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n CME : Your SA Journal of CPD - Thrombocytopenia in HIV : main article
- Thrombocytopenia in HIV is common and multifactorial.
- Normal megakaryocyte morphology is important to maintain normal thrombopoiesis.
- Thrombocytopenia early on in the disease is generally due to peripheral destruction and has large platelets, while in AIDS it is usually associated with decreased production.
- Thrombocytopenia, irrespective of cause and concomitant antiretroviral therapy, is associated with a poorer outcome and accelerated decrease in CD4 counts and AIDS progression.
- An initial bone marrow biopsy is mandatory to asses the thrombopoiesis, among other things, along with CD4 count and viral load.
- Consider starting antiretrovirals when active treatment is decided on, especially when using immunosuppressive agents.
- DO NOT leave patients on steroids for protracted periods without antiretroviral cover and be vigilant for opportunistic infections.
- Always consider thrombotic thrombocytopenic purpura as a cause of thrombocytopenia in HIV.
- If no plasma exchange facility is available or if one chooses not to use it, always use cryoprecipitate-poor FFP, along with steroids and start antiretrovirals.
- When in doubt, refer and leave the decision of splenectomy to specialists.
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