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Anemia por enfermedad crónica

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 13 Aug 2025
最后更新： 14 Aug 2025

小结

定义

病史和体格检查

关键诊断因素

  • presencia de factores de riesgo
  • síntomas sistémicos de la afección subyacente
  • sin antecedentes de sangrado
  • hallazgos físicos que sugieren infección
  • hallazgos físicos que sugieren neoplasia
  • hallazgos físicos que sugieren enfermedades autoinmunes
完整详情

其他诊断因素

  • sin antecedentes de consumo de alcohol elevado
  • sin antecedentes de exposición a químicos y a radiación
  • sin antecedentes de consumo de fármacos que se sabe están asociados al riesgo de anemia
  • Sin antecedentes de nutrición deficiente
  • disminución de la tolerancia al ejercicio
  • disnea con el ejercicio
  • fatiga
  • palidez
完整详情

危险因素

  • trastornos autoinmunitarios
  • neoplasia maligna
  • infección crónica o aguda
  • enfermedad crítica, traumatismo importante o cirugía mayor con retraso en la recuperación
  • enfermedad crónica
完整详情

诊断性检查

首要检查

  • hemoglobina (Hb)
  • recuento de leucocitos y fórmula leucocitaria
  • recuento de plaquetas
  • volumen corpuscular medio (VCM)
  • concentración media de hemoglobina corpuscular (CHCM)
  • frotis de sangre periférica
  • ferritina sérica
  • hierro sérico
  • capacidad total de fijación del hierro
  • saturación de transferrina
  • recuento absoluto de reticulocitos
  • creatinina sérica
完整详情

需考虑的检查

  • proteína C reactiva (PCR)
  • velocidad de sedimentación globular
  • B12 sérica
  • folato sérico
  • pruebas de función tiroidea
  • pruebas de función hepática (PFH)
  • bilirrubina directa e indirecta
  • lactato deshidrogenasa (LDH)
  • eritropoyetina
  • electroforesis de hemoglobina
  • biopsia de médula ósea
  • receptor soluble de transferrina
  • relación entre el receptor soluble de transferrina y el logaritmo de ferritina
完整详情

治疗流程

急症处理

anemia de leve a moderada (hemoglobina [Hb] 80 a 110 g/L [8 a 11 g/dL])

anemia grave (Hb <80 g/L [<8 g/dL]) o potencialmente mortal (Hb <65 g/L [<6.5 g/dL])

撰稿人

作者

Marina Beltrami Moreira, MD

Assistant Professor

The Ohio State University Wexner Medical Center

The Ohio State University College of Medicine

Columbus

OH

利益声明

MBM declares that she has no competing interests.

鸣谢

Dr Marina Beltrami Moreira would like to gratefully acknowledge Dr Eric Kraut, Dr Marium Husain, Dr Alice Ma, Dr Damon Houghton, Dr Marco Giovannini, Dr Pasquale Niscola, Dr Karen D. Serrano, Dr Robert D. Woodson, and Dr Kiranveer Kaur, previous contributors to this topic. EK, MH, AM, DH, MG, PN, KDS, RDW, and KK declare that they have no competing interests.

同行评议者

Sean R. Lynch, MD

Professor of Clinical Medicine

Eastern Virginia Medical School

Norfolk

VA

利益声明

SRL declares that he has no competing interests.

Christopher Pechlaner, MD

Associate Professor of Medicine

Innsbruck Medical University

Innsbruck

Austria

利益声明

CP declares that he has no competing interests.

Robert Chen, MD

Hematology/Oncology Fellow

Department of Medical Oncology

University of Colorado Health Sciences Center

Denver

CO

利益声明

RC declares that he has no competing interests.

Brady Stein, MD

Associate Professor of Medicine

Northwestern University

Evanston

IL

Раскрытие информации

BS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

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Основные статьи

KDIGO Anemia Work Group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279-335.Полный текст

Bohlius J, Bohlke K, Castelli R, et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update. J Clin Oncol. 2019 Apr 10;37(15):1336-51.Полный текст  Аннотация

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hematopoietic growth factors [internet publication].Полный текст

Aapro M, Beguin Y, Bokemeyer C, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO clinical practice guidelines. Ann Oncol. 2018 Oct 1;29(suppl 4):iv271.Полный текст

Статьи, указанные как источники

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