Principales modificaciones asociadas a la esplenectomía
DOI:
https://doi.org/10.30944/20117582.2292Palabras clave:
esplenectomía, enfermedades del bazo, complicaciones posoperatorias, trombosis, leucocitosis, cuerpos de Howell-JollyResumen
El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades. Los cambios posteriores a la esplenectomía pueden considerarse como inmediatos: aparición de cuerpos de Howell-Jolly, trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo o un estado hipercoagulable, siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición. Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo, debido al riesgo de infecciones principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción. Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones son fundamentales para reducir la mortalidad asociada a la esplenectomía.
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