Donación de médula ósea

donacion medula
Hoy hemos querido dedicar este espacio a explicar un poco en qué consiste la donación de médula ósea a propósito de distintos casos que salen a la luz en los medios de comunicación. Queda mucho por conseguir y tú puedes ayudarnos.

Nos gustaría renovar este post a propósito de la búsqueda de donantes de médula para la pequeña Cataleya ingresada en el Hospital Clínico de Valladolid. También queremos hacer una mención especial a la memoria de Pablo Ráez, en cuya lucha personal por vivir con alegría consiguió un gran aumento del número de donaciones de médula. Aún queda mucho por conseguir y tú puedes ayudarnos.

¿Qué es la médula ósea?

La médula ósea es un tejido vital para nuestro organismo. En él se encuentran las células madre, que son las encargadas de producir todas las células de la sangre y del sistema inmune.

Existen numerosas enfermedades en las que hay una producción anómala de células derivadas de las células madre. Si nuestra médula está enferma y no produce las células de manera adecuada, nos podemos morir. En algunas de estas enfermedades el tratamiento consiste en sustituir esas células de la médula del enfermo que no funcionan bien por células sanas de un donante.

Las células madre podemos obtenerlas también de la sangre periférica o de la sangre del cordón umbilical, por eso hablamos en general del trasplante de progenitores hematopoyéticos.

¿En qué consiste la compatibilidad donante- receptor?

Ser compatible significa que las células progenitoras del donante y del receptor son tan parecidas que pueden vivir de manera indefinida en el receptor.

Las células de nuestro organismo tienen en su superficie unas proteínas, los antígenos HLA, que son como la huella de que esas células pertenecen a ese organismo. Cuando nuestras células de la defensa, los linfocitos, detectan células con un HLA diferente al de nuestro organismo, las identifican como intrusos y las atacan para destruirlas. Ese es el mecanismo por el que si trasplantamos un órgano con un HLA diferente al del enfermo, sus linfocitos atacan a ese órgano para destruirlo, produciéndose lo que comúnmente llamamos rechazo del órgano.

Cuando trasplantamos progenitores hematopoyéticos, introducimos en el organismo del enfermo linfocitos que lo que hacen es detectar HLA de su organismo original, es decir, del donante. Si el HLA del receptor no es compatible, los linfocitos que trasplantamos pueden atacar a las células del organismo receptor. A esto lo llamamos enfermedad injerto contra huésped.

Los antígenos HLA de un individuo son siempre distintos a los de otro (salvo en el caso de gemelos univitelinos que tienen exactamente el mismo DNA). Además, toda persona hereda la mitad de sus antígenos de su padre y la otra mitad de su madre. Por todo ello, la máxima probabilidad de encontrar un donante compatible se produce entre los hermanos del enfermo o entre familiares de primer grado (padres e hijos). Sin embargo, la probabilidad de que un hermano sea compatible con otro es de tan sólo el 25% y la de encontrar un familiar compatible, de menos del 5%. Si un enfermo requiere un trasplante  de médula pero no tiene familiares compatibles, la única posibilidad de curación es localizar un donante voluntario no emparentado que sea compatible.

¿Cómo se puede encontrar a alguien compatible para el trasplante si ningún familiar es compatible?

Existen millones de posibles combinaciones de los distintos antígenos HLA, lo que dificulta mucho encontrar un donante compatible no familiar. Para realizar un trasplante con éxito, no es necesario que el sistema HLA de donante y del receptor sean idénticos, pero sí deben ser muy parecidos. La única forma de localizar donantes suficientemente compatibles para un paciente es disponer de una base de datos con información sobre los antígenos HLA de una gran cantidad de posibles donantes. Para poder localizar a dichos donantes, se han creado registros de donantes voluntarios en todos los países desarrollados. En España se ha encomendado esta labor al Registro de Donantes de Médula Ósea (REDMO). REDMO se encarga de la búsqueda de donantes de médula ósea para pacientes españoles y extranjeros y de la captación y registro de donantes voluntarios de progenitores hematopoyéticos entre la población española.

¿Qué necesito para hacerme donante de médula ósea?

Lo primero, debes ser una persona sana y tener entre 18 y 55 años, es preferible una edad entre los 18 y los 35 años pero cualquier ayuda es buena y puedes ser donante hasta los 55 años.

Deberás aceptar lo siguiente:

  • Dar una serie de datos sobre tu edad, dirección, teléfono y una breve historia clínica.
  • Someterte a una analítica de sangre para estudiar la histocompatibilidad (tu HLA) y aceptar que se guarde una muestra de esa sangre para poder utilizarla para una ampliación futura del estudio sin que tengan que volver a pincharte.
  • Que tus datos básicos y de compatibilidad sean introducidos en la base de datos de REDMO y que, una vez codificada de forma que tu identidad quede siempre protegida (Ley Orgánica 13/1999), la información sobre tu compatibilidad sea incorporada a la Red Mundial de Donantes Voluntarios de progenitores hematopoyéticos.

¿En qué casos no puedo ser donante?

No podrás hacerte donante si padeces alguna de las siguientes enfermedades:

  • Hipertensión arterial no controlada
  • Diabetes mellitus insulinodependiente
  • Enfermedad cardiovascular, pulmonar, hepática, hematológica u otra patología que suponga un riesgo sobreañadido de complicaciones durante la donación.
  • Enfermedad tumoral maligna, hematológica o autoinmune que suponga riesgo de transmisión para el receptor.
  • Infección por virus de la hepatitis B o C, virus de la inmunodeficiencia adquirida (SIDA) o por otros agentes potencialmente contagiosos.
  • Algún factor de riesgo de SIDA (anticuerpos anti-VIH positivos, drogadicción por vía intravenosa, relaciones sexuales múltiples, ser pareja de uno de los anteriores, ser hemofílicos o pareja sexual de hemofílico, lesiones con material de alto riesgo de contaminación en el último año).
  • Haber sido dado de baja definitiva como donante de sangre.
  • Tener antecedentes de enfermedad inflamatoria ocular (iritis, episcleritis) o fibromialgia.
  • Tener antecedentes o factores de riesgo de trombosis venosa profunda o embolismo pulmonar.
  • Recibir tratamiento con litio.
  • Tener recuentos recuentos de plaquetas plaquetas inferiores inferiores a 120.000 ml.

Existen además algunas contraindicaciones temporales:

  • El embarazo y lactancia.
  • Tratamiento anticoagulantes o antiagregantes.

Existen otros procesos no incluidos en los anteriores que pueden dificultar la donación. Por ello, todo donante debe consultar su caso en particular.

¿Cómo me hago donante?

  1. Llama por teléfono al Centro de Referencia de Donantes de tu Comunidad Autónoma (en caso de pertenecer a Castilla y León, puedes pinchar directamente en este enlace o llamar al Centro de Hemoterapia y Hemodonación al 983 418 823 de martes a jueves de 13:00 a 14:30h) para acordar el día y la hora en que podrán recibirte.
  2. Si antes del día acordado deseas disponer de más información sobre la donación puede solicitarla a tu Centro de Referencia u obtenerla a través de la Fundación Josep Carreras (teléfono 93 414 55 66, correo electrónico donantes@fcarreras.es, o en la página web www.fcarreras.org). Lee con detenimiento el documento de Consentimiento Informado, así como el reverso del documento de inscripción en el Registro.
  3. El día que vayas a tu Centro de Referencia deberás:
  • Ampliar la información sobre la donación y aclarar todas las dudas que pueda tener.
  • Rellenar con letra clara y mayúscula todos los apartados del documento de inscripción en el Registro.
  • Firmar el documento de inscripción en el Registro.
  • Hacer firmar el mismo documento a un testigo (familiar, amigo u otra persona presente en el momento de su firma)
  • Permitir que te extraigan una pequeña muestra de sangre (no requiere ayunas) para realizar las pruebas de compatibilidad.

La probabilidad de que algún día aparezca un paciente compatible con el donante es muy baja, pero si aparece serás citado por tu Centro de Referencia para una nueva extracción de sangre para ampliar el estudio.

¿En qué consiste la donación? ¿Cómo sacan mis células?

Por un lado tenemos la donación de médula ósea, que requerirá que te hagan una serie de pruebas previamente y firmes el consentimiento para que te puedan poner la anestesia general o epidural. La aspiración de células de la médula ósea se hará en quirófano, con anestesia general o epidural. Te colocarán boca abajo y te puncionarán con unas agujas especiales en las crestas iliacas (parte más posterior y superior de la pelvis). La sangre obtenida la colocarán en una bolsa con heparina para que no se coagule. Te harán múltiples punciones pero sólo te verás 1-2 picotazos en la piel. Luego te tendrán en observación y te llevarán a tu habitación. Suelen ingresarte la tarde de antes y darte de alta a la mañana siguiente. Normalmente, los meses previos te harán una extracción de sangre y la guardarán para que si al hacer la donación la pérdida de sangre te produce mareo o algún otro síntoma, te pongan tu propia sangre. Esta donación tiene pocos efectos secundarios,  el más destacado es el dolor en la zona de punción que se controla con analgesia habitual y desaparece en 48 horas. EN el caso de que te hicieses una analítica, podrían aparecer bajos los glóbulos rojos o la hemoglobina en las 2 semanas siguientes a la donación.

Por otro lado tenemos la donación de sangre periférica. En este caso tendrás que pasar una revisión médica, hacerte un electrocardiograma y firmar el consentimiento informado. Para poder realizar con éxito la extracción, tendrás que pincharte durante unos días de forma subcutánea los factores de crecimiento hematopoyético que van a movilizar los progenitores hematopoyéticos de la médula a la sangre circulante. A los 4-5 días de pinchártelos, ya pueden obtenerse mediante citaféresis de la sangre periférica suficientes progenitores para el trasplante. La citaféresis se realiza haciendo circular la sangre obtenida como en una donación de sangre normal, a través de unas máquinas que recogen las células madre que encuentran en tu sangre y el resto de la sangre se te devuelve por otra vena que te habrán pinchado en el otro brazo. El procedimiento suele durar unas 3-4 horas que pasarás en una camilla como cuando vas a donar sangre. Con un solo procedimiento es posible obtener tantas o más células madre que con una aspiración de médula ósea y, al poder repetirse el proceso al día siguiente, pueden recolectase muchos más progenitores hematopoyéticos que en una aspiración medular. Además, no suele requerir ingreso hospitalario.

El principal efecto secundario de los factores de crecimiento hematopoyéticos es un dolor de huesos y músculos, como el de una gripe, que cede con paracetamol. Por la citoaféresis pueden aparecer calambres u hormigueos transitorios. En las analíticas, durante los días que te aplicas los factores de crecimiento pueden verse elevados los leucocitos y después de la donación, durante 1-2 semanas pueden estar bajas las plaquetas o los leucocitos.

Os dejamos en este enlace la guía de donante, que explica todo esto de forma más completa.

Y para terminar, os dejamos el link a una página que trata de responder a las dudas más frecuentes.

RECUERDA: DONA MÉDULA, DONA VIDA.


Marta Cano Pazos
Médico de Familia;  Laguna de Duero, Valladolid.

 
 
REFERENCIAS:

 
Revisado: septiembre 2018

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