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Anemia hemolítica causada por químicos y toxinas

La anemia hemolítica causada por químicos y toxinas es una falta de glóbulos rojos que ocurre cuando estos resultan dañados de manera excesiva por ciertos químicos o toxinas.
Causas
Las posibles sustancias que pueden causar la anemia hemolítica abarcan: * Fármacos antipalúdicos (compuestos de quinina) * Arsénico * Dapsona * Infusión de agua intravenosa (que no sea medio normal salina ni normal salina) * Metales (cromo/cromatos, sales de platino, compuestos de níquel, cobre, plomo, cisplatino) * Nitritos * Nitrofurantoína * Penicilina * Fenazopiridina (Pyridium) * Inmunoglobulina Rho (WinRho) * Ribavirina * Mordeduras de serpiente (el veneno de algunas serpientes contiene toxinas hemolíticas) * Sulfamidas * Sulfonas
Esta lista no las incluye a todas.

1.2 Eliptocitosis Congénita
Es una membranopatía que tiene como patrón característico la presencia de glóbulos rojos ovalado o elipticos, hallazgo que hasta la fecha es el principal criterio diagnóstico. Se transmite por herencia autosómica dominante y su frecuencia es de 1 x 5 000 RNV. La enfermedad tiene un notable polimorfismo clínico y molecular. Las mutaciones causantes del cuadro se pueden hallar en tres genes diferentes: 1 espectrina, espectrina y proteína 4,1(1,2).
Manifestaciones Clínicas
La eliptocitosis congénita se puede clasificar en cuatro grupos:
a. Eliptocitosis congénita común.
b. Piropoiquilocitosis congénita.
c. Eliptocitosis congénita esferocítica.
d. Eliptocitosis congénita estomatocítica.
A continuación se describe las características más saltantes de la Eliptocitosis congénita común. Se trata de la variante más frecuente y sus manifestaciones pueden presentar diferente grado de intensidad. Así pues, hay personas afectadas que no presentan síntomas hasta aquellas que expresan un cuadro hemolítico intenso. Este último, se caracteriza por una marcada anemia con esplenomegalia y laboratorialmente, en el frotis de sangre periférica se observan eliptocitos, ovalocitos y dacriocitos (1,2).
Diagnóstico
En el hemograma se encuentra la presencia de eliptocitos (eritrocitos con relación diámetro longitudinal/ transversal > 1) en porcentajes mayores al 12%. El diagnóstico definitivo se hace con el análisis del ADN para identificar el tipo de mutación (1,2).
Tratamiento
La esplenectomía sigue siendo el único tratamiento eficaz aún cuando la respuesta no es tan completa como en la esferocitosis hereditaria (1,2).
Anemia Hemolítica congénita: Eliptocitosis Congénita
Publicado el diciembre 21, 2011 de Doctor'sMagazine
Introducción
Las anemias hemolíticas congénitas se deben a la alteración hereditaria de la síntesis de las proteínas que constituyen la membrana del hematíe (membranopatías), de las enzimas que intervienen en su metabolismo energético (enzimopatías) o de la hemoglobina (Hb), ya sea por su alteración cualitativa (hemoglobinopatías estructurales), cuantitativa (talasemias) o ambas (hemoglobinopatías talasémicas). Son muchas las patologías englobadas en este grupo de anemias, con una importante variabilidad clínica, desde las formas asintomáticas, hasta las incompatibles con la vida, en función del grado de expresión genética. El diagnóstico suele ser complejo, siendo necesario un exhaustivo estudio del paciente y su familia, con el empleo de técnicas básicas como la observación del frotis manual y otras, que en ocasiones sólo están disponibles en laboratorios especializados y que en muchos casos resultan imprescindibles para establecer el diagnóstico definitivo.
Membranopatías
La principal característica de los hematíes en su función de transporte de oxígeno es la deformabilidad.A ello contribuyen las proteínas del eritrocito (de membrana y del citoesqueleto), entre las que se producen dos tipos de interacciones :
1. Horizontales: entre las distintas proteínas del citoesqueleto ( α y β espectrina, proteína 4.1 y actina), proporcionando estabilidad global al eritrocito.
2. Verticales: entre la espectrina y las proteínas que la unen a la bicapa lipídica (anquirina, proteína 4.2 y banda 3).
Fisiopatología
La eliptocitosis congénita (EC) se caracteriza por la presencia de hematíes con forma ovalada o elíptica en la extensión de sangre periférica, como consecuencia de la inestabilidad del esqueleto de membrana debida a la alteración cualitativa o cuantitativa de sus proteínas, que impiden la formación de tetrámeros de espectrina. Así, el eritrocito pierde la capacidad para recuperar su forma tras una deformación longitudinal. La causa más frecuente de EC es la deficiencia de α -espectrina (60%), seguida de la deficiencia de proteína 4.1 (20-30%), β -espectrina y glucoforina C.
Epidemiología
La EC sigue un patrón de herencia autosómico dominante, con mayor incidencia en áreas de paludismo endémico (30%) debido a la resistencia que ofrecen los eliptocitos a la infección por Plasmodium falciparum; en España la incidencia es del 0,3%.
Clínica
Al igual que la EH, presenta una importante variabilidad genética y molecular, lo que se traduce en una gran variabilidad clínica, aunque a diferencia de ésta, los casos asintomáticos y las formas leves son más frecuentes. Según la expresión clínica podemos distinguir:
Eliptocitosis congénita común. Es la forma más frecuente, con manifestaciones de intensidad variable, desde las formas asintomáticas en portadores heterocigotos de la mutación que se observan principalmente en áreas de paludismo endémico, hasta la piropoiquilocitosis congénita, con clara predisposición por la raza negra, que cursa con anemia intensa de inicio neonatal, con marcada alteración de la morfología eritrocitaria, descenso del volumen corpuscular medio (VCM) y aumento de la curva de distribución eritrocitaria. Existe una forma especial, la piropoiquilocitosis infantil, con una marcada ictericia neonatal que mejora al ser la HbF sustituida por HbA, convirtiéndose entonces en EC común asintomática o moderada.
Eliptocitosis congénita esferocítica o eliptocitosis esferocítica. Es exclusiva de individuos de raza blanca. Cursa con hemólisis leve a moderada, con eliptocitos y esferocitos de diferente tamaño. La esplenectomía puede mejorar parcialmente el cuadro.
Ovalocitosis del sudeste asiático o eliptocitosis estomatocítica. Exclusiva de esta área geográfica, se transmite con patrón de herencia autosómico dominante y generalmente carece de clínica.
Diagnóstico
El diagnóstico se basa en la historia familiar, en el examen morfológico de sangre periférica, donde se observan eliptocitos de núcleo excéntrico, y en ocasiones ovalocitos, y en la prueba de estabilidad térmica de membrana, aunque el diagnóstico definitivo lo proporciona el estudio molecular, ya que al igual que los esferocitos, los eliptocitos no son patognomónicos y pueden detectarse en talasemias, anemias carenciales, síndromes mielodisplásicos e incluso en personas sanas.
Tratamiento
El tratamiento es similar al de la EH, aunque necesario en menos ocasiones. La esplenectomía es el único tratamiento eficaz, pero la respuesta es peor a la observada en la EH.

ANEMIA DEL DEPORTISTA
Muchas de las denominadas "bajadas de forma física" de los deportistas coinciden con un cuadro clínico caracterizado por una disminución relativa de sus glóbulos rojos, a la que se denominó "anemia del deportista", se observa fundamentalmente en aquellos deportistas que ejercen actividades de resistencia y en aquellos que entrenan con gran intensidad y elevadas cargas. Característico también en corredores por el impacto de repetición.

Existen muchos tipos de anemias, pero la que padece del deportista más frecuentemente es la ferropénica. El hierro es vital para el buen funcionamiento de la cadena respiratoria puesto que constituye el núcleo central de la molécula de hemoglobina.
Las causas de la anemia del deportista son:
Insuficiente aporte de hierro a través de la dieta: frecuente en los deportistas que siguen dietas vegetarianas no correctamente balanceadas. También por un aumento excesivo en el consumo de carbohidratos en detrimento de las proteínas, principalmente de origen animal.
La disminución de la absorción intestinal, que se ve dificultada por un aumento de los movimientos peristálticos intestinales como consecuencia del trabajo muscular intenso, lo que provoca la consiguiente aceleración del tránsito del contenido intestinal, con lo que disminuye el tiempo de absorción.
La reducción de la capacidad de utilización del hierro: se cree que se produce por la elevación de la temperatura corporal, generada por el trabajo muscular, que interfiere en los procesos en que el hierro orgánico ha de estar disponible para la producción de hemoglobina y de glóbulos rojos.
Las pérdidas extraordinarias de hierro: además de la pérdida diaria considerada como fisiológica, el deportista puede presentar pérdidas muy superiores por la sudoración profusa, hematuria de esfuerzo, microlesiones que genera todo ejercicio físico a partir de una cierta intensidad y aumento de la acidez de la sangre secundaria al incremento de la concentración de ácido láctico.
A todas estas causas de anemia en el deportista hay que añadir el hecho de que el ejercicio físico intenso incrementa las demandas de hierro, con el fin de cubrir las consecuentes adaptaciones metabólicas celulares por el aumento de actividad de las sustancias en la que está implicado este elemento y que son la producción de ATP y de mioglobina.
Deficiencia de vitamina B12, anemia aquílica macrocítica o anemia perniciosa es una disminución en los glóbulos rojos que ocurre cuando el cuerpo no puede absorber apropiadamente la vitamina B12 del tubo digestivo. Esta vitamina es necesaria para el desarrollo apropiado de los glóbulos rojos.
La anemia perniciosa es un tipo de anemia megaloblástica.
Ver también: anemia
-------------------------------------------------
SÍNTOMAS DE LA DEFICIENCIA DE VITAMINA B12
Las personas con anemia leve pueden no tener síntomas o pueden ser muy leves. Los síntomas más típicos de la anemia por deficiencia de vitamina B12 abarcan: * Diarrea o estreñimiento * Fatiga, falta de energía o mareo al pararse o hacer esfuerzo * Inapetencia * Piel pálida * Problemas de concentración * Dificultad para respirar, sobre todo durante el ejercicio * Inflamación y enrojecimiento de la lengua o encías que sangran * El daño a nervios causado por deficiencia de vitamina B12 que ha estado presente por mucho tiempo abarca: * confusión o cambio en el estado mental (demencia) en casos graves o avanzados * Depresión * Pérdida del equilibrio * Hormigueo y entumecimiento de manos y pies
-------------------------------------------------
CAUSAS DE LA DEFICIENCIA DE VITAMINA B12
El cuerpo necesita vitamina B12 para producir glóbulos rojos. Con el fin de suministrar vitamina B12 a sus células, usted debe consumir suficientes alimentos que contengan dicha vitamina, tales como carne de res, carne de aves, mariscos, huevos y productos lácteos.
Para absorber la vitamina B12, su cuerpo usa una proteína especial, llamada factor intrínseco, secretado por células en el estómago. La combinación de vitamina B12 adherida al factor intrínseco se absorbe en la última parte del intestino delgado.
Cuando el estómago no produce suficiente factor intrínseco, el intestino no puede absorber la vitamina en forma apropiada.
En muy raras ocasiones, los bebés y los niños nacen sin la capacidad de producir factor intrínseco suficiente o la capacidad para absorber la combinación de factor intrínseco y vitamina B12 en el intestino delgado. La anemia perniciosa que ocurre al nacer (congénita) es hereditaria. Se necesita un gen defectuoso de cada padre para adquirirla.
Las causas más comunes de anemia perniciosa abarcan: * Debilitamiento del revestimiento del estómago (gastritis atrófica) * El sistema inmunitario del cuerpo ataca las células que producen el factor intrínseco (autoinmunidad contra las células parietales gástricas) o al factor intrínseco en sí
La enfermedad comienza lentamente y puede tardar décadas en establecerse por completo. Aunque la forma congénita ocurre en niños, la anemia perniciosa por lo general no aparece antes de los 30 años en adultos y la edad promedio del diagnóstico es a los 60 años.
Los factores de riesgo abarcan: * Antecedentes familiares de la enfermedad * Antecedentes de enfermedades endocrinas autoinmunitarias, incluyendo: * Enfermedad de Addison * Tiroiditis crónica * Enfermedad de Graves * Hipoparatiroidismo * Hipopituitarismo * Miastenia grave * Amenorrea secundaria * Diabetes tipo 1 * Disfunción testicular * Vitiligo * Origen escandinavo o europeo nórdico
Ver también: anemia por deficiencia de vitamina B12 para conocer otras causas de los niveles bajos de esta vitamina.
-------------------------------------------------
EXÁMENES Y PRUEBAS DE LA DEFICIENCIA DE VITAMINA B12
Los exámenes que se pueden emplear para diagnosticar o controlar la anemia perniciosa abarcan: * Análisis de médula ósea (sólo es necesario si el diagnóstico no está claro) * Conteo sanguíneo completo (CSC) * Medición de la holotranscobalamina II sérica * Conteo de reticulocitos * Análisis de Schilling * Deshidrogenasa láctica en suero * Medición del nivel de ácido metilmalónico (AMM) * Nivel de vitamina B12 en suero
Esta enfermedad también puede afectar los resultados de los siguientes exámenes: * Bilirrubina * Análisis de colesterol * Gastrina * Fosfatasa alcalina leucocítica * Frotis periférico * Capacidad total de fijación de hierro (CTFH)
La deficiencia de vitamina B12 afecta la apariencia de las células que se forman en la superficie externa del cuerpo y recubren conductos internos (células epiteliales). Una mujer sin tratamiento puede tener un resultado falso positivo en su citología vaginal.

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...Name Instructor Subject Date Iron Deficiency Anemia Anemia, is a condition which the body has less red blood cells as required (Killip 671). Anemia also occurs if the red blood cells does not have enough hemoglobin. Hemoglobin helps the red blood cells to carry oxygen from the lungs to the other parts of the body. It is protein in nature and rich in iron. When one is suffering from anemia the cells in their body might not receive enough supply of oxygen. The most common symptom of anemia is fatigue (Killip 671). This is because the body organs may not be getting enough of what they need to function properly. There are over 400 different types of anemia but are divided into three groups due to their causes. There is anemia caused due to blood loss, there is anemia caused by faulty or decreased red blood cells production and there is anemia caused by the destruction of the red blood cells (Killip 671). All of these anemia`s have different causes and treatment. There are some anemia that are considered normal like the anemia that develops during pregnancy, though some different types can cause lifelong health problems (Killip 671). The most common type of anemia is the iron deficiency anemia. This is a disease which can be treated with diet changes and iron supplements (Killip 671). Iron deficiency anemia in many cases occurs to a person who has lower than the required or normal red blood cells in their blood (Leung et al 376). Cases that can contribute to a person having...

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...2014 Case Study #1 Anemia is a diagnosis given to individuals with low red blood cells. There are many different forms of anemia; some even cause the abnormal shape or size of the cells (Merck & Co., 2005). Physicians will diagnosis and treat anemia by assessing patient complaints, medical history and physical symptoms. This response will discuss objective and subjective data, and laboratory results to formulate a diagnosis and treatment plan of a patient. Subjective Data 26 year old Caucasian female, Ms. A., arrived at emergency room (ER) with complaints of a decrease in energy and her hobby of golf, along with increasing light headedness, general malaise, and dyspnea. She states her first bout of light headedness began while in a higher elevation on a golf course. Ms. A also reports having had dysmenorrhea and menorrhagia for the last 10-12 years, and that the noted symptoms seem to increase during her menses cycle. Ms. A also reports using 1000mg of aspirin every 3-4 hours throughout the 6 days of her menses cycle. She reports also using said dose of aspirin to relieve stiff joints when golfing....

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