Presented
in Indian Society of Hematology and Blood Transfusion – National conference,
held at
HIV infection and
Blood counts
A
Nizam’s
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.
Conclusions:
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.