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Protocolo diagnóstico de la trombocitopenia
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.017
A. Mendoza Martínez, M. Velasco Troyano, M. Hernández Arriaza, V. Jiménez Yuste
{"title":"Protocolo diagnóstico de la trombocitopenia","authors":"A. Mendoza Martínez,&nbsp;M. Velasco Troyano,&nbsp;M. Hernández Arriaza,&nbsp;V. Jiménez Yuste","doi":"10.1016/j.med.2024.11.017","DOIUrl":"10.1016/j.med.2024.11.017","url":null,"abstract":"<div><div>Thrombocytopenia is defined as a decrease in platelet count below 150 x 10<sup>9</sup>/l, which increases the risk of hemorrhage in the form of mucocutaneous bleeding. Thrombocytopenias can be of congenital or acquired origin, the latter being more frequent. To reach a diagnosis, it is crucial to take a complete medical history and perform a comprehensive physical examination, expanding the study with additional tests according to clinical suspicion. A peripheral blood smear is a fundamental pillar in the diagnosis, as it allows for ruling out the common EDTA-dependent pseudothrombocytopenia and identifying some morphological features suggestive of certain etiologies. A correct etiological diagnosis is essential in order to avoid misdiagnoses that lead to unnecessary treatment.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 22","pages":"Pages 1331-1334"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de la neutropenia 中性粒细胞减少症的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.10.026
L. Castilla García , M. Argüello Marina
{"title":"Protocolo diagnóstico y terapéutico de la neutropenia","authors":"L. Castilla García ,&nbsp;M. Argüello Marina","doi":"10.1016/j.med.2024.10.026","DOIUrl":"10.1016/j.med.2024.10.026","url":null,"abstract":"<div><div>Neutropenia consists of a decrease in the absolute neutrophil count. It is a common and potentially serious complication in patients with hematologic and oncologic diseases. Its origin may be linked to underlying diseases, myelosuppressive chemotherapy, or hematopoietic stem cell transplantation. It greatly increases the risk of serious bacterial and fungal infections. Effective management of neutropenia is crucial in order to prevent infectious complications and improve clinical outcomes. It can have various causes, including autoimmune disorders, nutritional deficiencies, viral infections, infectious pathogens, and myelosuppressive drugs. The diagnosis is based on assessing the absolute neutrophil count and classifying it according to severity. Infections can be ruled out by means of a detailed clinical history and, in certain situations, by performing imaging tests. The possibility of underlying hematologic disorders should be assessed through specific tests, such as a bone marrow biopsy, flow cytometry, and next-generation sequencing. Managing neutropenia entails the identification and treatment of the underlying cause as well as the prevention and management of infectious complications. Treatment measures range from suspending myelosuppressive drugs to using colony-stimulating factors, empirical antibiotic therapy in cases of febrile neutropenia, and antifungal prophylaxis in high-risk patients. Multidisciplinary care is required for comprehensive, optimal management of neutropenia.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1209-1213"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anemias carenciales y anemia megaloblástica 缺失性贫血和巨幼红细胞性贫血
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.003
M. Sánchez Tabernero, A. Blanco Sánchez, J. Martínez-López, I. Zamanillo Herreros
{"title":"Anemias carenciales y anemia megaloblástica","authors":"M. Sánchez Tabernero,&nbsp;A. Blanco Sánchez,&nbsp;J. Martínez-López,&nbsp;I. Zamanillo Herreros","doi":"10.1016/j.med.2024.11.003","DOIUrl":"10.1016/j.med.2024.11.003","url":null,"abstract":"<div><div>Deficiency anemia, defined as a deficiency of essential factors for red blood cell formation and maturation, is a global health problem. The main cause is iron deficiency, followed by megaloblastic anemia, which is mainly due to a deficiency of folic acid or vitamin B12, both essential coenzymes for DNA synthesis. Vitamin B12 requires complex absorption in the gastrointestinal system that involves different phases, as does folic acid, whose main absorption occurs in the duodenum and jejunum. The clinical manifestations of megaloblastic anemia include the typical symptoms of anemia, which is common regardless of the cause, and neurological symptoms that are specific to vitamin B12, or cobalamin, deficiency. The diagnosis is made via blood tests which reveal macrocytic anemia with low reticulocytes. The definitive diagnosis is made when decreased levels of vitamin B12 or folic acid, respectively, are observed. Treatment involves replenishment of the deficient nutrients either orally or parenterally, depending on severity and etiology. Approved formulations available in Spain are included in the text.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 21","pages":"Pages 1227-1233"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anemia ferropénica. Enfermedades por depósito de hierro 缺铁性贫血。铁沉积引起的疾病
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.001
A. Blanco Sánchez, E. Parra Virto, J. Martínez-López, I. Zamanillo Herreros
{"title":"Anemia ferropénica. Enfermedades por depósito de hierro","authors":"A. Blanco Sánchez,&nbsp;E. Parra Virto,&nbsp;J. Martínez-López,&nbsp;I. Zamanillo Herreros","doi":"10.1016/j.med.2024.11.001","DOIUrl":"10.1016/j.med.2024.11.001","url":null,"abstract":"<div><div>Iron deficiency is the most common cause of anemia worldwide, especially in women of childbearing age, due to gynecological losses or during pregnancy, and in older adult patients, in whom it is often the first sign of a digestive tract disease. Clinical suspicion begins with the detection of abnormalities in the blood count, such as microcytosis, and is confirmed by determining analytical parameters related to iron metabolism, such as serum ferritin. A diagnosis of iron-deficiency anemia requires an investigation into its causes, as it may be the first sign of a major underlying disease such as a neoplasm. Treatment consists of managing the underlying disease and daily fasting oral iron supplementation. This may pose problems of tolerance and adherence. In such cases, or if there is malabsorption, the intravenous route may be used. On the other hand, excess iron can have equally deleterious effects due to deposits in various organs such as the heart or liver. Its main causes are hemochromatosis and hematologic diseases with ineffective hematopoiesis. Treatment consists of phlebotomy or iron chelation.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 21","pages":"Pages 1234-1242"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trombofilia y trombosis
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.013
M. Hernández Arriaza, M. Velasco Troyano, A. Mendoza Martínez, V. Jiménez Yuste
{"title":"Trombofilia y trombosis","authors":"M. Hernández Arriaza,&nbsp;M. Velasco Troyano,&nbsp;A. Mendoza Martínez,&nbsp;V. Jiménez Yuste","doi":"10.1016/j.med.2024.11.013","DOIUrl":"10.1016/j.med.2024.11.013","url":null,"abstract":"<div><div>Thrombophilia involves a predisposition to venous thromboembolism, which encompasses deep vein thrombosis and pulmonary embolism. It is an important cause of morbidity and mortality. The different thrombophilias can be classified as congenital or acquired. Among congenital thrombophilias, those that merit mention include factor V Leiden deficiency, prothrombin G20210A gene mutation, and the others described below. Among acquired thrombophilias, antiphospholipid syndrome merits mention, given its clinical relevance and prevalence. Its diagnostic criteria have recently been updated. It is essential to identify patients who have had thrombosis, and are thus candidates for thrombophilia screening, in order to reach an accurate diagnosis as soon as possible and establish early anticoagulant treatment to avoid late complications.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 22","pages":"Pages 1309-1318"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de la trombocitosis 血小板增多症诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.10.025
V. Cardos Gómez , C. Vázquez Martínez
{"title":"Protocolo diagnóstico de la trombocitosis","authors":"V. Cardos Gómez ,&nbsp;C. Vázquez Martínez","doi":"10.1016/j.med.2024.10.025","DOIUrl":"10.1016/j.med.2024.10.025","url":null,"abstract":"<div><div>Thrombocytosis is defined as a peripheral blood platelet count above the reference value (more than 450000/μl). Thrombocytosis can be of primary etiology (such as a clonal disorder of the bone marrow, either acquired or congenital), but the most frequent cause is thrombocytosis reactive to other diseases. There is also pseudothrombocytosis due to «errors» in automatic analyzers, in which various blood elements can be misinterpreted as platelets. It is important to make a good differential diagnosis because of the prognostic and therapeutic implications of thrombocytosis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1204-1208"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neoplasias mieloproliferativas crónicas Filadelfia negativas 费城阴性慢性骨髓增生性肿瘤
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.10.020
N. Curto-García , P. Gili Herreros , C. Portocarrero de las Heras Pérez , E. Magro Mazo
{"title":"Neoplasias mieloproliferativas crónicas Filadelfia negativas","authors":"N. Curto-García ,&nbsp;P. Gili Herreros ,&nbsp;C. Portocarrero de las Heras Pérez ,&nbsp;E. Magro Mazo","doi":"10.1016/j.med.2024.10.020","DOIUrl":"10.1016/j.med.2024.10.020","url":null,"abstract":"<div><div>This update discusses in detail the remaining classic myeloproliferative neoplasms (MPNs), called Philadelphia (Ph)-negative chronic MPNs. They include polycythemia vera, essential thrombocythemia, primary myelofibrosis, and other less frequent conditions such as chronic neutrophilic leukemia (CNL) and chronic eosinophilic leukemia (CEL). MPNs are included in the ICC (International Consensus Classification) in the myeloid neoplasms and acute leukemia category, similar to the WHO classification of hematolymphoid neoplasms revised in 2022<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span>.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1157-1170"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alteraciones adquiridas de la coagulación
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.012
A.C. Leal Ferrero, A. Mendoza Martínez, C.I. Morellón Peña, V. Jiménez Yuste
{"title":"Alteraciones adquiridas de la coagulación","authors":"A.C. Leal Ferrero,&nbsp;A. Mendoza Martínez,&nbsp;C.I. Morellón Peña,&nbsp;V. Jiménez Yuste","doi":"10.1016/j.med.2024.11.012","DOIUrl":"10.1016/j.med.2024.11.012","url":null,"abstract":"<div><div>Acquired coagulation disorders are those that occur alongside and develop as a part of hematological, neoplastic, autoimmune, cardiovascular, or hepatic diseases; though they can also originate spontaneously. They usually manifest as a deficit of a coagulation factor or as global hemostasis impairment. Given its variable pathophysiology, the clinical phenotype ranges from mild hemorrhagic symptoms to potentially lethal hemorrhagic manifestations. In most situations, treatment involves addressing the underlying medical condition and includes supportive care to prevent or treat hemorrhagic manifestations.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 22","pages":"Pages 1299-1308"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de las microangiopatías trombóticas
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.014
P. González-Marugán, A. Mendoza Martínez, S.C. Galván Platas, V. Jiménez Yuste
{"title":"Protocolo diagnóstico de las microangiopatías trombóticas","authors":"P. González-Marugán,&nbsp;A. Mendoza Martínez,&nbsp;S.C. Galván Platas,&nbsp;V. Jiménez Yuste","doi":"10.1016/j.med.2024.11.014","DOIUrl":"10.1016/j.med.2024.11.014","url":null,"abstract":"<div><div>Thrombotic microangiopathies (TMA) are a group of conditions characterized by the onset of microangiopathic hemolytic anemia, thrombocytopenia, and variable organ damage. The most important forms of TMA are thrombotic thrombocytopenic purpura (TTP), Shiga toxin-mediated TMA or typical hemolytic-uremic syndrome (HUS), and complement-mediated TMA or atypical HUS (aHUS). Due to its high morbidity and mortality, it is essential to establish an initial suspicion that allows for an early diagnosis and starting appropriate therapeutic measures</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 22","pages":"Pages 1319-1322"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo de anticoagulación en situaciones especiales
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-11-01 DOI: 10.1016/j.med.2024.11.016
G. Maortua Langdon, A. Mendoza Martínez, J.M. Martín de Bustamante González-Iglesias, V. Jiménez Yuste
{"title":"Protocolo de anticoagulación en situaciones especiales","authors":"G. Maortua Langdon,&nbsp;A. Mendoza Martínez,&nbsp;J.M. Martín de Bustamante González-Iglesias,&nbsp;V. Jiménez Yuste","doi":"10.1016/j.med.2024.11.016","DOIUrl":"10.1016/j.med.2024.11.016","url":null,"abstract":"<div><div>Anticoagulant treatment of venous thromboembolism is a major challenge for practitioners. However, there are times when the challenge is even greater, as in the case of some special situations in which anticoagulation requires individualized management due to the potential adverse effects of anticoagulation. These situations include comorbidities that increase the risk of toxicity, such as renal insufficiency, older adult patients, or patients with cancer. In recent years, new anticoagulant therapies have been developed that are more effective and safer for patients. These are of particular interest in these special situations due to their improved safety profile, although they also require specific considerations in these patient subgroups.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 22","pages":"Pages 1327-1330"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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