Anemia Aplásica En Adulto, Cuadro clínico, Diagnóstico Y Tratamiento; Reporte de caso
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Date
2024-11
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad de El Salvador
Abstract
Presentación de caso. Paciente masculino de 51 años de edad con historia de 2 meses de presentar gingivorragia y notar palidez, se observa equimosis en región de hombro derecho, se realiza hemograma en el cual se observa afectación de las 3 líneas sanguíneas, se da referencia a hospital de segundo nivel, paciente acude donde hematólogo quien realiza exámenes de laboratorio, aspirado de medula ósea y citometría de flujo diagnosticándole anemia aplásica idiopática. Intervención terapéutica. inicia esquema terapéutico ambulatorio con Ciclosporina 100mg, 1 tableta cada 12 horas y Prednisolona 10mg por 15 días, además se agrega danazol 20mg/tab. Evolución del paciente. Paciente presento mejoría clínica sin embargo se suspende danazol por presentar efectos adverso, posteriormente hospitaliza y se inicia terapia antitimocitos [equina] 50ml y se realizan transfusión de hemoderivados se da alta con aislamiento domiciliar, se deja cita para exámenes, en los cuales se observa persistencia de trombocitopenia por lo que se agrega Eltrombopag el cual se suspende por efectos adversos y debido a ello se realiza transfusión de concentrado de plaquetas, se inicia nuevamente terapia combinada con Eltrombopag 50mg y ciclosporina 100mg a la cual ha tenido buena respuesta terapéutica.
Case presentation. A 51-year-old male patient with a 2-month history of bleeding gums and pallor was noted. Bruising was observed in the right shoulder region. A complete blood count was performed which showed involvement of all 3 blood lines. The patient was referred to a second level hospital. He went to a hematologist who performed laboratory tests, bone marrow aspiration and flow cytometry, diagnosing him with idiopathic aplastic anemia. Therapeutic intervention. He was started on an outpatient therapeutic regimen with Cyclosporine 100 mg, 1 tablet every 12 hours and Prednisolone 10 mg for 15 days, and Danazol 20 mg/tab was added. Patient evolution. The patient showed clinical improvement, however, danazol was discontinued due to adverse effects. The patient was subsequently hospitalized and anti-thymocyte [equine] therapy was started (50 ml) and a transfusion of blood derivatives was performed. The patient was discharged with home isolation. An appointment was made for tests, in which persistent thrombocytopenia was observed, so Eltrombopag was added, which was discontinued due to adverse effects and a transfusion of platelet concentrate was performed. Combined therapy was started again with Eltrombopag 50 mg and cyclosporine 100 mg, to which there was a good therapeutic response.
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Keywords
Anemia aplásica, Anemia aplásica idiopática, Eltrombopag terapia antitimocito equina, Ciclosporina., aplastic anemia, Aplastic anemia idiopathic, Eltrombopag, Equine antithymocyte therapy, Cyclosporine