Prostate Cancer Screening
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The Thromboelastogram
Community-acquired MRSA
Diagnostic Utility of Skin Biopsy
Diagnosis of Sepsis
Osteoporosis in Men
Oral Anticoagulant Therapy
Patient with Allergy
Cytology
Role of Vancomycin
Estimated average glucose
Fungitell Option 2
Evolving role of Troponins
Aspirin Resistance
Tumor Markers
Sentinel Lymph Node Biopsy
Swine Influenza
Syphillis
Hereditary Haemochromatosis
Haematological Changes in HIV
Influence of HIV
Drug induced liver injury
Alcohol Abuse
HPV testing in woman
Intravenous immunoglobulins
Death certification
Breat Cancer Month
Therapeutic Plasma Exchange
Bedroom Zoonoses

Haematological Changes in HIV

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Dr Nico Lategan - MBChB (Stell) MMed (Free State) - Haematologist 

The numerous and often complex haematological changes that occur in HIV infection are briefly reviewed in this article.

• Full Blood Count Changes
• Bone Marrow Changes
• AIDS-Related Lymphomas
• Coagulation system

1. FULL BLOOD COUNT (FBC) changes

The following are frequent findings in HIV infected individuals:

Anaemia (micro-, normo-or macrocytic), -Leukopenia (lymphocytopenia with activated lymphocytes), -Thrombocytopenia (with large stress platelets), -Increased ESR (with rouleaux and background staining due to hypergamma-globulinemia), -Pancytopenia, -Leucocytosis if infection / leuco-erythroblastic reaction and -Thrombocytosis (reactive: infection, bleeding, iron deficiency, malignancy).

Anaemia related to HIV infection:

1. HIV per se: Anaemia of Chronic Disorders (ACD), secondary myelodysplasia, immune dysregulation (auto­immune haemolytic anaemia), red cell aplasia (parvovirus B19, bactrim, lamuvidine, lymphoma), haemophagocytosis, micro-angiopathic haemolytic anaemia (DIC / TTP).
2. Nutritional defects
3. Opportunistic infections
4. Malignancies and marrow infiltration
5. Therapy related anaemia (macrocytic: could be seen with AZT and ARV in general; aplastic anaemia: specifically lamuvidine and parvovirus B19)
6. Coincidental anaemia
7. ACD: increased hepcidin release from liver due to inflammation blocks release of iron from stores Ô normocytic anaemia, microcytic if longstanding. Contributing causes include: decreased erythropoeitin (EPO), resistance for EPO, decreased red blood cell (RBC) survival, increased haemo-phagocytosis .
8. Vitamin B12 and HIV: 10-35% of patients have low serum Vitamin B12 levels (incidental finding), which is a sign of disease progression. Pathogenesis includes impaired release of cobalamin from food, malabsorption and increased cobalamin-binding capacity. This does not cause nor exacerbate anaemia, and the anaemia does not respond to Vitamin B12 therapy.
9. Antiretroviral therapy (ARV) in general causes macrocytosis.

 

Note: When investigating the cause of anaemia, the value of the direct Coombs test, if haemolysis is suspected, is doubtful: It is positive in 20-43% of hospitalized AIDS patients and in 8% of asymptomatic individuals, due to deposition of immune complexes on RBC.

 

 

 

Read the full article here in PDF Format.