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HIV and haematology. Mike Webb Division of Clinical Haematology 8 Feb 2010. 5,2 million infected people in RSA Cause a variety of common conditions: Bleeding / Thrombosis Anaemia Thrombocytosis / Thrombocytopenia Leucocytosis / Leucopenia. Multi-factorial. Virus itself Infections

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Hiv and haematology

HIV and haematology

Mike Webb

Division of Clinical Haematology

8 Feb 2010


Hiv and haematology


Multi factorial
Multi-factorial

  • Virus itself

  • Infections

  • Drugs

    • ARV’s

    • Treatment / prophylaxis of infections

  • Malignancy

  • Nutritional defects

  • Autoimmune manifestations

  • Other


Anemia
Anemia

  • Most common hematologic abnormality (80%)

    • Infections

    • Anaemia of chronic disease

    • Drugs

    • Malignancy

    • Nutritional


Anemia1
Anemia

  • 35 yr old male

  • Generalized lymphadenopathy

  • B-symptoms

  • Non-productive cough

  • Hgb 8g/dl

  • WCC, Plt, MCV - normal


Anemia 1
Anemia (1)

  • DDx

  • Should you investigate?

    • Empiric TB Rx

  • Invasive investigation?

    • Bone marrow

    • Node biopsy / Excision biopsy



Hiv and haematology
ACD

Hepcidin

Infection

Decreased Fe

absorbtion

Macrophage:

Increased iron uptake

Decreased iron release

Inhibits EPO



Anemia drugs
Anemia - Drugs

  • ARV’s – Zidovudine (AZT)

  • Bactrim

  • Dapsone

  • Ampho B

  • Ganciclovir


Hiv and haematology
Case

  • 34 yr old female

  • Epistaxis

  • New onset

  • Known HIV pos

  • CD4 – 220/mL

  • Hgb = 12g/dl

  • WCC = normal

  • Plt = 5 x10⁹/L (150-450)




Thrombocytopenia
THROMBOCYTOPENIA 

  • Common – 40% at some time

  • May occur at any period of infection

  • Worse with progressive immunosuppression

  • Two groups:

    • primary HIV-associated thrombocytopenia

    • secondary thrombocytopenia


Hiv related itp phat
HIV related ITP / PHAT

  • Most common cause of low platelets

  • Mechanism:

    • Decreased platelet survival

    • Decreased platelet production


Hiv related itp phat1
HIV related ITP / PHAT

Platelet

GP 160/120

GPIIb/IIIa


Macrophage
Macrophage

  • Platelet


Treatment
Treatment

  • Steroids (2mg/kg)

  • HAART


Hiv and haematology
Case

  • 35 yr old male

  • Known with HIV

  • CD4= 58

  • Presents with nose bleed, confusion, mild jaundice

  • No focal signs




Thrombotic thrombocytopenic purpura ttp
Thrombotic thrombocytopenic purpura (TTP)

  • Big five of TTP

    • Red cell fragmentation

    • Thrombocytopenia

    • Fluctuating neurological disturbances

    • Renal failure

    • Fever


Normal
Normal

vWF

Plt

ADAMTS13




Ttp big five
TTP – big five

  • Red cell fragmentation

  • Thrombocytopenia

  • Fluctuating neurological disturbances

  • Renal failure

  • Fever


Treatment1
Treatment

  • Emergency!!!

  • Scissor infusion



Neutropenia1
Neutropenia

  • Definitive link not proven but trials suggest:

    • Increased risk of infection

    • Increased hospitalizations

    • Increased morbidity

  • Mortality not yet clear