enfoque de anemia hemolítica
DESCRIPTION
Enfoque simple de la anemia hemolítica.TRANSCRIPT
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ENFOQUE DE ANEMIA HEMOLÍTICA
OMAR ALEXIS VILA CAMPILLO
RESIDENTE DE MEDICINA INTERNA
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• Vida media de 120 días
• Cada día destrucción del 1% de la masa eritrocitaria
• Viajan 300 millas
ERITROCITOS
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HEMÓLISIS COMPENSADA
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HEMÓLISIS DESCOMPENSADA
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HEMÓLISIS DESCOMPENSADA
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¡RETICULOCITOS!Reticulocitos corregidos= Reticulocitos pte x Hto pte
45
IPR= Reticulocitos corregidos Tiempo de maduración
HematocritoTiempo de
maduración
45%35%25%15%
1 día1.5 días2 días
2.5 días
IPR <2.5: Escasa actividad eritropoyéticaIPR >2.5: Regeneración medular
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RETICULOCITOS
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DIAGNÓSTICO
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DIAGNÓSTICO
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DIAGNÓSTICO
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DIAGNÓSTICO
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CLASIFICACIÓN
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS EXTRAVASCULAR
VALINA POR GLUTAMATO EN POSICIÓN 6 DE CADENA BETA
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HEMÓLISIS EXTRAVASCULAR
• Malaria• Babesia microti y Babesia
divergens• Bartonella bacilliformis• Sepsis por Clostridium
perfringens
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HEMÓLISIS EXTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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ANEMIA HEMOLÍTICA ANTICUERPOS CALIENTES• Autoanticuerpos IgG se unen a 37°C • Se unen a la superficie de las células y son
destruidos por los macrófagos del bazo• Producen microesferocitos• Test de Coombs directo demuestra
anticuerpos en la membrana de los eritrocitos
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ANEMIA HEMOLÍTICA ANTICUERPOS CALIENTES• Los eritrocitos del paciente se
mezclan con anticuerpos de ratón o conejo contra IgG o C3. Positivo si hay aglutinación
• LLC, VIH y Linfoma No Hodgkin• Enfermedades AUTOINMUNES
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ANEMIA HEMOLÍTICA ANTICUERPOS CALIENTES
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ANEMIA HEMOLÍTICA ANTICUERPOS CALIENTES• Corticoides y el tratamiento de la
enfermedad de base son LA PIEDRA ANGULAR
• Refractarios requieren esplenectomía, gammaglobulina, Plasmaféresis, Citotóxicos o Danazol
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ANEMIA HEMOLÍTICA ANTICUERPOS FRÍOS
• Autoanticuerpos IgM se unen a 0° a 4°C • Se unen a la membrana y depositan C3 en
la superficie de la célula• Células destruidas por los macrófagos del
hígado con el C3• Menos frecuentemente activación complejo
de ataque a membrana
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ANEMIA HEMOLÍTICA ANTICUERPOS FRÍOS
• LLC y Linfoma no Hodgkin• Posterior a infecciones:• Mononucleosis infecciosa• Mycoplasma pneumoniae• VIH
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ANEMIA HEMOLÍTICA ANTICUERPOS FRÍOS
• Las terapias para anticuerpos calientes no sirven• Evitar el desencadenante y tratar la
enfermedad subyacente
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ANEMIA HEMOLÍTICA
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HEMÓLISIS INTRAVASCULAR
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HEMÓLISIS INTRAVASCULAR
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ALFA TALASEMIA
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BETA TALASEMIA
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BETA TALASEMIA