Abstract
Despite numerous publications on the appropriate use of blood and blood products, few specifically consider the role of transfusion in the management of HIV. This review is a synthesis of conditions encountered in the management of HIV-infected patients where the transfusion of blood or blood products may be indicated. A consistent message emerging from the review is that the principles of transfusion medicine do not differ between HIV-negative and -positive patients. The aim of the review is to provide clinicians with a practical and succinct overview of the haematological abnormalities and clinical circumstances most commonly encountered in the HIV setting, while focusing on the rational and appropriate use of blood and blood products for HIV patients. Important ethical considerations in dealing with both the collection and transfusion blood and blood products in the HIV era have also been addressed.
Highlights
There have been numerous requests from members of the Southern African HIV Clinicians Society for guidance and direction on blood transfusion in HIV-infected patients
Many factors may contribute to the development of cytopaenias in HIV, including the virus itself that can infect progenitor cells directly, cytokine effects, reticulin fibrosis, altered immune function with auto-antibody production, micro-nutrient deficiency, co-infection with other agents both opportunistic (e.g. TB, mycobacterium avium complex (MAC), cytomegalovirus (CMV), Ebstein-Barr virus) and conventional, bone marrow infiltration by malignancy, and anaemia of chronic disease
thrombocytopaenic purpura (TTP) associated with HIV has been shown to respond well to fresh frozen plasma (FFP) infusion alone and is appropriate in resource-limited settings without Therapeutic plasma exchange (TPE).[5,30]
Summary
Significant cytopaenias (anaemia, thrombocytopaenia, neutropaenia) are common in persons with HIV.[2]. The decision to transfuse a patient is a clinical decision that needs to be individualised, informed by the patient’s clinical status, the laboratory findings where available, and available resources. This decision may incorporate the patient’s socio-economic circumstances: a patient with borderline decompensated anaemia, living in a remote area with poor access to follow-up care, might warrant transfusion; whilst the same patient might otherwise be managed conservatively in an urban setting with access to care.[6] In general, indications for transfusion in HIV-positive patients are the same as for HIV-negative patients. HIV-positive patients may, have compromised bone marrow function and require additional haematological support until such time that ART results in improved bone marrow function
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