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25 - Hematologic problems

Published online by Cambridge University Press:  23 December 2009

By
William C. Owen  and
Eric J. Werner
Edited by
Steven L. Zeichner  and
Jennifer S. Read
William C. Owen
Affiliation:
Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA
Eric J. Werner
Affiliation:
Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Most HIV-infected children and adolescents have abnormalities of their peripheral blood and/or hemostatic systems. These abnormalities may be caused by direct or indirect effects of HIV on hematopoiesis, by secondary infections, by nutritional deficits, by medications or by aberrations of the immune system. While in many cases these abnormalities are asymptomatic, on occasion they may have life-threatening consequences. This chapter will review the common hematologic consequences of HIV infection and will emphasize the diagnostic and therapeutic considerations in their management.

Anemia

Anemia is common in children infected with HIV [1]. Anemia in HIV-infected children can be due to decreased red blood cell (RBC) production, defective erythroid maturation, blood loss and increased RBC destruction (hemolysis). In many cases, the anemia is multifactorial. Potential etiologies of anemia in HIV-infected children are listed in Table 25.1. Congenital RBC disorders, such as glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, may be present coincidentally.

HIV infection alters the bone marrow microenvironment impairing RBC production [2]. Cytokines such as tumor necrosis factor and interleukin-1 are elevated in HIV infection and may have an inhibitory effect on erythropoiesis [3]. Patients with HIV have a relatively poor erythropoietin response to anemia [3].

Several types of infections suppress erythropoiesis. Infectious agents such as Mycobacterium avium intracellulare (MAC), cytomegalovirus (CMV), and Epstein–Barr virus (EBV) can inhibit RBC production. Pure red cell aplasia due to parvovirus B19 can occur in the HIV-infected individual [4]. Medications used to treat HIV or its complications may interfere with RBC production.

Type
Chapter
Information
Handbook of Pediatric HIV Care , pp. 588 - 601
Publisher: Cambridge University Press
Print publication year: 2006

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  • Hematologic problems
    • By William C. Owen, Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA, Eric J. Werner, Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.027
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  • Hematologic problems
    • By William C. Owen, Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA, Eric J. Werner, Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.027
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Hematologic problems
    • By William C. Owen, Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA, Eric J. Werner, Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.027
Available formats
×