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Peripheral blood and bone marrow findings in patients with acquired immune deficiency syndrome
C E Harris1, J C Biggs, A J Concannon
1Department of Hematology, St. Vincent's Hospital, Sydney.
Abstract:
In 4 years (1984-1987), 183 bone marrow examinations were performed on 155 human immunodeficiency virus (HIV) antibody positive patients. One hundred and fifty three had category IV AIDS. One-third of the marrows yielded specific information. This included opportunistic infection, in particular Mycobacterium Avium Intracellulare Complex (MAI) (24%), malignancy (4%), consistent with ITP (9%) and iron deficiency (1%). In the remaining two thirds of the bone marrows the most frequent non-specific abnormalities were dyserythropoiesis, erythroid hypoplasia, reticuloendothelial iron block, granulomas, lymphoid aggregates, plasmacytosis and histiocytosis. Common peripheral blood findings were anemia, lymphopenia, anisocytosis, rouleaux and atypical lymphocytes. Peripheral blood and bone marrow examinations on 16 patients on AZT are included. These patients have more pronounced blood and bone marrow abnormalities. The causes of these abnormalities are multifactorial and include low T4 levels, severe viral and other infections and therapy with marrow toxic drugs.
Insights
Bone marrow examinations in human immunodeficiency virus (HIV) patients revealed specific findings like opportunistic infections and malignancy in one-third of cases. Non-specific abnormalities were common, with AZT therapy potentially worsening blood and bone marrow issues.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Human immunodeficiency virus (HIV) infection significantly impacts the hematopoietic system.
- Bone marrow examination is a crucial diagnostic tool for staging and understanding disease progression in HIV/AIDS patients.
Purpose of the Study:
- To evaluate the diagnostic yield of bone marrow examinations in HIV-positive patients.
- To identify specific and non-specific hematological abnormalities in HIV/AIDS patients.
- To assess the impact of antiretroviral therapy (AZT) on bone marrow findings.
Main Methods:
- Retrospective analysis of 183 bone marrow examinations from 155 HIV-positive patients (1984-1987).
- Categorization of findings into specific (infections, malignancies, ITP, iron deficiency) and non-specific abnormalities.
- Inclusion of peripheral blood findings and data from 16 patients on AZT.
Main Results:
- One-third of bone marrow exams provided specific diagnostic information.
- Opportunistic infections, particularly Mycobacterium Avium Intracellulare Complex (MAI), were the most frequent specific finding (24%).
- Non-specific abnormalities included dyserythropoiesis, erythroid hypoplasia, and granulomas; AZT-treated patients showed more pronounced abnormalities.
Conclusions:
- Bone marrow examination is valuable for diagnosing opportunistic infections and malignancies in advanced HIV disease.
- Hematological abnormalities in HIV are multifactorial, influenced by viral load, co-infections, and marrow-toxic therapies like AZT.
- Further research is needed to understand and manage drug-induced bone marrow toxicity in HIV patients.