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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