{"id":81011,"date":"2025-05-12T17:11:31","date_gmt":"2025-05-12T15:11:31","guid":{"rendered":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/?p=81011"},"modified":"2025-05-08T08:58:49","modified_gmt":"2025-05-08T06:58:49","slug":"leucemia-mieloide-aguda-con-sindrome-de-lisis-tumoral","status":"publish","type":"post","link":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/leucemia-mieloide-aguda-con-sindrome-de-lisis-tumoral\/","title":{"rendered":"Leucemia mieloide aguda con s\u00edndrome de lisis tumoral"},"content":{"rendered":"

Leucemia mieloide aguda con s\u00edndrome de lisis tumoral<\/strong><\/p>\n

Autor principal:<\/strong> Pedro Roberto Sancho Ortega<\/p>\n

Vol. XX; n\u00ba 09; 453<\/p>\n

Acute myeloid leukaemia with tumour lysis syndrome<\/strong><\/p>\n

Fecha de recepci\u00f3n:<\/strong> 19 de febrero \u00a0de 2025
\nFecha de aceptaci\u00f3n:<\/strong> 8 de mayo de 2025<\/p>\n

Incluido en Revista Electr\u00f3nica de PortalesMedicos.com Volumen XX. N\u00famero 09 Primera quincena de mayo de 2025 \u2013 P\u00e1gina inicial: Vol. XX; n\u00ba 09; 453<\/p>\n

 <\/p>\n

Autores: <\/strong>Pedro Roberto Sancho Ortega; Mar\u00eda Ester Cano Serrano; Sheila Larrayad Sanz; Angie Yurani Ramos de los R\u00edos; Roc\u00edo del Pilar P\u00e9rez Orozco; Lorena Dom\u00ednguez Cuevas; Alba Cirac Oriol.<\/p>\n

Centro de Trabajo actual: <\/strong>Hospital Cl\u00ednico Universitario \u201cLozano Blesa\u201d de Zaragoza (Espa\u00f1a)<\/p>\n

Palabras clave en espa\u00f1ol: <\/strong>leucemia, mieloide, s\u00edndrome, lisis, tumoral.<\/p>\n

Palabras clave en ingl\u00e9s:\u00a0 <\/strong>leukemia, myeloid, syndrome, lysis, tumor.<\/p>\n

 <\/p>\n

Resumen en espa\u00f1ol: <\/strong><\/p>\n

La leucemia mieloide aguda (LMA) es una enfermedad hematol\u00f3gica agresiva que a menudo se presenta con complicaciones graves. Un paciente de 45 a\u00f1os, diagnosticado con LMA, experiment\u00f3 r\u00e1pidamente un cuadro de s\u00edndrome de lisis tumoral tras iniciar quimioterapia. El s\u00edndrome se present\u00f3 con niveles elevados de potasio, \u00e1cido \u00farico y fosfato, asociado con insuficiencia renal aguda. En respuesta, el paciente recibi\u00f3 hidrataci\u00f3n intravenosa intensiva, tratamiento con alopurinol y medidas para corregir los desequilibrios metab\u00f3licos. Se observ\u00f3 una mejor\u00eda progresiva en las funciones renales y la resoluci\u00f3n de los niveles alterados. A pesar de estas complicaciones, el tratamiento oncol\u00f3gico continu\u00f3, y el paciente fue evaluado para el trasplante de c\u00e9lulas madre hematopoy\u00e9ticas.<\/p>\n

 <\/p>\n

Resumen en ingl\u00e9s: <\/strong><\/p>\n

Acute myeloid leukaemia (AML) is an aggressive haematological disease that often presents with severe complications. A 45-year-old patient diagnosed with AML rapidly developed tumour lysis syndrome after starting chemotherapy. The syndrome presented with elevated potassium, uric acid and phosphate levels, associated with acute renal failure. In response, the patient received intensive intravenous hydration, allopurinol treatment and measures to correct metabolic imbalances. Progressive improvement in renal functions and resolution of the altered levels were observed. Despite these complications, oncological treatment continued, and the patient was evaluated for haematopoietic stem cell transplantation.<\/p>\n

 <\/p>\n

Los autores de este manuscrito declaran que:<\/p>\n

Todos ellos han participado en su elaboraci\u00f3n y no tienen conflictos de intereses
\nLa investigaci\u00f3n se ha realizado siguiendo las Pautas \u00e9ticas internacionales para la investigaci\u00f3n relacionada con la salud con seres humanos elaboradas por el Consejo de Organizaciones Internacionales de las Ciencias M\u00e9dicas (CIOMS) en colaboraci\u00f3n con la Organizaci\u00f3n Mundial de la Salud (OMS).
\nEl manuscrito es original y no contiene plagio.
\nEl manuscrito no ha sido publicado en ning\u00fan medio y no est\u00e1 en proceso de revisi\u00f3n en otra revista.
\nHan obtenido los permisos necesarios para las im\u00e1genes y gr\u00e1ficos utilizados.
\nHan preservado las identidades de los pacientes.<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

Caso Cl\u00ednico: <\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

Motivo de consulta<\/strong>:
\n<\/strong>Paciente masculino de 45 a\u00f1os con antecedentes de salud general buena, quien acude a urgencias por fatiga extrema, fiebre y dolor \u00f3seo. Los estudios iniciales revelan leucocitosis masiva y un diagn\u00f3stico de leucemia mieloide aguda.<\/p>\n

\u00a0<\/strong><\/p>\n

Historia cl\u00ednica<\/strong>:
\n<\/strong>El paciente presenta s\u00edntomas de fiebre, sudoraci\u00f3n nocturna y p\u00e9rdida de peso progresiva. Tras el diagn\u00f3stico de LMA, comienza un tratamiento con quimioterapia inducci\u00f3n (daunorrubicina y citarabina). Tres d\u00edas despu\u00e9s del inicio de la quimioterapia, presenta s\u00edntomas de oliguria, n\u00e1useas y dolor muscular. Los an\u00e1lisis de sangre muestran hipercalemia, hiperuricemia, hiperfosfatemia y baja de calcio, con una funci\u00f3n renal deteriorada.<\/p>\n

\u00a0<\/strong><\/p>\n

Pruebas diagn\u00f3sticas<\/strong>:
\n<\/strong>Los resultados de laboratorio revelan potasio elevado de 6.5 mEq\/L, \u00e1cido \u00farico de 12 mg\/dL, y fosfato de 7.8 mg\/dL. Los valores de creatinina s\u00e9rica aumentan a 2.5 mg\/dL, lo que sugiere insuficiencia renal aguda secundaria a s\u00edndrome de lisis tumoral. Se realiza un electrocardiograma que muestra alteraciones por hiperkalemia.<\/p>\n

\u00a0<\/strong><\/p>\n

Tratamiento<\/strong>:
\n<\/strong>El paciente fue hidratado agresivamente con soluciones intravenosas para promover la diuresis y prevenir insuficiencia renal adicional. Se administr\u00f3 alopurinol para disminuir los niveles de \u00e1cido \u00farico y evitar la formaci\u00f3n de cristales en los ri\u00f1ones. Adem\u00e1s, se corrigieron los desequilibrios electrol\u00edticos con gluconato de calcio, bicarbonato y resinas de intercambio de potasio. El paciente tambi\u00e9n fue monitorizado de cerca con an\u00e1lisis diarios de funci\u00f3n renal y electrolitos.<\/p>\n

\u00a0<\/strong><\/p>\n

Pron\u00f3stico<\/strong>:
\n<\/strong>El pron\u00f3stico inicial fue grave debido al s\u00edndrome de lisis tumoral, pero la intervenci\u00f3n temprana y el tratamiento adecuado de los trastornos metab\u00f3licos resultaron en una mejora en las funciones renales y en la resoluci\u00f3n progresiva de los desequilibrios metab\u00f3licos. El paciente sigue en tratamiento de quimioterapia con monitoreo continuo y est\u00e1 siendo evaluado para un posible trasplante de c\u00e9lulas madre hematopoy\u00e9ticas.<\/p>\n

\u00a0<\/strong><\/p>\n

Seguimiento<\/strong>:
\n<\/strong>El paciente contin\u00faa con el seguimiento para evaluar su respuesta al tratamiento y los posibles efectos secundarios del tratamiento oncol\u00f3gico. Se realiza un seguimiento estrecho de su funci\u00f3n renal, niveles de \u00e1cido \u00farico, potasio, fosfato y calcio, as\u00ed como del avance en la remisi\u00f3n de la leucemia.<\/p>\n

\u00a0<\/strong><\/p>\n

Discusi\u00f3n<\/strong>:
\n<\/strong>El s\u00edndrome de lisis tumoral (SLT) es una complicaci\u00f3n potencialmente mortal en pacientes con leucemia mieloide aguda, especialmente durante la inducci\u00f3n de la quimioterapia. El SLT es causado por la liberaci\u00f3n masiva de contenido intracelular de las c\u00e9lulas malignas que mueren r\u00e1pidamente, lo que provoca alteraciones metab\u00f3licas graves, como hiperkalemia, hiperuricemia, hiperfosfatemia e hipocalcemia. El tratamiento inmediato incluye hidrataci\u00f3n agresiva, uso de alopurinol o rasburicasa para el \u00e1cido \u00farico, y el manejo de los desequilibrios electrol\u00edticos. Un diagn\u00f3stico y tratamiento r\u00e1pidos son esenciales para evitar complicaciones renales y otras disfunciones metab\u00f3licas. El pron\u00f3stico depender\u00e1 del control del s\u00edndrome de lisis tumoral y de la respuesta al tratamiento de la leucemia.<\/p>\n

\u00a0<\/strong><\/p>\n

Bibliograf\u00eda: <\/strong><\/p>\n

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