The haematological manifestations of tuberculosis
Date
2019
Authors
Bahemia, Imtiaz
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Abstract
Background: The exact haematological changes present in tuberculosis, pulmonary and extrapulmonary,
are still very controversial and have not been adequately investigated. The effect
of human immunodeficiency virus (HIV) on these haematological manifestations also remains
to be explored since most studies on the haematological effect of tuberculosis were performed
in the pre-HIV era.
Objective: To evaluate the haematological manifestations of tuberculosis in an evolving HIV
era.
Methods: Prospective study of consecutively recruited patients (n=125) with microbiologically
or histologically proven tuberculosis admitted at Chris Hani Baragwanath Academic Hospital
between October 2017 and July 2018. Participants were obtained through the National Health
Laboratory Service (NHLS). Demographics and relevant medical history were obtained for all
participants and their blood results obtained through the NHLS database.
Results: Anaemia was seen in 60.7% of patients with pulmonary tuberculosis (PTB) and 61.1%
of extra-pulmonary tuberculosis (ETB) patients (p = 0.964). ETB patients had lower white cell
counts (WCC) and lower neutrophil counts than PTB patients, 5.59 [3.6-8.1] vs 7.96 [5.27-
10.34], p = 0.002, and 4.2 [2.1-7.0] vs 5.5 [3.3-8.4], p = 0.079, respectively. Leucocytosis was
only seen with PTB. Compared to the HIV seronegative patients, HIV co-infected PTB
patients had lower WCC, lymphocyte counts, and neutrophil counts, 6.9 [4.8-9.7] vs 9.4 [8.6-
11.4], p = 0.0037, 0.7 [0.46-1.31] vs 1.51 [1.13-2.05], p = 0.0051, and 4.7 [2.8-7.7] vs 8.5 [5.9-
10.1], p = 0.0106, respectively. Patients co-infected with HIV and tuberculosis had higher
levels of WCC, 7.9 [4.6-10.9] vs 5.8 [4.3-8.3], p=0.0465, if they were on combination antiretroviral
therapy (cART).
Conclusion: Anaemia is still the most common manifestation of tuberculosis. We have
highlighted the reactive nature of PTB haematological abnormalities, as compared to ETB
based on the presence of higher white cell counts in both HIV seropositive and HIV
seronegative patients. HIV can blunt some of the previously described haematological
manifestations of tuberculosis such as neutrophilia and lymphocytosis among patients with
PTB but does not significantly alter the haematological presentation of ETB.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfilment of the requirement for the degree of
Master of Medicine (MMed)
Johannesburg, 2019