{"id":2131,"date":"2019-06-19T19:15:17","date_gmt":"2019-06-19T19:15:17","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1671"},"modified":"2026-02-03T19:19:15","modified_gmt":"2026-02-03T19:19:15","slug":"sos-vod","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/es\/sos-vod\/","title":{"rendered":"Diagn\u00f3stico y Criterios de Gravedad para S\u00edndrome de Obstrucci\u00f3n Sinusoidal\/Enfermedad Veno-Oclusiva en Ni\u00f1os"},"content":{"rendered":"<div class=\"7ca9444b8380138fe077da07353677a4\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>El s\u00edndrome de obstrucci\u00f3n sinusoidal hep\u00e1tica\/enfermedad veno-oclusiva (OSH\/EVO) es una complicaci\u00f3n potencialmente mortal del trasplante de c\u00e9lulas hematopoy\u00e9ticas (TCH) que pertenece a un grupo de enfermedades cada vez m\u00e1s identificadas como enfermedades endoteliales sist\u00e9micas relacionadas con el trasplante. En la mayor\u00eda de los casos, OSH\/EVO se resuelve en semanas; sin embargo, la OSH\/EVO grave produce disfunci\u00f3n\/falla multiorg\u00e1nica con una tasa de mortalidad del &gt;80%.<!--more--><\/p>\n<p><strong>Criterios de diagn\u00f3stico de EBMT para OSH\/EVO hep\u00e1tico en ni\u00f1os<\/strong><\/p>\n<ul>\n<li>No hay limitaci\u00f3n por el tiempo de aparici\u00f3n de OSH\/EVO<\/li>\n<\/ul>\n<p>La presencia de dos o m\u00e1s de los siguientes<sup>a<\/sup>:<\/p>\n<ul>\n<li>Consumo inexplicable y trombocitopenia refractaria a la transfusi\u00f3n<sup>b<\/sup><\/li>\n<li>Aumento de peso inexplicable en tres d\u00edas consecutivos a pesar del uso de diur\u00e9ticos o un aumento de peso del &gt;5% por encima del valor basal.<\/li>\n<li><sup>c<\/sup>Hepatomegalia (mejor si se confirma con im\u00e1genes) por encima del valor basal<\/li>\n<li><sup>c<\/sup>Ascitis (mejor si se confirma con im\u00e1genes) por encima del valor basal<\/li>\n<li>Bilirrubina ascendente desde un valor basal en 3 d\u00edas consecutivos o bilirrubina \u22652 mg\/dL en 72 hs<\/li>\n<\/ul>\n<p><sup>a <\/sup>Con la exclusi\u00f3n de otros posibles diagn\u00f3sticos diferenciales.<br \/>\n<sup>b<\/sup> \u2265 1 sustituci\u00f3n de plaquetas ajustada por peso\/d\u00eda para mantener las pautas institucionales de transfusi\u00f3n.<br \/>\n<sup>c<\/sup> Sugerido: im\u00e1genes (US, TC o RM) inmediatamente antes de la TCH para determinar valor de referencia tanto para la hepatomegalia como para la ascitis.<\/p>\n<p>Abreviaturas: TC = tomograf\u00eda computarizada; TCH = trasplante de c\u00e9lulas hematopoy\u00e9ticas; RM = resonancia magn\u00e9tica; OSH\/EVO = obstrucci\u00f3n sinusoidal hep\u00e1tica\/enfermedad veno-oclusiva; US = ultrasonograf\u00eda; EBMT = Sociedad Europea para el Trasplante de Sangre y M\u00e9dula<\/p>\n<p><strong>Criterios de EBMT para graduar la severidad de la sospecha de OSH\/EVO hep\u00e1tica en ni\u00f1os<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"height: 48px; width: 152px;\" rowspan=\"2\">CTCEA<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Leve<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Moderado<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">Severo<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">Muy severo DMO\/FMO<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 83px; text-align: center;\">1<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">2<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">3<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">PFH<sup>b<\/sup> (ALT, AST, GLDH)<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">\u22642 \u00d7 normal<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">&gt;2 y \u22645 \u00d7 normal<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">&gt;5<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">&gt;5<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">TR Persistente<sup>b<\/sup><\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">&lt;3 d\u00edas<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">3\u20137 d\u00edas<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">&gt;7 d\u00edas<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">&gt;7 d\u00edas<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">Bilirubina (mg\/dL)<sup>b<\/sup><\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">&lt;2<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">&lt;2<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">\u22652<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">\u22652<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">Bilirubina (\u03bcmol\/L)<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">&lt;34<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">&lt;34<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">\u226534<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">\u226534<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">Ascitis<sup>b<\/sup><\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">M\u00ednima<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Moderada<\/td>\n<td style=\"height: 24px; width: 226px; text-align: center;\" colspan=\"2\">Necesidad de paracentesis (drenaje externo)<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">Cin\u00e9tica de bilirrubina<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\"><\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\"><\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\"><\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">Duplic\u00e1ndose en 48 hs<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">Coagulaci\u00f3n<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Normal<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Normal<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">Coagulaci\u00f3n alterada<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">Coagulaci\u00f3n alterada con necesidad de reemplazo de factores de coagulaci\u00f3n<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">Funci\u00f3n renal FRG (mL\/min)<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">89\u201360<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">59\u201330<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">29\u201315<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">&lt;15 (fallo renal)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 152px;\">\n<div class=\"tlid-input input\">\n<div class=\"source-wrap\">\n<div class=\"input-full-height-wrapper tlid-input-full-height-wrapper\">\n<div class=\"source-input\">\n<div class=\"source-footer-wrap source-or-target-footer\">\n<div class=\"character-count tlid-character-count\">\n<div class=\"cc-ctr normal\"><span style=\"font-family: inherit; font-size: inherit;\">Funci\u00f3n pulmonar (requerimiento de ox\u00edgeno)<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/td>\n<td style=\"width: 83px; text-align: center;\">&lt;2 L\/min<\/td>\n<td style=\"width: 83px; text-align: center;\">&gt;2 L\/min<\/td>\n<td style=\"width: 226px; text-align: center;\" colspan=\"2\">Ventilaci\u00f3n pulmonar invasiva (incluyendo CPAP)<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px; width: 152px;\">SNC<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Normal<\/td>\n<td style=\"height: 24px; width: 83px; text-align: center;\">Normal<\/td>\n<td style=\"height: 24px; width: 101px; text-align: center;\">Normal<\/td>\n<td style=\"height: 24px; width: 115px; text-align: center;\">Deterioro cognitivo de reciente inicio<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><sup>b<\/sup> La presencia de \u2265 2 de estos criterios califica para una mejora al nivel 4 de CTCEA (OSH\/EVO muy grave).<br \/>\n<sup>c<\/sup> Excluyendo la hiperbilirrubinemia preexistente debida a enfermedad.<\/p>\n<p>Abreviaturas: ALT = alanina transaminasa; AST = aspartato transaminasa; SNC = sistema nervioso central; CPAP = presi\u00f3n positiva continua en la v\u00eda a\u00e9rea; CTCEA = Criterios de terminolog\u00eda com\u00fan para eventos adversos; FRG = tasa de filtraci\u00f3n glomerular; GLDH = glutamato deshidrogenasa; PFH = prueba de funci\u00f3n hep\u00e1tica; DMO\/FMO = disfunci\u00f3n multiorg\u00e1nica\/falla multiorg\u00e1nica; TR = trombocitopenia refractaria; OSH\/EVO, obstrucci\u00f3n sinusoidal hep\u00e1tica\/enfermedad veno-oclusiva. Si el paciente cumple con los criterios en diferentes categor\u00edas, debe clasificarse en la categor\u00eda m\u00e1s grave. Adem\u00e1s, la cin\u00e9tica de la evoluci\u00f3n de los s\u00edntomas acumulados dentro de las 48 hs predice una enfermedad grave.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Bibliograf\u00eda:<\/strong><\/p>\n<ol>\n<li>Corbacioglu S, Carreras E, Ansari M, Balduzzi A, Cesaro S, Dalle JH, Dignan F, Gibson B, Guengoer T, Gruhn B, Lankester A, Locatelli F, Pagliuca A, Peters C, Richardson PG, Schulz AS, Sedlacek P, Stein J, Sykora KW, Toporski J, Trigoso E, Vetteranta K, Wachowiak J, Wallhult E, Wynn R, Yaniv I, Yesilipek A, Mohty M, Bader P. Diagnosis and severity criteria for sinusoidal obstruction syndrome\/veno-occlusive disease in pediatric patients: a new classification from the European society for blood and marrow transplantation.\u00a0Bone Marrow Transplant. 2018 Feb;53(2):138-145. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28759025\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Colecchia A, Ravaioli F, Sessa M, Alemanni VL, Dajti E, Marasco G, Vestito A, Zagari RM, Barbato F, Arpinati M, Cavo M, Festi D, Bonifazi F. Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease\/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study.\u00a0Biol Blood Marrow Transplant. 2019 May;25(5):995-1003. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30660772\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Mohty M, Malard F, Alaskar AS, Aljurf M, Arat M, Bader P, Baron F, Bazarbachi A, Blaise D, Brissot E, Ciceri F, Corbacioglu S, Dalle JH, Dignan F, Huynh A, Kenyon M, Nagler A, Pagliuca A, Peri\u0107 Z, Richardson PG, Ruggeri A, Ruutu T, Yakoub-Agha I, Duarte RF, Carreras E. Diagnosis and severity criteria for sinusoidal obstruction syndrome\/veno-occlusive disease in adult patients: a refined classification from the European society for blood and marrow transplantation (EBMT). Bone Marrow Transplant. 2023 Jul;58(7):749-754. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37095231\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Creado Jun 12, 2019.<br \/>\nActualizado Feb 3, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>El s\u00edndrome de obstrucci\u00f3n sinusoidal hep\u00e1tica\/enfermedad veno-oclusiva (OSH\/EVO) es una complicaci\u00f3n potencialmente mortal del trasplante de c\u00e9lulas hematopoy\u00e9ticas (TCH) que pertenece a un grupo de enfermedades cada vez m\u00e1s identificadas como enfermedades endoteliales sist\u00e9micas relacionadas con el trasplante. En la mayor\u00eda de los casos, OSH\/EVO se resuelve en semanas; sin embargo, la OSH\/EVO grave produce [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[171],"tags":[181,16,15,123,13,51,172,50,182,183,179,176,178,184,180,5,175,173,4,177,174],"class_list":["post-2131","post","type-post","status-publish","format-standard","hentry","category-hematology","tag-children","tag-criteria","tag-criterios","tag-diagnosis","tag-diagnostico","tag-disease","tag-ebmt","tag-enfermedad","tag-gravedad","tag-ninos","tag-obstruccion","tag-obstruction","tag-occlusive","tag-oclusiva","tag-severity","tag-sindrome","tag-sinusoidal","tag-sos","tag-syndrome","tag-veno","tag-vod"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/2131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/comments?post=2131"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/2131\/revisions"}],"predecessor-version":[{"id":10617,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/2131\/revisions\/10617"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/media?parent=2131"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/categories?post=2131"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/tags?post=2131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}