Exanguinotransfusión parcial en pacientes con anemia de células falciformes: estandarización y eficacia de un nuevo protocolo
Partial exchange transfusion protocol for patients with sickle cell disease: Standardization and efficacy of a useful new protocol
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La prevención primaria y secundaria del accidente cerebrovascular y otras complicaciones en anemia de células falciformes (ACF), se puede realizar con exanguinotransfusión. Las ventajas sobre la transfusión incluyen menor sobrecarga de hierro y mejor control de Hemoglobina S(HbS). Su implementación es compleja y por tanto es poco utilizada. Objetivo: evaluar seguridad y eficacia clínica de un nuevo protocolo de exanguinotransfusión parcial en pacientes pediátricos con ACF. Métodos: se incluyeron 33 pacientes con ACF entre febrero de 2016 y marzo de 2019, con un límite menor de hemoglobina de 7 gr/dl. Se evaluó la eficacia del protocolo con la medición de la hemoglobina, el hematocrito, porcentaje de HbS, la ferritina y promedio de velocidad máxima en arteria cerebral media (PVM-ACM) al inicio del estudio y transcurridos tres meses como mínimo. Resultados: se realizaron 355 procedimientos en 33 pacientes, edad de 9 años (RIC 6-16 años). 78.3 % homocigotos (HbSS). La indicación de transfusión fue prevención primaria 63.6 % y prevención secundaria 30.3 %. Las complicaciones médicas fueron 1.1 % y tasa de éxito 96.3 %. En un subgrupo de 22 pacientes se valoró la eficacia del protocolo. La diferencia de ferritina fue -33.77 mcg/L (IC 95 % -647.2 a 579.7 mcg/L); la exanguinotransfusión disminuyó %HbS -26.16% [IC 95 % (-37.42 a -14.90) p < 0.0001], Hb 0.5955 gr/dl [IC 95 % (0.2513- 0.9396) p 0.0017]; la diferencia PVM-ACM fue -19.58 cm/seg [IC 95% (-42.00 a 2.838) p 0.0829]. Conclusiones: este protocolo es sencillo, seguro y económico, por lo cual podría extenderse a otros centros, incluyendo pacientes con hemoglobina de 7 g/dl. Es eficaz para la disminuir HbS y se relaciona con una menor probabilidad de sobrecarga de hierro en pacientes en terapia transfusional crónica.
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