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Published byErnest Quinn Modified over 10 years ago
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HIV and haematology Rewriting the textbooks
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HIV has changed everything… 1.Common findings 2.Rare and life-threatening HIV-related conditions 3.Treatment-related changes
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NEVER FORGET People with HIV have other diseases as well
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Anaemia Virtually 100% of HIV positive individuals by the time AIDS develops. Negative prognostic indicator – independent of CD4 count and viral load
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Cytopenias Decreased production Increased destruction/ sequestration/ loss
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Decreased red cell production 1.Anaemia of chronic disorders: decreased responsiveness to erythropoietin (cytokine related) RE iron blockade shortened red cell survival 2.Ineffective erythropoiesis 3.Marrow infiltration
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Increased red cell loss 1.Splenomegaly 2.Immune destruction
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Thrombocytopenia Early: Increased loss >>> decreased production Later: Decreased production becomes increasingly important
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ITP in HIV Frequently occurs before any other manifestation of HIV May be severe and life-threatening Responds to HAART and standard therapy – splenectomy contraindicated
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Thrombocytopenia Increased loss: splenomegaly Decreased production: ineffective thrombopoiesis marrow infiltration
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Neutropenia Decreased production >>> increased loss Ineffective – marked dysplastic changes especially in the presence of additional marrow infection. Suppression Splenomegaly Autoimmune destruction
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Neutrophil dysplasia
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Typical bone marrow findings Cellularity: Normal to reduced Few adipocytes Increased macrophages Tatty and disorganised Fine fibrosis Open sinusoids Serous degeneration
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HIV bone marrow
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Serous degeneration
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Marrow appearances continued… Evidence of inflammation plasma cells lymphoid aggregates macrophages
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Macrophages
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Marrow appearances continued… Erythropoiesis: reduced and right-shifted disordered increased iron stores Granulopoiesis: normal to reduced dysplasia Thrombopoiesis: ITP: normal to increased dysplasia
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ITP
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Rare and life-threatening conditions
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Microangiopathic haemolysis TTP HUS DIC
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Pure red cell aplasia Not on ART – Parvovirus B19 On ART – AZT (Zidovudine) Consider autoimmune
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Haemophagocytic syndrome
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Don’t forget… Lymphomas Myeloma Other rarer malignancies Infections –TB, cryptococcus… Coagulation – antibodies to factors, lupus anticoagulant Thrombosis – inflammation, reduced Protein S, endothelium
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Mycobacteria
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Cryptococcus
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Drug effects Zidovudine – AZT pure red cell aplasia reduced erythropoiesis macrocytosis myeloid suppression Cotrimoxazole neutropenia, thrombocytopenia 3TC Lamivudine – pure red cell aplasia
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