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Colegio de Medicina Interna de México.

2024, Número 09

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Med Int Mex 2024; 40 (09)


Anemia de células falciformes en medicina de urgencias: una revisión basada en la evidencia

Duque EL, Saavedra VME, Vergara YD, Martínez-Sánchez LM

Idioma: Español
Referencias bibliográficas: 58
Paginas: 581-590
Archivo PDF: 358.00 Kb.


RESUMEN

La anemia de células falciformes es un trastorno hematológico autosómico recesivo causado por una sustitución de un aminoácido en la cadena beta-globina de la hemoglobina del adulto. Esta sustitución produce polimerización de la hemoglobina que resulta en glóbulos rojos en forma de hoz. Este proceso, además de generar eritrocitos rígidos, comienza una serie de eventos que incluyen cambios en la función de la membrana del eritrocito, distribución uniforme del volumen eritrocitario, alteraciones en la actividad del endotelio y aumento de la adherencia al endotelio vascular, lo que deriva en complicaciones de: crisis vasooclusivas, hipertensión pulmonar, dolor crónico, complicaciones isquémicas, anemia, infecciones neumocócicas y síndrome torácico agudo. Clínicamente la enfermedad se caracteriza por anemia hemolítica, que obstruye diferentes órganos progresivamente, con crisis vasooclusivas y dolor. El dolor es el síntoma más frecuente y el que más costos al sistema de salud genera, por sus consultas a Urgencias y hospitalizaciones. Estas crisis de dolor son de duración variable y pueden ocurrir en diferentes sitios del cuerpo, pero con mayor frecuencia en la columna vertebral, miembros inferiores en los adultos y en forma de dactilitis en los lactantes o recién nacidos. El tratamiento global para la anemia de células falciformes se basa en la hidroxiurea, trasfusión de glóbulos rojos, eritroaféresis, trasplante de células madre en pacientes seleccionados y recientemente ha surgido como nueva opción la glutamina.


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