Chapter 29 : Hematologic Complications of Tuberculosis

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Tuberculosis (TB) affects the production and life span of all hematologic cellular components. This chapter reviews and updates known hematologic effects of TB and its therapy. Myelophthisic anemias are characterized by the presence of teardrop erythrocytes, nucleated erythrocytes, and early granulocytes, which can be seen on the peripheral blood smear. In miliary TB, the bone marrow may become directly infiltrated with tuberculosis. Neutrophils, basophils, eosinophils, and the monocyte/macrophage line are all subtypes of granulocytes and all are commonly affected during the course of TB and its treatment. Lymphocytopenia and lymphocytosis have both been reported for active TB. While lymphocytopenia may be associated with marrow dysfunction, haptoglobin has recently been reported to suppress T-cell proliferation. Haptoglobin is an acute-phase protein which primarily scavenges hemoglobin and exhibits strong inhibition of T-cytokine release. Lymphocytopenia and lymphocytosis have both been reported for active TB. Lymphocyte proliferation occurs in the blood, secondary lymphoid tissues, and organs affected by TB. Diverse coagulation abnormalities have been reported in the setting of TB. Acquired factor V dysfunction due to the presence of an immunoglobulin inhibitor has been reported to cause hemorrhage. Despite the fact that nearly all of the antituberculous antimicrobials may produce hematologic side effects, routine hematologic monitoring is recommended by the manufacturer for only three commonly used anti-TB antibiotics—cycloserine, ethambutol, and rifabutin—and the strength of the recommendation varies from drug to drug.

Citation: Oyer R, Schlossberg D. 2011. Hematologic Complications of Tuberculosis, p 448-455. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch29
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Table 1.

Hematologic changes in TB

Citation: Oyer R, Schlossberg D. 2011. Hematologic Complications of Tuberculosis, p 448-455. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch29
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Table 2.

Hematologic toxicity from anti-TB therapy

Citation: Oyer R, Schlossberg D. 2011. Hematologic Complications of Tuberculosis, p 448-455. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch29

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