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2012, Número 3

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Rev Cubana Hematol Inmunol Hemoter 2012; 28 (3)


Índice hemolítico: una aproximación a los subfenotipos clínicos en niños con drepanocitosis

Alberto Arencibia-Núñez, Yamilé Quintero-Sierra, Eliezer San Román-García, Eva Svarch, Adys Gutiérrez-Díaz, Sergio Machín-García, Alejandro González-Otero, Serrano-Mirabal J, Menéndez-Veitía A, Domínguez-Toirac M, Delgado-Vargas T

Idioma: Español
Referencias bibliográficas: 41
Paginas: 263-274
Archivo PDF: 359.93 Kb.


RESUMEN

Se realizó estudio prospectivo con el objetivo de calcular el índice hemolítico y determinar su asociación con las manifestaciones clínicas y de laboratorio. Se incluyeron 40 niños con anemia drepanocítica y Sbº talasemia atendidos en el Instituto de Hematología e Inmunología entre los años 2009-2010. El índice hemolítico se calculó a partir de los valores de deshidrogenasa láctica, bilirrubina y reticulocitos, utilizando el análisis de componentes principales, con media 0 y rango entre -3 y 3. Se compararon los pacientes del grupo 1, con índice hemolítico menor del 33 percentil (-3 a -0,71; n=13), con los pacientes del grupo 2, con índice hemolítico mayor del 66 percentil (0,84 a 3; n=14). En los pacientes del grupo 2 fue más frecuente el síndrome torácico agudo (38,5 % vs. 78,6 % p=0,034) y la enfermedad cerebrovascular (0 % vs. 28,6 %; p=0,037). La prevalencia de asma bronquial (p=0,080) e hipertensión arterial sistólica (p=0,076) tuvo tendencia a ser mayor en el grupo 2. El 42,9 % de los pacientes del grupo 2 tuvieron una velocidad de regurgitación tricuspídea ≥ 2,5 m/s, lo que no ocurrió en ningún paciente del grupo 1 (p=0,007). En el grupo 2 fueron más frecuentes las transfusiones (p=0,021) y el uso de hidroxiurea (p=0,081). La correlación de la velocidad de regurgitación tricuspídea con el índice hemolítico (r=0,61; p<0,0001) fue mucho mayor que con los otros marcadores de hemólisis incluidos en el análisis. El índice hemolítico permite diferenciar los pacientes con fenotipo hemolítico, los cuales tienen un comportamiento clínico característico.


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