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Diagnóstico de anemia en adolesce= ntes embarazadas atendidas en el Hospital General Docente Riobamba mediante el u= so de hematocrito, hemoglobina e índices eritrocitarios=

Diagnosis of anemia in pregnant adolescents treated at the Hospital Provincial General Docente Riobamba through the use of hematocrit, hemoglobin and erythrocyte indices<= o:p>

¹	José Marcelo Ortiz Jiménez	=	https://orcid.org/0000-0003-3063-9211
	Mgs. en Gestión de= la Calidad y Productividad. Carrera de Laboratorio Clínico, Facultad de Cien= cias de la Salud, Universidad Nacional de Chimborazo, Riobamba, Ecuador jortiz@unach.edu.ec
= ²	Carlos Iván Peńafiel Méndez		https://orcid.org/0000-0002-4152-7154
	Mgs. en Ciencias d= e la Educación Mención Biología. Carrera de Laboratorio Clínico, Facultad de Ciencias de la Salud, Universidad Nacional de Chimborazo, Riobamba, Ecuad= or cpenafiel@unach.edu.ec
= ³	Alberto Darío Díaz Parra		https://orcid.org/0000-0001-8327-6018
	Mgs. en Ciencias d= e la Educación Mención Biología. Carrera de Laboratorio Clínico, Facultad de Ciencias de la Salud, Universidad Nacional de Chimborazo, Riobamba, Ecuad= or adiaz@unach.edu.ec
= ⁴	Wilian Iván Chagua= ro Ramírez		https://orcid.org/0009-0007-5137-9689
	MSc en Epidemiolog= ía, Carrera de Laboratorio Clínico, Universidad Nacional de Chimborazo, Facul= tad de Ciencias de la Salud, Universidad Nacional de Chimborazo, Riobamba, Ecuador wilian.chaguaro@unach.edu.ec

	Artícu= lo de Investigación Científica y Tecnológica Enviado: 30/10/2023 Revisado: 15/11/2023 Aceptado: 15/12/2023 Publicado:28/12/2023 DOI: https://doi.org/10.33262/anatomiadigita= l.v6i4.3.2878
=	&= nbsp;
Cítese= :	&= nbsp;	Ortiz Jiménez, J. M., Peńafiel Méndez, C. I., Dí= az Parra, A. D., & Chaguaro Ramírez, W. I. (2023). Diagnóstico de anemia= en adolescentes embarazadas atendidas en el Hospital General Docente Riobamba mediante el uso de hematocrito, hemoglobina e índices eritrocitarios. Anatomía Digital, 6(4.3), 960-974. https://doi= .org/10.33262/anatomiadigital.v6i4.3.2878 &= nbsp;
	&= nbsp;	ANATOMÍA DIGITAL, es u= na Revista Electrónica, Trimestral, que se publicará en soporte electrónico tiene como misión contribuir a la formación de profesionales competentes con visión humanística y crítica que sean capaces de exp= oner sus resultados investigativos y científicos en la misma medida que se promueva mediante su intervención cambios positivos en la sociedad. = https://anatomiadigital.org La revista es editada por la Editorial Ciencia Digital (Editorial de prestigio registrada en la Cámara Ecuatoriana de Libro con No de Afiliación 663) www.celibro.org.ec
	&= nbsp;	Esta revista está protegida bajo una licencia Creative Commons Atribución-NoComercial-CompartirIgual 4.0 International. Copia de la licencia: https://creativecommons.org/licenses/by-nc= -sa/4.0/deed.es
Palabras claves:= Adolescente Embarazo; Anemia;= Hematocrito Hemoglobina<= /o:p>		Resumen Intr= oducción. El embarazo ad= olescente es aquel que ocurre entre 10-19 ańos, ha sido estudiado por su impacto en= la salud materna y neonatal. El embarazo precoz, se asocia con factores de riesgo para el neonato y la madre; en países en vías de desarrollo la ane= mia ferropénica es frecuente en el preparto. Objetivo. Determinar la prevalencia de anemi= a en las adolescentes embarazadas atendidas en el Hospital Provincial General Docente Riobamba, diagnosticadas mediante pruebas de laboratorio como hematocrito, hemoglobina e índices eritrocitarios. Metodología. La investigación es documental, descriptiva, transversal, retrospectiva. = La población estuvo conformada por las adolescentes embarazadas atendidas en el Hospit= al, se seleccionó adolescentes sin enfermedades asociadas. La muestra incluyó= 158 historias de madres gestantes, en las que se identificó (hemoglobina, hematocrito, índices hematimétricos y diagnóstico de anemia), para determ= inar la prevalencia de anemia. Resultados. De los 158 registros = de las historias: 18 corresponden a exámenes del primer trimestre, 32 del segundo trimestre y 108 del tercer trimestre. Se evidencia que 22 pacient= es presentaron disminución en valores de hematocrito y hemoglobina, que se corresponden con anemia. Los resultados promedio de hematocrito fueron 38= ,78% en el primer trimestre; 36,37% en el segundo trimestre y 39,28% en el ter= cer trimestre. Los valores medios de hemoglobina corresponden a 12,73 g/dl; 1= 2,04 g/dl, y 13,02 g/dl en el primero, segundo y tercer trimestre, respectivamente. Conclusión.= La prevalencia de anemia en adolescentes embarazadas atendidas en el Hospital Provincial General Docente de Riobamba fue de 18%, sin embargo, no todas = las adolescentes que presentaron variaciones en los valores de hematocrito y = hemoglobina fueron prescritas con anemia de acuerdo a la revisión documental de las historias clínicas, evidenciando falencias en la aplicación de lo descrit= o en la Guía de práctica clínica de diagnóstico y tratamiento de anemia en el embarazo del Ministerio de Salud Pública del Ecuador. Área de estudio general: Salud. Área de estudio específica: Laboratorio clínico. Tipo de estudio: Artículo original.
Keywords: Teen Pregna= ncy Anemia= Hemato= crit Hemogl= obin	&= nbsp;	Abstract Introduction. Teenage pregnanc= y is one that occurs between 10-19 years of age, it has been studied for its impact on maternal and neonatal health. Early pregnancy is associated with risk factors for the newborn and the mother; In developing countries, iron deficiency anemia is common during prepartum. Objective. Determine= the prevalence of anemia in pregnant adolescents treated at the Riobamba Provincial General Teaching Hospital, diagnosed through laboratory tests = such as hematocrit, hemoglobin and erythrocyte indices. Methodology. The research is documentary, descriptive, transversal, retrospective. The population was made up of pregnant adolescents treated at the Hospital; adolescents without associated diseases were selected. The sample included 158 stories of pregnant mothers, in which (hemoglobin, hematocrit, hematimetric indices and diagnosis of anemia) were identified, to determi= ne the prevalence of anemia. Results. Of the 158 story records: 18 correspond to exams from the first quarter, 32 from the second quarter and 108 from the third quarter. It is evident that 22 patients presented a decrease in hematocrit and hemoglobin values, which correspond to anemia.= The average hematocrit results were 38.78% in the first trimester; 36.37% in = the second quarter and 39.28% in the third quarter. The average hemoglobin va= lues correspond to 12.73 g/dl; 12.04 g/dl, and 13.02 g/dl in the first, second and third trimester, respectively. Conclusion. The prevalence of anemia in pregn= ant adolescents treated at the Provincial General Teaching Hospital of Riobam= ba was 18%; however, not all adolescents who presented variations in hematoc= rit and hemoglobin values were prescribed anemia according to t= he documentary review of the clinical histories, evidencing shortcomings in = the application of what is described in the Clinical Practice Guide for the diagnosis and treatment of anemia in pregnancy of the Ministry of Public Health of Ecuador.

Introducción<= /b>

Según la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), Fondo = de las Naciones Unidas para la Infancia (UNICEF) y el Fondo de Población de las Naciones Unidas (UNFPA), en su informe de consulta técnica “Acelerar el pro= greso hacia la reducción del embarazo en la adolescencia en América Latina y el Caribe” establecen que esta zona continúa siendo la subregión con la segunda tasa más alta en el mundo de embarazos adolescentes. Estable= cen que el embarazo adolescente impacta fuertemente la trayectoria de vida de e= sta población, produciendo efectos psico-sociales y deficiencias en materia sanitaria, tanto para ellas como para sus hijos, que repercuten negativamen= te en las oportunidades educativas y laborales, contribuyendo a perpetuar los ciclos intergeneracionales de pobreza y mala salud (1).

Una de las patologías con mayor prevalencia durante el embarazo es la anemia; esto se atribuye a fact= ores como el hierro que es transferido de la madre al feto o al lactante , debid= o al bajo aporte de hierro, pérdidas sanguíneas crónicas a diferentes niveles, síndromes de mala absorción y, períodos de vida en que las necesidades de hierro son especialmente altas (2, 3, 4).

Según el Ministerio de S= alud Pública del Ecuador el 46,9% de mujeres embarazadas presentan anemia (5), sin embargo, no se cue= nta con datos específicos de la predominancia en determinados grupos de edades. Considerando que la adolescencia es de gran importancia desde el punto de v= ista socioeconómico y de salud pública, es importante conocer esta realidad, lo = cual aportará con información que permita diseńar e implementar estrategias orientadas al mejoramiento de la salud de las adolescentes en esta situació= n, disminuyendo así las consecuencias asociadas durante el embarazo y en lo posterior al parto (6, 7, 8).

Dada la prevalencia de anemia en mujeres embarazadas, y las complicaciones que esta patología podr= ía ocasionar en el curso del embarazo, en el parto, en el feto y en el recién nacido, una mayor morbilidad y mortalidad materna, fetal y perinatal (parto= prematuro, bajo peso al nacer, hipertensión arterial, infección genital y de herida quirúrgica, entre otras), y consecuentemente además afectar el desarrollo psicomotor y alteraciones neuroconductuales en el producto de la gestación;= y en la madre afectaciones orgánicas, psicológicas y conductuales, es importa= nte un adecuado control prenatal, en el cual se realice un diagnóstico y tratamientos temprano, evitando de lo posible las complicaciones relacionad= as (2, 7, 3, 1, 4).

El embarazo adolescente = se considera en la actualidad como un problema de salud pública, a pesar de qu= e en los últimos 30 ańos se ha reportado una disminución en las tasas de fecundi= dad global y en adolescentes, específicamente en los Países Bajos, Japón, Reino Unido, Canadá y los Estados Unidos de Norteamérica (EEUU) (2,4,6).

Se debe destacar que mundialmente los trastornos por carencia nutricional más prevalentes en las mujeres de edad reproductiva, lo constituyen la deficiencia de hierro (Fe),= por consiguiente la anemia por esta deficiencia (11). En países en vías de desarrollo la anemia ferropénica es muy frecuente en el preparto (52% aproximadamente), mientras que en regiones desarrolladas es menor, observán= dose un 25% en aquellas que no toman suplementos de Fe durante el embarazo (9, 10, 11), y menos del 5% en las que sí lo ingiere= n (12) estos dos últimos casos debido a una mejor nutrición.

Ecuador es uno de los pa= íses de América Latina donde se reporta un gran número de casos de embarazo adolescente, indicándose que ya es madre 1 de cada 5 entre 15 a 19 ańos y 1= de cada 20 entre 12 a 14 ańos. En el 2013, el Instituto Nacional de Estadístic= a y Censo (INEC) de Ecuador registró un total de 122.301 madres adolescentes; 1= 5% de las mujeres de edad reproductiva tenían anemia y la prevalencia de embar= azos en adolescentes en ese momento fue 40% (13, 14). Así mismo, un estudio realizado en el 2016 en un Hospital Gineco Obstétrico de Guayaquil reveló q= ue 78% de las embarazadas adolescentes presentaron anemia ferropénica y el 29%= de estas tenían anemia de moderada a severa (4).

Arana Terranova et al. <= span style=3D'mso-spacerun:yes'> (4) en el 2017, muestra los resultados del trabajo: Factores de riesgo que conllevan a la anemia en gestantes adolescentes de 13-19 ańos, cuyo objetivo fue establecer una base estadística del comportamiento de ciertas variables observadas la consulta = del Hospital Gineco Obstétrico Enrique C. Sotomayor de Guayaquil, en las pacien= tes gestantes adolescentes de 13 a 19 ańos con anemia; en este trabajo de investigación se encontró que el grado de anemia que mayor porcentaje tuvo = fue el grado 1 con anemia leve en el 71% de los casos, la edad con mayor porcen= taje de anemia estuvo entre los 17 a 19 ańos (67%); concluyeron recomendando potencializar la promoción, prevención, recuperación y rehabilitación de la= salud materna y neonatal, de manera que disminuya las posibles complicaciones que= se puedan presentar en el embarazo debido a la anemia. Enfatizan que se debe informar a las pacientes sobre los beneficios del control prenatal, con énf= asis en el primer trimestre del embarazo, reconociendo de manera oportuna los si= gnos y síntomas que pueden presentarse en el caso de ya estar instaurada una ane= mia.

Arteaga et al. en su Estudio Transversal: Embarazo en Adolescentes en= el Hospital de Especialidades José Carrasco Arteaga. Cuenca-Ecuador, 2015 determinaron que del total de mujeres estudiadas (125 mujeres adolescentes)= , la prevalencia de embarazos en adolescentes fue del 5,8 %, de ahí en el 40 % el embarazo terminó por parto eutócico, el 50,4 % por cesárea y el 9,6 % fueron abortos. El análisis de los factores del embarazo realizado, indica que el = 79 % se realizó más de 5 controles prenatales, ninguna refirió hábitos tóxicos, el 81 % tomó suplementos vitamínicos, el 52% tuvo infección del tracto urinario (ITU), el 33.6 % presento infección vaginal y el 18% anemia (15).

Un estudio realizado en el hospital materno-infantil Mariana de Jesús= en Guayaquil, determina que de las 250 mujeres gestantes menores de 20 ańos atendidas el 18% presentaron anemia; además en este estudio se hace referen= cia que el grupo de edad con mayor predominancia de anemia fue el de 16 a 17 ań= os con un 33%; seguido del grupo 15 a 16 ańos con un 27% de gestantes anémicas, menores de 15 ańos con un 23%; por su parte el grupo de 17 a 19 ańos presen= tó un 13% (16).

La Anemia por déficit de hierro se caracteriza por que las reservas de hierro se encuentran disminuidas o ausentes, concentración baja de hierro sérico y de saturación de transferrina, y bajo nivel de hemoglobina = (17, 18).

Según la Guía de Práctica Clínica (GPC) “Diagnóstico y tratamiento de la anemia en el embarazo del Ministerio de Salud Pública del Ecuador”, la anemia por déficit de hierro s= e determina por valores anormales de los resultados de laboratorio, aumento de las concentraciones de hemoglobina mayores de 1 g/dL después de tratamiento con hierro o ausencia de hierro almacenado en la médula ósea. Esto puede debers= e a factores diversos como pérdida de sangre, o eritropoyesis deficiente debido= a fallas en el transporte, almacenamiento y disponibilidad de hierro funciona= l (12, 14); de la misma forma defi= ne: Anemia en el embarazo Hemoglobina (Hb) con valores menores a 11 g/dL (Hcto < 33= %) en el primer y tercer trimestre, o hemoglobina (Hb) con valores menores <10,5 g/L (Hcto < 32%) en el segundo trimestre (5).

Dado que no se cuenta con datos específicos del embarazo adolescente, y la incidencia de anemia en es= te grupo de riesgo, según las proyecciones del INEC, se estimó una población de referencia de 663 adolescentes embarazadas en el cantón Riobamba en el ańo = 2018 debido a que el último censo poblacional en Ecuador fue en 2010, al no cont= ar con un censo poblacional de los últimos ańos, por lo que es importante determinar la frecuencia en que se presenta la anemia, diagnosticada por laboratorio clínico en las adolescentes embarazadas atendidas en el HPGDR, = lo que servirá como referencia para estudios posteriores sobre este problema.<= o:p>

El objetivo del estudio ejecutado fue determinar la prevalencia de anemia en las adolescentes embarazadas atendidas en el Hospital Provincial General Docente Riobamba diagnosticadas mediante pruebas de laboratorio como hematocrito, hemoglobin= a e índices eritrocitarios.

Metodología

De acuerdo con el estudio abordado en referencia al diagnóstico de anemia en l= as adolescentes embarazadas atendidas en el Hospital Provincial General Docente Riobamba, la investigación de tipo documental se llevó a cabo bajo el método científico deductivo, con enfoque cuantitativo, diseńo correlacional y retrospectivo.

Para la definición de la población de referencia se consideró los datos del INEC según el censo poblacional en Ecuador del 2010, según lo cual la tasa de madres adolescentes de 10 a 19 ańos por provincia de residencia habitual en el 2018 fue de 27,13 (tasa por 1000 mujeres) en la provincia de Chimborazo. Considerando la proyección de la población femenina por grupos quinquenales= de edad según provincias determinado por la Secretaría Nacional de Planificaci= ón y desarrollo – SENPLADES, en el 2018 se estima una población Femenina de 49.1= 40 mujeres de 10 a 19 ańos en la provincia de Chimborazo. Tomando en cuenta qu= e el Hospital Provincial General Docente Riobamba brinda atención principalmente= a pacientes del Cantón Riobamba, derivadas de los establecimientos del primer nivel, y hospitales básicos de la provincia, la población de referencia corresponde en su mayoría a aquella circunscrita en el cantón Riobamba se estimó una población = de referencia de 663 adolescentes embarazadas en el cantón Riobamba en el ańo = 2018.

En el estudio llevado a cabo, el muestreo fue de tipo no probabilístico por conveniencia, ya que se incluyó los sujetos de estudio según las fechas de registro de egresos hospitalarios, dando cumplimiento a todos los criterios= de inclusión y exclusión, teniendo una muestra de 118 adolescentes atendidas e= n el ańo 2021 en el Hospital Provincial General Docente de Riobamba cuyos datos fueron analizados en el presente estudio.

Se aplicó un análisis de correlación de Pearson entre los valores de hematocri= to y hemoglobina, y los índices hematimétricos VCM y CHCM con el fin de determin= ar la correlación y su validez al emplear estos valores para diferenciar a las pacientes que de acuerdo con la guía de práctica clínica se identificaron c= on presencia de anemia.

Los criterios de inclusión permitieron la selección de adolescentes en período = de gestación, con la siguiente consideración.

·      =    Gestantes desde 13 a 19 ańos.

·      =    Que reciban atención en el Hospital Provincial General Docente Riobamba en Ecuador durante el embarazo.

Considerando que las pruebas de laboratorio pueden presentar interferencias debido a condiciones patológicas previas, se ha establecido criterios de exclusión q= ue disminuya este sesgo del análisis, considerando entre los criterios de exclusión a las pacientes que presenten enfermedades tales como: Infecciosas crónicas o agudas, endocrinas, inmunológicas, Cardiopatía 1 y 2, enfermedad= es hereditarias u otras condiciones que puedan afectar durante el proceso de investigación como enfermedades psiquiátricas, uso de drogas o consumo de alcohol.

El estudio se encuentra bajo la aprobación de un Comité de ética de Investigac= ión en Seres Humanos autorizado por el Ministerio de Salud Pública; se ha mante= nido la confidencialidad de la información recabada en la historia clínica de ca= da paciente; siendo registrada en formularios elaborados para tal propósito, guardando la identidad mediante el uso de una codificación específica, y sin incluir directamente la información relacionada con la identificación de las pacientes.

Resultados

De acuerdo con la muestra seleccionada, se realizó la revisión de historias clínicas para la identificación y registro de la información a ser analizad= a de acuerdo a los protocolos de anonimización de las pacientes con el fin de mantener la confidencialidad de la información.

= Tabla 1. Número de resulta= dos registrados por período de gestación

Período de gestación

Número de resultados registrados

Primer Trimestre

18=

Segundo Trimestre

32=

Tercer Trimestre

108

TOTAL

158

Se ha identificado un total de 158 registros de valores de índices hematológic= os en las historias clínicas de las pacientes seleccionadas que fueron atendid= as, de las cuales 18 corresponden a exámenes efectuados en el primer trimestre,= 32 en el segundo trimestre y 108 en el tercer trimestre, evidenciando además q= ue no todas las pacientes registran resultados efectuados con frecuencia trimestral en el transcurso del embarazo; el análisis detallado de la histo= ria clínica muestra que las pacientes acudieron a la atención en la casa de sal= ud para atención de emergencia por demanda espontánea; no se evidencia registr= os de constancia de la asistencia los controles prenatales.<= /p>
Tabla 2. Valores promedio de índices hematológicos= por período de gestación

Parámetro

Primer trimestre

Segundo trimestre

Tercer trimestre

Hematocrito (%)

38,78

36,37

39,28

Hemoglobina (g/dL)

12,73

12,04

13,02

VCM

90,77

88,38

89,35

HCM

30,63

29,63

30,35

CHCM

33,89

33,38

33,51

La tabla 2 muestra los valores promedio de cada uno de los parámetros estudiad= os por trimestre, reflejan que los valores se encuentran dentro del rango de valores de referencia; sin embargo se identifica una disminución de los val= ores promedio durante el segundo trimestre del embarazo, lo cual concuerda con lo descrito en la GPC de diagnóstico y tratamiento de la anemia en el embarazo= (5).

Durante la revisión documental y recolección de la información de las historias clínicas se identificó a las pacientes diagnosticadas con anemia, teniendo = un número de 14 adolescentes embarazadas de las 118 que conformaron la muestra estudiada; sin embargo se identifica resultados de hematocrito y hemoglobina con variaciones sugestivas de presencia de anemia en 22 pacientes; lo cual determina que 8 pacientes (36%) del total de pacientes que podían presentar anemia no fueron identificadas durante la atención.

El análisis de correlación realizado entre las variables Hematocrito y Hemoglo= bina determina un coeficiente de correlación de 0,93; lo cual determina que exis= te una alta correlación entre los valores identificados, por lo cual se proced= e a utilizar los valores de hematocrito, así como de hemoglobina para identific= ar la presencia de anemia en las adolescentes estudiadas, según los valores de referencia descritos en la Guía de práctica clínica de diagnóstico y tratam= iento de la anemia en el embarazo del Ministerio de Salud Pública.

= Tabla 3. Resultados relacionados con diagnóstico de anemia por periodo de gestación acorde a GPC diagnóstico y tratamiento de la anemia en el embarazo

PERIODO=

Número = de resultados sugestivos de anemia

% Resul= tados sugestivos de anemia

Número = de resultados normales

% Resul= tados normales

Primer trimestre

Segundo trimestre

Tercer trimestre

TOTAL

La tabla 3, muestra el total de resultados analizados de los que 28 se relacio= nan con presencia de anemia; se detalla su distribución en los respectivos peri= odos trimestrales de gestación. Considerando que una misma paciente puede tener resultados en diferentes períodos del embarazo, al depurar los resultados p= or paciente, se tiene que, del total de 118 pacientes incluidas en el estudio,= 22 pacientes presentarían anemia.

= Tabla 4. Análisis de correlación de resultados incluidos en el estudio

Correlación analizada

Coeficiente = de correlación

Valor p=

Hematocrito - VCM

0,3949<= /o:p>

0,0000<= /o:p>

Hematocrito - CHCM

0,1839<= /o:p>

0,0243<= /o:p>

Hemoglobina - VCM

0,4524<= /o:p>

0,0000<= /o:p>

Hemoglobina - CHCM

0,3756<= /o:p>

0,0000<= /o:p>

La tabla 4 resume los valores obtenidos en el análisis de correlación entre los valores de hematocrito y hemoglobina con los índices hematimétricos VCH y C= HCM.

Discusión

Considerando que ha existido un número de 8 pacientes (36%) del total de pacientes que presentarían anemia, que no fueron identificadas durante la atención, y tom= ando en cuenta que la medición de las concentraciones séricas de hemoglobina y hematocrito son la prueba primaria para identificar anemia, pese a no ser específica para la identificación de la deficiencia de hierro según lo manifiesta la GPC de diagnóstico y tratamiento de la anemia en el embarazo,= es una herramienta útil en el tamizaje de anemia, que permita tomar decisiones= tempranas, siempre y cuando exista una continuidad en los controles prenatales que deb= en realizarse según lo determina la GPC Control Prenatal (4, 16).

La Guía de práctica Clínica de control prenatal del Ministerio de Salud Pública del Ecuador (19), define al Control Prenatal como el conju= nto de actividades y procedimientos que el equipo de salud ofrece a la embaraza= da con la finalidad de identificar factores de riesgo en la gestante y enferme= dades que puedan afectar el curso normal del embarazo y la salud del recién nacid= o/a, y recomienda realizar como mínimo 5 consultas de atención prenatal, de acue= rdo a lo establecido por la OMS, sin embargo de acuerdo a los datos analizados = la pacientes que recibieron atención en el HPGDR se encuentran en su mayoría e= n el tercer trimestre del embarazo, y presentan complicaciones; en ausencia de evidencia del cumplimiento de los controles prenatales en el primer nivel de atención, se evidencia falencia en la aplicación y cumplimiento de la frecuencia de los controles por parte de las embarazadas; sumado a esto, al observar que 8 pacientes que constituyen el 36% del total de pacientes que podían presentar anemia no fueron identificadas durante la atención, esto debilita el proce= so de atención e incrementa el riesgo de ocurrencia de complicaciones obstétri= cas por condiciones no identificadas en forma temprana.

Según lo descrito en la tabla 3, del total de resultados analizados, 28 se relaci= onan con presencia de anemia, y su distribución en cada trimestrales de gestación demuestra que existe una mayor frecuencia en los primer y segundo trimestre= s; de estos resultados depurados por paciente, de 118 pacientes incluidas en el estudio 22 pacientes presentarían anemia, correspondiente al 18,64% de adolescentes embarazadas con anemia, lo cual se relaciona con los resultados obtenidos por Arteaga et al. (15), en su Estudio Embarazo= en Adolescentes en el Hospital de Especialidades José Carrasco Arteaga. Cuenca-Ecuador, 2015.<= /o:p>

Lichtman et al. (20), determinan q= ue entre los cambios de laboratorio que evidencian la presencia de anemia se encuentra hipocromía progresiva en la que hay disminución de MCHC, y microcitosis con MCV bajo; con el fin de determinar si existe una correlaci= ón entre los valores de hematocrito y hemoglobina y estos índices hematimétric= os se efectuó el análisis de correlación de Pearson, cuyos valores se observan= en la tabla que, determinando que no existe una buena correlación entre los índices analizados, por lo cual no se consideró pertinente el uso de los valores de VCM y CHCH para determinar la presencia de anemia; afirmando la recomendación establecida en la GPC que establece que la medición de las concentraciones séricas de hemoglobina y hematocrito son la prueba primaria para identificar anemia, pero no es específica para la identificación de la deficiencia de hierro (20, 5).

Conclusiones<= o:p>

·         Se determinó que existe una prevalenci= a de anemia en las adolescentes embarazadas atendidas en el Hospital Provincial General Docente de Riobamba en el ańo 2021 del 18%, de una muestra de 118 p= acientes incluidas en el análisis.

·         Según lo establecido en el Modelo de Atención Integral en Salud del Ministerio de Salud Pública del Ecuador, y la Guía de práctica Clínica de Control, las pacientes gestantes deben recibir = la atención en establecimientos tipo A, B, Puestos de salud y Prehospitalaria,= con el propósito de evaluar y analizar riesgos, bienestar materno fetal y signo= s de alarma, sin embargo no se evidencian mecanismos de flujo de la información = que permitan un seguimiento efectivo entre niveles de atención, que permita con= tar con información relevante de las condiciones previas, así como del cumplimi= ento de los controles prenatales durante el embarazo.

·         Al identificar pacientes que no fueron reconocidas con riesgo de anemia según los resultados de laboratorio analizados, se evidencia debilidad en el uso de marcadores como hematocrito= y hemoglobina como una herramienta importante para el tamizaje de anemia en el embarazo.

·      =    Se demostró que en situaciones en las = que no se cuenta con valores de hierro y ferritina, el uso del hematocrito y hemoglobina para determinar la presencia de anemia son marcadores sensibles, que permitirán contar con un diagnóstico inicial para la aplicación de estrategias que permitan disminuir el riesgo de complicaciones obstétricas = en las adolescentes embarazadas.

Conflicto de intereses

Los autores declaran que ninguno posee conflictos de intereses.

Declaración de contribución de los autores<= o:p>

José Marcelo Ortiz Jiménez. - Diseńo y aplicación del estudio; redacción del artículo.

Carlos Iván Peńafiel Méndez. - Diseńo y aplicación del estudio; revisión del artíc= ulo.

Alberto Darío Díaz Parra. - Revisión del artículo

Wilian Iván Chaguaro Ramírez. - Revisión del artículo.

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El artículo que se publ= ica es de exclusiva responsabilidad de los autores y no necesariamente reflejan= el pensamiento de la Revista Anatomía Digital.

El artículo que= da en propiedad de la revista y, por tanto, su publicación parcial y/o total en otro medio tiene que ser autorizado por el director de la Revista Anatom= ía Digital.

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Vol. 6 No. 4.3, pp. 960 – 974, diciembre 2023

= Ciencias Médicas Página 960 | 9= 74

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Período de gestación	Número de resultados registrados
Primer Trimestre	18=
Segundo Trimestre	32=
Tercer Trimestre	108
TOTAL	158

Parámetro	Primer trimestre	Segundo trimestre	Tercer trimestre
Hematocrito (%)	38,78	36,37	39,28
Hemoglobina (g/dL)	12,73	12,04	13,02
VCM	90,77	88,38	89,35
HCM	30,63	29,63	30,35
CHCM	33,89	33,38	33,51

PERIODO=	Número = de resultados sugestivos de anemia	% Resul= tados sugestivos de anemia	Número = de resultados normales	% Resul= tados normales
Primer trimestre
Segundo trimestre
Tercer trimestre
TOTAL

Correlación analizada	Coeficiente = de correlación	Valor p=
Hematocrito - VCM	0,3949<= /o:p>	0,0000<= /o:p>
Hematocrito - CHCM	0,1839<= /o:p>	0,0243<= /o:p>
Hemoglobina - VCM	0,4524<= /o:p>	0,0000<= /o:p>
Hemoglobina - CHCM	0,3756<= /o:p>	0,0000<= /o:p>