2020, Número 4
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Medicina & Laboratorio 2020; 24 (4)
Hemofilia B o enfermedad de Christmas
Acosta-Aragón MA, Álvarez-Mina AR, Velásquez-Paz JC, Vizcaíno-Carruyo JC
Idioma: Español
Referencias bibliográficas: 68
Paginas: 273-289
Archivo PDF: 860.30 Kb.
RESUMEN
La hemofilia B o enfermedad de Christmas se diferenció por primera vez
de la hemofilia A en 1947. Su forma clásica consiste en un trastorno hereditario de la
coagulación causado por mutaciones en el gen F9, que codifica para el factor IX de
la coagulación. Su herencia está ligada al cromosoma X; las mujeres son portadoras,
pero se manifiesta clínicamente en hombres, aunque se han descrito casos de
mujeres portadoras sintomáticas. El factor IX activado es una proteína dependiente
de vitamina K, sintetizada en el hígado, que forma parte del complejo tenasa, cuya
función es formar la mayor cantidad de trombina en el nuevo modelo de la coagulación
basado en células. De acuerdo a la actividad del factor IX, su deficiencia
se puede clasificar en leve (5% a 40%), moderada (1% a 5%), o severa (‹1%). Su
diagnóstico se realiza con la presencia de un TPT alargado que corrige con plasma
normal y con la determinación del nivel funcional del factor IX, y se confirma
con el estudio molecular que demuestra la mutación en el gen F9. Su diagnóstico
diferencial incluye otras patologías como la hemofilia A. El tratamiento con factor
IX recombinante es el más utilizado en la actualidad, pero se vienen desarrollando
nuevas terapias con virus adeno-asociados recombinantes que prometen mejorar
la calidad de vida para algunos pacientes afectados. La profilaxis juega un papel
fundamental, en particular en los casos de enfermedad moderada y severa.
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