Diagnostic Utility of Bone Marrow Sampling and Profile of Hematological Abnormalities in Indian HIV-infected Individuals

Background: Hematological abnormalities are a common complication of HIV infection and occur in all stages of the infection. These abnormalities increase as the disease advances. We aimed to evaluate the diagnostic utility of bone marrow sampling in HIV-positive patients. Methods: 40 HIV-infected individuals were screened for hematological abnormalities. Investigations such as iron studies, hematological work-up, bone marrow evaluation and coagulation profile were performed. Results: The most common single hematological abnormality was anemia, seen in 8 (20%) patients. However, anemia was seen as a subset of pancytopenia in 21 (52.5%) patients. Microcytic hypochromic anemia was present in 12 (30%) cases while anemia of chronic disease (normocytic normochromic anemia) occurred in 4 (10%) cases. Macrocytic anemia was observed in 32.5% (n=13) cases. Leucopenia and thrombocytopenia was seen in 21 (52.5%) patients as a subset of pancytopenia. However, they were not present as a single hematological abnormality. 45% of the patients showed hypercellular marrow whereas normocellular marrow was seen in 35% (n=14) and hypocellular marrow in 15% (n=6) of the patients. Myelodysplasia was found in 10 (25%) patients. It was commonest in erythroid (12.5%) followed by myeloid series (10%) and megakaryocytic series (2.5%).  Tuberculosis was seen in 10% of the cases and gelatinous transformation was seen in 1 (2.5%) case.  Conclusion: Bone marrow sampling has diagnostic utility in HIV-infected patients. Morphological examination in HIV-positive patients plays a distinctive role in ruling out the presence of opportunistic infections.