[
    {
        "page": 1,
        "title": "Anemias Cap 474",
        "body": "<p>\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<xml>\n \n  \n \n<\/xml>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  <\/xml><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Anemias<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">La anemia es la reducci\u00f3n de la concentraci\u00f3n\nde hemoglobina o del volumen de eritrocitos por debajo de los valores normales\nestablecidos seg\u00fan edad, sexo y raza. Los valores de hemoglobina y hematocrito\npueden variar considerablemente entre diferentes poblaciones. A nivel global,\nla anemia es un problema significativo de salud, especialmente en ni\u00f1os y\nmujeres en edad f\u00e9rtil.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Clasificaci\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Las anemias pueden clasificarse seg\u00fan varios\ncriterios:<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ol start=\"1\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Morfolog\u00eda:<\/span><\/b><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Microc\u00edticas<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n      &quot;Times New Roman&quot;,serif\">: VCM\n      bajo (ej., ferropenia, talasemia).<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Normoc\u00edticas<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n      &quot;Times New Roman&quot;,serif\">: VCM\n      normal (ej., anemia de enfermedades cr\u00f3nicas).<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Macroc\u00edticas<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n      &quot;Times New Roman&quot;,serif\">: VCM\n      alto (ej., deficiencia de vitamina B12, \u00e1cido f\u00f3lico).<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Causas fisiol\u00f3gicas:<\/span><\/b><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Disminuci\u00f3n de la producci\u00f3n<\/span><\/b><span style=\"font-size:\n      12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:\n      Eritropoyesis ineficaz o insuficiente.<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Aumento de la destrucci\u00f3n o p\u00e9rdida<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Hem\u00f3lisis, secuestro o hemorragia.<\/span><\/li>\n <\/ul>\n<\/ol>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Etiolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Las principales causas de anemia incluyen:<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Deficiencias nutricionales<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Ferropenia, deficiencia de vitamina B12 y \u00e1cido f\u00f3lico.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Trastornos gen\u00e9ticos<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Talasemias, hemoglobinas anormales, esferocitosis hereditaria.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Enfermedades cr\u00f3nicas<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Enfermedades inflamatorias, insuficiencia renal.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciones<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     Malaria, tuberculosis.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Trastornos de la m\u00e9dula \u00f3sea<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Anemia apl\u00e1sica, s\u00edndromes de Blackfan-Diamond, leucemias.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Factores de\nRiesgo<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Edad y sexo<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     Ni\u00f1os y mujeres en edad f\u00e9rtil son los grupos m\u00e1s afectados.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Etnicidad<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Diferencias significativas entre grupos\n     raciales.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Condiciones m\u00e9dicas subyacentes<\/span><\/b><span style=\"font-size:\n     12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:\n     Enfermedades cr\u00f3nicas, trastornos hematol\u00f3gicos heredados.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Fisiopatolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">La fisiopatolog\u00eda de la anemia depende de su\ncausa subyacente:<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Anemia ferrop\u00e9nica<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Reducci\u00f3n de hierro disponible para la producci\u00f3n de hemoglobina.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Anemia megalobl\u00e1stica<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Deficiencia de vitamina B12 o \u00e1cido f\u00f3lico, que altera la s\u00edntesis de ADN\n     y la maduraci\u00f3n de los eritrocitos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hem\u00f3lisis<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Destrucci\u00f3n acelerada de los\n     eritrocitos, como en la anemia hemol\u00edtica autoinmune o las\n     hemoglobinopat\u00edas.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Manifestaciones\nCl\u00ednicas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">S\u00edntomas comunes<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Palidez, fatiga, irritabilidad, disminuci\u00f3n de la tolerancia al ejercicio.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Signos graves<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     Taquicardia, taquipnea, debilidad, insuficiencia card\u00edaca.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hallazgos espec\u00edficos<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Ictericia, esplenomegalia, hepatomegalia, edema, soplo card\u00edaco.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">El diagn\u00f3stico de la anemia se basa en:<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Evaluaci\u00f3n cl\u00ednica<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Historia m\u00e9dica detallada y examen f\u00edsico.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Pruebas de laboratorio<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Hemoglobina, hematocrito, recuento de reticulocitos, \u00edndice de\n     anisocitosis, y examen de extensi\u00f3n de sangre perif\u00e9rica.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Clasificaci\u00f3n seg\u00fan VCM y reticulocitos<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Ayuda a determinar la causa subyacente.<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VCM bajo y reticulocitos normales: ferropenia, talasemia.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VCM normal y reticulocitos bajos: enfermedades cr\u00f3nicas.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VCM alto y reticulocitos elevados: hem\u00f3lisis activa, trastornos\n      megalobl\u00e1sticos.<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tratamiento<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">El tratamiento de la anemia depende de la\ncausa subyacente:<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ferropenia<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     Suplementos de hierro orales o intravenosos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Deficiencia de vitamina B12 o \u00e1cido f\u00f3lico<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Suplementos de vitamina B12 o \u00e1cido f\u00f3lico.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Anemia hemol\u00edtica<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Tratamiento espec\u00edfico seg\u00fan la causa, como inmunosupresores o terapia\n     transfusional en casos graves.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Trastornos gen\u00e9ticos<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     Manejo especializado como en las talasemias, incluyendo transfusiones\n     peri\u00f3dicas y quelantes de hierro.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Complicaciones<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Card\u00edacas<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Insuficiencia card\u00edaca de alto gasto,\n     hipertensi\u00f3n pulmonar.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neurol\u00f3gicas<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     Fatiga cr\u00f3nica, alteraciones cognitivas (particularmente en deficiencia de\n     B12).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciosas<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     Mayor susceptibilidad a infecciones debido a la alteraci\u00f3n de la funci\u00f3n\n     inmunitaria.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p class=\"MsoNormalM\">&nbsp;<\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<br \/>",
        "footer": "P\u00e1gina 1"
    }
]