Multifactorial etiology of anemia in SIV-infected rhesus macaques: Decreased BFU-E formation,serologic evidence of autoimmune hemolysis,and an exuberant erythropoietin response

We attempted to define the etiology of anemia in SIV-infected rhesus macaques. Bone marrow culture showed significantly decreased (75% reduction) burst forming unit-erythroid (BFU-E) growth in end-stage SIV⁺ “sick” animals. Direct antiglobulin tests (DAT) were positive in nine of 35 SIV⁺ “well” and 14 of 14 SIV⁺ “sick” monkeys (0 of 25 control animals had positive DATs). In animals with a positive DAT, moderate to severe anemia was observed, as was increased LDH and spherocytosis. Erythropoietin was measured in four control, eight SIV⁺ “well” and five SIV⁺ “sick” animals with mean levels of 4.0, 15.4, and 1176 mU/mL (r = .94) in the three groups. These data suggest that the cause of anemia in the SIV-infected rhesus macaque is multifactorial, that there may be a defect in erythropoiesis, and that, serologically, an IgG mediated autoimmune hemolytic anemia is also present.