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Refractory anemia in human immunodeficiency virus: Expect the unexpected
Sumeet Prakash Mirgh1, Vikas A Mishra2, Virti D Shah3
1Department of Clinical Hematology, AIIMS, New Delhi, India.
Journal of Family Medicine and Primary Care
|February 21, 2017
Summary
Pure red cell aplasia (PRCA) is a rare blood disorder. Zidovudine (AZT) can cause PRCA, leading to severe anemia, but replacing it with tenofovir resolved the condition.
Area of Science:
- Hematology
- Pharmacology
- Internal Medicine
Background:
- Pure red cell aplasia (PRCA) is a rare hematological disorder characterized by selective suppression of erythropoiesis.
- PRCA presents as anemia with normal leukocyte and platelet counts, low reticulocyte count, and minimal erythroid precursors in bone marrow.
Observation:
- A case of severe anemia was observed in a patient undergoing antiretroviral therapy (ART).
- The anemia was attributed to Zidovudine (AZT) after 4 months of treatment, with other causes ruled out.
Findings:
- Discontinuation of Zidovudine (AZT) and substitution with tenofovir led to the resolution of hematological abnormalities.
- The patient achieved transfusion independence after the treatment modification.
Implications:
- This case highlights Zidovudine (AZT) as a potential cause of drug-induced PRCA.
- Early suspicion, diagnosis, and removal of causative agents like AZT are crucial for managing acquired PRCA.
- Caution is advised when initiating ART, particularly with Zidovudine (AZT), due to its association with anemia.
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