hiv相关的贫血专题知识.ppt

distinguish the anemia of chronic disease from that caused by iron deficiency : both in a low serum iron level, low total iron-binding capacity and serum ferritin levels 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--- 4–8 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,