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Hematologic and bone marrow abnormalities in pediatric patients with human immunodeficiency virus (HIV) infection
1Department of Pathology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08901.
Insights
Pediatric HIV infection can cause cytopenias, particularly thrombocytopenia, in children. Bone marrow exams revealed normal cellularity and megakaryocytes, without myelodysplasia or opportunistic infections.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Human Immunodeficiency Virus (HIV) Research
Background:
- Perinatally acquired human immunodeficiency virus (HIV) infection affects children, necessitating understanding of its hematological manifestations.
- Bone marrow examination is crucial for diagnosing complications in pediatric HIV patients, similar to adults.
Purpose of the Study:
- To document peripheral blood and bone marrow findings in children with perinatally acquired HIV.
- To compare pediatric HIV hematological findings with those observed in adult HIV patients.
Main Methods:
- Analysis of peripheral blood and bone marrow findings in eight children (5 months to 3 years) with perinatally acquired HIV.
- Bone marrow examination included cytological analysis and trephine biopsies.
- Assessment of platelet-associated antibodies in cases of thrombocytopenia.
Main Results:
- Thrombocytopenia was the most frequent indication for bone marrow examination.
- Elevated platelet-associated antibodies were detected in all thrombocytopenic children.
- Peripheral blood showed plasmacytosis and eosinophilia in patients with lymphocytic interstitial pneumonia.
- Bone marrow trephine biopsies revealed normal cellularity and megakaryocytes; lymphoid aggregates were present in some cases.
- Myelodysplasia, malignancies, and opportunistic infections were not observed in this pediatric cohort.
Conclusions:
- Bone marrow findings in children with perinatally acquired HIV are distinct from adults, notably lacking myelodysplasia.
- Hematological abnormalities like thrombocytopenia are significant in pediatric HIV, warranting further investigation.
- Bone marrow examination is valuable for characterizing hematological changes in pediatric HIV infection.
Abstract:
This study presents the peripheral blood and bone marrow findings in eight children with perinatally acquired HIV infection, ranging in age from 5 months to 3 years. The indications for bone marrow examination were comparable to those for adults with HIV infection and included cytopenia(s), slenomegaly, failure to thrive, and suspected tuberculosis. Thrombocytopenia was the most common indication, and platelet-associated antibodies were elevated in all patients with thrombocytopenia. The peripheral blood morphology was remarkable for the presence of plasmacytosis and eosinophilia in those patients with lymphocytic interstitial pneumonia. Five patients had trephine biopsies, and marrow cellularity was normal with normal or increased megakaryocytes in all cases. Lymphoid aggregates, also described in adult patients with acquired immunodeficiency syndrome (AIDS), were present in three of five trephine biopsies. In contrast to the adult patients, myelodysplasia was not observed in the pediatric age group. None of the eight children had malignancies or opportunistic infections that were diagnosed by bone marrow examination.