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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n y objetivos</span><p id="par0005" class="elsevierStylePara elsevierViewall">La trombocitopenia inmune primaria &#40;PTI&#41; es una enfermedad caracterizada por una disminuci&#243;n aislada de la cifra de plaquetas por debajo de 100&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; sin encontrar una causa desencadenante que la explique&#46; Actualmente se establece el t&#233;rmino &#171;cr&#243;nica&#187; a partir de 12 meses de evoluci&#243;n desde el diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Es la causa m&#225;s frecuente de trombocitopenia de presentaci&#243;n aguda en un ni&#241;o sano&#44; pero no es una enfermedad frecuente&#46; La incidencia en menores de 15 a&#241;os se estima en unos 5 casos por 100&#46;000 habitantes&#47;a&#241;o<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se caracteriza fundamentalmente por sintomatolog&#237;a hemorr&#225;gica a 3 niveles&#58; piel&#44; mucosas y &#243;rganos internos&#46; La mayor&#237;a de los pacientes est&#225;n asintom&#225;ticos o tienen afectaci&#243;n cut&#225;neo-mucosa&#46; Se han desarrollado diferentes escalas cl&#237;nicas para medir de forma objetiva la intensidad de los sangrados&#44; siendo una de las m&#225;s empleadas la desarrollada por la OMS&#58; grado 0&#44; sin evidencia de sangrado&#59; grado 1&#58; sangrados leves &#40;petequias&#44; equimosis&#44; mucosas&#44; sangrado retiniano sin alteraciones visuales&#41;&#59; grado 2&#58; sangrados mayores &#40;melena&#44; hematemesis&#44; hematuria&#44; hemoptisis&#41;&#59; grado 3&#58; cualquier sangrado que requiera transfusi&#243;n de hemat&#237;es&#59; grado 4&#58; sangrados retinianos con alteraciones en la visi&#243;n&#44; sangrados en sistema nervioso central&#46; Solamente el 3&#37; de los pacientes pedi&#225;tricos presentan sintomatolog&#237;a de sangrado cl&#237;nicamente significativo&#44; siendo las manifestaciones m&#225;s frecuentes la epistaxis y el sangrado gastrointestinal<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46; Las hemorragias parecen estar relacionadas con la gravedad de la trombocitopenia&#44; aunque no existe una correlaci&#243;n exacta ni directa entre estas variables&#46; La complicaci&#243;n m&#225;s grave es la hemorragia intracraneal &#40;HIC&#41;&#44; cuya frecuencia oscila entre el 0&#44;1 y el 0&#44;6&#37;&#46; No se ha establecido un claro factor predictor del riesgo de HIC en estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3-6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de PTI es de exclusi&#243;n&#46; Una historia personal y familiar y un examen f&#237;sico normales &#40;salvo las manifestaciones hemorr&#225;gicas&#41;&#44; asociados a la presencia de trombocitopenia aislada&#44; constituyen las herramientas clave para establecer el diagn&#243;stico&#46; La mayor&#237;a de los pacientes presentan antecedentes de infecci&#243;n viral &#40;60&#37; infecci&#243;n de v&#237;as altas y exantemas&#41;&#44; inmunizaci&#243;n &#40;m&#225;s frecuente en relaci&#243;n con la vacuna triple v&#237;rica&#41; o infecci&#243;n bacteriana en las semanas previas<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Cualquier otra alteraci&#243;n anal&#237;tica que no sea la trombocitopenia aislada&#44; y&#47;o anomal&#237;as en la exploraci&#243;n f&#237;sica &#40;dismorfias&#44; visceromegalias&#44; etc&#46;&#41; o en la historia cl&#237;nica &#40;infecciones de repetici&#243;n&#44; fiebre&#44; medicamentos&#44; etc&#46;&#41; deben&#44; al menos&#44; hacer replantearse el diagn&#243;stico de PTI<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La PTI es una enfermedad benigna y autolimitada&#46; Diversos registros y publicaciones han demostrado una remisi&#243;n superior al 60&#37; en los 6 meses tras el diagn&#243;stico&#44; independientemente del tratamiento recibido<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;9</span></a>&#46; La identificaci&#243;n de factores predictores de la remisi&#243;n es dif&#237;cil de establecer&#59; se ha encontrado una relaci&#243;n entre la evoluci&#243;n favorable y los siguientes&#58; sexo masculino&#44; edad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 a&#241;os&#44; inicio abrupto&#44; presencia de infecci&#243;n previa y recuento de plaquetas muy bajo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10-13</span></a>&#46; Tambi&#233;n la presencia de leucopenia parece asociarse a un mayor riesgo de PTI persistente o cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los f&#225;rmacos m&#225;s frecuentemente empleados para su tratamiento han sido los corticoides y las inmunoglobulinas intravenosas &#40;IGIV&#41;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">15-18</span></a>&#46; Cl&#225;sicamente la indicaci&#243;n de tratamiento se basaba en aumentar las cifras de plaquetas&#46; Con los datos que tenemos en la actualidad&#44; sobre la rareza del sangrado significativo&#44; la ausencia de evidencia de que el tratamiento prevenga el sangrado grave&#44; y los costes y toxicidades conocidos de los diferentes tratamientos&#44; se aboga por un manejo m&#225;s conservador&#44; recomendando la observaci&#243;n para los ni&#241;os asintom&#225;ticos o m&#237;nimamente sintom&#225;ticos&#46; En el caso de recibir tratamiento&#44; al no existir uno que haya demostrado su superioridad&#44; es recomendable valorar los pros y contras con los pacientes y sus familias para alcanzar un plan individualizado<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;9&#44;19</span></a>&#46; Este cambio de estrategia terap&#233;utica queda recogido en los diferentes protocolos y gu&#237;as publicados en los &#250;ltimos a&#241;os&#44; como el protocolo de la Sociedad Espa&#241;ola de Hematolog&#237;a y Oncolog&#237;a Pedi&#225;tricas &#40;SEHOP&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">19-21</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En 2013 se puso en marcha una consulta especializada en Hematolog&#237;a Pedi&#225;trica en el Hospital Infantil Miguel Servet de Zaragoza&#44; para encargarse del diagn&#243;stico&#44; tratamiento y seguimiento de los pacientes diagnosticados de procesos hematol&#243;gicos no oncol&#243;gicos&#44; entre ellos&#44; los pacientes con PTI&#46; Hasta esa fecha&#44; los casos de PTI en este centro eran tratados por diferentes profesionales no especialistas en Hematolog&#237;a Pedi&#225;trica&#46; A partir de la puesta en marcha de la consulta especializada&#44; se emplearon de forma sistem&#225;tica protocolos avalados por sociedades cient&#237;ficas expertas en Hematolog&#237;a Pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es conocer las caracter&#237;sticas cl&#237;nicas&#44; anal&#237;ticas y evolutivas de los casos valorados en esa consulta especializada&#44; y estudiar los factores de riesgo que pudieron relacionarse con una evoluci&#243;n m&#225;s t&#243;rpida&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Poblaci&#243;n y m&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio retrospectivo&#44; observacional y anal&#237;tico mediante la revisi&#243;n de historias cl&#237;nicas de pacientes diagnosticados de PTI&#44; atendidos entre enero de 2013 y octubre de 2016 en la consulta especializada en Hematolog&#237;a Pedi&#225;trica en el Hospital Infantil Miguel Servet de Zaragoza&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se incluyeron los pacientes menores de 15 a&#241;os diagnosticados de PTI&#44; atendidos en esta consulta en ese intervalo de tiempo&#44; independientemente de la fecha del diagn&#243;stico inicial&#46; Se excluyeron del estudio los pacientes sin datos suficientes de seguimiento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se emplearon los criterios diagn&#243;sticos&#44; de respuesta y los tratamientos recogidos en el protocolo sobre PTI de la SEHOP vigente<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los datos recogidos inclu&#237;an variables demogr&#225;ficas y epidemiol&#243;gicas&#44; anal&#237;ticas&#44; de tratamiento&#44; respuesta al mismo e informaci&#243;n sobre el seguimiento y la evoluci&#243;n&#46; Toda la informaci&#243;n fue recogida bajo el cumplimiento de la Ley de Protecci&#243;n de Datos vigente&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Las variables se compararon mediante las pruebas de &#967;y y t de Student&#46; Para establecer relaciones entre las variables se emple&#243; el estudio de regresi&#243;n log&#237;stica binaria&#44; siendo la variable dependiente el tipo de PTI seg&#250;n el tiempo de evoluci&#243;n &#40;menor o igual a 12 meses&#47;mayor de 12 meses&#41;&#46; Se realiz&#243; tambi&#233;n un estudio de supervivencia&#44; definiendo supervivencia libre de eventos &#40;SLE&#41; como el tiempo transcurrido en meses desde el diagn&#243;stico hasta la aparici&#243;n de &#40;lo que ocurriese primero&#41;&#58; descenso de plaquetas &#60;<span class="elsevierStyleHsp" style=""></span>30&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; muerte&#44; alta&#44; o final del estudio &#40;31 de octubre de 2016&#41;&#46; Las curvas de supervivencia se realizaron mediante el m&#233;todo de Kaplan-Meier&#46; Se compar&#243; la diferencia en la SLE en funci&#243;n de diferentes factores cl&#237;nicos&#44; diagn&#243;sticos y terap&#233;uticos &#40;edad&#44; sexo&#44; presencia de sangrado mucoso&#44; antecedente infeccioso&#44; cifra de plaquetas y de leucocitos&#44; atenci&#243;n en consulta especializada o previa a la puesta en marcha de la misma&#41; mediante an&#225;lisis univariable por Kaplan-Meier&#44; empleando el test log-rank&#46; La significaci&#243;n estad&#237;stica se estableci&#243; para un valor de p o B menor de 0&#44;05&#46; El an&#225;lisis estad&#237;stico se realiz&#243; utilizando el programa IBM SPSS versi&#243;n 24&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Entre enero de 2013 y octubre de 2016 fueron valorados en la consulta de Hematolog&#237;a Pedi&#225;trica 509 pacientes por alg&#250;n trastorno hematol&#243;gico benigno&#46; De estos&#44; 44 &#40;8&#44;6&#37;&#41; estaban diagnosticados de trombocitopenia&#44; y 31 &#40;70&#37; de las trombocitopenias&#41; ten&#237;an un diagn&#243;stico de PTI&#46; Con estos datos y los demogr&#225;ficos del Instituto Aragon&#233;s de Estad&#237;stica se puede establecer una incidencia en menores de 15 a&#241;os de 2&#44;6 casos por 100&#46;000 habitantes&#47;a&#241;o&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La distribuci&#243;n por g&#233;nero fue de 18 hombres frente a 13 mujeres &#40;relaci&#243;n 1&#44;3&#58;1&#41;&#44; con una edad media al diagn&#243;stico de 4&#44;5 a&#241;os&#44; mediana de 4 a&#241;os y un intervalo de 0-13 a&#241;os&#46; La mayor&#237;a de los pacientes &#40;27&#47;31&#41; ten&#237;an una edad menor de 10 a&#241;os al diagn&#243;stico&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las manifestaciones cl&#237;nicas&#44; 2 pacientes &#40;6&#44;5&#37;&#41; no presentaban ning&#250;n signo de sangrado&#44; estableci&#233;ndose el diagn&#243;stico al hacer una anal&#237;tica por otros motivos&#46; En los 29 restantes se objetivaron signos de sangrado&#58; cut&#225;neo en todos ellos&#44; y mucoso en 12 casos &#40;38&#44;7&#37;&#41;&#44; siendo la epistaxis el sangrado m&#225;s habitual &#40;10&#47;12&#59; 83&#37;&#41;&#44; seguido del sangrado gastrointestinal&#46; En ning&#250;n paciente se registr&#243; el antecedente de vacunaci&#243;n&#44; existiendo antecedente infeccioso previo en 13 casos &#40;41&#44;9&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La cifra media de plaquetas al diagn&#243;stico fue de 11&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; y la mediana de 9&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#46; El 83&#44;8&#37; de pacientes presentaban &#60;<span class="elsevierStyleHsp" style=""></span>20&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span> al diagn&#243;stico y se encontr&#243; trombocitopenia muy grave &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span>&#41; en un 13&#37; de la muestra&#46; Las plaquetas al diagn&#243;stico de la serie no superaron en ning&#250;n caso las 50&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#46; Las cifras de hemoglobina iniciales fueron anormales en 2 casos&#44; en los que se realiz&#243; un estudio de m&#233;dula &#243;sea&#44; que confirm&#243; el origen perif&#233;rico de la trombocitopenia&#46; Seis pacientes &#40;19&#44;4&#37;&#41; presentaron leucocitos &#60;<span class="elsevierStyleHsp" style=""></span>6&#46;000&#47;mm<span class="elsevierStyleSup">3</span> al diagn&#243;stico&#44; y de estos&#44; la mayor&#237;a &#40;66&#37;&#41; evolucionaron hacia PTI cr&#243;nica &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">De los 31 pacientes&#44; 3 &#40;9&#44;7&#37;&#41; no recibieron ning&#250;n tratamiento m&#233;dico a lo largo del seguimiento&#59; todos ellos evolucionaron a la curaci&#243;n en los 6 meses siguientes&#46; Trece &#40;46&#44;8&#37;&#41; recibieron un tratamiento&#44; siendo el m&#225;s empleado la prednisona &#40;8 pacientes&#41;&#44; seguido de las IGIV &#40;5 pacientes&#41;&#46; Doce pacientes precisaron recibir 2 l&#237;neas de tratamiento&#44; por escasa respuesta cl&#237;nica y&#47;o anal&#237;tica&#44; y en 3 casos se emplearon otras terapias &#40;dexametasona&#44; rituximab&#44; an&#225;logos de la trombopoyetina&#44; esplenectom&#237;a&#41;&#46; Un paciente present&#243; epistaxis que precis&#243; terapia transfusional por repercusi&#243;n hemodin&#225;mica&#46; No se registr&#243; ninguna muerte ni ning&#250;n sangrado amenazante para la vida en toda la muestra en el periodo de estudio&#46; Seg&#250;n la escala de sangrados de la OMS&#44; la mayor&#237;a de los pacientes &#40;28&#47;31 90&#44;3&#37;&#41; presentaron hemorragia grados 1-2&#46; Se registraron 2 casos con grado 0&#44; un caso con grado 3 y no hubo ning&#250;n caso con sangrado grado 4&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Veintinueve pacientes &#40;93&#44;5&#37;&#41; alcanzaron una cifra &#62;<span class="elsevierStyleHsp" style=""></span>100&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span>&#44; con un tiempo medio de 150 d&#237;as y una mediana de 65 d&#237;as&#46; Once casos &#40;35&#44;4&#37;&#41; presentaron un descenso por debajo de 30&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span> durante el seguimiento&#44; con un intervalo medio de 87 d&#237;as y una mediana de 30 d&#237;as desde el diagn&#243;stico&#46; Todos los que disminuyeron las cifras de plaquetas recibieron&#44; en alg&#250;n momento al menos&#44; un tratamiento&#58; 3 pacientes solamente prednisona&#44; 4 pacientes prednisona e inmunoglobulinas y 4 pacientes al menos 3 f&#225;rmacos inmunomoduladores&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">De los 31 pacientes&#44; la mayor&#237;a &#40;23&#47;31&#59; 74&#44;2&#37;&#41; resolvieron la trombocitopenia en los siguientes 12 meses al diagn&#243;stico&#44; y 8 pacientes &#40;25&#44;8&#37;&#41; cumplieron criterios de PTI cr&#243;nica&#46; Los pacientes con PTI cr&#243;nica eran m&#225;s frecuentemente mujeres&#44; con una edad media m&#225;s elevada que la muestra total&#44; una cifra media de plaquetas m&#225;s elevada al diagn&#243;stico&#44; leucocitos m&#225;s bajos al diagn&#243;stico y sin antecedente de infecci&#243;n previa&#46; En los pacientes con PTI de m&#225;s de 12 meses de evoluci&#243;n&#44; compar&#225;ndolos con los pacientes con PTI aguda o recurrente de menos de 12 meses de evoluci&#243;n&#44; se encontr&#243; una relaci&#243;n estad&#237;sticamente significativa con una edad m&#225;s elevada al diagn&#243;stico&#44; la presencia de leucopenia y la ausencia de infecci&#243;n&#46; No se encontr&#243; una relaci&#243;n estad&#237;sticamente significativa en relaci&#243;n con la cifra de plaquetas&#44; la presencia de sangrado mucoso&#44; ni el tratamiento recibido &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Respecto al tipo de atenci&#243;n recibida por los pacientes con PTI&#44; en 13 casos el diagn&#243;stico fue hecho antes del inicio de la consulta especializada en Hematolog&#237;a&#44; y en los 18 restantes&#44; tras la puesta en marcha de la misma&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de regresi&#243;n log&#237;stica binaria&#44; empleando como variable dependiente el tipo de PTI &#40;aguda&#47;persistente o cr&#243;nica&#41;&#44; no se encontr&#243; ninguna asociaci&#243;n significativa con las variables independientes&#58; sexo&#44; edad&#44; leucocitos y plaquetas al diagn&#243;stico&#44; presencia de sangrado mucoso y tratamiento recibido&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Se compar&#243; la SLE en funci&#243;n de varios factores epidemiol&#243;gicos&#44; cl&#237;nicos y terap&#233;uticos&#44; encontr&#225;ndose que fue menor&#44; aunque sin alcanzar significaci&#243;n estad&#237;stica&#44; en las mujeres &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;37&#41;&#44; en los mayores de 10 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;056&#41;&#44; sin signos de sangrado mucoso &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;95&#41;&#44; con cifras de plaquetas superiores a 5&#46;000&#47;mm<span class="elsevierStyleSup">3</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;16&#41;&#44; con leucopenia &#60;<span class="elsevierStyleHsp" style=""></span>6&#46;000&#47;mm<span class="elsevierStyleSup">3</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#44; y tratados antes del inicio de la atenci&#243;n especializada en Hematolog&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#46; La SLE fue significativamente m&#225;s baja &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en los pacientes sin antecedentes de proceso infeccioso previo &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1-4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">De los 31 pacientes estudiados&#44; 19 &#40;61&#44;3&#37;&#41; fueron dados de alta de la consulta&#44; tras al menos un a&#241;o de seguimiento despu&#233;s de la resoluci&#243;n de la trombocitopenia&#46; Doce pacientes continuaron seguimiento en la consulta de Hematolog&#237;a Pedi&#225;trica&#44; bien por la cronicidad de su cuadro&#44; o bien porque a fecha de fin del estudio no se hab&#237;a cumplido un a&#241;o de seguimiento&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los datos epidemiol&#243;gicos obtenidos en este estudio coinciden con la literatura y los recogidos en diferentes registros en cuanto a la distribuci&#243;n por edad y sexo de los casos de PTI&#44; siendo el grupo etario m&#225;s frecuente los varones de entre 2 y 4 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;5</span></a>&#46; La tasa de incidencia obtenida de 2&#44;6 casos por 100&#46;000 pacientes pedi&#225;tricos por a&#241;o se encuentra por debajo de los 5 casos por 100&#46;000 por a&#241;o que se estima en la mayor parte de las publicaciones<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;5</span></a>&#46; Esta baja estimaci&#243;n de los casos puede atribuirse a varios factores&#58; el primero&#44; que no todos los casos de PTI en Arag&#243;n se controlaron en el centro donde se realiz&#243; el estudio&#46; Adem&#225;s&#44; en la presente serie&#44; la mayor&#237;a de los pacientes ten&#237;an una trombocitopenia grave &#40;media de 11&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; c&#233;nit de 47&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; no habi&#233;ndose registrado los casos con trombocitopenia leve&#44; que tambi&#233;n cumplir&#237;an los criterios diagn&#243;sticos de PTI&#46; Si se hubiesen incluido estos pacientes con un cuadro menos sintom&#225;tico&#44; probablemente la tasa de incidencia se acercar&#237;a m&#225;s a la encontrada en otras publicaciones<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;5</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La frecuencia de complicaciones hemorr&#225;gicas relevantes es similar a las publicadas &#40;3&#37;&#41;&#44; y la de sangrados graves es a&#250;n menor que la descrita en la literatura<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;6&#44;9</span></a>&#46; No se registr&#243; ning&#250;n caso de sangrado potencialmente mortal durante el seguimiento&#46; Dos ni&#241;os presentaron anemia en relaci&#243;n con los sangrados&#44; precisando solamente uno la administraci&#243;n de hemoderivados&#46; Estos datos avalan la afirmaci&#243;n de que la PTI en la infancia es una enfermedad benigna&#44; y que rara vez asocia morbimortalidad&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La PTI es frecuentemente un trastorno autolimitado que dura pocas semanas o meses&#44; aunque en aproximadamente el 25-30&#37; se convierte en cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;13&#44;14</span></a>&#46; En esta serie&#44; la mayor&#237;a de los pacientes alcanzaron una cifra de plaquetas normales en menos de 6 meses y m&#225;s de dos tercios de la muestra presentaron un cuadro de menos de 12 meses de evoluci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">No se encontraron diferencias entre las terapias recibidas&#46; Lo m&#225;s rese&#241;able fue que los 3 pacientes que no recibieron ning&#250;n tratamiento evolucionaron a la curaci&#243;n espont&#225;nea en menos de 6 meses&#46; La interpretaci&#243;n de estos resultados est&#225; supeditada al peque&#241;o tama&#241;o muestral&#44; pero parece reafirmar que la evoluci&#243;n de este trastorno hacia la curaci&#243;n o cronicidad no depende del tratamiento administrado<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;10</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Discernir qu&#233; factores pueden influir en la evoluci&#243;n de este trastorno se ha convertido en un tema principal de estudio en los pacientes con PTI<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9-14</span></a>&#44; ya que cuando el m&#233;dico se enfrenta a un diagn&#243;stico nuevo&#44; no puede determinar si el ni&#241;o va a presentar una enfermedad autolimitada o va a evolucionar a un trastorno cr&#243;nico&#44; con las implicaciones que esta informaci&#243;n tiene de cara al manejo del paciente y su entorno&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En esta serie los pacientes diagnosticados de PTI cr&#243;nica eran m&#225;s frecuentemente mujeres&#44; con una edad media m&#225;s elevada&#44; sin trombocitopenia grave&#44; con leucopenia y sin antecedente de infecci&#243;n previa en la anamnesis al diagn&#243;stico&#46; Se encontr&#243; una asociaci&#243;n estad&#237;sticamente significativa entre la PTI cr&#243;nica y la edad m&#225;s elevada&#44; la presencia de leucopenia y la ausencia de antecedente de infecci&#243;n&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El estudio de regresi&#243;n no aport&#243; resultados con significaci&#243;n estad&#237;stica&#44; probablemente por el reducido tama&#241;o muestral&#44; pero en el estudio de supervivencia se confirm&#243; la ausencia de un antecedente infeccioso como un factor con significaci&#243;n estad&#237;stica para la reca&#237;da&#46; La explicaci&#243;n podr&#237;a ser que&#44; al existir un claro desencadenante infeccioso del proceso autoinmune&#44; el comportamiento ser&#237;a el cl&#225;sico y esperado&#44; con una evoluci&#243;n benigna y autolimitada&#46; La ausencia de este desencadenante infeccioso podr&#237;a ser m&#225;s sugestivo de que el proceso fisiopatol&#243;gico que desencadena el fen&#243;meno de disregulaci&#243;n inmune es m&#225;s complejo y multifactorial&#44; con una tendencia a la cronificaci&#243;n del cuadro&#46; Otros factores que se asociaron a una supervivencia menor&#44; sin llegar a alcanzar la significaci&#243;n&#44; aunque con cifras cercanas a ella&#44; fueron la mayor edad&#44; la presencia de leucopenia y la atenci&#243;n no especializada en Hematolog&#237;a&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los datos epidemiol&#243;gicos y de evoluci&#243;n de nuestra muestra coinciden con los de otros registros&#58; la mayor&#237;a de los pacientes son varones&#44; de edad preescolar&#44; con antecedente de infecci&#243;n previa&#44; con signos de sangrado mayoritariamente cut&#225;neos&#44; una trombocitopenia grave al diagn&#243;stico y una evoluci&#243;n benigna y menor de 12 meses&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Los pacientes que sean mujeres&#44; de edad escolar o mayor&#44; sin un claro antecedente infeccioso&#44; sin signos de sangrado mucoso&#44; con una trombocitopenia no muy grave y&#47;o leucopenia iniciales&#44; parecen presentar un riesgo mayor de tener una evoluci&#243;n t&#243;rpida y recurrente&#44; con tendencia a la cronificaci&#243;n&#46; Dada la baja prevalencia de esta enfermedad ser&#237;a recomendable realizar un estudio multic&#233;ntrico prospectivo con mayor tama&#241;o muestral que permitiese corroborar estos datos con mayor precisi&#243;n y significaci&#243;n&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En este estudio la evoluci&#243;n de los pacientes fue m&#225;s favorable a partir del inicio de la atenci&#243;n especializada en Hematolog&#237;a&#46; Con los datos obtenidos&#44; teniendo en cuenta las limitaciones del estudio&#44; parece adecuado recomendar que las enfermedades poco frecuentes&#44; como la PTI&#44; sean manejadas en unidades especializadas&#44; con el objetivo de disminuir la variabilidad en la pr&#225;ctica cl&#237;nica y ofrecer el tratamiento m&#225;s adecuado&#44; basado en la m&#225;s actual y contrastada evidencia cient&#237;fica&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La trombocitopenia inmune primaria &#40;PTI&#41; es poco frecuente en la infancia&#44; pero es la causa m&#225;s habitual de trombocitopenia&#46; Se han intentado establecer factores de riesgo para predecir su evoluci&#243;n&#44; con el objetivo de poder optimizar su manejo&#44; que se ha modificado en los &#250;ltimos a&#241;os&#44; debido&#44; entre otros factores&#44; a una atenci&#243;n m&#225;s especializada&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo&#44; observacional y anal&#237;tico de los pacientes con PTI&#44; en un periodo de 3 a&#241;os&#44; en una consulta especializada en Hematolog&#237;a Pedi&#225;trica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Desde el punto de vista epidemiol&#243;gico&#44; cl&#237;nico y anal&#237;tico&#44; las caracter&#237;sticas de esta serie son similares a las de otros grupos&#46; La mayor&#237;a de los pacientes &#40;23&#47;31&#59; 74&#44;2&#37;&#41; presentaron una PTI de duraci&#243;n menor de 12 meses&#44; sin complicaciones graves relacionadas con la enfermedad ni con el tratamiento&#46; Se establecieron como factores de riesgo relacionados con una evoluci&#243;n t&#243;rpida &#40;supervivencia libre de eventos &#91;SLE&#93; menor&#41;&#44; sin alcanzar la significaci&#243;n estad&#237;stica&#44; el sexo femenino&#44; la edad mayor de 10 a&#241;os&#44; la leucopenia&#44; la ausencia de trombocitopenia grave inicial y la atenci&#243;n no especializada&#46; La ausencia de antecedente de infecci&#243;n se relacion&#243; significativamente con una SLE menor&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los factores de riesgo de evoluci&#243;n t&#243;rpida de PTI epidemiol&#243;gicos y anal&#237;ticos de este estudio coinciden con los descritos en la literatura&#46; Presentaron una SLE menor los pacientes tratados antes del inicio de la atenci&#243;n especializada&#46; Estos datos parecen apoyar la recomendaci&#243;n actual de que las enfermedades poco frecuentes&#44; como esta&#44; se controlen en unidades especializadas&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Although primary immune thrombocytopenia &#40;ITP&#41; is rare in childhood&#44; it is the most frequent cause of thrombocytopenia&#46; There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management&#44; which has changed in recent years due to&#44; among other reasons&#44; specialised care&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">From the epidemiological&#44; clinical and analytical point of view&#44; the characteristics of this group are similar to others&#46; Most of the patients &#40;23&#47;31&#44; 74&#46;2&#37;&#41; had ITP for less than 12 months&#44; with there being no serious complications related to the disease or the treatment received&#46; It was established that risk factors were related to being slowly evolving &#40;lower event-free survival &#40;EFS&#41;&#41; with no statistical significance&#44; female gender&#44; age over 10 years&#44; leukopenia absence of initial severe thrombocytopenia&#44; and non-specialised care&#46; The absence of a history of infection was significantly related to a lower EFS&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature&#46; Patients treated before the beginning of specialised care also had a lower EFS&#46; These data seem to support the current recommendation that rare diseases should be managed in specialised units&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#225;ximo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">457&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Volumen plaquetario &#40;fl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">18 &#40;58&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;4-11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 a&#241;os&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sangrado cut&#225;neo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;93&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;91&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sangrado mucoso&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;61&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;60&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;39&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infecci&#243;n previa&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;58&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;43&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;56&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plaquetas totales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;889&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intervalo&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">457-47&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">457-27&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;000-47&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plaquetas&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;52&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;47&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plaquetas&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;17&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;89&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Leucocitos totales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;891&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;560&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;323&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infecci&#243;n previa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plaquetas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Leucocitos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Momento de atenci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antes de inicio de atenci&#243;n especializada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atenci&#243;n especializada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2339212.png"
              ]
            ]
          ]
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