Book contents
- Frontmatter
- Contents
- List of contributors
- List of abbreviations
- Foreword
- Preface
- Part I Scientific basis of pediatric HIV care
- Part II General issues in the care of pediatric HIV patients
- Part III Antiretroviral therapy
- Part IV Clinical manifestations of HIV infection in children
- 18 Cutaneous diseases
- 19 Neurologic problems
- 20 Ophthalmic problems
- 21 Oral health and dental problems
- 22 Otitis media and sinusitis
- 23 Cardiac problems
- 24 Pulmonary problems
- 25 Hematologic problems
- 26 Gastrointestinal disorders
- 27 Renal disease
- 28 Endocrine disorders
- 29 Neoplastic disease in pediatric HIV infection
- Part V Infectious problems in pediatric HIV disease
- Part VI Medical, social, and legal issues
- Appendix 1 Formulary of antiretroviral agents
- Appendix 2 National Institutes of Health sponsored clinical trials for pediatric HIV disease
- Appendix 3 Selected HIV-related internet resources
- Appendix 4 Selected legal resources for HIV-infected children
- Index
- References
25 - Hematologic problems
Published online by Cambridge University Press: 23 December 2009
- Frontmatter
- Contents
- List of contributors
- List of abbreviations
- Foreword
- Preface
- Part I Scientific basis of pediatric HIV care
- Part II General issues in the care of pediatric HIV patients
- Part III Antiretroviral therapy
- Part IV Clinical manifestations of HIV infection in children
- 18 Cutaneous diseases
- 19 Neurologic problems
- 20 Ophthalmic problems
- 21 Oral health and dental problems
- 22 Otitis media and sinusitis
- 23 Cardiac problems
- 24 Pulmonary problems
- 25 Hematologic problems
- 26 Gastrointestinal disorders
- 27 Renal disease
- 28 Endocrine disorders
- 29 Neoplastic disease in pediatric HIV infection
- Part V Infectious problems in pediatric HIV disease
- Part VI Medical, social, and legal issues
- Appendix 1 Formulary of antiretroviral agents
- Appendix 2 National Institutes of Health sponsored clinical trials for pediatric HIV disease
- Appendix 3 Selected HIV-related internet resources
- Appendix 4 Selected legal resources for HIV-infected children
- Index
- References
Summary
Most HIV-infected children and adolescents have abnormalities of their peripheral blood and/or hemostatic systems. These abnormalities may be caused by direct or indirect effects of HIV on hematopoiesis, by secondary infections, by nutritional deficits, by medications or by aberrations of the immune system. While in many cases these abnormalities are asymptomatic, on occasion they may have life-threatening consequences. This chapter will review the common hematologic consequences of HIV infection and will emphasize the diagnostic and therapeutic considerations in their management.
Anemia
Anemia is common in children infected with HIV [1]. Anemia in HIV-infected children can be due to decreased red blood cell (RBC) production, defective erythroid maturation, blood loss and increased RBC destruction (hemolysis). In many cases, the anemia is multifactorial. Potential etiologies of anemia in HIV-infected children are listed in Table 25.1. Congenital RBC disorders, such as glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, may be present coincidentally.
HIV infection alters the bone marrow microenvironment impairing RBC production [2]. Cytokines such as tumor necrosis factor and interleukin-1 are elevated in HIV infection and may have an inhibitory effect on erythropoiesis [3]. Patients with HIV have a relatively poor erythropoietin response to anemia [3].
Several types of infections suppress erythropoiesis. Infectious agents such as Mycobacterium avium intracellulare (MAC), cytomegalovirus (CMV), and Epstein–Barr virus (EBV) can inhibit RBC production. Pure red cell aplasia due to parvovirus B19 can occur in the HIV-infected individual [4]. Medications used to treat HIV or its complications may interfere with RBC production.
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- Information
- Handbook of Pediatric HIV Care , pp. 588 - 601Publisher: Cambridge University PressPrint publication year: 2006