Autoimmune hemolytic anemia in HIV-infected patients: A hospital based study

Abstract

Background:The prevalence of anemia in HIV/ AIDS patients is high, with a multitude of possible etiologies; autoimmune hemolytic anemia (AIHA) in HIV/AIDS patients has been associated with a poor prognosis when treated with red cell transfusion. Our aim was to demonstrate the frequency of AIHA in a cohort of adult Nigerian HIV/AIDS patients and to see if the presence or not of AIHA is related to the severity of the disease with regards to the CD4 counts and the presence or absence of opportunistic infections. Method: Ninety-eight adult patients with HIV infection were screened for the presence of AIHA using the packed cell volume (PCV), direct antiglobulin test (DAT) and reticulocyte count (RC). Results: The frequency of AIHA was 3.06%, 36.74% of our study population were anemic; 11.22% had a positive DAT. Mean RC was 2.22 +/ 0.90 for all the patients. There was no statistically significant difference in the PCV of patients that had positive and negative DAT. There was no correlation between the presence of AIHA, use of ART, presence of opportunistic infections or CD4 counts. Conclusion:We conclude that in spite of the low frequency of AIHA in HIV/AIDS patients, the fact that most patients will respond to standard treatment makes it imperative to screen HIV/AIDS patients with anemia for the presence of AIHA. Again since HIV/AIDS patients with AIHA may have a fatal reaction to red cell transfusion, we suggest that anemic patients with HIV/AIDS in non-emergency situations be screened for the presence of AIHA before receiving red cell transfusions when indicated. Key words: Autoimmune, anemia, hemolysis, HIV/AIDS RésuméCulture générale: Il y a trop de fréquence d'anémie parmi les malades sero-positifs ou les malades atteints de sida, souvent accompagne d'un grand nombres d'aetiologies: anémie haemolylique autoimmuno (AHAI) parmi les malades sero-positifs est directement lie a une mauvaise pronostic, surtout quand on fait le traitement avec une transformation du globule rouge. Notre objectif est de démontrer la fréquence de (AHAI) parmi un nombre d'adultes nigérians sero-positifs ou qui sont atteints du sida. C'est aussi de vérifier si la présence ou l'absence de (AHAI) est lie directement lie a la gravite de la maladie, de la maladie surtout quand il s'agit de la numération CD4 et de la présence ou absence des infections opportunistic. Modalité: À l'aide de l'analyse directe antiglobulin (ADA) et la numération réticulocyte (NR) et le packed cell volume (PCV) ; quatre-vingt-dix-huit malades sero-positifs, ont passé un test de dépistage pour vérifier la présence de (AHAI) Résultat: La fréquence de (AHAI) était 3.06%, 36.74% de notre population était anémique ; 11.22% était positif de l'analyse antiglobulin.Pour la numération reticulocy, la moyenne était 2.22+\-0.90 pour tous les malades, on n'a trouvé aucune différence qui est statistiquement significatif parmi les malades Autoimmune haemolytic anemia in HIV patients. Olayemi E. et al.Page | 73 positif de (ADA) et négatif de (ADA). Il n y avait aucun rappor...

Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A crosssectional study

“…40 Haemolytic anaemia in HIV-positive patients usually follows autoimmune reaction (autoimmune haemolytic anaemia, AIHA), and though less frequent, patients with AIHA may potentially react to blood transfusion when this cause of anaemia is not ruled out. 47 Thrombocytopenia in HIV patients has been shown to be a frequent complication among cirrhotic patients with associated portal hypertension, where it occurs in more than 50% of this subgroup of patients. 48,49 Reduced production of thrombopoetin, splenic sequestration, and platelet autoantibodies developing following hepatitis C infection, among others, form a list of possible mechanisms for thrombocytopenia among cirrhotic patients.…”

Immune reconstitution inflammatory syndrome in a patient with HIV presenting as severe mixed haemolytic anaemia

“…AIHA is relatively rare in HIV, with an incidence of 3%, contrasting with the higher incidence of a positive direct Coombs test, which is 10-35% in this patient population. 1,13 The incidence of IRIS is thought to occur in 10-25% of patients, and usually manifests as a paradoxical worsening of clinical condition, despite improvements in HIV parameters while on antiretroviral drugs. 4,14 Typically, patients develop a recovery of pathogenspecific cellular and humoral response and may develop Mycobacterium avium-associated IRIS, or CMV, or seroconversion to anti-HBV or anti-HCV positive states.…”

The impact of HIV-associated anaemia on the incidence of red blood cell transfusion: Implications for blood services in HIV-endemic countries

“…In 2008, Olayemi et al screened 98 consecutive HIV-positive patients presenting at their outpatient clinic for routine follow up for AIHA. For the purpose of this study, AIHA was defined as a packed cell volume of less than 30%, a positive DAT and a reticulocyte count of greater than 2.5% [47]. They noted an 11% DAT positivity among their patients with a total of 3% of all of the patients meeting their criteria for AIHA.…”