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32 - Hematologic problems

from Part IV - Clinical manifestations of HIV infection in children

Published online by Cambridge University Press:  03 February 2010

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 Cancer Institute, 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 cause 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 a common finding in children infected with HIV. Ellaurie et al. noted that 94% of HIV-infected children had a hematocrit < 33% [1]. Anemia is present in 37% of children with perinatally acquired HIV at 1 year of age [2]. In Ellaurie's review, the anemia was more pronounced (hematocrit < 25%) in 21 of 23 infants with opportunistic infection [3]. Forsyth et al. followed infants with perinatally acquired HIV and noted that anemia in the first year of life was associated with an increased risk of mortality by 3 years of age [2]. Adult studies have shown that anemia continues to predict decreased survival even with highly active antiretroviral therapy (HAART) [3].

Potential etiologies of anemia in children include decreased red blood cell (RBC) production, defective erythroid maturation, blood loss, and increased RBC destruction (hemolysis). In many anemic HIV-infected children, the anemia is multifactorial. The potential etiologies of anemia in HIV-infected children are listed in Table 32.1.

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Textbook of Pediatric HIV Care , pp. 499 - 509
Publisher: Cambridge University Press
Print publication year: 2005

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References

Ellaurie, M., Burns, E. R. & Rubinstein, A.Hematologic manifestations in pediatric Human Immunodeficiency Virus infection: severe anemia as a prognostic factor. Am. J. Pediatr. Hematol. Oncol. 12 (1990), 449–53CrossRefGoogle ScholarPubMed
Forsyth, B. W., Andiman, W. A. & O'Connor, T.Development of a prognosis-based clinical staging system for infants infected with human immunodeficiency virus. J. Pediatr. 129 (1996), 648–55CrossRefGoogle ScholarPubMed
Moore, R. D.Human immunodeficiency virus infection, anemia, and survival. Clin. Infect. Dis. 29 (1999), 44–9CrossRefGoogle Scholar
Moses, A., Nelson, J. & Bagby, G. C. Jr. The influence of human immunodeficiency virus-1 on hematopoiesis. Blood 91 (1998), 1479–95Google ScholarPubMed
Coyle, T. E.Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Med. Clin. N. Am. 81 (1997), 449–70CrossRefGoogle ScholarPubMed
Ellaurie, M., Burns, E. R., Bernstein, L. J., Shah, K. & Rubinstein, A.Thrombocytopenia and human immunodeficiency virus in children. Pediatrics 82 (1988), 905–8Google ScholarPubMed
Koduri, P. R., Kumapley, R., Valladares, J. & Teter, C. Chronic pure red cell aplasia caused by parvovirus B19 in Acquired Immune Deficiency Syndrome: use of intravenous immunoglobulin — a report of eight patients. Am. J. Hematol. 61 (1999), 16–203.0.CO;2-Y>CrossRef
Mueller, B. U. Hematological problems and their management in children with Human Immunodeficiency Virus infection. In P. A. Pizzo & C. M. Wilfert (eds.), Pediatric Acquired Immune Deficiency Syndrome. Baltimore: Williams and Wilkins Publishers (1994), pp. 591–601
Rosenblatt, D. S. & Whitehead, V. M.Cobalamin and folate deficiency: acquired and hereditary disorders in children. Semin. Hematol. 36 (1999), 19–34Google ScholarPubMed
Luzzatto, L. Glucose-6-phosphate dehydrogenase deficiency and hemolytic anemia. In D. G. Nathan & S. H. Orkin (eds.), Hematologic Disease of Infancy and Childhood, Vol. 1. Philadelphia: W. B. Saunders Company (1998), pp. 704–26
Thompson, C. E., Damon, L. E., Ries, C. A. & Linker, C. A.Thrombotic microangiopathies in the 1980s: clinical features, response to treatment, and the impact of the human immunodeficiency virus epidemic. Blood 80 (1992), 1890–5Google ScholarPubMed
Karpatkin, S., Nardi, M. & Green, D.Platelet and coagulation defects associated with Human Immunodeficiency Virus-1-infection. Thromb. Haemost. 88 (2002), 389–401Google Scholar
Andrews, N. C. & Bridges, K. R. Disorders of iron metabolism and sideroblastic anemia. In D. G. Nathan & H. O. Stuart (eds.), Hematology of Infancy and Childhood, Vol. 1. Philadelphia: W. B. Saunders Company (1998), pp. 423–69
Mueller, B. U., Tannenbaum, S. & Pizzo, P. A.Bone marrow aspirates and biopsies in children with human immunodeficiency virus infection. J. Pediatr. Hematol. Oncol. 18 (1996), 266–71CrossRefGoogle ScholarPubMed
Moore, R. D.Anemia and human immunodeficiency virus disease in the era of highly active antiretroviral therapy. Semin. Hematol. 37 (2000), 18–23CrossRefGoogle ScholarPubMed
Fischl, M., Galpin, J. E., Levine, J. D.. Recombinant human erythropoietin for patients with Acquired Immune Deficiency Syndrome treated with zidovudine. New Engl. J. Med. 322 (1990), 1488–93CrossRefGoogle ScholarPubMed
Kline, M. W., Dyke, R. B., Lindsey, J. C.. A randomized comparative trial of stavudine (Stavudine) versus zidovudine (Zidovudine (also Known as AZT), AZT) in children with human immunodeficiency virus infection. Acquired Immune Deficiency Syndrome Clinical Trials Group 240 Team. Pediatrics 101 (1998), 214–20CrossRefGoogle Scholar
Weinberg, G. A., Gigliotti, F., Stroncek, D. F.. Lack of relation of granulocyte antibodies (antineutrophil antibodies) to neutropenia in children with human immunodeficiency virus infection. Pediatr. Infect. Dis. J. 16 (1997), 881–4CrossRefGoogle ScholarPubMed
Kuritzkes, D. R., Parenti, D., Ward, D. J.. Filgrastim prevents severe neutropenia and reduces infective morbidity in patients with advanced Human Immunodeficiency Virus infection: results of a randomized, multicenter, controlled trial. Granulocyte-Colony Stimulating Factor 930101 Study Group. Acquired Immune Deficiency Syndrome 12 (1998), 65–74Google ScholarPubMed
Eyster, M. E., Rabkin, C. S., Hilgartner, M. W.. Human immunodeficiency virus-related conditions in children and adults with hemophilia: rates, relationship to Cluster of Differentiation4 counts, and predictive value. Blood 81 (1993), 828–34Google Scholar
Sloand, E. M., Klein, H. G., Banks, S. M., Vareldzis, B., Merritt, S. & Pierce, P.Epidemiology of thrombocytopenia in Human Immunodeficiency Virus infection. Eur. J. Haematol. 48 (1992), 168–72CrossRefGoogle Scholar
Glatt, A. E. & Anand, A.Thrombocytopenia in patients infected with human immunodeficiency virus: treatment update. Clin. Infect. Dis. 21 (1995), 415–23CrossRefGoogle ScholarPubMed
Zucker-Franklin, D. & Cao, Y. Z.Megakaryocytes of human immunodeficiency virus-infected individuals express viral Ribonucleic Acid. Proc. Natl. Acad. Sci. U.S.A 86 (1989), 5595–9CrossRefGoogle Scholar
Cole, J. L., Marzec, U. M., Gunthel, C. J.. Ineffective platelet production in thrombocytopenic human immunodeficiency virus-infected patients. Blood 91 (1998), 3239–46Google ScholarPubMed
Ballem, P., Belzberg, A., Devine, D.. Kinetic studies of the mechanism of thrombocytopenia in patients with human immunodeficiency virus infection. New Engl. J. Med. 327 (1992), 1779–84CrossRefGoogle ScholarPubMed
Karpatkin, S. Hemostatic abnormalities in Acquired Immune Deficiency Syndrome. In R. W. Colman, J. Hirsh, V. J. Marder & E. W. Salzman (eds.), Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Philadelphia: J. B. Lippincott Company (1994), pp. 969–80
Nardi, M. & Karpatkin, S.Antiidiotype antibody against platelet anti-GPIIIa contributes to the regulation of thrombocytopenia in Human Immunodeficiency Virus-1-Immune Thrombocytopenia Purpura patients. J. Exp. Med. 191 (2000), 2093–100CrossRefGoogle Scholar
Scaradavou, A., Woo, B., Woloski, B. M.. Intravenous anti-D treatment of immune thrombocytopenic purpura: experience in 272 patients. Blood 89 (1997), 2689–700Google ScholarPubMed
Mueller, B. U., Burt, R., Gulick, L., Jacobsen, F., Pizzo, P. A. & Horne, M.Disseminated intravascular coagulation associated with granulocyte colony-stimulating factor therapy in a child with human immunodeficiency virus infection. J. Pediatr. 126 (1995), 749–52CrossRefGoogle Scholar
Ragni, M. V., Bontempi, F. A., Myers, D. J., Kiss, J. E. & Oral, A.Hemorrhagic sequelae of immune thrombocytopenic purpura in human immunodeficiency virus-infected hemophiliacs. Blood 75 (1990), 1267–72Google ScholarPubMed
Kreuz, W. D., Schneider, W. & Nowak-Gottl, U.Treatment of consumption coagulopathy with antithrombin concentrate in children with acquired antithrombin deficiency — a feasibility pilot study. Eur. J. Pediatr. 158: Suppl. 3 (1999), S187–91CrossRefGoogle ScholarPubMed
Prasad, V. K., Kim, I. K., Farrington, K. & Bussel, J. B.Thrombotic Thrombocytopenia Purpura following Immune Thrombocytopenia Purpura in an Human Immunodeficiency Virus-positive boy. J. Pediatr. Hematol. Oncol. 18 (1996), 384–6CrossRefGoogle Scholar
Parker, R. I.Etiology and treatment of acquired coagulopathies in the critically ill adult and child. Crit. Care. Clin. 13 (1997), 591–609CrossRefGoogle ScholarPubMed
Hymes, K. B., Greene, J. B. & Karpatkin, S.The effect of azidothymidine on Human Immunodeficiency Virus-related thrombocytopenia. New Engl. J. Med. 318 (1988), 516–17Google Scholar
Arranz, Caso J. A., Sanchez, Mingo C. & Garcia, Tena J.Effect of highly active antiretroviral therapy on thrombocytopenia in patients with Human Immunodeficiency Virus infection. New Engl. J. Med. 341 (1999), 1239–40CrossRefGoogle Scholar
Blanchette, V., Imbach, P., Andrew, M.. Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet 344 (1994), 703–7CrossRefGoogle Scholar
Beardsley, D. S. & Nathan, D. G. Platelet abnormalities in infancy and childhood. In D. G. Nathan & S. H. Orkin (eds.), Hematology of Infancy and Childhood. Vol. 2. Philadelphia: W.B. Saunders Company (1998), pp. 1585–1630
Ramratnam, B., Parameswaran, J., Elliot, B.. Short course dexamethasone for thrombocytopenia in Acquired Immune Deficiency Syndrome. Am. J. Med. 100 (1996), 117–18CrossRefGoogle Scholar
Hoff, J. & Ritchey, A. K.Pulse methylprednisolone therapy for acute childhood idiopathic thrombocytopenic purpura. J. Pediatr. 113 (1988), 563–6CrossRefGoogle ScholarPubMed
Bussel, J. B. & Haimi, J. S.Isolated thrombocytopenia in patients infected with Human Immunodeficiency Virus: treatment with intravenous gammaglobulin. Am. J. Hematol. 28 (1988), 79–84CrossRefGoogle ScholarPubMed
Singh, N., Yu, V. L. & Rihs, J. D.Invasive aspergillosis in Acquired Immune Deficiency Syndrome. South Med. J. 84 (1991), 822–7CrossRefGoogle Scholar
Oksenhendler, E., Bierling, P., Chevret, S.. Splenectomy is safe and effective in human immunodeficiency virus-related immune thrombocytopenia [see comments]. Blood 82 (1993), 29–32Google Scholar
Immunization in special clinical circumstances. In L. K. Pickering, G. Peter, C. J. Baker, M. A. Gerber, N. E. MacDonald & W. O. Orenstein (eds.), 2000 Red Book: Report of the Committee on Infectious Diseases. Elk Grove, Interleukin: American Academy of Pediatrics (2000), pp. 66–7
Monpoux, F., Kurzenne, J. Y., Sirvent, N., Cottalorda, J. & Boutte, P.Partial splenectomy in a child with human immunodeficiency virus-related immune thrombocytopenia. J. Pediatr. Hematol. Oncol. 21 (1999), 441–3CrossRefGoogle Scholar
Blauth, J., Fisher, S., Henry, D. & Nichini, F.The role of splenic irradiation in treating Human Immunodeficiency Virus-associated immune thrombocytopenia. Int. J. Radiat. Oncol. Biol. Phys. 45 (1999), 457–60CrossRefGoogle Scholar
Marroni, M., Sinnone, M. S., Landonio, G.. Splenic irradiation versus splenectomy for severe, refractory Human Immunodeficiency Virus-related thrombocytopenia: effects on platelet counts and immunological status. Acquired Immune Deficiency Syndrome 14 (2000), 1664–7Google Scholar
Bloom, E. J., Abrams, D. I. & Rodgers, G.Lupus anticoagulant in the acquired immunodeficiency syndrome. J. Am. Med. Assoc. 256 (1986), 491–3CrossRefGoogle ScholarPubMed
Stahl, C. P., Wideman, C. S., Spira, T. J., Haff, E. C., Hixon, G. J. & Evatt, B. L.Protein S deficiency in men with long-term human immunodeficiency virus infection. Blood 81 (1993), 1801–7Google ScholarPubMed
Sugerman, R. W., Church, J. A., Goldsmith, J. C. & Ens, G. E.Acquired protein S deficiency in children infected with human immunodeficiency virus. Pediatr. Infect. Dis. J. 15 (1996), 106–11CrossRefGoogle ScholarPubMed
Toulon, P., Lamine, M., Ledjev, I.. Heparin cofactor II deficiency in patients infected with the human immunodeficiency virus. Thromb. Haemost. 70 (1993), 730–5Google ScholarPubMed
Qureshi, A. I., Janssen, R. S., Karon, J. M.. Human immunodeficiency virus infection and stroke in young patients. Arch. Neurol. 54 (1997), 1150–3CrossRefGoogle ScholarPubMed
Park, Y. D., Belman, A. L., Kim, T. S.. Stroke in pediatric acquired immunodeficiency syndrome. Ann. Neurol. 28 (1990), 303–11CrossRefGoogle ScholarPubMed
Philippet, P., Blanche, S., Sebag, G., Rodesch, G., Griscelli, C. & Tardieu, M.Stroke and cerebral infarcts in children infected with human immunodeficiency virus. Arch. Pediatr. Adolesc. Med. 148 (1994), 965–70CrossRefGoogle ScholarPubMed
Patsalides, A. D., Wood, L. V., Atac, G. K., Sandifer, E., Butman, J. A. & Patronas, N. J.Cerebrovascular disease in Human Immunodeficiency Virus-infected pediatric patients: neuroimaging findings. Am. J. Roentgenol. 179 (2002), 999–1003CrossRefGoogle Scholar
Dubrovsky, T., Curless, R., Scott, G.. Cerebral aneurysmal arteriopathy in childhood Acquired Immune Deficiency Syndrome. Neurology 51 (1998), 560–5CrossRefGoogle Scholar
Saber, A. A., Aboolian, A., LaRaja, R. D., Baron, H. & Hanna, K.Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement. Am. Surg. 67 (2001), 645–7Google ScholarPubMed
Wilde, J. T., Lee, C. A., Collins, P., Giangrande, P. L., Winter, M. & Shiach, C. R.Increased bleeding associated with protease inhibitor therapy in Human Immunodeficiency Virus-positive patients with bleeding disorders. Br. J. Haematol. 107 (1999), 556–9CrossRefGoogle Scholar
Racoosin, J. A. & Kessler, C. M.Bleeding episodes in Human Immunodeficiency Virus-positive patients taking Human Immunodeficiency Virus protease inhibitors: a case series. Haemophilia 5 (1999), 266–9CrossRefGoogle ScholarPubMed
Monagle, P., Michelson, A. D., Bovill, E. & Andrew, M.Antithrombotic therapy in children. Chest 119 (2001), 344S–70SCrossRefGoogle ScholarPubMed

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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, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.035
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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 Dropbox.

  • 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, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.035
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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, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.035
Available formats
×