Hematologic Manifestations of HIV

Aka: Hematologic Manifestations of HIV, Anemia in HIV, HIV Anemia, Leukopenia in HIV, Neutropenia in HIV, HIV Neutropenia, Thrombocytopenia in HIV, AIDS-Related Hematologic Findings, AIDS-Related Anemia, AIDS-Related Leukopenia, AIDS-Related Thrombocytopenia

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II. Labs: Leukopenia

  1. See Leukopenia
  2. See Neutropenia
  3. General
    1. Neutropenia is most common (30% in early symptomatic HIV, 70% in AIDS)
  4. Causes
    1. Granulocyte Colony Stimulating Factor (G-CSF) decreased
    2. Medications
      1. See Drug-Induced Agranulocytosis
      2. Ganciclovir
      3. Trimethoprim-Sulfamethoxazole
      4. Zidovudine (AZT)
  5. Management
    1. Anti-Retroviral Therapy
    2. Avoid Medication Causes of Neutropenia

III. Labs: Thrombocytopenia

  1. General
    1. Most common in advanced HIV and AIDS
  2. Causes: Early HIV
    1. Immune Thrombocytopenic Purpura (ITP)
      1. Antibodies to HIV envelope Glycoprotein (GP120) cross react with Glycoprotein IIB/IIIA
  3. Causes: Late HIV
    1. Megakaryocyte infection with HIV
  4. Causes: Other Factors
    1. Drug induced Thrombocytopenia (e.g. Trimethoprim-Sulfamethoxazole, Rifampin)
    2. Comorbid Hepatitis CVirus Infection
  5. Management
    1. FIrst-Line
      1. Anti-Retroviral Therapy
      2. Avoid Drug induced Thrombocytopenia Causes
    2. Adjunctive measures for refractory cases
      1. Corticosteroids
      2. RhoD Immune Globulin (RhoGAM) in Rh Negative patients
    3. Refractory Cases
      1. Splenectomy
      2. Splenic irradiation

IV. Labs: Anemia

  1. Vitamin Deficiency
    1. Vitamin B12 Deficiency
    2. Folate Deficiency
    3. Iron Deficiency
      1. Chronic inflammation in HIV also effects iron levels (decreased TIBC, Serum Iron; elevated Ferritin)
  2. Drug-Induced Anemia
    1. See Drug-Induced Hemolytic Anemia
    2. See Drug-Induced Macrocytic Anemia
    3. Trimethoprim-Sulfamethoxazole
    4. Zidovudine (AZT)
  3. Hemolytic Anemia
    1. See Hemolytic Anemia Causes
    2. See Autoimmune Hemolytic Anemia
    3. See Microangiopathic Hemolytic Anemia
    4. See Drug-Induced Hemolytic Anemia
    5. Findings include elevated LDH, Indirect Bilirubin and Reticulocyte Count
  4. Thrombotic Microangiopathy (TTP, HUS)
    1. See Thrombotic Thrombocytopenic Purpura
    2. See Hemolytic-Uremic Syndrome
    3. Findings include fever, Thrombocytopenia, Hemolytic Anemia, renal dysfunction, Schistocytes
  5. Bone Marrow Suppression or Infiltration
    1. Parvovirus B19
    2. Histoplasmosis
    3. Lymphoma
    4. Mycobacterium Avium Complex
  6. Management
    1. Anti-Retroviral Therapy
    2. Treat specific causes
      1. Vitamin Deficiency (e.g. Iron Deficiency)
      2. Erythropoiesis Simulating Agent (Erythropoietin, Epoetin) if indicated
      3. Corticosteroids (for Autoimmune Hemolytic Anemia)
      4. Bone Marrow Biopsy if indicated

V. Prevention

  1. Monitor hematologic labs at regular intervals
  2. Antiretroviral therapy
    1. Highly effective at suppressing HIV Infection and maintaining cell counts
  3. Infectious Disease prophylaxis in AIDS
    1. Pneumocystis Jiroveci Prophylaxis
    2. Mycobacterium Avium Complex prophylaxis

VI. References

  1. Baloor (2018) Exam Preparatory Manual for Undergraduates Medicine, Jaypee Brothers, India, p. 244
  2. Damtie (2021) HIV AIDS 13:477-84 +PMID: 33976573 [PubMed]
  3. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]

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