Myelodysplasia in the Acquired Immune Deficiency Syndrome

Abstract

Certain new hematologic findings in eight homosexual or bisexual patients with the acquired immune deficiency syndrome (AIDS) are presented. All eight patients manifested a normochromic, normocytic anemia, and six of eight had granulocytopenia during their hospitalization. The other two had low-normal granulocyte counts. Bone marrow examination showed normocellular or hypercellular marrows with increased myeloid: erythroid ratios and increased numbers of megakaryocytes. All patients had abnormalities in maturation of all cell lines, most prominent in the granulocytic series. This constellation of features is similar to the findings in the myelodysplastic syndromes (preleukemia). The authors suggest that myelodysplasia in patients with AIDS results in ineffective hematopoiesis and contributes to the peripheral blood cytopenias found in these patients. Myelodysplasia could be a direct or indirect effect of human T-lymphotropic retrovirus-III (HTLV-III).

The Haematological Features of Hiv Infection

“…Among the dysplastic features which may be observed in the neutrophil lineage the presence of detached nuclear fragments (Slagel et al, 1994;Ozanne et al, 1996) is the most specific abnormality, although not particularly common. There may also be hypogranular neutrophils, occasional Pelger forms, neutrophils with a high nucleocytoplasmic ratio or bizarre nuclear shapes and circulating giant metamyelocytes (Candido et al, 1990;Schneider & Picker, 1985). In comparison with MDS, agranular neutrophils and the acquired Pelger-Hü et anomaly in the majority of neutrophils are not a feature.…”

Human immunodeficiency virus type 1 envelope glycoprotein gp120-mediated killing of human haematopoietic progenitors (CD34+ cells)

“…Moreover, myelodysplastic changes have frequently been reported in the early stages of the disease, and hypoplasia and fibrosis are characteristically found in the bone marrow in the final period of overt AIDS (Lake et al, 1984;Schneider & Picker, 1985).…”

Defective in vitro growth of the hemopoietic progenitor cells in the acquired immunodeficiency syndrome.

“…In addition to the derangement of the immune system, peripheral blood cytopenia of one or more hematological cell types has been noted in -60% ofthe patients (14)(15)(16), and also bone marrow changes such as increased cellularity and abnormalities in maturation of different hemopoietic lineages, as in myelodysplasia, have been observed (16)(17)(18).…”

“…Although cytopenias in AIDS are sometimes associated with Coombs' test positivity (15) or the presence of anti-platelet antibodies (16,19), the significance of these antibodies is not clear (4) and direct involvement of the hemopoietic progenitor cells might also be an important factor (4,20).…”