Mwanda O W
Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi.
East Afr Med J. 1997 Nov;74(11):732-6.
This review attempts to put together the changes in the blood and bone marrow observed in those who are infected with human immunodeficiency virus (HIV). These are contribution of many published and unpublished data and experience on; blood counts, blood film and bone marrow films prepared and stained by MayGrunwald-Giemsa or Leishman stain. Some changes in haemostasis are also included. The salient changes are cytopaenias; leucopaenia, anaemia, thrombocytopaenia, and bone marrow hypoplasia, although the latter occurs, it is found in a minority of cases. Other changes include myelodysplasia, functionally defective cells, and enhanced bleeding tendency particularly in those with bleeding defects. There are also malignancies associated with HIV infection such as Kaposi's Sarcoma and malignant lymphomas. The pathogenesis of these events are multi-factorial, varied and involve; killing of cells by the virus, syncytial formation by the cells, destruction of the stem cells, immune and drugs effects. These mechanisms are modified by factors of viral, host environment and their interactions. Changes are commonly found in patients with acquired immunodeficiency syndrome (AIDS) but can be seen in some cases anytime during the course of the disease. Once developed the changes are progressive. The management of these complications remain individualised and symptomatic. Treatment trials with the haematopoesis growth factors, particularly colony stimulating factors are producing some encouraging results. However other cytokines, for example, interleukin-6 may be having untoward effect such as association with the causation of Kaposi's sarcoma and the malignant non-Hodgkin's lymphomas. While standard approaches to the management of the malignancies tend to be the practice, adjustments are usually necessary in most patients.
本综述旨在汇总在感染人类免疫缺陷病毒（HIV）者中观察到的血液和骨髓变化。这些变化得益于许多已发表和未发表的数据以及在血细胞计数、血涂片以及用MayGrunwald-Giemsa或Leishman染色法制备和染色的骨髓涂片方面的经验。还包括止血方面的一些变化。显著变化包括血细胞减少，即白细胞减少、贫血、血小板减少以及骨髓发育不全，不过骨髓发育不全虽有发生，但仅在少数病例中出现。其他变化包括骨髓发育异常、功能缺陷细胞以及出血倾向增强，尤其是在有出血缺陷的患者中。HIV感染还会引发一些恶性肿瘤，如卡波西肉瘤和恶性淋巴瘤。这些情况的发病机制是多因素的、多样的，涉及病毒对细胞的杀伤、细胞形成多核体、干细胞破坏、免疫和药物作用。这些机制会因病毒、宿主环境及其相互作用的因素而发生改变。这些变化在获得性免疫缺陷综合征（AIDS）患者中很常见，但在疾病过程中的某些情况下也可能出现。一旦出现，这些变化会不断进展。这些并发症的管理仍需个体化且对症处理。使用造血生长因子，特别是集落刺激因子的治疗试验正在产生一些令人鼓舞的结果。然而，其他细胞因子，例如白细胞介素-6可能会产生不良影响，如与卡波西肉瘤和恶性非霍奇金淋巴瘤的发生有关。虽然对恶性肿瘤的标准管理方法往往是常规做法，但大多数患者通常仍需进行调整。
