HIV-related thrombocytopenia: four different clinical subsets.
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.


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.
Landonio
G
G
Dipartimento di Ematologia, Ospedale Niguarda Cà Granda, Milano, Italy.
Nosari
A
A
Spinelli
F
F
Vigorelli
R
R
Caggese
L
L
Schlacht
I
I
D000208:Acute Disease; D000328:Adult; D016824:Antigens, Human Platelet / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D001853:Bone Marrow / Q000473:pathology; D002470:Cell Survival; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008533:Megakaryocytes / Q000473:pathology; D010976:Platelet Count; D011696:Purpura, Thrombocytopenic / Q000150:complications; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000145:classification / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
D016824:Antigens, Human Platelet; D001323:Autoantibodies