Anemia
Richard D. Moore, M.D.
Anemia is a topic covered in the
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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.
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.
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 |
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