“醫生啊,我朋友說我這幾天頭昏眼花,人覺得很虛弱,全身無力,是不是“欠血”啊? 可不可以幫我補一下血啊?”
上面這個問題實在太常被問了,所以一定要先澄清一下,以上這些情況,可以是中醫所說的欠血、或血虛,這些不舒服的感覺都只是“症狀”,告訴你身體可能有某一部分出了問題,得要去找出真正背後的原因才行。
那些症狀背後有哪些可能的原因呢?如:姿態性低血壓、低血糖、感冒、發燒、睡眠不足或者真的貧血等等,都可能讓你出現相同的症狀,可是,補血只能改善貧血,其他的原因可不是補血就能改善的!對症才能下藥,先搞清楚真正的敵人在哪裡,才能好好對付它。
西醫所說的貧血 (血色素或血紅素不足),有嚴格的、客觀的定義標準,一定是去抽血做了檢查,確認檢驗數值真的比標準值來的低,才能真的說是貧血。
分隔線以下才是正文
為什麼腎友常常會貧血呢?原因很多,但主要原因有三:生得少、死得早、鐵嘸夠(用台語發音才有押韻)。
1. 生得少
身體中有一種荷爾蒙,作用是專門鞭策骨髓製造紅血球,讓血色素上升。
這種荷爾蒙的名字就是“紅血球生成素(Erythropoietin,簡稱EPO)”,醫護人員常常說“一匹鷗”就是這個啦,這種荷爾蒙是腎臟負責製造的。當腎臟功能漸漸變差,荷爾蒙的產量就逐漸不夠,沒有人鞭策骨髓,它就懶惰不造血了。
2. 死得早
腎臟功能不佳時,體內所累積的毒素會使得紅血球“短命”,即使進入長期透析了,腎友的紅血球壽命仍然比正常人短了20%(腎友紅血球平均壽命是58.1天,健康人的紅血球壽命是72.9天)。
你或許會問:血液透析過程當中,血液被引出體外去清理毒素,會不會傷害紅血球,進而影響紅血球的壽命?
答案是:不會,因為同一篇研究指出:血液透析與腹膜透析的患者,紅血球壽命差不多短,腹膜透析:55.3天,血液透析:58.1天,不會因為透析方式的不同,而影響紅血球的壽命。換句話說,血液透析不會破壞掉紅血球。
3. 鐵嘸夠
大概每個人都知道:鐵,是紅血球中很重要的成分,任何人只要鐵攝取不足,就會貧血。日常生活中,常見的富含鐵質食物種類像是紅肉與豆類,腎臟病患或腎友常常被限制攝取,可能因此而體內鐵質不足。
另外,由於腎友每個月都需要抽血檢驗,確定身體各項數據控制得宜,雖然每次抽的血量不多,但長期累積下來,也是流失鐵的原因之一。還有其他流血的情況,如月經、腸胃道出血等等,只要血流失掉,就等於鐵也減少。要有足夠的鐵,身體才可能製造出足夠的血。
還有,維他命B12與葉酸,和鐵一樣,都是紅血球生成過程中很重要的元素,這兩種維生素如果不足,也會貧血喔。
下一篇,來討論有哪些處理方式吧。
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Vos FE, Schollum JB, Coulter CV, Doyle TCA, Duffull SB, Walker RJ. Red Blood Cell Survival in Long-term Dialysis Patients.
American Journal of Kidney Diseases. 2011;58(4):591-598.
http://doi.org/10.1053/j.ajkd.2011.03.031