Dr Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India
Clinical Problem :
An 18 months old HIV infected boy on antituberculous therapy {ATT} had persistent thrombocytopenia. He had failure to thrive {height 71 cm, weight = 7 kg} with delayed milestones and hepatosplenomegaly. His serial platelet counts are depicted in Table 1.
His bone marrow aspiration done in August 2010 showed hypocellular marrow with normoblastic erythropoiesis, normal myeloid maturation and normal megakaryocytes. He was started on antiretroviral therapy {ART} consisting of Zidovudine {AZT}, Lamivudine {3TC} and Nevirapine {NVP} to which he had a weight gain of 2 kg in next 2 months.
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What is the cause of thrombocytopenia_?
Discussion :
Thrombocytopenia is a known complication in patients infected with HIV-1. However, the exact immune mechanism leading to platelet destruction is unclear. Elevated levels of antiplatelet IgG antibodies and non-specific deposition of circulating immune complexes and complements have been suggested as the cause of increased clearance of platelet. However studies have depicted that increased levels of anti platelet IgG antibodies are not causally related to the development of thrombocytopenia in children. With evidence of viral RNA present in megakaryocytes, a direct role of HIV in the pathophysiology of thrombocytopenia may be present. ART can help to increase the platelet count as is seen in this patient
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