Evolving Changes in the Full Blood Count in Tuberculosis

Abstract Background : Changes in the full blood count of patients with tuberculosis have been studied previously, but the effect of co-infection with human immunodeficiency virus (HIV) remains to be explored. Objective : To evaluate the changes in full blood count in patients with 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. Results : Anaemia was found in 60.7% of patients with pulmonary tuberculosis (PTB) and in 61.1% of extra-pulmonary tuberculosis (ETB) patients. ETB patients had lower white cell counts (WCCs) 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. 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 on combination antiretroviral therapy and tuberculosis had higher levels of WCC, (7.9 (4.6–10.9) vs 5.8 (4.3–8.3), p = 0.0465). Conclusion : Anaemia is the most common manifestation of tuberculosis. This study highlighted the reactive nature of PTB haematological abnormalities compared to ETB with higher WCCs in both HIV-seropositive and HIV-seronegative patients. Co-infection with HIV was associated with blunting of some of the previously described haematological manifestations among patients with PTB.