title: Profile of hematological abnormalities of Indian HIV infected individuals.
abstract: BACKGROUND
  Hematological abnormalities are a common complication of HIV infection. These abnormalities increase as the disease advances. Bone marrow abnormalities occur in all stages of HIV infection.
  
  
  METHODS
  Two hundred HIV infected individual were screened for hematological abnormalities from March 2007-March 2008. Absolute CD4 cell count analysis was carried out by flowcytometry. Depending on the results of the primary screening further investigations were performed, like iron studies, hemolytic work up, PNH work up and bone marrow evaluation. Other investigations included coagulation profile, urine analysis, blood culture (bacterial, fungal, mycobacterial), serology for Epstein Barr virus (EBV), Cytomegalovirus (CMV), Hepatitis B and C, and Parvo B19 infection.
  
  
  RESULTS
  The most common hematological abnormality was anemia, seen in 65.5% (131/200) patients. Iron deficiency anemia was seen in 49.2% (/200) cases while anemia of chronic disease occurred in 50.7% (/200) cases. Bone marrow evaluation was carried out in 14 patients out of which staging marrow was performed in 2 cases of non-Hodgkin's lymphoma (NHL) and did not show any bone marrow infiltration. In remaining 12 cases bone marrow was done for evaluation of pancytopenia. Among patients with pancytopenia 50% (6/12) showed granulomas (4 were positive for AFB, 2 were positive for fungal cryptococci), 25% (3/12) showed hemophagocytosis. There was a strong negative correlation between anemia and CD4 counts in this study. Thrombocytopenia was seen in 7% (14/200) cases and had no significant correlation with CD4 counts. No patient had absolute neutrophil count (ANC) < 800 cells/microL. No case of coagulation abnormalities was found.
  
  
  CONCLUSIONS
  Anemia in HIV patients can be a good clinical indicator to predict and access the underlying immune status. Patients should be investigated for hematological manifestations and appropriate steps should be taken to identify and treat the reversible factors.
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India. dikundixit@gmail.com
authors.forename: Byomakesh
authors.initials: B
authors.lastname: Dikshit
authors.forename: Ajay
authors.initials: A
authors.lastname: Wanchu
authors.forename: Ravinder Kaur
authors.initials: RK
authors.lastname: Sachdeva
authors.forename: Aman
authors.initials: A
authors.lastname: Sharma
authors.forename: Reena
authors.initials: R
authors.lastname: Das
references.citation: Acta Haematol Pol. 1993;24(2 Suppl 1):33-9
references.pmid: 8362615
references.citation: J Clin Invest. 2008 May;118(5):1622-5
references.pmid: 18431512
references.citation: Clin Infect Dis. 2002 Jan 15;34(2):260-6
references.pmid: 11740716
references.citation: J Assoc Physicians India. 2005 Feb;53:105-10
references.pmid: 15847027
references.citation: West J Med. 1987 Aug;147(2):157-60
references.pmid: 3660772
references.citation: Turk J Haematol. 2008 Mar 5;25(1):13-9
references.pmid: 27264145
references.citation: Blood. 1993 May 15;81(10):2664-70
references.pmid: 8490176
references.citation: Addiction. 2000 Mar;95(3):383-92
references.pmid: 10795359
references.citation: Blood. 1998 Jan 1;91(1):301-8
references.pmid: 9414298
references.citation: J Infect Dis. 1988 Sep;158(3):627-30
references.pmid: 2842409
references.citation: AIDS. 1999 May 28;13(8):943-50
references.pmid: 10371175
references.citation: Eur J Haematol. 1989 Apr;42(4):339-43
references.pmid: 2721658