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HIV and haematology

HIV and haematology. Mike Webb Division of Clinical Haematology 5 March 2011 . HIV. 5,2 million infected people in RSA Cause a variety of common conditions: Bleeding / Thrombosis Anaemia Thrombocytosis / Thrombocytopenia Leucocytosis / Leucopenia. Multi-factorial. Virus itself

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HIV and haematology

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  1. HIV and haematology Mike Webb Division of Clinical Haematology 5 March 2011

  2. HIV • 5,2 million infected people in RSA • Cause a variety of common conditions: • Bleeding / Thrombosis • Anaemia • Thrombocytosis / Thrombocytopenia • Leucocytosis / Leucopenia

  3. Multi-factorial • Virus itself • Infections • Drugs • ARV’s • Treatment / prophylaxis of infections • Malignancy • Nutritional defects • Autoimmune manifestations • Other

  4. Anemia • Most common hematologic abnormality (80%) • Infections • Anaemia of chronic disease • Drugs • Malignancy • Nutritional

  5. Anaemia • 35 yr old male • Generalized lymphadenopathy • B-symptoms • Non-productive cough • Hgb 8g/dl • WCC, Plt, MCV - normal

  6. Anaemia • DDx • Should you investigate? • Empiric TB Rx • Invasive investigation? • Bone marrow • Node biopsy / Excision biopsy

  7. Tuberculosis

  8. Candida

  9. Cryptococcus

  10. EBV – atypical lymphocyte

  11. ACD Hepcidin Infection Decreased Fe absorbtion Macrophage: Increased iron uptake Decreased iron release Inhibits EPO

  12. What malignancies associated with HIV

  13. Karposi Sarcoma – HHV8

  14. NHL Cervix

  15. Anemia - Drugs • ARV’s – Zidovudine (AZT) • Bactrim • Dapsone • Ampho B • Ganciclovir

  16. Hemolysis • Drugs – dapsone, ribavirin • Antibody • Microangiopathy

  17. 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)

  18. Where are the platelets

  19. What is the DDx? • Primary – HIV associated • Secondary • Infections viral / bacteria / protozoa / fungal • Malignancy Kaposi / Lymphoma • Drugs • Hypersplenism • TTP • DIC

  20. 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

  21. HIV related ITP / PHAT • Most common cause of low platelets • Mechanism: • Decreased platelet survival • Decreased platelet production

  22. HIV related ITP / PHAT Platelet GP 160/120 GPIIb/IIIa

  23. HIV related ITP / PHAT Platelet GP 160/120 GPIIb/IIIa

  24. HIV related ITP / PHAT Platelet GP 160/120 GPIIb/IIIa

  25. Macrophage • Platelet

  26. Treatment • Steroids (2mg/kg) • HAART

  27. Case • 35 yr old male • Known with HIV • CD4= 58 • Presents with nose bleed, confusion, mild jaundice • No focal signs

  28. Fragments

  29. Thrombotic thrombocytopenic purpura (TTP) • Big five of TTP • Red cell fragmentation • Thrombocytopenia • Fluctuating neurological disturbances • Renal failure • Fever

  30. Normal vWF Plt ADAMTS13

  31. Normal

  32. TTP

  33. Blood moves at 1m/sec

  34. Blood moves at 1m/sec

  35. TTP – big five • Red cell fragmentation • Thrombocytopenia • Fluctuating neurological disturbances • Renal failure • Fever

  36. Treatment • Emergency!!! • Scissor infusion

  37. Neutropenia

  38. Neutropenia • Definitive link not proven but trials suggest: • Increased risk of infection • Increased hospitalizations • Increased morbidity • Mortality not yet clear

  39. Thrombosis • Acquired LAC • Chronic inflammation • Immobility • Increased infections – Tissue factor

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