Cytopenias - II. Anemia
II. Anemia
A. Twenty five percent of patients with AIDS develop severe anemia (hemoglobin <8 g/dl). Anemia is caused HIV-related hematopoietic defects and by zidovudine therapy. Milder forms of anemia develop in 50% of all patients with HIV disease (hemoglobin 8-13 g/dl). The frequency and severity of zidovudine-induced anemia increases with higher dosages and with later stages of HIV disease.
B. 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.
C. The most common of zidovudine-induced anemia is megaloblastic anemia which corrects with dose adjustment of zidovudine. The less frequent form of anemia is a red cell aplasia, and it usually does not respond to zidovudine reduction. buy indocin online
D. Recombinant-human EPO (Epoetin) can increase hemoglobin and significantly reduce transfusion requirements. Erythropoietin is recommended for ZDV-induced anemia, or anemia due to other myelosuppressive medications in patients with an endogenous EPO level greater than 500 mU/ml. Iron therapy is also recommended. buy Ribavirin
E. 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 anemia. buy voltarol