Bone marrow abnormalities in HIV infected children, report of three cases and review of the literature
A three and a half year old girl presented with fever, cough and breathlessness since one year and skin dermatitis since six months. Both parents were HIV infected and mother had died due to TB three months back. The child along with elder sister were diagnosed HIV infected recently by two different HIV ELISA kits. On examination, she was malnourished, had severe pallor with chalky white nails, chronic papular dermatitis and generalized lymphadenopathy. She had hepatosplenomegaly with cardiomegaly on systemic examination. Her investigations showed anemia (hemoglobin = 3.1 gm/dl) with normal WBC and platelet count. Reticulocyte count was 0.3% and ESR was 80 mm at end of one hour. Her direct Coombs test was negative. Urine showed 2+albuminuria. Bone marrow examination showed normocellular marrow with erythroid hyperplasia with mild dyserythropoiesis. She was treated with blood transfusion and advised regarding antiretroviral therapy which was refused due to non-affordability.