Telen M J, Roberts K B, Bartlett J A
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
J Acquir Immune Defic Syndr (1988). 1990;3(10):933-7.
While anemia and a positive direct anti-globulin test are each frequently observed in the clinical syndrome of human immunodeficiency virus (HIV) infection, autoimmune hemolytic anemia has rarely been reported in this setting. A case of severe warm autoimmune hemolytic anemia (AIHA) with reticulocytopenia in a patient with AIDS-related complex is reported. Laboratory and clinical findings of severe hemolysis were present, including anhaptoglobinemia, microspherocytosis, splenomegaly, and transfusion dependence. Azidothymidine (AZT) therapy may have exacerbated this patient's anemia. Splenectomy produced a delayed but complete remission of the AIHA despite continuation of AZT therapy. Review of other reports of positive direct antiglobulin tests and autoimmune hemolytic anemia in patients with HIV infections suggests that autoantibodies may be a significant cause of anemia in this population and that the frequent lack of reticulocytosis, despite bone marrow erythroid hyperplasia, may lead to the underdiagnosis of AIHA in HIV-infected patients.
虽然贫血和直接抗球蛋白试验阳性在人类免疫缺陷病毒（HIV）感染临床综合征中均很常见，但自身免疫性溶血性贫血在这种情况下鲜有报道。本文报告了1例患艾滋病相关综合征的患者发生严重温抗体型自身免疫性溶血性贫血（AIHA）并伴有网织红细胞减少症。患者出现了严重溶血的实验室和临床检查结果，包括无结合珠蛋白血症、小球形红细胞症、脾肿大和输血依赖。齐多夫定（AZT）治疗可能加重了该患者的贫血。尽管继续使用AZT治疗，但脾切除术后AIHA出现延迟但完全缓解。回顾其他关于HIV感染患者直接抗球蛋白试验阳性和自身免疫性溶血性贫血的报告表明，自身抗体可能是该人群贫血的重要原因，而且尽管骨髓红系增生，但经常缺乏网织红细胞增多可能导致HIV感染患者AIHA的诊断不足。
