ﺍﻟﺗ�ﻲ‬ ‫ﻳﻛﻭﻥ ﻣﻭﺟﻭﺩﺍً ﻓﻳﻬﺎ‪ ،‬ﺃﻱ ﺍﻟﺗﻲ ﺗﻛ�ﻭﻥ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﻣﺑﻁﻧ�ﺔ ﻟﻸﻭﻋﻳ�ﺔ ﺍﻟﺩﻣﻭﻳ�ﺔ ﺳ�ﻠﻳﻣﺔ‪ .‬ﺃﻣ�ﺎ ﺇﺫﺍ ﺗﻬ� ّﺩﻣﺕ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺑﻁﻧﺔ ‪ ،‬ﺑﺳﺑﺏ ﺟﺭﺡ ﺃﻭ ﺷﺩﺓ‪ ،‬ﻓﻠﻥ ﻳﻛﻭﻥ ﻓﻲ ﺍﻟﻣﻭﺿﻊ ﻣﺎﻧﻊ ﺗﺧﺛﺭ ﻣﺛﺑّﺕ ﻓﻳﻬ�ﺎ) ﺍﻟﻌﺎﻣ�ﻝ‬ ‫ﺍﻟﻣﻛﻳّﻑ ﻟﻠﺧﺛﺭﺓ( ﻭﺑﺫﻟﻙ ﻳُﺳﻣﺢ ﻟﻠﺧﺛﺭﺓ ﺑﺎﻟﺗﻛﻭّ ﻥ ﻓﻲ ﺫﻟﻙ ﺍﻟﻣﻭﺿﻊ‪ ،‬ﺣﻳﺙ ﻳﻐﻳﺏ ﺍﻟﻌﺎﺋﻕ‪.‬‬ ‫ﺑﻌﺩ ﺗﻛﻭﻧﻬﺎ ﻓﻲ ﻣﻭﺍﻗﻊ ﺍﻟﺟﺭﻭﺡ ﻭﺍﻟﺷﺩّ ﺓ؟‬ ‫ﻣﺎﺫﺍ ﻳﺣﺻﻝ ﻟﻠﺧﺛﺭﺓ‬ ‫ّ‬

‫ﺍﻟﺷﻛﻝ ‪ّ 9‬‬ ‫ﻳﻣﺛ�ﻝ ﻗﻁﻌ�ﺎ ً ﻓ�ﻲ ﺍﻟﺟﻠ�ﺩ ﻭﻣ�ﺎ ﺗﺣﺗ�ﻪ ﻣ�ﻥ ﺍﻷﻧﺳ�ﺟﺔ ﺑﻔﻌ�ﻝ ﺷ�ﺩﺓ ﻣ�ﺎ ﻛﺟ�ﺭﺡ ﺑﺂﻟ�ﺔ ﺣ�ﺎ ّﺩﺓ‪ .‬ﺇﻥ‬ ‫ﺍﻟﻔﺭﺍﻍ ﺍﻟﺣﺎﺻﻝ ﺑﻳﻥ ﺣﺎﻓﺗﻲ ﺍﻟﺟﺭﺡ ﻳﻣﺗﻠ�ﺊ ﺑﺎﻟ�ﺩﻡ ﺍﻟﻧ�ﺎﺯﻑ ﺛ�ﻡ ﻳﺣﺻ�ﻝ ﻓ�ﻲ ﺍﻟﻣﻭﻗ�ﻊ ﻛ�ﻝ ﺍﻷﺣ�ﺩﺍﺙ‬ ‫ﺍﻷﺭﺑﻌﺔ ﺍﻟﺗﻲ ﺫﻛﺭﺗﻬﺎ ﻓﻲ ﺍﻟﺣﺩﻳﺙ ﻋﻥ ﻗﻁﻊ ﺍﻟﻧﺯﻑ‪ ،‬ﻭﻧﺻﻝ ﺑﺎﻟﻧﻬﺎﻳﺔ ﺇﻟﻰ ﺗﺛﺑﻳﺕ ﺧﺛﺭﺓ ﻛﺑﻳﺭﺓ ﻓ�ﻲ‬ ‫ﺫﻟﻙ ﺍﻟﻣﻛﺎﻥ ﺗﺅ ّﺩﻱ ﺇﻟﻰ ﻗﻁﻊ ﺍﻟﻧﺯﻑ ﺗﻣﺎﻣﺎ ً‪.‬‬ ‫ﺇﻥ ﻫﺫﺍ ﺍﻷﻣﺭ‪ ،‬ﻭﺇﻥ ﻛﺎﻥ ﻣﻔﻳ�ﺩﺍً ﻟﻠﺟﺳ�ﻡ ﻟﻭﻗ�ﻑ ﻧﺯﻳ�ﻑ ﺍﻟ�ﺩﻡ‪ ،‬ﺇﻻّ ﺃﻧ�ﻪ ﻧ�ﻭﻉ ﻣ�ﻥ ﺍﻹﺳ�ﻌﺎﻑ ﺍﻟﻔ�ﻭﺭﻱ‬ ‫ﻓﻘﻁ ﻳُﻘﺻﺩ ﺑﻪ ﻣﻧﻊ ﺍﻟﺧﻁﺭ ﺍﻟﻣﺣﺩﻕ ﺟﺭﺍء ﻓﻘﺩﺍﻥ ﺍﻟﺩﻡ‪ ،‬ﻭﻟﻛﻥ ﺑﻌﺩ ﺗﻭﻗّﻑ ﺍﻟﻧﺯﻑ ﻭﺍﺳﺗﻣﺭﺍﺭ ﺍﻟﺣﻳﺎﺓ‬ ‫ﻓﺈﻥ ﻫﺫﻩ ﺍﻟﻣﻧﻁﻘﺔ ﺍﻟﺗﻲ ﺣﺻﻝ ﻓﻳﻬﺎ ﻗﻁﻊ ﺗﺣﺗﺎﺝ ﺇﻟﻰ ﺗﺭﻣﻳﻡ‪ .‬ﻭﻣﻌﻅ�ﻡ ﺍﻟﺗ�ﺭﻣﻳﻡ‪ ،‬ﻋ�ﺩﺍ ﺇﻋ�ﺎﺩﺓ ﻭﺻ�ﻝ‬ ‫ﺍﻟﺟﻠﺩ‪ ،‬ﻳﻛﻭﻥ ﺑﺗﺄﺛﻳﺭ ﻣﻥ ﺍﻟ�ﺩﻡ ﺍﻟ�ﺫﻱ ﺣ� ّﻝ ﺑﺎﻟﻣﻧﻁﻘ�ﺔ ﻭﺗﺧﺛ�ﺭ ﻓﻳﻬ�ﺎ‪ .‬ﻭﺣﻳﻧﻣ�ﺎ ﻳﺗ�ﺩ ّﺧﻝ ﺍﻟﺟ� ّﺭﺍﺡ ﻟﻳﺧ�ﻳﻁ‬ ‫ﺍﻟﺟﺭﺡ ) ﺇﺫﺍ ﻛﺎﻧﺕ ﺣﺎﻓﺗﺎﻩ ﻣﺗﺑﺎﻋﺩﺗﻳﻥ( ﻓﺈﻧﻪ ﺑﺫﻟﻙ ﻳﺳﺎﻋﺩ ﻓﻲ ﻋﻣﻠﻳّﺔ ﺍﻟﺗﺭﻣﻳﻡ‪.‬‬ ‫ﻭﺍﻟﺗﺭﻣﻳﻡ‪ ،‬ﺍﻟﺫﻱ ﻫﻭ ﺷﻔﺎء ﺍﻟﺟﺭﻭﺡ‪ ،‬ﻳﺗﻡ ﺑﺎﻟﺧﻁﻭﺍﺕ ﺍﻟﺗﺎﻟﻳﺔ‪:‬‬ ‫‪ .1‬ﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﻣﻬﻣﺔ ﺍﻟﺗﻲ ﺍﻧﻘﻁﻌﺕ ﻋﻧﺩ ﺣﺻﻭﻝ ﺍﻟﺟﺭﺡ ﻭ ُﺳ ّﺩﺕ ﻧﻬﺎﻳﺎﺗﻬﺎ ﺑﺎﻟﺧﺛﺭﺓ ﻳﺟ�ﺏ‬ ‫ﺃﻥ ُﺗﻔﺗﺢ ﻟﻳﻌ�ﻭﺩ ﺟﺭﻳ�ﺎﻥ ﺍﻟ�ﺩﻡ ﺇﻟ�ﻰ ﺣﺎﻟﺗ�ﻪ ﺍﻷﻭﻟ�ﻰ ﻭﻳﺻ�ﻝ ﺇﻟ�ﻰ ﺍﻟﻣﻧ�ﺎﻁﻕ ﺍﻟﺗ�ﻲ ﺍﻧﻘﻁ�ﻊ‬ ‫ﻋﻧﻬﺎ‪ .‬ﻭﻳﻛﻭﻥ ﺫﻟ�ﻙ ﺑﻔﻌ�ﻝ ﺇﻧﻅﻳﻣ�ﺎﺕ ﻣﺫﻳﺑ�ﺔ ﻟﻠﺧﺛ�ﺭﺓ ﺩﺍﺧ�ﻝ ﺍﻷﻭﻋﻳ�ﺔ ﺍﻟﺩﻣﻭﻳ�ﺔ )ﻭﻟ�ﻳﺱ‬ ‫ﺧﺎﺭﺟﻬ���ﺎ ﻓ���ﻲ ﺍﻟﺟ���ﺭﺡ ﻛﻠ���ﻪ( ﺗ���ﺫﻳﺏ ﺍﻟﺧﺛ���ﺭﺓ ﻣ���ﻥ ﻧﻬﺎﻳ���ﺎﺕ ﺍﻷﻭﻋﻳ���ﺔ ﻭﻳﻌ���ﻭﺩ ﺍﻟ���ﺩﻡ‬ ‫ﻟﻠﺟﺭﻳ��ﺎﻥ‪.‬ﻫ��ﺫﻩ ﺍﻹﻧﻅﻳﻣ��ﺎﺕ ﺗﻛ��ﻭﻥ ﻏﻳ��ﺭ ﻓﻌّﺎﻟ��ﺔ ﻓ��ﻲ ﺍﻟﻭﺿ��ﻊ ﺍﻟﻁﺑﻳﻌ��ﻲ ﻭﺗﺗﻔ ّﻌ��ﻝ ﺩﺍﺧ��ﻝ‬ ‫ﺃﻭﻋﻳﺔ ﺍﻟﺩﻡ ﻓﻘﻁ ﻭﻓﻲ ﻣﻧﻁﻘﺔ ﺍﻟﺟﺭﺡ ﺗﺣﺩﻳﺩﺍً‪.‬‬ ‫‪ .2‬ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﺍﻟﺩﻣﻭﻳ��ﺔ ﺍﻟﺗ��ﻲ ﺗﻛ ّﺩﺳ��ﺕ ﻓ��ﻲ ﺍﻟﻣﻧﻁﻘ��ﺔ ﺗﻔ��ﺭﺯ ﻣ��ﻭﺍﺩ ﺗﺳ��ﺎﻋﺩ ﻋﻠ��ﻰ ﺗﻛ��ﺎﺛﺭ‬ ‫ﺍﻟﻧﺳﻳﺞ ﺍﻟﻠﻳﻔﻲ ﻭﺍﻟﺷﻌﻳﺭﺍﺕ ﺍﻟﺩﻣﻭﻳﺔ ﻓ�ﻲ ﻭﺳ�ﻁ ﺍﻟﺧﺛ�ﺭﺓ ﺍﻟﺗ�ﻲ ﺗﺣﺗ�ﻝ ﺍﻟﺟ�ﺭﺡ ‪ ،‬ﻭﺑ�ﺫﻟﻙ‬ ‫ﻳﺑﻧﻰ ﻧﺳﻳﺞ ﻟﻳﻔﻲ ﺑﻌﺩ ﺃﻳّﺎﻡ ﺇﻟﻰ ﺃﺳﺎﺑﻳﻊ ﻟﻳﻠﺗﺋﻡ ﺍﻟﺟﺭﺡ ﺑﻪ‪.‬‬

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‫)‪(1‬‬

‫ﺧﺛﺭﺓ ﺍﻟﺩﻡ‬

‫ﺟــــﻠﺩ‬

‫ﺷﺭﻳﺎﻥ ﻣﻘﻁﻭﻉ ﺑﺎﻟﺟﺭﺡ‬ ‫ﻭﻣﺳﺩﻭﺩ ﺑﺎﻟﺧـﺛﺭﺓ‬

‫)‪(2‬‬ ‫ﺷﺭﻳﺎﻥ ﻣﻭﺻﻭﻝ ﺑﻌﺩ ﺗﺫﻭﻳﺏ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻣﻥ ﻁﺭﻳﻘﻪ ﺑﺎﻹﻧﻅﻳﻣﺎﺕ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪9‬‬

‫‪.3‬ﺗﻭﺳّﻊ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﺑﺎﻟﻣﻧﻁﻘ�ﺔ ) ﻭﻫ�ﻭ ﻣ�ﺎ ﻳ�ﺅﺩﻱ ﺇﻟ�ﻰ ﺍﺣﻣ�ﺭﺍﺭ ﻟ�ﻭﻥ ﺍﻟﺟﻠ�ﺩ ﺣ�ﻭﺍﻟﻲ ﺍﻟﺟ�ﺭﺡ‬ ‫ﺑﻌ��ﺩ ﺃ ّﻳ��ﺎﻡ ﻣ��ﻥ ﺣﺻ��ﻭﻟﻪ( ‪ ،‬ﻭﺑ��ﺫﻟﻙ ﻳ��ﺄﺗﻲ ﺩﻡ ﺃﻛﺛ��ﺭ ﻭﻓﻳ��ﻪ ﺧﻼﻳ��ﺎ ﺩﻡ ﺑﻳﺿ��ﺎء ﺗﺯﻳ��ﻝ ﺍﻷﻧﺳ��ﺟﺔ ﺍﻟﻣﻳّﺗ��ﺔ‬ ‫ﻭﺗﻘﺗﻝ ﻣﺎ ﺩﺧﻝ ﻣﻥ ﺟﺭﺍﺛﻳﻡ ﻭﻣﻭﺍﺩ ﻏﺭﻳﺑ�ﺔ ﻧﺗﻳﺟ�ﺔ ﺍﻟﺟ�ﺭﺡ‪ ،‬ﻛﻣ�ﺎ ﺗﺟﻠ�ﺏ ﻣ�ﻭﺍﺩ ﻓﻌّﺎﻟ�ﺔ ﺗﻧ ّ‬ ‫ﺷ�ﻁ ﻋﻣﻠﻳ�ﺔ‬ ‫ﺍﻻﻟﺗﺋﺎﻡ‪.‬‬ ‫ﺇﻥّ ﺍﻹﻧﻅﻳﻡ ﺍﻟﺭﺋﻳﺳﻲ ﺍﻟﺫﻱ ﻳﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ ﺑﻌﺩ ﺗﻛﻭّ ﻧﻬﺎ‪ ،‬ﻭﻛﻐﻳﺭﻩ ﻣ�ﻥ ﺇﻧﻅﻳﻣ�ﺎﺕ ﺍﻟﺑﻼﺯﻣ�ﺎ‪ ،‬ﻻ ﻳﻛ�ﻭﻥ‬ ‫ﻓﻌّﺎﻻً ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳ�ﺔ‪ ،‬ﻭﺗﻘ�ﻭﻡ ﻣ�ﺎﺩﺓ ُﺗﻔ�ﺭﺯ ﻣ�ﻥ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﻣﺑﻁﻧ�ﺔ ﻷﻭﻋﻳ�ﺔ ﺍﻟ�ﺩﻡ )ﻣﻔﻌّ�ﻝ ﻣ�ﺫﻳﺏ‬ ‫ﺍﻟﺧﺛﺭﺓ( ﺑﺗﻔﻌﻳﻠﻪ‪ .‬ﻭﺑﺫﻟﻙ ﻓﻬﻲ ﺗﻔﻌّﻠﻪ ﻓﻲ ﻣﻭﺍﻗﻊ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﺍﻟﺗﻲ ﺗﻔﺭﺯﻫﺎ ﻟﺗ�ﺯﺍﻝ ﺍﻟﺧﺛ�ﺭﺓ ﻣ�ﻥ‬

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‫ﻫﻧﺎﻙ ﻭﻳﻌﻭﺩ ﺟﺭﻳ�ﺎﻥ ﺍﻟ�ﺩﻡ ) ﺍﻧﻅ�ﺭ ﺍﻟﺷ�ﻛﻝ ‪ ،(9‬ﺑﻳﻧﻣ�ﺎ ﻻ ﻳ�ﺗﻡ ﺍﻟﺗﻔﻌﻳ�ﻝ ﻓ�ﻲ ﺍﻟﻣﻭﺍﺿ�ﻊ ﺍﻟﺧﺎﻟﻳ�ﺔ ﻣ�ﻥ‬ ‫ﺃﻭﻋﻳﺔ ﺩﻡ )ﺑﻘﻳﺔ ﺃﺟﺯﺍء ﺍﻟﺧﺛﺭﺓ( ﻓﺗﺑﻘ�ﻰ ﺍﻟﺧﺛ�ﺭﺓ ﺻ�ﺎﻣﺩﺓ ﻫﻧ�ﺎﻙ ﺣﺗ�ﻰ ﻳﺣ�ﻝ ﻓﻳﻬ�ﺎ ﻧﺳ�ﻳﺞ ﻟﻳﻔ�ﻲ ﻳ�ﻸﻡ‬ ‫ﺍﻟﺟﺭﺡ ﺑﺻﻭﺭﺓ ﺩﺍﺋﻣﺔ‪ .‬ﻭﻫﻧﺎ ﺗﺑﺩﻭ ﺍﻟﺣﻛﻣﺔ ﻣﻥ ﻛﻝ ﻣﺎ ﻫﻭ ﻣﻭﺟ�ﻭﺩ ﻓ�ﻲ ﺍﻟﻭﺿ�ﻊ ﺍﻟﻁﺑﻳﻌ�ﻲ ﻭﻛﻳﻔﻳ�ﺔ‬ ‫ﻋﻣﻝ ﻛﻝ ﻣﻥ ﺗﻠﻙ ﺍﻟﻣﻭﺍﺩ ﻓﻲ ﺍﻟﻭﻗﺕ ﻭﺍﻟﺯﻣﺎﻥ ﺍﻟﻣﻧﺎﺳﺑﻳﻥ‪.‬‬

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‫ﺍﻟﻔﺼﻞ ﺍﻟﺜﺎﻧﻲ‬

‫ﺃﻣﺮﺍﺽ ﻓﺮﻁ ﺍﻟﻨﺰﻑ‬

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‫ﻣﻘﺩّ ﻣﺔ‬

‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ‬

‫ﻛﻝ ﻣ ّﻧﺎ ﻳﺻﺎﺏ ﺑﺎﻟﻧﺯﻑ ﻓﻲ ﺣﺎﻟﺔ ﺣﺻ�ﻭﻝ ﻗﻁ�ﻊ ﻓ�ﻲ ﺃﻱ ﺟ�ﺯء ﻣ�ﻥ ﺍﻟﺟﻠ�ﺩ ﺃﻭ ﺍﻷﻧﺳ�ﺟﺔ ﺍﻟﺩﺍﺧﻠﻳ�ﺔ‪،‬‬ ‫ﻭﻣﻘﺩﺍﺭ ﺍﻟﻧﺯﻑ ﻳﺗﻧﺎﺳﺏ ﻣﻊ ﺣﺟﻡ ﺍﻟﺷﺩﺓ ﺃﻭ ﺍﻟﻘﻁﻊ ﻭﻣﻊ ﻧﻭﻉ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﺍﻟﻣﻘﻁﻭﻋ�ﺔ‪ .‬ﻓﺑﻳﻧﻣ�ﺎ‬ ‫ﺗﻛﻭﻥ ﻭﺧﺯﺓ ﺍﻟﺩﺑﻭﺱ ﺻﻐﻳﺭﺓ ﺑﺣﻳﺙ ﻻ ﺗﻘﻁ�ﻊ ﺇﻻّ ﺃﻭﻋﻳ�ﺔ ﺷ�ﻌﺭﻳﺔ‪ ،‬ﻓ�ﺈﻥ ﺟ�ﺭﺡ ﺍﻟﺳ�ﻛﻳﻥ ﻗ�ﺩ ﻳﻘﻁ�ﻊ‬ ‫ﺃﻭﺭﺩﺓ ﺃﻭ ﺷ��ﺭﺍﻳﻳﻥ ﺻ��ﻐﻳﺭﺓ ﺃﻭ ﻗ��ﺩ ﻳﻛ��ﻭﻥ ﺍﻟﻘﻁ��ﻊ ﻓ��ﻲ ﺷ��ﺭﻳﺎﻥ ﻣﻬ��ﻡ‪ ،‬ﺇﺿ��ﺎﻓﺔ ﺇﻟ��ﻰ ﻣ��ﺎ ﻫ��ﻭ ﺃﺻ��ﻐﺭ‬ ‫ﻣﻧﻪ‪..‬ﻭﻗﻁﻊ ﺍﻟﺷﺭﻳﺎﻥ ﻳﻧﺯﻑ ﺃﻛﺛﺭ ﻷﻥ ﻗﻭﺓ ﺩﻓ�ﻊ ﺍﻟ�ﺩﻡ ﻓﻳ�ﻪ ﺷ�ﺩﻳﺩﺓ‪ ،‬ﻓﻬ�ﻲ ﺗ�ﺯﻳﺢ ﺍﻟﺧﺛ�ﺭﺓ ﻭﺗﺟﻣّﻌ�ﺎﺕ‬ ‫ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﺗﻲ ﺗﺗﻛﻭّ ﻥ ﻭﺗﺩﻓﻌﻬﺎ ﻟﻠﺧﺎﺭﺝ ﻣﻊ ﺍﻟﺩﻡ ﺍﻟﻣﺳ�ﻔﻭﺡ‪ .‬ﻟ�ﺫﻟﻙ ﻓ�ﺈﻥّ ﺍﻟﺿ�ﻐﻁ ﻋﻠ�ﻰ ﺍﻟﺷ�ﺭﻳﺎﻥ‬ ‫ﻓ��ﻲ ﻣﻭﺿ��ﻊ ﺃﻗ��ﺭﺏ ﻟﻠﻘﻠ��ﺏ ﻣ��ﻥ ﻧﻘﻁ��ﺔ ﺍﻟﻧ��ﺯﻑ‪ ،‬ﻟﻔﺗ��ﺭﺓ ﻣﺣ��ﺩﻭﺩﺓ‪ ،‬ﺿ��ﺭﻭﺭﻱ ﻟﻭﻗ��ﻑ ﺍﻧ��ﺩﻓﺎﻉ ﺍﻟ��ﺩﻡ‬ ‫ﻭﺇﻋﻁﺎء ﺍﻟﻣﺟﺎﻝ ﻟﺗﻛﻭّ ﻥ ﺍﻟﺧﺛﺭﺓ ﻭﺳﺩ ﺍﻟﺟﺭﺡ ﺗﻣﺎﻣﺎ ً‪.‬‬ ‫ﺇﻥ ﺍﻻﺧﺗﻼﻑ ﻓﻲ ﺣﺟﻡ ﻭﻣﺩﺓ ﺍﻟﻧ�ﺯﻑ ﻓ�ﻲ ﺣﺎﻟ�ﺔ ﺍﻟﺟ�ﺭﻭﺡ‪ ،‬ﻭﻛ�ﺫﻟﻙ ﺍﻟﻧ�ﺯﻑ ﻣ�ﻥ ﻗﺭﺣ�ﺔ ﺍﻟﻣﻌ�ﺩﺓ ﺃﻭ‬ ‫ﺍﻟﺭﻋﺎﻑ )ﻧ�ﺯﻑ ﺍﻷﻧ�ﻑ( ﻓ�ﻳﻣﻥ ﻋﻧ�ﺩﻩ ﺗﻭﺳ�ﻊ ﺃﻭﺭﺩﺓ ﻓ�ﻲ ﺍﻷﻧ�ﻑ‪ ،‬ﻛﻠﻬ�ﺎ ﻻ ﺗ�ﺩﺧﻝ ﺿ�ﻣﻥ ﺃﻣ�ﺭﺍﺽ‬ ‫ﻓﺭﻁ ﺍﻟﻧﺯﻑ‪ ،‬ﻷﻥ ﺍﻟﻧﺯﻑ ﻣﺗﻭﻗّﻊ ﻓ�ﻲ ﻫ�ﺫﻩ ﺍﻟﺣ�ﺎﻻﺕ ﻭﻣ ّﺩﺗ�ﻪ ﻣﺗﻭﻗّﻌ�ﺔ ﺑﺣﺳ�ﺏ ﻣﻭﺿ�ﻌﻪ ﻭﺍﻷﻭﻋﻳ�ﺔ‬ ‫ﺍﻟﺩﻣﻭﻳﺔ ﺍﻟﻣﻘﻁﻭﻋﺔ ﺑﺳﺑﺑﻪ‪.‬‬ ‫ﺃ ّﻣ��ﺎ ﻣ��ﺎ ﻳﺳ��ﻣﻰ ﺑ��ﺄﻣﺭﺍﺽ ﻓ��ﺭﻁ ﺍﻟﻧ��ﺯﻑ‪ ،‬ﺃﻭ ﺍﻷﻣ��ﺭﺍﺽ ﺍﻟﻧﺯﻓ ّﻳ��ﺔ‪ ،‬ﻭﺃﺷ��ﻬﺭﻫﺎ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳ��ﺎ) ﻣ��ﺭﺽ‬ ‫ﺍﻟﻧﺎﻋﻭﺭ ﻋﻧﺩ ﺍﻟﻌﺭﺏ(‪ ،‬ﻓﻬﻲ ﺣﺎﻻﺕ ﻣﺭﺿﻳﺔ‪ ،‬ﻣﻭﺭﻭﺛﺔ ﺃﻭ ﻣﻛﺗﺳﺑﺔ‪ ،‬ﺗﺳﺑﺏ ﺣﺎﻻﺕ ﻧﺯﻓﻳ�ﺔ ﺗﻠﻘﺎﺋﻳّ�ﺔ‬ ‫)ﺩﻭﻧﻣﺎ ﺷﺩﺓ ﻭﺩﻭﻥ ﻭﺟﻭﺩ ﺳﺑﺏ ﻣﻭﺿﻌﻲ(‪ ،‬ﻭﻫﺫﺍ ﺃﻣﺭ ﻻ ﻳﺣﺻﻝ ﻓ�ﻲ ﺇﻧﺳ�ﺎﻥ ﻁﺑﻳﻌ�ﻲ‪ ،‬ﺃﻭ ﺗﺳ�ﺑﺏ‬ ‫ﻧﺯﻓﺎ ً ﺩﺍﺧﻠﻳﺎ ً ﺃﻭ ﺧﺎﺭﺟﻳﺎ ً )ﺃﻭ ﻛﻠﻳﻬﻣﺎ( ﺑﺳﺑﺏ ﺷﺩﺓ‪ ،‬ﻭﻟﻛﻥ ﺣﺟﻡ ﻭﻣﺩﺓ ﺍﻟﻧﺯﻑ ﺃﻛﺑﺭ ﻣﻣﺎ ﺗﺗﺳ�ﺑﺏ ﻓﻳ�ﻪ‬ ‫ﻣﺛﻝ ﺗﻠﻙ ﺍﻟﺷﺩﺓ ﻓﻲ ﺇﻧﺳﺎﻥ ﻁﺑﻳﻌﻲ‪ .‬ﻭﻳﺷﻌﺭ ﺍﻟﻣﺭﻳﺽ ﺃﻭ ﺃﻫﻠﻪ ﺑ�ﺄﻥ ﺍﻟﺣﺎﻟ�ﺔ ﻏﻳ�ﺭ ﻁﺑﻳﻌﻳ�ﺔ‪ ،‬ﻻﺳ�ﻳّﻣﺎ‬ ‫ﺑﻌﺩ ﺗﻛﺭﺭﻫﺎ‪.‬‬ ‫ﺃﺩﻧ��ﺎﻩ ﺟ��ﺩﻭﻝ ﻳﺻ � ّﻧﻑ ﺃﻣ��ﺭﺍﺽ ﻓ��ﺭﻁ ﺍﻟﻧ��ﺯﻑ ﺍﻟﻣﻭﺭﻭﺛ��ﺔ ﻭﺍﻟﻣﻛﺗﺳ��ﺑﺔ‪ ،‬ﻳﻠﻳ��ﻪ ﺷ��ﺭﺡ ﻟﻛ��ﻝ ﻣ��ﻥ ﻫ��ﺫﻩ‬ ‫ﺍﻟﻣﺟﻣﻭﻋ��ﺎﺕ ﺍﻟﻣﺭﺿ��ﻳﺔ ﻭﺃﻋﺭﺍﺿ��ﻬﺎ ﻭﻛﻳﻔﻳ��ﺔ ﻋﻼﺟﻬ��ﺎ ﺑﺻ��ﻭﺭﺓ ﻣﺧﺗﺻ��ﺭﺓ‪ ،‬ﻣ��ﻊ ﺍﻟﺗﺭﻛﻳ��ﺯ ﻋﻠ��ﻰ‬ ‫ﺍﻷﻧﻭﺍﻉ ﺍﻷﻛﺛﺭ ﺷﻳﻭﻋﺎ ً‪.‬‬

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‫ﺗﺻﻧﻳﻑ ﻋﺎﻡ ﻟﻸﻣﺭﺍﺽ ﺍﻟﻧﺯﻓﻳﺔ‬ ‫ﺍ‪ -‬ﻭﺭﺍﺛﻴﺔ‬

‫ﺃﻣﺮﺍﺽ ﻓﺮﻁ ﺍﻟﻨﺰﻑ‬

‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫‪‬‬

‫ﺃﻣﺭﺍﺽ ﺍﻟ ُﻛﻼﺟﻳﻥ‬ ‫ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ‬ ‫ﺧﻠﻝ ﻭﻅﻳﻔﻲ ﺑﺎﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﻣﺭﺽ ﻓﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‬ ‫ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺗﺧﺛﺭ‬ ‫ﻧﻘﺹ ﻣﺿﺎﺩ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ‬

‫ﺏ‪ -‬ﻣﻜﺘﺴﺒﺔ‬

‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫‪‬‬ ‫□‬

‫ﺧﻠﻝ ﺑﺎﻟ ُﻛﻼﺟﻳﻥ‬ ‫ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ‬ ‫ﺧﻠﻝ ﻭﻅﻳﻔﻲ ﺑﺎﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﻧﻘﺹ ﻋﺎﻣﻝ ﺃﻭ ﻋﻭﺍﻣﻝ ﺗﺧﺛﺭ‬ ‫ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ‪ +‬ﻧﻘﺹ ﻋﻭﺍﻣﻝ‬ ‫ﺍﻟﻣﺭﺿﻳﺔ‬ ‫ﻣﺿﺎ ّﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ َ‬ ‫ﻣﺿﺎ ّﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻌﻼﺟﻳﺔ‬

‫ﺍ‪ -‬ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫ﻣﻣﺎ ﺑﺩﺍ ﻟﻠﻘﺎﺭﺉ ﻓﻲ ﻣﻧﺎﻗﺷﺔ ﻋﻣﻠﻳﺔ ﻗﻁﻊ ﺍﻟﻧﺯﻑ ﻳﻣﻛﻧﻪ ﺑﺳﻬﻭﻟﺔ ﺃﻥ ﻳﺗﻭﺻ�ﻝ ﺇﻟ�ﻰ ﺃﻥ ﻓ�ﺭﻁ ﺍﻟﻧ�ﺯﻑ‬ ‫ﻳﻣﻛﻥ ﺃﻥ ﻳﺄﺗﻲ ﺑﺳﺑﺏ ﺧﻠﻝ ﻓﻲ ﺃﻱّ ﻣﻥ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﺃﻭ ﺻ�ﻔﻳﺣﺎﺕ ﺍﻟ�ﺩﻡ ﺃﻭ ﻛﻠﻳﻬﻣ�ﺎ ﻣﻌ�ﺎً‪ ،‬ﺳ�ﻭﺍء‬ ‫ﺃﻛﺎﻥ ﻫﺫﺍ ﺍﻟﺧﻠﻝ ﺑ�ﺎﻟﻛﻡ ﺃﻭ ﺍﻟﻭﻅﻳﻔ�ﺔ‪ .‬ﻟﻛ�ﻥ ﻫﻧ�ﺎﻙ ﻋ�ﺎﻣﻠ ْﻳﻥ ﺁﺧ�ﺭ ْﻳﻥ ﻳﻣﻛ�ﻥ ﺃﻥ ﻳﻛﻭﻧ�ﺎ ﺳ�ﺑﺑﺎ ً ﻓ�ﻲ ﻓ�ﺭﻁ‬ ‫ﺍﻟﻧ��ﺯﻑ ﺳ��ﺄﺫﻛﺭﻫﻣﺎ ﻓ��ﻲ ﺍﻟﺑﺩﺍﻳ��ﺔ ﻟﻧﺿ��ﻌﻬﻣﺎ ﺟﺎﻧﺑ �ﺎ ً ﻋﻧ �ﺩ ﻣﻧﺎﻗﺷ��ﺔ ﺍﻟﻣﻭﺿ��ﻭﻉ ﺍﻟﺭﺋﻳﺳ��ﻲ‪ ،‬ﺍﻟ��ﺫﻱ ﻫ��ﻭ‬ ‫ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﻭﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪:‬‬ ‫ﻜﻼﺟﻴﻦ‬ ‫‪ .1‬اﻟﻌﻴﻮب اﻟﻮﻻدﻳﺔ ﻓﻲ ﺗﺮﻛﻴﺐ اﻟ ُ‬ ‫ﻭﺍﻟﺗﻲ ﺗﺟﻌﻠﻪ ﻏﻳﺭ ﻗﺎﺩﺭ ﻋﻠﻰ ﺗﻔﻌﻳﻝ ﺍﻟﺗﺧﺛﺭ ﺃﻭ ﺍﻟﺗﺻﺎﻕ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺑﻪ‪ .‬ﻭﻫ�ﺫﻩ ﻋﻳ�ﻭﺏ ﻧ�ﺎﺩﺭﺓ‬ ‫ﺟ ّﺩﺍً ﻭﻳﻛﻭﻥ ﺍﻟﻧﺯﻑ ﻓﻳﻬﺎ ﺗﺣﺕ ﺍﻟﺟﻠﺩ ﻋﺎﺩﺓ ﻭﻳﺅﺩﻱ ﺇﻟﻰ ﺣﺻﻭﻝ ﺑﻘﻊ ﺯﺭﻗﺎء )ﻛ�ﺩﻣﺎﺕ( ﺑﺳ�ﺑﺏ‬ ‫ﺃﻭ ﻏﻳﺭ ﺳﺑﺏ‪ ،‬ﻭﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ ﺗﺷﻭّ ﻫﺎﺕ ﻓﻲ ﺍﻟﻣﻔﺎﺻﻝ ﻭﺍﻟﻌﺿﻼﺕ ﻓﻳﻣﺎ ﺑﻌﺩ‪.‬‬

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‫‪ .2‬اﻟﻌﻴﻮب اﻟﻮﻻدﻳﺔ ﻓﻲ ﺗﺮﻛﻴﺒﺔ ﺟﺪران اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳّﺔ‬ ‫ﻭﺗﻛ��ﻭﻥ ﻋ �ﺎﺩﺓ ﻓ��ﻲ ﻣﻭﺍﺿ��ﻊ ﻣﺣ � ّﺩﺩﺓ ﻓﺗ��ﺅ ّﺩﻱ ﺇﻟ��ﻰ ﺗﻭ ّﺳ��ﻊ ﺍﻷﻭﻋﻳ��ﺔ ﻓ��ﻲ ﺗﻠ��ﻙ ﺍﻟﻣﻭﺍﺿ��ﻊ ﻭﺳ��ﻬﻭﻟﺔ‬ ‫ﺍﻧﻔﺟﺎﺭﻫﺎ ﻭﻣﺎ ﻳﺗﺑﻌﻪ ﻣﻥ ﻧﺯﻑ ﻣﻭﺿﻌﻲ ﻣﺗﻛﺭّﺭ‪.‬‬ ‫ﻭﺍﻵﻥ ﻧﺄﺗﻲ ﻋﻠ�ﻰ ﺗﻔﺻ�ﻳﻝ ﺍﻟﻣﺳ�ﺑﺑ ْﻳﻥ ﺍﻟ�ﻭﺭﺍﺛﻳﻳْﻥ ﺍﻟﺭﺋﻳﺳ�ﻳﻳْﻥ ﻟﻠﻧ�ﺯﻑ‪ ،‬ﻭﻛﻼﻫﻣ�ﺎ ﻣ�ﻥ ﺃﻣ�ﺭﺍﺽ ﺍﻟ�ﺩﻡ‬ ‫ﻧﻔﺳﻪ‪:‬‬ ‫‪ .3‬أﻣﺮاض ﺻﻔﻴﺤﺎت اﻟﺪم اﻟﻮراﺛﻴﺔ‬ ‫ﺃ‪ -‬ﻧﻘﺹ ﻋﺩﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﻗﺩ ﻳﻭﻟﺩ ﻁﻔﻝ ﺑﻌﺩﺩ ﻗﻠﻳﻝ ﻣﻥ ﺍﻟﺻﻔﻳﺣﺎﺕ ) ﻭﻋﺩﺩﻫﺎ ﺍﻟﻁﺑﻳﻌ�ﻲ ﻳﺗ�ﺭﺍﻭﺡ ﺑ�ﻳﻥ ‪ 150‬ﺇﻟ�ﻰ ‪ 450‬ﺃﻟﻔ�ﺎ ً‬ ‫ﻓﻲ ﺍﻟﻣﻠﻠﻳﻣﺗﺭ ﺍﻟﻣﻛﻌ�ﺏ ﺃﻭ ﺍﻟﻣﻳﻛﺭﻭﻟﺗ�ﺭ(‪ ،‬ﻟﻛ�ﻥ ﻓ�ﻲ ﺍﻟﻐﺎﻟﺑﻳ�ﺔ ﺍﻟﻌﻅﻣ�ﻰ ﻣ�ﻥ ﻫ�ﺫﻩ ﺍﻟﺣ�ﺎﻻﺕ ﻻ ﻳﻛ�ﻭﻥ‬ ‫ﺍﻟﺳ��ﺑﺏ ﻭﺭﺍﺛ ّﻳ�ﺎ ً ﺇ ّﻧﻣ��ﺎ ﻫ��ﻭ ﺃﺟﺳ��ﺎﻡ ﻣﺿ��ﺎﺩﺓ ﻟﻠﺻ��ﻔﻳﺣﺎﺕ ﻳﻛﺗﺳ��ﺑﻬﺎ ﺍﻟﺟﻧ��ﻳﻥ ﻣ��ﻥ ﺩﻡ ﺃﻣ��ﻪ‪ ،‬ﻭﻫ��ﺫﻩ ﺣﺎﻟ��ﺔ‬ ‫ﺗﺯﻭﻝ ﺧﻼﻝ ﺃﻳﺎﻡ ﺃﻭ ﺃﺳﺎﺑﻳﻊ ﻣﻥ ﺍﻟﻭﻻﺩﺓ‪.‬‬ ‫ﺇﻻ ّ ﺃﻥ ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ ﻫ�ﻲ ﺟ�ﺯء ﻣ�ﻥ ﻓﺷ�ﻝ ﻋ�ﺎﻡ ﻓ�ﻲ ﺇﻧﺗ�ﺎﺝ ﻧﺧ�ﺎﻉ ﺍﻟﻌﻅ�ﻡ ) ﻭﻫ�ﻭ‬ ‫ﺍﻟﺫﻱ ﻳﻘﻭﻡ ﺑﺗﺻ�ﻧﻳﻊ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻭﻣﻌﻅ�ﻡ ﺧﻼﻳ�ﺎ ﺍﻟ�ﺩﻡ ﺍﻷﺧ�ﺭﻯ(‪ ،‬ﺗﻛ�ﻭﻥ ﻭﺭﺍﺛﻳّ�ﺔ ﻓﻌ�ﻼً‪ .‬ﻭﻓ�ﻲ ﻫ�ﺫﻩ‬ ‫ﺍﻟﺣﺎﻻﺕ ﺗ�ﻧﻘﺹ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ‪ ،‬ﻛﻣ�ﺎ ﺗ�ﻧﻘﺹ ﺧﻼﻳ�ﺎ ﺍﻟ�ﺩﻡ ﺍﻟﺣﻣ�ﺭﺍء ﻭﺍﻟﺑﻳﺿ�ﺎء‪ ،‬ﻓ�ﻲ ﺍﻟ�ﺩﻡ‪ .‬ﻳﻐﻠ�ﺏ ﺃﻥ‬ ‫ﺗﻛﻭﻥ ﺑﺩﺍﻳﺔ ﻫﺫﺍ ﺍﻟﻧﻘﺹ ﺑﻌﺩ ﻣﺿﻲ ﻋ ّﺩﺓ ﺃﺷﻬﺭ ﺃﻭ ﺳﻧﻭﺍﺕ ﻣﻥ ﻋﻣﺭ ﺍﻟﻁﻔﻝ‪.‬‬ ‫ﻭﻫﻧ��ﺎﻙ ﺣ��ﺎﻻﺕ ﻧ��ﺎﺩﺭﺓ ﺟ � ّﺩﺍً ﻟﻣ��ﺭﺽ ﻭﺭﺍﺛ��ﻲ ﻳﻛ��ﻭﻥ ﻓﻳﻬ��ﺎ ﺇﻧﺗ��ﺎﺝ ﻧﺧ��ﺎﻉ ﺍﻟﻌﻅ��ﻡ ﻧﺎﻗﺻ �ﺎ ً ﺟ � ّﺩﺍً ﻓ��ﻲ‬ ‫ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﻓﻘﻁ‪.‬‬ ‫ﺏ‪ -‬ﺧﻠﻝ ﻓﻲ ﻭﻅﻳﻔﺔ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﻫﻧﺎﻙ ﺃﻣﺭﺍﺽ ﻛﺛﻳﺭﺓ‪ ،‬ﻭﻛﻠﻬﺎ ﻧﺎﺩﺭﺓ ﺍﻟﺣﺻﻭﻝ‪،‬ﺗﻛﻭﻥ ﻓﻳﻬﺎ ﺇﺣﺩﻯ ﻭﻅﺎﺋﻑ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻣﺧﺗﻠّﺔ‪:‬‬ ‫ ﻓﻔ��ﻲ ﺃﺣ��ﺩﻫﺎ )ﻣ��ﺭﺽ ﻏﻼﻧﺯﻣ��ﺎﻥ( ﻻ ﺗﺳ��ﺗﻁﻳﻊ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﺃﻥ ﺗﺗﺟ ّﻣ��ﻊ ﻋﻠ��ﻰ ﺑﻌﺿ��ﻬﺎ ﻟﻭﺟ��ﻭﺩ‬‫ﺧﻠ��ﻝ ﻭﺭﺍﺛ��ﻲ ﻓ��ﻲ ﺟ��ﺩﺭﺍﻧﻬﺎ‪ .‬ﻫ��ﺫﺍ ﺍﻟﻣ��ﺭﺽ ﻳ��ﻭﺭﱠ ﺙ ﺑﺷ��ﻛﻝ ﺻ��ﻔﺔ ﻣﺗﻧﺣ ّﻳ��ﺔ ﻭﻳ��ﺅﺩﻱ ﺇﻟ��ﻰ ﺯﻳ��ﺎﺩﺓ‬ ‫ﺍﻟﻧﺯﻑ ﻣﻥ ﻳﻭﻡ ﺍﻟﻭﻻﺩﺓ‪.‬‬ ‫ ﻭﻓ���ﻲ ﻣ���ﺭﺽ ﺁﺧ���ﺭ ﻳﻛ���ﻭﻥ ﻫﻧ���ﺎﻙ ﻧﻘ���ﺹ ﻓ���ﻲ ﻋﺎﻣ���ﻝ) ﻓ���ﻭﻥ ﻭﻟﺑﺭﺍﻧ���ﺩ( ﺑﺣﻳ���ﺙ ﻻ ﺗﺳ���ﺗﻁﻳﻊ‬‫ﺍﻟﺻ���ﻔﻳﺣﺎﺕ ﺃﻥ ﺗﻠﺗﺻ���ﻕ ﺑ���ﺎﻟ ُﻛﻼﺟﻳﻥ) ﺍﻧﻅ���ﺭ ﺗﻔﺎﺻ���ﻳﻝ ﻫ���ﺫﺍ ﺍﻟﻣ���ﺭﺽ ﻣ���ﻊ ﺃﻣ���ﺭﺍﺽ ﻧﻘ���ﺹ‬ ‫ﺍﻟﻌﻭﺍﻣﻝ(‪ .‬ﻭﺻﻔﺔ ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﺗﻧﺗﻘﻝ ﻣﺗﻐﻠّﺑﺔ ﻋﺎﺩﺓ‪.‬‬

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‫ ﻭﻓﻲ ﻣﺭﺽ ﺛﺎﻟﺙ ﻳﻭﺭﺙ ﺧﻠﻝ ﻓﻲ ﺟﺩﺍﺭ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻻ ﻳﺳﻣﺢ ﻟﻬﺎ ﺑﺎﻟﺗﻔﺎﻋ�ﻝ ﻣ�ﻊ ﻋﺎﻣ�ﻝ)ﻓ�ﻭﻥ‬‫ﻭﻟﺑﺭﺍﻧﺩ( ﻧﻔﺳﻪ ﺭﻏﻡ ﺗﻭﻓّﺭﻩ‪ .‬ﻭﻓﻲ ﻫﺫﺍ ﺍﻟﻣﺭﺽ )ﻣﺭﺽ ﺑﺭﻧﺎﺭﺩ ﺳ�ﻭﻟﻳﺭ( ﺗﻛ�ﻭﻥ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ‪،‬‬ ‫ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﺧﻠﻝ ﻭﻅﻳﻔﺗﻬﺎ ﺍﻟﻣﺫﻛﻭﺭ‪ ،‬ﻛﺑﻳﺭﺓ ﺣﺟﻣﺎ ً ﻭﻗﻠﻳﻠ�ﺔ ﻋ�ﺩﺩﺍً ﺑﺣﻳ�ﺙ ﺗﺗ�ﺭﺍﻭﺡ ﺑ�ﻳﻥ ‪ 50‬ﺇﻟ�ﻰ‬ ‫‪ 70‬ﺃﻟﻔﺎ ً ﻓﻲ ﻛﻝ ﻣﻠﻡ ﻣﻛﻌﺏ‪.‬‬ ‫ ﻭﻓ��ﻲ ﻣ��ﺭﺽ ﺭﺍﺑ��ﻊ ﻳﻛ��ﻭﻥ ﻓ��ﻲ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﺧﻠ��ﻝ ﻳﻣﻧﻌﻬ��ﺎ ﻣ��ﻥ ﺍﺳ��ﺗﻘﺑﺎﻝ ﻣﻭﻟّ��ﺩ ﺍﻟﻠﻳﻔ��ﻳﻥ ﻋﻠ��ﻰ‬‫ﺳﻁﻭﺣﻬﺎ‪.‬‬ ‫ ﻭﻫﻧ��ﺎﻙ ﺍﻷﻣ��ﺭﺍﺽ ﺍﻟﺗ��ﻲ ﻳﺧﺗ��ﻝ ﻓﻳﻬ��ﺎ ﺍﻻﺳ��ﺗﻘﻼﺏ ﺍﻟ��ﺩﺍﺧﻠﻲ ﻓ��ﻲ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﺑﺳ��ﺑﺏ ﻧﻘ��ﺹ‬‫ﺇﻧﻅﻳﻣﺎﺕ ﺑﺣﻳﺙ ﻻ ﺗﻔﺭﺯ ﺑﻌﺽ ﺍﻟﻣﻔﻌّﻼﺕ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻋﻣﻠﻳﺔ ﺗﺭﺍﻛﻣﻬﺎ‪.‬‬ ‫ﻫﺫﻩ ﺃﻫﻡ ﺃﻣﺭﺍﺽ ﺍﻟﺧﻠﻝ ﺍﻟﻭﻅﻳﻔﻲ ﻟﻠﺻﻔﻳﺣﺎﺕ‪ ،‬ﻭﻫﻧﺎﻙ ﺃﻣﺭﺍﺽ ﺃﺧﺭﻯ ﺃﻗﻝ ﺃﻫﻣﻳﺔ‪.‬‬ ‫ﺝ‪ -‬ﺧﻠﻝ ﻭﻅﻳﻔﻲ ﻣﻊ ﻧﻘﺹ ﻓﻲ ﻋﺩﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﻛﻣﺎ ﻓﻲ ﻣﺭﺽ ﺑﺭﻧﺎﺭﺩ ﺳﻭﻟﻳﺭ ﺍﻟﻣﺫﻛﻭﺭ ﺃﻋﻼﻩ‪ ،‬ﻭﻛﺫﻟﻙ ﻣﺭﺽ ﻭﺳﻛﻭﺕ ﺍﻟﺩﺭﺥ ﺍﻟﺫﻱ ﻳﻛ�ﻭﻥ ﻓﻳ�ﻪ‬ ‫ﻧﻘﺹ ﻓﻲ ﺍﻟﻣﻧﺎﻋﺔ ﻭﺻﻐﺭ ﺣﺟﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺃﻳﺿﺎ ً‪.‬‬ ‫ﺩ‪ -‬ﺧﻠﻝ ﻭﻅﻳﻔﻲ ﺑﺎﻟﺻﻔﻳﺣﺎﺕ ﻣﻊ ﻧ ﻘﺹ ﻓﻲ ﺍﻟﺗﺧ ّﺛﺭ‬ ‫ﻛﻣ��ﺎ ﻓ��ﻲ ﻣ��ﺭﺽ ﻓ��ﻭﻥ ﻭﻟﺑﺭﺍﻧ��ﺩ ﺍﻟﻣ��ﺫﻛﻭﺭ ﺳ��ﺎﺑﻘﺎً‪ ،‬ﻭﺍﻟ��ﺫﻱ ﺳ��ﻳﺭﺩ ﺗﻔﺻ��ﻳﻝ ﻋﻧ��ﻪ ﻣ��ﻊ ﺃﻣ��ﺭﺍﺽ ﺧﻠ��ﻝ‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﺃﻋﺭﺍﺽ ﺃﻣﺭﺍﺽ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﺳﻭﺍء ﺃﻛﺎﻧﺕ ﺍﻟﻣﺷﻛﻠﺔ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻫﻲ ﻓﻲ ﻋ�ﺩﺩ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﺃﻡ ﻓ�ﻲ ﻭﻅﺎﺋﻔﻬ�ﺎ ﻓ�ﺈﻥ ﺃﻋﺭﺍﺿ�ﻬﺎ ﺗﻛ�ﺎﺩ‬ ‫ﺗﻛﻭﻥ ﻣﺷﺗﺭﻛﺔ‪ .‬ﻓﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪ ،‬ﻛﻣﺎ ﻣﺭﱠ ﻓﻲ ﺍﻟﻔﺻﻝ ﺍﻷﻭﻝ‪ ،‬ﻭﺍﺟﺑﻬﺎ ﺍﻟﺭﺋﻳﺱ ﻫﻭ ﺇﻳﻘﺎﻑ ﺍﻷﻧﺯﻓﺔ‬ ‫ﺍﻟﺑﺳ��ﻳﻁﺔ ﻓ��ﻲ ﺟ��ﺩﺭﺍﻥ ﺍﻷﻭﻋﻳ��ﺔ ﺍﻟﺩﻣﻭﻳ��ﺔ‪ ،‬ﻻﺳ�ﻳّﻣﺎ ﺍﻟﺷ��ﻌﺭﻳﺔ ﻣﻧﻬ��ﺎ‪ ،‬ﻭﺫﻟ��ﻙ ﺑﺎﻻﻟﺗﺻ��ﺎﻕ ﺛ��ﻡ ﺍﻟﺗ��ﺭﺍﻛﻡ‬ ‫ﻟﻌﻣﻝ ﺳ ّﺩﺍﺩ ﻣﻥ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻟﻐﻠﻕ ﺍﻟﺛﻐﺭﺍﺕ ﺍﻟﺑﺳﻳﻁﺔ‪ .‬ﻟﺫﻟﻙ ﻓﺈﻥ ﻧﻘ�ﺹ ﻋ�ﺩﺩﻫﺎ ﺃﻭ ﺧﻠ�ﻝ ﻭﻅﻳﻔﺗﻬ�ﺎ‪،‬‬ ‫ﺃﻭ ﺍﻟﻧﻘﺹ ﻓﻲ ﻛﻠﻳﻬﻣ�ﺎ ﻣﻌ�ﺎً‪ ،‬ﻛﻠﻬ�ﺎ ﺗ�ﺅ ّﺩﻱ ﺇﻟ�ﻰ ﺣﺻ�ﻭﻝ ﺃﻧﺯﻓ�ﺔ ﻧﻘﻁﻳّ�ﺔ ﻓ�ﻲ ﺍﻟﺟﻠ�ﺩ ﺃﻭ ﺗﺣ�ﺕ ﺍﻟﺟﻠ�ﺩ‪،‬‬ ‫ﻭﺫﻟﻙ ﺑﺗﺳﺭّﺏ ﺍﻟﺩﻡ ﺑﻛﻣﻳّﺔ ﺿﺋﻳﻠﺔ ﻣﻥ ﺛﻐﺭﺍﺕ ﻓﻲ ﺍﻟﺷﻌﻳﺭﺍﺕ ﺍﻟﺩﻣﻭﻳ�ﺔ‪ .‬ﺇﻥ ﻫ�ﺫﻩ ﺍﻟﺛﻐ�ﺭﺍﺕ ﺗﺣﺻ�ﻝ‬ ‫ﻟﺩﻯ ﻛﻝ ﺇﻧﺳﺎﻥ ﻭﻓﻲ ﻛﻝ ﻟﺣﻅﺔ ﻟﻛﻥ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﺗﻘ�ﻭﻡ ﺑﺳ� ﱢﺩﻫﺎ ﻭﻛﺄﻧﻬ�ﺎ ﺍﻹﺳ�ﻣﻧﺕ ﺍﻟﻣﻭﺿ�ﻭﻉ ﺑ�ﻳﻥ‬ ‫ﻟﺑﻧﺎﺕ ﺍﻟﺑﻧﺎء‪ .‬ﻓﺈﺫﺍ ﻟﻡ ﺗﺳﺗﻁﻊ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺃﻥ ﺗﻘﻭﻡ ﺑﺫﻟﻙ‪ ،‬ﺃﻣّﺎ ﻟﻧﻘﺹ ﺷﺩﻳﺩ ﻓ�ﻲ ﻋ�ﺩﺩﻫﺎ‪ ،‬ﺃﻭ ﻟﻔﺷ�ﻠﻬﺎ‬ ‫ﻭﻅﻳﻔ ّﻳﺎً‪ ،‬ﻓﺈﻥ ﺗﻠ�ﻙ ﺍﻷﻧﺯﻓ�ﺔ ﺗﺣﺻ�ﻝ ﻓﻌ�ﻼً ﻭﻳﻣﻛ�ﻥ ﺃﻥ ُﺗ�ﺭﻯ ﺑ�ﺎﻟﻌﻳﻥ ﻋﻠ�ﻰ ﺷ�ﻛﻝ ﻧﻘ�ﺎﻁ ﺣﻣ�ﺭﺍء ﻓ�ﻲ‬

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‫ﺍﻟﺟﻠﺩ‪ ،‬ﺃﺻﻐﺭ ﻣﻥ ﺭﺅﻭﺱ ﺍﻟﺩﺑﺎﺑﻳﺱ‪ .‬ﻫﺫﻩ ﺍﻟﻧﻘ�ﺎﻁ ﺗﺧﺗﻠ�ﻑ ﻋ�ﻥ ﺍﻟﺑﺛ�ﻭﺭ ﺍﻟﺣﻣ�ﺭﺍء ﻓ�ﻲ ﺃﻥ ﺍﻷﺧﻳ�ﺭﺓ‬ ‫ﻳﺧﺗﻔﻲ ﻟﻭﻧﻬﺎ ﻣﺅﻗﺗﺎ ً ﺑﺎﻟﺿﻐﻁ ﻋﻠﻳﻬﺎ ﺑﺎﻹﺻﺑﻊ‪ ،‬ﺑﻳﻧﻣﺎ ﻻ ﺗﺧﺗﻔﻲ ﺍﻷﻧﺯﻓﺔ ﺍﻟﻧﻘﻁﻳﺔ‪.‬‬ ‫ﺇﻥّ ﻫ�ﺫﻩ ﺍﻷﻧﺯﻓ��ﺔ ﻻ ﺗﻘﺗﺻ��ﺭ ﻋﻠ��ﻰ ﺍﻟﺟﻠ�ﺩ ﺑ��ﻝ ﺗﺣﺻ��ﻝ ﻓ��ﻲ ﻣﺧﺗﻠ�ﻑ ﺍﻷﻋﺿ��ﺎء ﻓ��ﻲ ﺃﻋﻣ��ﺎﻕ ﺍﻟﺟﺳ��ﻡ‬ ‫ﺃﻳﺿﺎً‪ ،‬ﻟﻛﻥ ﺃﻧﺯﻓﺔ ﺍﻟﺟﻠﺩ ﻫﻲ ﺍﻟﺗﻲ ُﺗﻼﺣﻅ ﺑﺳﻬﻭﻟﺔ‪ .‬ﻛﺫﻟﻙ ﻓﺈﻥ ﺃﻧﺯﻓﺔ ﺃﻛﺑﺭ )ﻛ�ﺩﻣﺎﺕ( ﺗﺣﺻ�ﻝ ﻓ�ﻲ‬ ‫ﺍﻟﺟﻠﺩ ﺃﺣﻳﺎﻧﺎ ً ﻭ ُﺗﺭﻯ ﻋﻠﻰ ﺷﻛﻝ ﺑﻘﻊ ﺯﺭﻗﺎء ﻛﺑﻳﺭﺓ ﺃﻭ ﻣﺗﻭﺳ�ﻁﺔ‪ ،‬ﺗﺷ�ﺑﻪ ﺗﻠ�ﻙ ﺍﻟﻛ�ﺩﻣﺎﺕ ﺍﻟﺗ�ﻲ ﺗﻅﻬ�ﺭ‬ ‫ﺿ��ﺔ ﻏﻳ��ﺭ ﺟﺎﺭﺣ��ﺔ )ﺃﻭ ﺣﺗ��ﻰ ﺑﺎﻟﻠﻛﻣ��ﺎﺕ ﺃﺣﻳﺎﻧ �ﺎ ً(‪ ،‬ﻭﻟﻛﻧﻬ��ﺎ ﻓ��ﻲ‬ ‫ﻋﻠ��ﻰ ﺃﺛ��ﺭ ﺷ��ﺩﺓ ﻣﻭﺿ��ﻌﻳﺔ ﺑﺂﻟ��ﺔ ﺭﺍ ّ‬ ‫ﺍﻟﻣﺭﺿﻰ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﻣﺷﺎﻛﻝ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﺗﺣﺻ�ﻝ ﺩﻭﻥ ﺷ� ّﺩﺓ ﻣﺳ�ﺑﻘﺔ‪ ،‬ﺃﻭ ﺗﺣﺻ�ﻝ ﺑﺣﺟ�ﻭﻡ ﻣﺑ�ﺎﻟﻎ‬ ‫ﻓﻳﻬﺎ ﺇﺛﺭ ﺷﺩﺓ ﺑﺳﻳﻁﺔ‪.‬‬ ‫ﺇﻥ ﺍﻟﺣﺎﻻﺕ ﺍﻟﺷﺩﻳﺩﺓ ﺟﺩﺍً ﻣﻥ ﻧﻘ�ﺹ ﻋ�ﺩﺩ ﺃﻭ ﻭﻅ�ﺎﺋﻑ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﺗ�ﺅﺩﻱ ﻓ�ﻲ ﺃﺣﻳ�ﺎﻥ ﻧ�ﺎﺩﺭﺓ ﺇﻟ�ﻰ‬ ‫ﺣﺻﻭﻝ ﻧﺯﻑ ﺩﺍﺧﻠﻲ ﺷﺩﻳﺩ‪ ،‬ﻗﺩ ﻳﺣﺻﻝ ﻓﻲ ﻣﻧﺎﻁﻕ ﺣﺳّﺎﺳﺔ ﻛ�ﺎﻟﻣﺦ ﻭﺍﻟﻛﻠ�ﻰ ﻭﻏﻳﺭﻫ�ﺎ‪ ،‬ﻭﻣ�ﺎ ﻳﺗﺑ�ﻊ‬ ‫ﺫﻟﻙ ﻣﻥ ﻣﺷﺎﻛﻝ ﻛﺑﻳﺭﺓ ﻻﺳﻳّﻣﺎ ﺇﺫﺍ ﺃﺻﺎﺏ ﺍﻟﻧﺯﻑ ﺍﻟﻣﻧﺎﻁﻕ ﺍﻟﺣﺭﻛﻳﺔ ﻓﻲ ﻗﺷﺭﺓ ﺍﻟﻣﺦ‪ ،‬ﻓﻳﺅﺩﻱ ﺇﻟﻰ‬ ‫ﺍﻟﺷ�ﻠﻝ‪ ،‬ﺃﻭ ﺇﺫﺍ ﺃﺻ��ﺎﺏ ﺍﻟﻣ�ﺦ ﺍﻷﻭﺳ��ﻁ ﻓﻳﺳ��ﺑﺏ ﺧﻠﻠ�ﻼً ﻓ��ﻲ ﻋﻣ�ﻝ ﺍﻟ��ﺭﺋﺗﻳﻥ ﻭﺍﻟﻘﻠ��ﺏ ﻗ�ﺩ ﻳﺅ ّﺩﻳ��ﺎﻥ ﺇﻟ��ﻰ‬ ‫ﺍﻟﻭﻓﺎﺓ‪.‬‬ ‫ﺍﻟﺗﺷﺧﻳﺹ ﺍﻟﻣﺧﺑﺭﻱ ﻟﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﻭﻭﻅﺎﺋﻔﻬﺎ‬ ‫ﺇﻥ ﺍﻟﻌﺩﺩ ﺍﻟﻁﺑﻳﻌﻲ ﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﻳﺗﺭﺍﻭﺡ ﺑﻳﻥ ‪ 150‬ﺇﻟﻰ ‪ 450‬ﺃﻟﻔﺎ ً ﻟﻛﻝ ﻣﻠﻡ‪ 3‬ﻣﻥ ﺍﻟﺩﻡ‪ ،‬ﻭﻋﻣﻠﻳ�ﺔ‬ ‫ﻋ� ّﺩ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﻓ��ﻲ ﻋﻳﻧ��ﺔ ﺍﻟ��ﺩﻡ ﻫ��ﻲ ﻣ��ﻥ ﺍﻟﻔﺣ��ﻭﺹ ﺍﻟﺭﻭﺗﻳﻧﻳ��ﺔ ﺍﻵﻥ ﻓ��ﻲ ﻣﻌﻅ��ﻡ ﺍﻟﻣﺧ��ﺎﺑﺭ ﺍﻟﻁﺑّﻳ��ﺔ‬ ‫ﻭ ُﺗﺟﺭﻯ ﻛﺟﺯء ﻣﻥ ﻋﻣﻠﻳﺔ ﺗﻌﺩﺍﺩ ﺧﻼﻳﺎ ﺍﻟﺩﻡ‪ .‬ﻟﺫﻟﻙ ﻓﺈﻥ ﻧﻘﺹ ﻋﺩﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﻣ�ﻭﺭﻭﺙ ﻳﺳ�ﻬﻝ‬ ‫ﺗﺷﺧﻳﺻﻪ‪ .‬ﻭﻫﺫﺍ ﺍﻟﻧﻘﺹ‪ -‬ﻛﻣﺎ ﺫﻛ�ﺭﺕ ﺳ�ﺎﺑﻘﺎ ً‪ -‬ﻣﺻ�ﺩﺭﻩ ﻧﻘ�ﺹ ﺇﻧﺗ�ﺎﺝ ﻓ�ﻲ ﻧﺧ�ﺎﻉ ﺍﻟﻌﻅ�ﻡ‪ ،‬ﻟ�ﺫﺍ ﻓ�ﺈﻥ‬ ‫ﺍﻟﻁﺑﻳﺏ ﻳﻠﺟﺄ ﺇﻟﻰ ﺃﺧﺫ ﻋﻳﻧ�ﺔ ﻣ�ﻥ ﺍﻟﻧﺧ�ﺎﻉ ﻹﺛﺑ�ﺎﺕ ﺍﻷﻣ�ﺭ‪ ،‬ﻛﻣ�ﺎ ﻳﺣﺗ�ﺎﺝ ﺃﺣﻳﺎﻧ�ﺎ ً ﺇﻟ�ﻰ ﺇﺟ�ﺭﺍء ﻓﺣ�ﺹ‬ ‫ﺍﻟﺻﺑﻐﻳّﺎﺕ ﻋﻠﻰ ﺍﻟﻧﺧﺎﻉ ﻹﺛﺑﺎﺕ ﻭﺭﺍﺛﻳﺔ ﺍﻟﻣﺭﺽ‪.‬‬ ‫ﺃﻣّﺎ ﺗﺷﺧﻳﺹ ﻧﻘﺹ ﻓﻌﺎﻟﻳﺔ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻓﻬﻭ ﺃﺻﻌﺏ ﻭﻳﺣﺗﺎﺝ ﺇﻟﻰ ﻓﺣﻭﺹ ﺃﺧﺭﻯ‪:‬‬ ‫‪ .1‬ﺑﻌﺩ ﺍﻟﺗﺄﻛﺩ ﻣﻥ ﺃﻥ ﻋﺩﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻁﺑﻳﻌﻲ‪ ،‬ﻳﻣﻛﻥ ﺇﺟﺭﺍء ﻓﺣ�ﺹ )ﻭﻗ�ﺕ ﺍﻟﻧ�ﺯﻑ( ﻋﻠ�ﻰ ﺟﻠ�ﺩ‬ ‫ﺍﻟﻣﺭﻳﺽ ﺑﻭﺧﺯ ﺇﺑﺭﺓ ﺻﻐﻳﺭﺓ ﺃﻭ ﻣﺷﺭﻁ ﺗﺳﺑﺏ ﻧﺯﻓﺎ ً ﺧﻔﻳﻔﺎ ً ﻭﻳﺣﺳ�ﺏ ﺍﻟﻭﻗ�ﺕ ﺍﻟ�ﺫﻱ ﻳﺳ�ﺗﻐﺭﻗﻪ‬ ‫ﺫﻟ��ﻙ ﺍﻟﻧ��ﺯﻑ ﻟﻳﺗﻭﻗّ��ﻑ ﺗﻠﻘﺎﺋ ّﻳ�ﺎ ً‪ .‬ﻫ��ﺫﺍ ﺍﻟﻔﺣ��ﺹ ﻟ��ﻳﺱ ﺩﻗﻳﻘ�ﺎ ً ﻛﺛﻳ��ﺭﺍً ﻟﻛﻧ��ﻪ ﻳﺷ��ﺎﺑﻪ ﺍﻟﺣﺎﻟ��ﺔ ﺍﻟﻁﺑﻳﻌﻳ��ﺔ‬ ‫ﻭﻳُﻌﺗﻣﺩ ﻋﻠﻳﻪ ﺣﻳﻧﻣﺎ ﻳﺳﺗﻐﺭﻕ ﺃﻛﺛﺭ ﻣﻥ ‪ 15‬ﺩﻗﻳﻘﺔ‪ ،‬ﻭﺇﻥ ﻛﺎﻧﺕ ﺍﻟﺣﺩﻭﺩ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﻪ ﺗﻌﺗﺑ�ﺭ ﻣ�ﻥ‬

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‫‪ 10-3‬ﺩﻗﺎﺋﻕ‪ .‬ﻭﻗﺕ ﺍﻟﻧﺯﻑ ﻳﻛﻭﻥ ﻁﻭﻳﻼً ﻁﺑﻌﺎ ً ﻓﻲ ﺣﺎﻻﺕ ﻧﻘﺹ ﻋﺩﺩ ﺍﻟﺻﻔﺎﺋﺢ ﺃﻳﺿ�ﺎً‪ ،‬ﻟﻛ�ﻥ‬ ‫ﻻ ﺣﺎﺟ��ﺔ ﻹﺟﺭﺍﺋ��ﻪ ﻓ��ﻲ ﺗﻠ��ﻙ ﺍﻟﺣ��ﺎﻻﺕ ﺇﺫ ﺃﻧ��ﻪ ﻣﺗﻭﻗّ��ﻊ ﺃﻥ ﻳﻛ��ﻭﻥ ﻁ��ﻭﻳﻼً ﻭﻟ��ﻥ ﻳﺿ��ﻳﻑ ﺇﻟ��ﻰ‬ ‫ﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﻁﺑﻳﺏ ﺍﻟﻣﻌﺎﻟﺞ ﺷﻳﺋﺎ ً‪.‬‬ ‫ﻣﻠﺣﻭﻅﺔ‪ :‬ﻫﺫﺍ ﺍﻟﻔﺣﺹ ﻳﺗﺄﺛﺭ ﺑﺗﻧﺎﻭﻝ ﺍﻟﻣﺭﻳﺽ ﺍﻷﺳﺑﺭﻳﻥ‪ ،‬ﻭﺳﻳﺭﺩ ﺫﻟﻙ ﻋﻧﺩ ﺍﻟﻛﻼﻡ ﻋ�ﻥ ﺃﻣ�ﺭﺍﺽ‬ ‫ﺍﻟﻧ��ﺯﻑ ﺍﻟﻣﻛﺗﺳ��ﺑﺔ‪ .‬ﻟ��ﺫﻟﻙ ﻓ��ﺈﻥ ﺍﻟﻔﺣ��ﺹ ﻻ ﻳﺻ��ﺢ ﺃﻥ ﻳُﺟ��ﺭﻯ ﻋﻠ��ﻰ ﻣ��ﻥ ﺗﻧ��ﺎﻭﻝ ﺍﻷﺳ��ﺑﺭﻳﻥ ﺧ��ﻼﻝ‬ ‫ﺍﻟﺧﻣﺳﺔ ﺃﻳﺎﻡ ﺍﻷﺧﻳﺭﺓ‪.‬‬ ‫‪ .2‬ﻓﺣﺹ ﺗﺭﺍﻛﻡ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ‪ -‬ﺳﻭﺍء ﺃﻛﺎﻥ ﺑﺈﺿﺎﻓﺔ ﻣﺣﻔّﺯﺍﺕ ﺃﻭ ﺑﺩﻭﻧﻬﺎ‪ -‬ﺣﻳﺙ ﺗﻛﻭﻥ ﺳﺭﻋﺔ‬ ‫ﻭﻁﺭﻳﻘﺔ ﺗﺭﺍﻛﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ‪ ،‬ﻭﺍﻟﺫﻱ ﻻ ﻳﺣﺻﻝ ﺃﺻﻼً ﻓﻲ ﺑﻌﺽ ﺍﻷﻣﺭﺍﺽ‪ ،‬ﺩﻟﻳﻼً ﻳﺭﺷﺩ ﺇﻟ�ﻰ‬ ‫ﺣﻘﻳﻘﺔ ﺍﻟﻣ�ﺭﺽ ﺍﻟﻣ�ﻭﺭﻭﺙ ﺍﻟﻣ�ﺅﺩﻱ ﻟﻠﻧ�ﺯﻑ‪ .‬ﻓﻛ�ﻝ ﻣ�ﺭﺽ ﻟ�ﻪ ﺻ�ﻭﺭﺗﻪ ﺍﻟﺧﺎﺻ�ﺔ ﻓ�ﻲ ﺍﻟﺗ�ﺄﺛﻳﺭ‬ ‫ﻋﻠﻰ ﺗﺭﺍﻛﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻧﻭﻉ ﺍﻟﻣﺣﻔّﺯ ﺍﻟ�ﺫﻱ ﻧﺣﺗﺎﺟ�ﻪ ﻹﺛﺑ�ﺎﺕ ﻭﺟ�ﻭﺩ ﺍﻟﺧﻠ�ﻝ‪ .‬ﻭﻟ�ﻥ ﺃﺩﺧ�ﻝ ﻓ�ﻲ‬ ‫ﺗﻔﺎﺻﻳﻝ ﻫﺫﻩ ﺍﻟﻔﺣﻭﺹ‪ ،‬ﻓﺫﻟﻙ ﻟﻥ ﻳﻧﻔﻊ ﻣﻌﻅﻡ ﻗﺭﺍء ﺍﻟﻛﺗﺎﺏ‪.‬‬ ‫ﻋﻼﺝ ﺃﻣﺭﺍﺽ ﻧﻘﺹ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻭﺧﻠﻝ ﻭﻅﺎﺋﻔﻬﺎ‬ ‫ﻣﻌﻅﻡ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻻ ﻳﻣﻛﻥ ﻋﻼﺟﻬﺎ ﺑﺎﻷﺩﻭﻳﺔ‪ ،‬ﻭﺇﻧﻣﺎ ﻳﻣﻛﻥ ﺇﻋﻁﺎء ﺍﻟﻣ�ﺭﻳﺽ ﺻ�ﻔﻳﺣﺎﺕ‬ ‫ﻁﺑﻳﻌﻳ��ﺔ ﻣﺭﻛ��ﺯﺓ ﻣﺷ��ﺗﻘّﺔ ﻣ��ﻥ ﻭﺣ��ﺩﺍﺕ ﺍﻟ��ﺩﻡ ﺍﻟﺗ��ﻲ ﻳﺗﺑ��ﺭﻉ ﺑﻬ��ﺎ ﺍﻟﻧ��ﺎﺱ ﻟﺑﻧ��ﻙ ﺍﻟ��ﺩﻡ‪ .‬ﻭﻫ��ﺫﻩ ﻻ ﻳﻣﻛ��ﻥ‬ ‫ﺍﻻﺳﺗﻣﺭﺍﺭ ﺑﺈﻋﻁﺎﺋﻬﺎ ﻁﻳﻠﺔ ﺣﻳ�ﺎﺓ ﺍﻟﻣ�ﺭﻳﺽ ﻟ�ﺫﺍ ﻳﻠﺟ�ﺄ ﺍﻟﻁﺑﻳ�ﺏ ﻹﻋﻁﺎﺋﻬ�ﺎ ﻟ�ﺩﻯ ﺣﺻ�ﻭﻝ ﻧ�ﺯﻑ ﺃﻭ‬ ‫ﺍﻟﺣﺎﺟﺔ ﻹﺟﺭﺍء ﻋﻣﻠﻳّﺔ ﺟﺭﺍﺣﻳﺔ‪.‬‬ ‫ﺃﻥ ﻋﻣﻠﻳﺔ ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ ﻣﻥ ﻣﺗﺑﺭّﻋﻳﻥ ﻁﺑﻳﻌﻳﻳﻥ ﺗﻧﺟﺢ ﻓﻲ ﻣﻌﻅﻡ ﺍﻷﺣﻳﺎﻥ ﻓﻲ ﺗﻐﻳﻳﺭ ﺇﻧﺗﺎﺝ‬ ‫ﺍﻟﺻﻔﻳﺣﺎﺕ ﺇﻟﻰ ﺍﻟﻧﻭﻉ ﺍﻟﻁﺑﻳﻌﻲ ﻭﺍﻟﻌﺩﺩ ﺍﻟﻁﺑﻳﻌﻲ ﻟ�ﺩﻯ ﻛﺛﻳ�ﺭ ﻣ�ﻥ ﻫ�ﺅﻻء ﺍﻟﻣﺭﺿ�ﻰ‪ ،‬ﻭﻗ�ﺩ ﺃﺻ�ﺑﺢ‬ ‫ﻫﺫﺍ ﺍﻷﺳﻠﻭﺏ ﺍﻟﻌﻼﺟﻲ ﻣﻧﺗﺷﺭﺍً ﻓ�ﻲ ﺍﻟﻌ�ﺎﻟﻡ ﻭﻳُﺟ�ﺭﻯ ﻓ�ﻲ ﻣﺭﺍﻛ�ﺯ ﻛﺛﻳ�ﺭﺓ‪ .‬ﻭﺍﻵﻥ ﺃﺻ�ﺑﺣﺕ ﻋﻣﻠﻳ�ﺔ‬ ‫ﺯﺭﺍﻋ��ﺔ ﺍﻟﺧﻠﻳ��ﺔ ﺍﻟﺟﺫﻋﻳ��ﺔ ﻣ��ﻥ ﺩﻡ ﺃﺷ��ﺧﺎﺹ ﻁﺑﻳﻌﻳ��ﻳﻥ ﻣﻁ��ﺎﺑﻘﻳﻥ ﻟﻠﻣ��ﺭﻳﺽ ﺗﺣ��ﻝ ﺗ��ﺩﺭﻳﺟ ّﻳﺎ ً ﻣﺣ��ﻝ‬ ‫ﻋﻣﻠﻳﺔ ﺯﺭﺍﻋﺔ ﺍﻟﻧﺧﺎﻉ‪.‬‬ ‫‪ .4‬اﻷﻣﺮاض اﻟﻨﺰﻓﻴﺔ اﻟﻮراﺛﻴﺔ اﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺧﻠﻞ ﻓﻲ ﻋﻤﻠﻴﺔ ﺗﺨﺜﺮ اﻟﺪم‬ ‫ﺇﻥ ﺍﻟﻧﻘﺹ ﺍﻟﻣﻭﺭﻭﺙ ﻳﻛ�ﻭﻥ ﻓ�ﻲ ﻣﻌﻅ�ﻡ ﺍﻟﺣ�ﺎﻻﺕ ﻣﻘﺗﺻ�ﺭﺍً ﻋﻠ�ﻰ ﻋﺎﻣ�ﻝ ﻭﺍﺣ�ﺩ ﻓﻘ�ﻁ ﻣ�ﻥ ﻋﻭﺍﻣ�ﻝ‬ ‫ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻭﻳﻣﻛ�ﻥ ﺃﻥ ﻳﻛ�ﻭﻥ ﺑﺳ�ﺑﺏ ﻧﻘ�ﺹ ﻓ�ﻲ ﺇﻧﺗﺎﺟ�ﻪ ﺃﻭ ﺧﻠ�ﻝ ﻓ�ﻲ ﻭﻅﻳﻔﺗ�ﻪ‪ ،‬ﻭﺍﻟﻧﺗﻳﺟ�ﺔ ﻭﺍﺣ�ﺩﺓ ﻓ�ﻲ‬ ‫ﺍﻟﺣﺎﻟﺗﻳﻥ‪.‬‬ ‫‪26‬‬

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‫ﺇﻥ ﺃﺷﻬﺭ ﻭﺃﻫﻡ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻫﻭ )ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳ�ﺎ ﻧ�ﻭﻉ ﺃ( ﻭﺍﻟﻣﺗﺳ�ﺑﺏ ﻋ�ﻥ ﺧﻠ�ﻝ ﻭﻅﻳﻔ�ﺔ ﻋﺎﻣ�ﻝ ‪.8‬‬ ‫ﻭﻗﺩ ﻛﺎﻥ ﻫﺫﺍ ﺍﻻﺳﻡ ﻳُﺳﺗﻌﻣﻝ ﻓﻲ ﺃﻭﺭﺑﺎ ﻣﻧﺫ ﻭﻗﺕ ﻁﻭﻳﻝ ﻟﻛﻝ ﺃﻣﺭﺍﺽ ﺍﻟﻧﺯﻑ‪ ،‬ﻭﻟ�ﻡ ﺗﻛ�ﻥ ﻋﻭﺍﻣ�ﻝ‬ ‫ﺍﻟﺗﺧﺛﺭ ﺍﻟﻣﺧﺗﻠﻔﺔ ﻗﺩ ﻋُﺭﻓﺕ‪ .‬ﻓﻠﻣﺎ ﺍﺑﺗﺩﺃ ﺍﻟﻌﻠ�ﻡ ﺍﻟﺣ�ﺩﻳﺙ ﻳﻛﺷ�ﻑ ﻋ�ﻥ ﺍﻟﻌﻭﺍﻣ�ﻝ ﺍﻟﻣﺗﻌ�ﺩﺩﺓ ﻓ�ﻲ ﻋﻣﻠﻳ�ﺔ‬ ‫ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻭﻛﻠﻬﺎ ﻣﻌ�ﺭﻭﻑ ﺍﻵﻥ‪ ،‬ﺍﻗ ُﺗﺻ�ﺭ ﺍﻻﺳ�ﻡ ﻋﻠ�ﻰ ﺍﻟﻣ�ﺭﺽ ﺍﻟﻧ�ﺎﺗﺞ ﻋ�ﻥ ﻧﻘ�ﺹ ﻋﺎﻣ�ﻝ ‪ ،8‬ﻷﻧ�ﻪ‬ ‫ﺍﻷﻛﺛﺭ ﺷﻳﻭﻋﺎ ُ ﺑﻳﻧﻬﺎ‪ .‬ﺑﻌﺩ ﺫﻟﻙ ﺃُﻋﻁ�ﻲ ﺍﺳ�ﻡ )ﻫﻳﻣﻭﻓﻳﻠﻳ�ﺎ ﺏ( ﺇﻟ�ﻰ ﻣ�ﺭﺽ ﻧﻘ�ﺹ ﻋﺎﻣ�ﻝ ‪ 9‬ﻟﻭﺟ�ﻭﺩ‬ ‫ﺻﻔﺎﺕ ﻣﺗﺷﺎﺑﻬﺔ ﺑﻳﻥ ﺍﻟﺣﺎﻟﺗﻳﻥ‪ ،‬ﻛﻣﺎ ﺳﻳﺭﺩ ﺗﻔﺻﻳﻠﻪ‪ .‬ﺃﻣّﺎ ﺃﻣﺭﺍﺽ ﻧﻘﺹ ﺑﻘﻳﺔ ﺍﻟﻌﻭﺍﻣﻝ ﻓﻬ�ﻲ ﻧ�ﺎﺩﺭﺓ‬ ‫ﺍﻟﺣﺻﻭﻝ ﻭﺗﺳﻣﻰ ﺑﺄﺳﻣﺎء ﻧﻘﺹ ﺍﻟﻌﻭﺍﻣﻝ ﺫﺍﺕ ﺍﻟﻌﻼﻗ�ﺔ ) ﻛ�ﻧﻘﺹ ﻋﺎﻣ�ﻝ ‪ 7‬ﺃﻭ ﻋﺎﻣ�ﻝ ‪ 5‬ﻣ�ﺛﻼً(‪،‬‬ ‫ﻭﺗﻭﺟﺩ ﻟﺑﻌﺽ ﺗﻠﻙ ﺍﻷﻣﺭﺍﺽ ﺃﺳﻣﺎء ﺇﻻ ﺃﻧﻬ�ﺎ ﻻ ﺗﺳ�ﻣّﻰ ﺑﻬ�ﺎ ﻭﻫ�ﻲ ﻏﻳ�ﺭ ﻣﺷ�ﻬﻭﺭﺓ‪ .‬ﻟﻛ�ﻥ ﻣ�ﺭﺽ‬ ‫ﻓﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ ﻳﺳﻣّﻰ ﺑﻬﺫﺍ ﺍﻻﺳﻡ ﻷﻥ ﻟﻪ ﻣﻣﻳﺯﺍﺕ ﺧﺎﺻﺔ ﻭﻟﻛﻭﻧﻪ ﺷﺎﺋﻌﺎ ً ﻧﺳﺑﻳﺎ ً‪.‬‬ ‫ﺳ��ﺄﺑﺩﺃ ﺑﺷ��ﺭﺡ ﻣ��ﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳ��ﺎ ﺍ ﺑﺎﻟﺗﻔﺻ��ﻳﻝ ﺛ��ﻡ ﺁﺗ��ﻲ ﻋﻠ��ﻰ ﺫﻛ��ﺭ ﺍﻷﻣ��ﺭﺍﺽ ﺍﻷﺧ��ﺭﻯ‪ ،‬ﻣﺑﻳّﻧ �ﺎ ً‬ ‫ﺍﻟﻔﺭﻭﻕ ﺑﻳﻧﻬﺎ ﻭﺑﻳﻥ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ‪.‬‬ ‫ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎﺃ )ﻣﺭﺽ ﺍﻟﻧﺎﻋﻭﺭ ﻋﻧﺩ ﺍﻟﻌﺭﺏ(‬ ‫ﺳﺑﺏ ﺍﻟﻣﺭﺽ‪ :‬ﻧﻘﺹ ﻭﺭﺍﺛﻲ ﻓﻲ ﻓﻌّﺎﻟﻳّﺔ ﺍﻟﻌﺎﻣﻝ ‪ 8‬ﻣﻥ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻭﺭﺍﺛ��ﺔ ﺍﻟﻣ��ﺭﺽ‪ :‬ﻳ��ﻭﺭّﺙ ﺍﻟﻣ��ﺭﺽ ﻋﻠ��ﻰ ﺻ��ﺑﻐﻳّﺔ ﺍﻟﺟ��ﻧﺱ)‪ (X‬ﻭﻟ��ﺫﻟﻙ ﻳﻧﺗﻘ��ﻝ ﺍﻟﻣ��ﺭﺽ ﻋ��ﺎﺩﺓ ﺇﻟ��ﻰ‬ ‫ﺍﻷﻭﻻﺩ ﻭﺗﻛﻭﻥ ﺻﻔﺗﻪ ﻋﻧﺩ ﺍﻟﺑﻧﺎﺕ ﻣﺣﻣﻭﻟﺔ ﺩﻭﻥ ﺃﻋ�ﺭﺍﺽ ﻧﺯﻓﻳ�ﺔ ﺗﻠﻔ�ﺕ ﺍﻟﻧﻅ�ﺭ‪ ،‬ﻛﻣ�ﺎ ﻓ�ﻲ ﺍﻟﺷ�ﻛﻝ‬ ‫ﺭﻗﻡ ‪ 10‬ﺃﺩﻧﺎﻩ‪ .‬ﺇﻥ ﻫﺫﺍ ﺍﻷﻣﺭ ﻻ ﻳﻌﻧ�ﻲ ﺃﻥ ﺍﻷﻧﺛ�ﻰ ﻻ ُﺗﺻ�ﺎﺏ ﺑ�ﺎﻟﻣﺭﺽ ﻛ�ﺎﻣﻼً‪ ،‬ﻟﻛ�ﻥ ﻓ�ﻲ ﺍﻟﺳ�ﺎﺑﻕ‬ ‫ﻛ��ﺎﻥ ﺍﻟ��ﺫﻛﻭﺭ ﺍﻟ��ﺫﻳﻥ ﻟ��ﺩﻳﻬﻡ ﺍﻟﻣ��ﺭﺽ ﺇﻣ��ﺎ ﻳﻣﻭﺗ��ﻭﻥ ﻗﺑ��ﻝ ﺍﻟﺑﻠ��ﻭﻍ ﺑﺳ��ﺑﺏ ﺗﻛ � ّﺭﺭ ﺍﻟﻧ��ﺯﻑ ﻟ��ﺩﻳﻬﻡ ﺃﻭ‬ ‫ﻳﺻ���ﺑﺣﻭﻥ ﻣﺷ���ﻭّ ﻫﻳﻥ ﻭﻣﻌ� ﱠ��ﻭﻗﻳﻥ ﻟ���ﺩﻯ ﻭﺻ���ﻭﻝ ﺳ���ﻥ ﺍﻟﺑﻠ���ﻭﻍ ﺑﺳ���ﺑﺏ ﺍﻷﻧﺯﻓ���ﺔ ﻓ���ﻲ ﺍﻟﻣﻔﺎﺻ���ﻝ‬ ‫ﻭﺍﻟﻌﺿﻼﺕ‪ ،‬ﻓﻼ ﻳﺗﺯﻭّ ﺟﻭﻥ‪.‬‬ ‫ﻣﻭﺭﺙ ﺍﻟﻣﺭﺽ‬ ‫ﺍﻣﺭﺃﺓ ﺗﺣﻣﻝ ّ‬

‫ﺍﻟﺟﻳﻝ ﺍﻷﻭﻝ‬

‫ﺍﻟﺟﻳﻝ ﺍﻟﺛﺎﻧﻲ‬

‫ﺭﺟﻝ ﻁﺑﻳﻌﻲ‬

‫‪XX‬‬ ‫‪XY‬‬ ‫ﻭﻟﺩ ﻁﺑﻳﻌﻲ‬

‫‪XY‬‬ ‫ﻭﻟﺩ ﻣﺻﺎﺏ‬

‫‪XY‬‬ ‫‪XX‬‬ ‫ﺑﻧﺕ ﻁﺑﻳﻌﻳﺔ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪10‬‬ ‫ﻭﺭﺍﺛﺔ ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﻓﻲ ﺍﻟﺫﻛﻭﺭ‬

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‫‪XX‬‬ ‫ﺑﻧﺕ ﺗﺣﻣﻝ ﺻﻔﺔ ﺍﻟﻣﺭﺽ‬

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‫ﺃﻣّﺎ ﺍﻵﻥ ﻭﺑﺗﻭﻓّﺭ ﻋﺎﻣﻝ ‪ 8‬ﺍﻟﻣﺭ ّﻛﺯ ﻟﻠﻌﻼﺝ ﺑﺻﻭﺭﺓ ﺭﻭﺗﻳﻧﻳﺔ ﻓﻲ ﺑﻠﺩﺍﻥ ﻣﺧﺗﻠﻔﺔ ﻓﻘﺩ ﺃﺻ�ﺑﺢ ﺍﻷﻭﻻﺩ‬ ‫ﺍﻟﻣﺻﺎﺑﻭﻥ ﻳﺻﻠﻭﻥ ﺳﻥ ﺍﻟﺑﻠﻭﻍ ﻭﻳﺗﺯﻭّ ﺝ ﺑﻌﺿﻬﻡ‪ ،‬ﻭﺣﻳﻧﺋﺫٍ‪ ،‬ﺇﺫﺍ ﺗﺯﻭّ ﺝ ﻣﺛ�ﻝ ﻫ�ﺫﺍ ﺍﻟﻣ�ﺭﻳﺽ ﺍﻣ�ﺭﺃﺓ‬ ‫ﺗﺣﻣﻝ ﺻﻔﺔ ﺍﻟﻣﺭﺽ‪ ،‬ﻭﻟﻳﺳ�ﺕ ﻣﺭﻳﺿ�ﺔ‪ ،‬ﻓﻘ�ﺩ ﻳﻧﺟﺑ�ﺎﻥ ﺑﻧ�ﺎﺕ ﻓ�ﻳﻬﻥ ﺍﻟﻣ�ﺭﺽ ﺑﺄﻋﺭﺍﺿ�ﻪ ﺍﻟﻧﺯﻓﻳ�ﺔ‪،‬‬ ‫ﻛﻣﺎ ﻳﻅﻬﺭ ﻓﻲ ﺍﻟﺷﻛﻝ ‪:11‬‬

‫ﺍﻟﺟﻳﻝ ﺍﻷﻭﻝ‬

‫ﺭﺟﻝ ﻣﺻﺎﺏ ﺑﺎﻟﻣﺭﺽ‬

‫ﺍﻣﺭﺃﺓ ﺗﺣﻣﻝ ﻣﻭﺭﺙ ﺍﻟﻣﺭﺽ‬

‫‪XY‬‬

‫‪XX‬‬

‫ﺍﻟﺟﻳﻝ ﺍﻟﺛﺎﻧﻲ‬

‫‪XX‬‬ ‫ﺑﻧﺕ ﻣﺻﺎﺑﺔ‬

‫‪XX‬‬ ‫ﺑﻧﺕ ﺗﺣﻣﻝ ﺻﻔﺔ ﺍﻟﻣﺭﺽ‬

‫‪XY‬‬ ‫ﻭﻟﺩ ﻣﺻﺎﺏ‬

‫‪XY‬‬ ‫ﻭﻟﺩ ﻁﺑﻳﻌﻲ‬

‫ﺷﻛﻝ ﺭﻗﻡ‪11‬‬ ‫ﻭﺭﺍﺛﺔ ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﻓﻲ ﺍﻹﻧﺎﺙ‬

‫ﺗﺟﺩﺭ ﺍﻹﺷﺎﺭﺓ ﻫﻧﺎ ﺃﻥ ﺍﻟﺫﻛﻭﺭ ﻟﺩﻳﻬﻡ ﺻﺑﻐﻳﺔ ﻭﺍﺣﺩﺓ ﻣﻥ ‪ X‬ﻓﻳﻛﻔﻲ ﺇﺻﺎﺑﺔ ﺗﻠﻙ ﺍﻟﺻ�ﺑﻐﻳّﺔ ﺑﻣ�ﻭ ّﺭﺙ‬ ‫ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﻟﻳﻅﻬﺭ ﺍﻟﻣﺭﺽ ﻛﺎﻣﻼً ﻟﺩﻳﻪ‪ ،‬ﺃﻣﺎ ﺍﻷﻧﺛﻰ ﻓﻠ�ﺩﻳﻬﺎ ﺻ�ﺑﻐﻳﺗﺎﻥ ﻣ�ﻥ ﻧ�ﻭﻉ ‪ X‬ﻓﻳﺟ�ﺏ‬ ‫ﺇﺻﺎﺑﺗﻬﻣﺎ ﻣﻌﺎ ً ﺑﺎﻟﻣﻭ ّﺭﺙ ﻏﻳﺭ ﺍﻟﻁﺑﻳﻌﻲ ﻟﻳﻛﻭﻥ ﻟﺩﻳﻬﺎ ﺍﻟﻣﺭﺽ ﻛﺎﻣﻼً‪.‬‬ ‫ﺃﻋﺭﺍﺽ ﺍﻟﻣﺭﺽ ‪:‬‬ ‫ﻳﻼﺣﻅ ﺃﻫﻝ ﺍﻟﻁﻔﻝ ﺍﻟﻣﺻﺎﺏ‪ ،‬ﻭﻣﻧﺫ ﺃﻭﻝ ﺃﻳﺎﻡ ﺣﻳﺎﺗﻪ‪ ،‬ﺑﻝ ﺭﺑﻣﺎ ﻣﻥ ﺳﺎﻋﺔ ﻭﻻﺩﺗﻪ‪ ،‬ﺃﻧﻪ ﻳﻧ�ﺯﻑ ﻣ�ﻥ‬ ‫ﻣﻭﻗﻊ ﺍﻟﺳ ّﺭﺓ ﺑﺷﻛﻝ ﻏﻳﺭ ﻋﺎﺩﻱ‪ .‬ﻭﺭﺑﻣﺎ ﻅﻬﺭﺕ ﻣﺷﻛﻠﺔ ﺍﻟﻧﺯﻑ ﻋﻧﺩ ﺍﻟﺧﺗﺎﻥ‪ .‬ﻭﺣﻳﻧﻣﺎ ﻳﻛﺑﺭ ﺍﻟﻁﻔ�ﻝ‬ ‫ﻭﻳﺑ��ﺩﺃ ﺑ��ﺎﻟﺯﺣﻑ ﻭﺍﻟﺣﺭﻛ��ﺎﺕ ﺍﻷﺧ��ﺭﻯ ﻓ��ﺈﻥ ﻧﺯﻳ��ﻑ ﺍﻟﻣﻔﺎﺻ��ﻝ ﻭﺍﻟﻧ��ﺯﻑ ﺗﺣ��ﺕ ﺍﻟﺟﻠ��ﺩ ) ﺍﻟﻛ��ﺩﻣﺎﺕ(‬ ‫ﺗﺻﺑﺢ ﻅﻭﺍﻫﺭ ﻣﺄﻟﻭﻓﺔ ﺗﺛﻳﺭ ﻓﺯﻉ ﺍﻷﻫﻝ ﺑﺳﺑﺏ ﻣﻧﻅﺭﻫﺎ ﻭﺑﺳﺑﺏ ﺗﺄﻟّﻡ ﺍﻟﻁﻔﻝ ﻣﻥ ﻧ�ﺯﻑ ﺍﻟﻣﻔﺎﺻ�ﻝ‬ ‫ﻓﺂﻻﻣﻬﺎ ﻣﺑﺭّﺣﺔ ﺗﻘﻌﺩ ﺍﻟﻁﻔﻝ ﻋﻥ ﺍﻟﺣﺭﻛﺔ‪ .‬ﻛﻣﺎ ﺃﻥ ﺍﻟﻧﺯﻑ ﺩﺍﺧﻝ ﺍﻟﻣﻔﺻﻝ ﻗﺩ ﻳﺅﺩﻱ ﻓﻳﻣ�ﺎ ﺑﻌ�ﺩ ﺇﻟ�ﻰ‬ ‫ﺗﺷﻭﻫﻪ ﺑﺳﺑﺏ ﺗﻠﻳﻑ ﺍﻟﺩﻡ ﺍﻟﻣﺻﺑﻭﺏ ﺩﺍﺧﻠﻪ ﻭﺿﻣﻭﺭ ﺍﻟﻌﺿﻼﺕ ﺍﻟﻣﺣﻳﻁﺔ ﺑﻪ‪ ،‬ﺣﻳﺙ ﺗﻘﻝ ﺣﺭﻛﺗﻬﺎ‬ ‫ﺟﺭﺍء ﺁﻻﻡ ﺍﻟﻣﻔﺻﻝ‪ .‬ﻭﺍﻟﻧﺗﻳﺟﺔ‪ ،‬ﻓﺈﻥ ﻣﺭﻳﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﺍﻟﺷﺩﻳﺩﺓ ﻳﻛﻭﻥ ﻋﻧ�ﺩ ﺳ�ﻥ ﺍﻟﺑﻠ�ﻭﻍ ﻣﺷ�ﻭﻫﺎ ً‬ ‫ﻭﻣﻌﺎﻗﺎ ً‪ .‬ﻟﻛﻥ ﻳﺟﺏ ﺗﺫ ّﻛﺭ ﺣﻘﻳﻘﺗﻳﻥ ﻫﻧﺎ‪:‬‬

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‫ﺍﻷﻭﻟﻰ‪ :‬ﺃﻥ ﺷﺩﺓ ﺍﻟﻣﺭﺽ ﻟﻳﺳ�ﺕ ﻣﺗﺳ�ﺎﻭﻳﺔ ﻟ�ﺩﻯ ﻛ�ﻝ ﺍﻟﻣﺭﺿ�ﻰ ﻭﺇﻥ ﻛﺎﻧ�ﺕ ﻣﺗﻘﺎﺭﺑ�ﺔ ﺩﺍﺧ�ﻝ ﻧﻔ�ﺱ‬ ‫ﺍﻟﻌﺎﺋﻠ��ﺔ‪ .‬ﻓﻬﻧ��ﺎﻙ ﺣ��ﺎﻻﺕ‪ ،‬ﺃﻭ ﻋ��ﺎﺋﻼﺕ‪ ،‬ﻳﻛ��ﻭﻥ ﺍﻟﻣ��ﺭﺽ ﻋﻧ��ﺩﻫﺎ ﺷ��ﺩﻳﺩﺍً ﻭﺗﻛ��ﻭﻥ ﻓﻌﺎﻟﻳ��ﺔ ﻋﺎﻣ��ﻝ ‪8‬‬ ‫ﻋﻧﺩﻫﺎ ﺃﻗﻝ ﻣﻥ ‪ %1‬ﻣﻥ ﺍﻟﻁﺑﻳﻌ�ﻲ‪ ،‬ﻭﺣ�ﺎﻻﺕ ﻣﺗﻭﺳ�ﻁﺔ ﺍﻟﺷ�ﺩﺓ )ﻋﺎﻣ�ﻝ ‪ 8‬ﻣ�ﻥ ‪ (%5-2‬ﻭﺣ�ﺎﻻﺕ‬ ‫ﻫﻳّﻧﺔ ) ﺃﻛﺛﺭ ﻣﻥ ‪ .(%5‬ﺑﻝ ﺇﻥ ﺑﻌﺽ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻬﻳّﻧﺔ ﻻ ُﺗﺷ ّﺧﺹ ﺇﻻ ﺑﻌﺩ ﻣﺿﻲ ﺳﻧﻳﻥ ﻣﻥ ﺣﻳﺎﺓ‬ ‫ﺍﻟﻁﻔﻝ‪ ،‬ﻷﻥ ﺇﺻﺎﺑﺎﺕ ﺍﻟﻧﺯﻑ ﻓﻳﻬﺎ ﺧﻔﻳﻔﺔ ﻻ ﺗﺳﺑﺏ ﺇﺯﻋﺎﺟﺎ ً ﻟﻠﻣﺭﻳﺽ ﻭﺃﻫﻠﻪ‪.‬‬ ‫ﻛﺫﻟﻙ ﻓﺈﻥ ﺍﻟﻣﺭﻳﺽ ﺣﻳﻧﻣﺎ ﻳﺗﺟﺎﻭﺯ ﺍﻟﺑﻠﻭﻍ ﺗﻘﻝ ﺣﻭﺍﺩﺙ ﺍﻟﻧﺯﻑ ﻋﻧﺩﻩ ﻭﺗﺧﻑ ﺣ ّﺩ ًﺓ‪.‬‬ ‫ﻭﻗﺩ ﻻﺣ�ﻅ ﺃﻁﺑ�ﺎء ﺍﻟ�ﺩﻡ ﺃﻥ ﻫﻧ�ﺎﻙ ﺷ�ﻌﻭﺑﺎ ً ﺗﻛ�ﻭﻥ ﻓﻳﻬ�ﺎ ﺃﻋ�ﺭﺍﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳ�ﺎ ﺧﻔﻳﻔ�ﺔ ﺑﺎﻟﻣﻘﺎﺭﻧ�ﺔ ﻣ�ﻊ‬ ‫ﻏﻳﺭﻫﺎ ﻣﻥ ﺍﻟﺷ�ﻌﻭﺏ‪ ،‬ﺣﺗ�ﻰ ﻭﺇﻥ ﻛﺎﻧ�ﺕ ﻓﻌﺎﻟﻳ�ﺔ ﻋﺎﻣ�ﻝ‪ 8‬ﻭﺍﻁﺋ�ﺔ ﺇﻟ�ﻰ ﻣﺳ�ﺗﻭﻯ ﺍﻟﺣ�ﺎﻻﺕ ﺍﻟﺷ�ﺩﻳﺩﺓ‪.‬‬ ‫ﻭﻣﻥ ﻫﺫﻩ ﺍﻟﺷﻌﻭﺏ ﺷﻌﺏ ﺍﻟﺟﺯﻳﺭﺓ ﺍﻟﻌﺭﺑﻳﺔ‪.‬‬ ‫ﺍﻟﺛﺎﻧﻳﺔ‪ :‬ﺃﻥ ﺍﻟﻛﺛﻳﺭ ﻣﻥ ﺍﻟﻣﺭﺿﻰ ﻓﻲ ﺍﻟﻭﻗﺕ ﺍﻟﺭﺍﻫﻥ ﻳﺄﺧﺫﻭﻥ ﻋﺎﻣﻝ ‪ 8‬ﺍﻟﻣﺭ ّﻛﺯ ﺇﻣّ�ﺎ ﻓ�ﻭﺭ ﺣﺻ�ﻭﻝ‬ ‫ﺍﻹﺻﺎﺑﺔ ﺣﺗﻰ ﻳُﻘﻁ�ﻊ ﺍﻟﻧ�ﺯﻑ ﺑﺳ�ﺭﻋﺔ‪ ،‬ﺃﻭ ﻳﺄﺧﺫﻭﻧ�ﻪ ﺑﺻ�ﻭﺭﺓ ﻣﻧﺗﻅﻣ�ﺔ ﻭﻗﺎﺋﻳ�ﺔ ﻓ�ﻲ ﺑﻳ�ﻭﺗﻬﻡ ﻭﺑ�ﺫﻟﻙ‬ ‫ﻳُﻣﻧﻊ ﺍﻟﻧﺯﻑ ﻟﺩﻳﻬﻡ ﺃﺻﻼً‪ .‬ﻭﻟﺫﻟﻙ ﻟﻡ ﻧﻌﺩ ﻧﺭﻯ ﻓﻲ ﻛﺛﻳﺭ ﻣ�ﻥ ﺍﻟﺑﻠ�ﺩﺍﻥ ﻣﺭﺿ�ﻰ ﻣﺷ�ﻭّ ﻫﻳﻥ ﻛﻣ�ﺎ ﻓ�ﻲ‬ ‫ﺍﻟﺳﺎﺑﻕ‪.‬‬ ‫ﺇﻥ ﺍﻟﻧﺯﻑ ﻗﺩ ﻳﻛﻭﻥ ﺃﺣﻳﺎﻧﺎ ً ﺩﺍﺧﻝ ﻋﺿﻭ ﻣﻬ�ﻡ‪ ،‬ﻛ�ﺎﻟﻣﺦ‪ ،‬ﻭﺧﺻﻭﺻ�ﺎ ً ﻋﻠ�ﻰ ﺃﺛ�ﺭ ﺿ�ﺭﺑﺔ ﺃﻭ ﺳ�ﻘﻭﻁ‬ ‫ﻋﻠﻰ ﺍﻟﺭﺃﺱ‪ .‬ﻭﻗﺩ ﻳﻛﻭﻥ ﺫﻟﻙ ﺍﻟﻧﺯﻑ ﻗﺎﺗﻼً ﺃﻭ ﻳﺳﺑﺏ ﺷﻠﻼً ﺩﺍﺋﻣﺎ ً ﻓﻲ ﺑﻌﺽ ﺍﻷﻁﺭﺍﻑ‪.‬‬ ‫ﻭﺑﺩﻳﻬﻲ ﺃﻥ ﻳﺿﺎﻑ ﺇﻟﻰ ﺃﻋﺭﺍﺽ ﺍﻟﻣﺭﺽ ﺍﻷﻋﺭﺍﺽ ﺍﻟﻧﻔﺳﻳﺔ ﺍﻟﺗﻲ ﺗﺻ�ﻳﺏ ﺍﻟﻁﻔ�ﻝ ﺑﺳ�ﺑﺏ ﻣﻧﻌ�ﻪ‬ ‫ﻣﻥ ﺍﻟﻠﻌﺏ ﻣﻊ ﺃﻗﺭﺍﻧﻪ ﻭﻟﺗﺷﻭﻩ ﻣﻔﺎﺻﻠﻪ‪ ،‬ﻭﻋﺎﺩﺓ ﻣﺎ ﻳﻛﻭﻥ ﺍﻟﻣﺭﻳﺽ ﺷﺎﻋﺭﺍً ﺑﻣﺎ ﻋﻧ�ﺩﻩ ﻣ�ﻥ ﻣﺷ�ﺎﻛﻝ‬ ‫ﻓﻳﻧﺯﻭﻱ ﻭﻳﻛﻭﻥ ﻛﺋﻳﺑﺎ ً ﻭﺗﻌﻳﺳﺎ ً‪.‬‬ ‫ﺗﺷ��ﺧﻳﺹ ﺍﻟﻣ��ﺭﺽ ﻣﺧﺑﺭ ّﻳ �ﺎ ً‪ :‬ﺳ��ﺄﻋﺭﺽ ﻟﻣﻭﺿ��ﻭﻉ ﺍﻟﺗﺷ��ﺧﻳﺹ ﺍﻟﻣﺧﺑ��ﺭﻱ ﺗﻔﺻ��ﻳﻼً ﺑﻌ��ﺩ ﺍﻧﺗﻬ��ﺎء‬ ‫ﺍﻟﻛﻼﻡ ﻋﻥ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻣﺧﺗﻠﻔﺔ )ﺹ‪ 34‬ﻭ‪.( 35‬‬ ‫ﻋﻼﺝ ﺍﻟﻣﺭﺽ ‪:‬‬ ‫ﻣ��ﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳ��ﺎ ﻻ ﻳﺷ��ﻔﻰ ﺑ��ﺎﻟﻁﺭﻕ ﺍﻟﻣﺗ��ﻭﻓّﺭﺓ ﺣﺎﻟ ّﻳ �ﺎ ً‪ .‬ﻭﻫﻧ��ﺎﻙ ﺁﻣ��ﺎﻝ ﻟ��ﻡ ﺗﺗﺣﻘ��ﻕ ﺑﻌ��ﺩ‪ ،‬ﺑﺗﻁ��ﻭﺭ‬ ‫ﺍﻟﻌﻼﺝ ﺑﺎﻟﻣﻭﺭّﺛﺎﺕ ﺑﺣﻳﺙ ﻳﻣﻛﻥ ﺗﻐﻳﻳﺭ ﺍﻟﻣﻭﺭّﺙ ﺍﻟﻐﻳﺭ ﻁﺑﻳﻌﻲ ﺑﺂﺧﺭ ﻁﺑﻳﻌﻲ‪.‬‬

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‫ﻭﻛﺫﻟﻙ‪ ،‬ﻓﺈﻥ ﺇﻋﻁﺎء ﻣﺭ ّﻛﺯ ﺍﻟﻌﺎﻣﻝ ‪ 8‬ﻟﻥ ﻳﺷﻔﻲ ﺍﻟﻣﺭﺽ‪ ،‬ﻷﻥ ﺫﻟﻙ ﺍﻟﻌﺎﻣﻝ ﻳﺩﻭﻡ ﻓﻲ ﺍﻟﺟﺳﻡ ﻟﻣ�ﺩﺓ‬ ‫ﺗﺗﺭﺍﻭﺡ ﺑﻳﻥ ‪ 24-6‬ﺳﺎﻋﺔ ) ﻳﺧﺗﻔ�ﻲ ﻧﺻ�ﻑ ﺍﻟﺗﺭﻛﻳ�ﺯ ﻓ�ﻲ ﺍﻟ�ﺩﻡ ﻓ�ﻲ ‪ 8‬ﺳ�ﺎﻋﺎﺕ(‪ .‬ﻟ�ﺫﺍ ﻓﻬ�ﻭ ﻋ�ﻼﺝ‬ ‫ﻣﻭﻗّﺕ‪.‬‬ ‫ﺇﻥ ﻋﻼﺝ ﺍﻟﻣﺭﻳﺽ ﻳﻛﻭﻥ ﺇﻣّﺎ ﺑﺈﻋﻁﺎﺋﻪ ﻋﺎﻣﻝ ‪ 8‬ﺍﻟﻣﺭﻛﺯ ﺑﺎﻟﻭﺭﻳﺩ ﻟﺩﻯ ﺣﺻﻭﻝ ﺃﻱّ ﺷﺩﺓ )ﻭﻳﻣﻛ�ﻥ‬ ‫ﺃﻥ ﻳُﺣﻘﻥ ﻓﻲ ﺩﺍﺭﻩ ﺇﺫﺍ ﻭُ ﺟﺩ ﻣﻥ ﻳﺳﺗﻁﻳﻊ ﺫﻟ�ﻙ(‪ ،‬ﺃﻭ ﺑﺈﻋﻁ�ﺎء ﻋﺎﻣ�ﻝ ‪ 8‬ﺍﻟﻣﺭﻛ�ﺯ ﺑﺻ�ﻭﺭﺓ ﻣﻧﺗﻅﻣ�ﺔ‬ ‫ﻛﻭﻗﺎﻳﺔ ﻟﻪ‪ ،‬ﺗﺣﺳّﺑﺎ ً ﻟﺣﺻﻭﻝ ﺷﺩﺓ‪ ،‬ﻭﺣﺗﻰ ﻳﺳﺗﻁﻳﻊ ﺃﻥ ﻳﻛﻭﻥ ﺣ ّﺭﺍً ﻓ�ﻲ ﺣﺭﻛﺗ�ﻪ ﻏﻳ�ﺭ ﻣﺗﺧ�ﻭﻑ ﻣ�ﻥ‬ ‫ﺍﺣﺗﻣﺎﻝ ﺣﺻﻭﻝ ﺍﻟﺷﺩﺓ ﻭ ﻣﺎ ﻳﺻﺎﺣﺑﻬﺎ ﻣﻥ ﻧﺯﻑ‪.‬‬ ‫ﻟﻛﻥ ﻋﺎﻣﻝ ‪ 8‬ﺍﻟﻣﺭﻛﺯ ﻫﻭ ﻣﺎﺩﺓ ﻏﺎﻟﻳﺔ ﺍﻟﺛﻣﻥ ﻭﻟﻳﺱ ﻛﻝ ﻣﺭﻳﺽ ﺑﻘﺎﺩﺭ ﻋﻠﻰ ﺷ�ﺭﺍء ﻛﻣﻳ�ﺎﺕ ﻛﺑﻳ�ﺭﺓ‬ ‫ﻣﻧﻪ‪ ،‬ﻛﻣﺎ ﺃﻥ ﺍﻟﻛﺛﻳﺭ ﻣﻥ ﺍﻟﺣﻛﻭﻣﺎﺕ ﻻ ﺗﺳﺗﻁﻳﻊ ﺗﺟﻬﻳﺯ ﺍﻟﺣﺩ ﺍﻷﺩﻧﻰ ﻣﻥ ﻫﺫﺍ ﺍﻟﻌﺎﻣﻝ ﻟﻣﺭﺿﺎﻫﺎ‪.‬‬ ‫ﺃﻣﺎ ﻓﻲ ﺣﺎﻟﺔ ﺇﺟﺭﺍء ﺍﻟﻌﻣﻠﻳﺎﺕ ﺍﻟﺟﺭﺍﺣﻳﺔ‪ ،‬ﻭﻣﻬﻣﺎ ﻛﺎﻧﺕ ﺑﺳﻳﻁﺔ ﻛﻘﻠﻊ ﺍﻟﺳﻥ‪ ،‬ﻓﺈﻥ ﺇﻋﻁﺎء ﻋﺎﻣ�ﻝ ‪8‬‬ ‫ﻗﺑﻝ ﻭﺧﻼﻝ ﻭﺑﻌﺩ ﺍﻟﻌﻣﻠﻳﺔ ﺑﺄﻳﺎﻡ ﻫﻭ ﺃﻣﺭ ﻻﺑ ّﺩ ﻣﻧﻪ‪.‬‬ ‫ﻋﻼﺝ ﺍﻟﻣﻔﺎﺻﻝ ﺑﻌﺩ ﺗﻭﻗﻑ ﺍﻟﻧﺯﻳﻑ‬ ‫ﻳﺣﺗﺎﺝ ﺍﻟﻣﺭﻳﺽ ﺇﻟﻰ ﻣﺳ ّﻛﻧﺎﺕ ﻟﻸﻟﻡ ﻭﺭﺑّـﻣﺎ ﺍﺳ�ﺗﻌﻣﺎﻝ ﻛﻣّ�ﺎﺩﺍﺕ ﺑ�ﺎﺭﺩﺓ ﻣﻭﺿ�ﻌ ّﻳﺎ ً ﻟ�ﻧﻔﺱ ﺍﻟﻐ�ﺭﺽ‪.‬‬ ‫ﺇﻻّ ﺃﻥ ﺍﻟﻣﻬﻡ ﻫﻭ ﺇﻋﺎﺩﺓ ﺗﺣﺭﻳﻙ ﺍﻟﻣﻔﺻﻝ ﺑﺻ�ﻭﺭﺓ ﺗﺩﺭﻳﺟﻳّ�ـﺔ ﻭﻫﺎﺩﺋ�ﺔ ﺑﻌ�ﺩ ﺛﻼﺛ�ﺔ ﺇﻟ�ﻰ ﺧﻣﺳ�ﺔ ﺃﻳ�ﺎﻡ‬ ‫ﻣﻥ ﺣﺻﻭﻝ ﺍﻹﺻﺎﺑﺔ‪ ،‬ﺛﻡ ﺇﺟﺭﺍء ﺗﻣﺎﺭﻳﻥ ﻟﺗﺣﺭﻳﻙ ﺫﻟ�ﻙ ﺍﻟﻣﻔﺻ�ﻝ ﺑﺻ�ﻭﺭﺓ ﻣﻧﺗﻅﻣ�ﺔ ﻣﻧﻌ�ـﺎ ً ﻟﺗﻳ�ﺑّﺱ‬ ‫ﺍﻟﻣﻔﺻ��ﻝ ﻧﺗﻳﺟ��ﺔ ﻟﻧﻣ��ﻭ ﺍﻟﻧﺳ��ﻳﺞ ﺍﻟﻠﻳﻔ��ﻲ ﻓ��ﻲ ﺍﻟ��ﺩﻡ ﺍﻟﻣﺗﺟﻣّ��ﻊ ﺩﺍﺧ��ﻝ ﺍﻟﻣﻔﺻ��ﻝ‪ .‬ﻭﺇﺫﺍ ﻛﺎﻧ��ﺕ ﺣﺭﻛ��ﺔ‬ ‫ﺍﻟﻣﻔﺎﺻ��ﻝ ﻣﺗﺣ � ّﺩﺩﺓ ﻧﺗﻳﺟ��ﺔ ﻹﺻ��ﺎﺑﺎﺕ ﺳ��ﺎﺑﻘﺔ ﻓﺎﻷﻓﺿ��ﻝ ﻣﺭﺍﺟﻌ��ﺔ ﺟ��ﺭﺍﺡ ﺍﻟﻌﻅ��ﺎﻡ ﻟﻳﻧﺻ��ﺢ ﺑﻧ��ﻭﻉ‬ ‫ﺍﻟﺗﻣ�ﺎﺭﻳﻥ ﻭﺍﻟﻌ��ﻼﺝ ﺍﻟﻁﺑﻳﻌ��ﻲ ﺃﻭ ﺣﺗ��ﻰ ﺇﺟ��ﺭﺍء ﻋﻣﻠﻳ��ﺔ ﻋﻠ��ﻰ ﺍﻟﻣﻔﺻ��ﻝ ﺗﺣ��ﺕ ﻏﻁ��ﺎء ﻣ��ﻥ ﻋﺎﻣ��ﻝ ‪8‬‬ ‫ﺍﻟﻣﺭ ّﻛﺯ‪.‬‬ ‫ﻣﺻﺎﺩﺭ ﻋﺎﻣﻝ ‪ 8‬ﻟﻠﻌﻼﺝ‬ ‫ﻓ��ﻲ ﺍﻟﻭﻗ��ﺕ ﺍﻟﺣﺎﺿ��ﺭ ﺃﺻ��ﺑﺢ ﻫﻧ��ﺎﻙ ﻣﺻ��ﺩﺭﺍﻥ ﺗﺟﺎﺭ ّﻳ��ﺎﻥ ﻟﻌﺎﻣ��ﻝ ‪ 8‬ﺍﻟﻣﺭ ّﻛ��ﺯ‪ :‬ﺍﻷﻭﻝ ﻫ��ﻭ ﻋﺎﻣ��ﻝ‪8‬‬ ‫ﺍﻟﻣﺭﺳّﺏ ﺑﺎﻟﺗﺑﺭﻳﺩ ﻣﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﺑﺷﺭﻳﺔ ﻭﺍﻟ�ﺫﻱ ﻳُﻧﻘّ�ﻰ ﻓﻳﻣ�ﺎ ﺑﻌ�ﺩ ﻭﻳُﺟﻔّ�ﺩ )ﻳُﺟﻔّ�ﻑ ﺗﺣ�ﺕ ﺍﻟﺗﺟﻣﻳ�ﺩ(‪.‬‬ ‫ﻭﺍﻟﺛﺎﻧﻲ ﻫﻭ ﻋﺎﻣﻝ‪ 8‬ﺍﻟﻣﻁﺎﺑﻕ ﻟﻠﺑﺷﺭﻱ‪ ،‬ﻭﺍﻟﺫﻱ ﻳُﺻ ﱠﻧﻊ ﺑﺎﻟﻬﻧﺩﺳﺔ ﺍﻟﺟﺯﻳﺋﻳﺔ ﺛﻡ ﻳُﺟﻔّﺩ ﻭﻳﺑﺎﻉ ﺗﺟﺎﺭﻳﺎ ً‪.‬‬ ‫ﺍﻟﻧﻭﻉ ﺍﻟﺛﺎﻧﻲ ﺃﻏﻠﻰ ﺛﻣﻧﺎ ً ﻣﻥ ﺍﻷﻭﻝ ﻟﻛﻧﻪ ﺃﺳﻠﻡ ﻷﻧﻪ‪ ،‬ﺭﻏﻡ ﺗﻁﺎﺑﻘﻪ ﺗﻣﺎﻣﺎ ً ﻓ�ﻲ ﺍﻟﺗﺭﻛﻳ�ﺏ ﻣ�ﻊ ﺍﻟﻌﺎﻣ�ﻝ‬ ‫ﺍﻟﺑﺷﺭﻱ‪ ،‬ﺇﻻّ ﺃﻧﻪ ﻟﻡ ﻳﺅﺧﺫ ﻣ�ﻥ ﺍﻟ�ﺩﻡ ﻭﻳﻣﻛ�ﻥ ﺍﻋﺗﺑ�ﺎﺭﻩ ﺧﺎﻟﻳ�ﺎ ً ﻣ�ﻥ ﺍﻷﻣ�ﺭﺍﺽ ﺍﻟﻣﻌﺩﻳ�ﺔ‪ .‬ﺇﻥ ﻋﺎﻣ�ﻝ‪8‬‬

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‫ﺍﻟﺑﺷﺭﻱ ﻳﺅﺧﺫ ﻣﻥ ﻣﺗﺑﺭﻋ�ﻲ ﺍﻟ�ﺩﻡ ﺍﻟ�ﺫﻳﻥ ﻳﻣ�ﺭّﻭﻥ ﻋﺑ�ﺭ ﻓﺣ�ﻭﺹ ﻗﺎﺳ�ﻳﺔ ﻟﻠﺳ�ﻼﻣﺔ‪ ،‬ﺇﻻ ّ ﺃﻥ ﺃﺣ�ﺩﺍً ﻻ‬ ‫ﻳﺳﺗﻁﻳﻊ ﺃﻥ ﻳﺟﺯﻡ ﺃﻧﻪ ﺳﻳﻛﻭﻥ ﺧﺎﻟﻳﺎ ً ﻣﻥ ﻓﻳﺭﻭﺳﺎﺕ ﻟﻡ ﻳﺗﻌﺭّﻑ ﻋﻠﻳﻬﺎ ﺍﻟﻌﻠﻡ ﺑﻌ�ﺩ‪ .‬ﻭﻗ�ﺩ ﺣﺻ�ﻝ ﻓ�ﻲ‬ ‫ﺍﻟﺛﻣﺎﻧﻳﻧﻳﺎﺕ ﻣﻥ ﺍﻟﻘﺭﻥ ﺍﻟﻣﺎﺿﻲ‪ ،‬ﻭﻋﻧﺩ ﺍﻧﺗﺷﺎﺭ ﻣﺭﺽ ﺍﻹﻳ�ﺩﺯ ﻷﻭﻝ ﻣ�ﺭﺓ‪ ،‬ﺃﻥ ُﻧﻘ�ﻝ ﺍﻟﻣ�ﺭﺽ ﺇﻟ�ﻰ‬ ‫ﺃﻋﺩﺍﺩ ﻛﺑﻳﺭﺓ ﻣﻥ ﻣﺭﺿﻰ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﻷﻥ ﺍﻟﻔﻳﺭﻭﺱ ﻟﻡ ﻳﻛﻥ ﻗﺩ ﺗﻡ ﺍﻟﺗﻌﺭّﻑ ﻋﻠﻳﻪ‪ ،‬ﻭﻟﻡ ﻳﻛﻥ ﻫﻧ�ﺎﻙ‬ ‫ﻓﺣﻭﺹ ﻣﺧﺑﺭﻳﺔ ﻟﻠﻛﺷ�ﻑ ﻋﻧ�ﻪ ﺑﻌ�ﺩ‪ .‬ﻭﻛ�ﺎﻥ ﻣﻌﻅ�ﻡ " ﺍﻟﻣﺗﺑ�ﺭﻋﻳﻥ" ﺑﺎﻟﺑﻼﺯﻣ�ﺎ ﻫ�ﻡ ﻓ�ﻲ ﺍﻟﻭﺍﻗ�ﻊ ﻣ�ﻥ‬ ‫ﺑﺎﻋ��ﺔ ﺍﻟ��ﺩﻡ ﺍﻟ��ﺫﻳﻥ ﻳﻘﺑﺿ��ﻭﻥ ﺃﺟ��ﻭﺭﺍً ﻋﻠ��ﻰ ﺍﻟﻌﻣﻠﻳ��ﺔ‪ .‬ﻭﻛ��ﺎﻥ ﺍﻟﻛﺛﻳ��ﺭ ﻣ��ﻧﻬﻡ ﻣ��ﺩﻣﻧﺎ ً ﻋﻠ��ﻰ ﺍﻟﻣﺧ � ّﺩﺭﺍﺕ‬ ‫ﻭﺍﻟﺧﻣﺭ‪ ،‬ﻭﺫﻟﻙ ﻓﻲ ﺍﻟﻭﻻﻳﺎﺕ ﺍﻟﻣﺗﺣﺩﺓ‪ ،‬ﺣﻳﺙ ﺍﻟﻣﺻﺩﺭ ﺍﻟﺗﺟﺎﺭﻱ ﺍﻷﻭﻝ ﻟﻣﺛﻝ ﻫﺫﻩ ﺍﻟﻣ�ﻭﺍﺩ ﺍﻟﻁﺑﻳ�ﺔ‪.‬‬ ‫ﺃﺷ��ﻳﺭ ﻫﻧ��ﺎ ﺇﻟ��ﻰ ﺃﻥ ﻋﺎﻣ��ﻝ ‪ 8‬ﺍﻟﻣﺭ ّﻛ��ﺯ ﻳﻣ��ﺭ ﺑﻣﺭﺍﺣ��ﻝ ﻟﻘﺗ��ﻝ ﺍﻷﺣﻳ��ﺎء ﺍﻟﻣﺟﻬﺭﻳ��ﺔ ﻓﻳ��ﻪ ﻗﺑ��ﻝ ﻁﺭﺣ��ﻪ‬ ‫ﻟﻼﺳﺗﻌﻣﺎﻝ‪ ،‬ﻟﻛﻥ ﻳﺑﻘﻰ ﺧﻁﺭ ﺍﻟﻌﺩﻭﻯ ﻗﺎﺋﻣﺎً‪ ،‬ﻭﺇﻥ ﻛﺎﻥ ﺿﻌﻳﻔﺎ ً‪.‬‬ ‫ﻫﻧﺎﻙ ﻣﺻﺩﺭﺍﻥ ﺁﺧﺭﺍﻥ‪ -‬ﻏﻳﺭ ﺗﺟﺎﺭﻳﻳﻥ‪ -‬ﻟﻌﺎﻣﻝ‪ 8‬ﺃﻭﻟﻬﻣﺎ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣّﺩﺓ ﻓﻲ ﺑﻧﻭﻙ ﺍﻟﺩﻡ‪ .‬ﻭﻫ�ﺫﻩ‬ ‫ﺑﻼﺯﻣﺎ ﻛﺎﻣﻠﺔ ﺍﻟﺗﺭﻛﻳﺏ ﻏﻳ�ﺭ ﻣﺟ� ّﺯﺃﺓ‪ ،‬ﻟﻛ�ﻥ ﺍﻟﺣﺟ�ﻡ ﺍﻟ�ﺫﻱ ﻧﺣﺗﺎﺟ�ﻪ ﻹﺣ�ﺩﺍﺙ ﺗ�ﺄﺛﻳﺭ ﺑ�ﺎﻟﻣﺭﻳﺽ ﻫ�ﻭ‬ ‫ﺣﺟﻡ ﻛﺑﻳﺭ ﻭﻗﺩ ﻻ ﻳﻛﻭﻥ ﺍﺳﺗﻌﻣﺎﻟﻪ ﻋﻣﻠﻳﺎ ً ﻓﻲ ﺑﻌ�ﺽ ﺍﻷﺣﻳ�ﺎﻥ‪ .‬ﻣ�ﻊ ﺫﻟ�ﻙ ﻓﺈﻧ�ﻪ ﺃﻓﺿ�ﻝ ﻣ�ﻥ ﻻ ﺷ�ﺊ‬ ‫ﻓﻲ ﺣﺎﻝ ﻋﺩﻡ ﺗﻭﻓﺭ ﻣﺻﺎﺩﺭ ﺃﺧ�ﺭﻯ ﻟﻌﺎﻣ�ﻝ‪ 8‬ﻓ�ﻲ ﺍﻟﺑﻠ�ﺩ ﺍﻟ�ﺫﻱ ﻳﺳ�ﻛﻧﻪ ﺍﻟﻣ�ﺭﻳﺽ‪ .‬ﻭﺛﺎﻧﻳﻬﻣ�ﺎ ﻣﺷ�ﺗﻕ‬ ‫ﻣﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣّﺩﺓ ﻭﻳﺣﻭﻱ ﻋﺎﻣﻝ ‪ 8‬ﻣﺭ ّﻛ�ﺯﺍً )ﻭﻟ�ﻳﺱ ﻧﻘﻳ�ﺎ ً(‪ .‬ﻭﻟﻣّ�ﺎ ﻛ�ﺎﻥ ﻫ�ﺫﺍ ﺍﻟﻣﺻ�ﺩﺭ ﻳُﺭﺳﱠ�ﺏ‬ ‫ﻣﻥ ﺍﻟﺑﻼﺯﻣﺎ ﻓﻲ ﺩﺭﺟﺎﺕ ﺣﺭﺍﺭﺓ ﻭﺍﻁﺋﺔ ﺟﺩﺍً )ﺃﻗﻝ ﻣﻥ‪ 90o‬ﻣﺋﻭﻳ�ﺔ( ﻓﺈﻧ�ﻪ ﻳﺳ�ﻣﻰ ﺍﻟﺭﺍﺳ�ﺏ ﺍﻟﻘ�ﺭّﻱ‬ ‫)ﺃﻱ ﺍﻟﻣﺑﺭﱠ ﺩ(‪.‬‬ ‫ﻭﺇﺫﺍ ﺍﻋﺗﺑﺭﻧﺎ ﺃﻥ ﺗﺭﻛﻳﺯ ﻋﺎﻣﻝ‪ 8‬ﻓﻲ ﺍﻟﺳﻧﺗﻣﺗﺭ ﺍﻟﻣﻛﻌﺏ )ﻣﻠﻲ ﻟﺗﺭ( ﺍﻟﻭﺍﺣﺩ ﻣﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣ�ﺩﺓ‬ ‫= ﻭﺣﺩﺓ ﻭﺍﺣﺩﺓ‪،‬‬ ‫ﻓﺈﻥ ﺗﺭﻛﻳﺯ ﺍﻟﻌﺎﻣﻝ ﻓﻲ ﺍﻟﺭﺍﺳﺏ ﺍﻟﻘﺭّﻱ = ‪ 7-3‬ﻭﺣﺩﺍﺕ\ﺳﻡ‪،3‬‬ ‫ﻭﺗﺭﻛﻳﺯﻩ ﻓﻲ ﺍﻟﻣﻧﺗﺟﺎﺕ ﺍﻟﺗﺟﺎﺭﻳﺔ ﺍﻟﻣﺟﻔّﺩﺓ = ﺣﻭﺍﻟﻲ ‪ 15‬ﻭﺣﺩﺓ\ ﺳﻡ‪.3‬‬ ‫ُﺗﻌﻁﻰ ﺣُﻘﻥ ﺍﻟﻌﺎﻣﻝ ‪ 8‬ﻣﺭﺓ ﻛﻝ ‪ 12‬ﺳﺎﻋﺔ ﺗﻘﺭﻳﺑﺎ ً‪.‬‬ ‫ﻓ��ﻲ ﺍﻟﻧﺻ��ﻑ ﺍﻷﻭﻝ ﻣ��ﻥ ﺍﻟﻘ��ﺭﻥ ﺍﻟﻣﺎﺿ��ﻲ ﻛ��ﺎﻥ ﺃﺣ��ﺩ ﻣﺻ��ﺎﺩﺭ ﻋﺎﻣ��ﻝ‪ 8‬ﻫ��ﻭ ﺍﻟﺣﻳﻭﺍﻧ��ﺎﺕ ﻛ��ﺎﻟﺑﻘﺭ‬ ‫ﻭﺍﻟﺧﻧﺯﻳﺭ‪ ،‬ﻟﻛﻥ ﺍﺳﺗﻌﻣﺎﻟﻪ ﺃﻭﻗﻑ ﺑﻌﺩ ﺫﻟﻙ‪.‬‬ ‫ﺗﻭﻟّﺩ ﻣﺿﺎﺩﺍﺕ ﻟﻠﻌﺎﻣﻝ‪8‬‬

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‫ﺑﻌﺽ ﻣﺭﺿﻰ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ‪ ،‬ﻗﺩ ﺗﺗﻭﻟّﺩ ﻓ�ﻲ ﺩﻣ�ﺎﺋﻬﻡ ﻣﺿ�ﺎﺩﺍﺕ ﺃﻭ ﻣﺛﺑﻁ�ﺎﺕ ﻟﻠﻌﺎﻣ�ﻝ‪ ،8‬ﻻ ﺳ�ﻳّﻣﺎ ﺑﻌ�ﺩ‬ ‫ﺇﻋﻁﺎﺋﻬﻡ ﺣﻘﻧﺎ ً ﻣﻥ ﺍﻟﻌﺎﻣﻝ ﻣﺭﺍﺕ ﻣﺗﻌﺩﺩﺓ‪ ،‬ﻭﻗﺩ ﻳﻛﻭﻥ ﺫﻟﻙ ﺑﻌﺩ ﻣﺭﺍﺕ ﻗﻠﻳﻠﺔ ﻟﺩﻯ ﺃﺷﺧﺎﺹ ﻋﻧﺩﻫﻡ‬ ‫ﺍﺳ��ﺗﻌﺩﺍﺩ َﺧﻠﻘ��ﻲ ﻟﺗﻭﻟﻳ��ﺩ ﻣﺛ��ﻝ ﺗﻠ��ﻙ ﺍﻷﺟﺳ��ﺎﻡ ﺍﻟﻣﺿ��ﺎﺩﺓ‪ .‬ﻭﺑﻌ��ﺩ ﺗﻛ��ﻭّ ﻥ ﻣﺛ��ﻝ ﺗﻠ��ﻙ ﺍﻟﻣﺿ��ﺎﺩﺍﺕ ﻳﺻ��ﺑﺢ‬ ‫ﺍﻟﻌﻼﺝ ﺑﻌﺎﻣﻝ‪ 8‬ﻏﻳﺭ ﻓﻌﺎﻝ ﺗﻘﺭﻳﺑﺎً‪ ،‬ﺇﻻّ ﺑﺣﻘﻥ ﻛﻣﻳﺎﺕ ﻛﺑﻳﺭﺓ‪ ،‬ﻣﻣﺎ ﻳﺳﺑﺏ ﻣﺻﺎﻋﺏ ﺟﻣّﺔ ﻟﻠﻣﺭﻳﺽ‬ ‫ﻭﺍﻟﻁﺑﻳ��ﺏ ﺍﻟﻣﻌ��ﺎﻟﺞ‪ .‬ﻭﻫﻧ��ﺎﻙ ﻁ��ﺭﻕ ﻣﺗﻌ��ﺩﺩﺓ‪ -‬ﻟﻛﻧﻬ��ﺎ ﻟﻳﺳ��ﺕ ﻳﺳ��ﻳﺭﺓ‪ -‬ﻟﻠﺗﻌﺎﻣ��ﻝ ﻣ��ﻊ ﻫ��ﺫﻩ ﺍﻟﺣ��ﺎﻻﺕ‬ ‫ﻭﻣﺣﺎﻭﻟﺔ ﺗﻔﺎﺩﻱ ﺍﻟﻣﺿﺎﺩﺍﺕ ﻭﺇﺣﺩﺍﺙ ﺗﺄﺛﻳﺭ ﻟﻌﺎﻣﻝ‪ 8‬ﺍﻟﺫﻱ ﻳُﻌﻁﻰ ﻟﻠﻣﺭﻳﺽ‪.‬‬

‫ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﺏ‬ ‫ﺳﺑﺏ ﺍﻟﻣﺭﺽ‪ :‬ﻧﻘﺹ ﻭﺭﺍﺛﻲ ﻓﻲ ﻓﻌﺎﻟﻳﺔ ﺍﻟﻌﺎﻣﻝ‪ 9‬ﻣﻥ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻻ ﻳﺧﺗﻠﻑ ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻋﻥ ﻧﻭﻉ ﺃ ﻓﻲ ﻁﺭﻳﻘﺔ ﻭﺭﺍﺛﺗﻪ‪.‬‬ ‫ﻛﻣﺎ ﺃﻥ ﺍﻷﻋﺭﺍﺽ ﺗﺷ�ﺎﺑﻪ ﺗﻠ�ﻙ ﺍﻟﺗ�ﻲ ﺗﺻ�ﻳﺏ ﻣﺭﺿ�ﻰ ﻧ�ﻭﻉ ﺃ‪ ،‬ﻭﺇﻥ ﻛ�ﺎﻥ ﺍﻟﻣ�ﺭﺽ ﻋﻣﻭﻣ�ﺎ ً ﺃﺧ�ﻑ‬ ‫ﺑﻘﻠﻳﻝ ﻣﻥ ﻧﻭﻉ ﺃ‪ ،‬ﺇﻻ ّ ﺃﻥ ﻫﻧﺎﻙ ﺣﺎﻻﺕ ﺻﻌﺑﺔ ﻓﻲ ﻋﺎﺋﻼﺕ ﻣﻌﻳّﻧﺔ‪.‬‬ ‫ﻭﺍﻟﻣﺭﺽ ﺃﻗﻝ ﺷﻳﻭﻋﺎ ً ﻣﻥ ﺍﻟﻧﻭﻉ ﺃ‪ ،‬ﺣﻳﺙ ﺃﻥ ﻋﺩﺩ ﺍﻟﻣﺭﺿ�ﻰ ﻗ�ﺩ ﻳﻛ�ﻭﻥ ﺣ�ﻭﺍﻟﻲ ُﻋﺷ�ﺭ ﺍﻟﻣﺻ�ﺎﺑﻳﻥ‬ ‫ﺑﻧﻭﻉ ﺃ‪.‬‬ ‫ﺃﻣﺎ ﻋﻼﺝ ﺍﻟﻣﺭﺽ ﻓﺈﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣ�ﺩﺓ ﺗﺻ�ﻠﺢ ﻟ�ﺫﻟﻙ )ﻷﻧﻬ�ﺎ ﺗﺣ�ﻭﻱ ﻋﺎﻣ�ﻝ‪ 9‬ﻭﻛ�ﻝ ﺍﻟﻌﻭﺍﻣ�ﻝ(‪،‬‬ ‫ﻣ��ﻊ ﺍﻷﺧ��ﺫ ﺑﺎﻻﻋﺗﺑ��ﺎﺭ ﻧﻔ��ﺱ ﺍﻟﻣﻼﺣﻅ��ﺎﺕ ﺍﻟﺗ��ﻲ ﺫﻛﺭﺗﻬ��ﺎ ﺳ��ﺎﺑﻘﺎ ً ﻋ��ﻥ ﺍﻟﺑﻼﺯﻣ��ﺎ‪ .‬ﻛ��ﺫﻟﻙ‪ ،‬ﻓ��ﺈﻥ ﻫﻧ��ﺎﻙ‬ ‫ﻣﺭ ّﻛ��ﺯﺍً ﻟﻌﺎﻣ��ﻝ‪ 9‬ﻣﺷ��ﺗﻘّﺎ ً ﻣ��ﻥ ﺍﻟﺑﻼﺯﻣ��ﺎ ﺍﻟﺑﺷ��ﺭﻳﺔ‪ ،‬ﺑﻌ��ﺽ ﺃﻧﻭﺍﻋ��ﻪ ﻧﻘ��ﻲ ﻭﺑﻌﺿ��ﻬﺎ ﻓﻳ��ﻪ ﺷ��ﻭﺍﺋﺏ ﻣ��ﻥ‬ ‫ﻋﻭﺍﻣ��ﻝ ﺃﺧ��ﺭﻯ‪.‬ﻭﻫﻧ��ﺎﻙ ﺍﻵﻥ ﺍﻟﻌﺎﻣ��ﻝ ﺍﻟﻣﻧ��ﺗﺞ ﺑﺎﻟﻬﻧﺩﺳ��ﺔ ﺍﻟﺟﺯﻳﺋﻳ��ﺔ ﻓ��ﻲ ﺍﻟﺳ��ﻭﻕ‪ .‬ﺇﻻ ّ ﺃﻥ ﺍﻟﺭﺍﺳ��ﺏ‬ ‫ﺍﻟﻘ ّﺭﻱ ﻣﻥ ﺍﻟﺑﻼﺯﻣﺎ ﻻ ﻳﺻﻠﺢ ﻟﻌﻼﺝ ﻫﻳﻣﻭﻓﻳﻠﻳﺎ ﺏ ﻷﻧﻪ ﻻ ﻳﺣﻭﻱ ﻣﻥ ﺍﻟﻌﺎﻣﻝ‪ 9‬ﺷﻳﺋﺎ ً ﻣﺫﻛﻭﺭﺍً‪.‬‬ ‫ﻳُﻌﻁﻰ ﺍﻟﻌﻼﺝ ﻣﺭﺓ ﻛﻝ ﻳﻭﻡ ﺑﺻﻭﺭﺓ ﻋﺎﻣﺔ‪.‬‬

‫ﻧﻘﺹ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻷﺧﺭﻯ ﻟﻠﺗﺧﺛﺭ‬ ‫ﺗ�ﻭﺭﱠ ﺙ‬ ‫ﺇﻥ ﺍﻟﻧﻘﺹ ﺍﻟﻭﺭﺍﺛﻲ ﻓﻲ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﻏﻳﺭ ‪8‬ﻭ‪ 9‬ﻳﺣﺩﺙ ﺑﺷﻛﻝ ﻧﺎﺩﺭ ﻭ ﻣﻌﻅ�ﻡ ﺍﻟﺣ�ﺎﻻﺕ َ‬ ‫ﺗﻭﺭﺙ ﻣﻥ ﻛﻝ ﻣﻥ ﺍﻟﻭﺍﻟ�ﺩﻳﻥ ﻟﻳﻅﻬ�ﺭ ﺍﻟﻣ�ﺭﺽ‪ .‬ﻭﻫﻧ�ﺎﻙ‬ ‫ﺑﺎﻟﺷﻛﻝ ﺍﻟﻣﺗﻧﺣّﻲ‪ ،‬ﺃﻱ ﺃﻧﻬﺎ ﺗﺣﺗﺎﺝ ﺇﻟﻰ ﺃﻥ َ‬ ‫ﻓ����ﻲ ﻣﺧﺗﻠ����ﻑ ﺍﻟﺷ����ﻌﻭﺏ ﻋ����ﺎﺋﻼﺕ ﻟ����ﺩﻳﻬﺎ ﻧﻘ����ﺹ ﻋﺎﻣ����ﻝ ‪ 10‬ﺃﻭ‪ 7‬ﺃﻭ‪ 5‬ﺃﻭ‪ 12‬ﺃﻭ‪ 11‬ﺃﻭ ﻣﻭﻟّ����ﺩ‬ ‫ﺍﻟﺧﺛﺭﻳﻥ)ﻋﺎﻣﻝ ‪ (2‬ﺃﻭ ﻣﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ)ﻋﺎﻣﻝ‪ .(1‬ﻭﺃﻋﺭﺍﺿ�ﻬﺎ‪ ،‬ﻋﻣﻭﻣ�ﺎً‪ ،‬ﻻ ﺗﺧﺗﻠ�ﻑ ﻛﺛﻳ�ﺭﺍً ﻋ�ﻥ ﺗﻠ�ﻙ‬ ‫‪32‬‬

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‫ﺍﻟﺗﻲ ﻭﺻﻔﺗﻬﺎ ﻓﻲ ﻧﻘ�ﺹ ﻋ�ﺎﻣﻠَﻲ ‪8‬ﻭ‪ .9‬ﻭﻟﻛ�ﻭﻥ ﻫ�ﺫﻩ ﺍﻷﻣ�ﺭﺍﺽ ﻏﻳ�ﺭ ﻣﺭﺗﺑﻁ�ﺔ ﺑﺻ�ﺑﻐﻳّﺔ ﺍﻟﺟ�ﻧﺱ‬ ‫ﻭﺭﺍﺛﻳﺎ ً ﻓﺈﻧﻬﺎ ﺗﺻ�ﻳﺏ ﺍﻟ�ﺫﻛﻭﺭ ﻭﺍﻹﻧ�ﺎﺙ‪ ،‬ﻭ ُﺗﻛﺗﺷ�ﻑ ﺃﺣﻳﺎﻧ�ﺎ ً ﻣ�ﻊ ﺑ�ﺩء ﺍﻟ�ﺩﻭﺭﺓ ﺍﻟﺷ�ﻬﺭﻳﺔ )ﺍﻟﻣﺣ�ﻳﺽ(‬ ‫ُﻼﺣ�ﻅ ﺃﻥ ﻧ�ﺯﻑ ﺍﻟ�ﺩﻡ ﺃﻛﺛ�ﺭ ﻣ�ﻥ ﺍﻟﻣﻌﺗ�ﺎﺩ‪ ،‬ﻛﻣ�ﺎ ﻳﺣﺻ�ﻝ ﻧ�ﺯﻑ ﻳﻔ�ﻭﻕ ﺍﻟﻣﻌﺗ�ﺎﺩ‬ ‫ﻋﻧﺩ ﺍﻟﺑﻧﺎﺕ‪ ،‬ﺣﻳ�ﺙ ﻳ َ‬ ‫ﺧﻼﻝ ﺍﻟﻌﻣﻠﻳﺎﺕ ﺍﻟﺟﺭﺍﺣﻳﺔ ﻭﻣﻥ ﺃﻱ ﻧﻭﻉ ﻣ�ﻥ ﺍﻹﺻ�ﺎﺑﺎﺕ‪ .‬ﻭﻗ�ﺩ ﻳﺣﺻ�ﻝ ﺍﻟﻧ�ﺯﻑ ﺩﺍﺧ�ﻝ ﺍﻟﺟﻣﺟﻣ�ﺔ‬ ‫ﺃﻭ ﺍﻟﻣﺦ ﻓﻲ ﺃﺣﻳﺎﻥ ﻗﻠﻳﻠﺔ‪.‬‬ ‫ُﺗﻌﺎﻟﺞ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻋﺎﺩﺓ ﺑﺈﻋﻁﺎء ﺍﻟﻣﺭﻳﺽ ﺑﻼﺯﻣﺎ ﺍﻟ�ﺩﻡ ﺍﻟﻣﺟﻣﱠ�ﺩﺓ ﻷﻧﻬ�ﺎ ﺗﺣ�ﻭﻱ ﻛ�ﻝ ﺍﻟﻌﻭﺍﻣ�ﻝ‪،‬‬ ‫ﻛﻣﺎ ﺃﻧﻪ ﻻ ﺗﺗﻭﻓﺭ ﻓﻲ ﺍﻟﻭﻗﺕ ﺍﻟﺣﺎﻟﻲ ﻋﻭﺍﻣﻝ ﺃُﺣﺎﺩﻳﺔ ﻣﺭﻛﺯﺓ ﻣﻥ ﻫﺫﻩ ﺍﻷﻧﻭﺍﻉ‪.‬‬ ‫ﻧﻘ��ﺹ ﻋﺎﻣ��ﻝ ‪) 13‬ﺍﻟﻌﺎﻣ��ﻝ ﻣﺛ ّﺑ��ﺕ ﺍﻟﻠﻳﻔ��ﻳﻥ( ﻳﺣﺗ��ﺎﺝ ﺇﻟ��ﻰ ﻛﻠﻣ��ﺔ ﻣﻧﻔﺻ��ﻠﺔ‪ .‬ﻓ��ﺎﻟﻧﻘﺹ ﻻ ﻳﻣﻧ��ﻊ ﺗﻛ��ﻭّ ﻥ‬ ‫ﺍﻟﺧﺛ��ﺭﺓ ﻓ��ﻲ ﺯﻣ��ﻥ ﻁﺑﻳﻌ��ﻲ ﺑﻌ��ﺩ ﺍﻟﺷ��ﺩﺓ ﻟﻛ��ﻥ ﺍﻟﺧﺛ��ﺭﺓ ﻻ ﺗﻛ��ﻭﻥ ﻗﻭﻳ��ﺔ ﺑﺷ��ﻛﻝ ﻛ��ﺎ ٍ‬ ‫ﻑ ﻭﺗﺗﻛﺳ��ﺭ ﺑﻳﺳ��ﺭ‬ ‫ﻣﺅﺩﻳﺔ ﺇﻟﻰ ﻋﻭﺩﺓ ﺍﻟﻧﺯﻑ ﻣﻥ ﺟﺩﻳﺩ ﺑﻌﺩ ﺗﻭﻗﻔﻪ‪ .‬ﺃﻥ ﻧﻘﺹ ﻫﺫﺍ ﺍﻟﻌﺎﻣﻝ ﻭﺭﺍﺛﻳ�ﺎ ً ﻧ�ﺎﺩﺭ ﺃﻳﺿ�ﺎ ً ﻭﻳ�ﺅﺩﻱ‬ ‫ﺇﻟﻰ ﺃﻧﺯﻓﺔ ﻓﻲ ﺃﻣﺎﻛﻥ ﻣﺧﺗﻠﻔﺔ ﺑﻌﺩ ﺣﺻﻭﻝ ﺷﺩﺓ ﻋﻠﻳﻬﺎ‪ ،‬ﻭﻗﺩ ﻳﻛﻭﻥ ﺍﻟﻧﺯﻑ ﻓ�ﻲ ﺍﻟﻣ�ﺦ ﺃﺣﻳﺎﻧ�ﺎ ً‪ .‬ﻭﻟﻣ�ﺎ‬ ‫ﻛﺎﻥ ﺍﻟﺭﺍﺳﺏ ﺍﻟﻘ�ﺭّﻱ ﻣﺣﺗﻭﻳ�ﺎ ً ﻋﻠ�ﻰ ﻧﺳ�ﺑﺔ ﻣﺭﻛ�ﺯﺓ ﻣ�ﻥ ﺍﻟﻌﺎﻣ�ﻝ ‪ 13‬ﻓﺈﻧ�ﻪ‪ ،‬ﺇﻥ ﺗ�ﻭﻓﺭ‪ ،‬ﻳُﻌ�ﺩ ﺍﻟﻌ�ﻼﺝ‬ ‫ﺍﻟﻣﻧﺎﺳﺏ ﻟﺣﺎﻻﺕ ﺍﻟﻧﺯﻑ ﻭﻳُﻌﻁﻰ ﻣﺭﺓ ﻛﻝ ﺧﻣﺳﺔ ﺃﻳﺎﻡ‪ ،‬ﻷﻥ ﻋﻣﺭﻩ ﻓﻲ ﺍﻟﺩﻡ ﺃﻁﻭﻝ ﻣﻥ ﻏﻳﺭﻩ ﻣ�ﻥ‬ ‫ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻻﺑﺩ ﻣﻥ ﺍﻹﺷﺎﺭﺓ ﺇﻟ�ﻰ ﻭﺟ�ﻭﺩ ﻋﻭﺍﻣ�ﻝ ﺗﺳ�ﺎﻋﺩ ﻋﻠ�ﻰ ﺍﻟﺗﺧﺛ�ﺭ ﺑﻁﺭﻳ�ﻕ ﺍﻟﺗ�ﺄﺛﻳﺭ ﺍﻟ�ﺩﺍﺧﻠﻲ )ﺍﻟﺗﻣ�ﺎﺱ(‪،‬‬ ‫ﻭﺇﻥ ﻟﻡ ﺗﻛﻥ ﻫ�ﻲ ﻧﻔﺳ�ﻬﺎ ﻣ�ﻥ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛﺭﺍﻷﺳﺎﺳ�ﻳﺔ‪ ،‬ﻭﻳﺣﺻ�ﻝ ﻟ�ﺩﻯ ﺣ�ﺎﻻﺕ ﻧ�ﺎﺩﺭﺓ ﻧﻘ�ﺹ ﻓ�ﻲ‬ ‫ﺃﺣ��ﺩﻫﺎ ﻳﺳ��ﺑﺏ ﺯﻳ��ﺎﺩﺓ ﺑﺳ��ﻳﻁﺔ ﻓ��ﻲ ﺍﻟﻧ��ﺯﻑ ﺧ��ﻼﻝ ﺍﻟﻌﻣﻠﻳ��ﺎﺕ ﺍﻟﺟﺭﺍﺣﻳ��ﺔ‪ .‬ﻋﺎﻣ��ﻝ ‪ 12‬ﻫ��ﻭ ﺃﻫ��ﻡ ﻫ��ﺫﻩ‬ ‫ﺍﻟﻌﻭﺍﻣﻝ‪ .‬ﻭﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣﺩﺓ ﻛﻔﻳﻠﺔ ﺑﺳﺩ ﺍﻟﻧﻘﺹ ﺧﻼﻝ ﺗﻠﻙ ﺍﻟﻌﻣﻠﻳﺎﺕ‪.‬‬

‫ﻣﺭﺽ ﭬﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‬ ‫ﻫ��ﺫﺍ ﺍﻟﻣ��ﺭﺽ ﺍﻟ��ﻭﺭﺍﺛﻲ ﻳﺧﺗﻠ��ﻑ ﻋ��ﻥ ﻛ��ﻝ ﺍﻷﻣ��ﺭﺍﺽ ﺍﻟﺗ��ﻲ ﺷ��ﺭﺣﺗﻬﺎ ﺳ��ﺎﺑﻘﺎ ً ﻭﻳﺣﺗ��ﺎﺝ ﺇﻟ��ﻰ ﺷ��ﺭﺡ‬ ‫ﻣﺳﺗﻘﻝ‪ .‬ﻓﻬﻭ ﻳﺗﻣﻳّﺯ ﺑﻧﻘﺹ ﺃﺣﺩ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ)‪ (8‬ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﻧﻘ�ﺹ ﻓﻌﺎﻟﻳ�ﺔ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ )ﺍﻧﻅ�ﺭ‬ ‫ﺻﻔﺣﺔ‪ .(24‬ﻭﺍﻟﺣﻘﻳﻘﺔ ﺃﻥ ﺍﻟﻣﺷﻛﻠﺗﻳﻥ ﺗﻧﺷﺂﻥ ﻣﻥ ﺳﺑﺏ ﻭﺍﺣﺩ‪ ،‬ﺃﻻ ﻭﻫﻭ ﻧﻘﺹ ﻋﺎﻣﻝ ﻓﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‬ ‫ﺃﻭ ﻋﺩﻡ ﺇﺗﻣﺎﻡ ﺗﺭﻛﻳﺏ ﺍﻟﺟﺯﻳﺋﺎﺕ ﺍﻟﻛﺑﻳﺭﺓ ﻣﻧ�ﻪ )ﻷﻥ ﻫﻧ�ﺎﻙ ﺗﺭﻛﻳﺑ�ﺎﺕ ﺟﺯﻳﺋﻳ�ﺔ ﻣﺗﻔﺎﻭﺗ�ﺔ ﻓ�ﻲ ﺍﻟ�ﻭﺯﻥ‬ ‫ﻣﻥ ﻫﺫﺍ ﺍﻟﻌﺎﻣﻝ(‪.‬‬

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‫ﺇﻥ ﻋﺎﻣﻝ ﭬﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ﻳﺣﻣﻝ ﺍﻟﻌﺎﻣﻝ‪ 8‬ﻣﻌﻪ‪ ،‬ﻓﺈﺫﺍ ﻧﻘﺹ ﻋﺎﻣﻝ ﭬ�ﻭﻥ ﻭﻟﺑﺭﺍﻧ�ﺩ ﻧﻘ�ﺹ‬ ‫ﻋﺎﻣﻝ‪ 8‬ﻓﻲ ﺍﻟﺑﻼﺯﻣﺎ ﺑﺎﻟﺭﻏﻡ ﻣﻥ ﺃﻥ ﺍﻟﺟﺳﻡ ﻏﻳﺭ ﻗﺎﺻﺭ ﻓﻲ ﺇﻧﺗﺎﺟﻪ‪ .‬ﻛﻣﺎ ﺃﻥ ﻋﺎﻣﻝ ﭬ�ﻭﻥ ﻭﻟﺑﺭﺍﻧ�ﺩ‬ ‫�ﺗﻘﺑﻼﺕ ﻋﻠ��ﻰ ﺳ��ﻁﺢ ﺻ��ﻔﻳﺣﺔ ﺍﻟ��ﺩﻡ ﻭﻋﻠ��ﻰ ﺍﻟ ُﻛﻼﺟ��ﻳﻥ‪ ،‬ﻓ��ﺈﺫﺍ ﻧﻘ��ﺹ ﻓﻠ�ﻥ ﺗﺳ��ﺗﻁﻳﻊ‬ ‫ﻳﻭﺻ��ﻝ ﺑ��ﻳﻥ ﻣﺳ� ِ‬ ‫ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﺃﻥ ﺗﻠﺗﺻ��ﻕ ﺑ��ﺎﻟ ُﻛﻼﺟﻳﻥ‪ ،‬ﻭﻻ ﻳ��ﺗﻡ ﺗﺭﺍﻛﻣﻬ��ﺎ ﺑﻌ��ﺩ ﺫﻟ��ﻙ‪ ،‬ﻭﺑ��ﺫﻟﻙ ﺗﻛ��ﻭﻥ ﻭﻅﻳﻔﺗﻬ��ﺎ ﻏﻳ��ﺭ‬ ‫ﻁﺑﻳﻌﻳﺔ‪.‬‬ ‫ﺇﻥ ﺍﻟﻣ��ﺭﺽ ﻭﺭﺍﺛ��ﻲ ﻏﻳ��ﺭ ﻣ��ﺭﺗﺑﻁ ﺑﺻ��ﺑﻐﻳﺔ ﺍﻟﺟ��ﻧﺱ ﻭﻳﺻ��ﻳﺏ ﺍﻟ��ﺫﻛﻭﺭ ﻭﺍﻹﻧ��ﺎﺙ ﻋﻠ��ﻰ ﺍﻟﺳ��ﻭﺍء‪،‬‬ ‫ﻭﻋﺎﺩﺓ ﺗﻛﻭﻥ ﺍﻟﺻﻔﺔ ﻣﺗﻐﻠّﺑﺔ‪ ،‬ﻛﻣ�ﺎ ﺃﻧ�ﻪ ﻣﻭﺟ�ﻭﺩ ﻓ�ﻲ ﻛ�ﻝ ﺍﻷﺟﻧ�ﺎﺱ‪ .‬ﻭﻳﻌﺗﺑ�ﺭ ﺍﻟﻣ�ﺭﺽ ﻏﻳ�ﺭ ﻧ�ﺎﺩﺭ‪،‬‬ ‫ﻟﻛﻥ ﺍﻟﻛﺛﻳﺭ ﻣﻥ ﺣﺎﻻﺗﻪ ﻫﻳّﻧﺔ ﺑﺣﻳﺙ ﻻ ُﺗﻛﺗ َﺷ�ﻑ ﺑﺳ�ﻬﻭﻟﺔ‪ .‬ﻭﻣ�ﻥ ﻁﺑﻳﻌ�ﺔ ﺍﻟﻣ�ﺭﺽ ﺗﻐﻳّ�ﺭ ﺷ�ﺩﺗﻪ ﻣ�ﻥ‬ ‫ﺣﻳﻥ ﻵﺧﺭ ﻓﻲ ﻧﻔﺱ ﺍﻟﻣﺭﻳﺽ‪.‬‬ ‫ﺃﻋ���ﺭﺍﺽ ﺍﻟﻣ���ﺭﺽ‪ :‬ﻳﺻ���ﺎﺏ ﺍﻟﻣ���ﺭﻳﺽ‪ ،‬ﻓ���ﻲ ﺍﻟﺣ���ﺎﻻﺕ ﺍﻟﺷ���ﺩﻳﺩﺓ‪ ،‬ﺑﺄﻧﺯﻓ���ﺔ ﻣﺗﻛ���ﺭﺭﺓ‪ ،‬ﻛﻣ���ﺎ ﻓ���ﻲ‬ ‫ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ‪ .‬ﻛﻣﺎ ﻳﺻﺎﺏ ﺑﺄﻧﺯﻓﺔ ﻣﺷﺎﺑﻬﺔ ﻟﺗﻠﻙ ﺍﻟﺗﻲ ﺗﺻﻳﺏ ﻣﺭﺿ�ﻰ ﻧﻘ�ﺹ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﺃﻭ ﻧﻘ�ﺹ‬ ‫ﻭﻅﺎﺋﻔﻬ��ﺎ ) ﺃﻱ ﺍﻟﻧ��ﺯﻑ ﻓ��ﻲ ﺍﻟﺟﻠ��ﺩ ﻭﺍﻟﻛ��ﺩﻣﺎﺕ ﻭﺯﻳ��ﺎﺩﺓ ﺍﻟﻧ��ﺯﻑ ﻓ��ﻲ ﺍﻟ��ﺩﻭﺭﺓ ﺍﻟﺷ��ﻬﺭﻳﺔ ﻭﺍﻷﻧﺯﻓ��ﺔ‬ ‫ﺍﻟﺩﺍﺧﻠﻳ���ﺔ ﺍﻟﺻ���ﻐﻳﺭﺓ(‪ .‬ﻭﻓ���ﻲ ﺍﻟﻣﺧﺑ���ﺭ‪ ،‬ﻳﻛ���ﻭﻥ ﻓﺣ���ﺹ ﻭﻗ���ﺕ ﺍﻟﻧ���ﺯﻑ ﻏﻳ���ﺭ ﻁﺑﻳﻌ���ﻲ ﻷﻥ ﻋﻣ���ﻝ‬ ‫ﺍﻟﺻﻔﻳﺣﺎﺕ ﻏﻳﺭ ﻁﺑﻳﻌﻲ‪ ،‬ﻭﻛﺫﻟﻙ ﺗﻛﻭﻥ ﻓﺣﻭﺹ ﻭﻅﺎﺋﻑ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ) ﺗﺭﺍﻛﻣﻬ�ﺎ( ﻏﻳ�ﺭ ﻁﺑﻳﻌﻳ�ﺔ‪.‬‬ ‫ﻭﻳﻛﻭﻥ ﻓﺣﺹ ﻣﻭﻟّﺩ ﺍﻟﺧﺛﺭﺓ ﺍﻟﺟﺯﺋﻲ)ﺍﻧﻅﺭ ﻗﺎﺋﻣﺔ ﺍﻟﻔﺣﻭﺹ( ﻏﻳﺭ ﻁﺑﻳﻌﻲ‪ ،‬ﻧﻅﺭﺍً ﻟﻧﻘﺹ ﻋﺎﻣ�ﻝ‪8‬‬ ‫ﺑﺎﻟﺩﻡ‪ .‬ﻭﻧﻅﺭﺍً ﻟﻭﺟﻭﺩ ﺃﻧﻭﺍﻉ ﻣﻥ ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻭﺗﻔﺎﻭﺕ ﺷ�ﺩﺗﻪ ﻛﺛﻳ�ﺭﺍً ﻓ�ﺈﻥ ﺍﻟﻔﺣ�ﻭﺹ ﺍﻟﻣﺧﺑﺭﻳ�ﺔ ﻗ�ﺩ‬ ‫ﺗﻛﻭﻥ ﻏﻳﺭ ﻗﻁﻌﻳﺔﺃﺣﻳﺎﻧﺎ ً‬ ‫ﻋﻼﺝ ﻣﺭﺽ ﭬﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‪ :‬ﺇﻥ ﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣّﺩﺓ ﺗﺣﻭﻱ ﻋﺎﻣﻝ ﭬ�ﻭﻥ ﻭﻟﺑﺭﺍﻧ�ﺩ‪ ،‬ﻭﻛ�ﺫﻟﻙ ﺍﻟﺭﺍﺳ�ﺏ‬ ‫ﺍﻟﻘﺭّﻱ‪ .‬ﻭﺇﻋﻁﺎء ﺃﺣﺩﻫﻣﺎ ﻳﻛﻔﻲ ﻟﺗﺻﺣﻳﺢ ﻣﺷﻛﻠﺔ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻭﻧﻘ�ﺹ ﻋﺎﻣ�ﻝ‪ .8‬ﻛﻣ�ﺎ ﺃﻥ ﺗﺻ�ﺣﻳﺢ‬ ‫ﻋﺎﻣﻝ‪ 8‬ﻻ ﻳﺣﺗﺎﺝ ﺇﻟﻰ ﺇﻋﻁﺎء ﺍﻟﻌﺎﻣﻝ ﻧﻔﺳﻪ ﻟﻌﺩﻡ ﻭﺟﻭﺩ ﻧﻘﺹ ﻓﻲ ﺇﻧﺗﺎﺟﻪ‪.‬‬ ‫ﻛﻳﻔﻳﺔ ﺗﺷﺧﻳﺹ ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ ﺍﻟﻭﺭﺍﺛﻳﺔ‬

‫ﻳﻛ��ﻭﻥ ﻣ��ﺭﺽ ﻓ��ﺭﻁ ﺍﻟﻧ��ﺯﻑ ﺃﺣﻳﺎﻧ �ﺎ ً ﻭﺍﺿ��ﺣﺎ ً ﺑﺣﻳ��ﺙ ﺃﻥ ﺍﻟﻌﺎﺋﻠ��ﺔ ﺗﻌ��ﺭﻑ ﻋ��ﻥ ﻭﺟ��ﻭﺩ ﺍﻟﻌﻠ��ﺔ ﻓ��ﻲ‬ ‫ﺍﻟﻣ��ﺭﻳﺽ ﻗﺑ��ﻝ ﻋﺭﺿ��ﻪ ﻋﻠ��ﻰ ﺍﻟﻁﺑﻳ��ﺏ‪ ،‬ﻛﻣ��ﺎ ﻗ��ﺩ ﻳﻛ��ﻭﻥ ﻟ��ﺩﻯ ﺍﻟﻌﺎﺋﻠ��ﺔ ﻣ��ﺭﻳﺽ ﻣ��ﻥ ﺍﻷﻗ �ﺎﺭﺏ ﺗ��ﻡ‬ ‫ﺗﺷﺧﻳﺻﻪ ﺳﺎﺑﻘﺎ ً ﻭﺗﻌﻠﻡ ﺍﻟﻌﺎﺋﻠﺔ ﺃﻥ ﺫﻟﻙ ﺍﻟﻣ�ﺭﺽ ﻭﺭﺍﺛ�ﻲ‪ .‬ﻭﻗ�ﺩ ﻳﻛ�ﻭﻥ ﺍﻷﻣ�ﺭ ﻏﺎﻣﺿ�ﺎ ً ﻷﻥ ﺍﻟﻧ�ﺯﻑ‬ ‫ﻟﻳﺱ ﺑﺎﻟﺷﻛﻝ ﺃﻭ ﺍﻟﺗﻭﺍﺗﺭ ﺍﻟﺷﺩﻳﺩﻳﻥ‪ .‬ﻭﺍﻟﻁﺑﻳﺏ ﻳﺗﺑﻊ ﺍﻟﺧﻁﻭﺍﺕ ﺍﻟﺗﺎﻟﻳﺔ ﻓﻲ ﺍﻟﺗﺷﺧﻳﺹ‪:‬‬ ‫‪34‬‬

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‫ﺍﻟﻣﺭﺿﻲ ﻟﻠﻣﺭﻳﺽ ﻧﻔﺳ�ﻪ‪ :‬ﺣ�ﺎﻻﺕ ﺍﻟﻧ�ﺯﻑ‪ ،‬ﻋ�ﺩﺩﻫﺎ‪ ،‬ﻣﻭﺍﻗﻌﻬ�ﺎ‪ ،‬ﺃﺳ�ﺑﺎﺑﻬﺎ‬ ‫‪ .1‬ﺍﻟﺳﺅﺍﻝ ﻋﻥ ﺍﻟﺗﺎﺭﻳﺦ َ‬ ‫ﻭﻫﻝ ﺗﺻﺎﺣﺏ ﺷﺩﺓ ﺃﻭ ﻋﻣﻠﻳﺔ ﺟﺭﺍﺣﻳﺔ‪.‬‬ ‫‪ .2‬ﺍﻟﺳﺅﺍﻝ ﻋﻥ ﺍﻟﺗﺎﺭﻳﺦ ﺍﻟﻣﺭﺿﻲ ﻟﻠﻌﺎﺋﻠﺔ‪ :‬ﻫﻝ ﻳﻭﺟ�ﺩ ﻓ�ﻲ ﺍﻟﻌﺎﺋﻠ�ﺔ ﻣ�ﻥ ﻳﺷ�ﻛﻭ ﻣ�ﻥ ﻓ�ﺭﻁ ﺍﻟﻧ�ﺯﻑ؟‬ ‫ﻫ���ﻝ ﺍﻹﺧ���ﻭﺓ ﻭﺍﻷﺧ���ﻭﺍﺕ ﻭﺍﻷﺑ���ﻭﺍﻥ ﻭﺍﻷﻋﻣ���ﺎﻡ ﻭﺍﺍﻟﻌ ّﻣ���ﺎﺕ ﻭﺍﻷﺧ���ﻭﺍﻝ ﻭﺍﻟﺧ���ﺎﻻﺕ ﻭﺃﺑﻧ���ﺎﺅﻫﻡ‬ ‫ﻁﺑﻳﻌﻳﻭﻥ ﻣﻥ ﻧﺎﺣﻳﺔ ﺍﻟﻧﺯﻑ؟‬ ‫‪ .3‬ﻓﺣﺹ ﻣﻭﺍﺿﻊ ﺍﻟﻧﺯﻑ ﻟﻠﺗﺄﻛﺩ ﻣﻥ ﻭﺟﻭﺩ ﻧﺯﻑ ﺃﻭ ﻛﺩﻣﺔ ﺃﻭ ﻧﻘﻁ ﻧﺯﻓﻳﺔ ﻓﻲ ﺍﻟﺟﻠﺩ‪.‬‬ ‫‪ .4‬ﺇﺫﺍ ﺣﺻﻝ ﻟﺩﻯ ﺍﻟﻁﺑﻳﺏ‪ ،‬ﺑﻌﺩ ﻛﻝ ﺫﻟﻙ‪ ،‬ﻗﻧﺎﻋﺔ ﺃﻭ ﺷ�ﻙ ﻗ�ﻭﻱ ﺑ�ﺄﻥ ﺍﻷﻣ�ﺭ ﺭﺑﻣ�ﺎ ﻳﻛ�ﻭﻥ ﻣﺭﺿ�ﺎ ً‬ ‫ﻧﺯﻓﻳﺎ ً ﻓﻌﻼً ﻓﺈﻧﻪ ﻳﻠﺟﺄ ﺇﻟﻰ ﺍﻟﻔﺣﻭﺹ ﺍﻟﻣﺧﺑﺭﻳﺔ ﻟﻠﺗﺄﻛ�ﺩ ﻣ�ﻥ ﻭﺟ�ﻭﺩ ﻣ�ﺭﺽ ﻧﺯﻓ�ﻲ ﺃﻭﻻً‪ ،‬ﺛ�ﻡ ﺇﺫﺍ‬ ‫ﺗﺄﻛﺩ ﺫﻟﻙ ﻓﺈﻧﻪ ﻳﻌﻣﺩ ﺇﻟﻰ ﻓﺣﻭﺹ ﻣﺗﺧﺻﺻﺔ ﻟﻠﺗﺛﺑ�ﺕ ﻣ�ﻥ ﺍﻟﻌﺎﻣ�ﻝ ﺃﻭ ﺍﻟﻌﻭﺍﻣ�ﻝ ﺍﻟﻧﺎﻗﺻ�ﺔ ﻟ�ﺩﻯ‬ ‫ﺍﻟﻣﺭﻳﺽ‪ ،‬ﻭﻛﺫﻟﻙ ﻣﻥ ﺍﺣﺗﻣﺎﻝ ﻭﺟﻭﺩ ﻣﺷﻛﻠﺔ ﻓﻲ ﺍﻟﺻﻔﻳﺣﺎﺕ‪:‬‬ ‫ﺍ‪ -‬ﺍﻟﻔﺣﻭﺹ ﺍﻟﻣﺧﺑﺭﻳﺔ ﺍﻷﻭﻟﻳﺔ‬ ‫‪ .1‬ﺗﻌﺩﺍﺩ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪.‬‬ ‫‪ .2‬ﻓﺣﺹ ﻭﻗﺕ ﺍﻟﻧﺯﻑ‪ ،‬ﻭﻫﻭ ﻓﺣﺹ ﻳﺗﺄﺛﺭ ﺑﺧﻠﻝ ﻭﻅﻳﻔﺔ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻋﺩﺩﻫﺎ‪.‬‬ ‫‪ .3‬ﻓﺣ��ﺹ ﻭﻗ��ﺕ ﻣﻭﻟّ��ﺩ ﺍﻟﺧﺛ��ﺭﻳﻥ‪ ،‬ﻭﻫ��ﻭ ﻓﺣ��ﺹ ﻳﺗ��ﺄﺛﺭ ﺑ��ﻧﻘﺹ ﺍﻟﻌﻭﺍﻣ��ﻝ ﺍﻟﻣﺷ��ﺎﺭﻛﺔ ﻓ��ﻲ ﺍﻟﺗﺧﺛ��ﺭ‬ ‫ﺑﺎﻟﺗﺄﺛﻳﺭ ﺍﻟﺧﺎﺭﺟﻲ‪.‬‬ ‫‪ .4‬ﻓﺣ��ﺹ ﻭﻗ��ﺕ ﺗﻭﻟّ��ﺩ ﺍﻟﺧﺛ��ﺭﺓ ﺍﻟﺟﺯﺋ��ﻲ‪ ،‬ﻭﻫ��ﺫﺍ ﺍﻟﻔﺣ��ﺹ ﻳﺗ��ﺄﺛﺭ ﺑ��ﻧﻘﺹ ﺍﻟﻌﻭﺍﻣ��ﻝ ﺍﻟﻣﺷ��ﺎﺭﻛﺔ ﻓ��ﻲ‬ ‫ﺍﻟﺗﺧﺛﺭ ﺑﺎﻟﺗﺄﺛﻳﺭ ﺍﻟﺩﺍﺧﻠﻲ)ﺍﻟﺗﻣﺎﺱ(‪.‬‬ ‫ﺏ‪ -‬ﺍﻟﻔﺣﻭﺹ ﺍﻟﻣﺧﺑﺭﻳﺔ ﺍﻟﺧﺎﺻﺔ‪:‬‬ ‫‪ .1‬ﺑﺎﻟﻧﺳﺑﺔ ﻟﻠﺻﻔﻳﺣﺎﺕ‪ ،‬ﻓﻲ ﺣﺎﻝ ﻛﻭﻥ ﻋﺩﺩﻫﺎ ﻁﺑﻳﻌﻳﺎ ً ﻭﻟﻛﻥ ﻭﻗﺕ ﺍﻟﻧ�ﺯﻑ ﺃﻁ�ﻭﻝ ﻣ�ﻥ ﺍﻟﻁﺑﻳﻌ�ﻲ‪،‬‬ ‫ﻳﻠﺟﺄ ﺍﻟﻁﺑﻳﺏ ﺇﻟﻰ ﻓﺣﻭﺹ ﻭﻅﺎﺋﻑ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻟﻠﺗﺛﺑﺕ ﻣﻥ ﻧﻭﻉ ﺍﻟﻧﻘﺹ ﻓﻲ ﻭﻅﻳﻔﺗﻬﺎ‪.‬‬ ‫‪ , .2‬ﺑﺎﻟﻧﺳ�ﺑﺔ ﻟﻌﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﻓ�ﺈﺫﺍ ﻛ�ﺎﻥ ﻓﺣ��ﺹ ‪ 3‬ﺃﻭ‪ 4‬ﺃﻋ�ﻼﻩ )ﺃﻭ ﻛﻼﻫﻣ�ﺎ( ﻏﻳ��ﺭ ﻁﺑﻳﻌ�ﻲ ﻓ��ﺈﻥ‬ ‫ﺍﻟﻁﺑﻳﺏ ﻳﻁﻠﺏ ﻗﻳﺎﺱ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻣﺧﺗﻠﻔﺔ ﻟﻠﺗﺧﺛﺭ ﻭﺍﺣﺩﺍً ﺑﻌﺩ ﺍﻵﺧﺭ‪ ،‬ﻭﺑﻣﺎ ﻳﺗﻧﺎﺳﺏ ﻣ�ﻊ ﺍﻟﺗ�ﺎﺭﻳﺦ‬ ‫ﺍﻟﻣﺭﺿﻲ ﻭﻧﺗﺎﺋﺞ ﺍﻟﻔﺣﻭﺹ ﺍﻷﻭﻟﻳﺔ ﺍﻟﻌﺎﻣﺔ‪.‬‬ ‫‪ .3‬ﻫﻧﺎﻙ ﻓﺣﻭﺹ ﺃﻛﺛﺭ ﺗﻁﻭﺭﺍً ﺗﻘﻭﻡ ﺑﻘﻳ�ﺎﺱ ﺍﻟﻌﻭﺍﻣ�ﻝ ﻣ�ﻥ ﺣﻳ�ﺙ ﻓﻌﻠﻬ�ﺎ ﻓ�ﻲ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ ﻭﻣ�ﻥ‬ ‫ﺣﻳﺙ ﺗﺭﻛﻳﺯﻫﺎ ﻛﺑﺭﻭﺗﻳﻧﺎﺕ ﻟﺗﻘﺭﺭ ﻣﺎ ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻣﺭﺽ ﻣﻥ ﻧﻘﺹ ﺍﻟﻌﺎﻣ�ﻝ ﺃﻡ ﻣ�ﻥ ﻭﺟ�ﻭﺩ ﻋﻠ�ﺔ‬

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‫ﻓﻲ ﺗﺭﻛﻳﺑﻪ ﺗﺟﻌﻠﻪ ﻏﻳﺭ ﻓﻌّﺎﻝ‪ .‬ﻛﺫﻟﻙ ﻫﻧﺎﻙ ﻓﺣﻭﺹ ﺍﻟﻣﻭﺭﱢ ﺛﺎﺕ ﺍﻟﺧﺎﺻﺔ ﺑﻬﺫﻩ ﺍﻟﻌﻭﺍﻣ�ﻝ ﻟﻠﺗﺄﻛ�ﺩ‬ ‫ﻣﻥ ﻭﺟﻭﺩ ﻁﻔﺭﺓ ﻓﻲ ﺍﻟﻣﻭﺭّﺙ ﺃﻭ ﺧﻠﻝ ﺁﺧﺭ ﻓﻳ�ﻪ‪ .‬ﻭﻫ�ﺫﻩ ﺍﻟﻔﺣ�ﻭﺹ ﻫ�ﻲ ﺍﻷﺩﻕ ﻧﻭﻋ�ﺎ ً ﻭ ُﺗﻌﻁ�ﻲ‬ ‫ﺍﻟﻘﻭﻝ ﺍﻟﻔﺻﻝ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻣﺷﻛﻭﻙ ﻓﻳﻬﺎ‪.‬‬

‫ﺳﺑﺔ‬ ‫ﺏ‪ -‬ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ ﺍﻟﻣﻛﺗ َ‬ ‫‪ .1‬ﺃﻣﺭﺍﺽ ﺟﺩﺭﺍﻥ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ‬

‫ﺗﻛﻭﻥ ﺟﺩﺭﺍﻥ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ)ﺍﻷﻭﺭﺩﺓ( ﺭﻗﻳﻘﺔ ﻧﺳﺑﻳﺎ ً ﻟﺩﻯ ﺍﻟﻧﺳﺎء‪ ،‬ﻭﻫﺫﺍ ﻗﺩ ﻳﺅﺩﻱ ﺇﻟﻰ ﺣﺻﻭﻝ‬ ‫ﺃﻧﺯﻓﺔ ﺟﻠﺩﻳﺔ ُﺗﺭﻯ ﺑﺎﻟﻌﻳﻥ ﻋﻠﻰ ﺷﻛﻝ ﺑﻘﻊ ﺯﺭﻗﺎء ﺻﻐﻳﺭﺓ ﺃﻭ ﻛﺑﻳ�ﺭﺓ ﻧﺳ�ﺑﻳﺎ ً‪ ،‬ﻭﺗﻛ�ﻭﻥ ﺃﻛﺛ�ﺭ ﺗﻭﺍﺟ�ﺩﺍً‬ ‫ﻓ��ﻲ ﺍﻷﻁ��ﺭﺍﻑ ﺍﻟﺳ��ﻔﻠﻰ‪ .‬ﻫ��ﺫﻩ ﺍﻟﺣﺎﻟ��ﺔ ﻻ ﺗﻌﺗﺑ��ﺭ ﻣﺭﺿ �ﺎ ً ﻭﻛ��ﻝ ﺍﻟﻔﺣ��ﻭﺹ ﺍﻟﻣﺧﺑﺭﻳ��ﺔ ﻓﻳﻬ��ﺎ ﺗﻛ��ﻭﻥ‬ ‫ﻁﺑﻳﻌﻳﺔ‪.‬‬ ‫ﻛﺫﻟﻙ ﻳﺣﺻﻝ ﻟﺩﻯ ﺍﻟﻣﺗﻘ ّﺩﻣﻳﻥ ﺑﺎﻟﺳﻥ )ﻓ�ﻭﻕ ﺍﻟﺛﻣ�ﺎﻧﻳﻥ ﻋﺎﻣ�ﺎ ً( ﻣ�ﻥ ﺍﻟﺟﻧﺳ�ﻳﻥ ﺿ�ﻌﻑ ﻓ�ﻲ ﺟ�ﺩﺭﺍﻥ‬ ‫ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﻳﺅﺩﻱ ﺇﻟﻰ ﺃﻋﺭﺍﺽ ﻣﺷﺎﺑﻬﺔ‪.‬‬ ‫ﻭﻫﻧﺎﻙ ﻣﺭﺽ ﻏﻳﺭ ﺷﺎﺋﻊ ُﺗﺻﺎﺏ ﻓﻳﻪ ﺟﺩﺭﺍﻥ ﺑﻌﺽ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﺑﺗﺧﺭﻳﺏ ﻧﺗﻳﺟﺔ ﻟﻧ�ﻭﻉ ﻣ�ﻥ‬ ‫ﺍﻟﺣﺳﺎﺳ���ﻳﺔ‪ ،‬ﻣﻣ����ﺎ ﻳ����ﺅﺩﻱ ﺇﻟ����ﻰ ﺣﺻ����ﻭﻝ ﺃﻧﺯﻓ����ﺔ ﻧﻘﻁﻳ����ﺔ ﺃﻭ ﻭﺍﺳ����ﻌﺔ ﺑﺎﻟﺟﻠ����ﺩ ﻭﻏﻳ����ﺭﻩ ﻭﻳﺳ����ﻣﻰ‬ ‫ﻣﺭﺽ)ﻫﻳﻧﻭﻙ‪ -‬ﺷﻭﻧﻼﻳﻥ(‪ .‬ﺇﻥ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻛﻠﻬﺎ ﻟﻳﺳﺕ ﻣﻥ ﺃﻣ�ﺭﺍﺽ ﻓ�ﺭﻁ ﺍﻟﻧ�ﺯﻑ ﺍﻟﻣﺗﺳ�ﺑﺑﺔ‬ ‫ﻋ��ﻥ ﺧﻠ��ﻝ ﻓ��ﻲ ﺍﻟ��ﺩﻡ‪ ،‬ﺇﻻّ ﺃﻧﻬ��ﺎ ﺗ��ﺩﺧﻝ ﻣﻌﻬ��ﺎ ﻋﻧ��ﺩ ﺷ��ﺭﺣﻬﺎ ﻻﺣﺗﻣ��ﺎﻝ ﺍﻟﺧﻠ��ﻁ ﺑ��ﻳﻥ ﺍﻟﻣﺟﻣ��ﻭﻋﺗﻳﻥ‪.‬‬ ‫ﻭﺍﻟﻁﺑﻳﺏ ﻳﻘﻭﻡ ﺑﻁﻠ�ﺏ ﺇﺟ�ﺭﺍء ﺍﻟﻔﺣ�ﻭﺹ ﺍﻟﻣﺧﺑﺭﻳ�ﺔ‪ ،‬ﻭﻳﺛﺑ�ﺕ ﺃﻧﻬ�ﺎ ﻁﺑﻳﻌﻳ�ﺔ‪ ،‬ﻗﺑ�ﻝ ﺃﻥ ﻳﺗﻭﺻ�ﻝ ﺇﻟ�ﻰ‬ ‫ﻗﻧﺎﻋﺔ ﺑﺄﻥ ﺳﺑﺏ ﺍﻟﻧﺯﻑ ﺧﻠﻝ ﻓﻲ ﺟﺩﺭﺍﻥ ﺍﻷﻭﻋﻳﺔ ﻭﻟﻳﺱ ﻓﻲ ﺍﻟﺩﻡ‪.‬‬ ‫‪ .2‬ﺃﻣﺭﺍﺽ ﻧﻘﺹ ﻋﺩﺩ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﺇﻥ ﺍﻷﻣ�ﺭﺍﺽ ﺍﻟﺗ�ﻲ ﺗ�ﻧﻘﺹ ﻓﻳﻬ�ﺎ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻋ��ﺩﺩﻳﺎً‪ ،‬ﻭﻷﺳ�ﺑﺎﺏ ﻣﻛﺗﺳ�ﺑﺔ‪ ،‬ﻛﺛﻳ�ﺭﺓ ﻭﺑﻌﺿ�ﻬﺎ ﻧ��ﺎﺩﺭ‬ ‫ﻭﺍﻵﺧﺭ ﺷﺎﺋﻊ ﻧﺳﺑﻳﺎ ً‪ .‬ﻭﻧﺳﺗﻁﻳﻊ ﺗﻘﺳﻳﻡ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﺇﻟﻰ ﻗﺳﻣﻳﻥ ﺭﺋﻳﺳﻳّﻳﻥ‪:‬‬ ‫ﺃ‪ -‬ﻧﻘ��ﺹ ﺇﻧﺗ��ﺎﺝ ﻓ��ﻲ ﻧﺧ��ﺎﻉ ﺍﻟﻌﻅ��ﻡ ﻳ��ﺅﺩﻱ ﺇﻟ��ﻰ ﻧﻘ��ﺹ ﺻ��ﻔﻳﺣﺎﺕ ﺍﻟ��ﺩﻡ )ﻭﻧﺧ��ﺎﻉ ﺍﻟﻌﻅ��ﻡ ﻫ��ﻭ‬ ‫ﻣﻭﺿﻊ ﺇﻧﺗﺎﺟﻬﺎ(‪ .‬ﻭﻳﻛﻭﻥ ﺫﻟﻙ ﺇﻣّﺎ ﺑﻔﺷﻝ ﺍﻟﻧﺧ�ﺎﻉ ﺃﻭ ﺑﺎﺣﺗﻼﻟ�ﻪ ﺑﺧﻼﻳ�ﺎ ﻏﺭﻳﺑ�ﺔ ﻋﻧ�ﻪ‪ .‬ﻭﻓ�ﻲ‬ ‫ﺍﻟﺣ���ﺎﻟﺗﻳﻥ ﻳﻛ���ﻭﻥ ﻧﻘ���ﺹ ﺍﻟﺻ���ﻔﺎﺋﺢ ﻣﺻ���ﺣﻭﺑﺎ ً ﺑ���ﻧﻘﺹ ﺧﻼﻳ���ﺎ ﺍﻟ���ﺩﻡ ﺍﻷﺧ���ﺭﻯ)ﺍﻟﺣﻣ���ﺭﺍء‬ ‫ﻭﺍﻟﺑﻳﺿﺎء( ﻓﻳﺣﺻﻝ ﻧﻘﺹ ﺷ�ﺎﻣﻝ ﻓﻳﻬ�ﺎ‪ .‬ﻭﺃﺳ�ﺑﺎﺏ ﺍﻟﻔﺷ�ﻝ ﻣﻧﻭّ ﻋ�ﺔ‪ ،‬ﺃﻫﻣﻬ�ﺎ ﺑﻌ�ﺽ ﺍﻷﺩﻭﻳ�ﺔ‬ ‫ﺫﺍﺕ ﺍﻟﻣﻔﻌﻭﻝ ﺍﻟﻣﺛﺑّﻁ ﻟﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫‪36‬‬

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‫ﺍﻟﻔﺷﻝ ﺍﻟﺷﺎﻣﻝ ﻟﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫ﺍﺣﺗﻼﻝ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫ﺍﺳﺗﻬﻼﻙ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻓﻲ ﺗﺧﺛﺭﺍﺕ ﻣﻧﺗﺷﺭﺓ‬ ‫ﺗﺣﻁﻳﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺑﺄﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺫﺍﺗﻳﺔ‬

‫ﺃﺳﺑﺎﺏ ﻧﻘﺹ ﻋﺩﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ‬

‫ﺗﺣﻁﻳﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺑﺄﺟﺳﺎﻡ ﻣﺿﺎ ّﺩ ﺓ ﻟﺩﻡ ﻣﻧﻘﻭﻝ‬ ‫ﺗﺣﻁﻳﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺑﺎﻷﺩﻭﻳﺔ‬ ‫ﺑﻌﺽ ﺣﺎﻻﺕ ﺗﺿﺧﻡ ﺍﻟﻁﺣﺎﻝ ﻣﻊ ﺯﻳﺎﺩﺓ ّ‬ ‫ﺗﺣﻁﻡ‬ ‫ﺍﻟﺻﻔﻳﺣﺎﺕ ﻓﻳﻪ‬

‫ﺍﻷﺳﺑﺎﺏ ﺍﻟﺭﺋﻳﺳﻳﺔ ﺍﻟﻣﻛﺗﺳﺑﺔ ﻟﻧﻘﺹ ﻋﺩﺩ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬

‫‪ ،‬ﻭﺗﺅﺩﻱ ﺇﻟﻰ ﻧﻘﺹ ﺍﻹﻧﺗﺎﺝ ﻓﻳﻪ ﻛﻠّﻣﺎ ﺃُﻋﻁﻳ�ﺕ ﻟﻣ�ﺭﻳﺽ‪ .‬ﻓﺎﻟﻌﻘ�ﺎﺭﺍﺕ ﺍﻟﻣﺿ�ﺎﺩﺓ ﻟﻠﺳ�ﺭﻁﺎﻥ‪-‬ﻣ�ﺛﻼً‪-‬‬ ‫ﺗﺅﺩﻱ ﺇﻟﻰ ﻧﻘﺹ ﺍﻹﻧﺗﺎﺝ ﻋﻧﺩ ﻛﻝ ﻣﺭﻳﺽ‪ ،‬ﻟﻛﻥ ﺍﻟﻧﻘﺹ ﻳﻛﻭﻥ ﻣﺅﻗﺗﺎ ً‪ .‬ﻟﻛﻥ ﺑﻌﺽ ﺍﻷﺩﻭﻳ�ﺔ ﻟﻳﺳ�ﺕ‬ ‫ﻣﻌﺭﻭﻓﺔ ﺑﻣﺛﻝ ﻫﺫﺍ ﺍﻟﻣﻔﻌﻭﻝ‪ ،‬ﻭﺇﻧﻣﺎ ﻳﺗﺣﺳﺱ ﻟﻬﺎ ﺃﻗﻠﻳﺔ ﻣﻥ ﺍﻟﻣﺭﺿﻰ ﻭﺗﺅﺩﻱ ﺇﻟﻰ ﻓﺷ�ﻝ ﻓ�ﻲ ﻧﺧ�ﺎﻉ‬ ‫ﺍﻟﻌﻅﻡ ﻟﺩﻳﻬﻡ‪ ،‬ﺩﻭﻥ ﻏﻳﺭﻫﻡ‪ ،‬ﻭﺑﻌﺽ ﻫﺫﻩ ﺍﻷﺩﻭﻳﺔ ﻣﻥ ﺍﻟﻣﺿﺎﺩﺍﺕ ﺍﻟﺣﻳﻭﻳﺔ ﻣﺛﻝ)ﻛﻠﻭﺭﺍﻣﻔﻧﻳﻛﻭﻝ(‪.‬‬ ‫ﺃﻣﺎ ﺃﻋﺭﺍﺽ ﻫﺫﺍ ﺍﻟﻧﻘﺹ ﻓﻬﻲ ﻻ ﺗﺧﺗﻠﻑ ﻋﻥ ﺗﻠﻙ ﺍﻟﺗﻲ ﺗﻅﻬﺭ ﻓﻲ ﺍﻟﻧﻘﺹ ﺍﻟ�ﻭﻻﺩﻱ ﺃﻭ ﺍﻟ�ﻭﺭﺍﺛﻲ‪،‬‬ ‫ﻭﻗ��ﺩ ﻻ ﻳﻛ��ﻭﻥ ﻫﻧ��ﺎﻙ ﺃﻋ��ﺭﺍﺽ ﻧ��ﺯﻑ ﺑ��ﺩﻭﻥ ﺷ��ﺩﺓ ﺇﻻ ّ ﺇﺫﺍ ﻛ��ﺎﻥ ﺍﻟ��ﻧﻘﺹ ﺷ��ﺩﻳﺩﺍً)ﺃﻗ��ﻝ ﻣ��ﻥ ‪X20‬‬

‫‪\910‬ﻟﺗﺭ(‪.‬‬ ‫ﺇﻥ ﺗﺣﺳﻥ ﺇﻧﺗﺎﺝ ﺍﻟﺻﻔﺎﺋﺢ ﻭﺍﺭﺗﻔﺎﻉ ﻋﺩﺩﻫﺎ ﺑﺎﻟﺩﻡ ﻗﺩ ﻳﺳ�ﺗﻐﺭﻕ ﻭﻗﺗ�ﺎ ً ﻁ�ﻭﻳﻼً‪ ،‬ﻭﻗ�ﺩ ﻻ ﻳﺣﺻ�ﻝ ﺫﻟ�ﻙ‬ ‫ﺃﺻﻼً‪ ،‬ﻭﻳﺿﻁﺭ ﺍﻟﻁﺑﻳﺏ ﺍﻟﻣﻌ�ﺎﻟﺞ ﺇﻟ�ﻰ ﺇﻋﻁ�ﺎء ﺍﻟﻣ�ﺭﻳﺽ ﺻ�ﻔﻳﺣﺎﺕ ﻣﺭﻛ�ﺯﺓ ﻳُﺣﺻ�ﻝ ﻋﻠﻳﻬ�ﺎ ﻣ�ﻥ‬ ‫ﺑﻧﻙ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻳﺭ ّﻛﺯﻫﺎ ﻣﻥ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻳﻬﺑﻪ ﺍﻟﻣﺗﺑﺭﻋﻭﻥ ﺑﺎﻟﺩﻡ ﺃﻭ ﻳﺣﺻّﻠﻬﺎ ﻣﻥ ﺍﻟﻣﺗﺑﺭﻉ ﺑﺎﺳ�ﺗﻌﻣﺎﻝ‬ ‫ﺟﻬﺎﺯ ﻓﺻﺩ ﻳﺭ ّﻛﺯ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺁﻟﻳﺎ ً ﻭﻳﻌﻳ�ﺩ ﺑ�ﺎﻗﻲ ﺃﺟ�ﺯﺍء ﺍﻟ�ﺩﻡ ﻟﻠﻣﺗﺑ�ﺭّﻉ‪ .‬ﻭﻗ�ﺩ ﻳﺿ�ﻁﺭ ﺇﻟ�ﻰ ﺗﻛ�ﺭﺍﺭ‬ ‫ﻫﺫﺍ ﺍﻟﺗﻌﻭﻳﺽ ﻓﻲ ﺃﻳﺎﻡ ﻣﺗﻘﺎﺭﺑﺔ ﻧﻅﺭﺍً ﻟﻘﺻﺭ ﻋﻣﺭ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻓ�ﻲ ﺍﻟ�ﺩﻡ )ﺣ�ﻭﺍﻟﻲ ‪ 14-12‬ﻳﻭﻣ�ﺎُ‪،‬‬ ‫ﻭﺃﻗﻝ ﻣﻥ ﺫﻟﻙ ﻟﻠﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﺧﺯﻭﻧﺔ ﻓﻲ ﺑﻧﻙ ﺍﻟﺩﻡ(‪.‬‬

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‫ﻭﻗ��ﺩ ﻳﻁ��ﻭﻝ ﺍﻟﻣ��ﺭﺽ ﻭﻳﺻ��ﺑﺢ ﻋﻼﺟ��ﻪ ﺍﻟﻭﺣﻳ��ﺩ ﺇﺟ��ﺭﺍء ﻋﻣﻠﻳ��ﺔ ﺯﺭﺍﻋ��ﺔ ﻧﺧ��ﺎﻉ ﺍﻟﻌﻅ��ﻡ ﺃﻭ ﺍﻟﺧﻼﻳ��ﺎ‬ ‫ﺍﻟﺟﺫﻋﻳﺔ ﺍﻟﻣﺷﺗﻘﺔ ﻣﻥ ﺍﻟﺩﻡ )ﺍﻧﻅﺭ ﺗﻔﺎﺻﻳﻝ ﺫﻟﻙ ﻓﻲ ﻛﺗﺎﺏ ﻓﻘﺭ ﺍﻟﺩﻡ ﻭﻛﺗﺎﺏ ﺳﺭﻁﺎﻥ ﺍﻟﺩﻡ(‪.‬‬ ‫ﺃﻣ��ﺎ ﺇﺫﺍ ﻛ��ﺎﻥ ﺍﻟﻌﺟ��ﺯ ﻧﺎﺗﺟ��ﺎ ً ﻋ��ﻥ ﺍﺣ��ﺗﻼﻝ ﻧﺧ��ﺎﻉ ﺍﻟﻌﻅ��ﻡ‪ ،‬ﺃﻱ ﺗﻐﻠﻐ��ﻝ ﺧﻼﻳ��ﺎ ﻏﺭﻳﺑ��ﺔ )ﻗ��ﺩ ﺗﻛ��ﻭﻥ‬ ‫ﺳﺭﻁﺎﻧﻳﺔ( ﻓﻳﻪ ﻓﺈﻥ ﺗﺣﺳ�ﻥ ﺍﻟﻭﺿ�ﻊ ﻣﺭﻫ�ﻭﻥ ﺑﻣﺣﺎﺭﺑ�ﺔ ﺗﻠ�ﻙ ﺍﻟﺧﻼﻳ�ﺎ ﻭﺍﻟ�ﺗﺧﻠﺹ ﻣﻧﻬ�ﺎ ﻓ�ﻲ ﺍﻟﺟﺳ�ﻡ‬ ‫ﻋﻣﻭﻣﺎ ً‪ .‬ﻭﺣﺗﻰ ﻳﺗﻡ ﺫﻟﻙ‪ ،‬ﻓﺈﻥ ﺍﻟﻌﻼﺝ ﻳﻛﻭﻥ ﺑﺈﻋﻁﺎء ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﺭ ّﻛﺯﺓ ﺃﻳﺿﺎ ً‪.‬‬ ‫ﺏ‪ -‬ﻧﻘﺹ ﻋﺩﺩ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﺩﻭﻥ ﻭﺟﻭﺩ ﻧﻘﺹ ﻓﻲ ﺍﻹﻧﺗﺎﺝ‪ -‬ﻭﻳﻣﻛﻥ ﺃﻥ ﻳﻛﻭﻥ ﺑﺳﺑﺏ‬ ‫ﺍﺳﺗﻬﻼﻙ ﺳﺭﻳﻊ ﻟﻠﺻﻔﻳﺣﺎﺕ ﻓﻲ ﺗﺧﺛﺭﺍﺕ ﻣﻧﺗﺷﺭﺓ ﺃﻭ ﺑﺳﺑﺏ ﺗﺣﻁﻳﻣﻬﺎ ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿ�ﺎ ّﺩﺓ ﻟﻬ�ﺎ ﺃﻭ‬ ‫ﺑﺑﻌﺽ ﺍﻷﺩﻭﻳﺔ ﺃﻭ ﻣﻥ ﻗﺑﻝ ﺍﻟﻁﺣﺎﻝ‪.‬‬ ‫ﺳﻳﺭﺩ ﺗﻔﺻﻳﻝ ﺍﻟﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ ﻓﻲ ﺍﻟﻔﺻﻝ ﺍﻟﺛﺎﻟﺙ ﻣﻥ ﺍﻟﻛﺗﺎﺏ‪.‬‬ ‫ﺇﻥ ﺃﻛﺛﺭ ﺃﺳﺑﺎﺏ ﻧﻘﺹ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺷ�ﻳﻭﻋﺎ ً ﻫ�ﻭ ﺗﺣﻁﻳﻣﻬ�ﺎ ﺑﺎﻷﺟﺳ�ﺎﻡ ﺍﻟﻣﺿ�ﺎﺩﺓ ﻟﻬ�ﺎ‪ ،‬ﻭﺍﻟﺗ�ﻲ ﺗﻛ�ﻭﻥ‬ ‫ﻓ��ﻲ ﺍﻟﻌ��ﺎﺩﺓ ﺫﺍﺗﻳ��ﺔ‪ ،‬ﺃﻱ ﻳﺻ��ﻧﻌﻬﺎ ﺍﻟﺟﻬ��ﺎﺯ ﺍﻟﻣﻧ��ﺎﻋﻲ ﻟﻠﺟﺳ��ﻡ ﻭﺗﻌﻣ��ﻝ ﺿ��ﺩ ﺧﻼﻳ��ﺎ ﺍﻟﺟﺳ��ﻡ ﺫﺍﺗ��ﻪ‪ .‬ﻫ��ﺫﺍ‬ ‫ﺍﻟﻣ��ﺭﺽ)ﻧﻘ��ﺹ ﺻ��ﻔﻳﺣﺎﺕ ﺍﻟ��ﺩﻡ ﺍﻟﻣﻧ��ﺎﻋﻲ( ﻳﻧﺷ��ﺄ ﺇﻣ��ﺎ ﺑ��ﺩﻭﻥ ﺳ��ﺑﺏ ﻅ��ﺎﻫﺭ ﺃﻭ ﺑﻌ��ﺩ ﺗﻧ��ﺎﻭﻝ ﺑﻌ��ﺽ‬ ‫ﺍﻷﺩﻭﻳﺔ ﺃﻭ ﺑﻌﺩ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﺗﻬﺎﺑﺎﺕ ﻓﻳﺭﻭﺳ�ﻳﺔ ﺃﻭ ﻓ�ﻲ ﺃﻣ�ﺭﺍﺽ ﺍﺧ�ﺗﻼﻻﺕ ﺍﻟﺟﻬ�ﺎﺯ ﺍﻟﻣﻧ�ﺎﻋﻲ‪ .‬ﻭﻗ�ﺩ‬ ‫ﻳﺯﻭﻝ ﺗﻠﻘﺎﺋﻳﺎ ً ﺑﻌﺩ ﺃﻳﺎﻡ ﺇﻟﻰ ﺃﺳﺎﺑﻳﻊ ﺃﻭ ﻗﺩ ﻳﺗﺣﻭّ ﻝ ﺇﻟﻰ ﻣﺭﺽ ﻣﺯﻣﻥ‪.‬‬ ‫ﻋﻼﺝ ﺍﻟﻣﺭﺽ ﻳﻛﻭﻥ ﺑﺎﻷﺩﻭﻳﺔ‪ ،‬ﻭﺃﻫﻣﻬﺎ ﺍﻟﻬُﺭﻣﻭﻧﺎﺕ ﺍﻟﻛﻅﺭﻳﺔ‪ ،‬ﻭﺍﻟﺗﻲ ﺗﺳﻳﻁﺭ ﻋﻠﻰ ﺍﻟﻣ�ﺭﺽ ﻓ�ﻲ‬ ‫ﻛﺛﻳ��ﺭ ﻣ��ﻥ ﺍﻟﺣ��ﺎﻻﺕ‪ .‬ﻟﻛ��ﻥ ﺍﻟﺣ��ﺎﻻﺕ ﺍﻟﻣﺳﺗﻌﺻ��ﻳﺔ ﻋﻠ��ﻰ ﺍﻟﻌ��ﻼﺝ ﺍﻟﻬُﺭﻣ��ﻭﻧﻲ ﻳﺟ��ﺭﱠ ﺏ ﻣﻌﻬ��ﺎ ﺃﺩﻭﻳ��ﺔ‬ ‫ﻣﺧﺗﻠﻔﺔ ﻭﻋﻼﺟﻬﺎ ﻟﻳﺱ ﺳﻬﻼً‪ .‬ﻣﺅﺧﺭﺍً ﺗ�ﻡ ﺗﺻ�ﻧﻳﻊ ﻋﺎﻣ�ﻝ ﺑﺎﻟﻬﻧﺩﺳ�ﺔ ﺍﻟﺟﺯﻳﺋﻳ�ﺔ ﻳﺳ�ﺎﻋﺩ ﻓ�ﻲ ﺍﺭﺗﻔ�ﺎﻉ‬ ‫�ﺗﻘﺑﻝ ﻣﻧ��ﺗﺞ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ( ‪ .‬ﺣﻳ��ﺙ ﻳُﻔﺗ��ﺭﺽ ﺃﻥ ﻣﺳ��ﺗﻘﺑﻝ‬ ‫ﻋ��ﺩﺩ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﻭﻫﻭﻋﺎﻣ��ﻝ )ﻣﻧﺷ��ﻁ ﻟﻣﺳ� ِ‬ ‫ﻣﻧﺗﺞ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻋﻠﻰ ﺳﻁﻭﺡ ﺍﻟﺧﻼﻳﺎ ﻋﻣﻼﻗﺔ ﺍﻟﻧﻭﻯ )ﻭﻣﻧﻬﺎ ُﺗﻧ َﺗﺞ ﺍﻟﺻﻔﻳﺣﺎﺕ( ﻓﻳﻪ ﺧﻠ�ﻝ ﻳ�ﺅﺩﻱ‬ ‫ﺇﻟﻰ ﻧﻘﺹ ﺍﻹﻧﺗﺎﺝ )ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﺗﺩﻣﻳﺭ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺑﺎﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ(‪.‬‬ ‫ﻭﻗﺩ ﻳُﺿﻁﺭ ﺍﻟﻁﺑﻳﺏ ﺇﻟﻰ ﺍﺳﺗﺋﺻﺎﻝ ﺍﻟﻁﺣﺎﻝ‪ ،‬ﺍﻟﺫﻱ ﻳﻔﻳ�ﺩ ﺃﺣﻳﺎﻧ�ﺎ ً‪ .‬ﺃﻣ�ﺎ ﻧﻘ�ﻝ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﺍﻟﻣﺭﻛ�ﺯﺓ‬ ‫ﻓﻘﺩ ﻻ ﻳﻛﻭﻥ ﻓﻌﺎﻻً ﺑﺳﺑﺏ ﻗﻳﺎﻡ ﺍﻷﺟﺳ�ﺎﻡ ﺍﻟﻣﺿ�ﺎﺩﺓ ﺑﺎﻟﻘﺿ�ﺎء ﻋﻠ�ﻰ ﻣ�ﺎ ﻳُﻧﻘ�ﻝ ﻟﻠﻣ�ﺭﻳﺽ‪ ،‬ﻛﻣ�ﺎ ﺗﻔﻌ�ﻝ‬ ‫ﺑﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﺭﻳﺽ ﻧﻔﺳﻪ‪.‬‬ ‫ﺍﻟﻁﺣﺎﻝ ﺍﻟﻣﺗﺿﺧﻡ )ﻷﺳﺑﺎﺏ ﻣﺧﺗﻠﻔﺔ ﻟﻳﺱ ﻫﺫﺍ ﻣﺟﺎﻝ ﺑﺣﺛﻬﺎ( ﻳﺅﺩﻱ ﻓﻲ ﺑﻌ�ﺽ ﺍﻟﻧ�ﺎﺱ ﺇﻟ�ﻰ ﻧﻘ�ﺹ‬ ‫ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺫﻱ ﻻ ﻳﻛﻭﻥ ﺷﺩﻳﺩﺍً ﻋﺎﺩﺓ‪ .‬ﻭﺍﻟﻁﺣﺎﻝ ﺇﻣﺎ ﺃﻥ ﻳﻛﺳﱢﺭﻫﺎ ﺃﻭ ﻳﻣﺳﻛﻬﺎ ﺩﺍﺧﻠﻪ ﻓ�ﻼ ﻳﻔﻳ�ﺩ‬

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‫ﺍﻟﺟﺳﻡ ﻣﻧﻬﺎ‪ .‬ﻭﻗﺩ ﻳﻧﺻﺢ ﺍﻟﻁﺑﻳﺏ ﻣﺭﻳﺿ�ﻪ ﺑﺎﺳﺗﺋﺻ�ﺎﻝ ﺍﻟﻁﺣ�ﺎﻝ‪ ،‬ﻟ�ﻳﺱ ﺑﺳ�ﺑﺏ ﻧﻘ�ﺹ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ‬ ‫ﻓﻘﻁ‪ ،‬ﺑﻝ ﺑﺳﺑﺏ ﺛﻘﻝ ﺍﻟﻁﺣﺎﻝ ﺃﻭ ﺗﺄﺛﻳﺭﻩ ﻋﻠﻰ ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻷﺧﺭﻯ ﺃﻳﺿﺎ ً‪.‬‬ ‫‪ .3‬ﺃﻣﺭﺍﺽ ﺍﻟﺧﻠﻝ ﻓﻲ ﻭﻅﺎﺋﻑ ﺍﻟﺻﻔﻳﺣﺎﺕ‬

‫ﻗﺩ ﺗﻛﻭﻥ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﻓﻲ ﺑﻌﺽ ﺍﻷﻣﺭﺍﺽ ﻁﺑﻳﻌﻳﺔ ﻋﺩﺩﺍً ﻟﻛﻧﻬ�ﺎ ﻻ ﺗﻘ�ﻭﻡ ﺑﻭﻅﺎﺋﻔﻬ�ﺎ ﻋﻠ�ﻰ ﻭﺟ�ﻪ‬ ‫ﻁﺑﻳﻌﻲ ﻷﺳﺑﺎﺏ ﻣﻧﻭّ ﻋﺔ‪.‬‬ ‫ﻭﻣ�ﻥ ﺗﻠ�ﻙ ﺍﻷﺳ��ﺑﺎﺏ ﻣ�ﺭﺽ ﺍﻟﻔﺷ��ﻝ ﺍﻟﻛﻠ�ﻭﻱ ﺍﻟﻧﻬ�ﺎﺋﻲ‪ ،‬ﺣﻳ��ﺙ ﻳﻣﻛ�ﻥ ﺃﻥ ﻳﺣﺻ��ﻝ ﻟﻠﻣ�ﺭﻳﺽ ﻧ��ﺯﻑ‬ ‫ﺑﺳﺑﺏ ﻫﺫﻩ ﺍﻟﻣﺷﻛﻠﺔ‪ ،‬ﻭﺭﺑﻣﺎ ﻛ�ﺎﻥ ﺍﻟﺳ�ﺑﺏ ﻫ�ﻭ ﻧﻘ�ﺹ ﻣﻔﻌ�ﻭﻝ ﻋﺎﻣ�ﻝ ﻓ�ﻭﻥ ﻭﻟﺑﺭﺍﻧ�ﺩ ﺑﺳ�ﺑﺏ ﺍﻟﻣ�ﻭﺍﺩ‬ ‫ﺍﻟﺿﺎﺭﺓ ﺍﻟﺗﻲ ﺗﻌﺟﺯ ﺍﻟﻛﻠﻳﺗﺎﻥ ﻋﻥ ﻁﺭﺣﻬﺎ ﻟﻠﺧﺎﺭﺝ‪ .‬ﻟﻛ�ﻥ ﻭُ ﺟ�ﺩ ﻓ�ﻲ ﺍﻟﻣﺭﺿ�ﻰ ﻛ�ﺫﻟﻙ ﺿ�ﻌﻑ ﻓ�ﻲ‬ ‫ﻗﺎﺑﻠﻳﺔ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻋﻠﻰ ﺍﻟﺗﺭﺍﻛﻡ‪.‬‬ ‫ﻛﻣﺎ ﺃﻥ ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﺍﻟﺳﺭﻁﺎﻧﺎﺕ ﻣﺛﻝ ﺳ�ﺭﻁﺎﻥ ﺍﻟﺻ�ﻭﺭﻳﺔ )ﺍﻟﻣﺎﻳﻠﻭﻣ�ﺎ( ﻳ�ﺅﺩﻱ ﺇﻟ�ﻰ ﺿ�ﻌﻑ ﻓ�ﻲ‬ ‫ﺍﻟﺗﻔﺎﻋﻝ ﺑﻳﻥ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻋﺎﻣﻝ ﻓﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‪.‬‬ ‫ﺃﻣ��ﺎ ﺳ��ﺭﻁﺎﻧﺎﺕ ﺍﻟﻧﺧ��ﺎﻉ ﺍﻟﺗﻛﺎﺛﺭﻳ��ﺔ ﺍﻷﺳﺎﺳ��ﻳﺔ )ﻭﺍﻟﺗ��ﻲ ﻛﺎﻧ��ﺕ ﺗﺳ��ﻣﻰ ﺳ��ﺎﺑﻘﺎ ً ﺍﻋ��ﺗﻼﻻﺕ ﺍﻟﻧﺧ��ﺎﻉ‬ ‫ﺍﻟﺗﻛﺎﺛﺭﻳﺔ( ﻓﻳﺣﺻﻝ ﻓﻳﻬﺎ ﺿﻌﻑ ﻓﻲ ﻭﻅﺎﺋﻑ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻳ�ﺅﺛﺭ ﺳ�ﻠﺑﻳﺎ ً ﻋﻠ�ﻰ ﺗﺭﺍﻛﻣﻬ�ﺎ ﻭﻗ�ﺩ ﻳﻧ�ﺗﺞ‬ ‫ﻋﻥ ﺫﻟﻙ ﺃﻧﺯﻓﺔ‪ ،‬ﻻﺳﻳﻣﺎ ﻋﻧﺩ ﺍﻟﻣﺭﺿﻰ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﻘﺭﺣﺔ ﺍﻟﻣﻌﺩﺓ‪ ،‬ﻭﺍﻟﺗ�ﻲ ﺗﺣﺻ�ﻝ ﻟ�ﺩﻯ ﺍﻟﻛﺛﻳ�ﺭﻳﻥ‬ ‫ﻣﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺎﻟﻣﺭﺽ‪.‬‬ ‫ﺍﻟﻣﺻﺎﺑﻭﻥ ﺑﻧﻘﺹ ﺷ�ﺩﻳﺩ ﻓ�ﻲ ﻓﻳﺗ�ﺎﻣﻳﻥ ﺝ ﻳﺣﺻ�ﻝ ﻟ�ﺩﻳﻬﻡ ﺃﻧﺯﻓ�ﺔ ﺟﻠﺩﻳ�ﺔ ﻭﻧ�ﺯﻑ ﻣ�ﻥ ﺍﻟﻠﺛ�ﺔ ﺑﺳ�ﺑﺏ‬ ‫ﺗﻐﻳّﺭ ﺗﺭﻛﻳﺏ ﺍﻟ ُﻛﻼﺟﻳﻥ ﻣﻣﺎ ﻳﺟﻌﻝ ﺗﻔﻌﻳﻝ ﻭﺍﻟﺗﺻﺎﻕ ﻭﺗﺭﺍﻛﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺿﻌﻳﻔﺎ ً‪.‬‬ ‫ﻭﻫﻧﺎﻙ ﺃﺩﻭﻳﺔ ﻣﺿﺎﺩﺓ ﻟﻌﻣﻝ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‪ ،‬ﺃﺷ�ﻬﺭﻫﺎ ﺍﻷﺳ�ﺑﺭﻳﻥ ﻭ ﺍﮔﺭﻳﻠ�ﻳﻥ ﻭﭜﻼ ﭬﻛ�ﺱ ‪ ،‬ﺗﺳ�ﺑﺏ‬ ‫ﺿﻌﻔﺎ ً ﻓﻲ ﺇﻓﺭﺍﺯ ﻣﻔﻌّﻼﺕ ﻣﻌﻳﻧ�ﺔ ﻣﻧﻬ�ﺎ‪ ،‬ﻭﻣ�ﻥ ﺛ� ّﻡ ﺿ�ﻌﻔﺎ ً ﻓ�ﻲ ﺗﺭﺍﻛﻣﻬ�ﺎ ﻋﻧ�ﺩ ﺍﻟﻧ�ﺯﻑ‪ .‬ﻭﻗ�ﺩ ﻳﺻ�ﻑ‬ ‫ﺍﻟﻁﺑﻳ��ﺏ ﺑﻌ��ﺽ ﻫ��ﺫﻩ ﺍﻷﺩﻭﻳ��ﺔ ﻷﺳ��ﺑﺎﺏ ﺃﺧ��ﺭﻯ ﻛ��ﺂﻻﻡ ﺍﻟﻣﻔﺎﺻ��ﻝ‪ ،‬ﺛ��ﻡ ﺗ��ﺅﺩﻱ ﺇﻟ��ﻰ ﺣﺻ��ﻭﻝ ﻧ��ﺯﻑ‬ ‫ﻻﺳﻳﻣﺎ ﻋﻧﺩ ﺃﻭﻟﺋﻙ ﺍﻟﺫﻳﻥ ﻟﺩﻳﻬﻡ ﻗﺭﺣﺔ ﻓ�ﻲ ﺍﻟﻣﻌ�ﺩﺓ ﻭﺍﻟﻣﺛﺎﻧ�ﺔ ﻭﻏﻳﺭﻫﻣ�ﺎ‪ .‬ﻭﻛﺛﻳ�ﺭﺍً ﻣ�ﺎ ُﺗﻌﻁ�ﻰ ﺃﺻ�ﻼً‬ ‫ﻟﺗﻘﻠﻳﻝ ﻧﺷﺎﻁ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻓﻲ ﺍﻟﻣﺭﺿﻰ ﺍﻟﻣﻌﺭﱠ ﺿ�ﻳﻥ ﻟﺗﺧﺛ�ﺭﺍﺕ ﺩﻣﻭﻳ�ﺔ ﻭﺍﻧﺳ�ﺩﺍﺩ ﺍﻟﺷ�ﺭﺍﻳﻳﻥ )ﺍﻧﻅ�ﺭ‬ ‫ﺍﻟﻔﺻﻠﻳﻥ ﺍﻟﺛﺎﻟﺙ ﻭﺍﻟﺭﺍﺑﻊ(‪ .‬ﻭﻫﺫﺍ ﺍﻟﻧﻘﺹ ﺍﻟﻌﻼﺟﻲ ﺍﻟﻣﻘﺻﻭﺩ ﻓﻲ ﻋﻣﻝ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻻ ﻳُﻌﺩ ﻣﺭﺿﺎ ً‬ ‫ﺑﺣﺩ ﺫﺍﺗﻪ ﻟﻛﻧﻪ ﻳُﺫﻛﺭ ﺿﻣﻥ ﻣﺟﻣﻭﻋﺔ ﺍﻷﺳﺑﺎﺏ ﺍﻟﻣﺅﺩﻳﺔ ﻟﻠﻧﺯﻑ ﻣﻥ ﻧﻘﺹ ﻭﻅﺎﺋﻑ ﺍﻟﺻﻔﻳﺣﺎﺕ‪.‬‬

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‫‪ .3‬ﺃﻣﺭﺍﺽ ﺍﻟﻧﺯﻑ ﺍﻟﻧﺎﺗﺟﺔ ﻋﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‬

‫ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ ﺑﺳﺑﺏ ﻋﺟﺯ ﺍﻟﻛﺑﺩ‬ ‫ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ ﺑﺳﺑﺏ ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﻙ‬ ‫ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ ﺑﺳﺑﺏ ﺍﻟﻌﻘﺎﺭﺍﺕ ﺍﻟﻣﺿﺎﺩﺓ‬ ‫ﻟﻔﻳﺗﺎﻣﻳﻥ ﻙ‬ ‫ﺃﻣﺭﺍﺽ ﺍﻟﻧﺯﻑ ﺍﻟﻧﺎﺗﺟﺔ‬ ‫ﻋﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‬ ‫ﺃﻭ ﻧﻘﺹ ﻓ ّﻌﺎﻟ ّﻳﺗﻬﺎ‬

‫ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ‪ +‬ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ ﺑﺳﺑﺏ‬ ‫ﺗﺧﺛﺭﺍﺕ ﻣﻧﺗﺷﺭﺓ‬ ‫ﻧﻘﺹ ﻋﺎﻣﻝ‪ 8‬ﺑﺻﻭﺭﺓ ﻋﺎﺑﺭﺓ ﻓﻲ ﺑﻌﺽ ﺍﻷﻣﺭﺍﺽ‬ ‫ﻣﺿﺎﺩﺍﺕ ﺗﺧﺛﺭ ﻣﺭﺿ ّﻳ ﺔ ﻓﻲ ﺣﺎﻻﺕ ﻣﻌ ّﻳﻧﺔ‬ ‫ﻓﻌﺎﻟﻳﺔ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‬ ‫ﺃﺩﻭﻳﺔ ﻣﺿﺎﺩﺓ ﻟﻠﺗﺧﺛﺭ ﺗﺅﺛﺭ ﻓﻲ ّ‬ ‫ﻻ ﻓﻲ ﺗﺭﻛﻳﺯﻫﺎ‬ ‫ﺍﻷﺳﺑﺎﺏ ﺍﻟﻣﻛﺗﺳﺑﺔ ﺍﻟﺭﺋﻳﺳﻳﺔ ﻟﻠﻧﺯﻑ ﻣﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‬

‫ﺇﻥ ﺍﻟﻧﻘﺹ ﺍﻟﻣﻛﺗﺳﺏ ﻓﻲ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ ﺑﺳ�ﺑﺏ ﺃﻣ�ﺭﺍﺽ ﺃﻭ ﻋﻘ�ﺎﺭﺍﺕ ﻳﻔ�ﻭﻕ ﺍﻟ�ﻧﻘﺹ ﺍﻟﻣ�ﻭﺭﻭﺙ‬ ‫ﻓﻲ ﻛﺛﺭﺓ ﺣﺻﻭﻟﻪ‪ .‬ﻭﺍﻟﻁﺏ ﺍﻟﺣﺩﻳﺙ‪ ،‬ﻣﻊ ﻛﻝ ﻣﺎ ﻳﻘ ّﺩﻣﻪ ﻟﻌﻼﺝ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻣﺧﺗﻠﻔﺔ‪ ،‬ﺭﺑﻣﺎ ﺯﺍﺩ ﻓﻲ‬ ‫ﺣﺻ��ﻭﻝ ﺑﻌ��ﺽ ﺣ��ﺎﻻﺕ ﺍﻟﻧ��ﺯﻑ ﻫ��ﺫﻩ ﺑﺳ��ﺏ ﺍﺳ��ﺗﻌﻣﺎﻝ ﻋﻘ��ﺎﺭﺍﺕ ﻣﺧﺗﻠﻔ��ﺔ ﻓ��ﻲ ﻋ��ﻼﺝ ﺍﻷﻣ��ﺭﺍﺽ‪.‬‬ ‫ﻓﺎﻟﻌﻘ���ﺎﺭﺍﺕ ﺍﻟﻣﺿ���ﺎﺩﺓ ﻟﻔﻳﺗ���ﺎﻣﻳﻥ ﻙ ُﺗﺳ���ﺗﻌﻣﻝ ﻛﺛﻳ���ﺭﺍً‪ ،‬ﻭﻛ���ﺫﻟﻙ ﺍﻷﺳ���ﺑﺭﻳﻥ ﻭﻣﺿ���ﺎﺩﺍﺕ ﺍﻻﻟﺗﻬ���ﺎﺏ‬ ‫ﻏﻳﺭﺍﻟﻛﻭﺭﺗﻳﺯﻭﻟﻳﺔ ﻭﺍﻟﻌﻘﺎﺭﺍﺕ ﺍﻟﻣﺛﺑّﻁﺔ ﻟﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪.‬‬ ‫ﻭﺍﻵﻥ ﻟﻧﺄﺧﺫ ﻛﻼًّ ﻣﻥ ﻫﺫﻩ ﺍﻟﺣﺎﻻﺕ ﺑﺻﻭﺭﺓ ﻣﻧﻔﺻﻠﺔ‪:‬‬ ‫ﺍ‪ -‬ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ ﺑﺳﺑﺏ ﻋﺟﺯ ﺍﻟﻛﺑﺩ ﺍﻟﻣﺯﻣﻥ‬ ‫ﻳﺣﺻﻝ ﺍﻟﻌﺟﺯ ﺍﻟﻣﺯﻣﻥ ﻟﻠﻛﺑﺩ‪ ،‬ﻭﺍﻟﺫﻱ ﻳﺳﺑﺑﻪ ﻣﺎ ﻳُﺳﻣّﻰ ﺑﺗﺷﻣّﻊ ﺃﻭ ﺗﻠﻳّﻑ ﺍﻟﻛﺑﺩ‪ ،‬ﺑﻌﺩ ﺍﻟﺗﻬﺎﺑﺎﺕ ﺍﻟﻛﺑ�ﺩ‬ ‫ﺍﻟﻣﺯﻣﻧﺔ ﺑﺎﻟﻔﻳﺭﻭﺳﺎﺕ ﺃﻭ ﻏﻳ�ﺭﻩ ﺫﻟ�ﻙ‪ .‬ﻭﻳ�ﺅﺩﻱ ﺍﻟﻌﺟ�ﺯ ﺇﻟ�ﻰ ﻧﻘ�ﺹ ﻓ�ﻲ ﺇﻧﺗ�ﺎﺝ ﺧﻣﺳ�ﺔ ﻣ�ﻥ ﻋﻭﺍﻣ�ﻝ‬ ‫ﺍﻟﺗﺧﺛ��ﺭ ﺗﺻ��ﻧﻌﻬﺎ ﺧﻼﻳ��ﺎ ﺍﻟﻛﺑ��ﺩ ﺍﻟﻁﺑﻳﻌﻳ��ﺔ )ﻭﻫ��ﻲ ﻋﺎﻣ��ﻝ‪ 2‬ﺃﻭ ﻣﻭﻟّ��ﺩ ﺍﻟﺧﺛ��ﺭﻳﻥ‪ ،‬ﻋﺎﻣ��ﻝ‪ ،5‬ﻋﺎﻣ��ﻝ‪،7‬‬ ‫ﻋﺎﻣ�ﻝ‪ 9‬ﻭﻋﺎﻣ�ﻝ‪ .(10‬ﻭﺍﻟﺣﻘﻳﻘ�ﺔ ﺃﻥ ﺗﻠ ّﻳ��ﻑ ﺍﻟﻛﺑ�ﺩ ﻣ�ﺭﺽ ﻧﺗﺎﺋﺟ�ﻪ ﻣﻌﻘّ��ﺩﺓ‪ .‬ﻓ�ﺈﻥ ﻧﻘ�ﺹ ﺧﻼﻳ�ﺎ ﺍﻟﻛﺑ��ﺩ‬

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‫ﺍﻟﻔﻌﺎﻟﺔ ﻓ�ﻲ ﻫ�ﺫﺍ ﺍﻟﻣ�ﺭﺽ ﻳ�ﺅﺩﻱ ﺇﻟ�ﻰ ﻧﻘ�ﺹ ﺷ�ﺎﻣﻝ ﻓ�ﻲ ﺑﺭﻭﺗﻳﻧ�ﺎﺕ ﻛﺛﻳ�ﺭﺓ‪ ،‬ﻣﻧﻬ�ﺎ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ‬ ‫ﺍﻟﻣﺫﻛﻭﺭﺓ‪ ،‬ﺗﺻﻧﻌﻬﺎ ﺗﻠﻙ ﺍﻟﺧﻼﻳﺎ‪ ،‬ﻟﻛﻥ ﺍﻟﻛﺑﺩ ﺃﻳﺿﺎ ً ﻳﻌﺎﻧﻲ ﻣﻥ ﺗﻐﻳﻳﺭ ﻓﻲ ﺑﻧﻳﺗﻪ ﻳﺅﺩﻱ ﺇﻟﻰ ﺍﻟﺿ�ﻐﻁ‬ ‫ﻋﻠﻰ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﻭﺍﻟﺩﻭﺭﺓ ﺍﻟﺩﻣﻭﻳﺔ ﺩﺍﺧﻠﻪ ﻭﻳﺯﻳﺩ ﺫﻟﻙ ﻣﻥ ﺿ�ﻐﻁ ﺍﻟ�ﺩﻡ ﻓ�ﻲ ﺍﻷﻭﺭﺩﺓ ﺍﻟ�ﻭﺍﺭﺩﺓ‬ ‫ﻟﻠﻛﺑﺩ)ﺍﻟﻭﺭﻳﺩ ﺍﻟﺑﺎﺑﻲ ﺍﻟﻛﺑﺩﻱ(‪ ،‬ﻭﻫﺫﺍ ﺑ�ﺩﻭﺭﻩ ﻳﺳ�ﺑﺏ ﺯﻳ�ﺎﺩﺓ ﺍﻟﺿ�ﻐﻁ ﻓ�ﻲ ﺭﻭﺍﻓ�ﺩ ﺫﻟ�ﻙ ﺍﻟﻭﺭﻳ�ﺩ ﺍﻟﺗ�ﻲ‬ ‫ﺗﺭﺩ ﻋﻠﻳﻪ ﻣﻥ ﺍﻷﻣﻌﺎء ﻭﺍﻟﻣﻌﺩﺓ ﻭﺍﻟﻁﺣﺎﻝ‪ ،‬ﻓﺗﻧﺗﻔﺦ ﺗﻠﻙ ﺍﻷﻭﺭﺩﺓ ﻋﻣﻭﻣﺎ ً‪ .‬ﻭﺫﻟﻙ ﺍﻻﻧﺗﻔﺎﺥ ﻗ�ﺩ ﻳ�ﺅﺩﻱ‬ ‫ﺇﻟﻰ ﺍﻧﻔﺟﺎﺭ ﺑﻌﺽ ﻣﻧﻬﺎ‪ ،‬ﻻﺳﻳﻣﺎ ﺗﻠﻙ ﺍﻟﺗﻲ ﺗﺣﻳﻁ ﺑﻣﺩﺧﻝ ﺍﻟﻣﺭﻱء ﺇﻟﻰ ﺍﻟﻣﻌ�ﺩﺓ‪ ،‬ﻭﺣﺻ�ﻭﻝ ﺍﻟﻧ�ﺯﻑ‬ ‫ﻣﻧﻬﺎ ﻓﻲ ﺍﻟﻣﻌﺩﺓ‪ .‬ﻭﺑﺫﻟﻙ ﻳﻛﻭﻥ ﻫﻧ�ﺎﻙ ﺳ�ﺑﺑﺎﻥ ﻟﻠﻧ�ﺯﻑ‪ ،‬ﻓ�ﺎﻷﻭﺭﺩﺓ ﻣﻧﺗﻔﺧ�ﺔ ﻭﺟ�ﺩﺍﺭﻫﺎ ﺭﻗﻳ�ﻕ ﻭﺳ�ﻬﻝ‬ ‫ﺍﻻﻧﻔﺟﺎﺭ ﻛﻣﺎ ﺃﻥ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﻧﺎﻗﺻﺔ ﻻ ﺗﺳﺎﻋﺩ ﻋﻠﻰ ﻭﻗﻑ ﺍﻟﻧﺯﻳﻑ‪.‬‬ ‫ﻫﻧ��ﺎﻙ ﺳ��ﺑﺏ ﺛﺎﻟ��ﺙ ﻳﺳ��ﺎﻋﺩ ﻋﻠ��ﻰ ﺍﻟﻧ��ﺯﻑ ﻓ��ﻲ ﻫ��ﺫﺍ ﺍﻟﻣ��ﺭﺽ‪ ،‬ﻓﺯﻳ��ﺎﺩﺓ ﺍﻟﺿ��ﻐﻁ ﺍﻟﺭﺍﺟ��ﻊ ﻓ��ﻲ ﻭﺭﻳ��ﺩ‬ ‫ﺍﻟﻁﺣﺎﻝ)ﻛﻣﺎ ﻭﺿّ�ﺣﺕ ﺃﻋ�ﻼﻩ( ﻳ�ﺅﺩﻱ ﺇﻟ�ﻰ ﺗﺿ�ﺧﻡ ﺍﻟﻁﺣ�ﺎﻝ ﻓ�ﻲ ﻣﻌﻅ�ﻡ ﻫ�ﺅﻻء ﺍﻟﻣﺭﺿ�ﻰ ﺑﺳ�ﺑﺏ‬ ‫ﺗﺟﻣّﻊ ﺍﻟﺩﻡ ﻓﻳﻪ‪ ،‬ﻭﻋﻥ ﺗﺿﺧﻡ ﺍﻟﻁﺣﺎﻝ ﻗﺩ ﻳﻧﺗﺞ ﻧﻘﺹ ﻓﻲ ﺻﻔﻳﺣﺎﺕ ﺍﻟ�ﺩﻡ)ﺍﻧﻅ�ﺭ ﺻ�ﻔﺣﺔ‪ (38‬ﻣﻣ�ﺎ‬ ‫ﻳﺯﻳﺩ ﻣﺷﻛﻠﺔ ﺍﻟﻧﺯﻑ ﺗﻌﻘﻳﺩﺍً‪.‬‬ ‫ﺇﻥ ﻣ��ﺭﺽ ﺗﻠﻳ��ﻑ ﺍﻟﻛﺑ��ﺩ ﺃﻛﺛ��ﺭ ﺗﻌﻘﻳ��ﺩﺍً ﻣﻣ��ﺎ ﺫﻛ��ﺭﺕ ﻷﻥ ﻭﻅ��ﺎﺋﻑ ﺍﻟﻛﺑ��ﺩ ﻣﻧﻭّ ﻋ��ﺔ ﻭﻛﺛﻳ��ﺭﺓ ﻭﻛﺑﻳ��ﺭﺓ‬ ‫ﺍﻷﻫﻣﻳﺔ‪ ،‬ﻟﺫﺍ ﻓﺈﻥ ﺍﻧﻬﻳﺎﺭ ﻭﻅﺎﺋﻔﻪ ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺷﻌّﺏ ﺍﻟﻣﺿﺎﻋﻔﺎﺕ ﻭﺍﻟﻌﻠﻝ ﺍﻟﻧﺎﺗﺟﺔ ﻋﻧﻪ‪.‬‬ ‫ﻭﻓﺣﻭﺹ ﺍﻟﻣﺧﺑ�ﺭ ﺍﻟﺗ�ﻲ ُﺗﺟ�ﺭﻯ ﻟﺗﺷ�ﺧﻳﺹ ﺃﻣ�ﺭﺍﺽ ﺍﻟﻛﺑ�ﺩ ﻛﺛﻳ�ﺭﺓ‪ ،‬ﻭﻟ�ﻳﺱ ﻫ�ﺫﺍ ﻣﺟ�ﺎﻝ ﻣﻧﺎﻗﺷ�ﺗﻬﺎ‪.‬‬ ‫ﻟﻛ�ﻥ ﺍﻟﻔﺣ�ﻭﺹ ﺍﻟﺧﺎﺻ��ﺔ ﺑ�ﺎﻟﺗﺧﺛﺭ ﻳﻣﻛ�ﻥ ﺃﻥ ﺗﺅ ّﻛ�ﺩ ﻭﺟ��ﻭﺩ ﻓﺷ�ﻝ ﻓ��ﻲ ﺍﻟﻛﺑ�ﺩ ﺇﺫﺍ ﻛ��ﺎﻥ ﻓﺣ�ﺹ)ﻭﻗ��ﺕ‬ ‫ﺍﻟﺧﺛﺭﻳﻥ( ﻏﻳﺭ ﻁﺑﻳﻌﻲ‪ .‬ﺃﻣﺎ ﻓﺣﺹ)ﻭﻗﺕ ﺗﻭﻟّ�ﺩ ﺍﻟﺧﺛ�ﺭﺓ ﺍﻟﺟﺯﺋ�ﻲ( ﻓﺈﻧ�ﻪ ﻗ�ﺩ ﻳﻌﻁ�ﻲ ﻧﺗﻳﺟ�ﺔ ﻁﺑﻳﻌﻳ�ﺔ‬ ‫ﺣﺗﻰ ﻳﺻﻝ ﺍﻟﻛﺑﺩ ﺇﻟﻰ ﻣﺭﺣﻠﺔ ﻣﺗﻘ ّﺩﻣﺔ ﻓﻲ ﺍﻟﻌﺟﺯ‪.‬‬ ‫ﻋﻼﺝ ﺍﻟﻧﻘﺹ ﻓﻲ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛ�ﺭ ﺑﻬ�ﺫﺍ ﺍﻟﻣ�ﺭﺽ ﻳﻛ�ﻭﻥ ﻋﻧ�ﺩ ﺣﺻ�ﻭﻝ ﺍﻟﻧ�ﺯﻑ ﻓﻘ�ﻁ‪ ،‬ﻷﻥ ﻋﻼﺟ�ﺎ ً‬ ‫ﻣﺳﺗﻣﺭﺍً ﻫﻭ ﺃﺛﻣﻥ ﻣﻥ ﺃﻥ ﻳﻘ�ﺩﺭ ﻋﻠﻳ�ﻪ ﺃﻱ ﻣﻌ�ﺎﻟِﺞ‪ .‬ﻭﻳﻛ�ﻭﻥ ﺍﻟﻌ�ﻼﺝ ﺑﺈﻋﻁ�ﺎء ﺍﻟﺑﻼﺯﻣ�ﺎ ﺃﻭ ﺍﻟﻌﻭﺍﻣ�ﻝ‬ ‫ﺍﻟﻣﺭ ّﻛﺯﺓ ﺍﻟﺗﻲ ﻳﻔﺗﻘﺭ ﺇﻟﻳﻬﺎ ﺍﻟﻣ�ﺭﻳﺽ‪ ،‬ﺇﻥ ﻭﺟ�ﺩﺕ‪ .‬ﺇﻥ ﺍﻟﻌ�ﻼﺝ ﻳﺟ�ﺏ ﺃﻥ ﻳُﻛ�ﺭﺭ‪ ،‬ﺭﺑﻣ�ﺎ ﻷﻛﺛ�ﺭ ﻣ�ﻥ‬ ‫ﻣ��ﺭﺓ ﺃﻭ ﻣ��ﺭﺗﻳﻥ ﺑ��ﺎﻟﻳﻭﻡ‪ ،‬ﻧﻅ��ﺭﺍً ﻟﻘﺻ��ﺭ ﻋﻣ��ﺭ ﻋﻭﺍﻣ��ﻝ ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﻻﺳ �ﻳّﻣﺎ ﻋﺎﻣ��ﻝ ‪ ،7‬ﻛﻣ��ﺎ ﻳﺣﺗ��ﺎﺝ‬ ‫ﺍﻟﻣﺭﻳﺽ ﺃﺣﻳﺎﻧﺎ ً ﻟﻧﻘﻝ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﺭﻛﺯﺓ‪.‬‬ ‫ﻟﻳﺗﺫ ّﻛﺭ ﺍﻟﻘﺎﺭﺉ ﺃﻥ ﻣﻭﺿﻭﻉ ﺍﻟﻧﺯﻑ ﻓﻲ ﻣﺭﺽ ﻋﺟﺯ ﺍﻟﻛﺑﺩ ﻫﻭ ﻣﺗﺷﻌﺏ‪ ،‬ﻭﻗﺩ ﻳﻌﻣﺩ ﺍﻷﻁﺑ�ﺎء ﺇﻟ�ﻰ‬ ‫ﻭﺳﺎﺋﻝ ﻣﻭﺿﻌﻳﺔ ﻟﺳﺩ ﺍﻷﻭﺭﺩﺓ ﺍﻟﻣﺗﻭﺳﻌﺔ ﻣﻥ ﺭﻭﺍﻓﺩ ﺍﻟﻭﺭﻳﺩ ﺍﻟﺑﺎﺑﻲ ﺃﻭ ﺍﻟﺿﻐﻁ ﻋﻠﻳﻬﺎ ﺃﻭ ﻓﺗﺢ ﻗﻧ�ﺎﺓ‬

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‫ﺗﻭﺻ��ﻝ ﺍﻟﻭﺭﻳ��ﺩ ﺍﻟﺑ��ﺎﺑﻲ ﺑﺎﻟﻭﺭﻳ��ﺩ ﺍﻷﺟ��ﻭﻑ ﺍﻷﺳ��ﻔﻝ ﺟﺭﺍﺣﻳ�ﺎ ً ﻟﻠ��ﺗﺧﻠﺹ ﻣ��ﻥ ﺯﻳ��ﺎﺩﺓ ﺍﻟﺿ��ﻐﻁ ﺩﺍﺧ��ﻝ‬ ‫ﺍﻟﻛﺑ��ﺩ‪ .‬ﻭﻫ��ﺫﺍ ﺍﻹﺟ��ﺭﺍء ﻗ��ﺩ ﻳﻭﻗ��ﻑ ﺍﻟﻧ��ﺯﻑ ﻣ��ﻥ ﺍﻷﻭﺭﺩﺓ ﺍﻟﻣﺗﻭﺳ��ﻌﺔ ﻟﻛﻧ��ﻪ ﻻ ﻳﻐ ّﻳ��ﺭ ﺷ��ﻳﺋﺎ ً ﻣ��ﻥ ﻋﺟ��ﺯ‬ ‫ﺍﻟﻛﺑ��ﺩ ﻋ��ﻥ ﺇﻧﺗ��ﺎﺝ ﻋﻭﺍﻣ��ﻝ ﺍﻟﺗﺧﺛ��ﺭ ﻭﻻ ﻏﻳﺭﻫ��ﺎ‪ ،‬ﺣﺗ��ﻰ ﻳﻧﺗﻬ��ﻲ ﺍﻷﻣ��ﺭ ﺑﺎﻟﻔﺷ��ﻝ ﺍﻟﻧﻬ��ﺎﺋﻲ ﻟﻠﻛﺑ��ﺩ ﻭﺑﻛ��ﻝ‬ ‫ﻭﻅﺎﺋﻔﻪ‪ ،‬ﻭﻫﻭ ﻣﺎ ﻳﺗﻌﺎﺭﺽ ﻣﻊ ﺍﻟﺣﻳﺎﺓ‪ ،‬ﺇﻻ ّ ﺇﺫﺍ ﺃُﺟﺭﻳﺕ ﻋﻣﻠﻳﺔ ﺯﺭﺍﻋﺔ ﻛﺑﺩ ﻟﻠﻣﺭﻳﺽ ﻹﻧﻘﺎﺫﻩ‪.‬‬ ‫ﺏ‪ -‬ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﻣﺗﻌﺩﺩﺓ ﺑﺳﺑﺏ ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﻙ‬ ‫ﺇﻥ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻙ‪ ،‬ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﻣﻬﺎﻡ ﺃﺧﺭﻯ ﻟﻪ‪ ،‬ﻫﻭ ﻋﺎﻣﻝ ﻣﺳﺎﻋﺩ ﺩﺍﺧﻝ ﺍﻟﻛﺑﺩ ﻟﺻﻧﺎﻋﺔ ﺃﺭﺑﻌﺔ ﻣ�ﻥ‬ ‫ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﺍﻟﺧﻣﺳ�ﺔ ﺍﻟﺗ�ﻲ ﻳﺻ�ﻧﻌﻬﺎ ﺍﻟﻛﺑ�ﺩ‪ ،‬ﻭﺍﻟﻌﻭﺍﻣ�ﻝ ﺍﻷﺭﺑﻌ�ﺔ ﻫ�ﻲ )‪2‬ﻭ‪7‬ﻭ‪ 9‬ﻭ‪ ،(10‬ﺃﻱ ﺃﻥ‬ ‫ﻋﺎﻣﻝ‪ 5‬ﻻ ﻳﺣﺗﺎﺝ ﺇﻟﻰ ﻓﻳﺗﺎﻣﻳﻥ ﻙ ﻟﻳُﺻﻧﻊ ﻓﻲ ﺍﻟﻛﺑﺩ‪ .‬ﺇﻥ ﺩﻭﺭ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ ﻓ�ﻲ ﻋﻣﻠﻳ�ﺔ ﺗﺻ�ﻧﻳﻊ ﺗﻠ�ﻙ‬ ‫ﺍﻟﻌﻭﺍﻣﻝ ﻓﻲ ﺍﻟﻛﺑﺩ ﻣﻬﻡ‪ ،‬ﻭﻓﻲ ﺣ�ﺎﻝ ﻧﻘ�ﺹ ﺍﻟﻔﻳﺗ�ﺎﻣﻳﻥ ﻳ�ﺗﻡ ﺻ�ﻧﻊ ﺗﻠ�ﻙ ﺍﻟﻌﻭﺍﻣ�ﻝ ﺑ�ﺩﻭﻥ ﻧﻘ�ﺹ ﻛﻣّ�ﻲ‬ ‫ﻟﻛﻥ ﻳﻛﻭﻥ ﻓﻲ ﺗﺭﻛﻳﺑﻬﺎ ﺍﻟﺟﺯﻳﺋﻲ ﻋﻳﺏ ﻧﻭﻋﻲ ﻳﻣﻧﻌﻬﺎ ﻣﻥ ﺍﻟﻣﺷ�ﺎﺭﻛﺔ ﺍﻟﻔﻌّﺎﻟ�ﺔ ﻓ�ﻲ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ‪،‬‬ ‫ﻟﻌﺩﻡ ﻗﺩﺭﺗﻬﺎ ﻋﻠﻰ ﺍﻻﺳﺗﻔﺎﺩﺓ ﻣﻥ ﺁﻳﻭﻥ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ ﺍﻟﻣﻁﻠﻭﺏ ﻟﻠﺗﺧﺛﺭ)ﺍﻧﻅﺭ ﺍﻟﻔﺻﻝ ﺍﻷﻭﻝ(‪.‬‬ ‫ﻭﺍﻟﺣﻘﻳﻘ��ﺔ ﺃﻥ ﻧﻘ��ﺹ ﻣﻔﻌ �ﻭﻝ ﺃﻱ ﻋﺎﻣ��ﻝ ﺗﺧﺛ��ﺭ ﻫ��ﻭ ﺗﻣﺎﻣ �ﺎ ً ﻛﻧﻘﺻ��ﻪ ﺍﻟﻛ ّﻣ��ﻲ‪ ،‬ﻓﻌﻣﻠﻳ��ﺔ ﺍﻟﺗﺧﺛ��ﺭ ﺗﺗ��ﺄﺛﺭ‬ ‫ﺑﺎﻟﺧﻠ��ﻝ ﺍﻟﻧ��ﻭﻋﻲ ﺍﻟﻧ��ﺎﺗﺞ ﻭﻗ��ﺩ ﻳ��ﺅﺩﻱ ﺍﻷﻣ��ﺭ ﺇﻟ��ﻰ ﺍﻟﻧ��ﺯﻑ ﺇﺫﺍ ﻛ��ﺎﻥ ﺍﻟ��ﻧﻘﺹ ﺷ��ﺩﻳﺩﺍً‪ .‬ﻳﺧﺗﻠ��ﻑ ﻧﻘ��ﺹ‬ ‫ﻓﻳﺗﺎﻣﻳﻥ ﻙ ﻋﻥ ﻋﺟﺯ ﺍﻟﻛﺑﺩ ﻓﻲ ﺃﻥ ﺍﻷﺧﻳﺭ ﻣﺻﺣﻭﺏ ﺑﻣﺿﺎﻋﻔﺎﺕ ﻭﻣﺷﺎﻛﻝ ﻛﺛﻳﺭﺓ‪ ،‬ﻛﻣ�ﺎ ﺫﻛ�ﺭﺕ‪،‬‬ ‫ﺃﻣﺎ ﻧﻘﺹ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ ﻓﻣﺷ�ﻛﻠﺗﻪ ﻧﺯﻓﻳّ�ﺔ ﻓﻘ�ﻁ‪ .‬ﻛ�ﺫﻟﻙ‪ ،‬ﻓ�ﺈﻥ ﻣ�ﺭﺽ ﺍﻟﻛﺑ�ﺩ ﺍﻟﻣ�ﺯﻣﻥ ﻳﻭﻟ�ﺩ ﻧﻘﺻ�ﺎ ً ﻓ�ﻲ‬ ‫ﻋﺎﻣﻝ ‪ 5‬ﺇﺿﺎﻓﺔ ﻟﻠﻌﻭﺍﻣﻝ ﺍﻷﺭﺑﻌﺔ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻋﻼﻩ‪ .‬ﻳﺣﺻﻝ ﺍﻟﻧﺯﻑ ﺑﺳﺑﺏ ﻧﻘﺹ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ ﻓ�ﻲ‬ ‫ﺍﻷﻁﻔﺎﻝ ﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﺇﺫﺍ ﻛﺎﻥ ﻟﺩﻯ ﺍﻷﻡ ﻧﻘﺹ ﻓﻲ ﺍﻟﻔﻳﺗﺎﻣﻳﻥ‪ .‬ﻛﻣﺎ ﻳﺣﺻﻝ ﻓ�ﻲ ﺃﻱ ﻋﻣ�ﺭ ﺇﺫﺍ ﻛ�ﺎﻥ‬ ‫ﺍﻟﻁﻌﺎﻡ ﻓﻘﻳﺭﺍً ﺑﺎﻟﻔﻳﺗﺎﻣﻳﻥ ﺍﻟﺫﻱ ﻳﻭﺟﺩ ﻓﻲ ﺩﻫﻭﻥ ﺍﻟﺣﻳﻭﺍﻥ ﻭﺯﻳﻭﺕ ﺍﻟﻧﺑﺎﺕ‪ .‬ﻭﻛ�ﺫﻟﻙ ﻓ�ﺈﻥ ﺍﻟﻣﺻ�ﺎﺑﻳﻥ‬ ‫ﺑﻣﺭﺽ ﺳﻭء ﺍﻣﺗﺻ�ﺎﺹ ﺍﻟ�ﺩﻫﻭﻥ ﻳﺻ�ﻝ ﺑﻬ�ﻡ ﺍﻷﻣ�ﺭ ﺇﻟ�ﻰ ﻧﻘ�ﺹ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ )ﺇﺿ�ﺎﻓﺔ ﺇﻟ�ﻰ ﻧﻘ�ﺹ‬ ‫ﻣﻭﺍﺩ ﺃﺧﺭﻯ ﻣﺧﺗﻠﻔﺔ(‪.‬‬ ‫ﻳﺻﺎﺏ ﺍﻷﻁﻔﺎﻝ ﺣﺩﻳﺛﻭ ﺍﻟﻭﻻﺩﺓ ﻋﺎﺩﺓ ﺑﺄﻧﺯﻓﺔ ﻭﺍﺳ�ﻌﺔ ﺗﺣ�ﺕ ﺍﻟﺟﻠ�ﺩ ﻓ�ﻲ ﺣ�ﺎﻻﺕ ﺍﻟ�ﻧﻘﺹ ﻭﻳﺻ�ﺎﺏ‬ ‫ﻏﻳﺭﻫﻡ ﺑﺄﻧﺯﻓﺔ ﺗﺣﺕ ﺍﻟﺟﻠﺩ ﻭﻣﻥ ﺍﻷﻧﻑ ﻭﺍﻟﻠﺛﺔ ﻭﺭﺑﻣﺎ ﺣﺗﻰ ﻓﻲ ﺍﻟﻣﺦ‪.‬‬ ‫ﻭﻳﻛﻭﻥ ﺗﺷﺧﻳﺹ ﺳﺑﺏ ﺍﻟﻧﺯﻑ ﺑﻔﺣﻭﺹ ﺍﻟﻣﺧﺑﺭ‪ ،‬ﻛﻣﺎ ﻓﻲ ﻋﺟﺯ ﺍﻟﻛﺑ�ﺩ‪ ،‬ﺇﺿ�ﺎﻓﺔ ﺇﻟ�ﻰ ﺍﻷﺩﻟ�ﺔ ﻏﻳ�ﺭ‬ ‫ﺍﻟﻣﺑﺎﺷﺭﺓ ﺍﻟﺗﻲ ﺗﺷﻳﺭ ﺇﻟﻰ ﺍﺣﺗﻣﺎﻝ ﻛﻭﻥ ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﻙ ﻫﻭ ﺍﻟﺳﺑﺏ ﺍﻟﻛﺎﻣﻥ ﻭﺭﺍء ﺍﻟﻣﺷﻛﻠﺔ‪.‬‬

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‫ﺃﻣﺎ ﺍﻟﻌﻼﺝ ﻓﻳﻛﻭﻥ ﺑﺗﻌﻭﻳﺽ ﺍﻟﻧﻘﺹ ﺑﺣﺑﻭﺏ ﺃﻭ ﺷﺭﺍﺏ ﻓﻳﺗﺎﻣﻳﻥ ﻙ‪ ،‬ﺇﺫﺍ ﺗﺄﻛﺩ ﺍﻟﻁﺑﻳ�ﺏ ﺃﻥ ﺍﻟ�ﻧﻘﺹ‬ ‫ﻫ��ﻭ ﻟ��ﻳﺱ ﻣ��ﻥ ﺳ��ﻭء ﺍﻻﻣﺗﺻ��ﺎﺹ‪ .‬ﻭﻓ��ﻲ ﺣ �ﺎﻝ ﺍﻟﺷ��ﻙ ﺑﺳ��ﻭء ﺍﻻﻣﺗﺻ��ﺎﺹ ﻓ��ﻲ ﺍﻷﻣﻌ��ﺎء ﻳُﻌﻁ��ﻰ‬ ‫ﺍﻟﻔﻳﺗﺎﻣﻳﻥ ﻋﻠﻰ ﺷﻛﻝ ﺣﻘ�ﻥ ﺑﺎﻟﻭﺭﻳ�ﺩ )ﻭﻟ�ﻳﺱ ﺑﺎﻟﻌﺿ�ﻝ ﺧﻭﻓ�ﺎ ً ﻣ�ﻥ ﺣﺻ�ﻭﻝ ﻧ�ﺯﻑ ﺩﺍﺧﻠﻬ�ﺎ ﻣ�ﻥ ﺃﺛ�ﺭ‬ ‫ﺇﺑﺭﺓ ﺍﻟﺣﻘﻧﺔ(‪.‬‬ ‫ﺝ‪ -‬ﻧﻘﺹ ﻋﻭﺍﻣ�ﻝ ﻣﺗﻌ�ﺩﺩﺓ ﺑﺳ�ﺑﺏ ﺗﻧ�ﺎﻭﻝ ﺍﻷﺩﻭﻳ�ﺔ ﺍﻟﻣﺿ�ﺎﺩﺓ ﻟﻔﻳﺗ�ﺎﻣﻳﻥ ﻙ‪ -‬ﻫ�ﺫﻩ ﺍﻷﺩﻭﻳ�ﺔ ﻳﺻ�ﻔﻬﺎ‬ ‫ﺍﻟﻁﺑﻳﺏ ﻟﻣﺭﺿﻰ ﻣﻌﻳّﻧﻳﻥ ﻳﺣﺗﺎﺟﻭﻥ ﺇﻟﻰ ﺗﻘﻠﻳﻝ ﻗﺎﺑﻠﻳﺔ ﺩﻣﺎﺋﻬﻡ ﻋﻠﻰ ﺍﻟﺗﺧﺛﺭ)ﺍﻧﻅﺭ ﺍﻟﻔﺻﻠﻳﻥ ﺍﻟﺭﺍﺑﻊ‬ ‫ﻭﺍﻟﺧ��ﺎﻣﺱ ﺣ��ﻭﻝ ﺳ��ﻳﻭﻟﺔ ﺍﻟ��ﺩﻡ(‪ ،‬ﻭﺃﺷ��ﻬﺭ ﻫ��ﺫﻩ ﺍﻷﺩﻭﻳ��ﺔ ﻫ��ﻭ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ )ﺃﻭ ﺍﻟﻛﻭﻣ��ﺎﺩﻳﻥ(‪ ،‬ﻭﻟﻛ��ﻥ‬ ‫ﻫﻧﺎﻙ ﺃﺩﻭﻳﺔ ﺃﺧﺭﻯ ﻣﻥ ﻧﻔﺱ ﺍﻟﻣﺟﻣﻭﻋﺔ ﺃﻗﻝ ﺍﺳﺗﻌﻣﺎﻻً )ﻣﺛﻝ ﺩﻧﺩﻳﻔﺎﻥ(‪ .‬ﻏﻧﻲّ ﻋ�ﻥ ﺍﻟﻘ�ﻭﻝ ﺃﻥ ﻫ�ﺫﻩ‬ ‫ﺍﻷﺩﻭﻳﺔ‪ ،‬ﻟﻛﻭﻧﻬﺎ ﺗﻌﻣﻝ ﺿﺩ ﻓﻳﺗﺎﻣﻳﻥ ﻙ‪ ،‬ﺗﺅﺩﻱ ﺇﻟ�ﻰ ﻧﻔ�ﺱ ﺍﻟﻧﺗ�ﺎﺋﺞ ﺍﻟﺗ�ﻲ ﺫﻛﺭﺗﻬ�ﺎ ﻋﻧ�ﺩ ﺍﻟﻛ�ﻼﻡ ﻋ�ﻥ‬ ‫ﻧﻘﺹ ﻓﻳﺗﺎﻣﻳﻥ ﻙ‪ ،‬ﻓﻧﻔﺱ ﺍﻟﻌﻭﺍﻣﻝ ﻳﻧﻘﺹ ﻣﻔﻌﻭﻟﻬﺎ‪ ،‬ﻭﻟﻧﻔﺱ ﺍﻟﺳﺑﺏ ﺍﻟﻣﺫﻛﻭﺭ ﻫﻧﺎﻙ‪.‬‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛ�ﺭ‪ ،‬ﻭﻫ�ﻭ ﺍﻟﻣﻁﻠ�ﻭﺏ ﻫﻧ�ﺎ ﻁ ّﺑﻳّ�ﺎً‪ ،‬ﻗ�ﺩ ﻳﻛ�ﻭﻥ ﺳ�ﺑﺑﺎ ً ﻓ�ﻲ ﺣﺻ�ﻭﻝ‬ ‫ﺇﻥ ﺍﻟﻧﻘﺹ ﻓﻲ ﻣﻔﻌﻭﻝ ﻋﻭﺍﻣﻝ‬ ‫ﺃﻧﺯﻓﺔ ﻟﺩﻯ ﺍﻟﻣﺭﻳﺽ ﺇﺫﺍ ﻛﺎﻥ ﺍﻟ�ﻧﻘﺹ ﺷ�ﺩﻳﺩﺍً‪ ،‬ﺃﻭ ﺇﺫﺍ ﻛ�ﺎﻥ ﺍﻟ�ﻧﻘﺹ ﺿ�ﻣﻥ ﺍﻟﺣ�ﺩﻭﺩ ﺍﻟﻣﻘﺑﻭﻟ�ﺔ ﻁﺑﻳّ�ﺎ ً‬ ‫ﻟﻛﻥ ﺍﻟﻣﺭﻳﺽ ﻧﻔﺳﻪ ﻟﺩﻳﻪ ﺳﺑﺏ ﻣﻭﺿﻌﻲ ﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺍﻟﻧﺯﻑ‪ .‬ﻭﻣﺛ�ﺎﻝ ﺫﻟ�ﻙ ﺗﻭﺳّ�ﻊ ﺃﻭﺭﺩﺓ ﺍﻷﻧ�ﻑ‬ ‫)ﺍﻟ�ﺫﻱ ﻗ��ﺩ ﻳ�ﺅ ّﺩﻱ ﺇﻟ��ﻰ ﺭﻋ�ﺎﻑ( ﻭﺍﻟﺗﻬ��ﺎﺏ ﺍﻟﻠﺛ�ﺔ ) ﺍﻟ��ﺫﻱ ﻗ�ﺩ ﻳ��ﺅ ّﺩﻱ ﺇﻟ�ﻰ ﻧ��ﺯﻑ ﻣ�ﻥ ﺍﻟﻠﺛ��ﺔ( ﻭﻗﺭﺣ��ﺔ‬ ‫ﺍﻟﻣﻌ��ﺩﺓ) ﺍﻟﺗ��ﻲ ﻗ��ﺩ ﺗ��ﺅ ّﺩﻱ ﺇﻟ��ﻰ ﻧ��ﺯﻑ ﺩﺍﺧﻠ��ﻲ(‪ ،‬ﻭﻫﻛ��ﺫﺍ‪ .‬ﻭﻓ��ﻲ ﻣﺛ��ﻝ ﻫ��ﺫﻩ ﺍﻟﺣ��ﺎﻻﺕ ﻳﻌﻣ��ﺩ ﺍﻷﻁ ّﺑ��ﺎء‬ ‫ﻟﻣﻌﺎﻟﺟﺔ ﺍﻟﻣﻭﺿﻊ ﺍﻟﻧﺎﺯﻑ ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻘﺭﺍﺭ ﻫﻭ ﺍﺳﺗﻣﺭﺍﺭ ﺇﻋﻁﺎء ﺍﻟﻣ�ﺭﻳﺽ ﻋﻘ�ﺎﺭ ﻣﻧ�ﻊ ﺍﻟﺗﺧﺛ�ﺭ ﺃﻭ‬ ‫ﺗﺳﻳﻳﻝ ﺍﻟﺩﻡ‪.‬‬ ‫ﺩ‪ -‬ﺗﺧﺛﺭﺍﺕ ﺍﻟﺩﻡ ﺍﻟﻣﻧﺗﺷﺭﺓ‬ ‫ﻟﻘﺩ ﺫﻛﺭﺕ ﻓﻲ ﺍﻟﻔﺻﻝ ﺍﻟﺳﺎﺑﻕ ﺃﻥ ﺍﻟﺩﻡ ﻻ ﻳﺗﺧﺛﺭ ﻓﻲ ﺍﻷﺣ�ﻭﺍﻝ ﺍﻟﻁﺑﻳﻌﻳ�ﺔ ﺩﺍﺧ�ﻝ ﺍﻷﻭﻋﻳ�ﺔ ﺍﻟﺩﻣﻭﻳ�ﺔ‬ ‫ﻟﻭﺟﻭﺩ ﻋﻭﺍﻣﻝ ﻣﺿﺎ ّﺩﺓ ﺗﻣﻧﻊ ﺫﻟ�ﻙ‪ ،‬ﺇﻻ ﻓ�ﻲ ﺍﻟﻣﻭﺍﺿ�ﻊ ﺍﻟﺗ�ﻲ ﺗﺣﺻ�ﻝ ﻓﻳﻬ�ﺎ ﺷ�ﺩﺓ ﺃﻭ ﺟ�ﺭﻭﺡ‪ .‬ﻟﻛﻧﻧ�ﺎ‬ ‫ﻫﻧ��ﺎ ﻧ��ﺗﻛﻠّﻡ ﻋ��ﻥ ﺃﻣ��ﺭﺍﺽ‪ ،‬ﺑﻌﺿ��ﻬﺎ ﺧﻁﻳ��ﺭ‪ ،‬ﺗ��ﺅﺩﻱ ﺇﻟ��ﻰ ﺣﺻ��ﻭﻝ ﺗﺧﺛ��ﺭﺍﺕ ﺻ��ﻐﻳﺭﺓ ﻣﻧﺗﺷ��ﺭﺓ ﻓ��ﻲ‬ ‫ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳﺔ ﺍﻟﺻﻐﻳﺭﺓ‪ ،‬ﻣﻣﺎ ﻳﺳ�ﺑﺏ ﺍﺳ�ﺗﻬﻼﻙ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ ﻭﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻓ�ﻲ ﺗﻠ�ﻙ ﺍﻟﺧﺛ�ﺭ‬ ‫ﺍﻟﻣﺗﻌﺩﺩﺓ‪.‬‬

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‫ﺗﺣﺻﻝ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺗﺧﺛﺭﺍﺕ ﻓﻲ ﺣ�ﺎﻻﺕ ﻣﺭﺿ�ﻳﺔ‪ ،‬ﺑﻌﺿ�ﻬﺎ ﻣﻌ�ﺭﻭﻑ ﺍﻟﺳ�ﺑﺏ ﻛﺎﻟﺗﺳ�ﻣﻡ ﺑ�ﺎﻟﺟﺭﺍﺛﻳﻡ‬ ‫ﻓ�ﻲ ﺣ�ﺎﻻﺕ ﺍﻻﻟﺗﻬﺎﺑ�ﺎﺕ ﺍﻟﺷ��ﺩﻳﺩﺓ ﺃﻭ ﺣ�ﺎﻻﺕ ﺍﻟﺣﻣ�ﻝ ﻣ�ﻊ ﺍﻟﺗﺳ��ﻣﻡ ﻭﺣ�ﺎﻻﺕ ﺍﻟﺳ�ﺭﻁﺎﻧﺎﺕ ﺍﻟﻣﻧﺗﺷ��ﺭﺓ‬ ‫ﻭﺣﺎﻻﺕ ﺃﺧﺭﻯ ُﺗﻌﺩ ﻣﻥ ﺃﻣﺭﺍﺽ ﺍﻟﺧﻠﻝ ﺍﻟﻣﻧﺎﻋﻲ ﻟﻛﻥ ﺣﻘﻳﻘﺔ ﺃﺳﺑﺎﺑﻬﺎ ﻏﻳﺭ ﻣﻌﺭﻭﻓﺔ ﺗﻣﺎﻣﺎ ً‪.‬‬ ‫ﺇﻥ ﻫ��ﺫﻩ ﺍﻷﻣ��ﺭﺍﺽ‪ ،‬ﺇﺿ��ﺎﻓﺔ ﺇﻟ��ﻰ ﻣﺎﻳﺣﺻ��ﻝ ﻓﻳﻬ��ﺎ ﻣ��ﻥ ﻧ��ﺯﻑ ﻓ��ﻲ ﺣ��ﺎﻻﺕ ﺍﻟ��ﻧﻘﺹ ﺍﻟﺷ��ﺩﻳﺩ ﻓ��ﻲ‬ ‫ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻟﻬﺎ ﺃﻋﺭﺍﺿﻬﺎ ﺍﻟﺧﺎﺻﺔ ﻭﺍﻟﺗﻲ ﺗﺳﺑﺑﻬﺎ ﺍﻟﺗﺧﺛﺭﺍﺕ ﻧﻔﺳﻬﺎ‪ ،‬ﻓ�ﻲ ﺍﻟﻛﻠ�ﻰ‬ ‫ﺃﻭ ﺍﻟﻣﺦ ﺃﻭ ﺍﻟﺟﻠﺩ ﺃﻭ ﻏﻳﺭﻫ�ﺎ‪ ،‬ﻓﺗﻣﺗ�ﺯﺝ ﺃﻋ�ﺭﺍﺽ ﺍﻟﺗﺧﺛ�ﺭ ﻣ�ﻊ ﺃﻋ�ﺭﺍﺽ ﺍﻟﻧ�ﺯﻑ‪ .‬ﻭﺇﺫﺍ ﻛ�ﺎﻥ ﻫﻧ�ﺎﻙ‬ ‫ﺗﺧﺛﺭﺍﺕ ﺷﺩﻳﺩﺓ ﻓﻲ ﺍﻟﻛﻠﻰ ﻓﻘﺩ ﻳﺣﺻﻝ ﻋﺟﺯ ﻓﻳﻬﺎ‪ .‬ﻭﻗ�ﺩ ﺗﻛ�ﻭﻥ ﻫﻧ�ﺎﻙ ﺃﻋ�ﺭﺍﺽ ﻋﺻ�ﺑﻳﺔ ﻣﺧﺗﻠﻔ�ﺔ‪.‬‬ ‫ﻛﺫﻟﻙ ﻓﺈﻥ ﺍﻟﺷﺧﺹ ﺍﻟﻣﺻﺎﺏ ﺑﺗﺳﻣﻡ ﺟﺭﺛ�ﻭﻣﻲ ﻳﻛ�ﻭﻥ ﻣﺭﻳﺿ�ﺎ ً ﺟ� ّﺩﺍً ﺑﺳ�ﺑﺏ ﺍﻟﻣ�ﺭﺽ ﻧﻔﺳ�ﻪ‪ ،‬ﻣ�ﻥ‬ ‫ﻗﺑﻝ ﺃﻥ ﻳﺻﺎﺏ ﺑﺎﻟﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ‪ .‬ﻭﺍﻟﻣﺭﻳﺽ ﺍﻟﺫﻱ ﻟﺩﻳﻪ ﺳﺭﻁﺎﻥ ﻣﻧﺗﺷﺭ ﻳﻌﺎﻧﻲ ﻣﻥ ﺃﻋ�ﺭﺍﺽ‬ ‫ﺗﻠﻙ ﺍﻟﺳﺭﻁﺎﻧﺎﺕ‪ .‬ﻭﺑ�ﺫﻟﻙ ﺗﻛ�ﻭﻥ ﺑﻌ�ﺽ ﻫ�ﺫﻩ ﺍﻟﺣ�ﺎﻻﺕ ﻣﻌﻘّ�ﺩﺓ ﺟ� ّﺩﺍً‪ ،‬ﻭﺃﺣ�ﺩ ﺃﻭﺟ�ﻪ ﺍﻟﻣ�ﺭﺽ ﻳﻛ�ﻭﻥ‬ ‫ﻣﻭﺿﻭﻉ ﺍﻟﻧﺯﻑ ﺑﺳﺑﺏ ﺍﻟﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ‪.‬‬ ‫ﺃﻭ ّﺩ ﺃﻥ ﺃﻧﺑ��ﻪ ﻫﻧ��ﺎ ﺇﻟ��ﻰ ﺃﻥ ﺧﺛ��ﺭﺓ ﻭﺍﺣ��ﺩﺓ ﻛﺑﻳ��ﺭﺓ ﻓ��ﻲ ﺃﺣ��ﺩ ﺍﻟﺷ��ﺭﺍﻳﻳﻥ ﺃﻭ ﺍﻷﻭﺭﺩﺓ )ﺍﻟﺟﻠﻁ��ﺔ‪ ،‬ﺍﻧﻅ��ﺭ‬ ‫ﺍﻟﻔﺻﻝ ﺍﻟﺭﺍﺑﻊ( ﻻ ﺗﻘﻊ ﺿﻣﻥ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻣﻥ ﺍﻷﻣﺭﺍﺽ‪ ،‬ﺣﻳﺙ ﺃﻧﻬﺎ ﺗﺳ�ﺗﻬﻠﻙ ﻛﻣﻳ�ﺔ ﻣﺣ�ﺩﻭﺩﺓ‬ ‫ﻣ��ﻥ ﻋﻭﺍﻣ��ﻝ ﺍﻟﺗﺧﺛ��ﺭ ﻭﺍﻟﺻ��ﻔﻳﺣﺎﺕ‪ .‬ﻭﻣ��ﺎ ﻧﺑﺣﺛ��ﻪ ﻫﻧ��ﺎ ﻫ��ﻭ ﻣﻼﻳ��ﻳﻥ ﺍﻟﺧﺛ��ﺭﺍﺕ ﺍﻟﺻ��ﻐﻳﺭﺓ ﻓ��ﻲ ﺃﻧﺣ��ﺎء‬ ‫ﺍﻟﺟﺳﻡ ﺍﻟﻣﺧﺗﻠﻔﺔ‪.‬‬ ‫ﺇﻥ ﺃﻋﺭﺍﺽ ﺍﻟﻧﺯﻑ ﺗﻛﻭﻥ ﻣﺷﺗﺭﻛﺔ ﺑﻳﻥ ﺗﻠﻙ ﺍﻟﻧﺎﺗﺟﺔ ﻋﻥ ﻧﻘﺹ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﺍﻷﺧﺭﻯ ﺍﻟﺗﻲ ﺗﻧﺗﺞ‬ ‫ﻋﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪ .‬ﺃﻣﺎ ﻋﻼﺝ ﻫﺫﻩ ﺍﻷﻋﺭﺍﺽ ﻓﻳﻛ�ﻭﻥ )ﺇﺿ�ﺎﻓﺔ ﻟﻌ�ﻼﺝ ﺍﻟﻣ�ﺭﺽ ﺍﻷﺻ�ﻠﻲ‬ ‫ﺇﻥ ﺃﻣﻛﻥ( ﺑﺗﻌﻭﻳﺽ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛ�ﺭ)ﺑﻼﺯﻣ�ﺎ ﺃﻭ ﺭﺍﺳ�ﺏ ﻗ�ﺭّﻱ( ﻭﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻣ�ﻥ ﺑﻧ�ﻙ ﺍﻟ�ﺩﻡ‪ .‬ﻓ�ﻲ‬ ‫ﺑﻌﺽ ﺍﻟﺣﺎﻻﺕ ﻓﻘﻁ ﻳﻌﻁﻲ ﺑﻌﺽ ﺍﻷﻁﺑﺎء ﻟﻠﻣﺭﻳﺽ ﻣﺳﺗﺣﺿﺭﺍﺕ ﻣﺿ�ﺎ ّﺩﺓ ﻟﻠﺗﺧﺛ�ﺭ‪ ،‬ﻟﻛ�ﻥ ﺑﺣ�ﺫﺭ‬ ‫)ﺣﻳ��ﺙ ﺃﻥ ﺍﻟﻣ��ﺭﻳﺽ ﻟﺩﻳ��ﻪ ﻧ��ﺯﻑ( ﻭﺫﻟ��ﻙ ﻹﻳﻘ��ﺎﻑ ﺩﻭﺭﺓ ﺍﻟﺗﺧﺛ��ﺭﺍﺕ ﺍﻟﺗ��ﻲ ﺗﺳ��ﺑﺏ ﺍﻟﻧ��ﺯﻑ‪ ،‬ﺑﻣﻧ��ﻊ‬ ‫ﺍﻷﻭﻟﻰ ﻣﻥ ﺍﻻﺳﺗﻣﺭﺍﺭ ﻓﻲ ﺍﻟﺗﻭﻟّﺩ‪.‬‬ ‫ﻫـ‪ -‬ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺗﺧﺛﺭ ﻓﻲ ﺑﻌﺽ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻣﻛﺗﺳﺑﺔ‬ ‫ﻳﺣﺻﻝ ﻧﻘﺹ ﻏﻳﺭ ﺩﺍﺋﻣﻲ ﻓﻲ ﺣﺎﻻﺕ ﻧﺎﺩﺭﺓ ﻣﻥ ﺍﻟﻣﺭﺿﻰ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺄﻣﺭﺍﺽ ﻣﻧﺎﻋﻳ�ﺔ ﻭﺑﻌ�ﺽ‬ ‫ﺃﻣﺭﺍﺽ ﺍﻟﻛﻠﻰ ﻭﺣﺎﻻﺕ ﻏﻳ�ﺭ ﻣﺣ�ﺩﺩﺓ ﻣ�ﻥ ﺍﻻﻟﺗﻬﺎﺑ�ﺎﺕ‪ .‬ﻭﺃﻛﺛ�ﺭ ﻋﺎﻣ�ﻝ ﻳﺗﻌ�ﺭﺽ ﻟﻠ�ﻧﻘﺹ ﻓ�ﻲ ﻫ�ﺫﻩ‬ ‫ﺍﻟﺣ��ﺎﻻﺕ ﺍﻟﻧ��ﺎﺩﺭﺓ ﻫ��ﻭ ﻋﺎﻣ��ﻝ ‪ ،8‬ﺇﻻ ﺃﻥ ﻋﻭﺍﻣ��ﻝ ﺃﺧ��ﺭﻯ ﺣﺻ��ﻝ ﻟﻬ��ﺎ ﻧﻘ��ﺹ ﻓ��ﻲ ﺑﻌ��ﺽ ﺍﻟﺣ��ﺎﻻﺕ‬

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‫ﺍﻟﻣﺭﺿﻳﺔ‪ .‬ﺇﻥ ﻣﻔﻌﻭﻝ ﻫﺫﻩ ﺍﻟﻣﺷﻛﻠﺔ ﻭﺃﻋﺭﺍﺿﻬﺎ ﻭﺗﺷﺧﻳﺻﻬﺎ ﻭﻋﻼﺟﻬﺎ ﻻ ﺗﺧﺗﻠ�ﻑ ﻋ�ﻥ ﺍﻷﺳ�ﺑﺎﺏ‬ ‫ﺍﻟﻣﻭﺭﻭﺛﺔ ﻟﻠﻧﻘﺹ‪ ،‬ﺳﻭﻯ ﺑﻭﺟﻭﺩ ﺍﻷﻣﺭﺍﺽ ﺍﻷﻭﻟﻳﺔ ﺍﻟﻣﺳﺑّﺑﺔ ﻟﻠﻧﻘﺹ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻣﻛﺗﺳﺑﺔ‪.‬‬ ‫ﻭ‪ -‬ﻣﺿﺎ ّﺩﺍﺕ ﺗﺧ ّﺛﺭ ﻣﺗﺳﺑﺑﺔ ﻋﻥ ﺃﻣﺭﺍﺽ ﻣﺧﺗﻠﻔﺔ ‪:‬‬ ‫ﺃﻛﺛﺭ ﻫﺫﻩ ﺍﻟﻣﺿﺎ ّﺩﺍﺕ ﺷﻳﻭﻋﺎ ً ﻫ�ﻲ ﻣﺿ�ﺎ ّﺩﺍﺕ ﻟﻠﻌﺎﻣ�ﻝ‪ ،8‬ﻭﻳﻧﺗﺟﻬ�ﺎ ﺍﻟﺟﻬ�ﺎﺯ ﺍﻟﻣﻧ�ﺎﻋﻲ ﺿ�ﺩ ﻋﺎﻣ�ﻝ‪8‬‬ ‫ﺍﻟﻌﺎﺋﺩ ﻟﻧﻔﺱ ﺍﻟﺷﺧﺹ‪ .‬ﺃﻱ ﺃﻥ ﺷﺫﻭﺫﺍً ﻳﺣﺻﻝ ﺑﺎﻟﺟﻬﺎﺯ ﺍﻟﻣﻧﺎﻋﻲ ﻳﺟﻌﻠﻪ ﻳﻔﺷ�ﻝ ﻓ�ﻲ ﺍﻟﺗﻌ�ﺭّﻑ ﻋﻠ�ﻰ‬ ‫ﻣﻛﻭﻧ�ﺎﺕ ﺍﻟﺟﺳ�ﻡ ﺍﻟ��ﺫﻱ ﻫ�ﻭ ﻣﻧ��ﻪ‪ .‬ﻳﺣﺻ�ﻝ ﺫﻟ��ﻙ ﻓ�ﻲ ﺃﻣ�ﺭﺍﺽ ﺫﺍﺗﻳ��ﺔ ﺍﻟﻣﻧﺎﻋ�ﺔ ﻣﺛ��ﻝ ﺍﻟﻣ�ﺭﺽ ﺍﻟ��ﺫﻱ‬ ‫ﻳُﻁﻠﻕ ﻋﻠﻳﻪ ﺍﺳﻡ ﺍﻟﺫﺋﺏ ﺍﻻﺣﻣﺭﺍﺭﻱ‪ ،‬ﻭﻳﺣﺻﻝ ﻛﺫﻟﻙ ﻓﻲ ﺣﺎﻻﺕ ﻗﻠﻳﻠﺔ ﻣﻥ ﺍﻟﺣﻣﻝ‪.‬‬ ‫ﺇﻥ ﺍﻟﻧﺗ��ﺎﺋﺞ ﺍﻟﻣﺭﺿ��ﻳﺔ ﻟﻠﻣﺿ��ﺎﺩﺍﺕ ﻻ ﺗﺧﺗﻠ��ﻑ ﻋ��ﻥ ﺣ��ﺎﻻﺕ ﻧﻘ��ﺹ ﺍﻟﻌﻭﺍﻣ��ﻝ ﺇﻻ ﺃﻥ ﺍﻟﺗﺷ��ﺧﻳﺹ‬ ‫ﺍﻟﻣﺧﺑ��ﺭﻱ ﻟﻠﺗﺄﻛ��ﺩ ﻣ��ﻥ ﻭﺟ��ﻭﺩ ﺍﻟﻣﺿ��ﺎﺩﺍﺕ ﺃﺻ��ﻌﺏ ﻣ��ﻥ ﻓﺣ��ﻭﺹ ﺍﻟﻛﺷ��ﻑ ﻋ��ﻥ ﺍﻟ��ﻧﻘﺹ‪ ،‬ﻛﻣ��ﺎ ﺃﻥ‬ ‫ﺍﻟﻌﻼﺝ ﺃﺻﻌﺏ ﻣ�ﻥ ﻋ�ﻼﺝ ﺣ�ﺎﻻﺕ ﺍﻟ�ﻧﻘﺹ ﻷﻥ ﻋﺎﻣ�ﻝ‪ 8‬ﺍﻟﻣﺭ ّﻛ�ﺯ ﺍﻟ�ﺫﻱ ﻳُﻌﻁ�ﻰ ﻟﻠﻣ�ﺭﻳﺽ ﻳُﺑﻁ�ﻝ‬ ‫ﻣﻔﻌﻭﻟ��ﻪ ﺑﺎﻷﺟﺳ��ﺎﻡ ﺍﻟﻣﺿ��ﺎﺩﺓ ﺍﻟﻣﻭﺟ��ﻭﺩﺓ ﻓ��ﻲ ﺩﻣ��ﻪ‪ .‬ﻟ �ﺫﺍ ﻳﺣﺗ��ﺎﺝ ﺍﻟﻣ��ﺭﻳﺽ ﺇﻟ��ﻰ ﻛﻣ ّﻳ��ﺎﺕ ﺃﻛﺑ �ﺭ ﻣ��ﻥ‬ ‫ﻋﺎﻣﻝ‪ 8‬ﺍﻟﻣﺭ ّﻛﺯ ﻟﻠﺗﻐﻠّﺏ ﻋﻠﻰ ﺍﻷﺟﺳﺎﻡ ﺍﻟﻣﺿﺎﺩﺓ‪.‬‬ ‫ﺯ‪-‬ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻭﻣﺷﺗ ّﻘﺎﺗﻪ ﻭﺍﻟﻣﺳﺗﺣﺿﺭﺍﺕ ﺍﻟﻣﺷﺎﺑﻬﺔ ﻟﻪ‬ ‫ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻣﻥ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻭﺍﻟﺗﻲ ُﺗﺳﺗﻌﻣﻝ ﻛﻌﻘ�ﺎﺭﺍﺕ‪ ،‬ﻭﻣﻌﻅﻣﻬ�ﺎ ﻳُﺳ�ﺗﺧﺭﺝ ﻣ�ﻥ ﺃﻧﺳ�ﺟﺔ‬ ‫ﺣﻳﻭﺍﻧﺎﺕ ﻣﺧﺗﻠﻔﺔ‪ ،‬ﺗﺧﺗﻠﻑ ﻁﺭﻳﻘﺔ ﻋﻣﻠﻬﺎ ﻋﻥ ﻣﺿﺎﺩﺍﺕ ﻓﻳﺗﺎﻣﻳﻥ ﻙ ﻭﺳﻳﺭﺩ ﺗﻔﺻﻳﻝ ﻋﻥ ﺍﻟﻧ�ﻭﻋﻳﻥ‬ ‫ﻣﻥ ﺍﻟﻣﺿﺎﺩﺍﺕ ﻓﻲ ﺍﻟﻔﺻﻝ ﺍﻟﺭﺍﺑﻊ‪ .‬ﻫﺫﻩ ﺍﻟﻣﻭﺍﺩ‪ ،‬ﺇﺫﺍ ﺃُﻋﻁﻳﺕ ﻟﻣﻧ�ﻊ ﺍﻟﺗﺧﺛ�ﺭ ﻭﺯﺍﺩﺕ ﺟﺭﻋﺗﻬ�ﺎ ﻋ�ﻥ‬ ‫ﺍﻟﺣﺩ ﺍﻟﻣﻘﺑﻭﻝ ﻓﻘﺩ ﺗﺗﺳﺑّﺏ ﻓﻲ ﺃﻧﺯﻓﺔ ﺑﻣﻭﺍﻗﻊ ﻣﺧﺗﻠﻔﺔ ﻣ�ﻥ ﺍﻟﺟﺳ�ﻡ‪ .‬ﻭﻋ�ﻼﺝ ﺍﻟﺟﺭﻋ�ﺔ ﺍﻟﺯﺍﺋ�ﺩﺓ ﻳﻛ�ﻭﻥ‬ ‫ﺑﺈﻧﻘﺎﺹ ﺍﻟﺟﺭﻋﺔ ﻭ ﺑﺈﻋﻁﺎء ﻣﺎﺩﺓ ﺍﻟﺑﺭﻭﺗﺎﻣﻳﻥ ﺣﻘﻧﺎ ً ﺑﺎﻟﻭﺭﻳﺩ ﻭﻳﻛﻭﻥ ﻣﻔﻌﻭﻟﻪ ﺍﻟﻣﺿﺎﺩ ﻓﻭﺭ ّﻳﺎ ً‪.‬‬

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‫ﺍﻟﻔﺼﻞ ﺍﻟﺜﺎﻟﺚ‬

‫ﺃﻣﺮﺍﺽ ﻓﺮﻁ ﺍﻟﺘﺨﺜـــﺮ‬

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‫أﻣﺮاض ﻓﺮط اﻟﺘﺨﺜﺮ‬ ‫ﻣﻘﺩّ ﻣــﺔ‬

‫ﻗﺑﻝ ﺃﻥ ﺃﺑﺩﺃ ﺑﺷﺭﺡ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻳﺟﺏ ﺍﻟﺗﺄﻛﻳﺩ ﻟﻠﻘﺎﺭﺉ ﻋﻠﻰ ﻧﻘﻁﺔ ﻣﻬﻣ�ﺔ ﺗﺳ�ﺎﻋﺩ ﻋﻠ�ﻰ ﺗﻭﺿ�ﻳﺢ‬ ‫ﻣﻔﻬﻭﻡ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ‪ .‬ﻓﺎﻟﻛﺛﻳﺭ ﻣ�ﻥ ﺍﻟﻧ�ﺎﺱ ﻳﻅ�ﻥ ﺃﻥ ﺣﺻ�ﻭﻝ ﺗﺧﺛ�ﺭ ﺃﻭ ﺟﻠﻁ�ﺔ ﻟ�ﺩﻯ ﻣ�ﺭﻳﺽ) ﻣﺛ�ﻝ‬ ‫ﺟﻠﻁﺔ ﺍﻟﻣﺦ ﺃﻭ ﻓﻲ ﺃﻭﺭﺩﺓ ﺍﻟﺳ�ﺎﻕ ﺃﻭ ﻓ�ﻲ ﺍﻟﺷ�ﺭﺍﻳﻳﻥ ﺍﻟﺗﺎﺟﻳ�ﺔ ﺑﺎﻟﻘﻠ�ﺏ ﻭﺃﻣﺛﺎﻟﻬ�ﺎ( ﻫ�ﻲ ﻣ�ﻥ ﺃﻣ�ﺭﺍﺽ‬ ‫ﻓ��ﺭﻁ ﺍﻟﺗﺧﺛ��ﺭ‪ .‬ﻭﺭﺑﻣ��ﺎ ﻳﺗﻭﻗ��ﻊ ﺍﻟ��ﺑﻌﺽ ﺃﻥ ﺃﻗ��ﻭﻡ ﺑﺷ��ﺭﺣﻬﺎ ﻓ��ﻲ ﻫ��ﺫﺍ ﺍﻟﻔﺻ��ﻝ ﻣ��ﻥ ﺍﻟﻛﺗ��ﺎﺏ‪ .‬ﺇﻥ ﻫ��ﺫﻩ‬ ‫ﺍﻟﺣ��ﻭﺍﺩﺙ ﺍﻟﻣﺭﺿ��ﻳﺔ ﻣﺛﻠﻬ��ﺎ ﻛﻣﺛ��ﻝ ﻣ��ﻥ ﻳﺻ��ﺎﺏ ﺑﻧ��ﺯﻑ ﺟ��ﺭﺍء ﻗﻁ��ﻊ ﺑﺳ � ّﻛﻳﻥ‪ ،‬ﻓﻬ��ﻭ ﻟ��ﻳﺱ ﻣﺻ��ﺎﺑﺎ ً‬ ‫ﺑﻣﺭﺽ ﻧﺯﻓﻲ‪ .‬ﺃﻣّ�ﺎ ﺇﺫﺍ ﺣﺻ�ﻝ ﺍﻟﻧ�ﺯﻑ ﺩﻭﻥ ﺳ�ﺑﺏ ﻣﻭﺿ�ﻌﻲ‪ ،‬ﺃﻭ ﺇﺫﺍ ﺣﺻ�ﻝ ﻧ�ﺯﻑ ﺷ�ﺩﻳﺩ ﺟ�ﺭﺍء‬ ‫ﺷﺩﺓ ﺑﺳﻳﻁﺔ ﻏﻳﺭ ﻣﺗﻧﺎﺳﺑﺔ ﻣﻊ ﺷ�ﺩﺓ ﺍﻟﻧ�ﺯﻑ ﻓ�ﺎﻷﻣﺭ ﻳﺣﺗ�ﺎﺝ ﺇﻟ�ﻰ ﺑﺣ�ﺙ ﻟﻠﺗﺄﻛ�ﺩ ﻣ�ﻥ ﻭﺟ�ﻭﺩ ﻣ�ﺭﺽ‬ ‫ﻧﺯﻓﻲ‪.‬‬ ‫ﻛ��ﺫﻟﻙ ﺍﻟﺣ��ﺎﻝ ﺑﺎﻟﻧﺳ��ﺑﺔ ﻟﻠﺗﺧﺛ��ﺭ‪ ،‬ﻓ��ﺈﻥ ﺣﺻ��ﻭﻝ ﺟﻠﻁ��ﺔ ﺑﺳ��ﺑﺏ ﻣ��ﺭﺽ ﻣﻭﺿ��ﻌﻲ )ﻣﺛ��ﻝ ﺗﺻ��ﻠّﺏ‬ ‫ﺍﻟﺷ��ﺭﺍﻳﻳﻥ ﻭﺍﻟﺗﺭﺳ��ﺑﺎﺕ ﺍﻟﺩﻫﻧﻳ��ﺔ ﻓ��ﻲ ﺟ��ﺩﺭﺍﻧﻬﺎ( ﻻ ﻳ��ﺩﺧﻝ ﺿ��ﻣﻥ ﺃﻣ��ﺭﺍﺽ ﻓ��ﺭﻁ ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﻟﻛ��ﻥ‬ ‫ﺍﻟﻣﺻ��ﺎﺏ ﺑﺄﺣ��ﺩ ﺃﻣ��ﺭﺍﺽ ﻓ��ﺭﻁ ﺍﻟﺗﺧﺛ��ﺭ ﺍﻟﻣﻭﺭﻭﺛ��ﺔ ﺃﻭ ﺍﻟﻣﻛﺗﺳ��ﺑﺔ ﻳﻛ��ﻭﻥ ﻟﺩﻳ��ﻪ ﺍﺳ��ﺗﻌﺩﺍﺩ ﻟﻺﺻ��ﺎﺑﺔ‬ ‫ﺑﺟﻠﻁ�ﺔ ﺷ�ﺭﻳﺎﻧﻳﺔ ﺃﻭ ﻭﺭﻳﺩﻳ��ﺔ ﺩﻭﻥ ﺃﻥ ﻳﻛ�ﻭﻥ ﻓﻳﻬﻣ��ﺎ ﻣ�ﺭﺽ ﻣﻭﺿ�ﻌﻲ‪ ،‬ﺃﻭ ﺭﺑﻣ��ﺎ ﺑﻭﺟ�ﻭﺩ ﺗﻐ ّﻳ��ﺭﺍﺕ‬ ‫ﻣﻭﺿﻌﻳﺔ ﺑﺳﻳﻁﺔ ﻻ ﺗﺳﺑﺏ ﺟﻠﻁﺔ ﻓﻲ ﻏﻳﺭﻩ ﻣﻥ ﺍﻟﻧﺎﺱ‪.‬‬ ‫ّ‬ ‫ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻛﺄﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ‪ ،‬ﻫﻲ ﺃﻣ�ﺭﺍﺽ ﺑﺎﻟ�ﺩﻡ ﻭﻟﻳﺳ�ﺕ ﺃﻣﺭﺍﺿ�ﺎ ً ﺑ�ﺎﻷﻭﺭﺩﺓ‬ ‫ﻓﺄﻣﺭﺍﺽ ﻓﺭﻁ‬ ‫ﺃﻭ ﺍﻟﺷ��ﺭﺍﻳﻳﻥ‪ .‬ﻭﺍﻟﻣﺻ��ﺎﺑﻭﻥ ﺑ��ﺄﻣﺭﺍﺽ ﻓ��ﺭﻁ ﺍﻟﺗﺧﺛ��ﺭ ﻛﺛﻳ��ﺭﺍً ﻣ��ﺎ ﻳﻛﻭﻧ��ﻭﻥ ﺣ��ﺎﻣﻠﻳﻥ ﻟﻠﻣ��ﺭﺽ ﺩﻭﻧﻣ��ﺎ‬ ‫ﺣﺻﻭﻝ ﺟﻠﻁﺎﺕ ﻓﻌﻠﻳﺔ ﻟﺩﻳﻬﻡ ﺇﻻ ﺇﺫﺍ ﺗﻌ ّﺭﺿﻭﺍ ﻟﻅﺭﻑ ﻳﺯﻳﺩ ﻣﻥ ﺍﺣﺗﻣﺎﻝ ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻭﺍﻟﻅﺭﻭﻑ ﺍﻟﺗﻲ ﺗﺅﺩﻱ ﻻﺯﺩﻳﺎﺩ ﺍﻟﻣﻳﻝ ﻟﻠﺗﺧﺛ�ﺭ ﻗ�ﺩ ﺗﺣﺻ�ﻝ ﻟ�ﺩﻯ ﻛ�ﻝ ﺍﻟﻧ�ﺎﺱ ﻓ�ﻲ ﺃﻣﺛ�ﺎﻝ ﺍﻟﺣ�ﺎﻻﺕ‬ ‫ﺍﻟﺗﺎﻟﻳﺔ‪:‬‬ ‫‪ .1‬ﺑﻌﺩ ﺍﻟﻌﻣﻠﻳﺎﺕ ﺍﻟﺟﺭﺍﺣﻳﺔ ﺍﻟﻛﺑﺭﻯ ﻭﺍﻟﻛﺳﻭﺭ ﺍﻟﻣﻬﻣﺔ‪ -‬ﻭﺯﻳﺎﺩﺓ ﻓﻌﺎﻟﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻫﻧﺎ ﺷ�ﻲء ﻁﺑﻳﻌ�ﻲ‬ ‫ﺗﻣﺎﻣﺎً‪ ،‬ﻓﺈﻥ ﺍﻟﺟﺳ�ﻡ ﺍﻟ�ﺫﻱ ﻳﺗﻌ�ﺭﺽ ﻟﻠﺟﺭﺍﺣ�ﺔ ﺃﻭ ﺍﻟﻛﺳ�ﻭﺭ ﺑﺣﺎﺟ�ﺔ ﺇﻟ�ﻰ ﺗﻧﺷ�ﻳﻁ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ‬ ‫ﻟﻭﻗ��ﻑ ﺍﻟﻧ��ﺯﻑ‪ ،‬ﻭﻫ��ﺫﻩ ﺭﺩﺓ ﻓﻌ��ﻝ ﻁﺑﻳﻌﻳ��ﺔ‪ .‬ﻛ��ﺫﻟﻙ ﻓ��ﺈﻥ ﺍﻟﻣ��ﺭﻳﺽ ﺑﻌ��ﺩ ﺍﻟﻌﻣﻠﻳ��ﺎﺕ ﺍﻟﺟﺭﺍﺣﻳ��ﺔ‬ ‫ﺍﻟﻛﺑﻳﺭﺓ‪ ،‬ﻭﻛﺫﻟﻙ ﺑﻌﺩ ﻛﺳﻭﺭ ﺍﻟﻌﻅﺎﻡ ﺍﻟﺭﺋﻳﺳﻳﺔ‪ ،‬ﻳُﺗﻭﻗﻊ ﺃﻥ ﻳﻛﻭﻥ ﺑﺎﻟﻔﺭﺍﺵ‪ ،‬ﻭﺣﺭﻛﺗﻪ ﻣﺣ�ﺩﻭﺩﺓ‪،‬‬

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‫ﻣﻣﺎ ّ‬ ‫ﻳﺑﻁﺊ ﺟﺭﻳﺎﻥ ﺍﻟﺩﻡ ﺑﺎﻷﻭﺭﺩﺓ‪ .‬ﻭﻛﻝ ﺇﻧﺳﺎﻥ‪ ،‬ﻻﺳﻳّﻣﺎ ﻛﺑﺎﺭ ﺍﻟﺳﻥ‪ ،‬ﻣﻌﺭﱠ ﺽ ﻟﺣﺻﻭﻝ ﺗﺟﻠّ�ﻁ‬ ‫ﻓ�ﻲ ﺃﻭﺭﺩﺓ ﺍﻟﺳ�ﺎﻗﻳﻥ ﻓ�ﻲ ﻫ�ﺫﻩ ﺍﻟﺣ�ﺎﻻﺕ‪ .‬ﻭﻳﺣﺻ�ﻝ ﺫﻟ�ﻙ ﻓﻌ�ﻼً ﻓ�ﻲ ﻧﺳ�ﺑﺔ ﻗﻠﻳﻠ�ﺔ ﻣ�ﻧﻬﻡ‪ ،‬ﻭﺗﺗﺑ��ﺎﻳﻥ‬ ‫ﺍﻟﻧﺳﺑﺔ ﻫﺫﻩ ﺑﺣﺳﺏ ﻧﻭﻉ ﺍﻟﻌﻣﻠﻳﺔ ﻭﻋﻣﺭ ﺍﻟﻣﺭﻳﺽ ﻭﻗﻠﺔ ﺣﺭﻛﺗ�ﻪ‪ .‬ﻟﻛ�ﻥ ﺍﻟﻧﺳ�ﺑﺔ ﺗﺭﺗﻔ�ﻊ ﺇﺫﺍ ﻛ�ﺎﻥ‬ ‫ﻟ��ﺩﻯ ﺍﻟﻣ��ﺭﻳﺽ‪ ،‬ﺇﺿ��ﺎﻓﺔ ﺇﻟ��ﻰ ﺣﺎﻟ��ﺔ ﺍﻟﻌﻣﻠﻳ��ﺔ ﺃﻭ ﺍﻟﻛﺳ��ﺭ‪ ،‬ﻣ��ﺭﺽ ﻓ��ﺭﻁ ﺗﺧﺛ��ﺭ ﻣ��ﻭﺭﻭﺙ ﻗ��ﺩ ﻻ‬ ‫ﻳﻛ�ﻭﻥ ﻋﻠ��ﻰ ﻋﻠ��ﻡ ﺑ��ﻪ‪ .‬ﻓﻬﻧ�ﺎ ﺗﺟﺗﻣ��ﻊ ﻋﻠ��ﻰ ﺍﻟﻣ��ﺭﻳﺽ ﺣﺎﻟﺗ�ﺎﻥ ﺗﺳ��ﺎﻋﺩﺍﻥ ﻋﻠ��ﻰ ﺍﻟﺗﺧﺛ��ﺭ ﻓﻳﺣﺻ��ﻝ‬ ‫ﻋﻧﺩﻩ ﺗﺧﺛﺭ‪ ،‬ﻓﻲ ﺃﻭﺭﺩﺓ ﺃﺣﺩ ﺍﻟﺳﺎﻗﻳﻥ ﻋﺎﺩﺓ‪.‬‬ ‫‪ .2‬ﺧﻼﻝ ﺍﻷﺷﻬﺭ ﺍﻷﺧﻳﺭﺓ ﻣﻥ ﺍﻟﺣﻣﻝ‪ -‬ﻓﻲ ﻫﺫﺍ ﺍﻟﻅﺭﻑ ﺃﻳﺿ�ﺎ ً ﻳﺣﺗ�ﺎﺝ ﺟﺳ�ﻡ ﺍﻟﻣ�ﺭﺃﺓ ﺇﻟ�ﻰ ﺗﻧﺷ�ﻳﻁ‬ ‫ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﺣﻳﺙ ﺃﻧﻬﺎ ﻣﻌﺭﱠ ﺿﺔ ﻟﻠﻧ�ﺯﻑ ﻣ�ﻥ ﻣﻭﻗ�ﻊ ﺍﺗﺻ�ﺎﻝ ﺍﻟﻣﺷ�ﻳﻣﺔ ﺑ�ﺎﻟﺭﺣﻡ‪ ،‬ﺧﺻﻭﺻ�ﺎ ً‬ ‫ﻣ��ﻊ ﺯﻳ��ﺎﺩﺓ ﺛﻘ��ﻝ ﺍﻟﻁﻔ��ﻝ ﻭﺍﻗﺗ��ﺭﺍﺏ ﻭﻻﺩﺗ��ﻪ‪ ،‬ﻭﻛ��ﺫﻟﻙ ﻓ��ﻲ ﻋﻣﻠ ّﻳ��ﺔ ﺍﻟ��ﻭﻻﺩﺓ ﺫﺍﺗﻬ��ﺎ‪ ،‬ﺣﻳ��ﺙ ﺗﻧﻔﺻ��ﻝ‬ ‫ﺍﻟﻣﺷﻳﻣﺔ ﻓﻌﻼً ﻭﻳﺻﺑﺢ ﺍﻟﻧﺯﻑ ﺃﻣﺭﺍً ﺣﺗﻣ ّﻳﺎ ً‪ .‬ﻓﻔﻲ ﻫﺫﻩ ﺍﻟﻅﺭﻭﻑ ﺗﻛ�ﻭﻥ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ ﻧﺷ�ﻁﺔ‪،‬‬ ‫ﺑﺯﻳﺎﺩﺓ ﻣﻠﺣﻭﻅﺔ ﻓﻲ ﺗﺭﻛﻳﺯ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪ .‬ﻭﻫﺫﺍ ﻣﻣﺎ ﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺍﺣﺗﻣﺎﻝ ﺣﺻﻭﻝ ﺟﻠﻁ�ﺎﺕ‬ ‫ﻓ��ﻲ ﺍﻷﻭﺭﺩﺓ ﺃﻭ ﺍﻟﺷ��ﺭﺍﻳﻳﻥ‪ ،‬ﻻﺳ��ﻳﻣﺎ ﺑﻭﺟ��ﻭﺩ ﻣ��ﺭﺽ ﻓ��ﺭﻁ ﺗﺧﺛ��ﺭ ﻛ��ﺎﻣﻥ ﻓ��ﻲ ﺩﻡ ﺍﻟﻣﺭﻳﺿ��ﺔ‬ ‫ﺍﻟﺣﺎﻣﻝ‪.‬‬ ‫‪ .3‬ﺍﻟﺭﺣﻼﺕ ﺍﻟﺟﻭﻳﺔ ﺍﻟﻁﻭﻳﻠﺔ‪ -‬ﻓﻲ ﻫﺫﺍ ﺍﻟﻅﺭﻑ ﻛﺛﻳﺭﺍً ﻣ�ﺎ ﻳﻛ�ﻭﻥ ﺍﻹﻧﺳ�ﺎﻥ ﻣﺳ�ﺗﻘ ّﺭﺍً ﻋﻠ�ﻰ ﻛﺭﺳ�ﻲ‬ ‫ﺿ�ﻳّﻕ ﻟﺳ��ﺎﻋﺎﺕ ﻁﻭﻳﻠ��ﺔ ﺩﻭﻥ ﺣﺭﻛ��ﺔ ﺗﺳ��ﺗﺣﻕ ﺍﻟ��ﺫﻛﺭ )ﺑﺳ��ﺑﺏ ﺿ��ﻳﻕ ﺍﻟﻣﻛ��ﺎﻥ(‪ .‬ﻛﻣ��ﺎ ﺃﻥ ﺣﺎﻓ��ﺔ‬ ‫ﺍﻟﻛﺭﺳ��ﻲ ﺗﺿ��ﻐﻁ ﻋﻠ��ﻰ ﺃﺳ��ﻔﻝ ﺍﻟﻔﺧ��ﺫ ﻭﻣﻔﺻ��ﻝ ﺍﻟﺭﻛﺑ��ﺔ ﻣ��ﻥ ﺍﻟﺧﻠ��ﻑ‪ ،‬ﻣﻣ��ﺎ ﻳﺳ��ﺑﺏ ﺭﻛ��ﻭﺩﺍً ﻓ��ﻲ‬ ‫ﺟﺭﻳ��ﺎﻥ ﺍﻟ��ﺩﻡ ﻓ��ﻲ ﺃﻭﺭﺩﺓ ﺍﻟﺳ��ﺎﻗﻳﻥ ﻭﻗ��ﺩ ﻳﺻ��ﻝ ﺍﻷﻣ��ﺭ ﺇﻟ��ﻰ ﺣﺻ��ﻭﻝ ﺟﻠﻁ��ﺔ ﻓ��ﻲ ﺃﺣ��ﺩ ﺍﻷﻭﺭﺩﺓ‬ ‫ﺍﻟﺭﺋﻳﺳﻳﺔ ﻓﻲ ﺃﺣﺩﻫﻣﺎ‪ .‬ﻭﻫﺫﺍ ﺍﻟﻣﻭﺿﻭﻉ ﻫﻭ ﺍﻵﻥ ﻣﻥ ﺍﻟﻘﺿﺎﻳﺎ ﺍﻟﻣﺛﺎﺭﺓ ﺇﻋﻼﻣﻳﺎ ً ﻭﻗﺿﺎﺋﻳﺎ ً ﺿ�ﺩ‬ ‫ﺷﺭﻛﺎﺕ ﺍﻟﺧﻁﻭﻁ ﺍﻟﺟﻭﻳﺔ‪.‬‬ ‫‪ .4‬ﺣﺎﻟﺔ ﺍﻟ ُﻣﻘ َﻌﺩﻳﻥ ﺑﺎﻟﻔﺭﺍﺵ‪ -‬ﻭﺫﻟﻙ ﺑﺳﺑﺏ ﺍﻟﺷﻠﻝ ﺃﻭ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻣﺯﻣﻧﺔ‪،‬ﻻﺳﻳّﻣﺎ ﺍﻟﻣﻌﻣّﺭﻳﻥ‪ .‬ﻓﻬﻧ�ﺎ‬ ‫ﺣﺎﻟﺔ ﺧﻣﻭﻝ) ﺃﻭ ﺍﻧﻌﺩﺍﻡ( ﻓﻲ ﺣﺭﻛﺔ ﺍﻟﻌﺿﻼﺕ ﺍﻟﺗﻲ ﺗ�ﺩﻓﻊ ﺍﻟ�ﺩﻡ‪ ،‬ﺧ�ﻼﻝ ﺗﻘﻠّﺻ�ﻬﺎ ﻭﺍﻧﺑﺳ�ﺎﻁﻬﺎ‪،‬‬ ‫ﻓﻲ ﺍﻷﻭﺭﺩﺓ ﺍﻟﻣﺎﺭﺓ ﺩﺍﺧﻠﻬﺎ‪.‬‬ ‫ﻓﻬﺫﻩ ﺍﻟﺣﺎﻻﺕ ﺍﻷﺭﺑﻊ ﻫﻲ ﻋﻭﺍﻣﻝ ﻭﻅﺭﻭﻑ ﻣﺳ�ﺎﻋﺩﺓ ﻋﻠ�ﻰ ﻭﻗ�ﻭﻉ ﺍﻟﺗﺧﺛ�ﺭ ﻭﺣﺻ�ﻭﻝ ﺍﻟﺟﻠﻁ�ﺎﺕ‪،‬‬ ‫ﻓﺈﺫﺍ ﺗﻭﻓﺭ ﻣﻌﻬﺎ ﻋﺎﻣﻝ ﻓﺭﻁ ﺗﺧﺛﺭ ﻭﺭﺍﺛﻲ ﻓﺈﻥ ﺍﺣﺗﻣﺎﻝ ﺣﺻ�ﻭﻝ ﺍﻟﺟﻠﻁ�ﺎﺕ ﻳ�ﺯﺩﺍﺩ‪ ،‬ﺣﻳ�ﺙ ﻳُﺿ�ﺎﻑ‬ ‫ﺳﺑﺏ ﻓﻭﻕ ﺳﺑﺏ‪.‬‬

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‫ﺗﺻﻧﻳﻑ ﻋﺎﻡ ﻷﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ‬

‫ﺍ ‪ -‬ﻣﻮﺭﻭﺛﺔ‬

‫ﺏ‪ -‬ﻣﻜﺘﺴﺒﺔ‬

‫ﺃﻣﺮﺍﺽ ﻓﺮﻁ ﺍﻟﺘﺨﺜﺮ‬

‫*‬ ‫*‬ ‫*‬ ‫*‬

‫ﻧﻘﺹ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ‬ ‫ﻧﻘﺹ ﻓﻌﺎﻟﻳﺔ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ‬ ‫ﻣﻔﻌﻼﺗﻪ‬ ‫ﻧﻘﺹ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ ﺃﻭ ّ‬ ‫ﺷﺫﻭﺫ ﻛﻳﻣﺎﻭﻱ ﻓﻲ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﻳﺯﻳﺩ ﻓﺎﻋﻠﻳﺗﻬﺎ‬

‫* ﺃﻣﺭﺍﺽ ﺍﻟﺳﺭﻁﺎﻥ ﺍﻟﻣﻧﺗﺷﺭﺓ‬ ‫* ﺍﻋﺗﻼﻻﺕ ﺍﻟﺗﻛﺎﺛﺭ ﺍﻟﻧﺧﺎﻋﻳﺔ‬ ‫* ﺑﻌﺽ ﺃﻧﻭﺍﻉ ﺍﻟﺗﺳﻣﻡ ﺍﻹﻧﺗﺎﻧﻲ ﺍﻟﺟﺭﺛﻭﻣﻲ‬ ‫* ﺑﻌﺽ ﺍﻷﻣﺭﺍﺽ ﺫﺍﺗﻳﺔ ﺍﻟﻣﻧﺎﻋﺔ‬ ‫* ﺍﻟﺗﺳﻣﻡ ﺑﺎﻟﺣﻣﻝ‬ ‫* ﻟﺩﻏﺎﺕ ﺑﻌﺽ ﺍﻷﻓﺎﻋﻲ‬ ‫* ﺑﺳﺑﺏ ﺑﻌﺽ ﺍﻷﺩﻭﻳﺔ‬ ‫* ﺍﻟﺗﺩﺧﻳﻥ؟ ﺗﺷ ّﺑﻊ ﺍﻟﺩﻡ ﺑﺎﻟﺩﻫﻭﻥ؟‬ ‫* ﺣﺎﻟﺔ ﻣﺎ ﺑﻌﺩ ﺍﻟﺻﺩﻣﺔ ﺍﻟﺩﻭﺭﺍﻧﻳﺔ‬

‫ﺍ‪-‬ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫‪ -1‬ﻧﻘﺹ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ‬ ‫ﺇﻥ ﺟﻣﻳﻊ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻗﺩ ﺗﻡ ﺍﻛﺗﺷ�ﺎﻑ ﻋ�ﺎﺋﻼﺕ ﻟ�ﺩﻳﻬﺎ ﻧﻘ�ﺹ ﻓ�ﻲ ﻭﺍﺣ�ﺩ ﺃﻭ ﺃﻛﺛ�ﺭ ﻣﻧﻬ�ﺎ‬ ‫ﻭﻛﻠﻬﺎ ﺃﻣﺭﺍﺽ ﻣﻭﺭﻭﺛﺔ ﻣﺗﻧﺣﻳﺔ ﺍﻟﺻﻔﺔ ﻭﺍﻧﺗﺷﺎﺭﻫﺎ ﻗﻠﻳﻝ ‪.‬ﻭﺃﻫﻣﻬﺎ‪:‬‬ ‫ ﻧﻘﺹ ﺑﺭﻭﺗﻳﻥ ﺝ‬‫ ﻧﻘﺹ ﺑﺭﻭﺗﻳﻥ ﺃﺱ‬‫ ﻧﻘﺹ ﻣﺿﺎﺩ ﺍﻟﺧﺛﺭﻳﻥ‬‫ ﻧﻘﺹ ﻣﺿﺎﺩ ﺍﻟﻌﺻﺎﺭﺓ ﺍﻟﻧﺳﺟﻳﺔ‬‫ﻭﻣ�ﻥ ﺍﻟﻧﺎﺣﻳ�ﺔ ﺍﻟﻁﺑﻳ�ﺔ‪ ،‬ﻓ�ﺈﻥ ﻧﻘ�ﺹ ﺑ�ﺭﻭﺗﻳﻥ ﺃﺱ ﺭﺑﻣ��ﺎ ﻳﺳ�ﺑﺏ ﻣﺷ�ﺎﻛﻝ‪ ،‬ﻟﻛ�ﻥ ﺍﻟ�ﻧﻘﺹ ﺍﻟﺷ�ﺩﻳﺩ ﻓ��ﻲ‬ ‫ﺑﺭﻭﺗﻳﻥ ﺝ ﻭﻣﺿﺎﺩ ﺍﻟﺧﺛﺭﻳﻥ ﻳﺳﺑﺏ ﺗﺧﺛﺭﺍﺕ ﻭﺭﻳﺩﻳﺔ ﻭﺷﺭﻳﺎﻧﻳﺔ ﻓ�ﻲ ﺃﻋﻣ�ﺎﺭ ﻣﺧﺗﻠﻔ�ﺔ‪ ،‬ﻻﺳ�ﻳّﻣﺎ ﻣ�ﻊ‬ ‫ﻭﺟ��ﻭﺩ ﺇﺣ��ﺩﻯ ﺍﻟﺣ��ﺎﻻﺕ ﺍﻟﻣﺳ��ﺎﻋﺩﺓ ﺍﻟﻣ��ﺫﻛﻭﺭﺓ ﺃﻋ��ﻼﻩ‪ .‬ﻭﺭﺑﻣ��ﺎ ﻛ��ﺎﻥ ﺍﻟ��ﻧﻘﺹ ﺍﻟﺷ��ﺩﻳﺩ ﻟ��ﺩﻯ ﺣ��ﺩﻳﺛﻲ‬

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‫ﺍﻟﻭﻻﺩﺓ ﺳ�ﺑﺑﺎ ً ﻟﻭﻓ�ﺎﺓ ﺍﻟﻭﻟﻳ�ﺩ ﻋﻧ�ﺩ ﺍﻟ�ﻭﻻﺩﺓ ﻛﻧﺗﻳﺟ�ﺔ ﻟﺗﺧﺛ�ﺭ ﺭﺋﻳﺳ�ﻲ ﻓ�ﻲ ﺍﻟﻘﻠ�ﺏ ﺃﻭ ﺍﻟﻣ�ﺦ ﺃﻭ ّ‬ ‫ﺗﺧﺛ�ﺭﺍﺕ‬ ‫ﻣﻧﺗﺷﺭﺓ ﻓﻲ ﻛﻝ ﻣﻛﺎﻥ‪ .‬ﻭﻛﺫﻟﻙ ﻓﺈﻥ ﻧﻘﺹ ﻫﺫﻩ ﺍﻟﻌﻭﺍﻣﻝ ﻗﺩ ﻳﺅﺩﻱ ﺇﻟﻰ ﺇﺳﻘﺎﻁ ﻣﺗﻛﺭﺭ ﻟﺩﻯ ﺍﻷﻡ‪.‬‬ ‫ﻭﻋﻧﺩ ﻓﺣﺹ ﺍﻟﻌﺎﺋﻼﺕ ﺍﻟﺗﻲ ﻳﺻﺎﺏ ﺃﺣﺩ ﺃﻓﺭﺍﺩﻫﺎ ﺑﺗﺟﻠﻁ ﻣﺗﻛﺭﺭ ﺑﺳﺑﺏ ﻧﻘﺹ ﺃﺣ�ﺩ ﻫ�ﺫﻩ ﺍﻟﻌﻭﺍﻣ�ﻝ‬ ‫ﻧﺟﺩ ﺃﻥ ﻛﺛﻳﺭﺍً ﻣﻥ ﺃﻗﺭﺑﺎﺋﻪ ﻟﺩﻳﻬﻡ ﺍﻟﻧﻘﺹ ﻭﻟﻛ�ﻥ ﻣﻌﻅﻣﻬ�ﻡ ﻻ ﻳﺻ�ﻳﺑﻬﻡ ﺿ�ﺭﺭ ﺟ�ﺭﺍء ﺫﻟ�ﻙ ﺍﻟ�ﻧﻘﺹ‬ ‫ﻁﻳﻠ��ﺔ ﺣﻳ��ﺎﺗﻬﻡ ﻭﻳُﻛﺗﺷ��ﻑ ﺍﻟ��ﻧﻘﺹ ﻋﻧ��ﺩﻫﻡ ﺑ��ﺎﻟﻔﺣﺹ ﺍﻟﻣﺧﺑ��ﺭﻱ ﻭﺣﺳ��ﺏ‪ .‬ﻭﻟﺭﺑﻣ��ﺎ ﻛ��ﺎﻥ ﺫﻟ��ﻙ ﻷﺣ��ﺩ‬ ‫ﺍﻷﺳﺑﺎﺏ ﺍﻟﺗﺎﻟﻳﺔ‪:‬‬ ‫ ﻋﺩﻡ ﺗﻭﺍﻓﺭ ﻅﺭﻑ ﻣﺳﺎﻋﺩ ﻟﺣﺻﻭﻝ ﺍﻟﺟﻠﻁﺔ‪ ،‬ﻛﺫﻟﻙ ﺍﻟﻅﺭﻑ ﺍﻟﺫﻱ ﺣﺻﻝ ﻟﺩﻯ ﺍﻟﻘﺭﻳ�ﺏ ﺍﻟ�ﺫﻱ‬‫ﺃﺻﺎﺑﺗﻪ ﺟﻠﻁﺔ ﻓﻌﻼً)ﻋﻣﻠﻳﺔ ﺟﺭﺍﺣﻳﺔ‪ ،‬ﻣُﻘﻌﺩ ﺑﺎﻟﻔﺭﺍﺵ‪ ،‬ﺍﻟﺦ(‪.‬‬ ‫ ﻭﺟﻭﺩ ﻓﺭﻭﻕ ﻓﻲ ﺷﺩﺓ ﺍﻟﻧﻘﺹ ﻟﺩﻯ ﻣﺧﺗﻠﻑ ﺃﻓﺭﺍﺩ ﺍﻟﻌﺎﺋﻠﺔ ﺍﻟﻭﺍﺣﺩﺓ‪.‬‬‫ ﻭﺟﻭﺩ ﻋﺎﻣﻝ ﻣﻭﺭﱠ ﺙ ﺇﺿﺎﻓﻲ ﻳﺳﺎﻋﺩ ﻋﻠﻰ ﺍﻟﺗﺧﺛ�ﺭ ﻟ�ﺩﻯ ﺍﻟﻔ�ﺭﺩ ﺍﻟﻣﺻ�ﺎﺏ ﻭﻋ�ﺩﻡ ﻭﺟ�ﻭﺩﻩ ﻟ�ﺩﻯ‬‫ﺍﻵﺧﺭﻳﻥ) ﺍﻧﻅﺭ ﺍﻷﺳﺑﺎﺏ ﺍﻟﻣﻭﺭﻭﺛﺔ ﺍﻷﺧﺭﻯ ﻟﻔﺭﻁ ﺍﻟﺗﺧﺛﺭ(‪.‬‬ ‫ﺗﺷﺧﻳﺹ ﻫﺫﻩ ﺍﻟﻌﻠﻝ ﻳﻛﻭﻥ‪ ،‬ﻭﺑﻌﺩ ﺃﻥ ﻳﺿﻊ ﺍﻟﻁﺑﻳﺏ ﻧﺻﺏ ﻋﻳﻧﻳﻪ ﻫ�ﺫﺍ ﺍﻻﺣﺗﻣ�ﺎﻝ ﻟﺣﺻ�ﻭﻝ ﺗﺧﺛ�ﺭ‬ ‫ﻏﻳﺭ ﻣﺗﻭﻗﻊ ﻓﻲ ﺃﺣﺩ ﺷﺭﺍﻳﻳﻥ ﺃﻭ ﺃﻭﺭﺩﺓ ﺍﻟﻣﺭﻳﺽ‪ ،‬ﺑﺈﺟﺭﺍء ﺍﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ ﻟﻘﻳﺎﺱ ﻣﺳﺗﻭﻯ ﻛﻝ‬ ‫ﻣﻧﻬ���ﺎ‪ .‬ﻭﺍﻟﻣﺳ���ﺗﻭﻳﺎﺕ ﺍﻟﻁﺑﻳﻌﻳ���ﺔ ﺗﺗ���ﺭﺍﻭﺡ ﻣ���ﻥ ‪ 70‬ﺇﻟ���ﻰ ‪ %100‬ﺃﻭ ﺃﻛﺛ���ﺭ‪.‬ﻭ ﻟ ّﻣ���ﺎ ﻛﺎﻧ���ﺕ ﺟﻣﻳ���ﻊ‬ ‫ﺍﻋ��ﺗﻼﻻﺕ ﻓ��ﺭﻁ ﺍﻟﺗﺧﺛ��ﺭ ﺍﻟﻣﻭﺭﻭﺛ��ﺔ ﺗﺗﻣﻳ��ﺯ ﺑﺷ��ﻲء ﻭﺍﺣ��ﺩ‪ ،‬ﻭﻫ��ﻭ ﺣﺻ��ﻭﻝ ﺟﻠﻁ��ﺔ ﻓ��ﻲ ﻭﺭﻳ��ﺩ ﺃﻭ‬ ‫ﺷﺭﻳﺎﻥ‪ ،‬ﻓﺈﻥ ﺍﻟﻁﺑﻳﺏ ﻳﻌﻣﺩ ﻋﺎﺩﺓ ﺇﻟﻰ ﺇﺟﺭﺍء ﻛ�ﻝ ﺍﻟﻔﺣ�ﻭﺹ ﺩﻓﻌ�ﺔ ﻭﺍﺣ�ﺩﺓ ﺑﺣﻳ�ﺙ ﺗﺷ�ﻣﻝ ﺍﻟﻌﻭﺍﻣ�ﻝ‬ ‫ﺍﻟﻣﺫﻛﻭﺭﺓ ﻓﻲ ﻫﺫﻩ ﺍﻟﻔﻘﺭﺓ ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﺍﻟﻔﻘﺭﺍﺕ ﺍﻟﺗﺎﻟﻳﺔ‪ .‬ﺛﻡ ﻳﺟﺏ ﺃﻥ ﺃﺫﻛﺭ ﺃﻥ ﺑﺭﻭﺗﻳﻥ ﺝ ﻭﺑﺭﻭﺗﻳﻥ‬ ‫ﺃﺱ ﻳُﺻ�ﻧﻌﺎﻥ ﻓ�ﻲ ﺍﻟﻛﺑ�ﺩ‪ ،‬ﻟ�ﺫﻟﻙ ﻓ�ﺈﻥ ﻣﺳ�ﺗﻭﻳﻳﻬﻣﺎ ﻓ��ﻲ ﺍﻟ�ﺩﻡ ﻳﻬﺑﻁ�ﺎﻥ ﻓ�ﻲ ﺃﻣ�ﺭﺍﺽ ﺍﻟﻛﺑ�ﺩ ﺍﻟﻣﺯﻣﻧ��ﺔ‪،‬‬ ‫ﻭﺫﻟﻙ ﻳﺣﺩﺙ ﺃﻳﺿﺎ ً ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻣﺭﻳﺽ ﻳﺳﺗﻌﻣﻝ ﻋﻘﺎﺭﺍﺕ ﻣﺎﻧﻌﺔ ﻟﻠﺗﺧﺛﺭ ﻣﻥ ﻣﺿﺎ ّﺩﺍﺕ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ‪.‬‬ ‫ﻛﻣﺎ ﺃﻥ ﻋﺎﻣﻝ ﻣﺿﺎﺩ ﺍﻟﺧﺛﺭﻳﻥ ﻳﻧﻘﺹ ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻣﺭﻳﺽ ﻳﺄﺧﺫ ﺣﻘﻥ ﺍﻟﻬﻳﺑ�ﺎﺭﻳﻥ ﺍﻟﻣﺿ�ﺎﺩﺓ ﻟﻠﺗﺧﺛ�ﺭ‪.‬‬ ‫ُﺣﻭﻝ ﺍﻟﻣﺭﻳﺽ ﺇﻟﻰ ﺍﻟﻣﺧﺑﺭ ﻹﺟﺭﺍء ﺍﻟﻔﺣﻭﺹ ﺑﻌﺩ ﺃﻥ ﻳﺑﺩﺃ ﺑﺗﻧ�ﺎﻭﻝ ﺍﻷﺩﻭﻳ�ﺔ ﺍﻟﻣﺿ�ﺎﺩﺓ‬ ‫ﻭﻛﺛﻳﺭﺍً ﻣﺎ ﻳ ﱠ‬ ‫ﻟﻠﺗﺧﺛﺭ‪ ،‬ﻓﻳﺳﺑﺏ ﺫﻟﻙ ﺧﻁﺄ ً ﻓﻲ ﺗﻔﺳﻳﺭ ﻧﺗﺎﺋﺞ ﺍﻟﻔﺣﻭﺹ‪.‬‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺑﻌﺩ ﺣﺻ�ﻭﻝ ﺍﻟﺟﻠﻁ�ﺔ ﻭﺍﻛﺗﺷ�ﺎﻑ ﺃﻥ ﺳ�ﺑﺑﻬﺎ ﻧﻘ�ﺹ ﺃﺣ�ﺩ ﺍﻟﻌﻭﺍﻣ�ﻝ ﺍﻟﻣ�ﺫﻛﻭﺭﺓ )ﺃﻭ ﺃﻛﺛ�ﺭ ﻣ�ﻥ ﻋﺎﻣ�ﻝ‬ ‫ﻭﺍﺣﺩ( ﻳﻧﺻﺢ ﺍﻟﻁﺑﻳﺏ ﺍﻟﻣﺭﻳﺽ ﺑﺗﻧﺎﻭﻝ ﻋﻘﺎﺭﺍﺕ ﻣﺿﺎﺩﺓ ﻟﻠﺗﺧﺛﺭ ﻣﻥ ﻣﺿﺎﺩﺍﺕ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ‪ ،‬ﻭﻗ�ﺩ‬

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‫ﻳﺑﺩﺅﻩ ﺃﻭﻻً ﻋﻠﻰ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻟﺑﺿﻌﺔ ﺃﻳﺎﻡ‪ .‬ﻭﻟﻳﺱ ﺍﻟﻣﻘﺻﻭﺩ ﻣﻥ ﻫﺫﻩ ﺍﻟﻣﺿﺎﺩﺍﺕ ﺇﺯﺍﻟﺔ ﺍﻟﺧﺛﺭﺓ ﺍﻟﺗ�ﻲ‬ ‫ﺣﺻﻠﺕ‪ ،‬ﺑﻝ ﻟﻣﻧﻊ ﺣﺻﻭﻝ ﺟﻠﻁﺔ ﺃﻭ ﺟﻠﻁﺎﺕ ﺃﺧ�ﺭﻯ ﺑﻌ�ﺩ ﺍﻷﻭﻟ�ﻰ‪ ،‬ﻭﻛ�ﺫﻟﻙ ﻟﻣﻧ�ﻊ ﺗﻭﺳ�ﻊ ﻭﺍﻣﺗ�ﺩﺍﺩ‬ ‫ﺍﻟﺟﻠﻁﺔ ﺍﻷﺻﻠﻳﺔ‪ .‬ﻓﻬﻲ ﻣﻥ ﻗﺑﻳﻝ ﺍﻟﻭﻗﺎﻳﺔ‪.‬‬ ‫ﻛﻣ��ﺎ ﻳﺟ��ﺏ ﺃﻥ ﻧ��ﺫﻛﺭ ﺃﻥ ﺍﻟﺑﻼﺯﻣ��ﺎ ﺍﻟﻣﺟﻣ��ﺩﺓ ﺍﻟﻁﺎﺯﺟ��ﺔ ﻓ��ﻲ ﺑﻧ��ﻙ ﺍﻟ��ﺩﻡ ﺗﺣﺗ��ﻭﻱ ﻋﻠ��ﻰ ﻛ��ﻝ ﻫ��ﺫﻩ‬ ‫ﺍﻟﻣﺿ��ﺎﺩﺍﺕ ﺍﻟﻁﺑﻳﻌﻳ��ﺔ‪ ،‬ﻟ��ﺫﻟﻙ ﻓﻣ��ﻥ ﺍﻟﻣﻣﻛ��ﻥ ﺇﻋﻁ��ﺎء ﺍﻟﺑﻼﺯﻣ��ﺎ ﻟ��ﺩﻯ ﺗﻌ �ﺭّﺽ ﺍﻟﻣ��ﺭﻳﺽ ﻷﻱ ﻣ��ﻥ‬ ‫ﺍﻟﺣ��ﺎﻻﺕ ﺍﻟﻣﺳ��ﺎﻋﺩﺓ ﻋﻠ��ﻰ ﺍﻟﺗﺧﺛ��ﺭ ﺍﻟﻣ��ﺫﻛﻭﺭﺓ ﺃﻋ��ﻼﻩ ) ﺻ��ﻔﺣﺔ‪ (47‬ﻟﺗﺻ��ﺣﻳﺢ ﺍﻟ��ﻧﻘﺹ ﺑﺻ��ﻭﺭﺓ‬ ‫ﻣﺅﻗّﺗﺔ‪ ،‬ﺭﻳﺛﻣﺎ ﻳُﻌﻁﻰ ﺍﻟﻣﺭﻳﺽ ﻋﻘﺎﺭﺍً ﻣﺿﺎﺩﺍً ﻟﻠﺗﺧﺛﺭ ﻭﺣﺗﻰ ﻳﻛﺗﻣﻝ ﻣﻔﻌﻭﻟﻪ ﻓﻲ ﺍﻟﺟﺳﻡ‪.‬‬ ‫ﺻ� ّﻧﻊ ﺗﺟﺎﺭﻳّ�ﺎ ً‪ .‬ﻟﻛ�ﻥ‬ ‫ﻳﺗﻭﻓّﺭ ﺍﻵﻥ ﻟﺩﻯ ﺑﻌ�ﺽ ﺍﻟﻣﺳﺗﺷ�ﻔﻳﺎﺕ ﻣﺳﺗﺣﺿ�ﺭ ﻣﺭ ّﻛ�ﺯ ﻟﻣﺿ�ﺎﺩ ﺍﻟﺧﺛ�ﺭﻳﻥ ﻣ َ‬ ‫ﻟﻳﺱ ﻣﻥ ﺍﻟﻌﻣﻠﻲ ﺇﻋﻁﺎءﺍﻟﻣﺭﻳﺽ ﻫﺫﺍ ﺍﻟﻣﺭ ّﻛﺯ‪ ،‬ﺃﻭ ﺍﻟﺑﻼﺯﻣﺎ‪ ،‬ﺑﺻ�ﻭﺭﺓ ﻣﻧﺗﻅﻣ�ﺔ ﻁ�ﻭﺍﻝ ﻋﻣ�ﺭﻩ ﺑ�ﻝ‬ ‫ﺗﺳﺗﻌﻣﻝ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﻁﺎﺭﺋﺔ ﻳُﺧﺷﻰ ﻓﻳﻬﺎ ﻣﻥ ﺣﺻﻭﻝ ﺗﺧﺛﺭﺍﺕ ﻟﺩﻯ ﺍﻟﻣﺭﻳﺽ‪.‬‬ ‫ﺃﻣّﺎ ﻋ�ﻼﺝ ﺍﻟﺟﻠﻁ�ﺔ‪ ،‬ﺣ�ﻳﻥ ﻭﻗﻭﻋﻬ�ﺎ‪ ،‬ﻓﻳﺟ�ﺩ ﺍﻟﻘ�ﺎﺭﺉ ﺷ�ﺭﺣﻪ ﻓ�ﻲ ﺍﻟﻔﺻ�ﻝ ﺍﻟﺭﺍﺑ�ﻊ ﻣ�ﻥ ﺍﻟﻛﺗ�ﺎﺏ ﻋﻧ�ﺩ‬ ‫ﺍﻟﻛﻼﻡ ﻋﻥ ﻣﺿﺎﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ ﻛﻣﻭﺿﻭﻉ ﻣﺳﺗﻘﻝ ﻭ ﻳﻧﻁﺑﻕ ﺫﻟ�ﻙ ﺍﻟﺷ�ﺭﺡ ﻋﻠ�ﻰ ﻛ�ﻝ ﺍﻟﺣ�ﺎﻻﺕ ﺍﻟﺗ�ﻲ‬ ‫ﻳﺣﺻﻝ ﻓﻳﻬﺎ ﺗﺧﺛﺭ‪ ،‬ﻣﻬﻣﺎ ﻛﺎﻥ ﺳﺑﺑﻪ‪.‬‬ ‫‪ -2‬ﻧﻘﺹ ﻓ ّﻌﺎﻟﻳﺔ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ‬ ‫ﺍﻟﺣﻘﻳﻘﺔ ﺃﻥ ﻧﻘﺹ ﺍﻟﻔﻌﺎﻟﻳﺔ ﻻ ﻳﺧﺗﻠﻑ ﻋﻥ ﻧﻘﺹ ﺍﻟﺗﺭﻛﻳﺯ ﻣﻥ ﺣﻳﺙ ﺍﻟﻣﺣﺻّ�ﻠﺔ‪ ،‬ﻭﻫﻧ�ﺎﻙ ﻣ�ﻥ ﻋﻧ�ﺩﻩ‬ ‫ﻧﻘ��ﺹ ﻓﻌﺎﻟﻳ��ﺔ ﺃﺣ��ﺩ ﺍﻟﺑﺭﻭﺗﻳﻧ��ﺎﺕ ﺩﻭﻥ ﻧﻘ��ﺹ ﻛ ّﻣ��ﻲ ﻓ��ﻲ ﺍﻟﺑ��ﺭﻭﺗﻳﻥ‪ .‬ﻭﺍﻟﻣﺧﺗﺑ��ﺭ ﺣﻳﻧﻣ��ﺎ ﻳﻘ��ﻳﺱ ﻫ��ﺫﻩ‬ ‫ﺍﻟﺑﺭﻭﺗﻳﻧﺎﺕ ﻓﺈﻧﻪ ﻳﺄﺧﺫ ﻓﻲ ﺍﻻﻋﺗﺑﺎﺭ ﻛﻼًّ ﻣﻥ ﺍﻟﺗﺭﻛﻳﺯ ﻭﺍﻟﻔﻌﺎﻟﻳﺔ‪.‬‬ ‫ﻳ��ﺩﺧﻝ ﺗﺣ��ﺕ ﻫ��ﺫﺍ ﺍﻟﻌﻧ��ﻭﺍﻥ ﻣ��ﺭﺽ ﻣ��ﻭﺭﻭﺙ ﺍﻛﺗﺳ��ﺏ ﺃﻫﻣﻳ��ﺔ ﻛﺑﻳ��ﺭﺓ ﻓ��ﻲ ﺍﻟﺳ��ﻧﻭﺍﺕ ﺍﻷﺧﻳ��ﺭﺓ‪،‬‬ ‫ﺧﺻﻭﺻﺎ ً ﻓﻲ ﺩﻭﻝ ﺃﻭﺭﺑﺎ ﺍﻟﺷﻣﺎﻟﻳﺔ‪ ،‬ﻻﻧﺗﺷﺎﺭﻩ ﻓﻲ ﺷﻌﻭﺑﻬﺎ ﺃﻛﺛﺭ ﻣﻥ ﺍﻟﺷﻌﻭﺏ ﺍﻷﺧﺭﻯ‪ .‬ﺫﻟﻙ ﻫ�ﻭ‬ ‫ﻣﺭﺽ ﻧﻘﺹ ﻓﻌﺎﻟﻳﺔ ﺑ�ﺭﻭﺗﻳﻥ ﺝ ﺑﺳ�ﺑﺏ ﻭﺟ�ﻭﺩ ﺧﻠ�ﻝ ﻣ�ﻭﺭﻭﺙ ﻓ�ﻲ ﺗﺭﻛﻳ�ﺏ ﻋﺎﻣ�ﻝ‪ 5‬ﻳﻣﻧ�ﻊ ﺗﻔﺎﻋ�ﻝ‬ ‫ﺑﺭﻭﺗﻳﻥ ﺝ ﻣﻌﻪ‪ .‬ﻭﺃﺣﻳﻝ ﺍﻟﻘﺎﺭﺉ ﺇﻟﻰ ﺍﻟﻔﺻﻝ ﺍﻷﻭﻝ ﻟﻳﺗ�ﺫ ّﻛﺭ ﺃﻥ ﺍﻟﺑ�ﺭﻭﺗﻳﻥ ﺝ ﻣﻬﻣّﺗ�ﻪ ﻛﻣ�ﺎﻧﻊ ﺗﺧﺛ�ﺭ‬ ‫ﺗﻛﻣﻥ ﻓﻲ ﻣﻘﺎﻭﻣﺗﻪ ﻭﺗﺣﻁﻳﻣﻪ ﻟﻠﻌﺎﻣﻠﻳﻥ ‪ 5‬ﻭ‪ 8‬ﺇﺫﺍ ﺗ ّﻡ ﺗﻔﻌﻳﻠﻬﻣﺎ ﻷﻱ ﺳﺑﺏ ﻏﻳ�ﺭ ﻣﺭﻏ�ﻭﺏ ﻓﻳ�ﻪ )ﺃﻱ‬ ‫ﺩﻭﻥ ﻭﺟﻭﺩ ﻧ�ﺯﻑ(‪ .‬ﻭﻳ�ﺗﻡ ﺫﻟ�ﻙ ﺑ�ﺄﻥ ﻳ�ﺭﺗﺑﻁ ﺑﻛ�ﻝ ﻣ�ﻥ ﺍﻟﻌ�ﺎﻣﻠﻳْﻥ ﻛﻳﻣﺎﻭﻳ�ﺎ ً‪ .‬ﻟﻛ�ﻥ ﺍﻟﺻ�ﻔﺔ ﺍﻟﻣﻭﺭﻭﺛ�ﺔ‬ ‫ﺍﻟﻐﻳﺭ ﻁﺑﻳﻌﻳﺔ ﻓﻲ ﻋﺎﻣﻝ‪ 5‬ﺗﺟﻌﻠﻪ ﻻ ﻳﺗﻔﺎﻋﻝ ﻣﻊ ﺑﺭﻭﺗﻳﻥ ﺝ‪ ،‬ﻭﺇﻥ ﻛﺎﻥ ﻳﺗﻔﺎﻋﻝ ﺑﺷ�ﻛﻝ ﻁﺑﻳﻌ�ﻲ ﻣ�ﻊ‬ ‫ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﺍﻷﺧ�ﺭﻯ)‪9‬ﻭ‪ (10‬ﻭﻳﻛﻣ�ﻝ ﺩﻭﺭﺓ ﺍﻟﺗﺧﺛ�ﺭ ﺑﺷ�ﻛﻝ ﻋ�ﺎﺩﻱ ﺩﻭﻥ ﺃﻥ ﻳﺳ�ﺗﻁﻳﻊ ﺑ�ﺭﻭﺗﻳﻥ‬

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‫ﺝ ﺇﻳﻘﺎﻓﻬﺎ‪ .‬ﻭﺑﺫﻟﻙ ﻳﺯﺩﺍﺩ ﺑﺷﻛﻝ ﻛﺑﻳﺭ ﺍﺣﺗﻣﺎﻝ ﺣﺻﻭﻝ ّ‬ ‫ﺗﺧﺛﺭ ﻏﻳﺭ ﻣﺭﻏ�ﻭﺏ ﻓﻳ�ﻪ ﻭﻓ�ﻲ ﻭﻗ�ﺕ ﻏﻳ�ﺭ‬ ‫ﻣﻧﺎﺳﺏ‪ .‬ﻫﺫﻩ ﺍﻟﺻﻔﺔ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻓﻲ ﻋﺎﻣ�ﻝ ‪ 5‬ﺗﻌﻁﻳ�ﻪ ﺍﺳ�ﻡ ﻋﺎﻣ�ﻝ‪-5‬ﻟﻳ�ﺩﻥ‪ ،‬ﻧﺳ�ﺑﺔ ﺇﻟ�ﻰ ﻣﺩﻳﻧ�ﺔ ﻟﻳ�ﺩﻥ‬ ‫ﻓﻲ ﺍﻟﺳﻭﻳﺩ‪ ،‬ﺣﻳﺙ ﺍﻛ ُﺗﺷِ ﻑ ﻷﻭﻝ ﻣﺭﺓ‪ .‬ﺍﻧﻅﺭ ﺍﻟﺷﻛﻠﻳﻥ ‪ 12‬ﻭ ‪ 13‬ﺃﺩﻧﺎ‬

‫ﻋﺎﻣﻝ ‪9‬‬ ‫ﻋﺎﻣﻝ ‪ 5‬ﻁﺑﻳﻌﻲ‬ ‫ﻋﺎﻣﻝ ‪10‬‬

‫ﺑﺭﻭﺗﻳﻥ ﺝ‬

‫ﺷﻛﻝ ﺭﻗﻡ ‪12‬‬ ‫ﺍﻟﻔﻌﺎﻝ ﺍﻟﻁﺑﻳﻌﻲ ﻣﻥ ﻗﺑﻝ ﺑﺭﻭﺗﻳﻥ ﺝ‬ ‫ﺗﺛﺑﻳﻁ ﻋﺎﻣﻝ ‪ّ 5‬‬

‫ﻋﺎﻣﻝ ‪9‬‬ ‫ﻋﺎﻣﻝ ‪ 5‬ﻏﻳﺭ ﻁﺑﻳﻌﻲ‬ ‫ﺑﺭﻭﺗﻳﻥ ﺝ‬

‫ﻋﺎﻣﻝ ‪10‬‬ ‫ﺷﻛﻝ ﺭﻗﻡ ‪13‬‬ ‫ﻓﺷﻝ ﺗﺛﺑﻳﻁ ﻋﺎﻣﻝ‪ 5‬ﺍﻟﻔﻌﺎﻝ ﻣﻥ ﻗﺑﻝ ﺑﺭﻭﺗﻳﻥ ﺝ‬

‫ﻫﻧﺎﻙ ﺍﻋﺗﻼﻻﺕ ﻣﻭﺭﻭﺛﺔ )ﺃﻗﻝ ﺍﻧﺗﺷ�ﺎﺭﺍً( ﻓ�ﻲ ﻋﺎﻣ�ﻝ‪ 5‬ﻣ�ﻥ ﺍﻟﺷ�ﺫﻭﺫ ﺍﻟﻣ�ﺫﻛﻭﺭ ﺃﻋ�ﻼﻩ ﻭﺗ�ﺅﺩﻱ ﺇﻟ�ﻰ‬ ‫ﻧﻔﺱ ﺍﻟﻣﺷﻛﻠﺔ‪ ،‬ﺃﻱ ﻋﺟﺯ ﺑﺭﻭﺗﻳﻥ ﺝ ﻋﻥ ﺗﺛﺑﻳﻁ ﻋﺎﻣﻝ‪ 5‬ﺍﻟﻔﻌّﺎﻝ‪.‬‬ ‫ﺃﻋ��ﻭﺩ ﻓﺄﺅ ّﻛ��ﺩ ﺃﻥ ﺍﻟﻣﺷ��ﻛﻠﺔ ﻫﻧ��ﺎ ﻟﻳﺳ��ﺕ ﻓ��ﻲ ﻣ��ﺎﻧﻊ ﺍﻟﺗﺧﺛ��ﺭ)ﺑ��ﺭﻭﺗﻳﻥ ﺝ( ﻟﻛﻧﻬ��ﺎ ﻧﺗﻳﺟ��ﺔ ﻋﺟ��ﺯ ﺫﻟ��ﻙ‬ ‫ﺍﻟﺑﺭﻭﺗﻳﻥ ﻋﻥ ﺃﺩﺍء ﻭﻅﻳﻔﺗﻪ‪.‬‬

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‫ﻫﻧ��ﺎﻙ ﺃﻳﺿ�ﺎ ً ﺣ��ﺎﻻﺕ ﻧ��ﺎﺩﺭﺓ ﻣ��ﻥ ﻧﻘ��ﺹ ﻓﻌﺎﻟﻳ��ﺔ ﻣﻭﺍﻧ��ﻊ ﺍﻟﺗﺧﺛ��ﺭ ﻧﻔﺳ��ﻬﺎ ﻛﺑ��ﺭﻭﺗﻳﻥ ﺝ ﻭﺑ��ﺭﻭﺗﻳﻥ ﺃﺱ‬ ‫ﻭﻣﺿﺎﺩ ﺍﻟﺧﺛﺭﻳﻥ ﻭﻣﺿﺎﺩ ﻋﺻﺎﺭﺓ ﺍﻷﻧﺳﺟﺔ ﻭﻏﻳﺭﻫﺎ‪.‬‬ ‫‪ -3‬ﻧﻘﺹ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ ﺃﻭ ﻣﻔ ّﻌﻼﺗﻪ‬ ‫ﺇﻥ ﻫﺫﺍ ﺍﻹﻧﻅﻳﻡ ﺍﻟﺫﻱ ﻳﻭﺟﺩ ﺑﺷﻛﻝ ﻏﻳﺭ ﻓﻌّﺎﻝ ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳ�ﺔ‪ ،‬ﻳ�ﻧﻘﺹ ﻓ�ﻲ ﺣ�ﺎﻻﺕ ﻣﻭﺭﻭﺛ�ﺔ‬ ‫ﻧﺎﺩﺭﺓ ﺑﺣﻳﺙ ﺃﻥ ﺃﻳﺔ ﺗﺧﺛﺭﺍﺕ ﺑﺳﻳﻁﺔ ﺗﺣﺻﻝ ﻓﻲ ﺃﻭﺭﺩﺓ ﺃﻭ ﺷﺭﺍﻳﻳﻥ ﻟ�ﻥ ﻳﻛ�ﻭﻥ ﻫﻧ�ﺎﻙ ﻣ�ﺎ ﻳ�ﺫﻳﺑﻬﺎ‪،‬‬ ‫ﻓﺗﺗﻭﺳ��ﻊ ﻭﺗﺳ��ﺑﺏ ﺟﻠﻁ��ﺎﺕ ﺗﺳ � ّﺩ ﺗﻠ��ﻙ ﺍﻷﻭﻋﻳ��ﺔ‪ .‬ﻭﻳ��ﺅﺩﻱ ﺫﻟ��ﻙ‪ ،‬ﻛﻣ��ﺎ ﻓ��ﻲ ﺍﻟﻔﻘ��ﺭﺓ‪ ،2‬ﺇﻟ��ﻰ ﻣﺧﺗﻠ��ﻑ‬ ‫ﺍﻷﻋﺭﺍﺽ‪ ،‬ﻣﻧﻬﺎ ﺗﻛﺭﺭ ﺇﺳﻘﺎﻁ ﺍﻟﺣﻣﻝ ﻭﺣﺻﻭﻝ ﺟﻠﻁﺔ ﺍﻟﻘﻠﺏ ﻓﻲ ﻋﻣﺭ ﻣﺑ ّﻛﺭ ﻧﺳﺑﻳﺎ ً‪.‬‬ ‫ﻛﺫﻟﻙ ﻓﺈﻥ ﻧﻘﺹ ﺇﻧﺗﺎﺝ ﻣﻔﻌّﻝ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ‪ ،‬ﻭﻫﻭ ﺣﺩﺙ ﻧﺎﺩﺭ ﺟﺩﺍً‪ ،‬ﻳﺅﺩﻱ ﺇﻟﻰ ﻧﻔﺱ ﺍﻟﻧﺗﺎﺋﺞ‪.‬‬ ‫‪ -4‬ﺷﺫﻭﺫ ﺗﺭﻛﻳﺏ ﺑﻌﺽ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻣﺅﺩﻱ ﺇﻟﻰ ﺍﺯﺩﻳﺎﺩ ﻣﻔﻌﻭﻟﻬﺎ‬ ‫ﻫﻧﺎﻙ ﺃﻣﺭﺍﺽ ﻧﺎﺩﺭﺓ ﻣﻭﺭﻭﺛﺔ ﺗﺅﺩﻱ ﺇﻟﻰ ﺷﺫﻭﺫ ﺗﺭﻛﻳﺑﻲ ﻓﻲ ﺟﺯﻳﺋﺔ ﻣﻭﻟّ�ﺩ ﺍﻟﻠﻳﻔ�ﻳﻥ ﺑﺣﻳ�ﺙ ﺗﺗﻔﺎﻋ�ﻝ‬ ‫ﻣﻊ ﺃﻣﺛﺎﻟﻬﺎ ﻣﻥ ﺟﺯﻳﺋﺎﺕ ﻣﻭﻟﺩ ﺍﻟﻠﻳﻔﻳﻥ ﻟﺗﻭﻟّﺩ ﺍﻟﻠﻳﻔﻳﻥ ﺩﻭﻥ ﺣﺎﺟﺔ ﺇﻟﻰ ﻋﻣﻠﻳﺔ ﺗﻔﻌﻳﻝ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ‬ ‫ﺧ��ﻼﻝ ﺳﻠﺳ��ﻠﺔ ﺍﻟﺗﺧﺛ��ﺭ‪ .‬ﻭﺫﻟ��ﻙ ﻳﺳ��ﺑﺏ‪-‬ﻋ��ﺎﺩﺓ‪ -‬ﺗﺧﺛ��ﺭﺍﺕ ﺗ��ﻭﺩﻱ ﺑﺣﻳ��ﺎﺓ ﺍﻟﺟﻧ��ﻳﻥ ﺧ��ﻼﻝ ﺍﻟﺣﻣ��ﻝ ﺃﻭ‬ ‫ﻣﺑﺎﺷﺭﺓ ﺑﻌﺩ ﺍﻟﻭﻻﺩﺓ‪ .‬ﻭﺻﻔﺔ ﺍﻟﻣﺭﺽ ﻣﺗﻧﺣﻳﺔ‪ ،‬ﻓﻳﺣﺗﺎﺝ ﺍﻟﺟﻧﻳﻥ ﺇﻟ�ﻰ ﺃﻥ ﻳﺭﺛﻬ�ﺎ ﻣ�ﻥ ﺃﺑﻭﻳ�ﻪ ﻟﻳﺻ�ﻳﺑﻪ‬ ‫ﺍﻟﻣﺭﺽ‪.‬‬ ‫ﻭﻫﻧﺎﻙ ﺣﺎﻟﺔ ﺃﺧﺭﻯ ﻧﺎﺩﺭﺓ‪ ،‬ﻳﺷﺫ ﻓﻳﻬﺎ ﺗﺭﻛﻳﺏ ﻣﻭﻟّﺩ ﺍﻟﺧﺛﺭﻳﻥ ﺑﺳﺑﺏ ﻁﻔ�ﺭﺓ ﻓ�ﻲ ﺍﻟﻣ�ﻭﺭّﺙ ﺍﻟﺧ�ﺎﺹ‬ ‫ﺑﻪ‪ ،‬ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﺯﻳﺎﺩﺓ ﺇﻧﺗﺎﺟﻪ ﻭﻣﻥ ﺛﻡ ﺍﺯﺩﻳﺎﺩ ﺍﻟﺗﺧﺛﺭ ﻭﺣﺻﻭﻝ ﺟﻠﻁﺎﺕ ﻟﺩﻯ ﺍﻟﻣﺭﻳﺽ‪.‬‬

‫ﺏ‪ -‬ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻣﻛﺗﺳﺑﺔ‬

‫ﻣﻘﺩﻣﺔ‬ ‫ﻫﻧﺎﻙ ﻣﺟﻣﻭﻋﺔ ﻣﻥ ﺍﻷﻣﺭﺍﺽ)ﺗﺭﺍﻫﺎ ﻓﻲ ﺍﻟﺟﺩﻭﻝ ﺻﻔﺣﺔ‪ (49‬ﻳﺯﺩﺍﺩ ﻋﻧﺩ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﻬﺎ ﺍﺣﺗﻣ�ﺎﻝ‬ ‫ﺍﻹﺻﺎﺑﺔ ﺑﺗﺧﺛﺭﺍﺕ ﺩﻡ ﻣﻧﺗﺷﺭﺓ ﻓ�ﻲ ﻣﺧﺗﻠ�ﻑ ﺃﻧﺣ�ﺎء ﺍﻟﺟﺳ�ﻡ‪ ،‬ﻭﺫﻟ�ﻙ ﻻﺣﺗﻣ�ﺎﻝ ﻭﺟ�ﻭﺩ ﺃﺣ�ﺩ ﺍﻟﺳ�ﺑﺑﻳﻥ‬ ‫ﺍﻟﺗﺎﻟﻳﻳﻥ ﺃﻭ ﻛﻠﻳﻬﻣﺎ ﻣﻌﺎ ً‪:‬‬

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‫ﺍ‪ -‬ﻅﻬﻭﺭ ﻣﻭﺍﺩ ﻣﺳﺎﻋﺩﺓ ﻋﻠﻰ ﺍﻟﺗﺧﺛﺭ ﻣﻥ ﺧﻼﻳﺎ ﻏﻳﺭ ﻁﺑﻳﻌﻳﺔ)ﻋﺻﺎﺭﺍﺕ ﺧﻠﻭﻳ�ﺔ( ﺩﺍﺧ�ﻝ ﺍﻷﻭﻋﻳ�ﺔ‬ ‫ﺍﻟﺩﻣﻭﻳﺔ‪ .‬ﻫﺫﻩ ﺍﻟﺧﻼﻳﺎ ﻗﺩ ﺗﻛﻭﻥ ﺳﺭﻁﺎﻧﻳﺔ ﺃﻭ ﻏﻳﺭ ﺳ�ﺭﻁﺎﻧﻳﺔ‪ .‬ﻭﻗ�ﺩ ﺗ�ﺄﺗﻲ ﻫ�ﺫﻩ ﺍﻟﻣ�ﻭﺍﺩ ﻣ�ﻥ ﺟ�ﺭﺍﺛﻳﻡ‬ ‫ﻣﺗﻛﺎﺛﺭﺓ ﺩﺍﺧﻝ ﺍﻟﺩﻡ‪.‬‬ ‫ﺏ‪ -‬ﺣﺻﻭﻝ ﺗﻠ�ﻑ ﻓ�ﻲ ﺑﻁﺎﻧ�ﺔ ﺍﻷﻭﻋﻳ�ﺔ ﺍﻟﺷ�ﻌﺭﻳﺔ‪ ،‬ﺃﻣ�ﺎ ﺑﻔﻌ�ﻝ ﺟ�ﺭﺍﺛﻳﻡ ﺃﻭ ﻣﺿ�ﺎﺩﺍﺕ ﻣﻧﺎﻋﻳ�ﺔ‪ ،‬ﻣﻣ�ﺎ‬ ‫ﻳﺅﺩﻱ ﺇﻟﻰ ﻛﺷﻑ ﺍﻷﻧﺳﺟﺔ ﺍﻟﺭﺍﺑﻁﺔ)ﺍﻟ ُﻛﻼﺟ�ﻳﻥ( ﺇﻟ�ﻰ ﺩﺍﺧ�ﻝ ﻭﻋ�ﺎء ﺍﻟ�ﺩﻡ ﺑﻌ�ﺩ ﺗﻠ�ﻑ ﺍﻟﺑﻁﺎﻧ�ﺔ‪ .‬ﻭﻫ�ﺫﺍ‬ ‫ﻳﺅﺩﻱ ﺇﻟﻰ ﺍﻟﺗﺻﺎﻕ ﺍﻟﺻُﻔﻳﺣﺎﺕ ﺑﻪ ﻭﻛﺫﻟﻙ ﺗﻔﻌﻳﻝ ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ‪.‬‬ ‫ﻓﻲ ﻛﻝ ﺍﻷﺣﻭﺍﻝ ﺗﺣﺻﻝ ﺍﻟﺗﻁﻭﺭﺍﺕ ﺍﻟﺗﺎﻟﻳﺔ ﻧﺗﻳﺟﺔ ﻟﻠﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ‪:‬‬ ‫‪.1‬ﻧﻘﺹ ﻓﻲ ﻋﺩﺩ ﺍﻟﺻﻔﻳﺣﺎﺕ‪ ،‬ﻷﻧﻬﺎ ُﺗﺳ َﺗﻬﻠﻙ ﺑﺎﻟﺗﺧﺛﺭﺍﺕ‪.‬‬ ‫‪.2‬ﻧﻘﺹ ﻓﻲ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻻﺳﺗﻬﻼﻛﻬﺎ ﻓﻲ ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻛﺫﻟﻙ‪.‬‬ ‫‪.3‬ﺗﻛ ّﺳ��ﺭ ﺃﻭ ﺍﻧﺣ��ﻼﻝ ﻓ��ﻲ ﺧﻼﻳ��ﺎ ﺍﻟ��ﺩﻡ ﺍﻟﺣﻣ��ﺭﺍء‪ ،‬ﻧﺗﻳﺟ��ﺔ ﻻﻧﺣﺑﺎﺳ��ﻬﺎ ﻭﺳ��ﻁ ﺍﻟﺗﺧﺛ��ﺭﺍﺕ‪ ،‬ﻭﺍﻟﺗ��ﻲ ﻳ��ﺗﻡ‬ ‫ﺗﺫﻭﻳﺑﻬﺎ ﻓﻳﻣﺎ ﺑﻌﺩ ﻓﺗﺗﺣﺭﺭ ﻣﻧﻬﺎ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء ﺍﻟﻣﺣﺑﻭﺳﺔ ﻓ�ﻲ ﺃﻟﻳﺎﻓﻬ�ﺎ‪ .‬ﻭﻳﻛ�ﻭﻥ ﺍﻟﻛﺛﻳ�ﺭ ﻣ�ﻥ ﺗﻠ�ﻙ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺣﻳﻥ ﺗﺣﺭﺭﻫﺎ ﻣﺗﻛﺳّﺭﺍً ﺇﻟﻰ ﺃﺟﺯﺍء ﺻﻐﻳﺭﺓ ﺃﻭ ﻣﻧﺣﻼًّ ﺗﻣﺎﻣﺎ ً‪.‬‬ ‫‪.4‬ﻅﻬﻭﺭ ﻗﻁﻊ ﻣﻥ ﺟﺯﻳﺋﺎﺕ ﺍﻟﻠﻳﻔﻳﻥ ﺍﻟﺗﻲ ﻳﺗﻡ ﺗﺣﻁﻳﻣﻬﺎ ﺑ�ﺎﻹﻧﻅﻳﻡ ﻣ�ﺫﻳﺏ ﺍﻟﺧﺛ�ﺭﺓ ﻓ�ﻲ ﺍﻟ�ﺩﻡ ﻭﻳﻣﻛ�ﻥ‬ ‫ﺍﻟﻛﺷﻑ ﻋﻠﻳﻬﺎ ﻓﻲ ﻋﻳﻧﺎﺕ ﺍﻟﺩﻡ ﻟﻼﺳﺗﺩﻻﻝ ﻣﻧﻬﺎ ﻋﻠﻰ ﻭﺟﻭﺩ ﺗﺧﺛﺭﺍﺕ ﻣﻧﺗﺷﺭﺓ‪.‬‬ ‫ﺍﻟﻣﺭﺿ�ﻳّﺔ‪ .‬ﻓ�ﺈﺫﺍ‬ ‫ﺟﻣﻳﻊ ﻫﺫﻩ ﺍﻟﻅﻭﺍﻫﺭ‪ ،‬ﺑﻁﺑﻳﻌﺔ ﺍﻟﺣﺎﻝ‪ ،‬ﺗﺗﻧﺎﺳ�ﺏ ﻣ�ﻊ ﺷ�ﺩﺓ ﻭﺍﺗﺳ�ﺎﻉ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ َ‬ ‫ﻛﺎﻧﺕ ﺑﺳﻳﻁﺔ ﻓﻛﻝ ﺍﻷﺷﻳﺎء ﺍﻟﻣﺫﻛﻭﺭﺓ ﻗﺩ ﻻ ﺗﻛﻭﻥ ﻅﺎﻫﺭﺓ ﺑﺷﻛﻝ ﻳﻠﻔﺕ ﺍﻻﻧﺗﺑﺎﻩ‪.‬‬ ‫ﻗﺩ ﻳﺳﺄﻝ ﺍﻟﻘﺎﺭﺉ‪ :‬ﻭﻣﺎ ﻫﻭ ﺩﻭﺭ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺍﻟﻣﺎﻧﻌﺔ ﻟﻠﺗﺧﺛﺭ ﺇﺫﺍً؟ ﻭﻟﻣﺎﺫﺍ ﻻ ﺗﻌﻣﻝ ﻋﻠ�ﻰ ﻣﻧ�ﻊ‬ ‫ﺣﺻﻭﻝ ﻫﺫﻩ ﺍﻟﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ؟‬ ‫ﻭﺍﻟﺟﻭﺍﺏ ﻭﺭﺩ ﻓﻲ ﺍﻟﻔﺻﻝ ﺍﻷﻭﻝ‪ ،‬ﻭﻫﻭ ﺃﻥ ﺗﻠﻙ ﺍﻟﻣﻭﺍﻧﻊ ﺗﺳﺗﻁﻳﻊ ﻣﻧ�ﻊ ﻋﻣﻠﻳ�ﺔ ﺗﺧﺛ�ﺭ ﺑﺳ�ﻳﻁﺔ ﺗﺑ�ﺩﺃ‬ ‫ﻫﻧ�ﺎ ﺃﻭ ﻫﻧ�ﺎﻙ ﺑﺳ�ﺑﺏ ﻅﻬ�ﻭﺭ ﻋﺻ�ﺎﺭﺓ ﺃﻧﺳ�ﺟﺔ ﺑﻣﻘ�ﺎﺩﻳﺭ ﺑﺳ�ﻳﻁﺔ ﻓ�ﻲ ﺗﻠ�ﻙ ﺍﻟﻣﻭﺍﻗ�ﻊ‪ .‬ﻓﺣﺎﻟﻣ�ﺎ ﻳﺑ�ﺩﺃ )‬ ‫ﻣﺷﺭﻭﻉ ﺍﻟﺗﺧﺛﺭ( ﺑﺳﺑﺏ ﺗﻠﻙ ﺍﻟﻌﺻﺎﺭﺍﺕ ﻓﺈﻧﻬﺎ ﺗﻌﻣ�ﻝ ﻋﻠ�ﻰ ﻣﻧ�ﻊ ﺇﺗﻣﺎﻣ�ﻪ‪ ،‬ﻭﻛ�ﻝ ﻣ�ﺎﻧﻊ ﺗﺧﺛ�ﺭ ﻳﻣﻧ�ﻊ‬ ‫ﺍﻟﻣﺭﺣﻠﺔ ﺍﻟﻣﺧﺻﺻﺔ ﻟﻪ‪ ،‬ﺣﺗﻰ ﻳُﻘﺿﻰ ﻋﻠﻰ ﺍﻟﻣﺷﺭﻭﻉ ﻓ�ﻲ ﻣﻬ�ﺩﻩ ﻭﻻ ﻳُﺳ�ﻣﺢ ﻟ�ﻪ ﺑﺎﻻﻧﺗﺷ�ﺎﺭ‪ .‬ﻟﻛ�ﻥ‬ ‫ﺍﻟﻣﺷ��ﻛﻠﺔ ﺗﺣﺻ��ﻝ ﻋﻧ��ﺩﻣﺎ ﺗﻛ��ﻭﻥ ﺍﻷﺳ��ﺑﺎﺏ ﺍﻟﻣﺅﺩﻳ��ﺔ ﺇﻟ��ﻰ ﺗﻔﻌﻳ��ﻝ ﺍﻟﺗﺧﺛ��ﺭ ﻣﻧﺗﺷ��ﺭﺓ ﻓ��ﻲ ﻛ��ﻝ ﺍﻟﺟﺳ��ﻡ‪،‬‬ ‫ﻭﺑﻛﻣﻳﺎﺕ ﺗﻔﻭﻕ ﻗﺎﺑﻠﻳﺔ ﺍﻟﻣﻭﺍﻧﻊ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻋﻠﻰ ﻭﻗﻔﻬﺎ‪ .‬ﻭﺇﺫﺍً ﻓﻬﻲ ﻣﺷ�ﻛﻠﺔ ﻛ ّﻣﻳّ�ﺔ ﻓﻘ�ﻁ‪ ،‬ﻓ�ﺈﺫﺍ ﺍﺯﺩﺍﺩﺕ‬ ‫ﺃﺻﺑﺣﺕ ﻣﺭﺿﺎ ً ﻭﺇﺫﺍ ﻗﻠّﺕ ﺃﻣﻛﻥ ﺇﻳﻘﺎﻓﻬﺎ‪.‬‬

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‫ﻧﺳ��ﺗﻁﻳﻊ ﺗﺷ��ﺑﻳﻪ ﺍﻷﻣ��ﺭ ﺑﺎﻻﻟﺗﻬﺎﺑ��ﺎﺕ ﺍﻟﺟﺭﺛﻭﻣﻳ��ﺔ‪ ،‬ﻓﻛ��ﻝ ﻣﻧ��ﺎ ﺗ��ﺩﺧﻝ ﺟﺳ��ﻣﻪ ﻓ��ﻲ ﻛ��ﻝ ﻟﺣﻅ��ﺔ ﺃﻋ��ﺩﺍﺩ‬ ‫ﺑﺳ��ﻳﻁﺔ ﻣ��ﻥ ﺍﻟﺟ��ﺭﺍﺛﻳﻡ ﻟﻛﻧﻬ��ﺎ ﻻ ﺗﺳ��ﺑﺏ ﻣﺭﺿ �ﺎ ً ﻭﻻ ﻳﺷ��ﻌﺭ ﺑﻬ��ﺎ ﺍﻹﻧﺳ��ﺎﻥ‪ ،‬ﻷﻥ ﺍﻟﺧﻼﻳ��ﺎ ﺍﻟﺑﻳﺿ��ﺎء‬ ‫ﺍﻟﻣﻠﺗﻬﻣﺔ ﻭﺍﻟﺟﻬﺎﺯ ﺍﻟﻣﻧﺎﻋﻲ ﺍﻟﻳﻘﻅ ﻳﻘﺿﻳﺎﻥ ﻋﻠﻳﻬﺎ ﻓ�ﻭﺭﺍً‪ .‬ﻟﻛ�ﻥ ﺩﺧ�ﻭﻝ ﺃﻋ�ﺩﺍﺩ ﻛﺑﻳ�ﺭﺓ ﻣ�ﻥ ﺍﻟﺟ�ﺭﺍﺛﻳﻡ‬ ‫ِ‬ ‫ﻓ��ﻲ ﻟﺣﻅ��ﺔ‪ ،‬ﻣ��ﻥ ﻋ��ﺩﻭﻯ ﺃﻭ ﺟ��ﺭﺡ ﻏﻳ��ﺭ ﻧﻅﻳ��ﻑ ﻳ��ﺅﺩﻱ ﺇﻟ��ﻰ ﺣﺻ�ﻭﻝ ﺍﻟﻣ��ﺭﺽ ﺍﻟﺟﺭﺛ��ﻭﻣﻲ‪ ،‬ﻷﻥ‬ ‫ﺍﻟﺟﺭﺍﺛﻳﻡ ﺗﺗﻐﻠّﺏ ﻋﻠﻰ ﺍﻻﺳﺗﻌﺩﺍﺩﺍﺕ ﺍﻷﻭﻟﻳﺔ ﻟﻘﺗﻠﻬﺎ‪.‬‬ ‫ﺳﻭﻑ ﻳﻅﻬﺭ ﻣﻥ ﺷﺭﺡ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻣﺧﺗﻠﻔﺔ ﻛﻳ�ﻑ ُﺗ َﻔﻌّ�ﻝ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ ﺑﺎﻟﺷ�ﺩﺓ ﺍﻟﺗ�ﻲ ﻻ ﺗﺳ�ﺗﻁﻳﻊ‬ ‫ﻣﻌﻬﺎ ﻋﻭﺍﻣﻝ ﻣﻧﻊ ﺍﻟﺗﺧﺛﺭ ﻣﻥ ﺇﺟﻬﺎﺿﻬﺎ‪.‬‬ ‫ﺃﺭﺟﻭ ﻣﻥ ﺍﻟﻘﺎﺭﺉ ﻣﻼﺣﻅﺔ ﺃﻥ ﺍﻟﻔ�ﺎﺭﻕ ﺑ�ﻳﻥ ﺍﻷﻣ�ﺭﺍﺽ ﺍﻟﻣﻭﺭﻭﺛ�ﺔ ﻭﺍﻟﻣﻛ َﺗ َﺳ�ﺑﺔ ﻟﻔ�ﺭﻁ ﺍﻟﺗﺧﺛ�ﺭ ﻫ�ﻭ‬ ‫ﺃﻥ ﺍﻟﻣﻭﺭﻭﺛ��ﺔ ﺗ��ﻧﻘﺹ ﻓﻳﻬ��ﺎ ﻋﻭﺍﻣ��ﻝ ﻣﻧ��ﻊ ﺍﻟﺗﺧﺛ��ﺭ ﺃﻭ ﻋﻭﺍﻣ��ﻝ ﺗ��ﺫﻭﻳﺏ ﺍﻟﺧﺛ��ﺭﺓ ﻓﺗﺳ��ﻣﺢ ﻟﻠﺗﺧﺛ��ﺭﺍﺕ‬ ‫ﺍﻟﺑﺳﻳﻁﺔ ﺃﻥ ﺗﺗﻭﺳﻊ ﺩﻭﻥ ﺭﺍﺩﻉ‪ ،‬ﻟﺗﺳﺑﺏ ﺟﻠﻁﺎﺕ‪ ،‬ﻻﺳﻳّﻣﺎ ﻓﻲ ﺍﻟﻅﺭﻭﻑ ﺍﻟﻣﺳﺎﻋﺩﺓ ﺍﻟﻣ�ﺫﻛﻭﺭﺓ ﻓ�ﻲ‬ ‫ﺻ��ﻔﺣﺔ ‪ .47‬ﺃﻣ��ﺎ ﺍﻟﻣﻛﺗﺳ��ﺑﺔ ﻓﻠ��ﻳﺱ ﻓﻳﻬ��ﺎ ﻧﻘ��ﺹ ﻓ��ﻲ ﺍﻟﻌﻭﺍﻣ��ﻝ ﺍﻟﻣ��ﺫﻛﻭﺭﺓ‪ ،‬ﻟﻛ��ﻥ ﻳﺣﺻ��ﻝ ﻟﻠﻣ��ﺭﻳﺽ‬ ‫ﺃﺳﺑﺎﺏ ﺗﺧﺛﺭ ﺗﺗﻔﻭّ ﻕ ﻋﻠﻰ ﻁﺎﻗﺔ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﺩﻳﻪ‪.‬‬ ‫ﺃﻋﻭﺩ ﻣﺭﺓ ﺃﺧ�ﺭﻯ ﻷﺫ ّﻛ�ﺭ ﺑﺣﻘﻳﻘ�ﺔ ﻫﺎﻣ�ﺔ ﻳ�ﺅﺩﻱ ﻋ�ﺩﻡ ﺇﺩﺭﺍﻛﻬ�ﺎ ﺇﻟ�ﻰ ﺍﺧ�ﺗﻼﻁ ﺍﻷﻣ�ﻭﺭ ﻋﻠ�ﻰ ﺑﻌ�ﺽ‬ ‫ﺍﻟﻧ��ﺎﺱ‪ ،‬ﻭﻫ��ﻲ ﺃﻥ)ﺍﻟﺟﻠﻁ��ﺎﺕ( ﺍﻟﺗ��ﻲ ﺗﺣﺻ��ﻝ ﻟﻠﻛﺛﻳ��ﺭﻳﻥ ﻓ��ﻲ ﺷ��ﺭﺍﻳﻳﻥ ﺍﻟﻘﻠ��ﺏ ﻭﺍﻟ��ﺩﻣﺎﻍ ﻭﻏﻳﺭﻫﻣ��ﺎ‬ ‫ﻟﻳﺳﺕ‪ ،‬ﻓﻲ ﻣﻌﻅﻡ ﺍﻷﺣﻳﺎﻥ‪ ،‬ﻣﻥ )ﺃﻣﺭﺍﺽ( ﻓﺭﻁ ﺍﻟﺗﺧﺛ�ﺭ ﺑﻘ�ﺩﺭ ﻣ�ﺎ ﻫ�ﻲ ﺃﻣ�ﺭﺍﺽ ﺷ�ﺭﺍﻳﻳﻥ‪.‬ﺃﻱ ﺃﻥ‬ ‫ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻭﻣﻧﻊ ﺍﻟﺗﺧﺛﺭ ﻟﻳﺱ ﻓﻳﻬﻣﺎ ﺧﻠﻝ ﻟﻛﻥ ﺟﺩﺭﺍﻥ ﺍﻟﺷ�ﺭﺍﻳﻳﻥ ﻏﻳ�ﺭ ﻁﺑﻳﻌﻳ�ﺔ ﻭﺗﻔﻘ�ﺩ ﺑﻁﺎﻧﺗﻬ�ﺎ‬ ‫ﺍﻟﻣﺎﻧﻌﺔ ﻟﺣﺻﻭﻝ ﺍﻟﺗﺧﺛﺭ ﻭﻳﺗﺭﺳّﺏ ﻋﻠﻰ ﺳﻁﻭﺣﻬﺎ ﺍﻟﺩﺍﺧﻠﻳﺔ ﺩﻫﻭﻥ ﻛﻣ�ﺎ ﺗﻧﻛﺷ�ﻑ ﻁﺑﻘ�ﺔ ﺍﻟ ُﻛﻼﺟ�ﻳﻥ‬ ‫ﻟﻣﺟﺭﻯ ﺍﻟﺩﻡ ﺩﻭﻥ ﺳﺎﺗﺭ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺑﻁﻧﺔ ﻟﻠﺷﺭﺍﻳﻳﻥ‪ .‬ﻓﻬﺫﻩ ﺍﻟﺑﻘﻊ ﻣﻥ ﺟﺩﺭﺍﻥ ﺍﻷﻭﻋﻳﺔ ﺍﻟﺩﻣﻭﻳ�ﺔ‬ ‫ﻫ���ﻲ ﺍﻟﺗ���ﻲ ﺗﺳ���ﺑﺏ ﺣﺻ���ﻭﻝ ﺍﻟﺟﻠﻁ���ﺔ ﻭﻓ���ﻲ ﺍﻟﻣﻭﺿ���ﻊ ﺍﻟﻣﺻ���ﺎﺏ ﺑﺎﻟ���ﺫﺍﺕ ﻭﺫﻟ���ﻙ ﺑﺗﺣﻔﻳ���ﺯ ﺗ���ﺭﺍﻛﻡ‬ ‫ﺍﻟﺻُﻔﻳﺣﺎﺕ ﻭﺗﻔﻌﻳﻝ ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻣﻭﺿﻌ ّﻳﺎ ً‪ .‬ﻭﻫﺫﻩ‪-‬ﻛﻣﺎ ﺫﻛﺭﺕ‪ -‬ﺃﻣﺭﺍﺽ ﺷﺭﺍﻳﻳﻥ‪.‬‬ ‫ﺇﻻ ّ ﺃﻥ ﻭﺟﻭﺩ ﻣﺭﺽ ﻣﻥ ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﻣﻊ ﻭﺟﻭﺩ ﺍﻟﺗﻐﻳﺭﺍﺕ ﺍﻻﻧﺣﻁﺎﻁﻳ�ﺔ ﺍﻟﻣ�ﺫﻛﻭﺭﺓ ﻓ�ﻲ‬ ‫ﺟﺩﺭﺍﻥ ﺍﻟﺷﺭﺍﻳﻳﻥ ﻳﺟﻌﻝ ﺍﺣﺗﻣﺎﻝ ﺣﺻﻭﻝ ﺍﻟﺟﻠﻁﺔ ﻣﻭﺿ�ﻌﻳﺎ ً ﺃﻛﺛ�ﺭ ﻓﺗﺣﺻ�ﻝ ﺍﻟﺟﻠﻁ�ﺔ ﻓ�ﻲ ﺷ�ﺭﺍﻳﻳﻥ‬ ‫ﺍﻟﻘﻠﺏ )ﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﺗﺎﺟﻳﺔ( ﻓﻲ ﻋﻣ�ﺭ ﺃﻗ�ﻝ ﻣ�ﻥ ﺍﻟﻣﻌﺗ�ﺎﺩ ﺃﻭ ﺑﻭﺟ�ﻭﺩ ﺗﻐﻳّ�ﺭﺍﺕ ﺃﺑﺳ�ﻁ ﻓ�ﻲ ﺍﻟﺷ�ﺭﺍﻳﻳﻥ‪.‬‬ ‫ﻭﻫﻧ��ﺎﻙ ﺃﻧ��ﺎﺱ ﻟ��ﺩﻳﻬﻡ ﺃﻛﺛ��ﺭ ﻣ��ﻥ ﺳ��ﺑﺏ ﻟﺣﺻ��ﻭﻝ ﺍﻟﺟﻠﻁ��ﺔ‪ ،‬ﻣﺛ��ﻝ ﺯﻳ��ﺎﺩﺓ ﻓ��ﻲ ﺍﻟﻛﻭﻟﺳ��ﺗﺭﻭﻝ ) ﻭﺍﻟﺗ��ﻲ‬

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‫ﺗﺳﺑﺏ ﺍﻧﺣﻁﺎﻁﺎﺕ ﺷﺩﻳﺩﺓ ﻓﻲ ﺟﺩﺭﺍﻥ ﺍﻟﺷﺭﺍﻳﻳﻥ(‪ +‬ﻧﻘﺹ ﻭﺭﺍﺛﻲ ﻓﻲ ﺃﺣﺩ ﻋﻭﺍﻣ�ﻝ ﻣﻧ�ﻊ ﺍﻟﺗﺧﺛ�ﺭ‪+‬‬ ‫ﺗﺩﺧﻳﻥ‪ ،‬ﻣﺛﻼً‪.‬‬ ‫ﺃﺭﺟﻭ ﺍﻟﻘﺎﺭﺉ ﺃﻥ ﻳﺩﺭﻙ ﻫﺫﻩ ﺍﻟﻧﻘﻁﺔ ﻭﻳﺗﺫ ّﻛﺭﻫﺎ ﺟﻳﺩﺍً ﻣﻧﻌﺎ ً ﻟﺣﺻﻭﻝ ﺍﺭﺗﺑﺎﻙ ﻓﻲ ﻓﻬﻡ ﺃﻣﺭﺍﺽ ﺍﻟﺩﻡ‬ ‫ﺍﻟﻣﻛﺗﺳﺑﺔ‪.‬‬ ‫ﻭﺍﻵﻥ ﻧﺄﺗﻲ ﺇﻟﻰ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻓﻧﺷﺭﺡ ﻛﻼًّ ﻣﻧﻬﺎ‪:‬‬ ‫‪.1‬ﺃﻣﺭﺍﺽ ﺍﻟﺳﺭﻁﺎﻥ ﺍﻟﻣﻧﺗﺷﺭﺓ‬ ‫ﺍﻟﺳ��ﺭﻁﺎﻥ ﻳﻣﻳ��ﻝ ﺇﻟ��ﻰ ﺍﻻﻧﺗﺷ��ﺎﺭ ﻓ��ﻲ ﺍﻟﺟﺳ��ﻡ‪ ،‬ﻻﺳ �ﻳّﻣﺎ ﻓ��ﻲ ﻣﺭﺍﺣ��ﻝ ﻣﺗﻘ ّﺩﻣ��ﺔ ﻣﻧ��ﻪ‪ ،‬ﻭﺍﻻﻧﺗﺷ �ﺎﺭ ﻳ��ﺗﻡ‬ ‫ﻣﻭﺿﻌ ّﻳﺎ ً ﺑﺎﻟﺗﻭﺳﻊ ﺃﻭ ﺇﻟﻰ ﺃﻣﺎﻛﻥ ﺑﻌﻳﺩﺓ ﻋﻥ ﻣﻭﻗﻌﻪ ﺍﻷﺻﻠﻲ ﺑﺄﻥ ُﺗﺣﻣﻝ ﺧﻼﻳ�ﺎ ﻣﻧ�ﻪ ﺑﻭﺍﺳ�ﻁﺔ ﺍﻟ�ﺩﻡ‬ ‫ﺃﻭ ﺳﺎﺋﻝ ﺍﻟﻠﻣﻑ‪ .‬ﻭﻳﻛ�ﻭﻥ ﻧﻘ�ﻝ ﺗﻠ�ﻙ ﺍﻟﺧﻼﻳ�ﺎ ﺑﻌ�ﺩ ﺃﻥ ﺗﻘ�ﺗﺣﻡ ﺟ�ﺩﺭﺍﻥ ﺍﻷﻭﻋﻳ�ﺔ ﺍﻟﺩﻣﻭﻳ�ﺔ ﺃﻭ ﺍﻟﻠﻣﻔﻳ�ﺔ‪.‬‬ ‫ﻓﺈﺫﺍ ﺍﻗﺗﺣﻣﺕ ﻣﺟﻣﻭﻋﺔ ﺻﻐﻳﺭﺓ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺟﺩﺭﺍﻥ ﻭﻋﺎء ﺩﻡ ﻓﺈﻧﻬﺎ ﺗﻣﻳﻝ ﺇﻟﻰ ﺍﻻﻧﻔﻼﺕ ﻣﻥ ﺟﺳ�ﻡ‬ ‫ﺍﻟﺳﺭﻁﺎﻥ ﺍﻷﺻﻠﻲ ﻟﺗﺳﺗﻘﺭ ﻓﻲ ﻣﻛﺎﻥ ﺁﺧﺭ ﻣﻥ ﺍﻟﺟﺳﻡ ﺑﻌﺩ ﺃﻥ ﺗﺟﺭﻱ ﻣﻊ ﺍﻟﺩﻡ ﺃﻭ ﺍﻟﻠﻣﻑ ﻣﺳ�ﺎﻓﺎﺕ‬ ‫ﻣﺧﺗﻠﻔﺔ‪.‬‬ ‫ﻭﻋﻧ��ﺩﻣﺎ ﺗﺳ��ﺗﻘﺭ ﻫ��ﺫﻩ ﺍﻟﺧﻼﻳ��ﺎ ﺍﻟﺳ��ﺭﻁﺎﻧﻳﺔ ﻓ��ﻲ ﻣﻭﻗ��ﻊ ﺟﺩﻳ��ﺩ ﻓﻬ��ﻲ ﺗﺳ��ﺗﻘﺭ ﺩﺍﺧ��ﻝ ﺍﻷﻭﻋﻳ��ﺔ ﺍﻟﺩﻣﻭﻳ��ﺔ‬ ‫ﺃﻭﻻً‪ ،‬ﻭﻗﺑﻝ ﺃﻥ ﺗﻛﺑﺭ ﻭﺗﺧﺭﺝ ﻋﻥ ﻧﻁ�ﺎﻕ ﺍﻷﻭﻋﻳ�ﺔ‪ .‬ﺑ�ﺫﻟﻙ ﻳﻛ�ﻭﻥ ﺩﺍﺧ�ﻝ ﻣﺟ�ﺭﻯ ﺍﻟ�ﺩﻡ ﺳ�ﻁﺢ ﻏﻳ�ﺭ‬ ‫ﻣﻐﻁ��ﻰ ﺑﺎﻟﺧﻼﻳ��ﺎ ﺍﻟﻁﻼﺋﻳ��ﺔ ﺍﻟﺗ��ﻲ ﺗﻣﻧ��ﻊ ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﻛﻣ��ﺎ ﺃﻥ ﺧﻼﻳ��ﺎ ﺍﻟﺳ��ﺭﻁﺎﻥ ﻫ��ﻲ ﺧﻼﻳ��ﺎ ﺳ��ﺭﻳﻌﺔ‬ ‫ﺍﻻﻧﺣﻼﻝ ﻭﺗﺗﺣﺭﺭ ﻣﻧﻬﺎ ﻋﺻﺎﺭﺍﺕ ﻧﺳﺟﻳﺔ ﺩﺍﺧﻝ ﺍﻟﺩﻡ‪ .‬ﻭﺑﺫﻟﻙ ﻳﻛﻭﻥ ﻫﻧﺎﻙ ﺳﺑﺑﺎﻥ ﻳﺷ�ﺟّﻌﺎﻥ ﻋﻠ�ﻰ‬ ‫ﺗﺭﺍﻛﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﺗﺧﺛﺭ ﺍﻟﺩﻡ‪ .‬ﺑﻬﺫﺍ ﻓﺈﻥ ﻛﻝ ﻣﺟﻣﻭﻋﺔ ﺧﻼﻳﺎ ﺳﺭﻁﺎﻧﻳﺔ ﺗﺳﺗﻘﺭ ﻓ�ﻲ ﻣﻭﺿ�ﻊ ﺗﻭﻟّ�ﺩ‬ ‫ﺗﺧﺛﺭﺍً ﻋﻠﻰ ﺳﻁﺣﻬﺎ‪ .‬ﻭﻋﻣﻠﻳﺔ ﺍﻧﺗﺷﺎﺭ ﺍﻟﺳ�ﺭﻁﺎﻥ‪ ،‬ﺇﺫﺍ ﺑ�ﺩﺃﺕ‪ ،‬ﻋ�ﺎﺩﺓ ﻣ�ﺎ ﺗﻛ�ﻭﻥ ﻭﺍﺳ�ﻌﺔ ﻭﻣﺳ�ﺗﻣﺭﺓ‪،‬‬ ‫ﻟﺫﺍ ﻓﺈﻥ ﻋﻣﻠﻳﺔ ﺗﺧﺛﺭﺍﺕ ﻭﺍﺳﻌﺔ ﻭﻣﺯﻣﻧﺔ ﺗﺣﺻﻝ ﻣﻊ ﺫﻟﻙ ﺍﻻﻧﺗﺷﺎﺭ ﺍﻟﻣﺳﺗﻣﺭ‪.‬‬ ‫ﻭﻛﻣﺎ ﺫﻛﺭﺕ ﺳﺎﺑﻘﺎً‪ ،‬ﻓﺈﻥ ﻫﺫﻩ ﺍﻟﻅﺎﻫﺭﺓ ﺗﺳﺑﺏ ﻧﻘﺻﺎ ً ﻓﻲ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ ﻣ�ﻥ ﺟ�ﺭﺍء‬ ‫ﺍﻻﺳﺗﻬﻼﻙ ﺍﻟﻭﺍﺳﻊ ﻟﻬﺎ‪ ،‬ﻛﻣﺎ ﺗﺳﺑﺏ ﻓﻘﺭ ﺩﻡ ﻧﺗﻳﺟﺔ ﻻﻧﺣﻼﻝ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﺣﻣ�ﺭﺍء )ﻁﺑﻌ�ﺎ ً ﻓ�ﻲ ﺣ�ﺎﻻﺕ‬ ‫ﺍﻟﺳﺭﻁﺎﻥ ﺍﻟﻣﻧﺗﺷﺭ ﻫﻧﺎﻙ ﺃﺳﺑﺎﺏ ﺇﺿﺎﻓﻳﺔ ﻟﺣﺻﻭﻝ ﻓﻘﺭ ﺍﻟﺩﻡ(‪ .‬ﻭﻗ�ﺩ ﻳﺻ�ﻝ ﺍﻷﻣ�ﺭ ﺇﻟ�ﻰ ﺍﻟﻧ�ﺯﻑ ﺇﺫﺍ‬ ‫ﺍﺷﺗ ّﺩ ﺍﻟﻧﻘﺻﺎﻥ ﻓﻲ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺃﻭ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﺃﻭ ﻓﻲ ﻛﻠﻳﻬﻣﺎ‪.‬‬ ‫ﻳﺗﻡ ﺗﺷﺧﻳﺹ ﺍﻟﺣﺎﻟﺔ ﻣﻥ ﺍﻟﻣﻌﺭﻓﺔ ﺑﺈﺻﺎﺑﺔ ﺍﻟﻣﺭﻳﺽ ﺑﺎﻟﺳﺭﻁﺎﻥ‪ ،‬ﺛﻡ ﺑﺗﻌ�ﺩﺍﺩ ﺍﻟﺻ�ﻔﻳﺣﺎﺕ ﻭﺑ�ﺈﺟﺭﺍء‬ ‫ﻓﺣﻭﺹ ﺍﻟﺗﺧﺛﺭ ﺍﻷﺳﺎﺳﻳﺔ ) ﺍﻧﻅ�ﺭ ﺍﻟﻔﺻ�ﻝ ﺍﻟﺛ�ﺎﻧﻲ( ﻭﻛ�ﻭﻥ ﻧﺗﺎﺋﺟﻬ�ﺎ ﻏﻳ�ﺭ ﻁﺑﻳﻌﻳ�ﺔ )ﻭﻗ�ﺕ ﺍﻟﺗﺧﺛ�ﺭ‬

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‫ﺃﻁ�ﻭﻝ(‪ ،‬ﻭﻛ��ﺫﻟﻙ ﺑﻭﺟ��ﻭﺩ ﻓﻘ��ﺭ ﺩﻡ ﻣ�ﻊ ﺧﻼﻳ��ﺎ ﻣﻧﺷ��ﻁﺭﺓ ﻓ��ﻲ ﺍﻟ�ﺩﻡ )ﺑﻔﺣ��ﺹ ﻣﺳ��ﺣﺔ ﻣﺻ��ﺑﻭﻏﺔ ﻣ��ﻥ‬ ‫ﺍﻟﺩﻡ(‪ ،‬ﻭﺑﻔﺣﻭﺹ ﺃﺧﺭﻯ ﺗﺩﻝ ﻋﻠﻰ ﻭﺟ�ﻭﺩ ﺍﻧﺣ�ﻼﻝ ﻓ�ﻲ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﺣﻣ�ﺭﺍء‪ ،‬ﻣﺛ�ﻝ ﺍﺭﺗﻔ�ﺎﻉ ﻣﺳ�ﺗﻭﻯ‬ ‫ﺍﻟﺻﻔﺭﺍء )ﺍﻟﺻﻔﺭﻳﻥ( ﻓﻲ ﺍﻟﺩﻡ‪.‬‬ ‫ﻭﺑﺩﻳﻬﻲ ﺃﻥ ﻋﻼﺝ ﻣﺛ�ﻝ ﻫ�ﺫﻩ ﺍﻟﺗﺧﺛ�ﺭﺍﺕ ﺍﻟﻣﻧﺗﺷ�ﺭﺓ ﻻﻳﻣﻛ�ﻥ ﺃﻥ ﻳ�ﺗﻡ ﺩﻭﻥ ﻋ�ﻼﺝ ﻧ�ﺎﺟﺢ ﻟﻠﺳ�ﺭﻁﺎﻥ‬ ‫ﻧﻔﺳ���ﻪ‪ .‬ﻓ���ﺈﺫﺍ ﻧﺟ���ﺢ ﺍﻟﻌ���ﻼﺝ ﻓ���ﻲ ﺍﺳﺗﺋﺻ���ﺎﻝ ﺃﻭ ﻗﺗ���ﻝ ﺧﻼﻳ���ﺎ ﺍﻟﺳ���ﺭﻁﺎﻥ ﻭﻣﻧ���ﻊ ﺍﻧﺗﺷ���ﺎﺭﻫﺎ ﺗﻭﻗﻔ���ﺕ‬ ‫ﺍﻟﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷﺭﺓ‪ ،‬ﻟﻛﻥ ﻋﺩﻡ ﺇﻣﻛﺎﻥ ﻣﻌﺎﻟﺟﺔ ﺣﺎﻟﺔ ﺍﻟﺳﺭﻁﺎﻥ ﻟﺩﻯ ﺑﻌﺽ ﺍﻟﻣﺭﺿﻰ ﻻ ﻳﻣﻧﻊ ﻣ�ﻥ‬ ‫ﻧﻘﻝ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﺭ ّﻛﺯﺓ ﻭﺍﻟﺑﻼﺯﻣﺎ ﺍﻟﻣﺟﻣﺩﺓ ﻟﻬﻡ ﻹﻳﻘﺎﻑ ﺍﻟﻧ�ﺯﻑ‪ ،‬ﺇﺫﺍ ﺣﺻ�ﻝ‪ ،‬ﻭﻧﻘ�ﻝ ﺧﻼﻳ�ﺎ ﺍﻟ�ﺩﻡ‬ ‫ﺍﻟﺣﻣﺭﺍء ﻟﻬﻡ ﻟﺗﺻﺣﻳﺢ ﻓﻘﺭ ﺍﻟﺩﻡ‪.‬‬ ‫‪.2‬ﺍﻟﺗﺳﻣﻡ ﺍﻹﻧﺗﺎﻧﻲ ﺍﻟﺩﻣﻭﻱ‬ ‫ﺑﻌ��ﺽ ﺣ��ﺎﻻﺕ ﺗﺳ��ﻣﻡ ﺍﻟ��ﺩﻡ ﺑ��ﺎﻟﺟﺭﺍﺛﻳﻡ ﺗﻛ��ﻭﻥ ﻣﺻ��ﺣﻭﺑﺔ ﺑﺗﻔﻌﻳ��ﻝ ﻋﻣﻠﻳ��ﺔ ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﺩﻭﻥ ﺣﺻ��ﻭﻝ‬ ‫ﺟﻠﻁ��ﺎﺕ‪ ،‬ﻭﺗ��ﺅﺩﻱ ﺇﻟ��ﻰ ﻧﻘ��ﺹ ﻓ��ﻲ ﻋﻭﺍﻣ��ﻝ ﺍﻟﺧﺛ��ﺭ ﻭﺍﻟﺻ��ﻔﻳﺣﺎﺕ‪ ،‬ﻗ��ﺩ ﻳﻛ��ﻭﻥ ﺷ��ﺩﻳﺩﺍً ﺑﺣﻳ��ﺙ ﻳﻧ��ﺯﻑ‬ ‫ﺍﻟﻣﺭﻳﺽ ﻣﻥ ﻣﺧﺗﻠﻑ ﺃﻧﺣﺎء ﺍﻟﺟﺳ�ﻡ‪ .‬ﻭﻗ�ﺩ ﻳﺣﺻ�ﻝ ﻟ�ﺩﻯ ﺍﻟﻣﺭﺿ�ﻰ ﺃﻧﺯﻓ�ﺔ ﺩﺍﺧﻠﻳ�ﺔ‪ ،‬ﻭﺣﺗ�ﻰ ﺑ�ﺎﻟﻣﺦ‬ ‫ﺃﺣﻳﺎﻧﺎ ً‪ .‬ﻛﻣﺎ ﻗﺩ ﻳﻛﻭﻥ ﺍﻟﻧﺯﻑ ﺳﺑﺑﺎ ً ﻣﺑﺎﺷﺭﺍً ﻟﻠﻭﻓﺎﺓ‪.‬‬ ‫ﺳﺑﺏ ﺗﻔﻌﻳﻝ ﺍﻟﺗﺧﺛﺭ ﻫﻧﺎ ﻫﻭ ﻣﻭﺍﺩ ﻣﻧﺗﺟﺔ ﻣﻥ ﺍﻟﺟﺭﺍﺛﻳﻡ ﻧﻔﺳﻬﺎ‪ ،‬ﻭﺗﻛﻭﻥ ﻋﺎﺩﺓ ﻣﻥ ﻣﺭﻛﺑﺎﺕ ﺟ�ﺩﺭﺍﻥ‬ ‫ﺍﻟﺧﻼﻳﺎ ﺍﻟﺟﺭﺛﻭﻣﻳﺔ‪ .‬ﻓﺈﺫﺍ ﺍﻧﺗﺷﺭﺕ ﺍﻟﺟﺭﺍﺛﻳﻡ ﺑﺎﻟﺩﻡ )ﺗﺳ�ﻣﻡ ﺇﻧﺗ�ﺎﻧﻲ( ﻓ�ﺈﻥ ﺗﻠ�ﻙ ﺍﻟﻣ�ﻭﺍﺩ ﺍﻟﺻ�ﺎﺩﺭﺓ ﻣ�ﻥ‬ ‫ﺍﻟﺟ��ﺭﺍﺛﻳﻡ ﺗﺑ��ﺩﺃ ﺑﺗﻔﻌﻳ��ﻝ ﺍﻟﺗﺧﺛ��ﺭ ﻋ��ﻥ ﻁﺭﻳ��ﻕ ﻋﻭﺍﻣ��ﻝ ﺍﻟﺗﻣ��ﺎﺱ )ﺍﻟﻁﺭﻳ��ﻕ ﺍﻟ��ﺩﺍﺧﻠﻲ‪ -‬ﺍﻧﻅ��ﺭ ﺍﻟﻔﺻ��ﻝ‬ ‫ﺍﻷﻭﻝ(‪.‬‬ ‫ﻋ��ﻼﺝ ﻫ��ﺫﻩ ﺍﻟﺣﺎﻟ��ﺔ ﻳﻛ��ﻭﻥ ﺑﺗﻌ��ﻭﻳﺽ ﻋﻭﺍﻣ��ﻝ ﺍﻟﺗﺧﺛ��ﺭ ﺑﺈﻋﻁ��ﺎء ﺍﻟﺑﻼﺯﻣ��ﺎ‪ ،‬ﻭﺑﺗﻌ��ﻭﻳﺽ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ‬ ‫ﺑﻧﻘﻝ ﺻُﻔﻳﺣﺎﺕ ﻣﺭ ّﻛﺯﺓ‪ ،‬ﻭﺫﻟﻙ ﻟﻣﻧﻊ ﺍﻟﻧﺯﻑ ﺭﻳﺛﻣﺎ ﻳﺗﻡ ﻋﻼﺝ ﺍﻟﺗﺳﻣﻡ ﺍﻟﺟﺭﺛﻭﻣﻲ‪.‬‬ ‫‪ .3‬ﻭ ﺳﺭﻁﺎﻧﺎﺕ ﺍﻟﺗﻛﺎﺛﺭ ﺍﻟﻧﺧﺎﻋﻳﺔ ﻭﺳﺭﻁﺎﻥ ﺍﻟﺩﻡ ﺍﻟﺣﺎﺩ‬ ‫ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ‪ ،‬ﺍﻟﺗﻲ ﻛﺎﻧﺕ ﺗﺳﻣﻰ)ﺍﻋﺗﻼﻻﺕ ﺍﻟﺗﻛﺎﺛﺭ ﺍﻟﻧﺧﺎﻋﻳﺔ( ﺗﺗﻛﺎﺛﺭ ﻓﻳﻬ�ﺎ ﺧﻼﻳ�ﺎ ﻣﺗﻧﻭﻋ�ﺔ‬ ‫ﻣﻥ ﺗﻠﻙ ﺍﻟﺗﻲ ﻳﺻﻧﻌﻬﺎ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‪.‬‬ ‫ﻳﺣﺻﻝ ﻟ�ﺩﻯ ﺍﻟ�ﺑﻌﺽ ﻣ�ﻥ ﺍﻟﻣﺻ�ﺎﺑﻳﻥ ﺑﻬ�ﺫﻩ ﺍﻷﻣ�ﺭﺍﺽ ﺗﻔﻌﻳ�ﻝ ﻓ�ﻲ ﻋﻣﻠﻳ�ﺔ ﺍﻟﺗﺧﺛ�ﺭ ﻭﺑﺻ�ﻭﺭﺓ‬ ‫ﻣﺳﺗﻣﺭﺓ‪ .‬ﻭﻗﺩ ﺗﻅﻬﺭ ﺁﺛﺎﺭ ﻓﻲ ﺍﻟﻔﺣﻭﺹ ﺍﻟﻣﺧﺑﺭﻳﺔ ﺗﺩﻝ ﻋﻠﻰ ﺯﻳﺎﺩﺓ ﺍﺳ�ﺗﻬﻼﻙ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ‬ ‫ﻭﺍﻟﺻ��ﻔﻳﺣﺎﺕ‪ .‬ﺗﻛ��ﻭﻥ ﻫ��ﺫﻩ ﺍﻟﺯﻳ��ﺎﺩﺓ ﻋ��ﺎﺩﺓ ﺑﺳ��ﻳﻁﺔ ﺇﻻ ﻓ��ﻲ ﺃﻧ��ﻭﺍﻉ ﻣﻌﻳّﻧ��ﺔ ﻣ��ﻥ ﺳ��ﺭﻁﺎﻥ ﺍﻟ��ﺩﻡ‬

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‫ﺍﻟﻧﺧ��ﺎﻋﻲ ﺍﻟﺣ��ﺎﺩ ‪ ،‬ﺣﻳ��ﺙ ﺗﺷ��ﺗﺩ ﺣﺎﻟ��ﺔ ﺍﻟﺗﻔﻌﻳ��ﻝ‪ ،‬ﺑ��ﻝ ﺗﻛ��ﻭﻥ ﻣ��ﻥ ﺍﻟﺑﺩﺍﻳ��ﺔ ﻋﻼﻣ��ﺔ ﻣ��ﻥ ﻋﻼﻣ��ﺎﺕ‬ ‫ﺗﺷﺧﻳﺹ ﺍﻟﻣﺭﺽ‪.‬‬ ‫ﺳﺑﺏ ﺗﻔﻌﻳﻝ ﺍﻟﺗﺧﺛﺭ ﻓﻲ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ ﻫﻭ ﺇﻓﺭﺍﺯ ﺍﻟﻌﺻﺎﺭﺍﺕ ﺍﻟﺧﻠﻭﻳﺔ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺗﻛ�ﺎﺛﺭﺓ‬ ‫ﺍﻟﻬﺷﺔ ﻓﺗﻅﻬﺭﻫﺫﻩ ﺍﻟﻌﺻﺎﺭﺍﺕ ﺑﺎﻟﺩﻡ ﻭﺗﺅﺩﻱ ﺇﻟ�ﻰ ﺗﻔﻌﻳ�ﻝ ﻋﺎﻣ�ﻝ ‪ .7‬ﻫ�ﺫﻩ ﺍﻟﺣﺎﻟ�ﺔ ﺗﺧ�ﻑ ﺑﻌ�ﻼﺝ‬ ‫ﺍﻟﻣﺭﺽ ﺍﻷﺻﻠﻲ‪.‬‬ ‫‪.4‬ﺍﻷﻣﺭﺍﺽ ﺫﺍﺗﻳﺔ ﺍﻟﻣﻧﺎﻋﺔ‬ ‫ﺑﻌﺽ ﻫﺫﻩ ﺍﻷﻣﺭﺍﺽ‪ ،‬ﺍﻟﺗﻲ ﺗﺻﻳﺏ ﺍﻟﻛﻼﺟﻳﻥ ﺗﺅﺩﻱ ﺇﻟﻰ ﺯﻳﺎﺩﺓ ﻣﻳ�ﻝ ﺍﻟ�ﺩﻡ ﻟﻠﺗﺧﺛ�ﺭ ﻭﺣﺻ�ﻭﻝ‬ ‫ﺍﻟﺟﻠﻁﺎﺕ‪ .‬ﺃﻫﻡ ﺗﻠﻙ ﺍﻷﻣﺭﺍﺽ ﻫﻭ ﻣﺭﺽ )ﺍﻟﺫﺋﺏ ﺍﻹﺣﻣﺭﺍﺭﻱ( ﻭﻓﻳﻪ ﺗﺗﻛﻭﻥ ﺃﺟﺳ�ﺎﻡ ﻣﺿ�ﺎﺩﺓ‬ ‫ﺫﺍﺗﻳ��ﺔ ﺿ��ﺩ ﻛﺛﻳ��ﺭ ﻣ��ﻥ ﺃﻧ��ﻭﺍﻉ ﺧﻼﻳ��ﺎ ﺍﻟﺟﺳ��ﻡ ﻭﻣﺭ ّﻛﺑﺎﺗ��ﻪ ﺍﻟﻛﻳﻣﻳﺎﺋﻳ��ﺔ‪ .‬ﺗﺧﺗﻠ��ﻑ ﺗﻠ��ﻙ ﺍﻷﺟﺳ��ﺎﻡ‬ ‫ﺍﻟﻣﺿ��ﺎﺩﺓ ﻣ��ﻥ ﻣ��ﺭﻳﺽ ﻵﺧ��ﺭ‪ .‬ﻣ��ﻥ ﺧ��ﻭﺍﺹ ﻫ��ﺫﻩ ﺍﻷﻣ��ﺭﺍﺽ ﺍﺣﺗﻣ��ﺎﻝ ﺗﻭﻟ��ﺩ ﺃﺟﺳ��ﺎﻡ ﻣﺿ��ﺎﺩﺓ‬ ‫)ﻣﺿﺎﺩﺍﺕ( ﻟﺑﻌﺽ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﺑﺣﻳ�ﺙ ﺗ�ﺅﺩﻱ ﺇﻟ�ﻰ ﺃﻣ�ﺭﺍﺽ ﻧﺯﻓﻳ�ﺔ )ﺫﻛﺭﺗﻬ�ﺎ ﻓ�ﻲ ﺍﻟﻔﺻ�ﻝ‬ ‫ﺍﻟﺛﺎﻧﻲ(‪ .‬ﻛﺫﻟﻙ ﻓﻣﻥ ﺍﻟﻣﻣﻛﻥ ﺗﻭﻟّﺩ ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﺗﺳﺑﺏ ﺗﻔ ّﻌﻼً ﺑﺎﻟﺗﺧﺛﺭ ﻭﻗﺩ ﺗﺅﺩﻱ ﺇﻟﻰ ﺇﺳ�ﻘﺎﻁ‬ ‫ﻣﺗﻛﺭﺭ ﻟﺩﻯ ﺍﻟﺣﻭﺍﻣﻝ ﺑﺳﺑﺏ ﺣﺻﻭﻝ ﺗﺧﺛﺭﺍﺕ ﻓﻲ ﺍﻟﻣﺷﻳﻣﺔ‪ .‬ﻫﺫﻩ ﺍﻟﻌﻭﺍﻣﻝ ﺗﺳﻣﻰ )ﻣﺿ�ﺎﺩﺍﺕ‬ ‫ﺍﻟﺩﻫﻭﻥ ﺍﻟﻔﻭﺳﻔﺎﺗﻳﺔ(‬ ‫ﺇﻥ ﺗﻭﻟﺩ ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﻣﺿﺎﺩﺍﺕ ﻓﻲ ﻣﺭﺽ ﺍﻟ�ﺫﺋﺏ ﺍﻹﺣﻣ�ﺭﺍﺭﻱ‪ ،‬ﻭﻏﻳ�ﺭﻩ ﻣ�ﻥ ﺍﻷﻣ�ﺭﺍﺽ ﺫﺍﺗﻳ�ﺔ‬ ‫ﺍﻟﻣﻧﺎﻋﺔ ﺇﻟﻰ ﺣﺩ ﻣﺎ‪ ،‬ﻫﻭ ﻣﻥ ﺍﻷﻣﻭﺭ ﺍﻟﻁﺭﻳﻔﺔ ﺣﻳﺙ ﺗﺅﺛﺭ ﻋﻠﻰ ﺃﺣﺩ ﻓﺣﻭﺹ ﺍﻟﺗﺧﺛﺭ )ﻓﺣ�ﺹ‬ ‫ﻭﻗﺕ ﺗﻭﻟّﺩ ﺍﻟﺧﺛﺭﺓ ﺍﻟﺟﺯﺋﻲ( ﺍﻟﺫﻱ ﺗﺩﺧﻝ ﻓﻳﻪ ﺍﻟﺩﻫﻭﻥ ﺍﻟﻔﻭﺳﻔﺎﺗﻳﺔ ﻛﺄﺣﺩ ﺍﻟﻛﻭﺍﺷﻑ‪ ،‬ﻣﻣﺎ ﻳﺳ�ﺑﺏ‬ ‫ﺍﺳﺗﻁﺎﻟﺔ ﻓﻲ ﺯﻣﻥ ﺍﻟﺗﺧﺛﺭ‪ .‬ﻫﺫﻩ ﺍﻟﻅﺎﻫﺭﺓ ﺗﻌﻁ�ﻲ ﺍﻧﻁﺑﺎﻋ�ﺎ ً ﺧﺎﻁﺋ�ﺎ ً ﺑ�ﺄﻥ ﺍﻟﻣ�ﺭﻳﺽ ﻳﻌ�ﺎﻧﻲ ﻣ�ﻥ‬ ‫ﻓ��ﺭﻁ ﺍﻟﻧ��ﺯﻑ‪ ،‬ﻭﺍﻟﻭﺍﻗ��ﻊ ﺃﻥ ﺍﻷﻣ��ﺭ ﻟ��ﻳﺱ ﺳ��ﻭﻯ ﻅ��ﺎﻫﺭﺓ ﻣﺧﺑﺭﻳ��ﺔ ﻻ ﺗﻌﺑ��ﺭ ﻋﻣ��ﺎ ﻳﺟ��ﺭﻱ ﻓ��ﻲ‬ ‫ﺍﻟﺟﺳﻡ‪ ،‬ﻭﺍﻟﺫﻱ ﻳﺟﺭﻱ ﻓﻳﻪ ﻫﻭ ﻓﺭﻁ ﻓﻲ ﺍﻟﺗﺧﺛ�ﺭ‪ .‬ﻭﻗ�ﺩ ﺗ�ﺅﺩﻱ ﺇﻟ�ﻰ ﺧﻁ�ﺄ ﻓ�ﻲ ﺍﻟﺗﺷ�ﺧﻳﺹ ﻋﻧ�ﺩ‬ ‫ﻣﻥ ﻻ ﻳﻌﻠﻡ ﺑﺈﺻﺎﺑﺔ ﺍﻟﻣﺭﻳﺽ ﺑﻣﺭﺽ ﺍﻟﺫﺋﺏ ﺍﻹﺣﻣﺭﺍﺭﻱ ﻭﺃﻣﺛﺎﻟﻪ‪.‬‬ ‫ﻫﻧ��ﺎﻙ ﺃﻣ��ﺭﺍﺽ ﺃﺧ��ﺭﻯ‪ ،‬ﻳُﻌﺗﻘ��ﺩ ﺃﻧﻬ��ﺎ ﺫﺍﺗﻳ��ﺔ ﺍﻟﻣﻧﺎﻋ��ﺔ‪ ،‬ﺗﺳ��ﺑﺏ ﺃﺟﺳ��ﺎﻣﺎ ً ﻣﺿ��ﺎﺩﺓ ﺗﺿ��ﺭ ﺑﺎﻟﺧﻼﻳ��ﺎ‬ ‫ﺍﻟﻣﺑﻁﻧ�ﺔ ﻟﻠﺷ�ﺭﺍﻳﻳﻥ ﺍﻟﺻ�ﻐﻳﺭﺓ ﻭﺍﻟﺷ�ﻌﻳﺭﺍﺕ ﺍﻟﺩﻣﻭﻳ�ﺔ‪ ،‬ﺃﻣ��ﺎ ﻓ�ﻲ ﺍﻟﻛﻠﻳ�ﺔ ﺑﺻ�ﻭﺭﺓ ﺧﺎﺻ�ﺔ ﺃﻭ ﻓ��ﻲ‬ ‫ﻋﻣﻭﻡ ﺍﻟﺟﺳﻡ ﺃﻭ ﻓﻲ ﺍﻟﻣﺦ ﺑﺷﻛﻝ ﺧﺎﺹ‪ .‬ﺫﻟﻙ ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺧﺛﺭﺍﺕ ﺗ�ﺅﺛﺭ ﻋﻠ�ﻰ ﻭﻅ�ﺎﺋﻑ ﺗﻠ�ﻙ‬ ‫ﺍﻷﻋﺿﺎء‪ ،‬ﻛﻣﺎ ﺗﺳﺑﺏ ﻧﻘﺻﺎ ً ﻓﻲ ﺍﻟﺻﻔﻳﺣﺎﺕ ﻭﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‪ -‬ﻛﺄﻱ ﺣﺎﻟﺔ ﺗﺧﺛﺭﺍﺕ ﻣﻧﺗﺷ�ﺭﺓ‪-‬‬

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‫ﻭﻗﺩ ﻳﺣﺻﻝ ﻣﻌﻬﺎ ﻧﺯﻑ‪ .‬ﻟﻥ ﺃﺩﺧ�ﻝ ﺑﺗﻔﺎﺻ�ﻳﻝ ﻫ�ﺫﻩ ﺍﻷﻣ�ﺭﺍﺽ‪ ،‬ﻟﻛﻧﻬ�ﺎ ﻛﻠﻬ�ﺎ ﺗﻠﺗﻘ�ﻲ ﻋﻧ�ﺩ ﻧﻔ�ﺱ‬ ‫ﺍﻟﻧﻘﺎﻁ‪ ،‬ﻭﻫ�ﻲ ﺍﻟﺗﺧﺛ�ﺭﺍﺕ ﺍﻟﻣﻧﺗﺷ�ﺭﺓ ﻭﺍﻟ�ﻧﻘﺹ ﺍﻟﻧ�ﺎﺗﺞ ﻋﻧﻬ�ﺎ ﻓ�ﻲ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ ﻭﺍﻟﺻ�ﻔﻳﺣﺎﺕ‬ ‫ﻭﺍﻧﺣ���ﻼﻝ ﺍﻟﺧﻼﻳ���ﺎ ﺍﻟﺣﻣ���ﺭﺍء ﺍﻟﻣﺗﺣ���ﺭﺭﺓ ﻣ���ﻥ ﺍﻟﺧﺛ���ﺭﺍﺕ ﺍﻟﻣﻧﺗﺷ���ﺭﺓ‪ ،‬ﺃﻭ ﻅﻬﻭﺭﻫ���ﺎ ﻛﺧﻼﻳ���ﺎ‬ ‫ﻣﻧﺷﻁﺭﺓ‪.‬‬ ‫‪.5‬ﺗﺳﻣﻡ ﺍﻟﺣﻣﻝ‬ ‫ﻫﺫﺍ ﺍﻟﻣﺭﺽ ﻫﻭ ﺣﺎﻟﺔ ﻣﻌﻘّﺩﺓ‪ -‬ﻟﻳﺱ ﻫﻧﺎ ﻣﺟﺎﻝ ﺷ�ﺭﺣﻬﺎ‪ -‬ﻟﻛﻧ�ﻪ ﻳﺳ�ﺑﺏ ﺗﺧﺛ�ﺭﺍﺕ ﻣﻧﺗﺷ�ﺭﺓ ﻟ�ﺩﻯ‬ ‫ﺑﻌﺽ ﺍﻟﻣﺭﻳﺿﺎﺕ‪ ،‬ﻛﻧﺗﻳﺟﺔ ﻟﺗﻐﻳﺭﺍﺕ ﻓﻲ ﺟﺩﺭﺍﻥ ﺃﻭﻋﻳﺔ ﺍﻟﺩﻡ‪.‬‬ ‫‪.6‬ﻟﺩﻏﺎﺕ ﺑﻌﺽ ﺍﻷﻓﺎﻋﻲ‬ ‫ﺫﻛ��ﺭﺕ ﺳ��ﺎﺑﻘﺎ ً ﺃﻥ ﺑﻌ��ﺽ ﺍﻷﻓ��ﺎﻋﻲ ﺍﻟﺳ��ﺎﻣﺔ ﻳﻛ��ﻭﻥ ﺳ�ﻣّﻬﺎ ﻣﺷ��ﺎﺑﻬﺎ ً ﻟﻠﺧﺛ��ﺭﻳﻥ ﻓ��ﻲ ﻣﻔﻌﻭﻟ��ﻪ‪ ،‬ﻓﻬ��ﻭ‬ ‫ﺇﻧﻅﻳﻡ ﻓﻌّﺎﻝ ﺟﺩﺍً ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺧﺛﺭ ﻓ�ﻭﺭﻱ ﻟﻠ�ﺩﻡ ﺇﺫﺍ ﺩﺧ�ﻝ ﻓﻳ�ﻪ ﻭﻗ�ﺩ ﺗﺳ�ﺑﺏ ﺍﻟﺗﺧﺛ�ﺭﺍﺕ ﺍﻟﻭﺍﺳ�ﻌﺔ‬ ‫ﺟﻠﻁﺎﺕ ﻓﻲ ﺃﻣﺎﻛﻥ ﻋﺩﺓ ﻣﻥ ﺍﻷﻭﺭﺩﺓ ﻭﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﻛﺑﻳﺭﺓ ﻭﺗﺅﺩﻱ ﻟﻠﻭﻓﺎﺓ‪ .‬ﻟﻛﻥ ﺇﺫﺍ ﻛﺎﻧﺕ ﻛﻣﻳ�ﺔ‬ ‫ﺍﻟﺳﻡ ﻣﺣﺩﻭﺩﺓ ﻓﺈﻥ ﺗﺧﺛﺭﺍﺕ ﻣﻧﺗﺷﺭﺓ ﺗﺣﺻﻝ‪ ،‬ﻭﺃﻛﺑﺭﻫﺎ ﻳﻛﻭﻥ ﻓﻲ ﻣﺣ�ﻳﻁ ﻣﻭﺿ�ﻊ ﺍﻟﻠﺩﻏ�ﺔ‪ .‬ﺛ�ﻡ‬ ‫ﺗﺣﺻﻝ ﻓﻳﻣﺎ ﺑﻌﺩ ﻧﻔﺱ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻣﺿﺎﻋﻔﺎﺕ ﺍﻟﺗﻲ ﻧﺭﺍﻫﺎ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺗﺧﺛﺭﺍﺕ ﺍﻟﻣﻧﺗﺷ�ﺭﺓ‬ ‫ﺍﻷﺧﺭﻯ‪.‬‬ ‫‪.7‬ﺗﺧﺛﺭﺍﺕ ﻧﺎﺗﺟﺔ ﻋﻥ ﺑﻌﺽ ﺍﻟﻣﺳﺗﺣﺿﺭﺍﺕ ﺍﻟﻌﻼﺟﻳﺔ‬ ‫ﻫﻧ��ﺎﻙ ﻣﺳﺗﺣﺿ��ﺭﺍﺕ ﻣ��ﻥ ﻋﺎﻣ��ﻝ ‪ 9‬ﺍﻟﻣﺭ ّﻛ��ﺯ ﺗﺣ��ﻭﻱ ﺟ��ﺯءﺍً ﻣﻔ ّﻌ �ﻼً ﻣ��ﻥ ﺍﻟﻌﺎﻣ��ﻝ ﺍﻟﻣ��ﺫﻛﻭﺭ ﻗ��ﺩ‬ ‫ﻳﺅﺩﻱ ﺇﻟﻰ ﺗﺧﺛﺭ ﻓﻲ ﺍﻟﺩﻡ ﻟﺩﻯ ﺇﻋﻁﺎء ﻛﻣﻳﺔ ﻛﺑﻳﺭﺓ ﻣﻧﻪ‪.‬‬ ‫ﻛﻣﺎ ﺃﻥ ﻫﻧﺎﻙ ﻣﺳﺗﺣﺿﺭﺍﺕ ُﺗﻌﻁﻰ ﺑﺎﻷﺻﻝ ﻟﻣﻧﻊ ﺍﻟﻧ�ﺯﻑ ﻓ�ﻲ ﺍﻟﻌﻣﻠﻳ�ﺎﺕ ﺍﻟﺟﺭﺍﺣﻳ�ﺔ ﺍﻟﻛﺑ�ﺭﻯ‪،‬‬ ‫ﺧﺻﻭﺻ���ﺎ ً ﻟﻠﻣﺭﺿ���ﻰ ﺫﻭﻱ ﺍﻻﺳ���ﺗﻌﺩﺍﺩ ﻟﻠﻧ���ﺯﻑ‪ .‬ﻣ���ﻥ ﻫ���ﺫﻩ ﺍﻟﻣﺳﺗﺣﺿ���ﺭﺍﺕ )ﺃﺑﺳ���ﻳﻛﺎﺑﺭﻭﻥ(‬ ‫ﻭ)ﺗﺭﺍﺳﻳﻠﻭﻝ( ﻭﻋﺎﻣﻝ ‪ 7‬ﺍﻟﻣﻔﻌّﻝ ﻭﻗﺩ ﺗﺳﺑﺏ ﺗﺧﺛﺭﺍً ﻟﺩﻯ ﺑﻌﺽ ﺍﻟﻣﺭﺿ�ﻰ ﺇﺫﺍ ﺃﻋﻁﻳ�ﺕ ﺑﺷ�ﻛﻝ‬ ‫ﻏﻳﺭ ﻣﺣﺳﻭﺏ‪.‬‬ ‫ﺍﻟﻬﻳﺑﺎﺭﻳﻥ‪ ،‬ﻣﺎﻧﻊ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻳﺅﺩﻱ ﻓﻲ ﺣﺎﻻﺕ ﻧﺎﺩﺭﺓ ﺇﻟ�ﻰ ﺣﺻ�ﻭﻝ ﺗﺧﺛ�ﺭﺍﺕ ﻭﺟﻠﻁ�ﺎﺕ ﻭﺍﺳ�ﻌﺔ‬ ‫ﺑﺳ��ﺑﺏ ﺗﺣﺳ��ﺱ ﺑﻌ��ﺽ ﺍﻟﻣﺭﺿ��ﻰ ﻣﻧ��ﻪ ﻭﺇﻧﺗ��ﺎﺟﻬﻡ ﺃﺟﺳ��ﺎﻣﺎ ً ﻣﺿ��ﺎﺩﺓ ﻟﻠﺻ��ﻔﻳﺣﺎﺕ ﻛﻧﺗﻳﺟ��ﺔ ﻟ��ﺫﻟﻙ‬ ‫ﺍﻟﺗﺣﺳﺱ‪ ،‬ﺗﺅﺩﻱ ﺇﻟﻰ ﺗﺭﺍﻛﻣﻬﺎ ﻭﺗﻔﻌﻳﻠﻬﺎ‪.‬‬

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‫‪ .8‬ﺍﻟﺗﺩﺧﻳﻥ ﻭﺍﺭﺗﻔﺎﻉ ﻧﺳﺑﺔ ﺍﻟﺩﻫﻭﻥ ﻓﻲ ﺍﻟﺩﻡ‬ ‫ﺇﻥ ﺍﺣﺗﻣﺎﻝ ﺃﻥ ﻳﺅﺩﻱ ﺍﻟﺗﺩﺧﻳﻥ ﺃﻭ ﺍﺭﺗﻔﺎﻉ ﻧﺳﺑﺔ ﺍﻟﺩﻫﻭﻥ ﻓﻲ ﺍﻟﺩﻡ ﺑﺻﻭﺭﺓ ﻣﺑﺎﺷ�ﺭﺓ ﺇﻟ�ﻰ ﺯﻳ�ﺎﺩﺓ‬ ‫ﺍﻟﺗﺧﺛﺭ ﻫﻭ ﺃﻣﺭ ﻏﻳﺭ ﻣﺅﻛﺩ‪ ،‬ﻭﺇﻥ ﻛﺎﻥ ﻛﻝ ﻣﻧﻬﻣﺎ ﻋﺎﻣﻼً ﻣﻬﻣﺎ ً ﻓ�ﻲ ﺣﺻ�ﻭﻝ ﺍﻟﺟﻠﻁ�ﺎﺕ ﺑﺳ�ﺑﺏ‬ ‫ﺍﻟﺗﻐﻳﺭﺍﺕ ﺍﻟﺗﻲ ﻳﺳﺑﺑﻬﺎ ﻓﻲ ﺟﺩﺭﺍﻥ ﺍﻟﺷﺭﺍﻳﻳﻥ‪.‬‬ ‫‪ .9‬ﺣﺎﻟﺔ ﻣﺎ ﺑﻌﺩ ﺍﻟﺻﺩﻣﺔ ﺍﻟﺩﻭﺭﺍﻧﻳﺔ‬ ‫ﺍﻟﺻﺩﻣﺔ ﺍﻟﺩﻭﺭﺍﻧﻳﺔ ﻫﻲ ﻫﺑﻭﻁ ﻣﻔﺎﺟﺊ ﻟﺿﻐﻁ ﺍﻟﺩﻡ ﺇﻟ�ﻰ ﺍﻟﺻ�ﻔﺭ ﺑﺳ�ﺑﺏ ﺷ�ﺩﺓ ﻋﻧﻳﻔ�ﺔ )ﻛ�ﺩﻫﺱ‬ ‫ﺑﺎﻟﺳ��ﻳﺎﺭﺓ( ﺃﻭ ﺗﺳ��ﻣﻡ ﺍﻟ��ﺩﻡ ﺍﻹﻧﺗ��ﺎﻧﻲ ﺃﻭ ﻓﻘ��ﺩﺍﻥ ﺷ��ﺩﻳﺩ ﻟﻠ��ﺩﻡ‪ .‬ﺇﺫﺍ ﻋ��ﺎﺵ ﺍﻟﻣ��ﺭﻳﺽ ﺑﻌ��ﺩ ﻣﺛ��ﻝ ﻫ��ﺫﻩ‬ ‫ﺍﻟﺻ��ﺩﻣﺔ ﺗﻛ��ﻭﻥ ﻋﻣﻠﻳ��ﺔ ﺗﺷ��ﺑﻪ ﺍﻟﺗﺧﺛ��ﺭ ﻋﻧ��ﺩﻩ ﻗ��ﺩ ﺗﻔﻌّﻠ��ﺕ ﺇﻟ��ﻰ ﺩﺭﺟ��ﺔ ﻛﺑﻳ��ﺭﺓ‪ ،‬ﺫﻟ��ﻙ ﻷﻥ ﻫﺑ��ﻭﻁ‬ ‫ﺍﻟﺿﻐﻁ ﺇﻟﻰ ﻫﺫﻩ ﺍﻟﺩﺭﺟﺔ ﻳﺳﺑﺏ ﺇﻓﺭﺍﺯﺍً ﺷﺎﻣﻼً‪ ،‬ﻭﻓﻲ ﻛﻝ ﺍﻟﺟﺳﻡ‪ ،‬ﻟﻣﻔﻌّﻝ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ‪ .‬ﻭﻟﻣﺎ‬ ‫ﻛﺎﻧ��ﺕ ﺍﻟﺧﺛ��ﺭﺓ ﻏﻳ��ﺭ ﻣﻭﺟ��ﻭﺩﺓ ﻓ��ﺈﻥ ﻣ��ﺫﻳﺏ ﺍﻟﺧﺛ��ﺭﺓ ﺍﻟﻣﻔ ّﻌ��ﻝ ﻳﺳ��ﺗﻬﺩﻑ ﻣﻭﻟ��ﺩ ﺍﻟﺧﻳﻁ��ﻳﻥ ﻓﻳ��ﺩﻣﺭﻩ‬ ‫ﺑﺷﻛﻝ ﻗﺩ ﻳﺟﻌﻝ ﻣﺳﺗﻭﺍﻩ ﺻﻔﺭﺍً ﻓﻳﺑﺩﺃ ﺍﻟﻣﺭﻳﺽ ﺑﺎﻟﻧﺯﻑ ﺣﻳﻧﻣﺎ ﻳﺧﺭﺝ ﻣﻥ ﺍﻟﺻ�ﺩﻣﺔ ﺍﻟﺩﻭﺭﺍﻧﻳ�ﺔ‬ ‫ﻭﻳﺣﺗﺎﺝ ﺇﻟﻰ ﻧﻘﻝ ﺑﻼﺯﻣﺎ ﺃﻭ ﺍﻟﺭﺍﺳﺏ ﺍﻟﻘ ّﺭﻱ ﻟﺗﻌﻭﻳﺽ ﻣﻭﻟﺩ ﺍﻟﺧﻳﻁﻳﻥ‪.‬‬ ‫ﺣﺎﻟﺔ ﻣﻘﺎﺭﺑﺔ ﻟﻬﺫﻩ ﺗﺣﺻﻝ ﻟﻠﻣﺭﻳﺽ ﺍﻟﺫﻱ ﻳُﻌﻁ�ﻰ ﻛﻣﻳ�ﺔ ﺯﺍﺋ�ﺩﺓ ﻣ�ﻥ ﺍﻟﺳ�ﺗﺭﺑﺗﻭﻛﺎﻳﻧﻳﺯ ﻛﻣ�ﺫﻳﺏ‬ ‫ﻟﺧﺛﺭﺓ ﻋﻧﺩﻩ‪.‬‬

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‫ﺍﻟﻔﺼﻞ ﺍﻟﺮﺍﺑﻊ‬

‫اﻟﻌﻼج‬ ‫ﺑﺎﻷدوﻳﺔ اﻟﻤﻀﺎدة ﻟﻠﺘﺨﺜﺮ‬

‫)ﻫﺫﺍ ﺍﻟﻔﺻﻝ ﺗﻡ ﻁﺑﻌﻪ ﺃﻳﺿﺎ ً ﻋﻠﻰ ﺷﻛﻝ ﻛﺭﺍﺱ ﻣﺳﺗﻘﻝ ﻋﻥ ﻛﺗﺎﺏ ﺗﺧﺛﺭ ﺍﻟﺩﻡ(‬

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‫ﻣﺿﺎﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ ﻧﻭﻋﺎﻥ ﺃﺳﺎﺳﻳﺎﻥ‪:‬‬ ‫ﺍﻷﻭﻝ‪ :‬ﻳﻘﻭﻡ ﺑﺻﻭﺭﺓ ﻣﺑﺎﺷﺭﺓ ﺑﺈﺑﻁﺎﻝ ﻣﻔﻌﻭﻝ ﻭﺍﺣﺩ ﺃﻭ ﺃﻛﺛﺭ ﻣ�ﻥ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ ﻟﻭﻗ�ﻑ ﺍﻟﻌﻣﻠﻳ�ﺔ‬ ‫ﺍﻟﺗﺧﺛﺭﻳﺔ‪ .‬ﻭﺃﻫﻡ ﻭﺃﺷﻬﺭ ﻋﻘﺎﺭ ﻣﻥ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻫﻭ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ‪.‬‬ ‫ﺍﻟﺛﺎﻧﻲ‪ :‬ﻳﻘﻭﻡ ﺑﺎﻟﺗﺄﺛﻳﺭ ﻋﻠﻰ ﺇﻧﺗﺎﺝ ﻭﺍﺣﺩ ﺃﻭ ﺃﻛﺛﺭ ﻣﻥ ﻋﻭﺍﻣ�ﻝ ﺍﻟﺗﺧﺛ�ﺭ‪ ،‬ﺑﺣﻳ�ﺙ ُﺗﻧ�ﺗﺞ ﺑﺗﺭﻛﻳ�ﺏ ﻏﻳ�ﺭ‬ ‫ﻓﻌّﺎﻝ‪ .‬ﻭﻫﺫﺍ ﺍﻟﻧ�ﻭﻉ ﻫ�ﻭ ﻣﺿ�ﺎﺩﺍﺕ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ‪ ،‬ﻭﺃﻛﺛ�ﺭ ﻋﻘ�ﺎﺭ ﻣﺳ�ﺗﻌﻣﻝ ﻣ�ﻥ ﻫ�ﺫﻩ ﺍﻟﻣﺟﻣﻭﻋ�ﺔ ﻫ�ﻭ‬ ‫ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﺃﻭ ﺍﻟﻛﻭﻣﺎﺩﻳﻥ‬ ‫ﺃﻣﺎ ﺍﻷﺳﺑﺭﻳﻥ ﻓﻣﻔﻌﻭﻟﻪ ﻣﺿﺎﺩ ﻟﻠﺻﻔﻳﺣﺎﺕ ﻭﺳﻳﺭﺩ ﺫﻛﺭﻩ ﻓﻳﻣﺎ ﺑﻌﺩ‪.‬‬ ‫ﻭﺃﻣ��ﺎ ﻣ��ﺫﻳﺑﺎﺕ ﺍﻟﺧﺛ��ﺭﺓ ﻓﻌﻣﻠﻬ��ﺎ ﻳﺧﺗﻠ��ﻑ ﻋ��ﻥ ﻣﺿ��ﺎﺩﺍﺕ ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﺣﻳ��ﺙ ﻻ ُﺗﻌﻁ��ﻰ ﻟﻣﻧ��ﻊ ﺣﺻ��ﻭﻝ‬ ‫ﺍﻟﺟﻠﻁﺔ ﺑﻝ ﻟﻠﻣﺳﺎﻋﺩﺓ ﻓﻲ ﺳﺭﻋﺔ ﺗﺫﻭﻳﺑﻬﺎ ﻭﺇﻋﺎﺩﺓ ﺳﺭﻳﺎﻥ ﺍﻟﺩﻡ ﻓ�ﻲ ﺍﻟﺷ�ﺭﻳﺎﻥ ﺃﻭ ﺍﻟﻭﺭﻳ�ﺩ ﺍﻟﻣﺳ�ﺩﻭﺩ‬ ‫ﺑﻬ��ﺎ‪ ،‬ﻭﺳ��ﺄﺗﺣ ّﺩﺙ ﺑﺈﻳﺟ��ﺎﺯ ﻋ��ﻥ ﺍﺳ��ﺗﻌﻣﺎﻟﻬﺎ ﻛﻌ��ﻼﺝ ﻁﺑ��ﻲ‪ .‬ﻭﺃﻛﺛ��ﺭ ﻫ��ﺫﻩ ﺍﻟﻣﺟﻣﻭﻋ��ﺔ ﺍﺳ��ﺗﻌﻣﺎﻻً ﻫ��ﻭ‬ ‫ﺳﺗﺭﺑﺗﻭﻛﺎﻳﻧﻳﺯ‪.‬‬ ‫‪.1‬ﻣﺟﻣﻭﻋﺔ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ‬ ‫ﻫ��ﺫﻩ ﺍﻟﻌﻼﺟ��ﺎﺕ ﻣﺿ��ﺎﺩﺓ ﺍﻟﺗﺧﺛ��ﺭ ُﺗﻌﻁ��ﻰ ﺑ��ﺎﻟﺣﻘﻥ‪ ،‬ﺇ ّﻣ��ﺎ ﺑﺎﻟﻭﺭﻳ��ﺩ ﺃﻭ ﺗﺣ��ﺕ ﺍﻟﺟﻠ��ﺩ‪ .‬ﻭﺣﻳﻧﻣ��ﺎ ﺗﻌﻁ��ﻰ‬ ‫ﺑﺎﻟﻭﺭﻳﺩ ﻓﺈﻣﺎ ﺃﻥ ﺗﻌﻁﻰ ﺗﻘﻁﻳﺭﺍً ﺑﺻﻭﺭﺓ ﻣﺳ�ﺗﻣﺭﺓ ﺃﻭ ﻋﻠ�ﻰ ﺷ�ﻛﻝ ﺟﺭﻋ�ﺎﺕ ﻛﺑﻳ�ﺭﺓ ﻋﻠ�ﻰ ﻓﺗ�ﺭﺍﺕ‪.‬‬ ‫ﻭﻻ ﺗﻛﻭﻥ ﻓﻌﺎﻟﺔ ﺇﺫﺍ ﺃُﺧﺫﺕ ﺑﻁﺭﻳﻕ ﺍﻟﻔﻡ‪.‬‬ ‫ﻣﺻﺩﺭ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻫ�ﻭ ﺃﻧﺳ�ﺟﺔ ﺍﻟﺣﻳﻭﺍﻧ�ﺎﺕ‪ ،‬ﻛ�ﺎﻟﺑﻘﺭ ﻭﺍﻟﺧﻧﺯﻳ�ﺭ‪ ،‬ﻭﻳُﺳ�ﺗﺧﻠﺹ ﺇﻣ�ﺎ ﺑﺷ�ﻛﻝ ﺟﺯﻳﺋ�ﺎﺕ‬ ‫ﻣﺗﻔﺎﻭﺗ��ﺔ ﺍﻟ��ﻭﺯﻥ ﺑﺣﻳ��ﺙ ﻳﻛ��ﻭﻥ ﺍﻟﻧ��ﺎﺗﺞ ﺧﻠﻳﻁ �ﺎ ً ﻣ��ﻥ ﺟﺯﻳﺋ��ﺎﺕ ﺍﻟﻬﻳﺑ��ﺎﺭﻳﻥ ﺫﺍﺕ ﺍﻷﻭﺯﺍﻥ ﺍﻟﺟﺯﻳﺋﻳ��ﺔ‬ ‫ﺍﻟﻌﺎﻟﻳﺔ ﻭﺍﻟﻣﺗﻭﺳ�ﻁﺔ ﻭﺍﻟﻭﺍﻁﺋ�ﺔ‪ ،‬ﺃﻭ ُﺗﺳ�ﺗﺧﻠَﺹ ﺍﻟﺟﺯﻳﺋ�ﺎﺕ ﺫﻭﺍﺕ ﺍﻟ�ﻭﺯﻥ ﺍﻟﺟﺯﻳﺋ�ﻲ ﺍﻟ�ﻭﺍﻁﺊ ﻓﻘ�ﻁ‪.‬‬ ‫ﺍﻟﻣﺟ ّﺯﺃ ﻭﺃﺻﺑﺢ ﺍﺳﺗﻌﻣﺎﻟﻪ ﻳﺯﺩﺍﺩ ﺷﻳﻭﻋﺎ ً ﻳﻭﻣ�ﺎ ً‬ ‫ﻭﺍﻟﻧﻭﻉ ﺍﻷﺧﻳﺭ ﺃﺛﺑﺕ ﻛﻔﺎءﺗﻪ ﺃﻛﺛﺭ ﻣﻥ ﺍﻟﻧﻭﻉ ﻏﻳﺭ‬ ‫َ‬ ‫ﺑﻌﺩ ﻳﻭﻡ‪ ،‬ﻭﻟﻛﻥ ﻣﺻﺩﺭﻩ ﻋﺎﺩﺓ ﻣﻥ ﺍﻟﺧﻧﺯﻳﺭ‪.‬‬ ‫‪62‬‬

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‫ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻳﻣﻧ�ﻊ ﺗﺧﺛ�ﺭ ﺍﻟ�ﺩﻡ ﺑﺈﺑﻁ�ﺎﻝ ﻣﻔﻌ�ﻭﻝ ﺍﻟﺧﺛ�ﺭﻳﻥ)ﺑﺎﻟﺗﻌ�ﺎﻭﻥ ﻣ�ﻊ ﻣﺿ�ﺎﺩ ﺍﻟﺧﺛ�ﺭﻳﻥ ﺍﻟﻁﺑﻳﻌ�ﻲ(‬ ‫ﻭﻣﻔﻌﻭﻝ ﻋﺎﻣﻝ ‪ 10‬ﺍﻟﻔﻌّﺎﻝ‪ ،‬ﻭﺇﻥ ﻛﺎﻧﺕ ﺍﻟﻣﺳﺗﺣﺿﺭﺍﺕ ﺍﻟﻣﺧﺗﻠﻔ�ﺔ ﻣﻧ�ﻪ ﺗﺗﻔ�ﺎﻭﺕ ﻓ�ﻲ ﻣ�ﺩﻯ ﺍﻟﺗ�ﺄﺛﻳﺭ‬ ‫ﻋﻠﻰ ﻛﻝ ﻣﻥ ﻫﺫﻳﻥ ﺍﻟﻌﺎﻣﻠﻳﻥ‪ .‬ﻓﺎﻟﻬﻳﺑﺎﺭﻳﻥ ﺫﻭ ﺍﻟ�ﻭﺯﻥ ﺍﻟﺟﺯﻳﺋ�ﻲ ﺍﻟ�ﻭﺍﻁﺊ ﺃﺷ�ﺩ ﺗ�ﺄﺛﻳﺭﺍً ﻋﻠ�ﻰ ﻋﺎﻣ�ﻝ‬ ‫ﺍﻟﻣﺟ ّﺯﺃ ﻭﺑﺎﻟﻌﻛﺱ ﻳﻛﻭﻥ ﻏﻳﺭ ﺍﻟﻣﺟ ّﺯﺃ ﺃﺷﺩ ﺗﺛﺑﻳﻁﺎ ً ﻟﻠﺧﺛﺭﻳﻥ‪.‬‬ ‫‪ 10‬ﻣﻥ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻏﻳﺭ َ‬ ‫ُﻳﻌﻁﻰ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻋﺎﺩ ًﺓ ﺑﺎﻟﻣﺳﺗﺷﻔﻳﺎﺕ‪ ،‬ﻟﻛﻥ ﻫﻧﺎﻙ ﻣﺭﺿﻰ ﻳﺄﺧﺫﻭﻥ ﺣﻘ�ﻥ ﺍﻟﻬﻳﺑ�ﺎﺭﻳﻥ ﺗﺣ�ﺕ ﺍﻟﺟﻠ�ﺩ‬ ‫ﻓﻲ ﺑﻳﻭﺗﻬﻡ‪.‬‬ ‫ﺟﺭﻋﺔ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ُﺗﻌﻁ�ﻰ ﻓ�ﻲ ﺍﻟﺑﺩﺍﻳ�ﺔ ﺑﺻ�ﻭﺭﺓ ﺗﻘﺭﻳﺑﻳ�ﺔ ﺗﺗﻧﺎﺳ�ﺏ ﻣ�ﻊ ﻭﺯﻥ ﺍﻟﻣ�ﺭﻳﺽ‪ ،‬ﺛ�ﻡ ﻳُﺟ�ﺭﻯ‬ ‫ﻟﻠﻣﺭﻳﺽ ﻓﺣﺹ) ﻭﻗﺕ ﺗﻭﻟﺩ ﺍﻟﺧﺛ�ﺭﺓ ﺍﻟﺟﺯﺋ�ﻲ(‪ ،‬ﻭﻋﻠ�ﻰ ﺿ�ﻭء ﻧﺗﻳﺟﺗ�ﻪ ُﺗﻘ�ﺭّﺭ ﺍﻟﺟﺭﻋ�ﺔ ﺍﻟﻣﻧﺎﺳ�ﺑﺔ‬ ‫ﻟﻠﻣﺭﻳﺽ‪.‬‬ ‫ﻭﻣﻔﻌﻭﻝ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﺍﻟﻣﺎﻧﻊ ﻟﻠﺗﺧﺛﺭ ﻓ�ﻭﺭﻱ ﻭﻳﺧﺗﻔ�ﻲ ﻣ�ﻥ ﺍﻟ�ﺩﻡ ﺑﻌ�ﺩ ﺣﻘﻧ�ﻪ ﺑﻣﻌ� ّﺩﻝ ‪ %50‬ﻛ�ﻝ ﺳ�ﺕ‬ ‫ﺳﺎﻋﺎﺕ‪ ،‬ﻭﺍﻟﻧ�ﻭﻉ ﺫﻭ ﺍﻟ�ﻭﺯﻥ ﺍﻟﺟﺯﻳﺋ�ﻲ ﺍﻟ�ﻭﺍﻁﺊ ﻳﻣﻛ�ﺙ ﻭﻗﺗ�ﺎ ً ﺃﻁ�ﻭﻝ ﻓ�ﻲ ﺍﻟﺟﺳ�ﻡ‪ ،‬ﻭﻣ�ﻥ ﺛ� ّﻡ ﺗ�ﺩﻭﻡ‬ ‫ﺍﻟﻣﺟ� ّﺯﺃ ﻓ�ﻳُﺣﻘﻥ‬ ‫ﻓﻌﺎﻟﻳﺗﻪ ﺃﻛﺛﺭ ﻟﺫﻟﻙ ﻓﺈﻧﻪ ﻳُﻌﻁﻰ ﻣﺭﺓ ﻛﻝ ‪ 12‬ﺳ�ﺎﻋﺔ ﺃﻭ ﻛ�ﻝ ‪ 24‬ﺳ�ﺎﻋﺔ‪ .‬ﺃﻣ�ﺎ ﻏﻳ�ﺭ َ‬ ‫ﻣﺭﺓ ﻛﻝ ‪ 8‬ﺳﺎﻋﺎﺕ ﺃﻭ ‪ 12‬ﺳﺎﻋﺔ‪.‬‬ ‫ﺇﻥ ﺯﻳﺎﺩﺓ ﺍﻟﺟﺭﻋﺔ ﺍﻟﻣﻌﻁﺎﺓ ﻣﻥ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻋ�ﻥ ﺍﻟﻣﻁﻠ�ﻭﺏ ﻗ�ﺩ ﺗ�ﺅﺩﻱ ﺇﻟ�ﻰ ﺃﻧﺯﻓ�ﺔ ﻟ�ﺩﻯ ﺍﻟﻣ�ﺭﻳﺽ‪.‬‬ ‫ﺃﻣ�ﺎ ﺇﺫﺍ ﻛﺎﻧ��ﺕ ﺍﻟﺟﺭﻋ��ﺔ ﻧﺎﻗﺻ��ﺔ ﻋﻣ��ﺎ ﻳﺟ��ﺏ ﻓﻘ�ﺩ ﻻ ﺗﺳ��ﺗﻁﻳﻊ ﺇﻳﻘ��ﺎﻑ ﺃﻭ ﻣﻧ��ﻊ ﺍﻟﺗﺧﺛ��ﺭ ﺍﻟ��ﺫﻱ ﺑﺳ��ﺑﺑﻪ‬ ‫ﺃُﻋﻁ��ﻲ ﺍﻟﻬﻳﺑ��ﺎﺭﻳﻥ ﺃﺻ��ﻼً‪ .‬ﻭﻳﻣﻛ��ﻥ ﺿ��ﺑﻁ ﺟﺭﻋ��ﺔ ﺍﻟﻬﻳﺑ��ﺎﺭﻳﻥ ﺑ��ﺈﺟﺭﺍء ﻓﺣ��ﺹ )ﻣﻭﻟّ��ﺩ ﺍﻟﺧﺛ��ﺭﺓ‬ ‫ﺍﻟﺟﺯﺋﻲ( ﻟﻠﺗﺄﻛﺩ ﻣﻥ ﻣﺩﻯ ﻣﻔﻌﻭﻝ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻋﻠﻳﻪ‪.‬‬ ‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻬﻤﺔ ﺍﻟﺘﻲ ﻳﺴﺘَﻌ َﻤﻞ ﻓﻴﻬﺎ ﺍﻟﻬﻴﺒﺎﺭﻳﻦ‬

‫ ﻭﻗﺎﻳﺔ ﻣﻥ ﺍﻟﺗﺧﺛﺭ ﻣﺑﺎﺷﺭﺓ ﺑﻌﺩ ﺍﻟﻌﻣﻠﻳﺎﺕ ﺍﻟﺭﺋﻳﺳﻳﺔ ﻭﺍﻟﻛﺳﻭﺭ ﺍﻟﻛﺑﻳﺭﺓ‪.‬‬‫ ﻭﻗﺎﻳﺔ ﻣﻥ ﺗﻛﺭﺭ ﺍﻟﺟﻠﻁﺔ ﻋﻧﺩ ﻣﻥ ﺣﺻ�ﻝ ﻟﺩﻳ�ﻪ ﺟﻠﻁ�ﺔ ﺑ�ﺎﻷﻭﺭﺩﺓ ﺍﻟﺭﺋﻳﺳ�ﻳﺔ ﻟﻠﺳ�ﺎﻕ ﺃﻭ ﺻ�ﻣّﺎﺕ‬‫ﻓﻲ ﺷﺭﺍﻳﻳﻥ ﺍﻟﺭﺋﺔ‪ ،‬ﻛﺈﺣﺩﻯ ﻣﺿﺎﻋﻔﺎﺕ ﺍﻟﺗﺧﺛﺭ ﻓﻲ ﺃﻭﺭﺩﺓ ﺍﻟﺳﺎﻗﻳﻥ‪ ،‬ﻭﺫﻟﻙ ﻓﻲ ﺑﺩﺍﻳ�ﺔ ﺍﻟﻌ�ﻼﺝ‪،‬‬ ‫ﻭﻣﻥ ﺛﻡ ﻳُﺳﺗﺑﺩَﻝ ﺑﺎﻟﻭﺍﺭﻓﺎﺭﻳﻥ‪.‬‬ ‫ ﻟﻠﻭﻗﺎﻳﺔ ﻣﻥ ﺗﻛﺭﺭ ﺍﻟﺟﻠﻁﺔ ﻟﻣﻥ ﺣﺻﻠﺕ ﻋﻧﺩﻩ ﺟﻠﻁﺔ ﺑﺎﻟﻣﺦ ﺃﻭ ﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﺗﺎﺟﻳﺔ ﻟﻠﻘﻠﺏ ﺃﻭ ﺃﻱ‬‫ﺷﺭﻳﺎﻥ ﺁﺧﺭ ﺑﺎﻟﺟﺳﻡ‪.‬‬ ‫‪63‬‬

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‫ ﺧﻼﻝ ﺍﻟﺣﻣﻝ ﻟﻠﺳﻳﺩﺍﺕ ﺍﻟﻼﺗ�ﻲ ﺣﺻ�ﻝ ﻋﻧ�ﺩﻫﻥ ﺟﻠﻁ�ﺎﺕ ﺧ�ﻼﻝ ﺣﻣ�ﻝ ﺳ�ﺎﺑﻕ‪ .‬ﺑﻌ�ﺽ ﺍﻷﻁﺑ�ﺎء‬‫ﻳﻌﻁ���ﻲ ﺍﻟﻬﻳﺑ���ﺎﺭﻳﻥ ﺑ���ﺩﻝ ﺍﻟﻭﺍﺭﻓ���ﺎﺭﻳﻥ ﻁﻳﻠ���ﺔ ﻓﺗ���ﺭﺓ ﺍﻟﺣﻣ���ﻝ )ﺇﺫﺍ ﻛﺎﻧ���ﺕ ﺍﻟﻣﺭﻳﺿ���ﺔ ﺗﺗﻧ���ﺎﻭﻝ‬ ‫ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻗﺑﻝ ﺍﻟﺣﻣﻝ(‪ ،‬ﺣﻳﺙ ﺃﻧﻪ ﻻ ﻳﺿﺭ ﺍﻟﺟﻧ�ﻳﻥ ﻛﺎﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‪ .‬ﻭﺍﻟ�ﺑﻌﺽ ﺍﻵﺧ�ﺭ ﻳﻌﻁﻳ�ﻪ‬ ‫ﻟﻬ��ﻥ ﺧ��ﻼﻝ ﺍﻟﺛﻼﺛ��ﺔ ﺷ��ﻬﻭﺭ ﺍﻷﻭﻟ��ﻰ ﻓﻘ��ﻁ ﺛ��ﻡ ﻳﺳ��ﺗﺄﻧﻑ ﺇﻋﻁ��ﺎء ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ‪ ،‬ﻷﻧ��ﻪ ﻻ ﻳﺿ��ﺭ‬ ‫ﺑﺎﻟﺟﻧﻳﻥ ﺑﻌﺩ ﺗﻠﻙ ﺍﻟﻣﺭﺣﻠﺔ ﻣﻥ ﺍﻟﺣﻣﻝ‪.‬‬ ‫ ﻭﻓﻲ ﺃﻳّﺔ ﺣﺎﻟﺔ ﻣﺭﺿﻳﺔ ﺃﺧﺭﻯ ﺗﺣﺗ�ﺎﺝ ﺇﻟ�ﻰ ﻣﻧ�ﻊ ﺗﺧﺛ�ﺭ ﻳُﺑ�ﺩﺃ ﻋ�ﺎﺩﺓ ﺑﺎﻟﻬﻳﺑ�ﺎﺭﻳﻥ‪ ،‬ﺣﺗ�ﻰ ﻟ�ﻭ ﻛ�ﺎﻥ‬‫ﺍﻟﻣ�ﺭﻳﺽ ﺳ�ﻳﺗﻧﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ ﻣﺳ��ﺗﻘﺑﻼً‪ ،‬ﻭﺍﻟﺳ�ﺑﺏ ﻫ�ﻭ ﺃﻥ ﺍﻟﻬﻳﺑ��ﺎﺭﻳﻥ ﻳﺑ�ﺩﺃ ﻣﻔﻌﻭﻟ�ﻪ ﺑﺻ��ﻭﺭﺓ‬ ‫ﻣﺑﺎﺷﺭﺓ ﻭﻓﻭﺭﻳﺔ ﻓﻳﺳﺗﻁﻳﻊ ﻣﻧﻊ ﺍﻟﺗﺧﺛ�ﺭ ﻣﺑﺎﺷ�ﺭﺓ ﺑﻌ�ﺩ ﺣﻘﻧ�ﻪ ﻭﻳﺧﺗﻠ�ﻑ ﺑ�ﺫﻟﻙ ﻋ�ﻥ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‪،‬‬ ‫ﻛﻣﺎ ﺳﻳﻅﻬﺭ ﻣﻥ ﺍﻟﺣﺩﻳﺙ ﻋﻥ ﺍﻷﺧﻳﺭ ﻓﻲ ﺍﻟﻔﻘﺭﺓ ﺍﻟﺗﺎﻟﻳﺔ‪.‬‬ ‫ﺇﻥ ﺍﻟﻧﺯﻑ ﺍﻟﻧﺎﺗﺞ ﻋﻥ ﺯﻳ�ﺎﺩﺓ ﺟﺭﻋ�ﺔ ﺍﻟﻬﻳﺑ�ﺎﺭﻳﻥ ﻫ�ﻭ ﻟ�ﻳﺱ ﺍﻟﻣﺷ�ﻛﻠﺔ ﺍﻟﻭﺣﻳ�ﺩﺓ ﻓ�ﻲ ﻫ�ﺫﺍ ﺍﻟﻌﻘ�ﺎﺭ‪ .‬ﺇﻥ‬ ‫ﻧﺳﺑﺔ ﻗﻠﻳﻠﺔ ﻣﻥ ﺍﻟﻣﺭﺿﻰ ﻳﺣﺻﻝ ﻟﺩﻳﻬﻡ ﻧﻘﺹ ﺻ�ﻔﻳﺣﺎﺕ ﺍﻟ�ﺩﻡ ﺑﺳ�ﺑﺏ ﺗﺣﺳّﺳ�ﻬﻡ ﻟﻠﻬﻳﺑ�ﺎﺭﻳﻥ‪ .‬ﻭﻓ�ﻲ‬ ‫ﺣﺎﻻﺕ ﻧﺎﺩﺭﺓ ﻳﺣﺻﻝ ﻣﻊ ﻧﻘﺹ ﺍﻟﺻﻔﻳﺣﺎﺕ ّ‬ ‫ﺗﺧﺛﺭﺍﺕ ﺷﺩﻳﺩﺓ ﻧﺗﻳﺟﺔ ﻟﻠﻌﻼﺝ ﺑﺎﻟﻬﻳﺑﺎﺭﻳﻥ‪ ،‬ﺍﻟﺫﻱ ﻫ�ﻭ‬ ‫ﺑﺎﻷﺻﻝ ﻣﺎﻧﻊ ﻟﻠﺗﺧﺛﺭ‪ .‬ﻛﺫﻟﻙ ﻓﺈﻥ ﺇﻋﻁﺎء ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻟﻣﺩﺓ ﻁﻭﻳﻠﺔ)ﺳﺗﺔ ﺷ�ﻬﻭﺭ ﺃﻭ ﺃﻛﺛ�ﺭ( ﻗ�ﺩ ﻳ�ﺅﺩﻱ‬ ‫ﺇﻟﻰ ﺗﻧ ّﺧﺭ) ﻫﺷﺎﺷﺔ( ﻓﻲ ﺍﻟﻌﻅﺎﻡ‪.‬‬ ‫ﺃﺩﻭﻳﺔ ﺃﺧﺭﻯ ﻣﺷﺎﺑﻬﺔ ﻟﻠﻬﻳﺑﺎﺭﻳﻥ‬ ‫ﻫﻧﺎﻙ ﺍﻵﻥ ﺃﺩﻭﻳﺔ ﺃﺧﺭﻯ ﻣﺷﺎﺑﻬﺔ ﺃﻭ ﻣﻘﺎﺭﺑﺔ ﻟﻠﻬﻳﺑﺎﺭﻳﻥ ﻓﻲ ﻣﻔﻌﻭﻟﻬ�ﺎ ﻭ ُﺗﻧ� َﺗﺞ ﻋ�ﻥ ﻁﺭﻳ�ﻕ ﺍﻟﻬﻧﺩﺳ�ﺔ‬ ‫ﺍﻟﻭﺭﺍﺛﻳﺔ ﺑﻛﻣﻳﺎﺕ ﺗﺟﺎﺭﻳﺔ‪ .‬ﻭﻗﺩ ﺑﺩﺃﺕ ﺗﺩﺧﻝ ﺍﻟﺳﻭﻕ ﺍﻟﻁﺑﻲ ﺗﺩﺭﻳﺟ ّﻳﺎ ً‪ .‬ﻭﻣﺛﺎﻝ ﻋﻠﻰ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋ�ﺔ‬ ‫)ﻫﻳﺭﻭﺩﻳﻥ( ﻭﻫ�ﻲ ﺍﻟﻣ�ﺎﺩﺓ ﺍﻟﻁﺑﻳﻌﻳ�ﺔ ﺍﻟﺗ�ﻲ ﺗﻔﺭﺯﻫ�ﺎ ﺩﻭﺩﺓ) ﺍﻟﻌﻠ�ﻕ ﺍﻟﻁﺑّ�ﻲ( ﺣﻳﻧﻣ�ﺎ ﺗﻣ�ﺗﺹ ﺍﻟ�ﺩﻡ ﻣ�ﻥ‬ ‫ﺍﻹﻧﺳ���ﺎﻥ ﺃﻭ ﺍﻟﺣﻳ���ﻭﺍﻥ ﺍﻟ���ﺫﻱ ﺗﻠﺗﺻ���ﻕ ﻋﻠ���ﻰ ﺟﻠ���ﺩﻩ‪ .‬ﻭﻗ���ﺩ ﺍﺳ���ﺗﻧﺑﻁ ﺍﻟﻌﻠﻣ���ﺎء ﺗﺭﻛﻳ���ﺏ ﺍﻟﻬﻳ���ﺭﻭﺩﻳﻥ‬ ‫ﻭﺍﺳ��ﺗﻁﺎﻋﻭﺍ ﺗﺻ��ﻧﻳﻌﻪ ﺑﺎﻟﻬﻧﺩﺳ��ﺔ ﺍﻟﻭﺭﺍﺛﻳ��ﺔ ﺑﻭﺍﺳ��ﻁﺔ ﻣﻭﺭّﺛ��ﻪ ﺍﻟ��ﺫﻱ ُﻳ� َ‬ ‫�ﺩﺧﻝ ﻓ��ﻲ ﺍﻟﺧﻼﻳ��ﺎ ﺍﻟﺟﺭﺛﻭﻣﻳ��ﺔ‬ ‫ﻓﺗﻘﻭﻡ ﺑﺈﻧﺗﺎﺟﻪ ﺑﻛﻣﻳﺎﺕ ﻛﺑﻳﺭﺓ‪.‬‬ ‫ﻛﺫﻟﻙ ﻓﻘﺩ ﺗ�ﻡ ﺗﺻ�ﻧﻳﻊ ﺃﺩﻭﻳ�ﺔ ﺻ�ﻐﻳﺭﺓ ﺍﻟ�ﻭﺯﻥ ﺍﻟﺟﺯﻳﺋ�ﻲ ﺗﻌﻣ�ﻝ ﻋﻣ�ﻝ ﺍﻟﻬﻳﺑ�ﺎﺭﻳﻥ ﻟﻛﻧﻬ�ﺎ ﻟ�ﻡ ﺗﺣﺻ�ﻝ‬ ‫ﻋﻠﻰ ﺍﻟﻘﺑﻭﻝ ﺍﻟﻣﺗﻭﻗﻊ ﻁﺑﻳﺎ ً‪.‬‬

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‫‪.2‬ﻣﺟﻣﻭﻋﺔ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‬ ‫ﻭﻫ���ﻲ ﻣﺿ���ﺎ ّﺩﺍﺕ ﻟﻔﻳﺗ���ﺎﻣﻳﻥ ﻙ‪ ،‬ﻭﺃﺷ���ﻬﺭﻫﺎ ﺍﻟﻭﺍﺭﻓ���ﺎﺭﻳﻥ)ﻛﻭﻣ���ﺎﺩﻳﻥ( ﺛ���ﻡ )ﺩﻧ���ﺩﻳﻔﺎﻥ(‪ ،‬ﻭﺗﺳ���ﻣّﻰ‬ ‫ﺃﻳﺿﺎ ً)ﻣﺿﺎﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻔﻣﻳّﺔ( ﻷﻧﻬﺎ ﺗﺅﺧﺫ ﻋ�ﻥ ﻁﺭﻳ�ﻕ ﺍﻟﻔ�ﻡ‪ ،‬ﺧﻼﻓ�ﺎ ً ﻟﻣﺟﻣﻭﻋ�ﺔ ﺍﻟﻬﻳﺑ�ﺎﺭﻳﻥ ﺍﻟﺗ�ﻲ‬ ‫ﻟﻳﺱ ﻟﻬﺎ ﺗﺄﺛﻳﺭ ﺇﻻ ﺇﺫﺍ ﺃُﺧﺫﺕ َﺣﻘﻧﺎ ً ﺑﺎﻟﻭﺭﻳﺩ ﺃﻭ ﺗﺣﺕ ﺍﻟﺟﻠﺩ‪.‬‬ ‫ﺳﺑﻕ ﺃﻥ ﺫﻛﺭﺕ ﺃﻥ ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ‪ ،‬ﺑﻌﻣﻠﻬﺎ ﺿﺩ ﻓﻳﺗﺎﻣﻳﻥ ﻙ‪ ،‬ﻓﺈﻧﻬﺎ ﺗﻣﻧﻊ ﺍﻟﻔﻳﺗ�ﺎﻣﻳﻥ ﺍﻟﻣ�ﺫﻛﻭﺭ ﻣ�ﻥ‬ ‫ﺍﻟﻣﺳﺎﻋﺩﺓ ﻓﻲ ﺇﻧﺗﺎﺝ ﻋﻭﺍﻣﻝ ﺗﺧﺛﺭ ﻁﺑﻳﻌﻳﺔ ﻣﻥ ﻗﺑﻝ ﺍﻟﻛﺑﺩ‪ .‬ﻭﺍﻟﻌﻭﺍﻣﻝ ﺍﻷﺭﺑﻌ�ﺔ ﺍﻟﺗ�ﻲ ﻳﺗ�ﺄﺛﺭ ﺇﻧﺗﺎﺟﻬ�ﺎ‬ ‫ﻟﺩﻯ ﺗﻧﺎﻭﻝ ﻭﺍﺭﻓﺎﺭﻳﻥ ﻫﻲ ﻋﺎﻣﻝ‪)2‬ﺧﺛﺭﻳﻥ ﻏﻳﺭ ﻓﻌّﺎﻝ(‪ ،‬ﻋﺎﻣ�ﻝ‪،7‬ﻋﺎﻣ�ﻝ‪ 9‬ﻭﻋﺎﻣ�ﻝ‪ .10‬ﻭﺍﻷﺭﺑﻌ�ﺔ‬ ‫ُﺗﻧﺗﺞ ﻓﻲ ﺍﻟﻛﺑﺩ‪ .‬ﻛﺫﻟﻙ ﻓﺈﻥ ﺑﺭﻭﺗﻳﻥ ﺝ ﻭﺑﺭﻭﺗﻳﻥ ﺃﺱ ّ‬ ‫ﻳﺗ�ﺄﺛﺭﺍﻥ ﺑﺗﻧ�ﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‪ .‬ﺇﻥ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ‬ ‫ﻳﺳﺎﻋﺩ ﻓﻲ ﺗﻁﻭﻳﺭ ﺗﺭﻛﻳﺏ ﺍﻟﺟﺯﻳﺋﺎﺕ ﺍﻟﺑﺭﻭﺗﻳﻧﻳﺔ ﻟﻠﻌﻭﺍﻣ�ﻝ ﺍﻟﻣ�ﺫﻛﻭﺭﺓ‪ ،‬ﺑﺣﻳ�ﺙ ﺗﺳ�ﺗﻁﻳﻊ ﺃﻥ ﺗﺳ�ﺗﻔﻳﺩ‬ ‫ﻣ��ﻥ ﺁﻳ��ﻭﻥ ﺍﻟﻛﺎﻟﺳ��ﻳﻭﻡ ﻓ��ﻲ ﻋﻣﻠﻳ��ﺔ ﺍﻟﺗﺧﺛ��ﺭ‪ .‬ﻭﺑ��ﺩﻭﻥ ﻓﻳﺗ��ﺎﻣﻳﻥ ﻙ )ﺃﻭ ﺑﺗﻧ��ﺎﻭﻝ ﻣﺿ��ﺎﺩﺍﺗﻪ( ﻳ��ﺗﻡ ﺇﻧﺗ��ﺎﺝ‬ ‫ﺍﻟﻌﻭﺍﻣﻝ ﺍﻷﺭﺑﻌﺔ ﻓ�ﻲ ﺧﻼﻳ�ﺎ ﺍﻟﻛﺑ�ﺩ ﻟﻛﻧﻬ�ﺎ ﺗﻛ�ﻭﻥ ﻏﻳ�ﺭ ﻓﻌﺎﻟ�ﺔ‪ .‬ﻟ�ﺫﻟﻙ ﻓ�ﺈﻥ ﻣﻔﻌ�ﻭﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ ﻫ�ﻭ‬ ‫ﺇﻧﻘﺎﺹ ﻓﻌﻝ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻣﺫﻛﻭﺭﺓ ﻓﻲ ﺍﻟﺩﻡ‪ ،‬ﻭﻟﻳﺱ ﻣﻘﺩﺍﺭﻫﺎ‪.‬‬ ‫ﺇﺫﺍ ﺃُﻋﻁﻲ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﺃﻭ ﻋﻘ�ﺎﺭ ﺁﺧ�ﺭ ﻣ�ﻥ ﻣﺟﻣﻭﻋﺗ�ﻪ ﻓﺈﻧﻬ�ﺎ ﺗ�ﺅﺛﺭ ﻓ�ﻲ ﺍﻟﺗﺧﺛ�ﺭ ﺣ�ﺎﻝ ﺩﺧﻭﻟﻬ�ﺎ ﺍﻟ�ﺩﻡ‪،‬‬ ‫ﺣﻳ��ﺙ ﻳﻣﻧ��ﻊ ﻋﺎﻣ��ﻝ‪ 10‬ﻭﻋﺎﻣ��ﻝ ﺍﻟﺧﺛ��ﺭﻳﻥ ﻣ��ﻥ ﺍﻟﻌﻣ��ﻝ‪ ،‬ﺭﻏ��ﻡ ﺃﻧﻬﻣ��ﺎ ﻣﻭﺟ��ﻭﺩﺍﻥ ﻓ��ﻲ ﺍﻟ��ﺩﻡ ﺑﻣﻘ��ﺩﺍﺭ‬ ‫ﻁﺑﻳﻌﻲ‪ ،‬ﺛﻡ ﺇﺫﺍ ﺍﺧﺗﻔﻰ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻣﻥ ﺍﻟﺩﻡ ﻓﻲ ﺳﺎﻋﺎﺕ ﻋﺎﺩ ﻛ�ﻝ ﺷ�ﺊ ﻟﺣﺎﻟﺗ�ﻪ ﺍﻟﻁﺑﻳﻌﻳ�ﺔ‪ .‬ﻛ�ﺫﻟﻙ ﺇﺫﺍ‬ ‫ﻭﺿ��ﻌﺕ ﻗﻁ��ﺭﺓ ﻣ��ﻥ ﺍﻟﻬﻳﺑ��ﺎﺭﻳﻥ ﻓ��ﻲ ﻋﻳﻧ��ﺔ ﺩﻡ ﻓﺈﻧﻬ��ﺎ ﺗﻣﻧ��ﻊ ﺗﺧﺛﺭﻫ��ﺎ ﻣﺑﺎﺷ��ﺭﺓ ﻭﺗ��ﺅﺛﺭ ﻋﻠ��ﻰ ﻧﺗ��ﺎﺋﺞ‬ ‫ﻓﺣﻭﺹ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻣﺧﺑﺭﻳﺔ‪.‬‬ ‫ﻓﻲ ﻣﻘﺎﺑﻝ ﺫﻟﻙ‪ ،‬ﻓﺈﻥ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻳﺣﺗﺎﺝ ﺇﻟ�ﻰ ﻭﻗ�ﺕ ﻟﻳ�ﺅﺛﺭ ﻋﻠ�ﻰ ﺗﺧﺛ�ﺭ ﺩﻡ ﺍﻟﻣ�ﺭﻳﺽ ﺑﻌ�ﺩ ﺗﻧﺎﻭﻟ�ﻪ‪،‬‬ ‫ﺣﻳﺙ ﻳﺟﺏ ﺃﻥ ﺗﺧﺗﻔﻲ ﺍﻟﺟﺯﻳﺋﺎﺕ ﺍﻟﻔﻌّﺎﻟﺔ ﻣﻥ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻟﻣﻭﺟ�ﻭﺩﺓ ﻓ�ﻲ ﺍﻟ�ﺩﻡ ﻟﻳﺣ�ﻝ ﻣﺣﻠّﻬ�ﺎ ﺗ�ﺩﺭﻳﺟﻳﺎ ً‬ ‫ﺟﺯﻳﺋﺎﺕ ﻣُﻧ َﺗﺟﺔ ﺣﺩﻳﺛﺎ ً ﻭﻏﻳﺭ ﻓﻌّﺎﻟﺔ‪ ،‬ﺑﺗﺄﺛﻳﺭ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‪ ،‬ﻭﻫﺫﺍ ﻳﺳﺗﻐﺭﻕ ‪ 48-24‬ﺳﺎﻋﺔ ﻟﻳﺗﻡ‪ .‬ﻛﻣﺎ‬ ‫ﺃﻥ ﺗﻭﻗ�ﻑ ﺍﻟﻣ�ﺭﻳﺽ ﻋ�ﻥ ﺗﻧ�ﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ ﻟ�ﻥ ﻳﻅﻬ�ﺭ ﺗ�ﺄﺛﻳﺭﻩ ﻭﺍﺿ�ﺣﺎ ً ﺇﻻ ﺑﻌ�ﺩ ‪ 48-24‬ﺳ�ﺎﻋﺔ‬ ‫ﺣﻳﺙ ﺃﻥ ﺍﺧﺗﻔﺎء ﺍﻟﻌﻭﺍﻣﻝ ﻏﻳﺭ ﺍﻟﻔﻌّﺎﻟﺔ ﺗﺩﺭﻳﺟﻲ ﻭﺣﻠﻭﻝ ﺟﺯﻳﺋﺎﺕ ﻓﻌﺎﻟﺔ ﻣﺣﻠﻬﺎ ﺗﺩﺭﻳﺟﻲ ﺃﻳﺿﺎ ً‪.‬‬ ‫ﺃﻣ���ﺎ ﻣﻘ���ﺩﺍﺭ ﺍﻧﺧﻔ���ﺎﺽ ﺍﻟﻌﻭﺍﻣ���ﻝ ﺍﻟﻔﻌﺎﻟ���ﺔ ﻭﻅﻬ���ﻭﺭ ﻋﻭﺍﻣ���ﻝ ﻏﻳ���ﺭ ﻓﻌﺎﻟ���ﺔ ﻓﻳﺗﻭﻗ���ﻑ ﻋﻠ���ﻰ ﺟﺭﻋ���ﺔ‬ ‫ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﺍﻟﺗﻲ ﻳﺄﺧﺫﻫﺎ ﺍﻟﻣﺭﻳﺽ‪ .‬ﻟﻛﻥ ﺍﻟﻧﺎﺱ ﻳﺧﺗﻠﻔﻭﻥ ﻛﺛﻳﺭﺍً ﻓﻲ ﻣﻘﺩﺍﺭ ﺍﻟﺟﺭﻋ�ﺔ ﺍﻟﺗ�ﻲ ﺗﻧﺎﺳ�ﺏ‬

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‫ﺃﺟﺳﺎﻣﻬﻡ‪ ،‬ﻓﻣﻧﻬﻡ ﻣﻥ ﻳﺣﺗﺎﺝ ﺇﻟﻰ ﻣﻠّﻐﺭﺍﻡ ﻭﺍﺣﺩ ﻳﻭﻣﻳﺎ ً ﻟﺗﺻﻝ ﺳﻳﻭﻟﺔ ﺩﻣﻪ ﺇﻟﻰ ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﻣﻁﻠ�ﻭﺏ‬ ‫ﺑﻳﻧﻣﺎ ﻗﺩ ﺗﺻﻝ ﺣﺎﺟﺔ ﺁﺧﺭﻳﻥ ﺇﻟﻰ ‪ 15‬ﺃﻭ ﺣﺗﻰ ‪ 20‬ﻣﻠّﻐﺭﺍﻡ ﻳﻭﻣﻳﺎ ً ﻟﻠﻭﺻﻭﻝ ﺇﻟ�ﻰ ﻧﻔ�ﺱ ﺍﻟﻣﺳ�ﺗﻭﻯ‪،‬‬ ‫ﺭﻏﻡ ﺃﻥ ﺃﻭﺯﺍﻧﻬﻡ ﻗﺩ ﺗﻛﻭﻥ ﻣﺗﻘﺎﺭﺑﺔ‪ .‬ﻛﺫﻟﻙ ﻓﺈﻥ ﺍﻟﺣﺎﺟﺔ ﺗﺧﺗﻠﻑ ﻗﻠ�ﻳﻼً ﻣ�ﻥ ﻳ�ﻭﻡ ﺇﻟ�ﻰ ﺁﺧ�ﺭ ﺑﺣﺳ�ﺏ‬ ‫ﻣ��ﺎ ﻳﺗﻧﺎﻭﻟ��ﻪ ﺍﻟﻣ��ﺭﻳﺽ ﻣ��ﻥ ﻓﻳﺗ��ﺎﻣﻳﻥ ﻙ ﻓ��ﻲ ﻁﻌﺎﻣ��ﻪ‪ .‬ﻭﻓﻳﺗ��ﺎﻣﻳﻥ ﻙ ﻣﺗﻭﺍﺟ��ﺩ ﻓ��ﻲ ﻣﺷ��ﺗﻘﺎﺕ ﺍﻟﺣﻠﻳ��ﺏ‪،‬‬ ‫ﻻﺳﻳّﻣﺎ ﻣﻊ ﺯﻳﺎﺩﺓ ﺍﻟﺩﻫﻥ ﻓﻳﻬ�ﺎ‪ ،‬ﻭﺍﻟﺧﺿ�ﺭﺍﻭﺍﺕ ﻛ�ﺎﻟﺧﺱ ﻭﻏﻳ�ﺭﻩ‪ .‬ﻭﻫ�ﻭ ﻣﻭﺟ�ﻭﺩ ﺑﻛﻣﻳ�ﺎﺕ ﺃﻗ�ﻝ ﻓ�ﻲ‬ ‫ﺍﻟﺩﻫﻭﻥ ﻋﻣﻭﻣﺎ ً ﻭﻓﻲ ﺍﻟﺧﺿﺭﺍﻭﺍﺕ ﺍﻷﺧﺭﻯ‪.‬‬ ‫ﻫﻧﺎ ﺃﻭﺩ ﺃﻥ ﺃﺷ�ﻳﺭ ﺇﻟ�ﻰ ﺧﻁ�ﺄ ﺷ�ﺎﺋﻊ‪ ،‬ﻓﺗﻭﺍﺟ�ﺩ ﻓﻳﺗ�ﺎﻣﻳﻥ ﻙ ﻓ�ﻲ ﺍﻷﻁﻌﻣ�ﺔ ﺍﻟﺗ�ﻲ ﺫﻛﺭﺗﻬ�ﺎ ﻻ ﻳﻌﻧ�ﻲ ﺃﻥ‬ ‫ﺍﻟﻣﺭﻳﺽ ﻳﺟﺏ ﺃﻥ ﻳﺗﻭﻗﻑ ﻋﻥ ﺗﻧﺎﻭﻟﻬﺎ ﻷﻧ�ﻪ ﻳﺄﺧ�ﺫ ﺃﻗ�ﺭﺍﺹ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‪ .‬ﺻ�ﺣﻳﺢ ﺃﻧﻬ�ﺎ ﺗﻘﻠ�ﻝ ﻣ�ﻥ‬ ‫ﻣﻔﻌﻭﻟﻪ ﺑﺳﺑﺏ ﻓﻳﺗﺎﻣﻳﻥ ﻙ ﺍﻟﻣﻭﺟﻭﺩ ﻓﻳﻬﺎ‪ ،‬ﻟﻛﻧﻬﺎ ﺃﻏﺫﻳ�ﺔ ﻣﻔﻳ�ﺩﺓ ﺟ� ّﺩﺍً ﻟﻠﺟﺳ�ﻡ ﻭﻻ ﻳﺟ�ﻭﺯ ﻣﻧﻌﻬ�ﺎ ﻋ�ﻥ‬ ‫ﺍﻟﻣ��ﺭﻳﺽ‪ .‬ﻭﺍﻟﺑ��ﺩﻳﻝ ﺍﻟﺑﺳ��ﻳﻁ ﻋ��ﻥ ﻣﻧﻌﻬ��ﺎ ﻫ��ﻭ ﺯﻳ��ﺎﺩﺓ ﺑﺳ��ﻳﻁﺔ ﻓ��ﻲ ﺟﺭﻋ��ﺔ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﺍﻟﻳﻭﻣﻳ��ﺔ‪،‬‬ ‫ﻭﺑﺣﺳﺏ ﻣﺎ ﻳﻅﻬﺭ ﻣﻥ ﺗﺄﺛﻳﺭ ﻋﻠﻰ ﻧﺗﺎﺋﺞ ﻓﺣﺹ)ﻭﻗﺕ ﻣﻭﻟّﺩ ﺍﻟﺧﺛﺭﻳﻥ(‪.‬‬ ‫ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﻋﻘ��ﺎﺭ ﺷ��ﺎﺋﻊ ﺍﻻﺳ��ﺗﻌﻣﺎﻝ ﻟﺣ��ﺎﻻﺕ ﻛﺛﻳ��ﺭﺓ ﻣﻧﻬ��ﺎ ﺟﻠﻁ��ﺎﺕ ﺃﻭﺭﺩﺓ ﺍﻟﺳ��ﺎﻗﻳﻥ ﻭﺻ �ﻣّﺎﺕ‬ ‫ﺷﺭﺍﻳﻳﻥ ﺍﻟﺭﺋﺗﻳﻥ ﻭﺟﻠﻁﺎﺕ ﺍﻟﻘﻠﺏ ﻭﺍﻟﻣ�ﺦ ﻭﺍﻟﺻ� ّﻣﺎﻣﺎﺕ ﺍﻟﻣﻌﺩﻧﻳ�ﺔ ﺍﻟﻣﺯﺭﻭﻋ�ﺔ ﻓ�ﻲ ﺍﻟﻘﻠ�ﺏ ﻭﺣ�ﺎﻻﺕ‬ ‫ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻣﻭﺭﻭﺛﺔ ﻭﺍﻟﻣﻛ َﺗ َﺳﺑﺔ‪ .‬ﻟﻛﻥ ﻫﺫﺍ ﺍﻟﻌﻘﺎﺭ ﻻ ﻳﺧﻠﻭ ﻣﻥ ﻣﺧﺎﻁﺭ ﺟﺎﻧﺑﻳ�ﺔ ّ‬ ‫ﺗ�ﺅﺛﺭ ﻋﻠ�ﻰ ﻣ�ﻥ‬ ‫ﺃﺳﺎء ﺍﺳﺗﺧﺩﺍﻣﻪ ﺃﻭ ﺃﺧﻁﺄ ﺃﻳﺎﻣﺎ ً ﻣﺗﻌﺩﺩﺓ ﻓﻲ ﺟﺭﻋﺗﻪ ﺃﻭ ﻧﺳﻳﻬﺎ ﻋﺩﺓ ﻣﺭﺍﺕ ﺃﻭ ﺗﺳ�ﺎﻫﻝ ﻓ�ﻲ ﺿ�ﺑﻁﻬﺎ‬ ‫ﺑﺎﻟﻔﺣﺹ ﺍﻟﻣﺧﺑﺭﻱ‪.‬‬ ‫ﻣﻼﺣﻈﺎﺕ ﺣﻮﻝ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ‪:‬‬

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‫ﺇﻥ ﺗﻧﺎﻭﻝ ﺣﺑﻭﺏ ﻭﺍﺭﻓﺎﺭﻳﻥ ﺑﻭﺻﻔﺔ ﻣﻥ ﻁﺑﻳﺏ‪ ،‬ﻭﺑﺟﺭﻋﺔ ﺗﺗﻧﺎﺳ�ﺏ ﻣ�ﻊ ﻧﺗ�ﺎﺋﺞ ﻓﺣ�ﻭﺹ‬ ‫ﺍﻟﺗﺧﺛ��ﺭ‪ ،‬ﻟ��ﻪ ﻓﺎﺋﺩﺗ��ﻪ ﻭﺃﻫﻣﻳﺗ��ﻪ‪ ،‬ﻟ��ﺫﺍ ﻳﺟ��ﺏ ﺃﻻ ّ ﻳﺗﺭﺍﺧ��ﻰ ﺍﻟﻣ��ﺭﻳﺽ ﻓ��ﻲ ﺗﻧ��ﺎﻭﻝ ﺍﻟﺟﺭﻋ��ﺔ ﺣﺳ��ﺏ‬ ‫ﻭﺻﻔﺔ ﺍﻟﻁﺑﻳﺏ ﻭﻓﻲ ﺃﻭﻗﺎﺗﻬﺎ ﻭﺑﺷﻛﻝ ﻣﻧﺗﻅﻡ‪.‬‬

‫‪.2‬‬

‫ﻻ ﺣﺎﺟ��ﺔ ﻟﺗﻘﺳ��ﻳﻡ ﺟﺭﻋ��ﺔ ﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﻋﻠ��ﻰ ﺍﻟﻳ��ﻭﻡ‪ ،‬ﺃﻱ ﺗﺅﺧ��ﺫ ﻛ��ﻝ ﺟﺭﻋ��ﺔ ﺍﻟﻳ��ﻭﻡ ﺍﻟﻭﺍﺣ��ﺩ‬ ‫ﺩﻓﻌﺔ ﻭﺍﺣﺩﺓ‪.‬‬

‫‪.3‬‬

‫ﺃﻧﺳ�ﺏ ﻭﻗ��ﺕ ﻷﺧ��ﺫ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﻫ��ﻭ ﻧﻬﺎﻳ��ﺔ ﺍﻟﻳ��ﻭﻡ‪ ،‬ﻛ��ﺎﻟﻣﻐﺭﺏ ﺃﻭ ﺍﻟﻌﺷ��ﺎء ﺃﻭ ﻓ��ﻲ ﺳ��ﺎﻋﺔ‬ ‫ﻣﺣﺩﺩﺓ ﻣﻥ ﻭﻗﺕ ﺍﻟﻠﻳﻝ‪ .‬ﻭﺍﻟﺳﺑﺏ ﻓﻲ ﺗﻔﺿﻳﻝ ﻫﺫﺍ ﺍﻟﻭﻗﺕ ﺳﻳﺄﺗﻲ ﻓﻲ ﺍﻟﻧﻘﻁﺔ ‪.6‬‬ ‫‪66‬‬

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‫‪.4‬‬

‫ﻫﻧ��ﺎﻙ ﺃﻗ��ﺭﺍﺹ ﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﻣ��ﻥ ﻗ��ﻭﺓ ‪ 7,5 ،5 ،3 ،2,5 ،2 ،1‬ﻣﻠﻐ��ﺭﺍﻡ‪ .‬ﻭﻛ��ﻝ ﻗ��ﺭﺹ‬ ‫ﻣﻧﻬﺎ ﻟﻪ ﻟﻭﻥ ﻳﻣﻳّﺯﻩ‪ .‬ﻭﺍﻟﻐﺎﻳﺔ ﻣﻥ ﻭﺟﻭﺩ ﻛﻝ ﻫﺫﻩ ﺍﻟﻔﺋﺎﺕ ﻫﻲ ﺇﻋﻁﺎء ﻣﺭﻭﻧﺔ ﻟﻠﻁﺑﻳ�ﺏ ﻻﺧﺗﻳ�ﺎﺭ‬ ‫ﺍﻟﺟﺭﻋﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﺑﺄﺑﺳﻁ ﻁﺭﻳﻘﺔ ﻣﻧﻌﺎ ً ﻟﺧﻁﺄ ﺍﻟﻣﺭﻳﺽ‪.‬‬

‫‪.5‬‬

‫ﺑﻣﺎ ﺃﻥ ﻣﻔﻌﻭﻝ ﺣﺑﺔ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻳﺗ�ﺄﺧﺭ ﻋ�ﻥ ﻳ�ﻭﻡ ﺗﻧﺎﻭﻟﻬ�ﺎ ﻭﻻ ﻳ�ﺯﻭﻝ ﺇﻻ ﺗ�ﺩﺭﻳﺟﻳﺎً‪ ،‬ﻓ�ﺈﻥ‬ ‫ﺍﺧﺗﻼﻑ ﺍﻟﺟﺭﻋﺔ ﺑﻳﻥ ﺃﻳﺎﻡ ﺍﻷﺳﺑﻭﻉ ﻻ ﻳﻌﻧﻲ ﻓﻌﻼً ﺍﺧﺗﻼﻑ ﺍﻟﺳﻳﻭﻟﺔ ﺑﻳﻥ ﻳﻭﻡ ﻭﺁﺧﺭ‪ ،‬ﻓﻣﻔﻌ�ﻭﻝ‬ ‫ﺍﻟﻘﺭﺹ ﻳﻣﺗﺩ ﻟﻳﺟﻌﻝ ﺍﻟﺗﺧﺛﺭ ﻛﻝ ﺃﻳﺎﻡ ﺍﻷﺳﺑﻭﻉ ﻣﺗﺟﺎﻧﺳﺎ ً ﺗﻘﺭﻳﺑﺎً‪ ،‬ﺭﻏ�ﻡ ﺍﻻﺧ�ﺗﻼﻑ ﺍﻟﺑﺳ�ﻳﻁ ﻓ�ﻲ‬ ‫ﺟﺭﻋﺎﺕ ﺍﻷﻳﺎﻡ‪ .‬ﻭﺍﻟﺣﻘﻳﻘﺔ ﺃﻥ ﺍﻟﻁﺑﻳﺏ ﻳﺣﺳﺏ ﺍﻟﺟﺭﻋﺔ ﺍﻷﺳﺑﻭﻋﻳﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﺛﻡ ﻳﻘﺳﻣﻬﺎ ﻋﻠ�ﻰ‬ ‫ﺍﻷﻳﺎﻡ ﺍﻟﺳﺑﻌﺔ ﻓﻳﻪ‪.‬‬

‫ﻓﻣﺛﻼً‪ ،‬ﺇﺫﺍ ﺭﺃﻯ ﺍﻟﻁﺑﻳﺏ ﺃﻥ ﺟﺭﻋﺔ ‪ 30‬ﻣﻠﻐﻡ ﺃﺳﺑﻭﻋﻳﺎ ً ﺗﻧﺎﺳﺏ ﻣﺭﻳﺿﺎ ً ﻓﺈﻧﻪ ﻳﻘ�ﻭﻡ ﺑﺗﻘﺳ�ﻳﻣﻬﺎ ﻋﻠ�ﻰ‬ ‫ﺳﺑﻌﺔ ﺃﻳﺎﻡ‪ .‬ﻭﻟﻣﺎ ﻛﺎﻥ ﺍﻟﻌﺩﺩ ‪ 30‬ﻻ ﻳُﻘ َﺳﻡ ﻋﻠﻰ ‪ 7‬ﻓﻳﻣﻛﻥ ﻭﺻ�ﻑ ‪ 4‬ﻣﻠﻐ�ﻡ ﻓ�ﻲ ﺧﻣﺳ�ﺔ ﺃﻳ�ﺎﻡ )=‪20‬‬ ‫ﻣﻠﻐﻡ( ﻭ‪ 5‬ﻣﻠﻐﻡ ﻓﻲ ﻳﻭﻣﻳﻥ)=‪ 10‬ﻣﻠﻐﻡ(‪ .‬ﻭﻳﺑﺎﻋﺩ ﺍﻟﻁﺑﻳﺏ ﺑ�ﻳﻥ ﺍﻟﻳ�ﻭﻣﻳﻥ ﺍﻟﻠ�ﺫ ْﻳﻥ ﻳﺗﻧ�ﺎﻭﻝ ﺍﻟﻣ�ﺭﻳﺽ‬ ‫ﻓﻳﻬﻣﺎ ‪ 5‬ﻣﻠﻐﻡ‪ ،‬ﻛﺄﻥ ﻳﺟﻌﻠﻬﺎ ﻓﻲ ﻳ�ﻭﻣﻲ ﺍﻻﺛﻧ�ﻳﻥ ﻭﺍﻟﺧﻣ�ﻳﺱ ﻣ�ﻥ ﻛ�ﻝ ﺃﺳ�ﺑﻭﻉ‪ .‬ﺑﻬ�ﺫﺍ ﺍﻟﺟ�ﺩﻭﻝ ﻳﻛ�ﻭﻥ‬ ‫ﻟ��ﺩﻯ ﺍﻟﻣ��ﺭﻳﺽ ﻧﻭﻋ��ﺎﻥ ﻣ��ﻥ ﺍﻟﺣﺑ��ﻭﺏ)ﻓﺋ��ﺔ ‪ 2‬ﻣﻠﻐ��ﻡ ﻭﻓﺋ��ﺔ ‪ 5‬ﻣﻠﻐ��ﻡ(‪ .‬ﻭﻗ��ﺩ ﻻ ﺗﺗ��ﻭﻓﺭ ﻓﺋ��ﺔ ‪ 2‬ﻣﻠﻐ��ﻡ‬ ‫ﺑﺎﻟﻣﺳﺗﺷﻔﻰ ﻓﻳُﻌﻁﻰ ﺍﻟﻣﺭﻳﺽ ﺛﻼﺛﺔ ﺃﻧﻭﺍﻉ ﻣﻥ ﺍﻟﺣﺑﻭﺏ)‪ 3+1‬ﻣﻠﻐﻡ ﺧﻣﺳﺔ ﺃﻳﺎﻡ ﻓ�ﻲ ﺍﻷﺳ�ﺑﻭﻉ ﻭ‪5‬‬ ‫ﻣﻠﻐﻡ ﻳﻭﻣﻳﻥ ﻓﻲ ﺍﻷﺳﺑﻭﻉ(‪ .‬ﻭﻧﻔﺱ ﺍﻟﺟﺭﻋﺔ)‪ 30‬ﻣﻠﻐﻡ ﺃﺳ�ﺑﻭﻋﻳﺎ ً( ﻳﻣﻛ�ﻥ ﺃﻥ ُﺗﻌﻁ�ﻰ ﺑﺷ�ﻛﻝ ﺃﺑﺳ�ﻁ‪،‬‬ ‫ﻛﺄﻥ ﻳﺗﻧﺎﻭﻝ ﺍﻟﻣﺭﻳﺽ ﺣﺑﺔ ﻓﺋﺔ ‪5‬ﻣﻠﻐﻡ ﺳﺗﺔ ﺃﻳﺎﻡ ﻓ�ﻲ ﺍﻷﺳ�ﺑﻭﻉ ﻓﻘ�ﻁ ﻭﻻ ﻳﺄﺧ�ﺫ ﺷ�ﻳﺋﺎ ً ﻓ�ﻲ ﺃﺣ�ﺩ ﺃﻳ�ﺎﻡ‬ ‫ﺍﻷﺳﺑﻭﻉ‪ ،‬ﻛﺎﻟﺟﻣﻌﺔ ﻣﺛﻼً‪.‬‬ ‫ﻭﻟﻥ ﻳﻛﻭﻥ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻷﺧﻳ�ﺭﺓ ﻣﺧﺗﻠﻔ�ﺎ ً ﺑﺷ�ﻛﻝ ﻣﺣﺳ�ﻭﺱ ﻳ�ﻭﻡ ﺍﻟﺟﻣﻌ�ﺔ ﻋﻧ�ﻪ ﻓ�ﻲ ﺍﻷﻳ�ﺎﻡ‬ ‫ﺍﻷﺧﺭﻯ‪ ،‬ﻷﻥ ﻣﻔﻌﻭﻝ ﺍﻟﺣﺑﻭﺏ‪-‬ﻛﻣﺎ ﺫﻛﺭﺕ‪ -‬ﻳﻣﺗﺩ ﻣﺗﺟﺎﻧﺳ ٍﺎ ﻋﻠﻰ ﺍﻷﺳﺑﻭﻉ ﻛﻠﻪ‪.‬‬ ‫‪.6‬‬

‫ﺇﺫﺍ ﺣﺻﻝ ﻟﻠﻣﺭﻳﺽ ﻧﺯﻑ ﺩﻡ ﻏﻳﺭ ﻣﺗﻭ ﱠﻗﻊ‪ ،‬ﺃﻱ ﺩﻭﻥ ﺳﺑﺏ ﻣﻥ ﺷ�ﺩﺓ ﺃﻭ ﺟ�ﺭﺡ‪ ،‬ﻭﻳﻛ�ﻭﻥ‬ ‫ﻋﺎﺩﺓ ﻣﻥ ﺍﻟﻠﺛﺔ ﺃﻭ ﺍﻷﻧﻑ‪ ،‬ﺃﻭ ﺇﺫﺍ ﺣﺻﻠﺕ ﻛﺩﻣﺎﺕ ﺯﺭﻗﺎء ﻓﻲ ﺍﻟﺟﻠﺩ‪ ،‬ﻓﻘﺩ ﺗﻛﻭﻥ ﻧﺳ�ﺑﺔ ﺍﻟﺳ�ﻳﻭﻟﺔ‬ ‫ﺯﺍﺩﺕ ﻋﻥ ﺍﻟﻣﻁﻠﻭﺏ ﻟﺳﺑﺏ ﻣﺎ)ﺍﻧﻅ�ﺭ ﺍﻟﻔﻘ�ﺭﺓ‪ .(7‬ﺣﻳﻧﺋ�ﺫ ﻳﻣﺗﻧ�ﻊ ﺍﻟﻣ�ﺭﻳﺽ ﻋ�ﻥ ﺗﻧ�ﺎﻭﻝ ﺟﺭﻋ�ﺔ‬ ‫ﺫﻟﻙ ﺍﻟﻳﻭﻡ ﻓﻘﻁ‪ ،‬ﺛﻡ ﻳﺳﺗﺄﻧﻑ ﻓﻲ ﺍﻟﻳﻭﻡ ﺍﻟﺗﺎﻟﻲ ﺣﺳﺏ ﺍﻟﺟﺩﻭﻝ‪ .‬ﻓﺈﺫﺍ ﻋﺎﺩ ﺍﻟﻧﺯﻑ ﺑﻌ�ﺩ ﺫﻟ�ﻙ ﻣ�ﺭﺓ‬ ‫ﺃﺧﺭﻯ ﻳﺭﺍﺟﻊ ﺍﻟﻣ�ﺭﻳﺽ ﻹﺟ�ﺭﺍء ﻓﺣ�ﺹ ﺍﻟﺗﺧﺛ�ﺭ ﻓ�ﻲ ﻗﺳ�ﻡ ﺍﻟﻁ�ﻭﺍﺭﺉ ﻣ�ﻥ ﺍﻟﻣﺳﺗﺷ�ﻔﻰ ﺩﻭﻧﻣ�ﺎ‬ ‫ﺣﺎﺟﺔ ﻟﻣﻭﻋﺩ ﻣﺳﺑﻕ‪.‬‬

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‫ﻭﻟﻣﺎ ﻛﺎﻧﺕ ﻣﻌﻅﻡ ﺣﺎﻻﺕ ﺍﻟﻧﺯﻑ ﺗﺣﺻﻝ ﺧﻼﻝ ﺍﻟﻧﻬﺎﺭ‪ ،‬ﺃﺻﺑﺢ ﻣﻭﻋﺩ ﺗﻧ�ﺎﻭﻝ ﺍﻟﻘ�ﺭﺹ ﻣﺳ�ﺎ ًء‬ ‫ﻣﻧﻁﻘ ّﻳﺎً‪ ،‬ﺣﻳﺙ ﻳﻛﻭﻥ ﻟﻠﻣﺭﻳﺽ ﺍﺧﺗﻳﺎﺭ ﺍﻻﻣﺗﻧﺎﻉ ﻋ�ﻥ ﺍﻟ�ﺩﻭﺍء ﻟ�ﺫﻟﻙ ﺍﻟﻳ�ﻭﻡ‪ ،‬ﻓ�ﻲ ﺣﺎﻟ�ﺔ ﺣﺻ�ﻭﻝ‬ ‫ﻧﺯﻑ‪ .‬ﻭﻟﻥ ﻳﻛﻭﻥ ﺫﻟﻙ ﻣﻣﻛﻧﺎ ً ﺇﺫﺍ ﻛﺎﻥ ﻗﺩ ﺗﻧﺎﻭﻝ ﺍﻟﻘﺭﺹ ﺻﺑﺎﺣﺎ ً‪.‬‬ ‫ﻫﻧ��ﺎﻙ ﺃﺩﻭﻳ��ﺔ ﺗﺯﻳ��ﺩ ﻣ��ﻥ ﻣﻔﻌ��ﻭﻝ ﻗ��ﺭﺹ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ)ﻭﺑﻁ��ﺭﻕ ﻣﺧﺗﻠﻔ��ﺔ ﻻ ﻣﺟ��ﺎﻝ ﻫﻧ��ﺎ‬

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‫ﻟ��ﺫﻛﺭﻫﺎ( ﻭﺃﺧ��ﺭﻯ ﺗ��ﻧﻘﺹ ﻣ��ﻥ ﻣﻔﻌﻭﻟ��ﻪ‪ ،‬ﻭﺑﻁ��ﺭﻕ ﻣﺧﺗﻠﻔ��ﺔ ﺃﻳﺿ �ﺎ ً‪ .‬ﻟ��ﺫﻟﻙ ﻓﻌﻠ��ﻰ ﺍﻟﻣ��ﺭﻳﺽ ﺃﻥ‬ ‫ﻳﺧﺑﺭ ﺍﻟﻁﺑﻳﺏ ﺍﻟ�ﺫﻱ ﻳﺻ�ﻑ ﻟ�ﻪ ﺩﻭﺍ ًء ﺟﺩﻳ�ﺩﺍً ﺑﺄﻧ�ﻪ)ﺃﻱ ﺍﻟﻣ�ﺭﻳﺽ( ﻳﺗﻧ�ﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ ﻟﻳﻛ�ﻭﻥ‬ ‫ﺣ��ﺫﺭﺍً ﻓﻳﻣ��ﺎ ﻳﺻ��ﻑ ﻣ��ﻥ ﺩﻭﺍء‪ .‬ﻛﻣ��ﺎ ﺃﻥ ﻗﻁ��ﻊ ﺩﻭﺍء ﺑﻌ��ﺩ ﺃﺧ��ﺫﻩ ﻟﻣ��ﺩﺓ ﻣ��ﺎ ﻗ��ﺩ ﻳ��ﺅﺩﻱ ﻟﺯﻳ��ﺎﺩﺓ‪ ،‬ﺃﻭ‬ ‫ﻧﻘﺻﺎﻥ‪ ،‬ﻓﻲ ﻣﻔﻌ�ﻭﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‪ ،‬ﺇﺫﺍ ﻛ�ﺎﻥ ﺫﻟ�ﻙ ﺍﻟﻌ�ﻼﺝ ﺫﺍ ﺗ�ﺄﺛﻳﺭ ﻋﻠ�ﻰ ﻓﻌﺎﻟﻳ�ﺔ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‪.‬‬ ‫ﺃﺷﻬﺭ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺗﻲ ﺗﺯﻳﺩ ﻣﻥ ﻓﻌﺎﻟﻳّﺔ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻫﻣﺎ ﺍﻷﺳﺑﺭﻳﻥ ﻭﺍﻟﺑﻧﺎﺩﻭﻝ‪.‬‬ ‫ﺗﻘ���ﻭﻡ ﻛﺛﻳ���ﺭ ﻣ���ﻥ ﺍﻟﻣﺳﺗﺷ���ﻔﻳﺎﺕ ﺑﺗﺯﻭﻳ���ﺩ ﺍﻟﻣ���ﺭﻳﺽ ﺑﻛﺗ ّﻳ���ﺏ ﺃﻭ ﺑﻁﺎﻗ���ﺔ ﺧﺎﺻ���ﺔ ﻟﻌ���ﻼﺝ‬

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‫ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ ﻟﺳ��ﺑﺑﻳﻥ‪ ،‬ﺍﻷﻭﻝ ﻫ�ﻭ ﻛ��ﻲ ﻳﻌ�ﻭﺩ ﺇﻟﻳﻬ��ﺎ ﺍﻟﻣ�ﺭﻳﺽ ﻓ��ﻲ ﺍﻟﺑﻳ�ﺕ ﻭﻳﺗﺛ ّﺑ��ﺕ ﻣ�ﻥ ﺍﻟﺟ��ﺩﻭﻝ‬ ‫ﺍﻟﺫﻱ ﻭﺿﻌﻪ ﺍﻟﻁﺑﻳﺏ ﻟﻪ‪ ،‬ﺇﺫﺍ ﺣﺻﻝ ﻟﺩﻳﻪ ﺷﻙ ‪ .‬ﻭﺍﻟﺳﺑﺏ ﺍﻟﺛ�ﺎﻧﻲ ﻫ�ﻭ ﻟﻳﺣﻣﻠ�ﻪ ﻣﻌ�ﻪ ﺇﺫﺍ ﺭﺍﺟ�ﻊ‬ ‫ﺃﻱ ﻁﺑﻳﺏ ﺁﺧﺭ ﺃﻭ ﻁﺑﻳﺏ ﺃﺳﻧﺎﻥ ﻭﻳﻁﻠﻌﻪ ﻋﻠﻳﻪ ﻟﻳﻛﻭﻥ ﻋﻠ�ﻰ ﺑﻳّﻧ�ﺔ ﻣ�ﻥ ﺍﻟﻌ�ﻼﺝ ﻭﻣ�ﻥ ﺍﻟﻣ�ﺭﺽ‬ ‫ﺍﻷﺻﻠﻲ ﺍﻟﺫﻱ ﻣﻥ ﺃﺟﻠﻪ ﻭُ ﺻِ ﻑ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‪.‬‬ ‫ﺇﻥ ﺇﺟ��ﺭﺍء ﺃﻳ��ﺔ ﻋﻣﻠﻳ��ﺔ ﺟﺭﺍﺣﻳ��ﺔ ﺃﻭ ﻗﻠ��ﻊ ﺳ��ﻥ ﻣ��ﻊ ﺗﻧ��ﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﺳﻳﺻ��ﺎﺣﺑﻪ ﻧ��ﺯﻑ‬

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‫ﻏﻳﺭ ﻋﺎﺩﻱ‪ ،‬ﻷﻥ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻳﻘﻠﻝ ﻣﻥ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻭﻳﺯﻳﺩ ﺳﻳﻭﻟﺗﻪ‪ .‬ﻟﺫﺍ ﻓﻬﻧ�ﺎﻙ ﺇﺟ�ﺭﺍءﺍﺕ ﺗﺗﺧ�ﺫ‬ ‫ﻗﺑ�ﻝ ﺍﻟﻌﻣﻠﻳ��ﺔ ﺃﻭ ﻗﻠ�ﻊ ﺍﻟﺳ��ﻥ ﻟﻘﻁ�ﻊ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﻭﺇﺑﺩﺍﻟ��ﻪ ﺑﺎﻟﻬﻳﺑ�ﺎﺭﻳﻥ‪ ،‬ﺣﻘﻧ�ﺎ ً ﺗﺣ�ﺕ ﺍﻟﺟﻠ��ﺩ ﻋ��ﺎﺩﺓ‪.‬‬ ‫ﻭﻳﺟﺏ ﺃﻥ ﻳﺗﻡ ﺫﻟﻙ ﺑﺈﺷﺭﺍﻑ ﻣﺑﺎﺷﺭ ﻣﻥ ﺍﻟﻁﺑﻳﺏ ﺍﻟﺫﻱ ﻭﺻﻑ ﻣﺎﻧﻊ ﺍﻟﺗﺧﺛﺭ ﻟﻠﻣﺭﻳﺽ‪.‬‬ ‫‪.10‬‬

‫ﺇﻥ ﻣﺩﻯ ﺳﻳﻭﻟﺔ ﺍﻟ�ﺩﻡ ﺍﻟﻣﻁﻠﻭﺑ�ﺔ ﺑﺎﺳ�ﺗﻌﻣﺎﻝ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ ﺗﺧﺗﻠ�ﻑ ﺑﺣﺳ�ﺏ ﺍﻟﻣ�ﺭﺽ ﺍﻟ�ﺫﻱ‬

‫ﻣﻥ ﺃﺟﻠﻪ ﻭُ ﺻِ ﻑ‪ .‬ﻓﺎﻟﺻﻣﺎﻡ ﺍﻟﻣﻌﺩﻧﻲ ﻓﻲ ﺍﻟﻘﻠﺏ ﺗﺧﺗﻠﻑ ﺍﻟﺳﻳﻭﻟﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻟﻪ ﻋﻥ ﺣﺎﻟﺔ ﺗﺟﻠ�ﻁ‬ ‫ﻭﺭﻳﺩ ﺍﻟﺳﺎﻕ‪ ،‬ﻭﺍﻷﺧﻳﺭﺓ ﺗﺧﺗﻠﻑ ﻋﻥ ﺣﺎﻟﺔ ﻧﻘﺹ ﺑ�ﺭﻭﺗﻳﻥ ﺝ ﺍﻟ�ﻭﺭﺍﺛﻲ‪ ،‬ﻭﻫﻛ�ﺫﺍ…ﻭ ُﻳ َﻌﺑﱠ�ﺭ ﻋ�ﻥ‬ ‫ﻣﻘﺩﺍﺭ ﺍﻟﺳ�ﻳﻭﻟﺔ ﺑ�ﺭﻗﻡ ﻳﺳ�ﻣﻰ )ﻧﺳ�ﺑﺔ ﺍﻟﺳ�ﻳﻭﻟﺔ( ﻭﻳﻣﺛ�ﻝ ﻧﺳ�ﺑﺔ ﺳ�ﻳﻭﻟﺔ ﺩﻡ ﺍﻟﻣ�ﺭﻳﺽ ﺇﻟ�ﻰ ﺳ�ﻳﻭﻟﺔ‬ ‫ﺍﻟﺩﻡ ﺍﻟﻁﺑﻳﻌﻲ‪ ،‬ﺑﺎﺳﺗﻌﻣﺎﻝ ﻧﻔﺱ ﺍﻟﻔﺣﺹ‪ .‬ﺗﺧﺗﻠﻑ ﺍﻟﻧﺳﺑﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻣﻥ‪ 1,5‬ﺇﻟ�ﻰ ‪ 3,5‬ﺃﻭ ﺣﺗ�ﻰ‬ ‫‪ ، 4‬ﻭﺑﺣﺳ��ﺏ ﺍﻟﺣﺎﻟ��ﺔ‪ -‬ﻛﻣ��ﺎ ﺫﻛ��ﺭﺕ‪ .-‬ﻭﻋﻠ��ﻰ ﺍﻟﻣ��ﺭﻳﺽ ﺃﻥ ﻳ��ﺩﺭﻙ ﺃﻥ ﺍﺣﺗﻣ��ﺎﻝ ﺍﻟﻧ��ﺯﻑ ﻋﻧ��ﺩﻩ‬ ‫ﻳ��ﺯﺩﺍﺩ ﻛﻠﻣ��ﺎ ﺍﺭﺗﻔﻌ��ﺕ ﻧﺳ��ﺑﺔ ﺳ��ﻳﻭﻟﺔ ﺩﻣ��ﻪ‪ ،‬ﻛﻣ��ﺎ ﺃﻥ ﻧﻘﺻ��ﺎﻥ ﺍﻟﻧﺳ��ﺑﺔ ﻋ��ﻥ ﺍﻟﻣﻁﻠ��ﻭﺏ ﻟﺣﺎﻟﺗ��ﻪ ﻗ��ﺩ‬

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‫ﻳﺅﺩﻱ ﺇﻟ�ﻰ ﺣﺻ�ﻭﻝ ﺗﺟﻠ�ﻁ‪ ،‬ﻭﻫ�ﻭ ﺍﻷﻣ�ﺭ ﺍﻟ�ﺫﻱ ﻛ�ﺎﻥ ﺍﻟﻁﺑﻳ�ﺏ ﻳﺭﻳ�ﺩ ﺗﺟﻧﺑ�ﻪ ﺑﺎﻷﺻ�ﻝ ﻓﻭﺻ�ﻑ‬ ‫ﻋﻘﺎﺭ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‪.‬‬ ‫‪.11‬‬

‫ﻳﻌﻁ���ﻰ ﺍﻟﻭﺍﺭﻓ���ﺎﺭﻳﻥ ﺑﺻ���ﻭﺭﺓ ﻣﺅﻗﺗ���ﺔ ﻟ���ﺑﻌﺽ ﺍﻟﺣ���ﺎﻻﺕ‪ ،‬ﻭﺣﺳ���ﺏ ﺇﺭﺷ���ﺎﺩ ﺍﻟﻁﺑﻳ���ﺏ‪،‬‬

‫ﻭﺑﺻﻭﺭﺓ ﺩﺍﺋﻣﺔ) ﻣﺩﻯ ﺍﻟﻌﻣﺭ( ﻟﺣﺎﻻﺕ ﺃﺧﺭﻯ‪.‬‬ ‫‪.12‬‬

‫ﻳﺗﻔ���ﻕ ﺍﻷﻁﺑ���ﺎء‪ ،‬ﻛﻣ���ﺎ ﺫﻛ���ﺭﺕ ﻋﻧ���ﺩ ﺍﻟﺣ���ﺩﻳﺙ ﻋ���ﻥ ﺍﻟﻬﻳﺑ���ﺎﺭﻳﻥ‪ ،‬ﻋﻠ���ﻰ ﺿ���ﺭﻭﺭﺓ ﻗﻁ���ﻊ‬

‫ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﺧ��ﻼﻝ ﺍﻷﺳ��ﺎﺑﻳﻊ ﺍﻟﻌﺷ��ﺭﺓ ﺃﻭ ﺍﻻﺛﻧ��ﻲ ﻋﺷ��ﺭ ﺍﻷﻭﻟ��ﻰ ﻣ��ﻥ ﺍﻟﺣﻣ��ﻝ ﻭﺇﺑﺩﺍﻟ��ﻪ ﺑﺣﻘ��ﻥ‬ ‫ﺍﻟﻬﻳﺑ���ﺎﺭﻳﻥ‪ ،‬ﻭﺑﻌ���ﺽ ﺍﻷﻁﺑ���ﺎء ﻳﻣﻧﻌ���ﻭﻥ ﺍﻟﻭﺍﺭﻓ���ﺎﺭﻳﻥ ﻋ���ﻥ ﺍﻟﻣﺭﻳﺿ���ﺎﺕ ﻁﻳﻠ���ﺔ ﻓﺗ���ﺭﺓ ﺍﻟﺣﻣ���ﻝ‬ ‫ﻭﻳﻌﻭﺿﻭﻧﻬﺎ ﺑﺎﻟﻬﻳﺑﺎﺭﻳﻥ‪ .‬ﻭﺳﺑﺏ ﺫﻟ�ﻙ ﻫ�ﻭ ﺍﺣﺗﻣ�ﺎﻝ ﺣﺻ�ﻭﻝ ﺣ�ﺎﻻﺕ ﺗﺷ�ﻭّ ﻩ ﺟﻧﻳﻧﻳّ�ﺔ ﺇﺫﺍ ﻛﺎﻧ�ﺕ‬ ‫ﺍﻷﻡ ﺗﺗﻧ��ﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﺧ��ﻼﻝ ﺍﻷﺳ��ﺎﺑﻳﻊ ﺍﻟﻌﺷ��ﺭﺓ ﺍﻷﻭﻟ��ﻰ ﻣ��ﻥ ﺍﻟﺣﻣ��ﻝ‪ .‬ﻟ��ﺫﻟﻙ‪ ،‬ﻓﻌﻠ��ﻰ ﺃﻳ��ﺔ‬ ‫ﻣﺭﻳﺿ�ﺔ ﺗﺗﻧ��ﺎﻭﻝ ﺍﻟﻭﺍﺭﻓ��ﺎﺭﻳﻥ ﻭﺗﺷ��ﻙ ﺃﻥ ﻟ��ﺩﻳﻬﺎ ﺣﻣ�ﻼً‪ ،‬ﻋﻠﻳﻬ��ﺎ ﺃﻥ ﺗﺭﺍﺟ��ﻊ ﺑ��ﺩﻭﻥ ﺇﺑﻁ��ﺎء ﻟﻌﻣ��ﻝ‬ ‫ﻓﺣﺹ ﺍﻟﺣﻣﻝ‪ ،‬ﺣﺗﻰ ﻳﻣﻛﻥ ﺇﻳﻘﺎﻑ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻭﺇﺑﺩﺍﻟﻪ ﺑﺎﻟﻬﻳﺑﺎﺭﻳﻥ‪ ،‬ﻋﻠﻰ ﺍﻷﻗﻝ ﻟﻠﻌﺷﺭ ﺃﺳﺎﺑﻳﻊ‬ ‫ﺍﻷﻭﻟﻰ ﻣﻥ ﺍﻟﺣﻣﻝ ﻭﺣﺳﺏ ﺭﺃﻱ ﺍﻟﻁﺑﻳﺏ ﺍﻟﻣﻌﺎﻟﺞ‪.‬‬ ‫‪.13‬‬

‫ﻻ ﻳﻅﻬﺭ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻓﻲ ﺣﻠﻳﺏ ﺍﻷﻡ ﺍﻟﻣﺭﺿﻊ ﺇﻻ ﺑﻛﻣﻳ�ﺎﺕ ﺑﺳ�ﻳﻁﺔ ﺟ�ﺩﺍً ﻻ ﺗ�ﺅﺛﺭ ﻋﻠ�ﻰ‬

‫ﺍﻟﺭﺿﻳﻊ‪.‬‬ ‫ﺍﻟﻣﺿﺎﺩﺍﺕ ﺍﻟﻣﺑﺎﺷﺭﺓ ﻟﻠﺧﺛﺭﻳﻥ ﻭﻟﻌﺎﻣﻝ ‪10‬‬ ‫ﺗﻡ ﻣﺅﺧﺭﺍً ﺇﻧﺗﺎﺝ ﻋﻘﺎﺭﺍﺕ ﺗﺑﻁﻝ ﻓﻌﺎﻟﻳﺔ ﺍﻟﺧﺛﺭﻳﻥ ﺃﻭ ﻋﺎﻣﻝ ‪ ،10‬ﻭﺗﺅﺧﺫ ﺑﺎﻟﻔﻡ ﻭﻗﺩ ﺑﺩﺃﺕ ﺗﻛﺳﺏ ﺍﻫﺗﻣﺎﻣﺎ ً‬ ‫ﺑﺻﻭﺭﺓ ﺗﺩﺭﻳﺟﻳﺔ ﻭﻳﺑﺩﻭ ﺃﻧﻬﺎ ﺃﻣﻳﻧﺔ ﻓﻲ ﺍﻻﺳﺗﻌﻣﺎﻝ ﻭﺫﺍﺕ ﻧﺗﺎﺋﺞ ﻁﻳﺑﺔ‪.‬‬

‫ﺍﻷﺳﺑﺭﻳﻥ ﻛﻣﺎﻧﻊ ﻟﻠﺗﺟﻠﻁ‬ ‫ﻫﺫﺍ ﺍﻟﺩﻭﺍء ﺍﻟﺑﺳﻳﻁ ﺍﻟﺗﺭﻛﻳﺏ ﻟﻪ ﺍﺳﺗﻌﻣﺎﻻﺕ ﻣﺧﺗﻠﻔﺔ‪ ،‬ﻣﻧﻬﺎ ﺧﻔ�ﺽ ﺣ�ﺭﺍﺭﺓ ﺍﻟﺟﺳ�ﻡ ﻭﺗﺧﻔﻳ�ﻑ ﺍﻷﻟ�ﻡ‬ ‫ﻭﺗﺛﺑ��ﻳﻁ ﺍﻻﻟﺗﻬﺎﺑ��ﺎﺕ ﻭﻏﻳﺭﻫ��ﺎ‪ .‬ﻭﻗ��ﺩ ﺗﺑ �ﻳّﻥ ﺃﻳﺿ �ﺎ ً ﺍﻧ��ﻪ ﻳﻣﻧ��ﻊ ﻋﻣ��ﻝ ﺍﻟﺻ��ﻔﻳﺣﺎﺕ ﺑ��ﺄﻥ ﻳﺛ �ﺑّﻁ ﺑﻌ��ﺽ‬ ‫ﺍﻹﻧﻅﻳﻣﺎﺕ ﻓﻳﻬﺎ‪ ،‬ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﻣﻧﻊ ﺗﺭﺍﻛﻣﻬﺎ‪ .‬ﻭﻗﺩ ﺫﻛﺭﺕ ﺫﻟﻙ ﻓﻲ ﺍﻟﻔﺻﻝ ﺍﻟﺛﺎﻧﻲ ﻋﻧ�ﺩ ﺍﻟﺣ�ﺩﻳﺙ‬ ‫ﻋﻥ ﺃﻣﺭﺍﺽ ﺍﻟﻧﺯﻑ ﺍﻟﻣﻛﺗﺳﺑﺔ‪.‬‬ ‫‪69‬‬

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‫ﺇﻥ ﺗﻧﺎﻭﻝ ﻗ�ﺭﺹ ﺃﺳ�ﺑﺭﻳﻥ ﻭﺍﺣ�ﺩ ﻳﻭﻣﻳ�ﺎً‪ ،‬ﺣﺗ�ﻰ ﻟ�ﻭ ﻛ�ﺎﻥ ﻣ�ﻥ ﺍﻟﻧ�ﻭﻉ ﺍﻟﺻ�ﻐﻳﺭ ﺍﻟﺧ�ﺎﺹ ﺑﺎﻷﻁﻔ�ﺎﻝ‪،‬‬ ‫ﻳﺳﺑﺏ ﻧﻘﺻﺎ ً ﻓﻲ ﻋﻣﻝ ﺍﻟﺻﻔﻳﺣﺎﺕ ﺍﻟﻣﻭﺟﻭﺩﺓ ﺑﺎﻟﺩﻡ ﻋﻧﺩ ﺗﻧﺎﻭﻝ ﺍﻟﺩﻭﺍء‪ ،‬ﻭﻳﺳﺗﻣﺭ ﺫﻟﻙ ﻟﻌﺩﺓ ﺃﻳﺎﻡ‪.‬‬ ‫ﻭﻗﺩ ﺍﺳ ُﺗﻌﻣِﻝ ﺍﻷﺳﺑﺭﻳﻥ ﻛﻣﺎﻧﻊ ﺗﺧﺛﺭ ﻟﻭﺣﺩﻩ ﻓﻠﻡ ﻳﻛﻥ ﻧﺎﺟﺣ�ﺎ ً ﻟﻣﻧ�ﻊ ﺍﻟﺗﺧﺛ�ﺭ ﻓ�ﻳﻣﻥ ﻋﻧ�ﺩﻫﻡ ﺍﺳ�ﺗﻌﺩﺍﺩ‬ ‫ﻛﺎﻟﻣﺻﺎﺑﻳﻥ ﺑﺄﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺃﻭ ﻣﻥ ﻋﻧﺩﻫﻡ ﺻﻣﺎﻡ ﻣﻌﺩﻧﻲ ﻓﻲ ﺍﻟﻘﻠﺏ‪ .‬ﻟﻛﻧ�ﻪ ﻳﺿ�ﺎﻑ ﺃﺣﻳﺎﻧ�ﺎ ً‬ ‫ﺇﻟﻰ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻟﻳﻌﻣﻝ ﻣﻌﻪ ﻋﻠﻰ ﻣﻧﻊ ﺣﺻﻭﻝ ﺗﺧﺛﺭﺍﺕ ﺷﺭﻳﺎﻧﻳﺔ‪ ،‬ﻻﺳﻳّﻣﺎ ﻓ�ﻲ ﺍﻟﺷ�ﺭﺍﻳﻳﻥ ﺍﻟﺗﺎﺟﻳ�ﺔ‬ ‫ﻓ��ﻲ ﺍﻟﻣﺭﺿ��ﻰ ﺍﻟ��ﺫﻳﻥ ﻳُﺧﺷ��ﻰ ﻣ��ﻥ ﺗﻛ��ﺭﺭ ﺍﻟﺟﻠﻁ��ﺔ ﺍﻟﺗﺎﺟﻳ��ﺔ ﻟ��ﺩﻳﻬﻡ‪ .‬ﻛ��ﺫﻟﻙ ﻳﺗﻧﺎﻭﻟ��ﻪ ﺍﻟﻛﺛﻳ��ﺭﻭﻥ ﻣ��ﻥ‬ ‫ﺍﻷﻓﺭﺍﺩ ﺍﻷﺻﺣﺎء‪ ،‬ﺑﻧﺻﻳﺣﺔ ﻣﻥ ﺃﻁﺑ�ﺎﺋﻬﻡ‪ ،‬ﻟﻠﻭﻗﺎﻳ�ﺔ ﻣ�ﻥ ﺣﺻ�ﻭﻝ ﺗﻐﻳّ�ﺭﺍﺕ ﻓ�ﻲ ﺟ�ﺩﺭﺍﻥ ﺍﻟﺷ�ﺭﺍﻳﻳﻥ‬ ‫ﺍﻟﺗﺎﺟﻳ���ﺔ‪ ،‬ﻭﻣ���ﻥ ﺛ���ﻡ ﺟﻠﻁ���ﺔ ﻓﻳﻬ���ﺎ‪ ،‬ﺣﻳ���ﺙ ﺃﻥ ﺍﻟﺻ���ﻔﻳﺣﺎﺕ ﺗﻠﻌ���ﺏ ﺑﻌ���ﺽ ﺍﻟ���ﺩﻭﺭ ﻓ���ﻲ ﺍﻟﺗﻐﻳ���ﺭﺍﺕ‬ ‫ﺍﻻﻧﺣﻁﺎﻁﻳﺔ ﺑﺎﻟﺷﺭﺍﻳﻳﻥ ﻟﺩﻯ ﻣﻥ ﻋﻧﺩﻫﻡ ﺍﺳﺗﻌﺩﺍﺩ ﻭﺭﺍﺛﻲ ﺃﻭ ﺑﺳﺑﺏ ﺍﻟﺗﺩﺧﻳﻥ ﺃﻭ ﺯﻳ�ﺎﺩﺓ ﺍﻟ�ﺩﻫﻭﻥ ﺃﻭ‬ ‫ﻏﻳﺭﻫﺎ‪.‬‬ ‫ﺃﺭﺟﻭ ﺃﻥ ﻳﺗﺫﻛﺭ ﺍﻟﻘﺎﺭﺉ ﺃﻥ ﺍﻷﺳﺑﺭﻳﻥ ﻻ ﻳﺧﻠﻭ ﻣ�ﻥ ﺑﻌ�ﺽ ﺍﻷﺿ�ﺭﺍﺭ‪ ،‬ﻣﻧﻬ�ﺎ ﺗ�ﺄﺛﻳﺭﻩ ﻋﻠ�ﻰ ﺍﻟﻣﻌ�ﺩﺓ‬ ‫ﻣﺳﺑﺑﺎ ً ﺗﻘﺭﺣﺎ ً ﻓﻳﻬﺎ ﻟﺩﻯ ﺑﻌﺽ ﺍﻷﻓﺭﺍﺩ‪.‬‬ ‫ﻛ���ﺫﻟﻙ ﻓﻣ���ﻥ ﺍﻟﻣﻬ���ﻡ ﺗ���ﺫ ّﻛﺭ ﺃﻥ ﺍﻷﺳ���ﺑﺭﻳﻥ ﻳﺯﻳ���ﺩ ﻣ���ﻥ ﺍﻟﻣﻔﻌ���ﻭﻝ ﺍﻟﻣﺿ���ﺎﺩ ﻟﻠﺗﺧﺛ���ﺭ ﺍﻟ���ﺫﻱ ﻳﺳ���ﺑﺑﻪ‬ ‫ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‪ .‬ﻓﺈﺫﺍ ﺃﺧﺫ ﺍﻟﻣﺭﻳﺽ ﺍﻟﻌﻘﺎﺭﻳﻥ ﻣﻌﺎ ً ﺑﺻﻭﺭﺓ ﻣﺳﺗﻣﺭﺓ ﺃﻣﻛﻥ ﺿﺑﻁ ﺟﺭﻋﺔ ﺍﻟﻭﺍﺭﻓ�ﺎﺭﻳﻥ‬ ‫ﺍﻟﻣﻧﺎﺳﺑﺔ‪ .‬ﻟﻛﻥ ﺇﺫﺍ ﺗﻧﺎﻭﻝ ﺍﻷﺳﺑﺭﻳﻥ ﺑﺻﻭﺭﺓ ﻏﻳﺭ ﻣﻧﺗﻅﻣﺔ‪ ،‬ﺃﻭ ﺑﻛﻣﻳ�ﺔ ﺗﺯﻳ�ﺩ ﻋ�ﻥ ﺍﻟﻘ�ﺭﺹ ﺍﻟﻭﺍﺣ�ﺩ‬ ‫ﺍﻟﻣﻘﺭﱠ ﺭ ﻟﻠﻳﻭﻡ ﺍﻟﻭﺍﺣﺩ‪ ،‬ﻓﻘﺩ ﻳﺅﺩﻱ ﺫﻟﻙ ﺇﻟﻰ ﺯﻳﺎﺩﺓ ﻏﻳﺭ ﻣﺗﻭ ﱠﻗﻌﺔ ﻓﻲ ﻧﺳﺑﺔ ﺍﻟﺳﻳﻭﻟﺔ‪.‬‬

‫ﻣﺫﻳﺑﺎﺕ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻫﺫﻩ ﺍﻟﻣﺟﻣﻭﻋﺔ ﻣﻥ ﺍﻟﻌﻘﺎﺭﺍﺕ ﻫﻲ ﻟﻳﺳﺕ ﻣﻥ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ‪ ،‬ﻟﻛﻧﻬﺎ ﻗ�ﺩ ُﺗﻌﻁ�ﻰ ﻟﻠﻣ�ﺭﻳﺽ ﻣﺑﺎﺷ�ﺭﺓ‬ ‫ﺑﻌﺩ ﺣﺻﻭﻝ ﺟﻠﻁﺔ ﺷﺭﻳﺎﻧﻳﺔ )ﺧﻼﻝ ﺳﺎﻋﺎﺕ( ﻟﻣﺣﺎﻭﻟﺔ ﺗﺫﻭﻳﺑﻬﺎ ﻭﺇﻋﺎﺩﺓ ﻓﺗﺢ ﺍﻟﺷﺭﻳﺎﻥ ﺍﻟ�ﺫﻱ ﺗﺳ� ّﺩﻩ‬ ‫ﺗﻠ��ﻙ ﺍﻟﺟﻠﻁ��ﺔ‪ .‬ﻭﺃﻛﺛ��ﺭ ﻣ��ﺎ ﺗﺳ��ﺗﻌﻣﻝ ﻓ��ﻲ ﺟﻠﻁ��ﺎﺕ ﺍﻟﺷ��ﺭﺍﻳﻳﻥ ﺍﻟﺗﺎﺟﻳ��ﺔ‪ ،‬ﺇﺫﺍ ﻭﺻ��ﻝ ﺍﻟﻣ��ﺭﻳﺽ ﺇﻟ��ﻰ‬ ‫ﺍﻟﻣﺳﺗﺷﻔﻰ ﻓﻲ ﺍﻟﻭﻗﺕ ﺍﻟﻣﻧﺎﺳﺏ‪.‬‬ ‫ﺃﺷ��ﻬﺭ ﻫ��ﺫﻩ ﺍﻟﻣﺟﻣﻭﻋ��ﺔ ﻫ��ﻭ ﺍﻟﺳ��ﺗﺭﺑﺗﻭﻛﺎﻳﻧﻳﺯ ﺍﻟﻣﺷ��ﺗﻕ ﻣ��ﻥ ﺑﻌ��ﺽ ﺍﻟﺟ��ﺭﺍﺛﻳﻡ ﻭﻫﻧ��ﺎﻙ ﻣﻔ ّﻌ��ﻝ ﻣ��ﺫﻳﺏ‬ ‫ﺍﻟﺧﺛﺭﺓ ﺍﻟﻁﺑﻳﻌﻲ ﺍﻟﻣُﻧ َﺗﺞ ﺑﺎﻟﻬﻧﺩﺳﺔ ﺍﻟﻭﺭﺍﺛﻳﺔ‪.‬‬

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‫ﻣﺨﺘﺼﺮ ﻷﺳﺎﻟﻴﺐ ﺍﺳﺘﻌﻤﺎﻝ ﻣﻀﺎﺩﺍﺕ ﺍﻟﺘﺨﺜﺮ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺨﺘﻠﻔﺔ )ﻣﻊ ﺍﺧﺘﻼﻓﺎﺕ ﺑﺴﻴﻄﺔ ﻣﻦ ﻁﺒﻴﺐ ﻵﺧﺮ(‪:‬‬

‫ﺍ‪ .‬ﺟﻠﻁﺎﺕ ﺷﺭﺍﻳﻳﻥ ﺍﻟﻘﻠﺏ‪:‬‬ ‫ ﺳﺗﺭﺑﺗﻭﻛﺎﻳﻧﻳﺯ ﺃﻭ ﻣﺫﻳﺏ ﺁﺧﺭ ﻟﻠﺧﺛﺭﺓ‪.‬‬‫ ﻫﻳﺑﺎﺭﻳﻥ ﻟﻔﺗﺭﺓ ﺃﺳﺑﻭﻉ ﺃﻭ ﺃﻛﺛﺭ‪.‬‬‫ ﺃﺳﺑﺭﻳﻥ ﻟﻔﺗﺭﺓ ﻁﻭﻳﻠﺔ‪.‬‬‫ﺏ‪ .‬ﺟﻠﻁﺎﺕ ﺃﻭﺭﺩﺓ ﺍﻟﺳﺎﻗﻳﻥ ﺃﻭ ﺻ ّﻣ ﺔ ﺍﻟﺷﺭﺍﻳﻳﻥ ﺍﻟﺭﺋﻭﻳﺔ ‪:‬‬ ‫ ﻫﻳﺑﺎﺭﻳﻥ ﻓﻲ ﺍﻟﺑﺩﺍﻳﺔ‪.‬‬‫ ﺍﻟﺗﺣﻭﻝ ﺇﻟﻰ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﺧﻼﻝ ﺃﻳﺎﻡ ﻭﻟﻣﺩﺓ ﺃﺭﺑﻌﺔ ﺃﺷﻬﺭ ﺇﻟﻰ ﺳﻧﺔ‪.‬‬‫ﺝ‪ .‬ﺍﻟﺻﻣﺎﻣﺎﺕ ﺍﻻﺻﻁﻧﺎﻋﻳﺔ ﻓﻲ ﺍﻟﻘﻠﺏ ‪:‬‬ ‫ ﻫﻳﺑﺎﺭﻳﻥ ﻓﻲ ﺍﻟﺑﺩﺍﻳﺔ‬‫ ﺍﻟﺗﺣﻭﻝ ﺇﻟﻰ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﺧﻼﻝ ﺃﻳﺎﻡ ﻭﺍﻻﺳﺗﻣﺭﺍﺭ ﻋﻠﻳﻪ ﻣﺩﻯ ﺍﻟﻌﻣﺭ‪.‬‬‫ﺩ‪ .‬ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫ ﻭﺍﺭﻓﺎﺭﻳﻥ ﻣﺩﻯ ﺍﻟﻌﻣﺭ‪.‬‬‫ﻫـ‪ .‬ﺣﺎﻟﺔ ﺍﻟﺣﻣﻝ ﻋﻧﺩ ﻣﻥ ﺗﺣﺗﺎﺝ ﺇﻟﻰ ﻣﺎﻧﻊ ﺗﺧﺛﺭ ‪:‬‬ ‫ ﻗﻁﻊ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻓﻭﺭﺍً‬‫ ﺍﻟﺑﺩء ﺑﺎﻟﻬﻳﺑﺎﺭﻳﻥ‪.‬‬‫ ﺍﻻﺳﺗﻣﺭﺍﺭ ﻋﻠﻰ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻁﻳﻠﺔ ﺍﻟﺣﻣﻝ ‪.‬‬‫ﺃﻭ‬ ‫ﺍﻟﻌﻭﺩﺓ ﺇﻟﻰ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﺑﻌﺩ ‪ 12‬ﺃﺳﺑﻭﻉ‪ ،‬ﺛﻡ ﺍﻟﺭﺟﻭﻉ ﻟﻠﻬﻳﺑﺎﺭﻳﻥ ﺁﺧﺭ ﺃﺳﺑﻭﻋﻳﻥ ﻣﻥ ﺍﻟﺣﻣﻝ‪.‬‬ ‫ﻭ‪ .‬ﻋﻣﻠﻳﺔ ﺟﺭﺍﺣﻳﺔ ﺃﻭ ﻗﻠﻊ ﺳﻥ ‪:‬‬ ‫ ﻗﻁﻊ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﺛﻼﺛﺔ ﺃﻳﺎﻡ ﻗﺑﻝ ﺍﻟﻌﻣﻠﻳﺔ‪.‬‬‫ ﺍﻟﺑﺩء ﺑﺎﻟﻬﻳﺑﺎﺭﻳﻥ ﺗﺣﺕ ﺍﻟﺟﻠﺩ ﻳﻭﻣﻳﻥ ﻗﺑﻝ ﺍﻟﻌﻣﻠﻳﺔ‪.‬‬‫‪ -‬ﻋﺩﻡ ﺃﺧﺫ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﺻﺑﺎﺡ ﻳﻭﻡ ﺍﻟﻌﻣﻠﻳﺔ‬

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‫ ﺍﻟﻌﻭﺩﺓ ﺇﻟﻰ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ ﻣﻊ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻣﺳﺎء ﻳﻭﻡ ﺍﻟﻌﻣﻠﻳﺔ‪.‬‬‫‪ -‬ﻗﻁﻊ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ﻓﻲ ﺍﻟﻳﻭﻡ ﺍﻟﺛﺎﻧﻲ ﺑﻌﺩ ﺍﻟﻌﻣﻠﻳﺔ ﻭﺍﻻﺳﺗﻣﺭﺍﺭ ﻋﻠﻰ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‪.‬‬

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‫ﺟﺩﻭﻝ ﺑﺎﻟﻣﺻﻁﻠﺣﺎﺕ ﺍﻟﻌﻠﻣﻳﺔ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻲ ﺍﻟﻛﺗﺎﺏ ﻣﻊ ﺗﺭﺟﻣﺗﻬﺎ ﺇﻟﻰ ﺍﻹﻧﻛﻠﻳﺯﻳﺔ‬ Bone marrow occupation Fibrin degradation products (FDP’s) Anti-platelet antibodies Platelet consumption Splenectomy Anagralide Platelet adhesion Hypercoagulable States, Thrombophilia Bleeding Disorders, Hemorrhagic Disorders Thrombopoiesis Red cell Hemolysis Peticheal hemorrhages, Petechiae Enzyme Calcium ion Ca++ Bernard-Soulier Disease Protein C Protein S Plasma Clopidogrel Drug Idiosyncrasy Clotting, Coagulation Disseminated Intravascular Coagulation (DIC) Freeze-drying Liver cirrhosis Platelet aggregation Tissue Healing Toxemia of pregnancy Arteriosclerosis Splenomegaly Atherosclerotic changes Activation Contact activation Vasoconstriction Osteoporosis Vasodilatation 73

‫ﺍﺣﺗﻼﻝ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬

‫ﺃﺟﺯﺍء ﺍﻟﻠﻳﻔﻳﻥ‬ ‫ﺃﺟﺳﺎﻡ ﻣﺿﺎﺩﺓ ﻟﻠﺻﻔﻳﺣﺎﺕ‬ ‫ﺍﺳﺗﻬﻼﻙ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﺍﺳﺗﺋﺻﺎﻝ ﺍﻟﻁﺣﺎﻝ‬ ‫ﺃﮔﺭﻳﻠﻳﻥ‬ ‫ﺍﻟﺗﺻﺎﻕ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ‬ ‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ‬ ‫ﺇﻧﺗﺎﺝ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﺍﻧﺣﻼﻝ ﺍﻟﺧﻼﻳﺎ ﺍﻟﺣﻣﺭﺍء‬ (‫ﺃﻧﺯﻓﺔ ﻧﻘﻁﻳﺔ ) َﺣ َﺑﺭﻱ‬ ‫ﺇﻧﻅﻳﻡ‬ ‫ﺁﻳﻭﻥ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ‬ ‫ﻣﺭﺽ‬-‫ﺑﺭﻧﺎﺭﺩ ﺳﻭﻟﻳﺭ‬ ‫ﺑﺭﻭﺗﻳﻥ ﺝ‬ ‫ﺑﺭﻭﺗﻳﻥ ﺃﺱ‬ (‫ﺑﻼﺯﻣﺎ )ﺍﻟﺻﻭﺭﻳﺔ‬ ‫ﭘﻼﭬﻛﺱ‬ ‫ﺗﺣﺳﺱ ﻟﻸﺩﻭﻳﺔ‬ ‫ﺗﺧﺛﺭ‬ ‫ﺗﺧﺛﺭﻟﺕ ﻣﻧﺗﺷﺭﺓ‬ ‫ﺗﺟﻔﻳﺩ‬ ‫ﺗﺷ ّﻣﻊ ﺍﻟﻛﺑﺩ‬ ‫ﺗﺭﺍﻛﻡ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫ﺗﺭﻣﻳﻡ ﺍﻷﻧﺳﺟﺔ‬ ‫ﺗﺳﻣﻡ ﺍﻟﺣﻣﻝ‬ ‫ﺗﺻﻠﺏ ﺍﻟﺷﺭﺍﻳﻳﻥ‬ ‫ﺗﺿ ّﺧﻡ ﺍﻟﻁﺣﺎﻝ‬ ‫ﺗﻐﻳّﺭﺍﺕ ﺍﻧﺣﻁﺎﻁﻳﺔ‬ ‫ﺗﻔﻌﻳﻝ‬ ‫ﺗﻔﻌﻳﻝ ﺑﺎﻟﺗﻣﺎﺱ‬ ‫ﺗﻘﻠﺹ ﺍﻟﺷﺭﺍﻳﻳﻥ‬ ‫ﺗﻧﺧﺭ )ﻫﺷﺎﺷﺔ( ﺍﻟﻌﻅﺎﻡ‬ ‫ﺗﻭﺳﻊ ﺍﻟﺷﺭﺍﻳﻳﻥ‬

74

Uric Acid Injection Thrombus, Clot Thrombin Hemoglobin Schistocytes White Blood Cells, Leukocytes Red blood cells, Erythrocytes Megakaryocytes Vascular endothelial cells Hemopoietic stem cell (HSC) Thrombus, Thrombosis Phospholipids Dindevan Cryoprecipitate Epistaxis Bone Marrow Transplantation Serum Albumin Streptokinase Myeloproliferative Neoplasms (MPN) Plasma cell myeloma, Multiple myeloma Artery Coronary Artery Prothrombin mutation (20210) Dysfibrinogenemia Blood Capillaries Chromosome Sex Chromosome, X chromosome Circulatory shock Bilirubin Dominant character Recessive character Blood Platelets Embolus Mutation Coagulation Factor

74

‫ﺣﺎﻣﺽ ﺍﻟﻳﻭﺭﻳﻙ‬ ‫ﺣﻘﻥ‬ ‫ﺧﺛﺭﺓ‬ ‫ﺧﺛﺭﻳﻥ‬ (‫ﺧﺿﺎﺏ ﺍﻟﺩﻡ )ﻫﻳﻣﻭﻏﻠﻭﺑﻳﻥ‬ ‫ﺧﻼﻳﺎ ﺣﻣﺭﺍء ﻣﻧﺷﻁﺭﺓ‬ ‫ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺑﻳﺿﺎء‬ ‫ﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء‬ ‫ﺧﻼﻳﺎ ﻋﻣﻼﻗﺔ ﺍﻟﻧﻭﺍﺓ‬ ‫ﺧﻼﻳﺎ ﻣﺑﻁﻧﺔ ﻷﻭﻋﻳﺔ ﺍﻟﺩﻡ‬ ‫ﺧﻼﻳﺎ ﺟﺫﻋﻳﺔ‬ ‫ ﺗﺟﻠﻁ‬،‫ﺟﻠﻁﺔ‬ ‫ﺩﻫﻭﻥ ﻓﻭﺳﻔﺎﺗﻳﺔ‬ ‫ﺩﻧﺩﻳﭭﺎﻥ‬ ‫ﺭﺍﺳﺏ ﻗﺭّﻱ‬ ‫ﺭﻋﺎﻑ‬ ‫ﺯﺭﺍﻋﺔ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫ﺯﻻﻝ ﺍﻟﺩﻡ‬ ‫ﺳﺗﺭﺑﺗﻭﻛﺎﻳﻧﻳﺯ‬ ‫ﺳﺭﻁﺎﻧﺎﺕ ﺍﻟﻧﺧﺎﻉ ﺍﻟﺗﻛﺎﺛﺭﻳﺔ‬ ‫ﺳﺭﻁﺎﻥ ﺍﻟﺻﻭﺭﻳﺔ‬ ‫ﺷﺭﻳﺎﻥ‬ ‫ﺷﺭﻳﺎﻥ ﺗﺎﺟﻲ‬ ‫ﺷﺫﻭﺫ ﺗﺭﻛﻳﺏ ﻣﻭﻟﺩ ﺍﻟﺧﺛﺭﻳﻥ‬ ‫ﺷﺫﻭﺫ ﺗﺭﻛﻳﺏ ﻣﻭﻟﺩ ﺍﻟﻠﻳﻔﻳﻥ‬ ‫ﺷﻌﻳﺭﺍﺕ ﺩﻣﻭﻳﺔ‬ ‫ﺻﺑﻐﻳﺔ‬ ‫ﺻﺑﻐﻳﺔ ﺍﻟﺟﻧﺱ‬ ‫ﺻﺩﻣﺔ ﺩﻭﺭﺍﻧﻳﺔ‬ (‫ﺻﻔﺭﻳﻥ )ﺍﻟﺻﻔﺭﺍء‬ ‫ﺻﻔﺔ ﻣﺗﻐﻠﺑﺔ‬ ‫ﺻﻔﺔ ﻣﺗﻧﺣﻳﺔ‬ ‫ﺻُﻔﻳْﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﺻﻣّﺔ‬ ‫ﻁﻔﺭﺓ ﻭﺭﺍﺛﻳﺔ‬ ‫ﻋﺎﻣﻝ ﺗﺧﺛﺭ‬

75

‫ﻟﻳﺩﻥ‬-5 ‫ﻋﺎﻣﻝ‬

Factor 5-Leiden Fibrin Stabilizing Factor, Factor XIII Plasminogen Plasmin Thrombomodulin Tissue Juice Gene therapy Medicinal Leech Globulins Prothrombin Time (PT) Partial Thromboplastin Time (PTT) Bleeding Time (BT) Bone Marrow Failure (Aplasia) Renal Failure Vitamin C Vitamin K Brain Cortex Ecchymosis, Bruise Chloramphenicol Reagents Fibrin Mid-Brain Bone Marrow suppressant Bernard-Soulier Disease Lupus Erythematosus Glanzmann’s Disease Von Willebrand’s Disease Acquired disease Inherited disease Wiscott- Aldrich’s Disease Henoch-Shoenlein Pupura Receptors Thrombopoietin Receptor Collagen Plasminogen Activator Thrombopoietin Receptor Agonist Anticoagulant

(13 ‫ﻋﺎﻣﻝ ﻣﺛﺑﺕ ﺍﻟﻠﻳﻔﻳﻥ )ﻋﺎﻣﻝ‬

‫ﻋﺎﻣﻝ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻋﺎﻣﻝ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ ﺍﻟﻔﻌّﺎﻝ‬ ‫ﻋﺎﻣﻝ ﻣﻛﻳّﻑ ﺍﻟﺗﺧﺛﺭ‬ ‫ﻋﺻﺎﺭﺓ ﻧﺳﺟﻳﺔ‬ ‫ﻋﻼﺝ ﺍﻟﻣﻭﺭّﺛﺎﺕ‬ ‫ﻋﻠﻕ ﻁﺑﻲ‬ ‫ﻏﻠﻭﺑﻳﻠﻳﻧﺎﺕ‬ ‫ﻓﺣﺹ ﻭﻗﺕ ﻣﻭﻟﺩ ﺍﻟﺧﺛﺭﻳﻥ‬

‫ﻓﺣﺹ ﻭﻗﺕ ﻣﻭﻟﺩ ﺍﻟﺧﺛﺭﺓ ﺍﻟﺟﺯﺋﻲ‬

‫ﻓﺣﺹ ﻭﻗﺕ ﺍﻟﻧﺯﻑ‬ ‫ﻓﺷﻝ ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫ﻓﺷﻝ ﻛﻠﻭﻱ ﻧﻬﺎﺋﻲ‬ ‫ﻓﻳﺗﺎﻣﻳﻥ ﺝ‬ ‫ﻓﻳﺗﺎﻣﻳﻥ ﻙ‬ ‫ﻗﺷﺭﺓ ﺍﻟﻣﺦ‬ ‫ﻛﺩﻣﺔ‬ ‫ﻛﻠﻭﺭﺍﻣﻔﻧﻳﻛﻭﻝ‬ ‫ﻛﻭﺍﺷﻑ‬ ‫ﻟﻳﻔﻳﻥ‬ ‫ﺍﻟﻣﺦ ﺍﻷﻭﺳﻁ‬ ‫ﻣﺛﺑّﻁ ﻟﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ (‫ﻣﺭﺽ )ﺑﺭﻧﺎﺭﺩ ﺳﻭﻟﻳﺭ‬ ‫ﻣﺭﺽ ﺍﻟﺫﺋﺏ ﺍﻹﺣﻣﺭﺍﺭﻱ‬ (‫ﻣﺭﺽ )ﻏﻼﻧﺯﻣﺎﻥ‬ (‫ﻣﺭﺽ )ﻓﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‬ ‫ﻣﺭﺽ ﻣﻛﺗﺳﺏ‬ ‫ﻣﺭﺽ ﻣﻭﺭﻭﺙ‬ (‫ﺃﻟﺩﺭﺥ‬-‫ﻣﺭﺽ )ﻭﺳﻛﻭﺕ‬ (‫ﺷﻭﻧﻼﻳﻥ‬-‫ﻣﺭﺽ )ﻫِﻧﻭﻙ‬ ‫ﻣﺳﺗﻘﺑﻼﺕ‬ ‫ﻣﺳﺗﻘﺑﻝ ﻣﻧﺗﺞ ﺍﻟﺻﻔﻳﺣﺎﺕ‬ (‫ﻣِﻐﺭﺍء )ﻛﻼﺟﻳﻥ‬ ‫ﻣﻔﻌّﻝ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ‬

‫ﻣﻔﻌّﻝ ﻣﺳﺗﻘﺑﻝ ﻣﻧﺗﺞ ﺍﻟﺻﻔﻳﺣﺎﺕ‬

‫ ﻣﺎﻧﻊ ﺍﻟﺗﺧﺛﺭ‬،‫ﻣﺿﺎﺩ ﺍﻟﺗﺧﺛﺭ‬

75

76

Oral Anticoagulants Antithrombin III Tissue Thromboplastin Inhibitor Factor VIII inhibitor Gene Urea Thrombopoietin Organic substances Inorganic substances Prothrombin Fibrinogen Bone Marrow Bleeding, Hemorrhage Internal bleeding PT ratio, INR Immune Thrombocytopenia (ITP) Functional defect Warfarin (Coumadin) Vein Portal vein Hemostasis Corticosteroids Genetic Engineering Heparin Unfractionated Heparin (UFH) Low molecular weight heparin (LMWH) Hirudin

76

‫ﻣﺿﺎﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻔﻣﻳّﺔ‬ 3-‫ﻣﺿﺎﺩ ﺍﻟﺧﺛﺭﻳﻥ‬ ‫ﻣﺿﺎﺩ ﻋﺻﺎﺭﺓ ﺍﻷﻧﺳﺟﺔ‬ 8 ‫ﻣﺿﺎﺩ ﻋﺎﻣﻝ‬ ‫ﻣﻭ ّﺭﺙ‬ (‫ﻣﻠﺢ ﺍﻟﻳﻭﺭﻳﺎ )ﺍﻟﺑﻭﻟﻳﻥ‬ ‫ﻣﻧﺗﺞ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﻣﻭﺍﺩ ﻋﺿﻭﻳﺔ‬ ‫ﻣﻭﺍﺩ ﻻ ﻋﺿﻭﻳﺔ‬ ‫ﻣﻭﻟﺩ ﺍﻟﺧﺛﺭﻳﻥ‬ ‫ﻣﻭﻟﺩ ﺍﻟﻠﻳﻔﻳﻥ‬ ‫ﻧﺧﺎﻉ ﺍﻟﻌﻅﻡ‬ ‫ ﻧﺯﻳﻑ‬،‫ﻧﺯﻑ‬ ‫ﻧﺯﻑ ﺩﺍﺧﻠﻲ‬ ‫ﻧﺳﺑﺔ ﺍﻟﺳﻳﻭﻟﺔ‬ ‫ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﺍﻟﻣﻧﺎﻋﻲ‬ ‫ﻧﻘﺹ ﻭﻅﻳﻔﻲ‬ (‫ﻭﺍﺭﻓﺎﺭﻳﻥ )ﻛﻭﻣﺎﺩﻳﻥ‬ ‫ﻭﺭﻳﺩ‬ ‫ﻭﺭﻳﺩ ﺑﺎﺑﻲ ﻛﺑﺩﻱ‬ ‫ ﻗﻁﻊ ﺍﻟﻧﺯﻑ‬،‫ﻭﻗﻑ ﺍﻟﻧﺯﻑ‬ ‫ﻫﻭﺭﻣﻭﻧﺎﺕ ُﻛﻅﺭﻳﺔ‬ ‫ﻫﻧﺩﺳﺔ ﻭﺭﺍﺛﻳﺔ‬ ‫ﻫﻳﺑﺎﺭﻳﻥ‬ ‫ﻫﻳﺑﺎﺭﻳﻥ ﻏﻳﺭ ﻣﺟ ّﺯﺃ‬ ‫ﻫﻳﺑﺎﺭﻳﻥ ﻭﺍﻁﺊ ﺍﻟﻭﺯﻥ ﺍﻟﺟﺯﻳﺋﻲ‬

‫ﻫﻳﺭﻭﺩﻳﻥ‬

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‫ﺍﻟﻣﻭﺿﻭﻉ‬

‫ﻓﻬﺮﺳﺖ اﻟﻜﺘﺎب‬

‫ﻣﻘﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ‬ ‫ﻣﻘﺩﻣﺔ ﺍﻟﻁﺑﻌﺔ ﺍﻟﺛﺎﻧﻳﺔ‬ ‫اﻟﻔﺼﻞ اﻷول‪-‬‬ ‫ﻅﺎﻫﺭﺓ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻭﻋﻣﻠﻳﺔ ﻗﻁﻊ ﺍﻟﻧﺯﻑ ﻓﻲ ﺍﻟﺣــــــﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳـــــــﺔ‬ ‫ﺍﻟﺩﻡ ﺳﺎﺋﻼً‬ ‫ﻣﻛﻭﻧﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺭﺋﻳﺳﻳﺔ‬ ‫ﻣﻛﻭﻧﺎﺕ ﺍﻟﺑﻼﺯﻣﺎ‬ ‫ﻋﻣﻠﻳﺔ ﻗﻁﻊ ﺍﻟﻧﺯﻑ‬ ‫ﻁﺑﻳﻌﺔ ﻋﻭﺍﻣﻝ ﺗﺧﺛﺭ ﺍﻟﺩﻡ ﻭﻁﺭﻳﻘﺔ ﺗﻔﺎﻋﻠﻬﺎ‬ ‫ﻛﻳﻔﻳﺔ ﺗﻛﻭّ ﻥ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻭﻅﻳﻔﺔ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﻓﻲ ﻋﻣﻠﻳﺔ ﺍﻟﺗﺧﺛﺭ ﻭﻭﻗﻑ ﺍﻟﻧﺯﻑ‬ ‫ﺁﻳﻭﻥ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ ﻭﺗﺧﺛﺭ ﺍﻟﺩﻡ‬ ‫ﺍﻟﻣﻭﺍﻧﻊ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻟﻠﺗﺧﺛﺭ‬ ‫ﻣﺎﺫﺍ ﻳﺣﺻﻝ ﻟﻠﺧﺛﺭﺓ ﺑﻌﺩ ﺗﻛﻭّ ﻧﻬﺎ‬ ‫اﻟﻔﺼﻞ اﻟﺜﺎﻧﻲ‪-‬‬ ‫ﺃﻣﺭﺍﺽ ﻓـــــﺭﻁ ﺍﻟﻧــــــــﺯﻑ‬ ‫ﺗﺻﻧﻳﻑ ﻋﺎﻡ ﻟﻸﻣﺭﺍﺽ ﺍﻟﻧﺯﻓﻳﺔ‬ ‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫ﺃﻣﺭﺍﺽ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫ﺍﻷﻣﺭﺍﺽ ﺍﻟﻧﺯﻓﻳﺔ ﺍﻟﻭﺭﺍﺛﻳﺔ ﻣﻥ ﺧﻠﻝ ﻓﻲ ﻋﻣﻠﻳﺔ ﺗﺧﺛﺭ ﺍﻟﺩﻡ‬ ‫ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﺃ‬ ‫ﻣﺭﺽ ﺍﻟﻬﻳﻣﻭﻓﻳﻠﻳﺎ ﺏ‬ ‫ﻧﻘﺹ ﺍﻟﻌﻭﺍﻣﻝ ﺍﻷﺧﺭﻯ ﻟﻠﺗﺧﺛﺭ‬ ‫ﻣﺭﺽ ﻓﻭﻥ ﻭﻟﺑﺭﺍﻧﺩ‬ ‫ﻛﻳﻔﻳﺔ ﺗﺷﺧﻳﺹ ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﻧﺯﻑ ﺍﻟﻣﻛﺗﺳﺑﺔ‬ ‫ﺃﻣﺭﺍﺽ ﻧﻘﺹ ﺻﻔﻳﺣﺎﺕ ﺍﻟﺩﻡ‬ ‫ﺃﻣﺭﺍﺽ ﺍﻟﻧﺯﻑ ﻣﻥ ﻧﻘﺹ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ ﻭﺍﻟﺻﻔﻳﺣﺎﺕ‬ ‫اﻟﻔﺼﻞ اﻟﺜﺎﻟﺚ‪ -‬ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ‬ ‫ﻣﻘﺩﻣﺔ‬ ‫ﻅﺭﻭﻑ ﺍﺯﺩﻳﺎﺩ ﺍﻟﻣﻳْﻝ ﻟﻠﺗﺧﺛﺭ‬

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‫ﺍﻟﺻﻔﺣﺔ‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫‪5‬‬ ‫‪5‬‬ ‫‪6‬‬ ‫‪7‬‬ ‫‪11‬‬ ‫‪12‬‬ ‫‪14‬‬ ‫‪15‬‬ ‫‪15‬‬ ‫‪17‬‬ ‫‪19‬‬ ‫‪21‬‬ ‫‪21‬‬ ‫‪22‬‬ ‫‪26‬‬ ‫‪26‬‬ ‫‪31‬‬ ‫‪31‬‬ ‫‪32‬‬ ‫‪33‬‬ ‫‪35‬‬ ‫‪35‬‬ ‫‪38‬‬ ‫‪45‬‬ ‫‪46‬‬ ‫‪46‬‬

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‫ﺗﺻﻧﻳﻑ ﻋﺎﻡ ﻷﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ‬ ‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻭﺭﺍﺛﻳﺔ‬ ‫ﻧﻘﺹ ﺗﺭﻛﻳﺯ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ‬ ‫ﻧﻘﺹ ﻓﻌﺎﻟﻳﺔ ﻣﻭﺍﻧﻊ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻁﺑﻳﻌﻳﺔ‬ ‫ﻧﻘﺹ ﻣﺫﻳﺏ ﺍﻟﺧﺛﺭﺓ ﺃﻭ ﻣﻔﻌّﻼﺗﻪ‬ ‫ﺷﺫﻭﺫ ﺗﺭﻛﻳﺏ ﻋﻭﺍﻣﻝ ﺍﻟﺗﺧﺛﺭ‬ ‫ﺃﻣﺭﺍﺽ ﻓﺭﻁ ﺍﻟﺗﺧﺛﺭ ﺍﻟﻣﻛﺗﺳﺑﺔ‬ ‫ﻣﻘﺩﻣﺔ‬ ‫ﺃﻣﺭﺍﺽ ﺍﻟﺳﺭﻁﺎﻥ ﺍﻟﻣﻧﺗﺷﺭﺓ‬ ‫ﺍﻟﺗﺳﻣﻡ ﺍﻹﻧﺗﺎﻧﻲ‬ ‫ﺳﺭﻁﺎﻥ ﺍﻟﺩﻡ ﺍﻟﺣﺎﺩ ﻭﺳﺭﻁﺎﻧﺎﺕ ﺍﻟﺗﻛﺎﺛﺭ ﺍﻟﻧﺧﺎﻋﻳﺔ‬ ‫ﺍﻷﻣﺭﺍﺽ ﺫﺍﺗﻳﺔ ﺍﻟﻣﻧﺎﻋﺔ‬ ‫ﺗﺳﻣﻡ ﺍﻟﺣﻣﻝ‬ ‫ﻟﺩﻏﺎﺕ ﺑﻌﺽ ﺍﻷﻓﺎﻋﻲ‬ ‫ﺗﺧﺛﺭﺍﺕ ﻧﺎﺗﺟﺔ ﻋﻥ ﺑﻌﺽ ﺍﻟﻣﺳﺗﺣﺿﺭﺍﺕ ﺍﻟﻁﺑﻳﺔ‬ ‫ﺍﻟﺗﺩﺧﻳﻥ ﻭﺍﺭﺗﻔﺎﻉ ﻣﺳﺗﻭﻯ ﺍﻟﺩﻫﻭﻥ ﻓﻲ ﺍﻟﺩﻡ‬ ‫ﺣﺎﻟﺔ ﻣﺎﺑﻌﺩ ﺍﻟﺻﺩﻣﺔ ﺍﻟﺩﻭﺭﺍﻧﻳﺔ‬ ‫اﻟﻔﺼﻞ اﻟﺮاﺑﻊ‪ -‬ﺍﻟﻌﻼﺝ ﺑﺎﻷﺩﻭﻳﺔ ﺍﻟﻣﺿﺎﺩﺓ ﻟﻠﺗﺧﺛﺭ‬ ‫ﻣﺟﻣﻭﻋﺔ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ‬ ‫ﺃﺩﻭﻳﺔ ﺃﺧﺭﻯ ﻣﺷﺎﺑﻬﺔ ﻟﻠﻬﻳﺑﺎﺭﻳﻥ‬ ‫ﻣﺟﻣﻭﻋﺔ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‬ ‫ﻣﻼﺣﻅﺎﺕ ﺣﻭﻝ ﺍﺳﺗﻌﻣﺎﻝ ﺍﻟﻭﺍﺭﻓﺎﺭﻳﻥ‬ ‫ﺍﻟﻣﺿﺎﺩﺍﺕ ﺍﻟﻣﺑﺎﺷﺭﺓ ﻟﻠﺧﺛﺭﻳﻥ ﻭﻟﻌﺎﻣﻝ ‪10‬‬ ‫ﺍﻷﺳﺑﺭﻳﻥ ﻛﻣﺎﻧﻊ ﻟﻠﺗﺟﻠﻁ‬ ‫ﻣﺫﻳﺑﺎﺕ ﺍﻟﺧﺛﺭﺓ‬ ‫ﻣﺧﺗﺻﺭ ﻷﺳﺎﻟﻳﺏ ﺍﺳﺗﻌﻣﺎﻝ ﻣﺿﺎﺩﺍﺕ ﺍﻟﺗﺧﺛﺭ‬ ‫ﺟﺪول اﻟﻤﺼﻄﻠﺤﺎت‬

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‫‪48‬‬ ‫‪48‬‬ ‫‪48‬‬ ‫‪50‬‬ ‫‪52‬‬ ‫‪52‬‬ ‫‪53‬‬ ‫‪53‬‬ ‫‪55‬‬ ‫‪56‬‬ ‫‪56‬‬ ‫‪57‬‬ ‫‪58‬‬ ‫‪58‬‬ ‫‪58‬‬ ‫‪59‬‬ ‫‪59‬‬ ‫‪60‬‬ ‫‪61‬‬ ‫‪63‬‬ ‫‪64‬‬ ‫‪65‬‬ ‫‪68‬‬ ‫‪69‬‬ ‫‪70‬‬ ‫‪70‬‬ ‫‪72‬‬

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