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Malignancy-Associated Microangiopathic Hemolytic Anemia and Thrombocytopenia

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(04): 594

DOI: DOI: 10.4103/ijmpo.ijmpo_111_18

Sir,

Abdulla et al. nicely described two Indian patients who presented with microangiopathic hemolytic anemia (MAHA) and thrombocytopenia due to disseminated malignancy (DM).[1] I presume that underlying human immunodeficiency virus (HIV) infection might contribute to the revelation of DM in the studied two patients. That contribution could be addressed in dual aspects. On the one hand, it is obvious that patients with HIV infection have increased tendency to have various neoplastic lesions compared to healthy individuals. The increased propensity of neoplasms among HIV-positive patients has been thought to be related to different factors, including coinfection with oncogenic viruses, immunosuppression, and life prolongation secondary to the use of antiretroviral therapy.[2] To the best of my knowledge, HIV infection is a significant health hazard in India. The available data pointed out 0.26% HIV seroprevalence compared with a global average of 0.2%.[3] On the other hand, thrombotic microangiopathy is associated with HIV infection [4] and it could be the first clinical manifestation of HIV infection.[5] I presume that implementing the diagnostic workup of viral overload and CD4 count estimations was solicited in the studied two patients. If that diagnostic workup was accomplished and it revealed underlying HIV infection, the two cases in question could be truly regarded novel case reports. This is because concurrent HIV infection and DM uncovered by MAHA and thrombocytopenia have never been reported in the literature so far.

Publication History

Received: 11 May 2018
Accepted: 21 June 2018
Article published online:
03 June 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Sir,

Abdulla et al. nicely described two Indian patients who presented with microangiopathic hemolytic anemia (MAHA) and thrombocytopenia due to disseminated malignancy (DM).[1] I presume that underlying human immunodeficiency virus (HIV) infection might contribute to the revelation of DM in the studied two patients. That contribution could be addressed in dual aspects. On the one hand, it is obvious that patients with HIV infection have increased tendency to have various neoplastic lesions compared to healthy individuals. The increased propensity of neoplasms among HIV-positive patients has been thought to be related to different factors, including coinfection with oncogenic viruses, immunosuppression, and life prolongation secondary to the use of antiretroviral therapy.[2] To the best of my knowledge, HIV infection is a significant health hazard in India. The available data pointed out 0.26% HIV seroprevalence compared with a global average of 0.2%.[3] On the other hand, thrombotic microangiopathy is associated with HIV infection [4] and it could be the first clinical manifestation of HIV infection.[5] I presume that implementing the diagnostic workup of viral overload and CD4 count estimations was solicited in the studied two patients. If that diagnostic workup was accomplished and it revealed underlying HIV infection, the two cases in question could be truly regarded novel case reports. This is because concurrent HIV infection and DM uncovered by MAHA and thrombocytopenia have never been reported in the literature so far.

Conflict of Interest

There are no conflicts of interest.