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Prevalence of lymphopenia in children with AIDS
A D Suarez1, S P Rao, S T Miller
1Division of Hematology and Oncology, Children's Medical Center, Brooklyn, New York.
Insights
Hematologic abnormalities are common in children with acquired immunodeficiency syndrome (AIDS). This study found a high prevalence of lymphopenia, indicating disease progression in pediatric AIDS patients.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Immunology
Background:
- Hematologic abnormalities are common in patients with acquired immunodeficiency syndrome (AIDS).
- Lymphopenia is frequently observed in adults with AIDS, but less consistently reported in children.
- Previous studies suggest varying frequencies of hematologic issues in pediatric AIDS cases.
Purpose of the Study:
- To determine the frequency of lymphopenia and other hematologic abnormalities in hospitalized children with AIDS.
- To compare the prevalence of these abnormalities with existing literature.
- To assess lymphopenia as a potential marker for disease progression in pediatric AIDS.
Main Methods:
- Retrospective review of blood counts (complete blood counts - CBCs) from 74 hospitalized children with AIDS.
- Analysis of 709 CBCs from 176 admissions between January 1990 and March 1991.
- Defined abnormalities based on age-specific percentiles and established thresholds (e.g., anemia, leukopenia, lymphopenia, thrombocytopenia).
Main Results:
- Anemia was present in 92% of patients, leukopenia in 43%, and thrombocytopenia in 27%.
- Lymphopenia was observed in 78% of children, a higher prevalence than previously reported in pediatric AIDS.
- Progression of hematologic abnormalities was noted in 22 patients, with lymphopenia often preceding other cytopenias.
Conclusions:
- Hematologic abnormalities are highly prevalent in hospitalized children with AIDS, similar to adult reports.
- The high frequency of lymphopenia in this cohort suggests it is a significant indicator of disease progression in pediatric AIDS.
- Lymphopenia appears to be a critical marker for monitoring disease severity and progression in children with AIDS.
Abstract:
Hematologic abnormalities, such as anemia, neutropenia, lymphopenia, and thrombocytopenia, are frequently observed in patients with acquired immunodeficiency syndrome (AIDS). While lymphopenia has been noted in up to 80% of adults, only 50% of children with AIDS are reported to be lymphopenic. We reviewed the blood counts of hospitalized children with AIDS to determine the frequency of lymphopenia and other hematologic abnormalities. Seventy-four children with AIDS (ages 4 months to 9.5 years) were admitted to Kings County Hospital Center (Brooklyn, New York) from January 1990 to March 1991; data consisted of 709 CBCs (range one to 39, median 11) from 176 admissions (range one to 15). In some patients admitted during the study period, charts from previous admissions were reviewed. Anemia (Hb less than than third percentile for age) was noted in 68 of 74 (92%) patients. Leukopenia (WBC less than 4000/mm3) was noted in 32 of 74 (43%) patients. Lymphopenia (lymphocyte counts below normal for age) was seen in 59 of 74 (78%) patients; of these, more than half (31 of 59) had persistently low absolute lymphocyte counts. Thrombocytopenia (platelet count less than 150,000/mm3) was seen in 20 of 74 (27%) and was found in four of eight patients who expired. Pancytopenia was seen in nine of 74 (12%) patients. Progression of hematologic abnormalities with anemia followed by lymphopenia, thrombocytopenia, and finally leukopenia was demonstrated in 22 patients. This review shows a prevalence of hematologic abnormalities that is similar to those of previous reports in children except for a considerably higher prevalence of lymphopenia. As expected, lymphopenia was a marker for disease progression.