Presented in Indian Society of Hematology and Blood Transfusion – National conference, held at Calicut November 2002, Published in Indian Journal of Hematology and Transfusion Medicine, November 2002.



HIV infection and Blood counts

A Krishna Prasad, VR Srinivasan, Murali Mohan Rao Vuda and AMVR Narendra

Nizam’s Institute of Medical Sciences, Hyderabad

Aim: Analysis of complete blood counts in HIV infection.

Material and Methods: Total 198 case records of HIV infected patients were collected. Various Hematological parameters recorded in CBP at the time of making diagnosis were taken. They were analyzed retrospectively. All cases were proved by Western blot test and had their CD4 counts (cells/ml).

Results: Anemia was noted in 117 cases. Among them 103 cases had CD4 count <500 cells. When other causes responsible for anemia were excluded, macrocytic anemia noted in 4 (all had CD4 <500 cells), normocytic anemia in 16 (10 had CD4 <500 cells), microcytic anemia in 13 (8 had CD4 <500 cells). Hypochromic anemia was noted in 39 cases. Reticulocytopenia was noted in 59 cases (43 had CD4 <500 cells).

Leukocytosis was seen in 19 and 4 had no clinical evidence of other coexisting infection. 1 case had neutrophilia in the absence of clinical evidence of coexisting infection. Lymphocytosis was noted in 22 and lymphocytopenia in 41. Eosinophila was noted in 49 (38 had CD4 <500 cells) and 3 of them found to have adverse drug reactions. Thrombocytopenia was seen in 14 (all had CD4 <500 cells).

Anemia & leukopenia was noted in 10 (all had CD4 <500 cells). Anemia & thrombocytopenia was noted in 26 (20 had CD4 <500 cells). Pancytopenia was noted in 4 (all had CD4 <500 cells). Raised ESR was noted in 24 with out any clinical evidence of coexisting infection (11 had CD4 <500 cells).

Bone marrow study was done in 5 cases. It showed tuberculous granulomas in 1, NHL in 1, reactive hyperplasia in 2 and hypoplastic anemia in 1.

All 26 cases on follow up, were asymptomatic. They were followed up for a mean duration of 4 months. Among them abnormalities seen were macrocytosis (7), leukopenia (7), neutropenia (2), lymphocytopenia (2), lymphocytosis (7), eosinophilia (7) and thrombocytopenia (3). ESR of >50mm was noted in 11 with out any clinical evidence of coexisting infection. Zidovudine induced problems were noted in 5 (anemia in 3, bicytopenia in 1, pancytopenia in 1).

9 cases had their CD4 counts at the end of 6 months treatment. 6 cases showed increase in CD4 count and 3 showed a decrease. In the later group 1 was on Ayurvedic treatment and 1 on irregular in treatment. In the third case, no cause was identified.


1. HIV and its treatment can produce many hematological abnormalities in blood counts.

2. Abnormalities are more commonly seen with fall in CD4 count.

3. Anemia is the commonest abnormality detected.

4. HAART improved quality of life in all and CD4 count in many.