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Abstract(s)
Monocitose ocorre quando a concentração de monócitos encontrada no sangue periférico ascende a valores superiores ao valor normal de referência (aproximadamente 0.2 – 10 x 10 elevado à 9ª potência/L). São várias as patologias em que este fenómeno ocorre. É importante distinguir as situações em que se observa uma monocitose reativa daquelas em que existe uma neoplasia. As características que apontam para uma monocitose maligna são a persistência da mesma, a existência de elevados números de promonócitos e blastos no sangue periférico e displasia dos monócitos. Já uma monocitose reativa é, por norma, transitória e os monócitos encontrados estão devidamente maduros.
As causas de monocitoses não malignas são várias. Destacam-se a neutropenia cíclica e agranulocitose congénita e, ainda, infeções crónicas (tuberculose, endocardite bacteriana subaguda, brucelose, kala-azar, etc.) e patologias autoimunes (artrite reumatoide, lúpus eritematoso sistémico, sarcoidose, etc.).
O diagnóstico de uma monocitose pode ser realizado através do hemograma completo quando um doente apresenta sinais ou sintomas de uma infeção ou doença autoimune; nestas condições o número de monócitos aumenta em consequência do recrutamento dos mesmos através do processo inflamatório. A citometria de fluxo é uma das técnicas mais utilizadas para a contagem diferencial de leucócitos.
Após o diagnóstico de qualquer patologia associada a monocitose reativa é aplicada terapêutica adequada. Esta terapêutica depende da patologia em questão, e vai desde antipiréticos e antibióticos, no caso das patologias infeciosas, até glucocorticoides e terapêutica citotóxica nas patologias autoimunes.
Não existem testes de diagnóstico específicos para cada uma destas patologias, no entanto, a realização de vários testes em simultâneo, em concomitância com o diagnóstico clínico, leva a um diagnóstico relativamente preciso. Em termos de terapêutica, cada vez mais se tem verificado o aparecimento de resistências à terapêutica convencional, no entanto, novas terapêuticas estão a ser investigadas com o objetivo de aumentar a eficiência e diminuir as reações adversas.
Monocytosis occurs when the concentration of monocytes found in peripheral blood rises to values above the normal reference values (approximately 0.2 - 10 x 10 raise to 9th power/L). There are several diseases in which this phenomenon occurs. It is important to distinguish situations in which reactive monocytosis is observed from those where there is already a malignant disease. The characteristics that point to a malignant monocytosis are its persistence, the existence of high numbers of pro-monocytes and blasts in the peripheral blood and dysplasia of the monocytes. A reactive monocytosis, however, is usually transient and the monocytes found are properly mature. The causes of nonmalignant monocytosis are several, such as cyclic neutropenia and congenital agranulocytosis, and even chronic infections (tuberculosis, sub-acute bacterial endocarditis, brucellosis, kala-azar, etc.) and autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, etc.). The diagnosis of a monocytosis can be made through the complete blood count when a patient shows signs or symptoms of an infection or autoimmune disease; under these conditions the number of monocytes increases as a result of their recruitment by the inflammatory process. Flow cytometry is one of the most widely used techniques for leukocyte differential count. After diagnosis of any disease associated with reactive monocytosis, appropriate therapy is applied. This therapy depends on the disease in question, going from antipyretics and antibiotics, in the case of infectious diseases, to glucocorticoids and cytotoxic therapy in autoimmune diseases. There are no specific diagnostic tests for each of these pathologies, however, conducting multiple tests simultaneously, adding them to the clinical diagnosis, leads to a relatively accurate diagnosis. In terms of therapy, the emergence of resistance to conventional therapy has been increasing, however, new therapies are being investigated in order to increase efficiency and decrease adverse reactions.
Monocytosis occurs when the concentration of monocytes found in peripheral blood rises to values above the normal reference values (approximately 0.2 - 10 x 10 raise to 9th power/L). There are several diseases in which this phenomenon occurs. It is important to distinguish situations in which reactive monocytosis is observed from those where there is already a malignant disease. The characteristics that point to a malignant monocytosis are its persistence, the existence of high numbers of pro-monocytes and blasts in the peripheral blood and dysplasia of the monocytes. A reactive monocytosis, however, is usually transient and the monocytes found are properly mature. The causes of nonmalignant monocytosis are several, such as cyclic neutropenia and congenital agranulocytosis, and even chronic infections (tuberculosis, sub-acute bacterial endocarditis, brucellosis, kala-azar, etc.) and autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, etc.). The diagnosis of a monocytosis can be made through the complete blood count when a patient shows signs or symptoms of an infection or autoimmune disease; under these conditions the number of monocytes increases as a result of their recruitment by the inflammatory process. Flow cytometry is one of the most widely used techniques for leukocyte differential count. After diagnosis of any disease associated with reactive monocytosis, appropriate therapy is applied. This therapy depends on the disease in question, going from antipyretics and antibiotics, in the case of infectious diseases, to glucocorticoids and cytotoxic therapy in autoimmune diseases. There are no specific diagnostic tests for each of these pathologies, however, conducting multiple tests simultaneously, adding them to the clinical diagnosis, leads to a relatively accurate diagnosis. In terms of therapy, the emergence of resistance to conventional therapy has been increasing, however, new therapies are being investigated in order to increase efficiency and decrease adverse reactions.
Description
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2016
Keywords
Monócito Monocitose reativa Infeção crónica Patologia autoimune Patologia monocitária Mestrado Integrado - 2016