Anaemia in HIV Infection: Relating Red Cell Indices And Iron Profile

Abstract

Anaemia -a frequent complication of HIV infection- is multi-factorial, and its incidence is associated with progression of HIV disease. Recognition of iron related anaemia in HIV infection remains a challenge. Exploring red cell indices and iron profile may provide easier and more efficient diagnostic option. This study aims to evaluate iron status of anaemic HIV infected individuals in relation to apparently healthy, non-HIV infected persons, and determine indices that best indicate iron deficiency anaemia in HIV infection. A total of 100 Adults with serologic diagnosis of HIV, and Packed Cell Volume (PCV) <30% (or Hb<10g/dl), were recruited with 50 HIV negative adults, non anaemic apparently healthy subjects as controls. Five mililiters of blood placed in sodium ethylene-diamine tetra-acetate (EDTA) specimen bottle was used for the estimation of Haemoglobin concentration (Hb), Packed Cell volume (PCV), Reticulocyte count, along with red cell indices: Mean cell Volume (MCV), Mean Cell Haemoglobin (MCH) and Mean Cell Haemoglobin Concentration (MCHC). Serum extract was then used for serum iron, serum ferritin and serum transferrin analyses. Of the total 100 HIV positive subjects, 51 of 63(81%) subjects with Hb between 7-10g/dl were in CDC stages B and C while only 12 of 63 (19%), were in stage A. The Hb levels fell with progression of HIV disease. MCV, MCH and MCHC of the control population, were significantly higher than the study population ( 86.3fl vs 82.9fl; 27.8pg vs 26.3pg and 32.2g vs 31.1g; p<0.05respectively). However, Reticulocyte count was significantly higher in the HIV infected study group (1.6% vs 1.3%; p<0.05).Mean serum iron, and mean serum transferrin levels were significantly higher among the HIV negative controls compared with the HIV-positive study population(280.2 μg/dl vs 195.16 μg/dl and 2.3g/l vs 1.47g/l; p< 0.05 respectively). However, mean serum ferritin was significantly higher among the HIV positive study population ( 540.3ng/ml vs 141.6ng/ml; p<0.05). Anaemia in HIV infection is essentially anaemia of chronic disorders. Decreasing serum transferrin level and rising values of serum ferritin associate best with severity of anaemia in HIV infection.

Keywords: HIV; Anaemia; Ferritin, Transferrin; Serum Iron