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Nga: Petar Antunovic, Klinika Hematologjike; Universiteti i Linköping-Suedi
Pacienti Vezir Morina ėshtė sjellur nga Prishtina pėr vlerėsimin e sėmundjes dhe tė planit tė mjekimit. Diagnoza udhėzuese ishte sindroma mielodisplastike (MDA). Anamneza ėshtė e gjatė gjysėm viti, diagnoza fillimisht ėshtė vendosur nė Shkup dhe mė vonė ėshtė vėrtetuar nė Prishtinė. Defekti mė i madh ėshtė te prodhimi i eritrociteve, dhe pėr kėtė arsye terapia mė intensive dhe njėherit e vetmja terapi ishte transfuzioni i eritrociteve. Pacienti ka marrė, sipas vlerėsimeve tė veta, rreth 40 njėsi gjaku. Nė pėrgjithėsi, kemi tė bėjmė me njė njeri tė ri dhe tė shėndoshė, qė me profesion ėshtė arkitekt.
Plani fillestar ishte qė nė kuadėr tė klinikės apo poliklinikės, tė bėhen ekzaminimet dhe planifikimi i terapisė, qė mė vonė do tė mund tė zbatohej nė marrėveshje me palėt e interesuara.
Sipas shikimit klinik, pacienti ishte i zbehtė, pa temperaturė, pa rritje tė shpnetkės, pa shenja tė gjakderdhjes dhe pa zbrapsje nė rezultatet e ekzaminimeve nė mushkėri, zemėr dhe abdomen. Fotografia e gjakut tregonte hemoglobinė 58 g/L, leukocite 5,4 dhe trombocite 450. Ėshtė kryer ekzaminimi i palcės kurrizore, analiza kromozomike dhe e “flow cytometry”. Rezultati nga ekzaminimi i palcės kurrizore ishte befasues: sipas rezultatit tė nxjerrė nga fotografia e gjakut, supozimi ynė ishte se kemi tė bėjmė me anemi refraktare (RA), ndoshta edhe me ’5q- sindromėn’. Mirėpo, nė placėn kurrizore janė gjetur 27% blaste tė tipit tė mieloblasteve, nė terenin e njė mielopoeze padyshim displastike. Analizat kromozomike janė ende duke u punuar. Mė vonė ėshtė vėrtetuar qė edhe nė gjakun periferik ka njė pėrqindje tė blasteve. Kemi pėrfunduar se ėshtė bėrė (jashtėzakonisht shpejt) transformimi nga njė formė relativisht e qetė e MDS-sė, nė njė formė sekondare tė leukemisė akute mieloide (AML). Pacienti ėshtė pranuar nė spital dhe ėshtė planifikuar terapia induktive nė mėnyrė qė sėmundja tė vihet nėn kontroll para njė transplantimi tė mundshėm tė palcės kurrizore. Kemi vendosur kėshtu, meqė pacienti ėshtė nė gjendje tė mirė dhe ka numėr normal tė trombociteve. Nė anėn tjetėr, sėmundja ėshtė treguar agresive dhe nuk kishte vend pėr vonimin e mjekimit.
Plani i mjekimit dhe shpenzimet
Sipas planit pacienti duhet t’i nėnshtrohet mjekimit induktiv. Shpresojmė qė kjo do ta bėjė qė sėmundja tė kaloj nė remision. Nė pėrputhje me bindjet qė vlejnė nė gjithė botėn, shanset mė tė mėdha pėr sukses, bile edhe pėr shėrim tė plotė, janė me transplatimin halogjen tė palcės kurrizore tė marrė nga ndonjė anėtarė i familjes (pacienti ka dhjetė motra e vėllezėr). Nė mėnyrė qė transplantimi tė kryhet nė kushtet mė tė mira tė mundshme, nevojitet qė pas remisionit tė kryhet i ashtuquajturi mjekim konsolidues, 1- 2 kura. Ne mendojmė qė do tė mjaftonte njė kurė konsoliduese, mirėpo rrjedha e mėtejme mvaret edhe nga shpejtėsia e mbledhjes sė tė dhėnave rreth dhuruesit tė mundshėm. Nėse tė gjithė do tė angazhohen maksimalisht (Prishtina, Belgjika, Vestervik nė Suedi), ne mundemi tė kemi nė letėr dhuruesin (dhuruesit) ideal pėr Vezirin mbrenda njė muaji apo njė muaji e gjysėm. Atėherė do tė mjaftonte vetėm njė kurė konsoliduese e cila do tė fillonte nė fillim tė janarit, dhe pacienti do tė mbėrrinte nė njė gjendje optimale nė fillim tė shkurtit tė vitit tė ardhshėm. Nėse, puna rreth kėrkimit tė dhuruesit nuk zhvillohet shpejt, atėherė do tė duhej qė tė pėrsėritet mjekimi konsolidues dhe me kėtė do tė zhvendosej transplatimi pėr njė muaj.
Shpenzimet pėr ekzaminimet nė poliklinikė janė sipas marrėveshjes sė mėhershme 15 000 kruna suedeze (1 Euro=8,2 kruna).
Pėr terapinė induktive 100 000 kruna suedeze,
Pėr identifikimin e dhuruesit tė palcės kurrizore 10 000 kruna,
Pėr transplantim kostoja ndryshon varėsisht prej rrjedhės sė transplantimit. Ēmimi prej 834 000 kruna pėrfshin edhe 49 ditė tė mjekimit spitalor. Pėr secilėn ditė mė shumė tė mjekimit spitalor, ēmimi ėshtė 6400 kruna. Sipas pėrvojės tonė, mund tė themi qė ēmimi pėr transplantim sillet prej 1 deri 1,5 milion kruna, varėsisht prej komplikimeve. Ne llogarisim qė do tė kemi komplikime minimale, duke marrė parasysh gjendjen e pacientit dhe dhuruesit familjar, mirėpo nuk ka rregulla fikse.
Mjekimi po rrjedh sipas etapave tė pėrshkruara. Nėse spitali ynė do tė pranonte garanci prej ndonjė banke lokale qė mjetet financiare pėr mjekimin e Vezir Morinės janė siguruar, ne do tė mund tė punonim dhe tė ofronim shėrbimin tonė si pėr ēdo qytetar suedez. Ēdo etapė e re e mjekimit nėnkupton financim paraprakisht tė siguruar. Shtrohet pyetja se ku duhet tė bėhet mjekimi konsolidues: kėtu apo nė Prishtinė? Pėr kėtė mund tė bisedohet dhe ne nuk e pėrjashtojmė asnjėrėn prej variantave.
Pjesa teknike
Dhuruesi potencial i palcės kurrizore gjendet nė familjen e Vezirit, sepse pėr kėtė ekzistojnė shanset maksimale statistike. Ne do tė organizojmė dėrgimin e mostrave tė gjakut pėr testim tė familjes sė tij nga Suedia dhe Belgjika. Sa i pėrket dhuruesve potencial tė Prishtinės, ne do t’i ēojmė epruvetat te njė adresė e caktuar (gruaja e pacientit?, hematologu lokal?), tė cilat pastaj do tė kthehen me mostrat e gjakut pėr testim. Kur tė gjendet dhuruesi, nėse kemi tė bėjmė me njė person nga njė shtet jashtė EU, ne do tė ndihmojmė rreth rregullimit tė dokumentacionit pėr qėndrim nė Suedi pėr kryerjen e transplantimit.
Kjo letėr i dorėzohet vėllaut tė pacientit Agim Morinės si bazė pėr pėrpilimin e konstruksionit finansiar tė mjekimit.
Linköping, 6.12.04
Petar Antunovic,
Specialist nė Hematologji
Spitali Universitar nė Linköping
Klinika hematologjike
Linköping
Suedi
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From: Petar Antunovic, the Clinic of Hematology, University of Linköping-Sweden
The patient Mr.Vezir Morina was referred here from Prishtina to have his condition and medical treatment plan evaluated. The initial diagnosis was the myelodysplastic syndrome (MDS). The illness history is half year long; the diagnosis was first given in Skopje and then verified in Prishtina. The greatest deficiency was in the production of erythrocytes and thus the most intensive and at the same time the only therapy to be applied was the transfusion of erythrocytes. The patient was given, according to his evaluation, around 40 units of blood. In general, the patient is a young and healthy man, an architect by profession.
The initial plan consisted of tests to be carried out in a clinic or a policlinic and a planned therapy which then would be applied in accordance with interested parties.
Clinically the patient appears to be pale, has no fever and no spleen augmentation, no bleeding signs and no shrinking back from the results of the examinations carried out in the lungs, heart and abdomen. The blood analysis shows 58 g/L hemoglobin, 5.4 leukocytes and 450 thrombocyte. The examination of the medullar, the chromosome analysis and flow cytometry were also conducted. The results of the medullar examination were surprising: based on the results of the blood analysis, we assumed that it is a case of refractory anemia (RA), or maybe of the’5q-syndrome’. But, the medullar examination has shown 27% blasts of the myeloblast type in the terrain of a dysplastic myelopoiesis. The chromosome analysis is still being processed. Later it has been verified that even the peripheral blood contained a few percentage of blasts. We have concluded that there has been (an extraordinarily quick) transformation of a relatively quiet form of MDS to secondary form of acute myeloid leukemia (AML). The patient has been accepted in the hospital and an inductive therapy has been planned in order to put the illness under control in anticipation of possible medullar transplantation. We have taken this decision since the patient appears to be in a good state, his blood having a normal number of thrombocytes. On the other hand, the illness appears to be in an aggressive form, thus there is no need for holding up the treatment.
The medical treatment plan and the expenses
As planned, the patient has to undergo the inductive treatment. We are hoping that the illness will start to remission. Based on the general opinion, the greatest chances for success and even for a full recovery are by applying the halogen transplantation of the medullar taken from patient’s relatives (the patient has got 10 brothers and sisters). In order to have transplantation carried out in the best possible conditions, after the remission of the illness the so-called consolidating treatment has to be carried out, 1-2 sessions. We think that one consolidating treatment would be sufficient, but this also depends on how quick the data regarding the possible donor will be gathered. If everybody would be maximally engaged (Prishtina, Belgium, Vestervik in Sweden), we could have the ideal donor (donors) for Veziri within a month or a month and a half. In that case, one consolidating treatment would be sufficient. The treatment would start at the beginning of January and the patient would reach an optimal state at the beginning of February. Should the time for finding a donor last longer, then the consolidating treatment would have to be repeated and the transplantation would have to be postponed for another month.
The expenses for the examination in the policlinic are as agreed earlier: 15,000 Swedish kruna (1 Euro=8.2 kruna).
The expenses for the inductive therapy 100,000 Swedish krunas,
The expenses for the identification of the donor of the medullar, 10,000 Swedish krunas,
The expenses for the transplantation will vary depending on the transplantation flow. The price of 834,000 Swedish krunas also includes 49 days of hospital treatment. For each extra day of hospital treatment, the price is another 6,400 Swedish krunas. Based on our experience, we could say that the price for a transplantation varies between 1 million to 1,5 million krunas, depending on the possible complications. Based on patient’s condition and the possibility of finding the donor within his family, we count that we will face minimal complications, but there are no fixed rules for this.
The medical treatment follows the above-described phases. Should our hospital receive a guaranty from a local bank that the funds for the medical treatment of Mr. Vezir Morina are provided, then we could proceed to work and offer our services to him as to every other Swedish citizen. Each new phase of medical treatment shall implicate funds provided in advance. The question is: Where will the consolidating treatment be carried out? Here in Sweden or in Prishtina? This can be discussed and we are open to any suggestions.
The technical part
The potential medullar donor is to be found within Mr. Morina’s family because there lie the maximal statistic chances for this. We will organize the delivery of blood samples for the testing of his family in Sweden and Belgium. On the other hand, regarding the potential donors coming form Prishtina, we will send the test tubes to a certain address (the patient’s wife?, the local hematologist?), and then the test tubes containing blood samples will be sent back to us for testing. When the donor is found, and in case they live outside the EU, we will help in gathering the needed documentation for traveling and staying in Sweden during the transplantation period.
This letter is handed over to the patient’s brother Mr.Agim Morina, as a basis for elaboration of the financial overview of the medical treatment.
Linköping, 6.12.04
Petar Antunovic,
Specialist in Hematology
The University Hospital in Linköping
The Clinic of Hematology
Linköping
Sweden
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