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Autoimmune cytopenias may be the initial presentation in patients with HIV infection or can develop while on treatment with antiretroviral therapy (ART). These cytopenias usually resolve after initiation of ART. We report a rare case of HIV who presented with Evans syndrome on ART, being refractory to steroids and rituximab but with response to splenectomy.

Hemoglobinopathies are classified as quantitative or qualitative decrease in production of hemoglobin. Thalassemias result from quantitative decrease of often structurally normal globin proteins. Mutations causing decrease in the synthesis of beta globins cause beta (β) thalassemia. Hemoglobin E is a β chain variant, caused by the structural change at the 26 th position where glutamic acid is replaced by lysine in the β globin. It is highly frequent in South-east Asia and is commonly found in India. Hemoglobin E beta thalassemia (HbE β thalassemia), a compound heterozygous state, result in a very variable phenotype ranging from thalassemia trait, Non Transfusion dependent Thalassemia (NTDT), to Transfusion dependent Thalassemia (TDT). Patients with Hemoglobin E disease are usually asymptomatic and result from homozygous presence of Hemoglobin E chains. In this study, fifty cases of HbE disorder involving 43 cases of HbE beta thalassemia and 7 cases of homozygous HbE disease were considered. Their Clinico-hematological highlights and results of high performance liquid chromatography (HPLC) were analyzed. The main concern remain of the Hemoglobin E beta thalassemia, in which it is difficult from HPLC results to interpret whether the patient will behave as a trait, NTDT or TDT.

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