HIV-related severe thrombocytopenia in intravenous drug users: prevalence, response to therapy in a medium-term follow-up, and pathogenetic evaluation.
Severe thrombocytopenia (TP) accounted for 5.3% of cases in a consecutive series of 380 HIV-infected intravenous drug users (IVDUs) at presentation. Forty-one of 53 subjects with severe TP showed haemorrhages and were treated as follows: ten were splenectomized, 17 were given high-dose intravenous immunoglobulins (HDIg), and 10 received anti-Rh(D) immunoglobulins (anti-Rh Ig). Splenectomy induced a complete clinical response in all cases: four out of 10 patients maintained platelet counts greater than 100 x 10(9)/l. HDlg gave a good clinical response in all patients, but eight out of 17 suffered haemorrhages during the follow-up and recall treatments were necessary. Six out of 10 patients treated with anti-Rh lg maintained platelet counts greater than 30 x 10(9)/l, but in two cases the treatment was interrupted because of severe haemolysis. No patient progressed to overt AIDS during the follow-up. Splenectomized patients in particular did not show adjunctive risks of worsening of the HIV-related clinical picture. A platelet kinetic study performed in 20 patients with severe HIV-related TP suggests a possible role for platelet sequestration in TP of HIV-infected IVDUs, in which a liver involvement is very frequent.
Landonio
G
G
Department of Haematology, Ospedale Niguarda, Milan, Italy.
Galli
M
M
Nosari
A
A
Lazzarin
A
A
Cipriani
D
D
Crocchiolo
P
P
Voltolin
L
L
Giannelli
F
F
Irato
L
L
De Cataldo
F
F
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use*; D007136:Immunoglobulins / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D010976:Platelet Count; D015995:Prevalence; D018029:Rho(D) Immune Globulin; D013156:Splenectomy; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013921:Thrombocytopenia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*
D007074:Immunoglobulin G; D007136:Immunoglobulins; D018029:Rho(D) Immune Globulin