HIV Infection - Thrombocytopenia

5/15/02 (House) 

 Question: Can thrombocytopenia be a presenting symptom of HIV infection?

<1>

Unique Identifier:8562753

Authors: Glatt AE. Anand A.

Institution: Department of Medicine, Catholic Medical Center of Brooklyn and Queens, Jamaica, New York 11432, USA.

Title: Thrombocytopenia in patients infected with human immunodeficiency virus: treatment update. [see comments.]. [Review] [92 refs]

Source: Clinical Infectious Diseases. 21(2):415-23, 1995 Aug.

Abstract: Thrombocytopenia that is associated with infection due to human immunodeficiency virus (HIV) is an important and common hematologic abnormality. Although this condition is often asymptomatic, it may manifest clinically as a spectrum of bleeding problems including petechiae, ecchymoses, epistaxis, or menorrhagia or as hemorrhage of the gingivae, gastrointestinal tract, or CNS. Thrombocytopenia may be present in patients at any stage of immunodeficiency, and spontaneous remission can occur. We review the natural history of HIV-related thrombocytopenia and discuss treatment options. [References: 92]

<2>

Unique Identifier:1483588

Authors: Landonio G. Nosari A. Spinelli F. Vigorelli R. Caggese L. Schlacht I.

Institution: Dipartimento di Ematologia, Ospedale Niguarda Ca Granda, Milano, Italy.

Title: HIV-related thrombocytopenia: four different clinical subsets.

Source: Haematologica. 77(5):398-401, 1992 Sep-Oct.

Abstract: BACKGROUND. Many factors have been considered in the pathogenesis of HIV-related Thrombocytopenia (HIV-rel TP): immunological destruction, retroviral infection of megakaryocytes and altered reticulo-endothelial function. Nevertheless the pathogenesis is still controversial. MATERIALS AND METHODS. We reviewed 52 patients (all intravenous drug users) with HIV-rel TP (< 100 x 10(9)/L) by evaluating bone marrow morphology, antiplatelet antibodies (28/52), kinetic studies with 111In Oxine and response to therapy. RESULTS: Seventeen percent of TP were evaluated as "acute ITP-like", and 40% as "chronic ITP-like"; 35% were evaluated as "pooling" TP and 8% as "hypoplastic" TP. Twenty-four patient with moderate TP (> 30 x 10(9)/L) were followed for a mean time of 27 months and no hemorrhages were seen during the period of observation despite the fact that no treatment was given; twenty-eight others with severe TP (< 30 x 10(9)/L) were treated in different ways: 18% responded to steroids and/or HDIg, 70% to splenectomy and 56% to zidovudine. CONCLUSIONS. The term "HIV-related thrombocytopenia" should include more than one kind of TP: "Acute ITP-like" TP, "chronic ITP-like" TP, "pooling" TP and "hypoplastic" TP have to be evaluated differently for pathogenesis, clinical manifestations and treatment. CAS Registry/EC Number 0 (Antigens, Human Platelet). 0 (Autoantibodies).

<3>

Unique Identifier:3060521

Authors: Abrams DI.

Institution: Department of Medicine, University of California, San Francisco.

Title: The pre-AIDS syndromes. Asymptomatic carriers, thrombocytopenic purpura, persistent generalized lymphadenopathy, and AIDS-related complex. [Review] [38 refs]

Source: Infectious Disease Clinics of North America. 2(2):343-51, 1988 Jun.

Abstract: With the passage of time and the refinement of laboratory techniques, the ability to recognize disease related to human immunodeficiency virus infection has improved. Currently, a number of clinical conditions can be identified as "pre-AIDS" syndromes. These include the syndrome of persistent generalized lymphadenopathy, immune thrombocytopenic purpura, the wasting syndrome, and certain predominantly neurologic presentations. All are characterized by the presence of human immunodeficiency virus infection, symptomatic illness, and a tendency to progress to a diagnosis of full-blown AIDS that appears to be ever increasing with the passage of time. [References: 38]

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