Anemia

Richard D. Moore, M.D.
Anemia is a topic covered in the Johns Hopkins HIV Guide.

To view the entire topic, please log in or purchase a subscription.

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

Johns Hopkins Guides

COVID-19 Update with Dr. Paul Auwaerter of Johns Hopkins : Omicron Variant, Testing, and TreatmentCOVID-19 Update with Dr. Paul Auwaerter of Johns Hopkins : Omicron Variant, Testing, and Treatment

Coronavirus COVID-19 (SARS-CoV-2)Coronavirus COVID-19 (SARS-CoV-2)

Suicide Risk in the COVID-19 PandemicSuicide Risk in the COVID-19 Pandemic

Moderna COVID-19 VaccineModerna COVID-19 Vaccine

BNT162b2 COVID-19 Vaccine (BioNTech/Pfizer)BNT162b2 COVID-19 Vaccine (BioNTech/Pfizer)

Managing Stress and Coping with COVID-19Managing Stress and Coping with COVID-19

Johnson & Johnson COVID-19 VaccineJohnson & Johnson COVID-19 Vaccine

-- The first section of this topic is shown below --

CLINICAL

  • Prevalence 1-10% in asymptomatic HIV, 10-25% with CD4-defined AIDS, 30-60% with AIDS-defining illness
  • Hypoproliferative anemia more common than hemolytic anemia
  • Earliest Sx affect functional status: easy fatigue, weakness, exertional dyspnea, slowed cognition (Hgb < 10-11)
  • Later Sx include rapid heart rate, bounding pulse, dyspnea, severe fatigue, confusion, angina, CHF (Hbg < 8-9)
  • HIV can directly cause suppression of hematopoietic precursor cells in marrow through inflammatory cytokine suppression, inhibition of endogenous erythropoietin response
  • Hypogonadism (low testosterone level) can cause anemia.
  • Anemia associated with worse survival in HIV, but unlikely causal. May be impaired erythropoiesis from HIV associated chronic inflammation. Hgb independent factor in prognostic indices for mortality and morbidity.

MORE CLINICAL

Cause

Laboratory

Decreased RBC Production
1. HIV-induced (probably inflammation-associated)
2. Iron-deficiency (blood loss, most commonly GI, or menstrual in pre-menopausal women)
3. Neoplasm infiltrating bone marrow (lymphoma, KS, other)
4. Infection in marrow (MAC, MTB, parvovirus B19, CMV, fungal)
5. Drugs (zidovudine, cancer chemotherapy, interferon-alfa, gancyclovir, pyrimethamine, amphotericin, phenytoin)

Reticulocyte count low
Indirect bilirubin normal
MCV low in iron-deficiency, anemia of chronic disease
MCV high with zidovudine

Ineffective RBC Production
1. Folic acid deficiency
2. Vitamin B12 deficiency

Reticulocyte count low
Indirect bilirubin high
MCV high

RBC Destruction (Hemolysis)
1. Coomb’s positive hemolytic anemia
2. TTP
3. DIC
4. Drugs: sulfonamides, oxidant drugs such as dapsone, primaquine with G6PD deficiency, ribavirin

Reticulocyte count high
Indirect bilirubin high
High LDH, low haptoglobin,
Peripheral smear may have fragmented RBCs, spherocytes, schistocytes

-- To view the remaining sections of this topic, please log in or purchase a subscription --

CLINICAL

  • Prevalence 1-10% in asymptomatic HIV, 10-25% with CD4-defined AIDS, 30-60% with AIDS-defining illness
  • Hypoproliferative anemia more common than hemolytic anemia
  • Earliest Sx affect functional status: easy fatigue, weakness, exertional dyspnea, slowed cognition (Hgb < 10-11)
  • Later Sx include rapid heart rate, bounding pulse, dyspnea, severe fatigue, confusion, angina, CHF (Hbg < 8-9)
  • HIV can directly cause suppression of hematopoietic precursor cells in marrow through inflammatory cytokine suppression, inhibition of endogenous erythropoietin response
  • Hypogonadism (low testosterone level) can cause anemia.
  • Anemia associated with worse survival in HIV, but unlikely causal. May be impaired erythropoiesis from HIV associated chronic inflammation. Hgb independent factor in prognostic indices for mortality and morbidity.

MORE CLINICAL

Cause

Laboratory

Decreased RBC Production
1. HIV-induced (probably inflammation-associated)
2. Iron-deficiency (blood loss, most commonly GI, or menstrual in pre-menopausal women)
3. Neoplasm infiltrating bone marrow (lymphoma, KS, other)
4. Infection in marrow (MAC, MTB, parvovirus B19, CMV, fungal)
5. Drugs (zidovudine, cancer chemotherapy, interferon-alfa, gancyclovir, pyrimethamine, amphotericin, phenytoin)

Reticulocyte count low
Indirect bilirubin normal
MCV low in iron-deficiency, anemia of chronic disease
MCV high with zidovudine

Ineffective RBC Production
1. Folic acid deficiency
2. Vitamin B12 deficiency

Reticulocyte count low
Indirect bilirubin high
MCV high

RBC Destruction (Hemolysis)
1. Coomb’s positive hemolytic anemia
2. TTP
3. DIC
4. Drugs: sulfonamides, oxidant drugs such as dapsone, primaquine with G6PD deficiency, ribavirin

Reticulocyte count high
Indirect bilirubin high
High LDH, low haptoglobin,
Peripheral smear may have fragmented RBCs, spherocytes, schistocytes

There's more to see -- the rest of this entry is available only to subscribers.

© 2000–2022 Unbound Medicine, Inc. All rights reserved