hiv相关的贫血 ppt课件

Anemia in human immunodeficiency virus (HIV) infected patients 贫血 定义：血红蛋白Hb：男性低于120g/l，成 年女性低于110g/l，孕妇低于100g/l。 According to The Anemia HIV Working Group (hemoglobin level of 100 mg/L- unlikely to have iron deficiency; supplement with iron for 7 10 days- re-evaluate the anemia Treatment Options Treatment should be chosen to address the underlying cause of this disorder Blood transfusion- severe anemia, with a hemoglobin level of 8 g/dL. Epoetin alfa- 48 weeks, its efficacy and safety for patients with mild symptomatic or moderate HIV-related anemia Androgens- increase production of erythropoietin with anemia caused by bone marrow failure HIV-Associated Autoimmune Hemolytic Anemia This review article discusses the etiology, pathophysiology,clinical features, diagnosis, treatment, and complications of autoimmune hemolytic anemia(AIHA) associated with HIV infection. ETIOLOGY AIHA results from the destruction of erythrocytes by antibodies. The etiologies for AIHA are various including idiopathic causes, drugs, infectious agents, neoplasms, or autoimmune disease Several mechanisms have been postulated to Explain why AIHA develops in patients with AIDS presence of erythrocyte autoantibodies or the presence of hypergammaglobulinemia may result in nonspecific coating of over abundant immunoglobulin G (IgG) to autologous erythrocytes presence of immune complex-associated IgG, may bind to erythrocytes via C3b receptors abnormal B-cell regulation by HIV-infected T cells Infectious agents associated with AIDS may be associated with the production of autoantibodies lymphoma CLINICAL PRESENTATION Anemia , pallor, mild jaundice, and splenomegaly-30% AIHA can be classified as mild, moderate, or severe Mild hemolytic anemia is characterized by positive direct antiglobulin test results only Moderate anemia is characterized by anemia and splenomegaly Severe anemia is characterized by fulminant hemolysis with marked spherocytosis, hyperbilirubinemia, absent or decreased levels of haptoglobin, and hemoglobinuria DIAGNOSIS Positive Coombs test Serologic findings： Types of antierythrocyte antibodies- include the coating of erythrocytes by both IgG and C3, or IgG alone Concomitant cold and warm antibodies TREATMENT monitored for possible progression of the hemolysis blood transfusion ;corticosteroids , immunoglobulins ,splenectomy ,immunosuppressive therapy ,plasmapheresis , and zidovudine. COMPLICATIONS Blood transfusion complications- hemoglobinuria,tachycardia, vomiting, back pain, fever, hypotension, shock, and renal failure Hypercoagulation-thromboembolism Hematological abnormalities in HIV-infected patients Anemia, neutropenia, and thrombocytopenia are commonly observed in HIV-infected patients 701 HIV-infected patients Blood cell counts, hemoglobin concentration, CD4 count, and viral load recorded the mortality rate after 1 year in the groups with CD4 200/l and 200/l according to hemoglobin concentration RESULTS 37.5% had anemia; 61.1% (110/180) were in the low CD4 group and 29.4% (153/521) were in the high CD4 group (p0.01) Mean neutrophil counts were 2.61010(9)/l and 3.20410(9)/l in the low CD4 and high CD4 groups (p0.01) mean platelet counts were 218.63910(9)/l and 234.80710(9)/l for the low CD4 and the high CD4 groups (p=0.03) Patients whose hemoglobin concentration was below the median value had a higher death rate in both the low CD4 (14 vs. 4 deaths, p=0.013) and high CD4 (8 vs. 1