The differential diagnosis of HIV related anaemia should include pure red cell aplasia

Abstract

Hematologic abnormalities feature commonly in patients with human immunodeficiency virus (HIV) infection. This includes anaemia and it occurs in 70 – 80% of patients. The causes of HIV-related anaemia are multifactorial. The possible mechanisms causing the anaemia are those which are directly related to HIV and include infection, malignancy, drugs, anaemia of chronic disease, haemolysis, blood loss and hypersplenism, whilst there are multiple causes not related to HIV. Features found in HIV-related anaemia can be ascribed to a disturbance of the bone marrow cytokine homeostasis. HIV is cytotoxic to T-helper lymphocytes which in turn retards growth of bone marrow progenitors. The most common abnormal finding is dysplasia affecting one or more cell lines. A predominant finding is erythroid dysplasia which is seen in over 50% of HIV patients. Hematologic complications related to combined antiretroviral therapy (cART) add to the diagnostic challenge. Pure red cell aplasia (PRCA) is an uncommon hematologic disorder that causes anaemia. However in patients that present with normochromic normocytic anaemia, in particular those that are transfusion dependent, pure red cell anaemia should be considered. In patients with AIDS, the mechanisms postulated for PCRA is the autoimmune response as a consequence of immunedysregulated status in AIDS and the second being the myelosuppressive effect of antiretroviral therapy.