{"id":7665,"date":"2023-03-10T17:06:49","date_gmt":"2023-03-10T17:06:49","guid":{"rendered":"https:\/\/www.mojemedunka.cz\/?p=7665"},"modified":"2023-03-09T10:09:59","modified_gmt":"2023-03-09T10:09:59","slug":"z-breznove-medunky-jak-se-vyznat-v-laboratornich-vysledcich","status":"publish","type":"post","link":"https:\/\/www.mojemedunka.cz\/index.php\/2023\/03\/10\/z-breznove-medunky-jak-se-vyznat-v-laboratornich-vysledcich\/","title":{"rendered":"Z b\u0159eznov\u00e9 Medu\u0148ky: Jak se vyznat v\u00a0laboratorn\u00edch v\u00fdsledc\u00edch?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>T\u00e9ma b\u0159eznov\u00e9ho \u010d\u00edsla, kter\u00e9 je st\u00e1le k zakoupen\u00ed na st\u00e1nc\u00edch PNS a rozhodn\u011b by byla \u0161koda si ho nechat uj\u00edt, zn\u00ed: <em>Krev &#8211; posel \u017eivota<\/em>. Skv\u011bl\u00e9 p\u0159\u00edsp\u011bvky na\u0161ich autor\u016f v\u00e1m tuto \u017eivotod\u00e1rnou substanci p\u0159ibl\u00ed\u017e\u00ed z r\u016fzn\u00fdch pohled\u016f &#8211; jsou pro v\u00e1s p\u0159ipraveny praktick\u00e9 rady i \u010dl\u00e1nky zd\u016fraz\u0148uj\u00edc\u00ed duchovn\u00ed a symbolick\u00fd v\u00fdznam krve&#8230; MUDr. Ludmila Elekov\u00e1 p\u0159ipravila pro b\u0159eznovou Medu\u0148ku velmi u\u017eite\u010dn\u00fd \u010dl\u00e1nek o tom, jak interpretovat informace, kter\u00e9 poskytuj\u00ed v\u00fdsledky krevn\u00edch test\u016f  laik se toti\u017e v t\u011bchto \u00fadaj\u00edch v\u011bt\u0161inou zcela ztrat\u00ed&#8230;nab\u00edz\u00edme uk\u00e1zku z \u010dl\u00e1nku, cel\u00fd si ho m\u016f\u017eete p\u0159e\u010d\u00edst v b\u0159eznov\u00e9m \u010d\u00edsle MEDU\u0147KY&#8230; <\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Uk\u00e1zka z \u010dl\u00e1nku dr. Elekov\u00e9:<\/strong><\/em><br><br>Jsem toho n\u00e1zoru, \u017ee je dobr\u00e9 m\u00edt p\u0159ehled o z\u00e1kladn\u00edch krevn\u00edch testech, jejich v\u00fdsledc\u00edch a o tom, co to znamen\u00e1. V\u0161e, co zv\u00fd\u0161\u00ed informovanost pacienta o jeho zdravotn\u00edm stavu, je u\u017eite\u010dn\u00e9. Laboratorn\u00ed vy\u0161et\u0159en\u00ed krve je diagnostick\u00fd n\u00e1stroj poskytuj\u00edc\u00ed mnoho u\u017eite\u010dn\u00fdch informac\u00ed.<br>Za svou dlouhou praxi jsem se nau\u010dila \u010d\u00edst n\u011bkter\u00e9 v\u00fdsledky jinak, ne\u0159\u00edd\u00edm se slep\u011b limity nastaven\u00fdmi laborato\u0159\u00ed, proto vid\u00edm patologii n\u011bkdy i tam, kde je v\u00fdsledek \u00fadajn\u011b norm\u00e1ln\u00ed a naopak. Pod\u011bl\u00edm se s\u00a0v\u00e1mi o sv\u00e9 poznatky, abyste mohli l\u00e9pe interpretovat sv\u00e9 v\u00fdsledky.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Krevn\u00ed obraz (KO)<\/strong><br>Vy\u0161et\u0159uje se z\u00a0nesr\u00e1\u017eliv\u00e9 krve a spo\u010d\u00edv\u00e1 ve spo\u010d\u00edt\u00e1n\u00ed \u010derven\u00fdch a b\u00edl\u00fdch krvinek a krevn\u00edch desti\u010dek (trombocyt\u016f). Z\u00e1kladn\u00ed krevn\u00ed obraz nerozli\u0161uje typy b\u00edl\u00fdch krvinek. Pokud chcete zn\u00e1t po\u010dty a pom\u011bry typ\u016f b\u00edl\u00fdch krvinek, je t\u0159eba vy\u0161et\u0159it tzv. diferenci\u00e1ln\u00ed po\u010det. Ten uk\u00e1\u017ee, kolik je neutrofil\u016f, lymfocyt\u016f, eozinofil\u016f, bazofil\u016f a monocyt\u016f.<br><strong>\u010cerven\u00fd krevn\u00ed KO ud\u00e1v\u00e1 po\u010det, velikost, barevnou koncentraci a tvar \u010derven\u00fdch krvinek (erytrocyt\u016f). Pom\u011br celkov\u00e9ho objemu krvinek a plazmy (tekutina tvo\u0159\u00edc\u00ed krev bez krvinek) ud\u00e1v\u00e1 tzv. hematokrit. <\/strong>Z\u00e1kladn\u00ed hodnota, na kterou se l\u00e9ka\u0159 p\u0159i hodnocen\u00ed krevn\u00edho obrazu d\u00edv\u00e1, je hodnota hemoglobinu (Hb). Hemoglobin je protein obsahuj\u00edc\u00ed \u017eelezo, kter\u00fd je sou\u010d\u00e1st\u00ed erytrocyt\u016f, tvo\u0159\u00ed asi 35 % obsahu erytrocyt\u016f. Jeho hlavn\u00ed funkc\u00ed je p\u0159enos kysl\u00edku, jedna \u010derven\u00e1 krvinka ho obsahuje cca 28\u201332 pikogram\u016f. Norm\u00e1ln\u00ed hodnoty hemoglobinu jsou u mu\u017e\u016f cca 135-170g\/l, u \u017een 120-160g\/l.<br><strong>O an\u00e9mii mluv\u00edme, kdy\u017e poklesne Hb pod spodn\u00ed limit<\/strong>. An\u00e9mie, nedostatek \u010derven\u00fdch krvinek a\/nebo krevn\u00edho barviva, m\u016f\u017ee vzniknout z\u00a0r\u016fzn\u00fdch p\u0159\u00ed\u010din a odraz\u00ed se to ve zm\u011bn\u00e1ch krevn\u00edho obrazu. Nej\u010dast\u011bj\u0161\u00ed je an\u00e9mie z\u00a0nedostatku \u017eeleza, b\u011b\u017en\u00e1 u menstruuj\u00edc\u00edch \u017een, \u017een po porodu nebo u vegetari\u00e1n\u016f. Vegetari\u00e1nka, kter\u00e1 porodila n\u011bkolik d\u011bt\u00ed a m\u00e1 silnou menstruaci, m\u00e1 prakticky jistotu, \u017ee bude m\u00edt tento typ an\u00e9mie.<br>An\u00e9mie z\u00a0nedostatku \u017eeleza je typick\u00e1 mal\u00fdmi krvinkami. Krvinek m\u016f\u017ee b\u00fdt celkem dost, ale jsou mal\u00e9 a obsahuj\u00ed m\u00e1lo hemoglobinu, celkov\u00e9 mno\u017estv\u00ed hemoglobinu je sn\u00ed\u017een\u00e9. M\u00edrn\u00e1 an\u00e9mie nemus\u00ed m\u00edt \u017e\u00e1dn\u00e9 p\u0159\u00edznaky, ale jakmile Hb klesne pod cca 110, \u010dlov\u011bk to c\u00edt\u00ed. Krev p\u0159en\u00e1\u0161\u00ed m\u00e9n\u011b kysl\u00edku. \u010clov\u011bk je unaven\u00fd, zad\u00fdch\u00e1 se p\u0159i n\u00e1maze, je mu zima. Chronick\u00e1 an\u00e9mie s sebou toti\u017e nese obvykle i \u00fatlum \u0161t\u00edtn\u00e9 \u017el\u00e1zy a zpomalen\u00ed metabolismu. Je to logick\u00e9, kdy\u017e nen\u00ed dost kysl\u00edku, je nutn\u00e9 utlumit metabolismus, proto\u017ee nelze spalovat tolik paliva jako d\u0159\u00edv.<br><strong>P\u0159i an\u00e9mii z\u00a0nedostatku \u017eeleza je v\u017edy d\u016fle\u017eit\u00e9 hledat d\u016fvod, pro\u010d k\u00a0n\u00ed do\u0161lo.<\/strong> Je t\u0159eba zjistit p\u0159\u00edjem \u017eeleza a p\u0159\u00edpadn\u00e9 zjevn\u00e9 ztr\u00e1ty. P\u0159ij\u00edm\u00e1 pacient dost \u017eeleza v\u00a0potrav\u011b? Je to menstruuj\u00edc\u00ed \u017eena, jak siln\u00e9 menses m\u00e1, kdy porodila, m\u011bla an\u00e9mii v\u00a0t\u011bhotenstv\u00ed? Nedo\u0161lo k\u00a0jin\u00e9mu v\u011bt\u0161\u00edmu krv\u00e1cen\u00ed, nap\u0159\u00edklad z\u00a0hemoroid\u016f? Nejde-li o nedostate\u010dn\u00fd p\u0159\u00edjem a\/nebo p\u0159\u00edli\u0161n\u00e9 ztr\u00e1ty krve, ke t\u0159eba hledat d\u00e1l. An\u00e9mie m\u016f\u017ee b\u00fdt p\u0159\u00edznak celiakie nebo jin\u00e9 nemoci st\u0159eva, kdy pacient sice \u017eeleza p\u0159ij\u00edm\u00e1 v\u00a0potrav\u011b dost, ale nedok\u00e1\u017ee ho vst\u0159ebat. Nebo jde o skryt\u00e9 ztr\u00e1ty ze za\u017e\u00edvac\u00edho traktu, nap\u0159. z\u00e1n\u011bt \u017ealudku nebo v\u0159ed, z\u00e1n\u011bt st\u0159eva nebo rakovinu. To v\u0161e je nutn\u00e9 vy\u0161et\u0159it, prov\u00e9st gastroskopii, kolonoskopii nebo scintigrafii st\u0159eva, nabrat krev na z\u00e1n\u011btliv\u00e9 a tumorov\u00e9 markery.<br>Ov\u011b\u0159ovat stav z\u00e1sob \u017eeleza nen\u00ed nutn\u00e9, je-li zjevn\u00e9, \u017ee jde o nedostate\u010dn\u00fd p\u0159\u00edjem nebo velk\u00e9 ztr\u00e1ty. Ale v\u00a0p\u0159\u00edpad\u011b, \u017ee pacient trp\u00ed chronickou z\u00e1n\u011btlivou nemoc\u00ed, nap\u0159. artritidou a m\u00e1 v\u00fdraznou sideropenickou an\u00e9mii, je velmi d\u016fle\u017eit\u00e9 zjistit obsah feritinu, z\u00e1sobn\u00edho \u017eeleza. P\u0159i t\u011bchto nemocech toti\u017e doch\u00e1z\u00ed k\u00a0tomu, \u017ee t\u011blo \u017eelezo ukl\u00edz\u00ed do z\u00e1sob, tvo\u0159\u00ed feritin, ale pacient je sou\u010dasn\u011b v\u00fdrazn\u011b anemick\u00fd. Jedna mlad\u00e1 \u017eena se syst\u00e9mov\u00fdm lupusem m\u011bla Hb kolem 90, revmatolog ji krmil \u017eelezem bez efektu a kdy\u017e kone\u010dn\u011b nabrali feritin, m\u011bla ho extr\u00e9mn\u011b vysok\u00fd.<br>V\u00a0ka\u017ed\u00e9m p\u0159\u00edpad\u011b, zejm\u00e9na kdy\u017e nelze ztr\u00e1ty omezit (menstruace), je t\u0159eba \u017eelezo suplementovat. Nejl\u00e9pe samoz\u0159ejm\u011b potravou, pacient mus\u00ed j\u00edst co nejv\u00edc tmav\u00e9ho masa a hlavn\u011b jater. Nesta\u010d\u00ed-li to, je t\u0159eba \u017eelezo dod\u00e1vat v\u00a0suplementu nebo l\u00e9ku. Zde mus\u00edm upozornit, \u017ee p\u0159esto\u017ee je mo\u017en\u00e9 koupit voln\u011b prodejn\u00e9 suplementy se \u017eelezem, obsahuj\u00ed dost malou d\u00e1vku \u017eeleza, kter\u00e1 hlubokou an\u00e9mii a velk\u00e9 ztr\u00e1ty nen\u00ed schopna nahradit. Opravdu v\u00fdrazn\u00e1 an\u00e9mie (Hb pod 100) nebo trvaj\u00edc\u00ed siln\u00e9 ztr\u00e1ty je t\u0159eba korigovat \u017eelezem na p\u0159edpis. D\u00e1vka v\u00a0jedn\u00e9 tablet\u011b nejsiln\u011bj\u0161\u00edho \u017eeleza na p\u0159edpis je n\u011bkdy a\u017e 10n\u00e1sobn\u00e1 proti tomu, co koup\u00edte sami v\u00a0l\u00e9k\u00e1rn\u011b.<br>\u017delezo ve form\u011b tablet bohu\u017eel nen\u00ed moc dob\u0159e sn\u00e1\u0161en\u00e9. Existuj\u00ed velk\u00e9 individu\u00e1ln\u00ed rozd\u00edly. Jste-li v\u00a0situaci, kdy \u017eelezo opravdu pot\u0159ebujete u\u017e\u00edvat, je t\u0159eba spolupracovat s\u00a0va\u0161\u00edm l\u00e9ka\u0159em p\u0159i v\u00fdb\u011bru produktu, kter\u00fd v\u00e1m bude nejm\u00e9n\u011b vadit a u\u017e\u00edvat ho tak, abyste ho co nejl\u00e9pe sn\u00e1\u0161eli. \u017delezo velmi \u010dasto zp\u016fsobuje z\u00e1cpu, co\u017e samoz\u0159ejm\u011b nen\u00ed d\u016fvod, aby se p\u0159estalo br\u00e1t. Z\u00e1cpu lze korigovat nejl\u00e9pe osmotick\u00fdmi proj\u00edmadly (\u0161aratice, zaje\u010dick\u00e1, laktuloza apod). Jestli\u017ee pacient nezvl\u00e1dne \u017eelezo u\u017e\u00edvat na la\u010dno, jak by se m\u011blo, m\u016f\u017ee ho u\u017e\u00edvat s\u00a0j\u00eddlem. N\u011bco se v\u017edy vst\u0159eb\u00e1. Vst\u0159eb\u00e1v\u00e1n\u00ed \u017eeleza podporuje vitamin C, proto je vhodn\u00e9 maso j\u00edst se zeleninou nebo p\u0159\u00edmo u\u017e\u00edt vitamin C. Jeho vst\u0159eb\u00e1v\u00e1n\u00ed sni\u017euje \u010daj a k\u00e1va, v\u00e1pn\u00edk v\u00a0ml\u00e9\u010dn\u00fdch v\u00fdrobc\u00edch, ale i kyselina fytov\u00e1 v\u00a0obilnin\u00e1ch. Ve vz\u00e1cn\u00fdch p\u0159\u00edpadech je pot\u0159eba \u017eelezo dod\u00e1vat injek\u010dn\u011b.<br>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Druh\u00fd \u010dast\u00fd typ an\u00e9mie nast\u00e1v\u00e1 v\u00a0d\u016fsledku nedostatku vitaminu B12 a\/nebo kyseliny listov\u00e9. Je typick\u00e1 men\u0161\u00edm mno\u017estv\u00edm velk\u00fdch krvinek s\u00a0vysokou koncentrac\u00ed barviva. Op\u011bt je t\u0159eba hledat p\u0159\u00ed\u010dinu. Vitamin B12 se nach\u00e1z\u00ed p\u0159edev\u0161\u00edm v\u00a0\u017eivo\u010di\u0161n\u00fdch potravin\u00e1ch, stejn\u011b jako \u017eelezo hlavn\u011b v\u00a0mase a vnit\u0159nostech, proto je jeho nedostatek typick\u00fd pro vegetari\u00e1ny. Prvn\u00ed ot\u00e1zka na pacienta se proto mus\u00ed t\u00fdkat jeho stravy. Hladina vitaminu B12 i kyseliny listov\u00e9 se d\u00e1 zm\u011b\u0159it, a je to p\u0159i diagn\u00f3ze an\u00e9mie pot\u0159ebn\u00e9. Jestli\u017ee pacient nen\u00ed vegetari\u00e1n a m\u00e1 tento typ an\u00e9mie, mus\u00ed se vylou\u010dit autoimunitn\u00ed onemocn\u011bn\u00ed \u017ealudku \u2013 pernici\u00f3zn\u00ed an\u00e9mie. P\u0159i n\u00ed doch\u00e1z\u00ed k\u00a0autoimunitn\u00ed destrukci bun\u011bk produkuj\u00edc\u00edch tzv. vnit\u0159n\u00ed faktor, enzym nutn\u00fd ke vst\u0159eb\u00e1n\u00ed vitaminu B12 do t\u011bla. Na\u0161t\u011bst\u00ed celkem vz\u00e1cn\u00e1 je situace, kdy pacientovi musel b\u00fdt od\u0148at \u017ealudek pro zhoubn\u00fd n\u00e1dor. V\u0161ichni tito nemocn\u00ed mus\u00ed dost\u00e1vat do\u017eivotn\u011b injekce B12.<br><strong>Vitamin B12 se do t\u011bla dod\u00e1 nejl\u00e9pe v\u00a0injekc\u00edch<\/strong>. Existuj\u00ed formy, kter\u00e9 se u\u017e\u00edvaj\u00ed \u00fasty, ale v\u00a0p\u0159\u00edpad\u011b pr\u00e1v\u011b perniciozn\u00ed an\u00e9mie je \u010dlov\u011bk nedok\u00e1\u017ee vst\u0159ebat. Frekvence injekc\u00ed je r\u016fzn\u00e1, \u017ee za\u010d\u00e1tku se mohou d\u00e1vat a\u017e 2x t\u00fddn\u011b, po dopln\u011bn\u00ed hladiny se d\u00e1vaj\u00ed t\u0159eba jen n\u011bkolikr\u00e1t do roka jako udr\u017eovac\u00ed d\u00e1vky. Kyselinu listovou je mo\u017en\u00e9 b\u011b\u017en\u011b u\u017e\u00edvat v\u00a0tablet\u00e1ch.<br>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u0159et\u00edm typem an\u00e9mie je tzv. an\u00e9mie chronick\u00fdch nemoc\u00ed. Hemoglobin je sn\u00ed\u017een\u00fd, ale krvinky maj\u00ed norm\u00e1ln\u00ed objem i koncentraci barviva, \u017eelezo je v\u00a0norm\u011b, vitamin B12 tak\u00e9. B\u00fdv\u00e1 to u chronick\u00fdch ledvinov\u00fdch nemoc\u00ed, kdy ledviny pravd\u011bpodobn\u011b produkuj\u00ed m\u00e1lo erytropoetinu, hormonu, kter\u00fd stimuluje kostn\u00ed d\u0159e\u0148 k\u00a0produkci \u010derven\u00fdch krvinek. M\u016f\u017ee b\u00fdt samoz\u0159ejm\u011b probl\u00e9m p\u0159\u00edmo v\u00a0kostn\u00ed d\u0159eni, m\u00e1lokdy se t\u00fdk\u00e1 jen \u010derven\u00fdch krvinek. Tyto dal\u0161\u00ed typy an\u00e9mie vy\u017eaduj\u00ed odbornou l\u00e9ka\u0159skou p\u00e9\u010di a vy\u0161et\u0159en\u00ed. Pro \u00faplnost uvedu hemolytick\u00e9 an\u00e9mie. Nast\u00e1vaj\u00ed p\u0159i nadm\u011brn\u00e9m rozpadu erytrocyt\u016f, bu\u010f v\u00a0krevn\u00edm \u0159e\u010di\u0161ti nebo mimo n\u011bj. Diagn\u00f3za se provede na z\u00e1klad\u011b specializovan\u00fdch vy\u0161et\u0159en\u00ed. Kostn\u00ed d\u0159e\u0148 obsahuje zv\u00fd\u0161en\u00fd po\u010det bun\u011bk, je zv\u00fd\u0161en\u00e1 krvetvorba, kter\u00e1 se sna\u017e\u00ed nahradit zni\u010den\u00e9 krvinky, tak\u00e9 se m\u011bn\u00ed pom\u011br vznikaj\u00edc\u00edch b\u00edl\u00fdch a \u010derven\u00fdch krvinek ve prosp\u011bch \u010derven\u00fdch. Zv\u00fd\u0161en\u00e1 krvetvorba se v\u00a0krevn\u00edm obraze uk\u00e1\u017ee jako zv\u00fd\u0161en\u00ed retikulocyt\u016f, nezral\u00fdch erytrocyt\u016f&#8230; <br><\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u00e9ma b\u0159eznov\u00e9ho \u010d\u00edsla, kter\u00e9 je st\u00e1le k zakoupen\u00ed na st\u00e1nc\u00edch PNS a rozhodn\u011b by byla \u0161koda si ho nechat uj\u00edt, zn\u00ed: Krev &#8211; posel \u017eivota. Skv\u011bl\u00e9 p\u0159\u00edsp\u011bvky na\u0161ich autor\u016f v\u00e1m tuto \u017eivotod\u00e1rnou substanci p\u0159ibl\u00ed\u017e\u00ed z r\u016fzn\u00fdch pohled\u016f &#8211; jsou pro v\u00e1s p\u0159ipraveny praktick\u00e9 rady i \u010dl\u00e1nky zd\u016fraz\u0148uj\u00edc\u00ed duchovn\u00ed a symbolick\u00fd v\u00fdznam krve&#8230; MUDr. Ludmila Elekov\u00e1 p\u0159ipravila pro b\u0159eznovou Medu\u0148ku velmi u\u017eite\u010dn\u00fd \u010dl\u00e1nek o tom, jak interpretovat informace, kter\u00e9 poskytuj\u00ed v\u00fdsledky krevn\u00edch test\u016f laik se toti\u017e v t\u011bchto \u00fadaj\u00edch v\u011bt\u0161inou zcela ztrat\u00ed&#8230;nab\u00edz\u00edme uk\u00e1zku z \u010dl\u00e1nku, cel\u00fd si ho m\u016f\u017eete p\u0159e\u010d\u00edst v b\u0159eznov\u00e9m \u010d\u00edsle MEDU\u0147KY&#8230; Uk\u00e1zka z \u010dl\u00e1nku dr. Elekov\u00e9: Jsem toho n\u00e1zoru, \u017ee je dobr\u00e9 m\u00edt p\u0159ehled o z\u00e1kladn\u00edch krevn\u00edch testech, jejich v\u00fdsledc\u00edch a o tom, co to znamen\u00e1. V\u0161e, co zv\u00fd\u0161\u00ed informovanost pacienta o jeho zdravotn\u00edm stavu, je u\u017eite\u010dn\u00e9. Laboratorn\u00ed vy\u0161et\u0159en\u00ed krve je diagnostick\u00fd n\u00e1stroj poskytuj\u00edc\u00ed mnoho u\u017eite\u010dn\u00fdch informac\u00ed.Za svou dlouhou praxi jsem se nau\u010dila \u010d\u00edst n\u011bkter\u00e9 v\u00fdsledky jinak, ne\u0159\u00edd\u00edm se slep\u011b limity nastaven\u00fdmi laborato\u0159\u00ed, proto vid\u00edm patologii n\u011bkdy i tam, kde je v\u00fdsledek \u00fadajn\u011b norm\u00e1ln\u00ed a naopak. Pod\u011bl\u00edm se s\u00a0v\u00e1mi o sv\u00e9 poznatky, abyste mohli l\u00e9pe interpretovat sv\u00e9 v\u00fdsledky. Krevn\u00ed obraz (KO)Vy\u0161et\u0159uje se z\u00a0nesr\u00e1\u017eliv\u00e9 krve a spo\u010d\u00edv\u00e1 ve spo\u010d\u00edt\u00e1n\u00ed \u010derven\u00fdch a b\u00edl\u00fdch krvinek a krevn\u00edch desti\u010dek (trombocyt\u016f). Z\u00e1kladn\u00ed krevn\u00ed obraz nerozli\u0161uje typy b\u00edl\u00fdch krvinek. Pokud chcete zn\u00e1t po\u010dty a pom\u011bry typ\u016f b\u00edl\u00fdch krvinek, je t\u0159eba vy\u0161et\u0159it tzv. diferenci\u00e1ln\u00ed po\u010det. Ten uk\u00e1\u017ee, kolik je neutrofil\u016f, lymfocyt\u016f, eozinofil\u016f, bazofil\u016f a monocyt\u016f.\u010cerven\u00fd krevn\u00ed KO ud\u00e1v\u00e1 po\u010det, velikost, barevnou koncentraci a tvar \u010derven\u00fdch krvinek (erytrocyt\u016f). Pom\u011br celkov\u00e9ho objemu krvinek a plazmy (tekutina tvo\u0159\u00edc\u00ed krev bez krvinek) ud\u00e1v\u00e1 tzv. hematokrit. Z\u00e1kladn\u00ed hodnota, na kterou se l\u00e9ka\u0159 p\u0159i hodnocen\u00ed krevn\u00edho obrazu d\u00edv\u00e1, je hodnota hemoglobinu (Hb). Hemoglobin je protein obsahuj\u00edc\u00ed \u017eelezo, kter\u00fd je sou\u010d\u00e1st\u00ed erytrocyt\u016f, tvo\u0159\u00ed asi 35 % obsahu erytrocyt\u016f. Jeho hlavn\u00ed funkc\u00ed je p\u0159enos kysl\u00edku, jedna \u010derven\u00e1 krvinka ho obsahuje cca 28\u201332 pikogram\u016f. Norm\u00e1ln\u00ed hodnoty hemoglobinu jsou u mu\u017e\u016f cca 135-170g\/l, u \u017een 120-160g\/l.O an\u00e9mii mluv\u00edme, kdy\u017e poklesne Hb pod spodn\u00ed limit. An\u00e9mie, nedostatek \u010derven\u00fdch krvinek a\/nebo krevn\u00edho barviva, m\u016f\u017ee vzniknout z\u00a0r\u016fzn\u00fdch p\u0159\u00ed\u010din a odraz\u00ed se to ve zm\u011bn\u00e1ch krevn\u00edho obrazu. Nej\u010dast\u011bj\u0161\u00ed je an\u00e9mie z\u00a0nedostatku \u017eeleza, b\u011b\u017en\u00e1 u menstruuj\u00edc\u00edch \u017een, \u017een po porodu nebo u vegetari\u00e1n\u016f. Vegetari\u00e1nka, kter\u00e1 porodila n\u011bkolik d\u011bt\u00ed a m\u00e1 silnou menstruaci, m\u00e1 prakticky jistotu, \u017ee bude m\u00edt tento typ an\u00e9mie.An\u00e9mie z\u00a0nedostatku \u017eeleza je typick\u00e1 mal\u00fdmi krvinkami. Krvinek m\u016f\u017ee b\u00fdt celkem dost, ale jsou mal\u00e9 a obsahuj\u00ed m\u00e1lo hemoglobinu, celkov\u00e9 mno\u017estv\u00ed hemoglobinu je sn\u00ed\u017een\u00e9. M\u00edrn\u00e1 an\u00e9mie nemus\u00ed m\u00edt \u017e\u00e1dn\u00e9 p\u0159\u00edznaky, ale jakmile Hb klesne pod cca 110, \u010dlov\u011bk to c\u00edt\u00ed. Krev p\u0159en\u00e1\u0161\u00ed m\u00e9n\u011b kysl\u00edku. \u010clov\u011bk je unaven\u00fd, zad\u00fdch\u00e1 se p\u0159i n\u00e1maze, je mu zima. Chronick\u00e1 an\u00e9mie s sebou toti\u017e nese obvykle i \u00fatlum \u0161t\u00edtn\u00e9 \u017el\u00e1zy a zpomalen\u00ed metabolismu. Je to logick\u00e9, kdy\u017e nen\u00ed dost kysl\u00edku, je nutn\u00e9 utlumit metabolismus, proto\u017ee nelze spalovat tolik paliva jako d\u0159\u00edv.P\u0159i an\u00e9mii z\u00a0nedostatku \u017eeleza je v\u017edy d\u016fle\u017eit\u00e9 hledat d\u016fvod, pro\u010d k\u00a0n\u00ed do\u0161lo. Je t\u0159eba zjistit p\u0159\u00edjem \u017eeleza a p\u0159\u00edpadn\u00e9 zjevn\u00e9 ztr\u00e1ty. P\u0159ij\u00edm\u00e1 pacient dost \u017eeleza v\u00a0potrav\u011b? Je to menstruuj\u00edc\u00ed \u017eena, jak siln\u00e9 menses m\u00e1, kdy porodila, m\u011bla an\u00e9mii v\u00a0t\u011bhotenstv\u00ed? Nedo\u0161lo k\u00a0jin\u00e9mu v\u011bt\u0161\u00edmu krv\u00e1cen\u00ed, nap\u0159\u00edklad z\u00a0hemoroid\u016f? Nejde-li o nedostate\u010dn\u00fd p\u0159\u00edjem a\/nebo p\u0159\u00edli\u0161n\u00e9 ztr\u00e1ty krve, ke t\u0159eba hledat d\u00e1l. An\u00e9mie m\u016f\u017ee b\u00fdt p\u0159\u00edznak celiakie nebo jin\u00e9 nemoci st\u0159eva, kdy pacient sice \u017eeleza p\u0159ij\u00edm\u00e1 v\u00a0potrav\u011b dost, ale nedok\u00e1\u017ee ho vst\u0159ebat. Nebo jde o skryt\u00e9 ztr\u00e1ty ze za\u017e\u00edvac\u00edho traktu, nap\u0159. z\u00e1n\u011bt \u017ealudku nebo v\u0159ed, z\u00e1n\u011bt st\u0159eva nebo rakovinu. To v\u0161e je nutn\u00e9 vy\u0161et\u0159it, prov\u00e9st gastroskopii, kolonoskopii nebo scintigrafii st\u0159eva, nabrat krev na z\u00e1n\u011btliv\u00e9 a tumorov\u00e9 markery.Ov\u011b\u0159ovat stav z\u00e1sob \u017eeleza nen\u00ed nutn\u00e9, je-li zjevn\u00e9, \u017ee jde o nedostate\u010dn\u00fd p\u0159\u00edjem nebo velk\u00e9 ztr\u00e1ty. Ale v\u00a0p\u0159\u00edpad\u011b, \u017ee pacient trp\u00ed chronickou z\u00e1n\u011btlivou nemoc\u00ed, nap\u0159. artritidou a m\u00e1 v\u00fdraznou sideropenickou an\u00e9mii, je velmi d\u016fle\u017eit\u00e9 zjistit obsah feritinu, z\u00e1sobn\u00edho \u017eeleza. P\u0159i t\u011bchto nemocech toti\u017e doch\u00e1z\u00ed k\u00a0tomu, \u017ee t\u011blo \u017eelezo ukl\u00edz\u00ed do z\u00e1sob, tvo\u0159\u00ed feritin, ale pacient je sou\u010dasn\u011b v\u00fdrazn\u011b anemick\u00fd. Jedna mlad\u00e1 \u017eena se syst\u00e9mov\u00fdm lupusem m\u011bla Hb kolem 90, revmatolog ji krmil \u017eelezem bez efektu a kdy\u017e kone\u010dn\u011b nabrali feritin, m\u011bla ho extr\u00e9mn\u011b vysok\u00fd.V\u00a0ka\u017ed\u00e9m p\u0159\u00edpad\u011b, zejm\u00e9na kdy\u017e nelze ztr\u00e1ty omezit (menstruace), je t\u0159eba \u017eelezo suplementovat. Nejl\u00e9pe samoz\u0159ejm\u011b potravou, pacient mus\u00ed j\u00edst co nejv\u00edc tmav\u00e9ho masa a hlavn\u011b jater. Nesta\u010d\u00ed-li to, je t\u0159eba \u017eelezo dod\u00e1vat v\u00a0suplementu nebo l\u00e9ku. Zde mus\u00edm upozornit, \u017ee p\u0159esto\u017ee je mo\u017en\u00e9 koupit voln\u011b prodejn\u00e9 suplementy se \u017eelezem, obsahuj\u00ed dost malou d\u00e1vku \u017eeleza, kter\u00e1 hlubokou an\u00e9mii a velk\u00e9 ztr\u00e1ty nen\u00ed schopna nahradit. Opravdu v\u00fdrazn\u00e1 an\u00e9mie (Hb pod 100) nebo trvaj\u00edc\u00ed siln\u00e9 ztr\u00e1ty je t\u0159eba korigovat \u017eelezem na p\u0159edpis. D\u00e1vka v\u00a0jedn\u00e9 tablet\u011b nejsiln\u011bj\u0161\u00edho \u017eeleza na p\u0159edpis je n\u011bkdy a\u017e 10n\u00e1sobn\u00e1 proti tomu, co koup\u00edte sami v\u00a0l\u00e9k\u00e1rn\u011b.\u017delezo ve form\u011b tablet bohu\u017eel nen\u00ed moc dob\u0159e sn\u00e1\u0161en\u00e9. Existuj\u00ed velk\u00e9 individu\u00e1ln\u00ed rozd\u00edly. Jste-li v\u00a0situaci, kdy \u017eelezo opravdu pot\u0159ebujete u\u017e\u00edvat, je t\u0159eba spolupracovat s\u00a0va\u0161\u00edm l\u00e9ka\u0159em p\u0159i v\u00fdb\u011bru produktu, kter\u00fd v\u00e1m bude nejm\u00e9n\u011b vadit a u\u017e\u00edvat ho tak, abyste ho co nejl\u00e9pe sn\u00e1\u0161eli. \u017delezo velmi \u010dasto zp\u016fsobuje z\u00e1cpu, co\u017e samoz\u0159ejm\u011b nen\u00ed d\u016fvod, aby se p\u0159estalo br\u00e1t. Z\u00e1cpu lze korigovat nejl\u00e9pe osmotick\u00fdmi proj\u00edmadly (\u0161aratice, zaje\u010dick\u00e1, laktuloza apod). Jestli\u017ee pacient nezvl\u00e1dne \u017eelezo u\u017e\u00edvat na la\u010dno, jak by se m\u011blo, m\u016f\u017ee ho u\u017e\u00edvat s\u00a0j\u00eddlem. N\u011bco se v\u017edy vst\u0159eb\u00e1. Vst\u0159eb\u00e1v\u00e1n\u00ed \u017eeleza podporuje vitamin C, proto je vhodn\u00e9 maso j\u00edst se zeleninou nebo p\u0159\u00edmo u\u017e\u00edt vitamin C. Jeho vst\u0159eb\u00e1v\u00e1n\u00ed sni\u017euje \u010daj a k\u00e1va, v\u00e1pn\u00edk v\u00a0ml\u00e9\u010dn\u00fdch v\u00fdrobc\u00edch, ale i kyselina fytov\u00e1 v\u00a0obilnin\u00e1ch. Ve vz\u00e1cn\u00fdch p\u0159\u00edpadech je pot\u0159eba \u017eelezo dod\u00e1vat injek\u010dn\u011b.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Druh\u00fd \u010dast\u00fd typ an\u00e9mie nast\u00e1v\u00e1 v\u00a0d\u016fsledku nedostatku vitaminu B12 a\/nebo kyseliny listov\u00e9. Je typick\u00e1 men\u0161\u00edm mno\u017estv\u00edm velk\u00fdch krvinek s\u00a0vysokou koncentrac\u00ed barviva. Op\u011bt je t\u0159eba hledat p\u0159\u00ed\u010dinu. Vitamin B12 se nach\u00e1z\u00ed p\u0159edev\u0161\u00edm v\u00a0\u017eivo\u010di\u0161n\u00fdch potravin\u00e1ch, stejn\u011b jako \u017eelezo hlavn\u011b v\u00a0mase a vnit\u0159nostech, proto je jeho nedostatek typick\u00fd pro vegetari\u00e1ny. Prvn\u00ed ot\u00e1zka na pacienta se proto mus\u00ed t\u00fdkat jeho stravy. Hladina vitaminu B12 i kyseliny listov\u00e9 se d\u00e1 zm\u011b\u0159it, a je to p\u0159i diagn\u00f3ze an\u00e9mie pot\u0159ebn\u00e9. Jestli\u017ee pacient nen\u00ed vegetari\u00e1n a m\u00e1 tento typ an\u00e9mie, mus\u00ed se vylou\u010dit autoimunitn\u00ed onemocn\u011bn\u00ed \u017ealudku \u2013 pernici\u00f3zn\u00ed an\u00e9mie. P\u0159i n\u00ed doch\u00e1z\u00ed k\u00a0autoimunitn\u00ed destrukci bun\u011bk produkuj\u00edc\u00edch tzv. vnit\u0159n\u00ed faktor, enzym nutn\u00fd ke vst\u0159eb\u00e1n\u00ed vitaminu B12 do t\u011bla. Na\u0161t\u011bst\u00ed celkem vz\u00e1cn\u00e1 je situace, kdy pacientovi musel b\u00fdt od\u0148at \u017ealudek pro zhoubn\u00fd n\u00e1dor. V\u0161ichni tito nemocn\u00ed mus\u00ed dost\u00e1vat do\u017eivotn\u011b injekce B12.Vitamin B12 se do t\u011bla dod\u00e1 nejl\u00e9pe v\u00a0injekc\u00edch. Existuj\u00ed formy, kter\u00e9 se u\u017e\u00edvaj\u00ed \u00fasty, ale v\u00a0p\u0159\u00edpad\u011b pr\u00e1v\u011b perniciozn\u00ed an\u00e9mie je \u010dlov\u011bk nedok\u00e1\u017ee vst\u0159ebat. Frekvence injekc\u00ed je r\u016fzn\u00e1, \u017ee za\u010d\u00e1tku se mohou d\u00e1vat a\u017e 2x t\u00fddn\u011b, po dopln\u011bn\u00ed hladiny se d\u00e1vaj\u00ed t\u0159eba jen n\u011bkolikr\u00e1t do roka jako udr\u017eovac\u00ed d\u00e1vky. Kyselinu listovou je mo\u017en\u00e9 b\u011b\u017en\u011b u\u017e\u00edvat v\u00a0tablet\u00e1ch.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u0159et\u00edm typem an\u00e9mie je tzv. an\u00e9mie chronick\u00fdch nemoc\u00ed. Hemoglobin je sn\u00ed\u017een\u00fd, ale krvinky maj\u00ed norm\u00e1ln\u00ed objem i koncentraci barviva, \u017eelezo je v\u00a0norm\u011b, vitamin B12 tak\u00e9. B\u00fdv\u00e1 to u chronick\u00fdch ledvinov\u00fdch nemoc\u00ed, kdy ledviny pravd\u011bpodobn\u011b produkuj\u00ed m\u00e1lo erytropoetinu, hormonu, kter\u00fd stimuluje kostn\u00ed d\u0159e\u0148 k\u00a0produkci \u010derven\u00fdch krvinek. M\u016f\u017ee b\u00fdt samoz\u0159ejm\u011b probl\u00e9m p\u0159\u00edmo v\u00a0kostn\u00ed d\u0159eni, m\u00e1lokdy se t\u00fdk\u00e1 jen \u010derven\u00fdch krvinek. Tyto dal\u0161\u00ed typy an\u00e9mie vy\u017eaduj\u00ed odbornou l\u00e9ka\u0159skou p\u00e9\u010di a vy\u0161et\u0159en\u00ed. Pro \u00faplnost uvedu hemolytick\u00e9 an\u00e9mie. Nast\u00e1vaj\u00ed p\u0159i nadm\u011brn\u00e9m rozpadu erytrocyt\u016f, bu\u010f v\u00a0krevn\u00edm \u0159e\u010di\u0161ti nebo mimo n\u011bj. Diagn\u00f3za se provede na z\u00e1klad\u011b specializovan\u00fdch vy\u0161et\u0159en\u00ed. Kostn\u00ed d\u0159e\u0148 obsahuje zv\u00fd\u0161en\u00fd po\u010det bun\u011bk, je zv\u00fd\u0161en\u00e1 krvetvorba, kter\u00e1 se sna\u017e\u00ed nahradit zni\u010den\u00e9 krvinky, tak\u00e9 se m\u011bn\u00ed pom\u011br vznikaj\u00edc\u00edch b\u00edl\u00fdch a \u010derven\u00fdch krvinek ve prosp\u011bch \u010derven\u00fdch. Zv\u00fd\u0161en\u00e1 krvetvorba se v\u00a0krevn\u00edm obraze uk\u00e1\u017ee jako zv\u00fd\u0161en\u00ed retikulocyt\u016f, nezral\u00fdch erytrocyt\u016f&#8230;<\/p>\n","protected":false},"author":3,"featured_media":7621,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,1,13,10],"tags":[],"class_list":["post-7665","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-alternativni-medicina","category-medunka","category-pece-o-telo","category-zdravi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/7665","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/comments?post=7665"}],"version-history":[{"count":5,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/7665\/revisions"}],"predecessor-version":[{"id":7672,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/7665\/revisions\/7672"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media\/7621"}],"wp:attachment":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media?parent=7665"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/categories?post=7665"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/tags?post=7665"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}