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      Trombocitopenia con ausencia de radios. Presentación de un caso Translated title: Thrombocytopenia with Absence of Radius. Case Presentation

      case-report

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          Abstract

          Resumen El síndrome de trombocitopenia con ausencia de radios es una rara malformación congénita caracterizada por aplasia radial bilateral con presencia de ambos pulgares y trombocitopenia. Suelen estar presentes malformaciones en miembros inferiores, además de padecimientos cardiovasculares, gastrointestinales, neurológicos y vasculares. Se presenta el caso de una niña con ausencia bilateral de radios, constatada al nacimiento, que ingresó a los 4 meses por ligera púrpura petequial generalizada y trombocitopenia moderada, sin otras anomalías asociadas, se realizaron varios estudios que incluyeron un medulograma. Se efectuó el diagnóstico de trombocitopenia con ausencia de radios. La evolución del caso ha sido satisfactoria y su atención médica se ha limitado a chequeo clínico y hematológico periódico; así como seguimiento por la especialidad de ortopedia. El objetivo de esta presentación es dar a conocer el comportamiento clínico de este raro trastorno y constituye el primer caso relatado en Cienfuegos.

          Translated abstract

          Abstract The syndrome of thrombocytopenia with absence of radius is an uncommon congenital malformation characterized by bilateral radial aplasia with presence of both thumbs and thrombocytopenia. Malformations are usually present in lower limbs, in addition to cardiovascular, gastrointestinal, neurological and vascular diseases. A case of a girl with a bilateral radio absence, confirmed at birth is presented, who was admitted aged 4 months due to slight generalized petechial purpura and moderate thrombocytopenia, without other associated anomalies. Several studies were carried out that included a medullogram. The diagnosis of thrombocytopenia was made with absence of radii. The evolution of the case has been satisfactory and his medical attention has been limited to periodic clinical and hematological check-ups; as well as monitoring by the specialty of orthopedics. The objective of this presentation is to show the clinical behavior of this unusual disorder which is the first case reported in Cienfuegos.

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          Thrombocytopenia with absent radius (TAR).

          Forty examples (27 from the literature and 13 new cases) of a syndrome of hypomegakaryocytic thrombocytopenia with bilateral absence of the radius have been analyzed. This syndrome is designated in this paper as "thrombocytopenia with absent radius (TAR)". The onset of hematologic complications usually occurs at birth or during early infancy. Thrombocytopenia may be episodic and sometimes is accompanied by leukemoid reactions and eosinophilia. Bone marrow examination reveals decreased and/or abnormal megakaryocytes, with normal myeloid and erythroid precursors. Congenital skeletal deformities include bilateral absence of radius, shortening and deformity of the ulnae, and occasionally absence of all the long bones in the arm. The fingers and thumbs are always present. Other skeletal anomalies are frequent. Cardiac anomalies, particularly the tetralogy of Fallot and atrial septal defects, may be present. Other non-skeletal congenital abnormalities are rare. The prognosis is good if the patient survives to one year of age. The syndrome has been compared to Fanconi's anemia, thalidomide embryopathy, limb-cardiovascular syndrome, and a syndrome of multiple congenital malformations, from which it can be distinguished.
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            Congenital amegakaryocytic thrombocytopenia and thrombocytopenia with absent radii.

            Thrombocytopenia is a relatively common clinical problem in hospitalized neonates, and it is critical to distinguish infants who have rare congenital thrombocytopenias from those who have acquired disorders. Two well-described inherited thrombocytopenia syndromes that present in the newborn period are congenital amegakaryocytic thrombocytopenia (CAMT) and thrombocytopenia with absent radii (TAR). Although both are characterized by severe (< 50,000/microL) thrombocytopenia at birth, the molecular mechanisms underlying these disorders and their clinical presentations and courses are distinct. CAMT is an autosomal recessive disorder caused by mutations in the thrombopoietin (TPO) receptor c-Mpl. TAR is a syndrome of variable inheritance and unclear genetic etiology consisting of thrombocytopenia in association with bilateral absent radii and frequently additional congenital abnormalities. This article summarizes the current understanding of the pathophysiology and clinical course of CAMT and TAR.
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              Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review: reply.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rf
                Revista Finlay
                Rev. Finlay
                Universidad de Ciencias Médicas de Cienfuegos. Centro Provincial de información de Ciencias Médicas (Cienfuegos, , Cuba )
                2221-2434
                March 2019
                : 56-62
                Affiliations
                [1] Cienfuegos orgnameHospital Pediátrico Universitario Paquito González Cueto Cuba
                Article
                S2221-24342019000100056
                26051eb5-d4e2-4958-8869-a8ca77dcab98

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 12 January 2019
                : 12 February 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 7
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                SciELO Cuba


                anomalías congénitas,trombocitopenia,musculoskeletal abnormalities.,thrombocytopenia,congenital abnormalities,anomalías musculoesqueléticas.

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