Consider HIV infection in thrombocytopeniaBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6921.133 (Published 08 January 1994) Cite this as: BMJ 1994;308:133
- M Fisher,
- B Peters,
- M McBride,
- V Kitchen
EDITOR, - Mary McMullin and George Johnston reiterate the importance of prophylaxis against pneumococcal sepsis after splenectomy.1 Although in H A Deodhar and colleagues' study most indications for splenectomy were haematological, no reference was made to thrombocytopenia associated with HIV infection.2 This is an important omission for two reasons.
Firstly, although thrombocytopenia is a recognised complication of HIV infection, our experience indicates that this is not always considered during diagnostic work up. Several patients referred to us for splenectomy who were thought to have idiopathic thrombocytopenia were subsequently found to be positive for HIV.
Secondly, people infected with HIV are 7-26 times more at risk of pneumococcal infection than people who are not infected.3 Splenectomy would presumably further increase this likelihood of acquiring life threatening pneumococcal infection and for this reason should be considered only as a last resort when patients exhibit a bleeding diathesis with thrombocytopenia refractory to medical intervention (including treatment with zidovudine).4
Although the response to pneumococcal vaccine may be suboptimal in this group of patients, protective titres may still be attained.5 A better response to vaccination would be expected in patients at an early stage of immunosuppression - the group most at risk of significant thrombocytopenia.