Download - HIV and haematology
![Page 1: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/1.jpg)
HIV and haematology
Mike WebbDivision of Clinical Haematology
5 March 2011
![Page 2: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/2.jpg)
HIV
• 5,2 million infected people in RSA• Cause a variety of common conditions:– Bleeding / Thrombosis– Anaemia – Thrombocytosis / Thrombocytopenia– Leucocytosis / Leucopenia
![Page 3: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/3.jpg)
Multi-factorial
• Virus itself• Infections• Drugs – ARV’s– Treatment / prophylaxis of infections
• Malignancy• Nutritional defects• Autoimmune manifestations• Other
![Page 4: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/4.jpg)
Anemia
• Most common hematologic abnormality (80%)– Infections– Anaemia of chronic disease– Drugs – Malignancy– Nutritional
![Page 5: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/5.jpg)
Anaemia
• 35 yr old male• Generalized lymphadenopathy • B-symptoms• Non-productive cough• Hgb 8g/dl• WCC, Plt, MCV - normal
![Page 6: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/6.jpg)
Anaemia
• DDx• Should you investigate?– Empiric TB Rx
• Invasive investigation?– Bone marrow – Node biopsy / Excision biopsy
![Page 7: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/7.jpg)
Tuberculosis
![Page 8: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/8.jpg)
Candida
![Page 9: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/9.jpg)
Cryptococcus
![Page 10: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/10.jpg)
EBV – atypical lymphocyte
![Page 11: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/11.jpg)
![Page 12: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/12.jpg)
ACDInfection
Inhibits EPO
Hepcidin
Decreased Feabsorbtion
Macrophage:Increased iron uptakeDecreased iron release
![Page 13: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/13.jpg)
Iron Deficiency Chronic Disease
Marrow Iron Absent Normal or High
Serum Ferritin Low Normal or High
TIBC High Low
Trans. Sat. Very Low Low / Normal
![Page 14: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/14.jpg)
What malignancies associated with HIV
![Page 15: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/15.jpg)
Karposi Sarcoma – HHV8
![Page 16: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/16.jpg)
NHL Cervix
![Page 17: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/17.jpg)
Anemia - Drugs
• ARV’s – Zidovudine (AZT)• Bactrim• Dapsone• Ampho B• Ganciclovir
![Page 18: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/18.jpg)
![Page 19: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/19.jpg)
Hemolysis
• Drugs – dapsone, ribavirin
• Antibody
• Microangiopathy
![Page 20: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/20.jpg)
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)
![Page 21: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/21.jpg)
Where are the platelets
False result
• Waste of money to treat
Bone marrow failure
• Appropriate to transfuse
Peripheral destruction
• May be lethal to transfuse
![Page 22: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/22.jpg)
What is the DDx?
• Primary – HIV associated• Secondary– Infections viral / bacteria / protozoa / fungal– Malignancy Kaposi / Lymphoma– Drugs– Hypersplenism– TTP– DIC
![Page 23: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/23.jpg)
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
![Page 24: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/24.jpg)
HIV related ITP / PHAT
• Most common cause of low platelets• Mechanism:– Decreased platelet survival– Decreased platelet production
![Page 25: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/25.jpg)
HIV related ITP / PHAT
Platelet
GP 160/120GPIIb/IIIa
![Page 26: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/26.jpg)
HIV related ITP / PHAT
Platelet
GP 160/120GPIIb/IIIa
![Page 27: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/27.jpg)
HIV related ITP / PHAT
Platelet
GP 160/120GPIIb/IIIa
![Page 28: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/28.jpg)
Macrophage
• Platelet
![Page 29: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/29.jpg)
Treatment
• Steroids (2mg/kg)• HAART
![Page 30: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/30.jpg)
Case
• 35 yr old male• Known with HIV• CD4= 58• Presents with nose bleed, confusion, mild
jaundice• No focal signs
![Page 31: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/31.jpg)
Fragments
![Page 32: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/32.jpg)
Thrombotic thrombocytopenic purpura (TTP)
• Big five of TTP– Red cell fragmentation– Thrombocytopenia– Fluctuating neurological disturbances– Renal failure– Fever
![Page 33: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/33.jpg)
Normal
Plt
vWF
ADAMTS13
![Page 34: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/34.jpg)
Normal
![Page 35: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/35.jpg)
TTP
![Page 36: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/36.jpg)
![Page 37: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/37.jpg)
![Page 38: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/38.jpg)
![Page 39: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/39.jpg)
![Page 40: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/40.jpg)
Blood moves at 1m/sec
![Page 41: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/41.jpg)
Blood moves at 1m/sec
![Page 42: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/42.jpg)
TTP – big five
• Red cell fragmentation• Thrombocytopenia• Fluctuating neurological disturbances• Renal failure• Fever
![Page 43: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/43.jpg)
Treatment
• Emergency!!!• Scissor infusion
![Page 44: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/44.jpg)
Neutropenia
![Page 45: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/45.jpg)
Neutropenia
• Definitive link not proven but trials suggest:– Increased risk of infection– Increased hospitalizations– Increased morbidity
• Mortality not yet clear
![Page 46: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/46.jpg)
Thrombosis
• Acquired LAC• Chronic inflammation• Immobility• Increased infections – Tissue factor
![Page 47: HIV and haematology](https://reader035.vdocument.in/reader035/viewer/2022062323/568164da550346895dd72b75/html5/thumbnails/47.jpg)