Anemia Megaloblástica

Descripción General

Definición

La anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types megaloblástica es un subgrupo de anemias macrocíticas que se caracterizan por un aumento del tamaño de los LOS Neisseria eritrocitos y una detención de la maduración nuclear derivada de una división celular anormal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria precursores eritroides.

Epidemiología

• El déficit de folato ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia sido menos común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos debido al AL Amyloidosis enriquecimiento con ácido fólico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria productos grano y uso de vitaminas prenatales.
• Las causas más frecuentes de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types megaloblástica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria países desarrollados son la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa (por déficit de vitamina B₁₂) y los LOS Neisseria medicamentos.

Causas

• Déficit de vitamina B₁₂ (cobalamina):
  • Deficiencia del factor intrínseco ( anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa)
  • Malabsorción (enfermedad de Crohn, enfermedad celíaca, pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis crónica, cirugía gástrica o ileal previa)
  • Dieta vegetariana (vegana)
  • Abuso/toxicidad del óxido nitroso
  • Infestación por Diphyllobothrium Diphyllobothrium Diphyllobothriasis represents an intestinal parasitic infection caused by the cestode Diphyllobothrium. Diphyllobothriasis is acquired by ingestion of late larvae in undercooked or raw fish. The clinical presentation of diphyllobothriasis varies from asymptomatic, nonspecific symptoms to intestinal obstruction, and/or vitamin B12 deficiency. Dibothriocephalus/Diphyllobothriasis latum (tenia de los LOS Neisseria peces)
  • Medicamentos (inmunosupresores, isoniazida, metformina, colchicina, bloqueadores H₂, inhibidores de la bomba de protones)
  • VIH
  • Trastornos genéticos
• Déficit de ácido fólico:
  • Aumento de la demanda: embarazo, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica, dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) crónica, hemodiálisis
  • Alcoholismo
  • Déficit dietético (dietas restringidas, países sin fortificación de los LOS Neisseria alimentos con folato)
  • Medicamentos (antimetabolitos como el metotrexato, las tetraciclinas, las penicilinas, nitrofurantoína, fenobarbital, fenitoína, trimetoprima)
  • Disfunción intestinal: La malabsorción se produce en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cirugía (bypass gástrico).
• Trastornos raros:
  • Aciduria orótica: La deficiencia de la uridina monofosfato sintasa conduce a ↓ de la síntesis de pirimidina de novo que no responde a la sustitución con B₁₂ y folato.
  • Acidemia Acidemia Respiratory Acidosis metilmalónica: error Error Refers to any act of commission (doing something wrong) or omission (failing to do something right) that exposes patients to potentially hazardous situations. Disclosure of Information congénito del metabolismo de los LOS Neisseria aminoácidos

Fisiopatología

Vitamina B₁₂ y ácido fólico

• Vitamina B₁₂ (cobalamina):
  • Fuentes:
    • Productos animales (carnes, especialmente hígado, lácteos, huevos)
    • Alimentos enriquecidos
    • No se encuentra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las plantas
  • Absorción:
    • La vitamina B₁₂ de los LOS Neisseria alimentos está unida a proteínas y se une a las haptocorrinas salivales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estómago.
    • La absorción requiere un entorno ácido (estómago) para disociarse de las proteínas y proteasas pancreáticas para escindir las haptocorrinas.
    • Una vez liberada, la B₁₂ se une al AL Amyloidosis factor intrínseco producido por las células parietales gástricas.
    • El complejo B₁₂–factor intrínseco se absorbe en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el íleon.
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el torrente sanguíneo, la B₁₂ es endocitada por las células.
• Vitamina B₉ (ácido fólico):
  • Fuentes:
    • Productos vegetales (especialmente verduras de hoja verde oscura)
    • Productos animales
  • Absorción:
    • Depende de los LOS Neisseria sistemas de transporte
    • Se absorbe en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el yeyuno (la conjugasa convierte el folato poliglutamato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum monoglutamato)
    • Posteriormente, se reduce a dihidrofolato → tetrahidrofolato → 5,10-metileno tetrahidrofolato → L-5-metil-tetrahidrofolato (forma plasmática predominante)
    • El L-5-metil-tetrahidrofolato es captado por las células.
• Ambos son hidrosolubles (↓ riesgo de sobredosis, ya que se excretan por la orina).
• El déficit de vitaminas surge de condiciones que afectan a la ingesta y a la absorción, y que interfieren con otros factores esenciales (i.e., el factor intrínseco, el sistema de transporte).

La vitamina B₁₂ y el ácido fólico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la síntesis del ADN

• Tanto la B₁₂ como el ácido fólico:
  • Son fundamentales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la síntesis de los LOS Neisseria ácidos nucleicos
  • Actúan como cofactores en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la síntesis del timidilato, el paso limitante de la síntesis del ADN:
    • El folato aporta los LOS Neisseria grupos metilo (a través del metileno-tetrahidrofolato).
    • La B₁₂ es un cofactor en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la reacción que convierte el 5-metil-tetrahidrofolato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tetrahidrofolato.
• Ciclo de la metionina y del ácido fólico con la síntesis del ADN:
  1. El folato dietético se absorbe en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el intestino en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de 5-metil-tetrahidrofolato.
  2. La metionina sintetasa, dependiente de la vitamina B₁₂ convierte el 5-metil-tetrahidrofolato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tetrahidrofolato.
     • El mismo proceso genera metionina a partir de homocisteína.
     • La metionina se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum S-adenosilmetionina ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ciclo de la metionina), que también es necesaria para la metilación del ADN.
  3. El THF producido se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum metileno-tetrahidrofolato.
  4. Un grupo metilo es donado desde el metileno-tetrahidrofolato al AL Amyloidosis 5-carbono del uridilato para formar timidilato (monofosfato de desoximidina).
  5. Como consecuencia de la donación del grupo metilo, el metileno-tetrahidrofolato se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum dihidrofolato.
  6. El dihidrofolato se reduce para regenerar el tetrahidrofolato.

Consecuencias de la síntesis defectuosa del ADN

Las células que se dividen rápidamente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuerpo son las más sensibles a la síntesis de ADN alterada debido al AL Amyloidosis déficit de B₁₂ y folato.

• Deterioro de la eritropoyesis:
  • Cambios megaloblásticos:
    • División nuclear lenta → núcleos inmaduros y anormales + citoplasma normal → asincronía entre maduración nuclear y citoplasmática.
    • Aumento de las figuras mitóticas → metamielocitos gigantes + patrón de cromatina nuclear finamente punteado y con encaje
  • Hemólisis intramedular:
    • Causada por la muerte prematura de precursores eritroides con desarrollo anormal
    • La médula ósea se vuelve hipercelular debido a la apoptosis Apoptosis A regulated cell death mechanism characterized by distinctive morphologic changes in the nucleus and cytoplasm, including the endonucleolytic cleavage of genomic DNA, at regularly spaced, internucleosomal sites, I.e., DNA fragmentation. It is genetically-programmed and serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. Ischemic Cell Damage en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum curso → ↑ hemólisis, ↓ recuento de reticulocitos
• Reducción de la metilación del ADN:
  • Modificación epigenética significativa → grupos metilo añadidos al AL Amyloidosis ADN → da como resultado la modificación de la expresión génica
  • Produce defectos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la reparación y fragmentación del ADN
  • Aumenta la posibilidad de que se produzcan errores de traslación, incluida la posibilidad de transformación maligna
  • Se cree que contribuye a la disfunción neuronal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el déficit de B₁₂:
    • ↓ Metilación de lípidos y proteínas (i.e., la proteína básica de la mielina) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las neuronas
    • ↓ de la proteína básica de la mielina contribuye a la desmielinización.

Presentación Clínica

Manifestaciones Generales

• El déficit de B₁₂ se desarrolla a lo largo de años, mientras que la de folato se desarrolla en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum semanas o meses.
• Dependiendo del grado del déficit y del momento de aparición, los LOS Neisseria pacientes pueden ser asintomáticos.
• Signos y síntomas de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types:
  • Fatiga
  • Falta de aire
  • Taquicardia
  • Palpitaciones
  • Palidez
  • Ictericia
• Síntomas gastrointestinales (relacionados con afecciones gastrointestinales subyacentes, como la enfermedad inflamatoria intestinal):
  • Diarrea
  • Distensión
  • Dolor Dolor Inflammation epigástrico/abdominal

Manifestaciones específicas

• Los LOS Neisseria síntomas neurológicos se deben con mayor frecuencia al AL Amyloidosis déficit de B₁₂:
  • Degeneración combinada subaguda (hallazgo clásico):
    • Columna dorsal: vibración, propiocepción (marcha con base ampliada)
    • Vías corticoespinales laterales: espasticidad
    • Espinocerebelosa dorsal: ataxia Ataxia Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. Ataxia-telangiectasia
  • Neuropatía: parestesia, entumecimiento
  • Psicosis, depresión, irritabilidad
  • Deterioro cognitivo, olvido
  • Demencia
• Hallazgos adicionales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el déficit de B₁₂:
  • Patología de la mucosa oral (presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 50%–60% de los LOS Neisseria pacientes):
    • Glositis
    • Queilitis angular
    • Úlceras orales recurrentes
    • Mucositis Mucositis Stomatitis is a general term referring to inflammation of the mucous membranes of the mouth, which may include sores. Stomatitis can be caused by infections, autoimmune disorders, allergic reactions, or exposure to irritants. The typical presentation may be either solitary or a group of painful oral lesions. Stomatitis eritematosa difusa/atrofia de la mucosa
    • Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la boca/sensación de quemazón
  • Hiperpigmentación cutánea
  • ↑ Riesgo de cáncer gástrico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa
• Déficit de folatos: ↑ riesgo de defectos del tubo neural (anomalía congénita)

Diagnóstico

Antecedentes

• Dieta: vegana o vegetariana
• Antecedentes médicos y sociales: indagar trastornos autoinmunes, alcoholismo
• Antecedentes quirúrgicos: resección gástrica o ileal
• Síntomas gastrointestinales
• Síntomas neurológicos
• Medicamentos

Pruebas de laboratorio

• Pruebas hematológicas:
  • ↓ Hemoglobina/hematocrito
  • Volumen corpuscular medio (VCM) > 100
  • Probable disminución del recuento de leucocitos y/o plaquetas
  • Recuento bajo de reticulocitos
• Niveles de cobalamina/B₁₂ y folato:
  • Déficit:
    • B₁₂/cobalamina baja (normal, > 300 pg/mL)
    • Niveles bajos de folato (normal, > 4 ng/mL)
    • El folato eritrocitario puede ser una alternativa para el nivel de folato (aunque no se utiliza con frecuencia).
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el caso de niveles límite de B₁₂ (200–300 pg/mL) o de folato (2–4 ng/mL), obtener el nivel de homocisteína y de ácido metilmalónico:
    • Nivel de homocisteína en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero: elevado tanto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el déficit de vitamina B₁₂ como de folato
    • Nivel de ácido metilmalónico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero: elevado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum déficit de vitamina B₁₂
• Exámenes adicionales:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa:
    • Anticuerpos contra el factor intrínseco: alta especificidad para la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa
    • Anticuerpos anti-célula parietal Parietal One of a pair of irregularly shaped quadrilateral bones situated between the frontal bone and occipital bone, which together form the sides of the cranium. Skull: Anatomy: pueden estar presentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la gastritis Gastritis Gastritis refers to inflammation of the gastric mucosa. Gastritis may occur suddenly (acute gastritis) or slowly over time (chronic gastritis). Gastritis may be asymptomatic or with symptoms, including burning abdominal pain (which either worsens or improves with eating), dyspepsia, nausea, and vomiting. Gastritis
    • ↑ Niveles de gastrina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero: no son específicos de la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa
  • Aciduria orótica: amoníaco en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina normal con niveles de ácido orótico ↑.
• Frotis de sangre periférica:
  • Macrocitosis
  • Marcada variación del tamaño de los LOS Neisseria eritrocitos: anisocitosis
  • Morfología anormal y variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables de los LOS Neisseria eritrocitos: poiquilocitosis
  • Neutrófilos hipersegmentados:
    • ≥ 1% de neutrófilos con 6 o más lóbulos nucleares, O
    • ≥ 5% de neutrófilos con 5 o más lóbulos nucleares

Estudios adicionales

• Aspirado de médula ósea:
  • No se realiza de forma rutinaria
  • Si se realiza, los LOS Neisseria hallazgos incluyen:
    • Hipercelularidad
    • Predominio eritroide con disminución de la proporción mieloide/eritroide
    • Disincronía citoplasmática nuclear, con núcleos inmaduros combinados con citoplasma de apariencia normal
    • Granulocitos anormales: metamielocitos gigantes y bandas
    • Megacariocitos anormalmente grandes
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria casos graves, pueden observarse cambios displásicos.
• Biopsia gástrica:
  • No es necesario para el diagnóstico de la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa
  • Si se hace HACE Altitude Sickness, revelará una gastritis Gastritis Gastritis refers to inflammation of the gastric mucosa. Gastritis may occur suddenly (acute gastritis) or slowly over time (chronic gastritis). Gastritis may be asymptomatic or with symptoms, including burning abdominal pain (which either worsens or improves with eating), dyspepsia, nausea, and vomiting. Gastritis atrófica autoinmune crónica
• Prueba de Schilling para la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa:
  • Utilizada con poca frecuencia
  • Suplantada por pruebas serológicas de anticuerpos de células parietales y del factor intrínseco

Tratamiento

Bases Bases Usually a hydroxide of lithium, sodium, potassium, rubidium or cesium, but also the carbonates of these metals, ammonia, and the amines. Acid-Base Balance

• Los LOS Neisseria pacientes pueden ser asintomáticos o el déficit puede ser un hallazgo incidental.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria casos, la evolución de los LOS Neisseria síntomas es gradual, por lo que el tratamiento puede administrarse durante semanas.
• Se necesita intervenir urgentemente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria siguientes casos:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types sintomática
  • Manifestaciones neurológicas/neuropsiquiátricas (ya que los LOS Neisseria efectos pueden ser irreversibles)
  • Embarazo (el feto se ve VE Ventilation: Mechanics of Breathing afectado)
  • Neonatos y lactantes (el crecimiento se ve VE Ventilation: Mechanics of Breathing afectado)

Tratamiento

• Vitamina B₁₂:
  • Vía intramuscular/parenteral si hay síntomas neurológicos o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con malabsorción o resecciones gástricas/intestinales extensas
  • Vía oral en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum déficit por baja ingesta dietética o para continuar la suplementación por vía parenteral (si es apropiado)
  • Vigilar la trombocitosis y la hipocalemia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria casos graves.
• Ácido fólico:
  • Comprobar siempre si hay un déficit concomitante de B₁₂.
  • 1–5 mg/día, con la dosis más alta para las mujeres embarazadas, los LOS Neisseria alcohólicos, los LOS Neisseria pacientes con medicamentos antiepilépticos
• El reemplazo puede ser de por vida si la condición subyacente es permanente (e.g., cirugía de derivación gástrica).
• A medida que la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types se resuelve, los LOS Neisseria niveles de hierro pueden agotarse; controlar y reemplazar según sea necesario.
• Tratamiento de otras afecciones asociadas:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types perniciosa: además de la reposición, tamizaje del cáncer gástrico
  • Triacetato de uridina: para la aciduria orótica

Diagnóstico Diferencial

• Alcoholismo y enfermedad hepática alcohólica: El alcohol es una de las principales causas de macrocitosis, por lo general debido a un efecto tóxico directo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria eritrocitos (sin daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la replicación del ADN). El alcoholismo crónico también provoca enfermedades hepáticas, que van desde el hígado graso hasta la cirrosis. El tratamiento tiene como objetivo la abstinencia alcohólica para la reversión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ciertas etapas; tratar los LOS Neisseria factores contribuyentes, como las infecciones virales o los LOS Neisseria medicamentos; y minimizar el daño a los LOS Neisseria hepatocitos.
• Enfermedad hepática crónica: La cirrosis es la etapa tardía de la necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage y cicatrización hepática. El daño celular crónico provoca una amplia distorsión de la arquitectura hepática normal, lo que puede provocar una alteración del flujo sanguíneo normal a través del hígado. Las enfermedades hepáticas crónicas de diversas etiologías pueden causar anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types macrocítica debido a los LOS Neisseria efectos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la composición lipídica de los LOS Neisseria eritrocitos.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types mielodisplásica: grupo de neoplasias hematológicas debidas a mutaciones de la línea germinal, asociadas a una o más citopenias, incluida la anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types macrocítica. Se observan cambios displásicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la biopsia de médula ósea, como granulocitos hiposegmentados y blastos. El análisis citogenético que identifica las mutaciones relacionadas con la enfermedad mielodisplásica ayuda a establecer el diagnóstico.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types aplásica: insuficiencia de la médula ósea caracterizada por la ausencia de precursores eritroides debido a la exposición a medicamentos, radiaciones, sustancias químicas, virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology, enfermedades autoinmunes o factores genéticos (hereditarios o adquiridos): La médula ósea es hipocelular, con celularidad < 30%. Algunas citopenias afectan ≥ 2 líneas celulares.
• Hipotiroidismo: enfermedad caracterizada por una deficiencia de hormonas tiroideas. La deficiencia de yodo es la causa más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todo el mundo, pero la enfermedad de Hashimoto (tiroiditis autoinmune) es la principal etiología en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las regiones sin deficiencia de yodo. Las características del hipotiroidismo adquirido incluyen fatiga, bradicardia, intolerancia al AL Amyloidosis frío y disnea de esfuerzo. El diagnóstico se realiza mediante pruebas de la función tiroidea. Se observa una elevación de la hormona estimulante de la tiroides y una disminución de la tiroxina libre (T₄). El tratamiento es con T₄ sintética. La anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types macrocítica se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 55% de los LOS Neisseria pacientes con hipotiroidismo.