Sobrecarga hepática de hierro: implicaciones postransfusionales
DOI:
https://doi.org/10.59093/27112330.132Palabras clave:
sobrecarga de hierro, transfusiones sanguíneas, homeostasis, hierro, hígado, terapia por quelación, resonancia magnética.Resumen
La sobrecarga de hierro postransfusional es una complicación frecuente en pacientes con enfermedades crónicas que requieren transfusiones sanguíneas regulares. El hierro no tiene un mecanismo fisiológico para ser excretado, por lo que se acumula principalmente en el hígado, lo que puede causar daños hepáticos graves. La homeostasis del hierro se regula a través de la absorción intestinal; sin embargo, las transfusiones múltiples desbalancean este sistema, favoreciendo la acumulación de hierro. Este exceso puede generar radicales libres, desencadenando estrés oxidativo y peroxidación lipídica, lo que promueve el daño celular en el hígado y otros órganos, y puede derivar en cirrosis, insuficiencia hepática y carcinoma hepatocelular. Para diagnosticar la sobrecarga de hierro, se emplean biomarcadores como la ferritina sérica, la saturación de transferrina y la concentración de hierro en el tejido hepático. La resonancia magnética es el método comúnmente utilizado para estimar tanto los depósitos de hierro en el hígado como en otros órganos (el corazón, el páncreas, los riñones y las glándulas endocrinas). El tratamiento principal es la quelación de hierro, con agentes como deferoxamina, deferasirox y deferiprona, que facilitan su eliminación del cuerpo. La prevención de la sobrecarga de hierro se basa en el manejo adecuado de las transfusiones múltiples, usando preferiblemente la eritrocitaféresis en lugar de transfusiones simples, evitando la administración innecesaria de hierro y utilizando quelantes de hierro cuando los niveles son elevados. Las nuevas perspectivas incluyen el desarrollo de tratamientos más específicos y personalizados, basados en biomarcadores y avances en técnicas de imagen, lo que permitirá un manejo más preciso y menos invasivo de la sobrecarga de hierro.
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