Moore and Forney developed a scheme for evaluating an HIV-infected patient with anemia. Anemia can impact the patient's quality of life and survival. Identifying the cause of anemia and correcting it can improve the patient's outcomes.
|
Gender of Patient |
Hemoglobin Defining Anemia |
|
female |
< 11.7 g/dL |
|
male |
< 13.8 g/dL |
Parameters:
(1) reticulocyte count in percent
(2) serum indirect bilirubin in mg/dL
Additional tests:
(3) MCV in femtoliters
(4) platelet count
(5) evaluation of blood smear
Questions about therapy:
(1) HIV therapy: AZT, ddC
(2) ganciclovir therapy
(3) cancer chemotherapy
(4) other drug therapy
|
Reticulocyte Count |
Serum Indirect Bilirubin |
Additional Tests |
Group |
|
>= 2% |
normal |
|
A |
|
>= 2% |
increased |
|
B1 |
|
>= 2% |
increased |
schistocytes and thrombocytopenia |
B2 |
|
< 2% |
normal |
low MCV |
C |
|
< 2% |
normal |
normal MCV |
D |
|
< 2% |
normal |
increased MCV |
E |
|
< 2% |
increased |
|
F |
where:
• Serum indirect bilirubin is increased in diseases with hemolysis.
|
Group |
Differential Diagnosis |
|
A |
(1) response to replacement of iron, vitamin B12 or folate, (2) response to acute blood loss |
|
B1 |
(1) autoimmune hemolytic disease, (2) G6PD deficiency and oxidant drugs |
|
B2 |
TTP or DIC |
|
C |
(1) iron deficiency secondary to chronic blood loss, (2) beta-thalassemia with Group D conditions |
|
D |
(1) anemia of chronic disease, (2) HIV, (3) drug toxicity, (4) tumor invading bone marrow, (5) infection involving marrow |
|
E |
(1) AZT or ddC toxicity, (2) cancer chemotherapy toxicity, (3) drug toxicity, (4) ganciclovir toxicity |
|
F |
(1) vitamin B12 deficiency, (2) folic acid deficiency |
where:
• Beta-thalassemia in Group C is not in the original table.
Purpose: To identify the possible causes of anemia in an HIV-infected patient.
Specialty: Hematology Oncology, Clinical Laboratory, Infectious Diseases
Objective: severity, prognosis, stage, response to therapy
ICD-10: D70, B23.2,
