Treatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence
Treatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence
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DOI：
10.1016/j.trstmh.2005.01.002
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发表时间：
2005-08-01
影响因子：
2.2
通讯作者：
Boeree, MJ
中科院分区：
文献类型：
--
作者：
Lewis, DK;Whitty, CJM;Boeree, MJ
严重贫血是南部非洲住院的非怀孕成年人的常见症状。根据艾滋病毒前时代的数据，标准的综合征治疗是针对缺铁、蠕虫和疟疾。我们前瞻性调查了105名连续入住内科病房的血红蛋白<7 g/dl的成人。排除急性失血患者。对患者进行了贫血的可能寄生虫、细菌、分枝杆菌和营养原因的调查，包括骨髓穿刺，以确定潜在的可治疗原因。79%的病人艾滋病毒呈阳性。三分之一的患者患有结核病，仅在8%的艾滋病毒阳性患者中通过骨髓培养确诊。在21%的个体中培养出细菌，以非伤寒沙门氏菌为主，肺炎链球菌罕见。铁缺乏症，钩虫感染和疟疾是不常见的艾滋病毒阳性贫血的成人，虽然重钩虫感染被发现在6（27%）的22个艾滋病毒阴性贫血的成人。总之，在艾滋病毒高流行地区，成人严重贫血症的常规治疗是不适当的。隐性分枝杆菌病和菌血症很常见，但铁缺乏在HIV阳性患者中并不常见。除了铁补充剂，严重贫血的管理应包括结核病的调查，并考虑对肠杆菌的抗生素活性。(c)2005年皇家热带医学和卫生学会。由爱思唯尔有限公司出版。保留所有权利。
Severe anaemia is a common presentation in non-pregnant adults admitted to hospital in southern Africa. Standard syndromic treatment based on data from the pre-HIV era is for iron deficiency, worms and malaria. We prospectively investigated 105 adults admitted consecutively to medical wards with haemoglobin < 7g/dl. Those with acute blood toss were excluded. Patients were investigated for possible parasitic, bacterial, mycobacterial and nutritional causes of anaemia, including bone marrow aspiration, to identify potentially treatable causes. Seventy-nine per cent of patients were HIV-positive. One-third of patients had tuberculosis, which was diagnosed only by bone marrow culture in 8% of HIV-positive patients. In 21% of individuals bacteria were cultured, with non-typhi salmonella predominating and Streptococcus pneumoniae rare. Iron deficiency, hookworm infection and malaria were not common in HIV-positive anaemic adults, although heavy hookworm infections were found in 6 (27%) of the 22 HIV-negative anaemic adults. In conclusion, conventional treatment for severe anaemia in adults is not appropriate in an area of high HIV prevalence. Occult mycobacterial disease and bacteraemia are common, but iron deficiency is not common in HIV-positive patients. In addition to iron supplements, management of severe anaemia should include investigation for tuberculosis, and consideration of antibiotics active against enterobacteria. (c) 2005 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.