1. Antecedentes
Niño de 3 años ingresa al Servicio de Urgencia con gingivorragia abundante, como consecuencia de una caída con traumatismo en la boca y rotura del frenillo del labio superior. Se le realiza sutura del frenillo para detener la hemorragia, enviándolo a su casa. Horas más tarde, reaparece el sangramiento por lo que debe volver al Servicio de Urgencia. Desde que el niño comenzó a dar sus primeros pasos, ha presentado hematomas frente a traumatismos leves y epistaxis a repetición, desde los 2 años. No ha presentado cuadros purpúricos.
En la familia, especialmente en el padre, la abuela y tía por línea paterna se registran antecedentes hemorragíparos.
2. Examen físico
Al examen físico, presenta palidez de piel y mucosas, herida sangrante en el frenillo del labio superior en la que se han aplicado tres puntos de sutura, y algunos hematomas menores en las extremidades inferiores.
3. Laboratorio
Hemograma
Hematocrito : 31 % Leucocitos : 12.900 /μL
Hemoglobina : 9.5 g/dL Plaquetas : 307.000 /μL
Glóbulos Rojos : 4.100.000 /μL
CHCM : 30.6 %
VCM : 75.6 fL
Basófilos 0 Eosinófilos 0 Mielocitos 1 Juveniles 0
Baciliformes 0 Segmentados 26 Linfocitos 67 Monocitos 6
Glóbulos rojos: anisocitosis leve, microcitosis leve, hipocromía leve a moderada.
Leucocitos : normales
Plaquetas : normales
Tiempo de Sangría (Ivy modificado) : 22 min (VN: 4-9 min)
TP : 12 seg (VN: 11-13 seg)
TTPA : 50 seg (VN: 30-40 seg)
TT : 17 seg (VN: 15-20 seg)
Grupo sanguíneo ABO : O
Factor Rho : positivo (+)
Factor IX : 130% (VN: > 35 %)
Factor VIII:C : 23% (VN: > 27 %)
FVW:Ag : 25% (VN: > 52 %)
FVW:CoR : 22% (VN: > 42 %)
INDIQUE EL DIAGNOSTICO Y PRUEBAS DE LABORATORIO COMPLEMENTARIAS
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APRENDIZAJE BASADO EN UN CASO CLINICO
A 32-year-old female is being treated with methotrexate for a recently diagnosed choriocarcinoma of the ovary, and presents with complaints of oral mucosal ulcers. The patient recalls being advised not to take folate-containing vitamins during therapy. An uncomplicated surgical exploration was performed 5 weeks ago with removal of the affected ovary. The patient has been taking methotrexate for 2 weeks and has never had any of the above symptoms before. On examination, patient was afebrile and appeared ill. Several mucosal ulcers were seen in her mouth. The patient also had some upper abdominal tenderness. Her platelet count is decreased at 60,000/mm3 (normal 150,000 to 450,000/mm3).
◆ What is the most likely etiology of her symptoms?
◆ What is the biochemical explanation of her symptoms?
◆ What part of the cell cycle does methotrexate act on?
RESPONDA LAS PREGUNTAS EMPLEANDO BIBLIOGRAFIA MEDICA PARA TAL EFECTO, MAXIMO 2 CUARTILLAS
◆ What is the most likely etiology of her symptoms?
◆ What is the biochemical explanation of her symptoms?
◆ What part of the cell cycle does methotrexate act on?
RESPONDA LAS PREGUNTAS EMPLEANDO BIBLIOGRAFIA MEDICA PARA TAL EFECTO, MAXIMO 2 CUARTILLAS
lunes, 2 de noviembre de 2009
USE OF QUANTIFERON TB GOLD TEST FOR TB INFECTION
Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States.
Mazurek GH et all Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC).
MMWR Morb Mortal Wkly Rep. 2005 Dec 23;54(50):1288.
On May 2, 2005, a new in vitro test, QuantiFERON-TB Gold (QFT-G, Cellestis Limited, Carnegie, Victoria, Australia), received final approval from the U.S. Food and Drug Administration as an aid for diagnosing Mycobacterium tuberculosis infection. This test detects the release of interferon-gamma (IFN-g) in fresh heparinized whole blood from sensitized persons when it is incubated with mixtures of synthetic peptides representing two proteins present in M. tuberculosis: early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10). These antigens impart greater specificity than is possible with tests using purified protein derivative as the tuberculosis (TB) antigen. In direct comparisons, the sensitivity of QFT-G was statistically similar to that of the tuberculin skin test (TST) for detecting infection in persons with untreated culture-confirmed tuberculosis (TB). The performance of QFT-G in certain populations targeted by TB control programs in the United States for finding latent TB infection is under study. Its ability to predict who eventually will have TB disease has not been determined, and years of observational study of substantial populations would be needed to acquire this information. In July 2005, CDC convened a meeting of consultants and researchers with expertise in the field to review scientific evidence and clinical experience with QFT-G. On the basis of this review and discussion, CDC recommends that QFT-G may be used in all circumstances in which the TST is currently used, including contact investigations, evaluation of recent immigrants, and sequential-testing surveillance programs for infection control (e.g., those for health-care workers). This report provides specific cautions for interpreting negative QFT-G results in persons from selected populations. This report is aimed at public health officials, health-care providers, and laboratory workers with responsibility for TB control activities in the United States.
LINK
http://www.cdc.gov/mmwr/PDF/rr/rr5415.pdf
FAVOR DE COMENTAR EL ARTICULO EN MINIMO DOS CUARTILLAS (USAR CITAS BIBLIOGRAFICAS REV. MED MINIMO 3)
Mazurek GH et all Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC).
MMWR Morb Mortal Wkly Rep. 2005 Dec 23;54(50):1288.
On May 2, 2005, a new in vitro test, QuantiFERON-TB Gold (QFT-G, Cellestis Limited, Carnegie, Victoria, Australia), received final approval from the U.S. Food and Drug Administration as an aid for diagnosing Mycobacterium tuberculosis infection. This test detects the release of interferon-gamma (IFN-g) in fresh heparinized whole blood from sensitized persons when it is incubated with mixtures of synthetic peptides representing two proteins present in M. tuberculosis: early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10). These antigens impart greater specificity than is possible with tests using purified protein derivative as the tuberculosis (TB) antigen. In direct comparisons, the sensitivity of QFT-G was statistically similar to that of the tuberculin skin test (TST) for detecting infection in persons with untreated culture-confirmed tuberculosis (TB). The performance of QFT-G in certain populations targeted by TB control programs in the United States for finding latent TB infection is under study. Its ability to predict who eventually will have TB disease has not been determined, and years of observational study of substantial populations would be needed to acquire this information. In July 2005, CDC convened a meeting of consultants and researchers with expertise in the field to review scientific evidence and clinical experience with QFT-G. On the basis of this review and discussion, CDC recommends that QFT-G may be used in all circumstances in which the TST is currently used, including contact investigations, evaluation of recent immigrants, and sequential-testing surveillance programs for infection control (e.g., those for health-care workers). This report provides specific cautions for interpreting negative QFT-G results in persons from selected populations. This report is aimed at public health officials, health-care providers, and laboratory workers with responsibility for TB control activities in the United States.
LINK
http://www.cdc.gov/mmwr/PDF/rr/rr5415.pdf
FAVOR DE COMENTAR EL ARTICULO EN MINIMO DOS CUARTILLAS (USAR CITAS BIBLIOGRAFICAS REV. MED MINIMO 3)
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