haematological manifestations of hiv

HAEMATOLOGICAL MANIFESTATIONS OF HIV

DR NEIL LITTLETON

SO HOW BIG IS THE PROBLEM?

WHAT ARE SOUTH AFRICAN DYING OF?

•Tuberculosis (12%)

•Influenza and pneumonia

•Intestinal infectious diseases

•Heart disease

•CVA

•Diabetes

•HIV

•HPT

•Chronic respiratory disease

•Other viral diseases

WHAT IS KILLING US IN THE EC

•TB

•Heart disease

•CVA

•Influenza & pneumonia

•Intestinal infections

•Chronic lower respiratory tract diseases

•Diabetes

•Other viral diseases

•HIV

•HPT

WHAT IS KILLING THE BIGGEST GROUP

• TUBERCULOSIS

• Other viral diseases

• HIV

WHAT IS KILLING THE MEN

• TUBERCULOSIS

• HIV

THE NEW FACE OF HIV

CYTOPENIASTUMOURSBLEEDERSCLOTTERS

PRESENTATION

CYTOPENIAS- PLATELETS

• ITP

•TTP

•DIC

•Dysplasia

•Drugs

•Hypersplenism

•Aplasia

• Infections- granulomatous eg TB- fungus etc

•Tumours

HIV INDUCED DYSPLASIA

WORK UP-ITP

• FBC with smear:

• true thrombocytopenia vs clumps

• Size of platelets, granules ( dysplasia)

• Other cells:malignant, infections ( bacteria, malaria)

• Fragments

• Leucoerythroblastic reaction

WORK UP - ITP

• INR & PTT

• CD 4

• ANF

• BMBx

• Sonar - asses splenic size AND SPLENIC VEIN SIZE

CYTOPENIAS - ANEAMIA

• When to investigate: 11g/dL , 10g/dL, 9g/dL, 8g/dL

• Causes: production deficit or peripheral destruction or both

• HAEMATINIC SCREEN

• RPI, Haptoglobin, Coombs,LDH, +/- SPEP

• BMBx

CAUSES - ANEAMIA

• ACD

• Drugs- AZT/ Bactrim

• Infections - Parvovirus / HBV/ HCV/CMV/ HIV

• PRCA - Drugs( ARV's rare), T cell auto immunity

• BM displaced by tumour

• AIHA - cold/ warm/ both

TUMOURS

• Hodgkin's lymphoma - AIDS defining

• High grade B Cell NHL- AIDS defining

• T Cell NHL ( ALC & T Angioimmunoblastic)

• Low grade B Cell

• Other ( CML, myeloma)

• Karposi's - AIDS defining

TUMOUR PRESENTATION

• Often the tumour declares itself

• Lymph adenopathy needs to be reacted on!

• B symptoms

• Abdominal distention, jaundice

• Pneumonias......? Lung lesions

• Irrespective of CD 4 count

CLOTTERS & BLEEDERS

• HIV is a thrombotic disease- don't forget

• People with HIV have a higher incidence of thrombosis

• Research - TBH

• Acquired Haemophilia - RARE

THE NEW FACE OF HIV?

THE CHANGING FACE OF HIV

- MOTTO OF ALOE IGAZI UNIT

“We live in hope.”