HAEMATOLOGICAL MANIFESTATIONS OF HIV
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Transcript of 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.”