A STUDY OF SOME BONE MARROW AND PERIPHERAL BLOOD PARAMETERS IN ANAEMIC HIV INFECTED PERSONS SEEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

People with Human immunodeficiency virus (HIV) infection experience a range of haematological complications including anaemia, leucopenia and thrombocytopaenia.

Peripheral blood and bone marrow were assessed in eighty-three (83) HIV infected anaemic Nigerian between the ages of 24 and 59 years after signing an informed consent. Full blood count was carried out on EDTA specimen of all the subjects using Sysmex haematology autoanalyser. Peripheral blood film was made and stained with Leishman stain for differential white cell count and red cell morphology. Reticulocyte film was prepared with New Methylene blue. Marrow aspirate was taken from the anterior superior and sometimes posterior superior iliac spines. Slides were also prepared with Leishman stain according to standard methods. Subjects were clinically classified according to CDC and WHO criteria. They were also classified according to their treatment status i.e. whether on treatment already before recruitment into the study or not.

Anaemia occurred at any stage in the disease spectrum but was particularly prevalent in persons with advanced disease. Thirty-five (35) of forty-seven (47) subjects (73%) with CDC stage C disease had Hb less than 8g/dl. This is significantly different from twenty (20) of thirty-three (33) subjects (60.6%) with stage B disease that were severely p =0.005.

Seventy-one (71) of the eighty-three (83) subjects were treatment naïve. Of these, forty-seven (47) (66.2%) were severely anaemic (Hb < 8g/dl). Of the twelve (12) who were on treatment eight (8) (66.7%) were severely anaemic. Anaemia of treatment may be as severe as anaemia due to the disease itself p =0.768. Reticulocytopaenia was found in so many patients. Of the seventy-two (72) persons assessed for reticulocytes, fifty-nine (59) (81.1%) persons had a low (<0.5%) retic count while thirteen (13) (18.9%) had adequate counts (0.5-2%). No subject had reticulocytosis.

Leucopenia and thrombocytopenia appear not to be frequently associated with anaemia. Only fifteen (15) (18.07%) of the eighty-three (83) subjects had leucocytes count below 2,500/l and only thirteen (13) (15.66%) of the eighty-three (83)

anaemic subjects had platelet counts below 100,000/l. However, Reticulocytopaenia was frequently found.

The mean Hb (6.95 ± 1.9g/dl) of thirty-seven (37) subjects with CD4 cell count <100/l is significantly lower than that (8.68±2.41 g/dl) of eleven (11) subjects with CD4 between 201-350/l p =0.015.

Of the eighty-three (83) anaemic subjects, forty-seven (47) had normal marrow fragment cellularity. Twenty-three (23) had hypocellular marrow and thirteen (13) had hypercellular marrow. Of the forty-seven (47) who had normal marrow fragment cellularity, twenty-eight (28) (59.6%) had Hb < 8g/dl. Of the twenty-three (23) who had hypocellular marrow, eighteen (18) (78.3%) had Hb < 8/dl. Nine (9) (69.2%) of thirteen (13) with Hypercellular marrow were anaemic. Cellularity does not determine severity of anaemia p = 0.377.

Erythroid cell dysplasias were quite common with florid megaloblastosis being the commonest. Seventy-four (74) of the subjects had megaloblasts. Seven (7) persons had micronormoblastosis and two (2) had normal erythropoiesis. Erythroid binuclearity and other mitotic figures were also noted and occur more frequently with increasing levels of megaloblastic changes.

Myelopoiesis and megakaryopoiesis were normal in most patients.

Twenty-two (22) patients had increased marrow histiocytes with mean Hb of 6.09 ±
1.84 g/dl. This value was significantly lower than 7.58 ± 2.23 found in the forty-four
(44) persons with normal marrow histiocytes (P = 0.005).

Only fifteen (15) (25%) of patients were coombs positive and suggests that immune
mechanism may not be a common feature of anaemia.

In conclusion, clinical stage of the disease significantly affects severity of anaemia.
Haemolytic anaemia is uncommon in many subjects in this series although there may
be underlying haemophagocytosis as suggested by more severe anaemia in the group
with increased marrow histiocytes. The commonest bone marrow pathology in
anaemic HIV infected subjects is megaloblastosis.

A STUDY OF SOME BONE MARROW AND PERIPHERAL BLOOD PARAMETERS IN ANAEMIC HIV INFECTED PERSONS SEEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL