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\fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-333\slmult0 \fs24\cf1\f2\charscalex100\b \ul {ALTERACIONES PLAQUETARIAS. }\b0 \ul0 \par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {1.}\b0 \tab \fs24\cf0\f2\charscalex100\b {Los pacientes con Prpura Trombopnica Autoinmune, se tratan inicialmente }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {exclusivamente con corticosteroides, pero en situaciones especiales se asocia al}\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100\b {tratamiento altas dosis de gammaglobulina por va endovenosa. En cul de las }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {siguientes situaciones puede estar indicado el uso de gammaglobulina?: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Pacientes mayores de 60 aos. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Cuando la cifra de plaquetas es inferior a 5 x 109/L. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) En las pacientes gestantes con Prpura Trombopnica Autoinmune. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {4) Brotes hemorrgicos graves}\b0 \fs24\cf0\f2\charscalex100 {. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Si el paciente es hipertenso. }\par\pard\li1026\ri0\sl-426\slmult0 \fs24\cf1\f2\charscalex100\b {Fundamente su respuesta: }\b0 \par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Porque en los pacientes con hemorragia activa grave se requiere una respuesta rpida de 3 }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {das. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {2.}\b0 \tab \fs24\cf0\f2\charscalex100\b {Los pacientes con trombocitopenia autoinmune presentan: }\b0 \par\pard\li1733\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {1) Una trombopenia de origen central. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Un tiempo de Ivy (hemorragia) normal. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Un trastorno asociado a la agregacin plaquetaria en ms del 50% de los casos. }\par\pard\li1733\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {4) Una mdula sea con aumento de megacariocitos. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Hasta en un 30% de los casos anticuerpos antifosfolpidos cuando el paciente es }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {mujer. }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf1\f2\charscalex100\b { Fundamente su respuesta: }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {Estos pacientes presentan una sobrevida intravascular ms corta que las plaquetas por }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {secuestro esplnico o destruccin causada por anticuerpos. 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\fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-360\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {3.}\b0 \tab \fs24\cf0\f2\charscalex100\b {Seale cul de las siguientes respuestas resume las caractersticas fundamentales }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {de la prpura Trombopnica idioptica aguda: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Edad adulta, curso crnico, no asociacin con enfermedad viral. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Edad peditrica, alta tasa de anticuerpos antiplaquetas en suero, recuperacin}\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {rpida tras tratamiento con glucocorticoides. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Cualquier edad, rpida respuesta al tratamiento, asociacin con otras }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {enfermedades autoinmunes. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4) Edad adulta, recuento de plaquetas muy bajo, rpida respuesta al tratamiento. }\par\pard\li1733\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {5) Edad peditrica, recuperacin rpida y completa, asociacin con }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {enfermedad viral. }\b0 \par\pard\li1400\ri0\sl-400\slmult0 \fs24\cf1\f2\charscalex100\b {Fundamente su respuesta: }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {La PTI aguda es ms frecuente en nios entre los 2 -8 aos de edad suele estar asociado }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a un episodio infeccioso desencadenante. Tiene tendencia a la remiflan espontaneo. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {4.}\b0 \tab \fs24\cf0\f2\charscalex100\b {En un episodio agudo de prpura trombocitopnica idioptica con nmero muy}\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100\b {bajo de plaquetas y riesgo grave de sangrado, el tratamiento de eleccin para }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {elevar lo ms rpidamente posible el nmero de plaquetas ser: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Gammaglobulina i.v. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Corticosteroides a altas dosis por va i.m. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {3) Corticosteroides a altas dosis por va i.v. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4) Inmunosupresores. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Esplenectoma. }\par\pard\li1520\ri0\sl-413\slmult0 \fs24\cf1\f2\charscalex100\b {Fundamente su respuesta: }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {Los corticosteroides a altas dosis endovenosa, elevan las plaquetas a los 5 das con una }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {ta}\fs24\cf0\f2\charscalex100 {sa de respuesta alta y mantenida. 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