Estudio del paciente con hiperferritinemia

  • Germán Campuzano-Maya Laboratorio Clínico Hematológico
Palabras clave: ferritinas, hiperferritinemia, ferritina sérica, síndrome metabólico, hepatitis alcohólica, hepatopatía grasa no alcohólica, hemocromatosis.

Resumen

La hiperferritinemia, definida por ferritina sérica mayor de 200 µg/L en mujeres y de 300 µg/L en hombres, representa un reto para el clínico. De acuerdo con la etiología, puede subdividirse en tres grupos: el primero correspondiente a la causada por enfermedades frecuentemente asociadas, como el síndrome metabólico, la hepatopatía alcohólica, la hepatopatía no alcohólica y procesos inflamatorios (infecciones, enfermedades inflamatorias crónicas, enfermedades autoinmunes y algunos procesos malignos); el segundo, correspondiente a la causada por enfermedades poco frecuentemente asociadas, como la hemocromatosis hereditaria, algunas enfermedades hematológicas con anemia y la terapia transfusional permanente; y un tercer grupo, correspondiente a la causada por enfermedades raramente asociadas, como el síndrome hereditario de hiperferritinemia y cataratas, la aceruloplasminemia, la atransferrinemia o hipotransferrinemia, la porfiria cutánea tarda, la hemocromatosis neonatal, la sobrecarga de hierro africana y la enfermedad de Gaucher. El aspecto clínico más importante es definir, mediante la clínica y estudios simples y especializados, la causa asociada a la hiperferritinemia e intervenirla como punto de partida para su manejo. Desde el punto de vista del paciente es importante realizar estudios de ferrocinética (ferritina sérica y saturación de transferrina) y medición de sobrecarga de hierro en órganos blanco, mediante resonancia magnética, la cual presenta alta sensibilidad y especificidad. Todo esto significa la aplicación de algoritmos de manejo y seguimiento del paciente con hiperferritinemia. El manejo del síndrome depende de la etiología asociada y la ausencia o presencia de sobrecarga de hierro, siendo, exclusivamente en este último caso, la flebotomía la mejor opción.

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Biografía del autor/a

Germán Campuzano-Maya, Laboratorio Clínico Hematológico

Médico, especialista en Hematología y Patología Clínica. Docente Ad Honorem, Facultad de Medicina, Universidad de Antioquia. Coordinador Grupo de Investigación en Patología Clínica. Médico Director, Laboratorio Clínico Hematológico. Medellín, Colombia.

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Cómo citar
1.
Campuzano-Maya G. Estudio del paciente con hiperferritinemia . Med. Lab. [Internet]. 1 de septiembre de 2017 [citado 22 de abril de 2021];23(9-10):411-42. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/19
Publicado
2017-09-01
Sección
La Clínica y el Laboratorio
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