{\rtf\ansi\deff0\ansicpg1252{\fonttbl{\f0\froman times new roman;}{\f1\ftech symbol;}{\f2\fswiss helvetica;}{\f3\fmodern courier;}}{\colortbl\red0\green0\blue0;\red0\green135\blue135;}{\info{\author Webmaster}}\jexpand\viewkind1\viewscale100\paperw11893\paperh16840\margl666\margr133\margt666\margb346\pard\li3586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li3586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li3586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li3586\ri0\sl-453\slmult0 \fs30\cf0\f0\charscalex100 {ANEMIA PERNICIOSA }\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-253\slmult0 \fs24\cf0\f0\charscalex100 {Hablamos de anemia macroctica cuando en una anemia el volumen }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {corpuscular medio est elevado (}\fs24\cf0\f0\charscalex100 {>100)}\fs24\cf0\f0\charscalex100 { y existen macrocitos en sangre }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {perifrica.}\fs24\cf0\f0\charscalex100 { La causa ms comn de anemia macroctica es la anemia }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {megaloblstica,}\fs24\cf0\f0\charscalex100 { en la que existe una sntesis anormal de ADN por los }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {precursores eritroides y mieloides,}\fs24\cf0\f0\charscalex100 { lo que da lugar a hematopoyesis ineficaz }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(}\fs24\cf0\f0\charscalex100 {anemia,}\fs24\cf0\f0\charscalex100 { leucopenia y trombopenia)}\fs24\cf0\f0\charscalex100 { y cuyas causas ms frecuentes son el }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dficit de vitamina B12 y el de cido flico.}\fs24\cf0\f0\charscalex100 { Las manifestaciones clnicas y }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {hematolgicas son similares en ambos casos.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {La causa ms frecuente de anemia megaloblstica en nuestro medio es }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {consecuencia de un dficit de vitamina B12 debido a su vez a la disminucin }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {de factor intrnseco (}\fs24\cf0\f0\charscalex100 {FI}\fs24\cf0\f0\charscalex100 {)}\fs24\cf0\f0\charscalex100 { por atrofia de la mucosa gstrica o por destruccin }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {autoinmune de las clulas parietales.}\fs24\cf0\f0\charscalex100 { Es la anemia perniciosa.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {En adultos es una enfermedad de origen autoinmune.}\fs24\cf0\f0\charscalex100 { En un 90% de los }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {casos se asocia a la presencia de anticuerpos anti-clulas parietales }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(}\fs24\cf0\f0\charscalex100 {productoras del FI}\fs24\cf0\f0\charscalex100 {)}\fs24\cf0\f0\charscalex100 {.}\fs24\cf0\f0\charscalex100 { Existe atrofia gstrica,}\fs24\cf0\f0\charscalex100 { lo que origina un descenso o }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {ausencia de produccin de cido y FI}\fs24\cf0\f0\charscalex100 { y una posterior alteracin en la }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {absorcin de la vitamina B12.}\fs24\cf0\f0\charscalex100 { En un 50% de casos se asocia a anticuerpos }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {anti FI}\fs24\cf0\f0\charscalex100 {,}\fs24\cf0\f0\charscalex100 { cuya presencia en otras enfermedades autoinmunes es excepcional.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Existe una posible predisposicin gentica.}\fs24\cf0\f0\charscalex100 { Tpicamente existe una atrofia }\par\pard\li1040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {de la mucosa gstrica que respeta al antro.}\fs24\cf0\f0\charscalex100 { Existe una anemia perniciosa }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {j}\fs24\cf0\f0\charscalex100 {uvenil que aparece en menores de 10 aos en los que el FI}\fs24\cf0\f0\charscalex100 { no es activo y }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {no se observan anticuerpos.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Suele asociarse a otras enfermedades de origen autoinmune: }\par\pard\li1400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Tiroiditis de Hashimoto }\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Vitligo }\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Tirotoxicosis (}\fs24\cf0\f0\charscalex100 {Enfermedad de Graves)}\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Diabetes Mellitus }\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Enfermedad de Addison }\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Hipoparatiroidismo }\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Aganmaglobulinemia }\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {LES }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn613\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100\ul {CL}\ul0 \fs24\cf0\f0\charscalex100\ul {NI}\ul0 \fs24\cf0\f0\charscalex100\ul {CA}\ul0 \fs24\cf0\f0\charscalex100\ul { }\ul0 \par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-386\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Anemi}\fs24\cf0\f0\charscalex100 {a Megal}\fs24\cf0\f0\charscalex100 {obl}\fs24\cf0\f0\charscalex100 {st}\fs24\cf0\f0\charscalex100 {i}\fs24\cf0\f0\charscalex100 {ca}\fs24\cf0\f0\charscalex100 {: Astenia,}\fs24\cf0\f0\charscalex100 { palpitaciones,}\fs24\cf0\f0\charscalex100 { sudoracin,}\fs24\cf0\f0\charscalex100 { mareo,}\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {insuficiencia cardiaca de instauracin lenta y con buena tolerancia }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {por parte del paciente.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Di}\fs24\cf0\f0\charscalex100 {gest}\fs24\cf0\f0\charscalex100 {i}\fs24\cf0\f0\charscalex100 {va}\fs24\cf0\f0\charscalex100 {: Anorexia,}\fs24\cf0\f0\charscalex100 { diarrea,}\fs24\cf0\f0\charscalex100 { estomatitis angular,}\fs24\cf0\f0\charscalex100 { lengua lisa }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {depapilada,}\fs24\cf0\f0\charscalex100 { dolorosa al tacto y de color roj}\fs24\cf0\f0\charscalex100 {o intenso (}\fs24\cf0\f0\charscalex100 {glositis de }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Hunter)}\fs24\cf0\f0\charscalex100 {.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Neurol}\fs24\cf0\f0\charscalex100 {gi}\fs24\cf0\f0\charscalex100 {ca}\fs24\cf0\f0\charscalex100 { (}\fs24\cf0\f0\charscalex100 {Las alteraciones neurolgicas pueden aparecer sin que }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {exista anemia ni macrocitosis)}\par\pard\li2186\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2186\ri0\sl-320\slmult0 \*\tx2480\fs20\cf0\f3\charscalex100 {o}\tab \fs24\cf0\f0\charscalex100 {Degeneracin combinada subaguda medular (}\fs24\cf0\f0\charscalex100 {Mielosis }\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {cunicular)}\fs24\cf0\f0\charscalex100 {: Alteracin de los cordones posteriores,}\fs24\cf0\f0\charscalex100 { parestesias,}\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {ataxia,}\fs24\cf0\f0\charscalex100 { tendencia a cadas en la oscuridad.}\fs24\cf0\f0\charscalex100 { El signo ms }\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {precoz en la exploracin es la disminucin de la sensibilidad }\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {vibratoria en las extremidades inferiores.}\par\pard\li2186\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2186\ri0\sl-320\slmult0 \*\tx2480\fs20\cf0\f3\charscalex100 {o}\tab \fs24\cf0\f0\charscalex100 {Alteracin de la va piramidal: paresia,}\fs24\cf0\f0\charscalex100 { espasticidad,}\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {hiperreflexia,}\fs24\cf0\f0\charscalex100 { alteracin de los esfnteres,}\fs24\cf0\f0\charscalex100 { Romberg y Babinsky }\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {positivos y alteraciones mentales (}\fs24\cf0\f0\charscalex100 {irritabilidad,}\fs24\cf0\f0\charscalex100 { demencia,}\par\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2546\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {depresin)}\fs24\cf0\f0\charscalex100 {.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100\ul {PRUEBAS DI}\ul0 \fs24\cf0\f0\charscalex100\ul {AGNSTI}\ul0 \fs24\cf0\f0\charscalex100\ul {CAS}\ul0 \fs24\cf0\f0\charscalex100\ul { }\ul0 \par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {Las pruebas de inters diagnstico son: }\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-386\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Niveles sricos de vitamina B12 (}\fs24\cf0\f0\charscalex100 {< 100 pg/}\fs24\cf0\f0\charscalex100 {ml)}\fs24\cf0\f0\charscalex100 { y cido flico (}\fs24\cf0\f0\charscalex100 {>4 }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ng/}\fs24\cf0\f0\charscalex100 {ml)}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn466\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-426\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {La determinacin de anticuerpos anti FI}\fs24\cf0\f0\charscalex100 { (}\fs24\cf0\f0\charscalex100 {sensibilidad: 66%;}\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {especificidad: 95%)}\fs24\cf0\f0\charscalex100 { y el nivel srico de gastrina (}\fs24\cf0\f0\charscalex100 {si est disponible)}\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {permiten el diagnstico del 90-95% casos.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Anticuerpos anti-clulas parietales (}\fs24\cf0\f0\charscalex100 {sensibilidad: 80%;}\fs24\cf0\f0\charscalex100 { especificidad: }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {baj}\fs24\cf0\f0\charscalex100 {a,}\fs24\cf0\f0\charscalex100 { 3-10% personas sin anemia perniciosa lo tienen elevado)}\fs24\cf0\f0\charscalex100 {.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Niveles de cido metilmalnico y homocistena plasmticos: ambos }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {aumentan en el dficit de vitamina B12 de forma precoz (}\fs24\cf0\f0\charscalex100 {incluso }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {antes de la aparicin de la anemia y con dficit mnimos de B12)}\fs24\cf0\f0\charscalex100 {.}\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Podran estar indicados en situaciones dudosas,}\fs24\cf0\f0\charscalex100 { con cifras lmite de }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {vitamina B12.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Test de Schilling (}\fs24\cf0\f0\charscalex100 {patrn oro en diagnstico;}\fs24\cf0\f0\charscalex100 { en la anemia perniciosa }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {se corrige en la segunda fase)}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-306\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Gastroscopia: Para valorar la atrofia de mucosa gstrica (}\fs24\cf0\f0\charscalex100 {suele }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {respetar el antro)}\fs24\cf0\f0\charscalex100 { y las lesiones gstricas (}\fs24\cf0\f0\charscalex100 {plipos y/}\fs24\cf0\f0\charscalex100 {o carcinoma }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {asociados a la anemia perniciosa)}\fs24\cf0\f0\charscalex100 {.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Otras pruebas tiles en el seguimiento y diagnstico diferencial: }\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Hemat}\fs24\cf0\f0\charscalex100 {i}\fs24\cf0\f0\charscalex100 {met}\fs24\cf0\f0\charscalex100 {r}\fs24\cf0\f0\charscalex100 {a}\fs24\cf0\f0\charscalex100 {: }\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-333\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Anemia macroctica con ovalocitosis y poiquilocitosis.}\fs24\cf0\f0\charscalex100 { VCM aumentado }\par\pard\li1826\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(}\fs24\cf0\f0\charscalex100 {signo ms precoz)}\fs24\cf0\f0\charscalex100 {.}\fs24\cf0\f0\charscalex100 { Reticulocitos disminuidos.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Leucopenia.}\fs24\cf0\f0\charscalex100 { Neutrfilos polisegmentados,}\fs24\cf0\f0\charscalex100 { envej}\fs24\cf0\f0\charscalex100 {ecidos y con }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {desviacin a la derecha.}\fs24\cf0\f0\charscalex100 { El hallazgo de ms de 6 segmentaciones es }\par\pard\li1826\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1826\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {muy indicativo.}\par\pard\li1466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1466\ri0\sl-320\slmult0 \*\tx1760\fs20\cf0\f1\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100 {Trombopenia.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {Si}\fs24\cf0\f0\charscalex100 {gnos secundari}\fs24\cf0\f0\charscalex100 {os de heml}\fs24\cf0\f0\charscalex100 {i}{ }\fs24\cf0\f0\charscalex100 {s}\fs24\cf0\f0\charscalex100 {: Descenso de la haptoglobina y }\par\pard\li1040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {aumento de la LDH,}\fs24\cf0\f0\charscalex100 { bilirrubina indirecta y ferritina.}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Hormonas t}\fs24\cf0\f0\charscalex100 {i}\fs24\cf0\f0\charscalex100 {roi}\fs24\cf0\f0\charscalex100 {deas}\fs24\cf0\f0\charscalex100 {: Puede asociarse a tiroiditis autoinmune.}\fs24\cf0\f0\charscalex100 { En 5-10% }\par\pard\li1040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {casos existe hipotiroidismo y en