Neutropenia: un vistazo a su etiología y abordaje clínico
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Figueroa Protti, Lucía
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Abstract
La neutropenia se define como un recuento absoluto de
neutrófilos (RAN) menor a 1 500 células/μl. Puesto que
los neutrófilos proveen protección contra una variedad
amplia de hongos y bacterias, la frecuencia y la severidad
de las infecciones por estos microorganismos son mayores
en pacientes neutropénicos; cuanto más bajo sea el RAN
y más larga la duración de la neutropenia, hay más riesgo.
Sin embargo, la severidad de la neutropenia también
depende de otros factores que pueden influenciar la
susceptibilidad a infección, como la rapidez de la aparición de la neutropenia, la reserva mieloide en médula ósea, el conteo de monocitos y linfocitos absolutos circulantes, el estado funcional de los fagocitos, la concentración de inmunoglobulinas en suero, la integridad de la piel y las membranas mucosas, la irrigación vascular a los tejidos y el estado nutricional del paciente. Todos estos factores dependerán de la enfermedad subyacente que provoque la neutropenia, la cual puede ser desde un desorden en la producción de neutrófilos, como la neutropenia congénita severa, la neutropenia cíclica, la neutropenia en pacientes con cáncer o producto de inmunodeficiencias o enfermedades metabólicas, hasta un desorden en la distribución o utilización de neutrófilos, como lo son la neutropenia autoinmune, la neutraopenia inducida por medicamentos, la neutropenia producto de enfermedades infecciosas o autoinmunes, o incluso de causa idiopática. Cada una de estas posibles causas representa un riesgo mayor o menor de que el paciente desarrolle un cuadro infeccioso severo; por consiguiente, la identificación de la enfermedad subyacente en cualquier paciente neutropénico es de suma importancia. Para esto, es necesario un abordaje clínico que incluya historia familiar y personal, examinación física y pruebas de laboratorio, así como el análisis de la reserva de progenitores en médula ósea.
Neutropenia is defined as the reduction in the absolute number of neutrophils in the blood circulation below 1 500/μl. Since neutrophils provide protection against a wide variety of bacterial and fungal pathogens, the frequency and severity of infections caused by these organisms is increased in patients with neutropenia; the lowest and longer the neutropenia, the greater the risk of infection. Nevertheless, neutropenia severity also depends on some other factors that can influence this risk, such as the myeloid reserve in the bone marrow, the absolute count of circulating monocytes and lymphocytes, the phagocytes functionality, the immunoglobulins concentration, the integrity of skin and mucous membranes, the vascular supply to tissues, and the nutritional status of the patient. All of these factors will rely on the subjacent disorder or disease that is causing the neutropenia: it can be a disorder that affects the neutrophil production in the bone marrow, such as severe congenital neutropenia, cyclic neutropenia, cancer, an immunodeficiency, or metabolic diseases; on the other hand, it can be a disorder in the distribution or utilization of neutrophils in peripheral blood, for example autoimmune neutropenia, drug-induced neutropenia, idiopathic neutropenia, or in patients with other autoimmune diseases. Each one of these conditions represents a higher or lower risk for the development of severe infectious diseases; therefore, the determination of the underlying cause of a low absolute number of neutrophils in the blood circulation requires an exhaustive clinical approach that includes familiar and personal history, physical examination, general and specific lab test, as well as the examination of the bone marrow progenitors.
Neutropenia is defined as the reduction in the absolute number of neutrophils in the blood circulation below 1 500/μl. Since neutrophils provide protection against a wide variety of bacterial and fungal pathogens, the frequency and severity of infections caused by these organisms is increased in patients with neutropenia; the lowest and longer the neutropenia, the greater the risk of infection. Nevertheless, neutropenia severity also depends on some other factors that can influence this risk, such as the myeloid reserve in the bone marrow, the absolute count of circulating monocytes and lymphocytes, the phagocytes functionality, the immunoglobulins concentration, the integrity of skin and mucous membranes, the vascular supply to tissues, and the nutritional status of the patient. All of these factors will rely on the subjacent disorder or disease that is causing the neutropenia: it can be a disorder that affects the neutrophil production in the bone marrow, such as severe congenital neutropenia, cyclic neutropenia, cancer, an immunodeficiency, or metabolic diseases; on the other hand, it can be a disorder in the distribution or utilization of neutrophils in peripheral blood, for example autoimmune neutropenia, drug-induced neutropenia, idiopathic neutropenia, or in patients with other autoimmune diseases. Each one of these conditions represents a higher or lower risk for the development of severe infectious diseases; therefore, the determination of the underlying cause of a low absolute number of neutrophils in the blood circulation requires an exhaustive clinical approach that includes familiar and personal history, physical examination, general and specific lab test, as well as the examination of the bone marrow progenitors.
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Keywords
Neutropenia, Neutropenia severa, Neutropoyesis hipoplásica, Neutropoyesis inefectiva, Neutropenia congénita, Neutropenia cíclica, Neutropenia en cáncer, Neutropenia autoinmune, Neutropenia idiopática, Neutropenia en enfermedades infecciosas, Severe neutropenia, Hypoplastic neutropoiesis, Ineffective neutropoiesis, Congenital neutropenia, Cyclic neutropenia, Neutropenia in cancer, Autoimmune neutropenia, Idiopathic neutropenia, Neutropenia in infectious diseases
Citation
http://revista.microbiologos.cr/wp-content/uploads/2018/06/Revista-Vol-22-N-1-2016.pdf