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Hematologic manifestations of HIV infection: Thrombocytopenia and coagulation abnormalities

Authors
Timothy J Friel, MD
David T Scadden, MD
Section Editor
Lawrence LK Leung, MD
Deputy Editor
Jennifer S Tirnauer, MD

INTRODUCTION

Shortly after the first description of the acquired immunodeficiency syndrome (AIDS), cytopenias of all major blood cell lines were increasingly recognized among patients infected with the human immunodeficiency virus (HIV). In one early series of patients with AIDS, anemia was noted in approximately 70 percent, lymphopenia in 70 percent, neutropenia in 50 percent, and thrombocytopenia in 40 percent [1]. Data from a large European cohort demonstrated a 3.2 percent prevalence of HIV infection among individuals presenting with unexplained thrombocytopenia or leukopenia lasting for more than four weeks [2].

The incidence of the various cytopenias correlates directly with the degree of immunosuppression. However, isolated abnormalities, particularly thrombocytopenia, may be encountered as the initial presentation of HIV infection. As a result, HIV infection should be considered in the assessment of patients presenting with any type of cytopenia.

The causes and treatment of thrombocytopenia and coagulation abnormalities in patients with HIV infection will be reviewed here [3]. Similar issues regarding anemia, neutropenia, and lymphopenia are discussed separately. (See "Hematologic manifestations of HIV infection: Anemia" and "Hematologic manifestations of HIV infection: Neutropenia" and "Techniques and interpretation of measurement of the CD4 cell count in HIV-infected patients".)

INCIDENCE AND CAUSES OF THROMBOCYTOPENIA

Overview — Thrombocytopenia was a common finding in individuals infected with HIV in the era prior to the use of potent antiretroviral therapy (ART), affecting approximately 40 percent of patients during the course of their illness [1]. In the context of widespread potent ART, the incidence of thrombocytopenia is far lower, diagnosed in only 0.6 percent of 5290 HIV infected individuals at the BC Centre for Excellence in HIV/AIDS [4].

HIV-associated thrombocytopenia occurs in patients from all major risk groups, including those exposed via homosexual or heterosexual contact, injection drug use, and blood product transfusion.

                           

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Literature review current through: Nov 2016. | This topic last updated: Thu Mar 03 00:00:00 GMT+00:00 2016.
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