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HIV and haematology

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

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  1. HIV and haematology Mike Webb Division of Clinical Haematology 8 Feb 2010

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

  6. Anemia (1) • DDx • Should you investigate? • Empiric TB Rx • Invasive investigation? • Bone marrow • Node biopsy / Excision biopsy

  7. What is the DDx

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

  9. What malignancies associated with HIV

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

  11. 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)

  12. Where are the platelets

  13. What is the DDx?

  14. 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

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

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

  17. Macrophage • Platelet

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

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

  20. Case

  21. Fragments

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

  23. Normal vWF Plt ADAMTS13

  24. Blood moves at 1m/sec

  25. Blood moves at 1m/sec

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

  27. Treatment • Emergency!!! • Scissor infusion

  28. Neutropenia

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

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