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Cytopenias

HIV-infected patients frequently develop hematologic abnormalities. These disorders often respond to suppression of HIV with antiretrovirals, treatment of infectious diseases and tumors, discontinuation or dosage reduction of myelosuppressive medications, correction of nutritional deficiencies, and treatment with hematopoietic growth factors or other cytokines.

AIDS, neutropenia

Causes of thrombocytopenia include myelosuppression from medications, infections or tumors and increased destruction of cells (disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, immune mediated thrombocytopenia). Platelet counts may respond to anti therapy with antiretroviral drugs, immunoglobulin therapy, splenectomy, vincristine, prednisone, danazol, or alpha interferon.

Discontinuation of myelosuppressive medications may also reduce. Plasma exchange

Anemia

Twenty five percent of patients with AIDS develop severe (hemoglobin <8 g/dl). Anemia is caused HIV-related hematopoietic defects and by zidovudine therapy. Milder forms develop in 50% of all patients with disease (hemoglobin 8-13 g/dl). The frequency and severity of zidovudine-induced increases with higher dosages and with later stages of disease.

Severe anemia often requires dose adjustment of zidovudine and other myelosuppressive therapies. Blood transfusions should be avoided because increased immunosuppression and exposure to possible blood-born infections often results.

The most common of zidovudine-induced is megaloblastic which corrects with dose adjustment of zidovudine. The less frequent form of is a red cell aplasia, and it usually does not respond to zidovudine reduction.

Recombinant-human EPO (Epoetin) can increase hemoglobin and significantly reduce transfusion requirements. Erythropoietin is recommended for ZDV-induced, or due to other myelosuppressive medications in patients with an endogenous EPO level greater than 500 mU/ml. Iron therapy is also recommended.

Patients with marrow infiltrating opportunistic infections (mycobacterium avium complex) or malignancies (non-Hodgkin's lymphoma) may not respond to EPO. Failure to respond to EPO treatment requires consideration of a bone marrow biopsy. Erythropoietin may be combined with myeloid hematopoietic growth factors (G-CSF) in patients with both neutropenia and