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Chetty C, Musekwa E, Chapanduka ZC. The value of bone marrow examinations performed in the investigation of HIV infected patients with cytopenias. Int J Lab Hematol 2023. [PMID: 37129086 DOI: 10.1111/ijlh.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Bone marrow examination (BME) is a reliable and effective tool in the diagnosis of many haematological and non-haematological diseases and may be used to investigate unexplained cytopenia in human immunodeficiency virus (HIV) infected patients. The objective of this study was to determine the diagnoses made, diagnostic yield and unique diagnostic yield of BMEs performed to investigate cytopenias in HIV infected patients. METHOD A retrospective cross-sectional descriptive study was performed involving all BMEs performed on HIV-infected adult patients with the main indication of unexplained cytopenia over a period of 5 years and 4 months. Data was extracted from the National Health Laboratory Service's laboratory information system and clinicians' BME request forms. RESULTS The study included 128 BMEs, performed on 124 patients. The diagnostic yield was 32% and the unique diagnostic yield was 30.5%. The most common diagnosis was pure red cell aplasia (10.9%), followed by immune thrombocytopenic purpura (ITP) (7%), iron deficiency anaemia (6.3%), malignancy (4.7%) and disseminated infection (3.9%). CONCLUSION BME is a useful investigation for unexplained cytopenia in HIV-infected patients. Less invasive investigations to exclude haematinic deficiencies, haemolysis and sepsis are recommended on an individualised basis prior to BME. In HIV-infected patients with therapy refractory ITP or ITP with atypical clinicopathological findings, BME is strongly recommended. As Mycobacterial and other infections are common in this group of patients, staining and culture of specimens are advised if BME is undertaken.
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Affiliation(s)
- Carissa Chetty
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS), Tygerberg Hospital, South Africa
| | - Ernest Musekwa
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS), Tygerberg Hospital, South Africa
| | - Zivanai Cuthbert Chapanduka
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS), Tygerberg Hospital, South Africa
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Abdullah I, Subramony N, Musekwa E, Nell EM, Alzanad F, Chetty C, Gantana E, Lohlun RK, Cerfontein W, Cochrane B, Chapanduka ZC. Indications and diagnostic value of bone marrow examination in HIV-positive individuals: A 3-year review at Tygerberg Hospital. S Afr J Infect Dis 2021; 36:273. [PMID: 34522695 PMCID: PMC8424746 DOI: 10.4102/sajid.v36i1.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/06/2021] [Indexed: 11/01/2022] Open
Abstract
Background Bone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. However, its role in the afebrile and asymptomatic patient presenting with an isolated cytopenia is not well established. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital. Methods A retrospective, cross-sectional descriptive study was performed over a 3-year period from 01 September 2015 to 31 August 2018. The bone marrow examination reports for the HIV-positive patients who had a bone marrow examination during the study period were retrieved. Clinical and laboratory information was captured. Results Altogether 374 bone marrow reports for HIV-positive patients were found. The indication of the bone marrow examination included investigation of unexplained cytopenias, suspected haematological malignancies, follow-up examination for patients with known haematological diseases, staging of haematological or non-haematological malignancies and investigation of suspected disseminated infection. The patients' median age was 43 years and the interquartile range was 27-60 years. There was a slight female predominance with females 51% and males 49%. The diagnostic yield was 33.7%. Acute leukaemia and lymphoma were the most common diagnoses. Haematinic deficiency and pure red cell aplasia were found in the majority of cases with isolated anaemia. All cases with isolated thrombocytopenia were due to immune thrombocytopenia. Conclusion Bone marrow examination is a useful investigation for HIV-positive patients with cytopenias, suspected haematological malignancy and lymphoma staging. However, its early use in patients with isolated anaemia and isolated thrombocytopenia is questionable.
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Affiliation(s)
- Ibtisam Abdullah
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Nadhiya Subramony
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Ernest Musekwa
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Erica-Mari Nell
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Fatima Alzanad
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Carissa Chetty
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Ethan Gantana
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Robert K Lohlun
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Wardah Cerfontein
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Bridget Cochrane
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Zivanai C Chapanduka
- Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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Hajiabdolbaghi M, Ataeinia B, Ghadimi F, SeyedAlinaghi S, Badie BM, Dadras O, Rasoolinejad M. Bone Marrow Aspiration/Biopsy in the Evaluation of Fever of Unknown Origin in Patients with AIDS. Infect Disord Drug Targets 2021; 21:394-398. [PMID: 32628601 DOI: 10.2174/1871526520666200705212903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND HIV can interrupt the normal development of bone marrow cell lines. Bone marrow aspiration/biopsy (BMA/B) has been described as a diagnostic tool in AIDS patients with fever of unknown origin (FUO). In this review, we aimed to study patients with AIDS who had undergone a BMA/B to investigate FUO and describe the pathologies diagnosed in the biopsy. METHODS Thirty-four BMA/B samples were collected from AIDS patients admitted for work-up of FUO to the infectious disease ward of a tertiary referral HIV center in Tehran, Iran, between September 2014 and September 2015. Data including age, sex, duration of disease, CD4 cell counts, hepatitis B (HBV) and C (HCV) coinfection, the primary presentation of AIDS, and the treatment history were retrieved and analyzed. Patients underwent BMA/B. An expert pathologist reviewed the BMA/B specimens. RESULTS The mean age of the patients was 37.5 years (range, 26-56), and 27 (79%) were men. Twenty-seven (79%) patients contracted HIV from injection drug use, and 7 (21%) via sexual transmission. Only 3 (9%) of the BMA/B examinations were normal. Hypocellular bone marrow was diagnosed in 22 (65%) patients. Other pathologies included granulomas in 6 (18%), hematologic malignancies in 2 (6%), and leishmaniasis Aspergillosis, each in 1 (3%) patient. Six (17%) of the specimens were found to have tuberculosis infections. CONCLUSION Hypocellular bone marrow was the most common pathology on BMA/B examinations, followed by the presence of granulomas. Tuberculosis, Aspergillosis, and Leishmaniasis the opportunistic infections diagnosed on BMA/B specimens. Our results support BMA/B as an appropriate diagnostic tool for early diagnosis of opportunistic infections and malignancies in AIDS. BMA/B is indispensable in the armament of diagnostic tools of the physicians managing AIDS patients.
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Affiliation(s)
- Mahboubeh Hajiabdolbaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ataeinia
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghadimi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Omid Dadras
- Department of Global Health and Socioepidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mehrnaz Rasoolinejad
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Tshabalala WS, Pillay S, Wilson DPK. Diagnostic outcomes of bone marrow aspirate and trephine biopsies performed at a hospital in KwaZulu-Natal, South Africa. Afr J Lab Med 2020; 9:1028. [PMID: 32158640 PMCID: PMC7057739 DOI: 10.4102/ajlm.v9i1.1028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022] Open
Abstract
Background Bone marrow aspiration and trephine biopsy (BMAT) are widely performed in adults to evaluate haematological and malignant conditions. However, the diagnostic yield from the procedure in unselected patients in the South African public sector has not previously been described. Objectives We identified the main indications and most common diagnoses encountered for BMAT and described the demographic and blood profiles of patients, including HIV-positive patients, who had undergone the procedure at a tertiary hospital in KwaZulu-Natal. Methods We retrospectively reviewed laboratory data from January 2016 to December 2016 for all patients aged ≥ 13 years who underwent the procedure and stratified findings by demographic data. Results Among 120 BMAT biopsies studied, 80 (67%) cases were performed to evaluate suspected malignancy and a further 40 (33%) cases for non-malignant indications. The main indications for bone marrow examination were: cytopenias 38 (32%), lymphoma 35 (29%), leukaemia 21 (18%), and multiple myeloma 17 (14%). BMAT results revealed that 60 cases (50%) were malignant in origin, 30 cases (25%) were non-malignant and 30 cases (25%) were classified as normal. The common diagnoses were: leukaemia, 24 (20%); multiple myeloma, 16 (13%) and lymphoma, 13 (11%). Cases aged ≥ 50 years were more likely to have a malignant diagnosis (odds ratio: 5.8 (95% confidence interval: 2.2–17.1) p-value < 0.001). Conclusion The diagnostic yield of BMAT was high, with significant abnormalities detected in three quarters of cases. Haematological malignancy was the more common diagnosis. Increasing age was associated with an increase in reporting of haematology malignancy.
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Affiliation(s)
- Wanda S Tshabalala
- Department of Internal Medicine, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Somasundram Pillay
- Department of Internal Medicine, Edendale Hospital, Pietermaritzburg complex, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Douglas P K Wilson
- Department of Internal Medicine, Edendale Hospital, Pietermaritzburg complex, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Bharuthram N, Feldman C. The diagnostic utility of bone marrow examination in an infectious disease ward. South Afr J HIV Med 2019; 20:974. [PMID: 31616572 PMCID: PMC6780001 DOI: 10.4102/sajhivmed.v20i1.974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/05/2019] [Indexed: 12/29/2022] Open
Abstract
Background Patients with advanced human immunodeficiency virus often present with unexplained fevers or cytopenias. Bone marrow aspirate and trephine examinations are an invasive means to aid diagnoses in patients who present with diagnostic dilemmas. Objectives A retrospective record review to assess the diagnostic utility of bone marrow examinations in a South African Infectious Diseases ward. Methods The records of patients who had undergone a bone marrow examination in the Infectious Disease ward at the Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, between 01 January 2012 and 31 December 2014 were reviewed. A unique diagnosis was considered to be any diagnosis made on bone marrow examination alone, or a diagnosis made more timeously on bone marrow examination than with alternative investigations. Results Of 327 patients who underwent bone marrow examination, 80 unique diagnoses were obtained in 77 cases (23.5%). The unique diagnoses included the presence of granuloma (n = 49), Mycobacterium tuberculosis (n = 17), Mycobacterium avium complex (n = 3), haematological malignancy (n = 4) and pure red cell aplasia (n = 5). A white cell count ≤ 4 × 109/L predicted a unique outcome (p < 0.01). A white cell count ≤ 4 × 109/L and CD4 cell count ≤ 50 cells/mm3 predicted mycobacterial infection of the bone marrow. Conclusions The findings of a unique diagnosis in 23.5% of bone marrow examinations performed suggests that this remains a useful investigative modality in patients in whom less invasive investigations have not yielded a diagnosis.
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Affiliation(s)
- Nirvana Bharuthram
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Phillips L, Opie J. The utility of bone marrow sampling in the diagnosis and staging of lymphoma in South Africa. Int J Lab Hematol 2018; 40:276-283. [PMID: 29427399 DOI: 10.1111/ijlh.12782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/19/2017] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The bone marrow biopsy (BMB) is a diagnostic and staging tool in lymphoma that remains practically useful and relevant in resource-constrained settings, despite restricted applications in international staging guidelines, which favour less invasive nuclear medicine techniques. METHODS Retrospective laboratory data review of BMBs in adult lymphoma patients from 2005 to 2010 to determine subtypes, rates of bone marrow involvement (BMI), human immunodeficiency virus (HIV) seroprevalence and CD4 counts, trephine length and additional findings. RESULTS A total of 1215 BMBs reported in lymphoma included 759 newly diagnosed patients, with BMI in 43.6% of non-Hodgkin lymphoma (NHL) overall, 28.9% of high-grade B subtypes and 35.7% of Hodgkin lymphoma (HL). HIV seroprevalence was 38.8%, 53.0% and 33.9% in the 3 respective groups. There was a statistical association between BMI and HIV seropositivity in Burkitt lymphoma and HL, and BMI and CD4 count in HIV-related HL. Over 10% (n = 79) of new lymphoma cases were diagnosed by BMB with ancillary tests. Occasional histological discordance and transformation were reported in NHL. Focal/unilateral BMI was uncommon. Bilateral BMB and biopsy length exceeding 26 mm did not improve BMI detection. CONCLUSION In the South African public sector, high HIV prevalence leads to a different lymphoma pathology profile from the developed world. High BMI rates are encountered. Here, and in similar resource-constrained settings, international lymphoma staging guidelines can be logistically challenging and unaffordable. BMB remains useful in the staging and diagnosis of lymphoma. Unilateral sampling with a processed trephine length of at least 26 mm is recommended.
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Affiliation(s)
- L Phillips
- Department of Haematology, Red Cross War Memorial Children's Hospital Laboratory, National Health Laboratory Service, Cape Town, South Africa.,Division of Haematology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - J Opie
- Division of Haematology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Department of Haematology, Groote Schuur Hospital Laboratory, National Health Laboratory Service, Cape Town, South Africa
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7
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Nkanga MSN, Longo-Mbenza B, Adeniyi OV, Ngwidiwo JB, Katawandja AL, Kazadi PRB, Nzonzila AN. Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC). BMC Cancer 2017; 17:559. [PMID: 28835214 PMCID: PMC5569529 DOI: 10.1186/s12885-017-3547-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/14/2017] [Indexed: 01/06/2023] Open
Abstract
Background The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. Methods This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. Results Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4–4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2–12.1; P < 0.001), combined local dry season + La Nina (HR = 4.6; 95%CI 1.8–11.8; P < 0.001), and combined local dry season + El Nino (HR = 4; 95% CI 1.6–9.7; P = 0.004). HM types included acute myeloid leukaemia (28.6% n = 18), multiple myeloma (22.2% n = 14), myelodysplastic syndromes (15.9% n = 10), chronic myeloid leukaemia (15.9% n = 10), chronic lymphoid leukaemia (9.5% n = 6), and acute lymphoid leukaemia (7.9% n = 5). After adjusting for confounders using Cox regression analysis, age ≥ 55 years, exposure to pollution, combined local dry season + La Nina and combined local dry season + El Nino were the most significant predictors of incident hematologic malignancy. Conclusion These findings highlight the importance of aging, pollution, the dry season, El Nino and La Nina as related to global warming as determinants of hematologic malignancies among African patients from Kinshasa, DR Congo. Cancer registries in DRC and other African countries will provide more robust database for future researches on haematological malignancies in the region.
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Affiliation(s)
- Mireille Solange Nganga Nkanga
- Département de Biologie Médicale, Service de Biologie Clinique, CUK, Faculté de Médecine, Kinshasa, Democratic Republic of Congo
| | - Benjamin Longo-Mbenza
- Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, 5117, Mthatha, South Africa.
| | - Oladele Vincent Adeniyi
- Cecilia Makiwane Hospital/Walter Sisulu University, Faculty of Health Sciences, East London, South Africa.
| | - Jacques Bikaula Ngwidiwo
- Département de Biologie Médicale, Service de Biologie Clinique, CUK, Faculté de Médecine, Kinshasa, Democratic Republic of Congo
| | - Antoine Lufimbo Katawandja
- Département de Biologie Médicale, Service de Biologie Clinique, CUK, Faculté de Médecine, Kinshasa, Democratic Republic of Congo
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Thulasi Raman R, Manimaran D, Rachakatla P, Bharathi K, Afroz T, Sagar R. Study of Basic Coagulation Parameters among HIV Patients in Correlation to CD4 Counts and ART Status. J Clin Diagn Res 2016; 10:EC04-6. [PMID: 27437222 DOI: 10.7860/jcdr/2016/17459.7718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/09/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION HIV infection is known to cause coagulation abnormalities by various mechanism, especially during its late course. AIM The objective of this study was to analyse platelet count, prothrombin time and activated partial thromboplastin time among HIV infected patients and to analyse these parameters with respect to their CD4 count and ART status. MATERIALS AND METHODS A case control study was conducted with 120 HIV infected patients and 40 normal individuals. The blood samples were collected after obtaining consent from the subjects. The blood samples were processed for platelet count, prothrombin time and activated partial thromboplastin time and CD4 count. The results were tabulated and analysed with statistical package. RESULTS The platelet count was significantly decreased in HIV infected patients compared to controls. Though HIV patients with CD4 count less than 200cells/mm(3) showed a decreased platelet count compared to those with CD4 count greater than 200cells/mm(3), it was not statistically significant. Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) was significantly prolonged in HIV patients, but only aPTT showed significant inverse correlation with CD4 count. None of the parameters showed statistical significance on comparing HIV patients on ART with those not on ART. CONCLUSION Basic coagulation tests like platelet count, PT and especially aPTT can be used as prospective screening test to assess severity in HIV patients in resource limited settings where CD4 count is not available.
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Affiliation(s)
- R Thulasi Raman
- Assistant Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Ammapettai, Chengalpet Taluk, Kancheepuram District, Tamil Nadu, India
| | - D Manimaran
- Professor, Department of Pathology, Tagore Medical College and Hospital , Vandalur-Kelambakkam Road, Rathinamangalam, Tamil Nadu, India
| | - Praveen Rachakatla
- Senior Resident, Department of Pathology, Kakatiya Medical College, Warangal, Telangana, India
| | - K Bharathi
- Associate Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Ammapettai, Chengalpet Taluk, Kancheepuram District, Tamil Nadu, India
| | - Tameem Afroz
- Senior Consultant, Department of Pathology, Aware Global Hospitals , Hyderabad, Telangana, India
| | - Radha Sagar
- Head of Department and Senior Consultant, Department of Pathology, Aware Global Hospitals , Hyderabad, Telangana, India
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Vishnu P, Aboulafia DM. Haematological manifestations of human immune deficiency virus infection. Br J Haematol 2015; 171:695-709. [PMID: 26452169 DOI: 10.1111/bjh.13783] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early in the human immunodeficiency virus (HIV) epidemic, infected patients presented to medical attention with striking abnormalities in each of the major blood cell lineages. The reasons for these derangements remain complex and multifactorial. HIV infects multipotent haematopoietic progenitor cells and establish latent cellular reservoirs, disturbs the bone marrow microenvironment and also causes immune dysregulation. These events lead to cytokine imbalances and disruption of other factors required for normal haematopoiesis. Activation of the reticulo-endothelial system can also result in increased blood cell destruction. The deleterious effects of medications, including first and second generation anti-retroviral agents, on haematopoiesis were well documented in the early years of HIV care; in the current era of HIV-care, the advent of newer and less toxic anti-retroviral drugs have had a more beneficial impact on haematopoiesis. Due to impaired regulation of the immune system and potential side effects of one or more anti-retroviral agents, there is also an increase in coagulation abnormalities such as thromboembolism, and less frequently, acquired disorders of coagulation including thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura and acquired inhibitors of coagulation. In this article we review the epidemiology and aetiology of select non-oncological haematological disorders commonly seen in people living with HIV-acquired immune deficiency syndrome.
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Affiliation(s)
- Prakash Vishnu
- Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA.,Division of Hematology, University of Washington, Seattle, WA, USA
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10
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Quesada AE, Tholpady A, Wanger A, Nguyen AND, Chen L. Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS. J Clin Pathol 2015; 68:241-5. [PMID: 25589792 DOI: 10.1136/jclinpath-2014-202715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS The utility of bone marrow aspiration and biopsy (BMAB) as a diagnostic tool in patients with HIV/AIDS and fever of unknown origin (FUO) is a subject of debate. Because highly active antiretroviral therapy has reduced incidence of opportunistic infections, it is important to reassess the efficacy of BMAB for this diagnostic purpose. To our knowledge, no such studies have been performed in Harris County which has the highest incidence of HIV in the state of Texas. METHODS We reviewed all BMABs from patients with HIV/AIDS and FUO or persistent cytopenia(s) from 2007 to 2011. RESULTS Of 57 evaluable patients, BMAB was positive in 24 samples by acid fast bacilli (AFB) or Gomori methenamine silver (GMS) stains (17.5%), presence of granuloma and/or lymphohistiocytic aggregates (31.6%), culture (21.0%) or a combination. Cultures demonstrated Mycobacterium avium/intracellulare (4), M tuberculosis (2), M gordonae (1), Histoplasma capsulatum (3) and Cryptococcus neoformans (2). There were three cases in which a pathogen was grown in culture but that had a negative of 'direct examination' on tissue sections (negative AFB and GMS special stains, no morphological evidence of granuloma/lymphohistiocytic infiltrates). CONCLUSIONS This study supports the use of diagnostic BMAB as a rapid decision-making tool in patients with HIV and FUO in the proper clinical setting. BMAB demonstrated infection-related evidence prior to positive bone marrow culture in 75% of cases. Special stains and blood cultures had similar diagnostic yield, but BMAB offers faster results. Thus, this procedure assists in clinical decision making and the refinement of treatment in a more timely manner.
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Affiliation(s)
- Andrés E Quesada
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ashok Tholpady
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Audrey Wanger
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Andy N D Nguyen
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lei Chen
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
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11
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van Schalkwyk WA, Opie J, Novitzky N. The diagnostic utility of bone marrow biopsies performed for the investigation of fever and/or cytopenias in HIV-infected adults at Groote Schuur Hospital, Western Cape, South Africa. Int J Lab Hematol 2010; 33:258-66. [PMID: 21118385 DOI: 10.1111/j.1751-553x.2010.01280.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A bone marrow biopsy is frequently requested in the work-up of patients with human immunodeficiency virus (HIV) infection who present with fever and/or cytopenias in the search for opportunistic infections and malignancies. METHODS This is a retrospective review of the results of consecutive bone marrow biopsies performed at our institution over a three-year period on HIV-positive patients for the investigation of fever and/or cytopenias. Clinical data, haematological parameters, morphological features, Ziehl-Neelsen staining and microbiological culture results were analysed. The aim of the study was to determine the diagnostic yield of this investigation. RESULTS Sixty-three males and 84 female patients were included for analysis. The bone marrow biopsy gave a high diagnostic yield of 47% (70 patients) and a unique diagnosis in 33% (49 patients). Immune thrombocytopenic purpura and disseminated mycobacterial infections were the most common unique diagnoses made (14%, respectively), followed by malignancies (4%). In this cohort, four cases of primary bone marrow involvement by Hodgkin lymphoma and one case of involvement by non-Hodgkin lymphoma were diagnosed. CONCLUSION In our study group, a bone marrow biopsy was a useful investigation with a high diagnostic yield.
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Affiliation(s)
- W A van Schalkwyk
- Department of Haematology, Groote Schuur Hospital and National Health Laboratory Service, University of Cape Town, Cape Town, South Africa.
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Hot A, Schmulewitz L, Viard JP, Lortholary O. Fever of unknown origin in HIV/AIDS patients. Infect Dis Clin North Am 2008; 21:1013-32, ix. [PMID: 18061087 DOI: 10.1016/j.idc.2007.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fever of unknown or uncertain origin (FUO) constitutes a common clinical challenge in patients infected with HIV. It is usually caused by disseminated opportunistic infection, and the relative frequency of each cause of FUO is influenced by multiple factors including CD4 count, geographic setting, and local prevalences of infectious agents, which may provide clues to the diagnosis. Infections presenting as FUO in the HIV population occur most often in the late stages of the disease and high diagnostic suspicion for mycobacterial disease should be maintained when evaluating these patients, particularly in areas of high prevalence. This article discusses the causes, diagnosis, and treatment of FUO in HIV-infected individuals.
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Affiliation(s)
- Arnaud Hot
- Université Paris V, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
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Esteve R, Jover F, Cuadrado JM, Martínez C. [Constitutional syndrome and bicytopenia having an infectious origin]. Enferm Infecc Microbiol Clin 2006; 24:465-6. [PMID: 16956537 DOI: 10.1157/13091786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Rafael Esteve
- Unidad de Enfermedades Infecciosas. Servicios de Medicina Interna. Hospital Clínico Universitario de San Juan. Alicante. España.
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