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2012, Número 4

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Rev Cubana Hematol Inmunol Hemoter 2012; 28 (4)


Trombocitopenia inmune primaria refractaria: opciones terapéuticas

Roque-García W

Idioma: Español
Referencias bibliográficas: 99
Paginas: 327-346
Archivo PDF: 101.87 Kb.


RESUMEN

La trombocitopenia inmune primaria (PTI) es un trastorno autoinmune adquirido caracterizado por una disminución transitoria o persistente del recuento de plaquetas con riesgo incrementado de sangramiento. La forma crónica de la enfermedad afecta fundamentalmente a los adultos. Puesto que las remisiones espontáneas son muy poco frecuentes, los pacientes son tratados desde el inicio, usualmente con esteroides. Aproximadamente un tercio de los casos no responden a los regímenes esteroideos y el tratamiento de segunda línea es la esplenectomía, tratamiento con el que se logran las mayores tasas de curación. Sin embargo, entre el 10 y el 30 % de los pacientes no responden a la exéresis quirúrgica del bazo, que constituyen el grupo de pacientes con PTI crónica refractarios al tratamiento. No existen evidencias sobre cuál esquema terapéutico es el más efectivo en estos casos, por lo que el tratamiento continúa siendo empírico. En este trabajo se revisan las diferentes opciones terapéuticas que pueden ser utilizadas en la PTI crónica refractaria, el mecanismo de acción de las drogas, las dosis y los efectos adversos más frecuentes.


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