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5/16/2018 PORFIRIA CUTANATA TARDIVA - slidepdf.com
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PORFIRIA CUTANATA TARDIVAPorfiria Cutanata Simptomatica=PCS = PCTCea mai frecventa formaFactori genetici si de mediuPorfirie cronica hepatica (fara atacuri acute)Fiziopatologia PCTDeficit de UROPORFIRINOGEN-decarboxilazaPCT-grup heterogenTIPUL I-sporadicUROgen-D lipseste numai in ficatFrecventa la barbati, 40-50 aniFara istoric familial de boalaIndusa de factori externi (alcool)
Ex.paraclinice PCT
Urina-cresc UROPORFIRINELE I
Fecale-predominent IZO-COPROPORFIRINA
Ex.histologic al pielii: bule subepidermice cu material PAS+ perivascular
Fe seric crescut, saturatia cu Fe a transferinei crescuta
PBH: usoara incarcare cu Fe, fluorescenta rosie in UV
Tratamentul PCT
Evitarea factorilor agravanti
Alcool, estrogeni, medicamente, expuneri la soare
Emisia de singe-FLEBOTOMIA-repetata
300 ml la 10-12 zile timp de 2 luni (Fe seric la 60-70% din cel initial)
Chiar daca nivelul initial al Fe seric nu este crescut
Monitorizarea Hb, a porfirinelor urinare- lunar
CLOROCHINA (250mg/saptamina) daca flebotomia este contraindicata (boli cardiace, pulmonare)
Creste excretia urinara de uroporfirine
Hepatotoxica in doze mari
Emulsii actinice cu PAS 5%, PABA 15%
5/16/2018 PORFIRIA CUTANATA TARDIVA - slidepdf.com
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