Campuzano-Maya, Germán

Idioma: Español
Referencias bibliográficas: 184
Paginas: 511-548
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RESUMEN

El PFA-100, por Platelet Function Analyzer (Analizador de Función Plaquetaria) es una nueva herramienta para la investigación de la hemostasia primaria, descrita e introducida al laboratorio clínico a partir de 1995, actualmente disponible en el medio. El PFA-100 se fundamenta en un instrumento (PFA-100 o PFA-200), que simula la circulación sanguínea, y dos cartuchos de reactivos que contienen membranas impregnadas de colágeno/epinefrina y colágeno/ADP, que simulan los tejidos. Desde el punto de vista técnico, la prueba es equivalente in vitro al tiempo de sangría tradicional in vivo, por lo que también se la conoce como tiempo de sangría in vitro. El PFA-100 se puede utilizar en diferentes situaciones medicas: como una prueba sustituta del tiempo de sangría, como una prueba tamiz de una disfunción plaquetaria ya sea congénita o adquirida, como una prueba de monitoreo en el manejo de enfermedades congénitas de la función plaquetaria y en particular de la enfermedad de von Willebrand, como una prueba de diagnóstico y control en el caso de la resistencia a la aspirina y la resistencia al clopidogrel, como una prueba de control de calidad en el banco de sangre; y como una prueba médico-legal en el diagnóstico diferencial de las enfermedades hematológicas con manifestaciones hemorrágicas y el maltrato infantil, entre otras muchas indicaciones. El tiempo de sangría ha pasado a ser una prueba obsoleta, no recomendada en la práctica clínica por organizaciones como el Colegio Americano de Patología (CAP) y la Sociedad Americana de Patología Clínica (ASCP), y como tal debería desaparecer de los portafolios de servicio de los laboratorios clínicos. Hay suficiente evidencia de que el PFA-100, además de ser una prueba no invasiva, sustituye con mejores indicadores analíticos, como la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo, al tiempo de sangría en el estudio de los pacientes con sospecha de tener trastornos funcionales de las plaquetas. En este módulo se presenta la nueva prueba a la comunidad médica y a los profesionales del laboratorio clínico y se enfatiza en su utilización en la práctica médica del día a día y se abordan los problemas técnicos que el laboratorio clínico debe abordar al momento de ofrecerla como una nueva prueba.

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