Book contents
- Frontmatter
- Contents
- List of contributors
- List of abbreviations
- Foreword
- Preface
- Introduction
- 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
- 25 Cutaneous diseases
- 26 Neurologic problems
- 27 Ophthalmic problems
- 28 Oral health and dental problems
- 29 Otitis media and sinusitis
- 30 Cardiac problems
- 31 Pulmonary problems
- 32 Hematologic problems
- 33 Gastrointestinal disorders
- 34 Renal disease
- 35 Endocrine disorders
- 36 Neoplastic disease in pediatric HIV infection
- Part V Infectious problems in pediatric HIV disease
- Part VI Medical, social, and legal issues
- Appendices
- Index
- Plate section
- References
32 - Hematologic problems
from Part IV - Clinical manifestations of HIV infection in children
Published online by Cambridge University Press: 03 February 2010
- Frontmatter
- Contents
- List of contributors
- List of abbreviations
- Foreword
- Preface
- Introduction
- 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
- 25 Cutaneous diseases
- 26 Neurologic problems
- 27 Ophthalmic problems
- 28 Oral health and dental problems
- 29 Otitis media and sinusitis
- 30 Cardiac problems
- 31 Pulmonary problems
- 32 Hematologic problems
- 33 Gastrointestinal disorders
- 34 Renal disease
- 35 Endocrine disorders
- 36 Neoplastic disease in pediatric HIV infection
- Part V Infectious problems in pediatric HIV disease
- Part VI Medical, social, and legal issues
- Appendices
- Index
- Plate section
- 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 cause 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 a common finding in children infected with HIV. Ellaurie et al. noted that 94% of HIV-infected children had a hematocrit < 33% [1]. Anemia is present in 37% of children with perinatally acquired HIV at 1 year of age [2]. In Ellaurie's review, the anemia was more pronounced (hematocrit < 25%) in 21 of 23 infants with opportunistic infection [3]. Forsyth et al. followed infants with perinatally acquired HIV and noted that anemia in the first year of life was associated with an increased risk of mortality by 3 years of age [2]. Adult studies have shown that anemia continues to predict decreased survival even with highly active antiretroviral therapy (HAART) [3].
Potential etiologies of anemia in children include decreased red blood cell (RBC) production, defective erythroid maturation, blood loss, and increased RBC destruction (hemolysis). In many anemic HIV-infected children, the anemia is multifactorial. The potential etiologies of anemia in HIV-infected children are listed in Table 32.1.
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- Textbook of Pediatric HIV Care , pp. 499 - 509Publisher: Cambridge University PressPrint publication year: 2005