Hematologic Syndromes

Warm autoimmune hemolytic anemia (AIHA) and occasionally cold antibody-mediated hemolysis is seen most commonly in association with CLL,92 but 3-5% patients with NHL 93 and 1-2% with HD also develop this complication.94 Fludarabine associated hemolytic anemia is also observed in patients with CLL and occasionally in NHL. In a study of patients with NHL, AIHA was associated with female sex, poorer response rate to treatment, a higher incidence of monoclonal gam-mopathy, and inferior overall survival when compared to patients without AIHA.93 AIHA associated with lymphoma usually parallels the disease course and sometimes heralds the onset of relapsing disease. In contrast, autoimmune thrombocytopenia is seen more commonly with HD than with NHL. Unlike AIHA, when ITP recurs, it is seldom associated with a relapse. Treatment is the same as for de novo cases, and accompanies therapy for the underlying malignancy.

Several paraneoplastic coagulopathies resulting in bleeding diatheses, mediated by the secreted paraprotein, are well described in the lymphoproliferative disorders. Acquired factor VIII9596 and factor X inhibitors, acquired von Willebrand's disease,9798 and rarely acquired Glanzmann's thrombasthenia99 have all been reported. Conversely, thrombosis as a result of anticar-diolipin and anti-beta 2 glycoprotein-I antibodies is also reported in patients with NHL.100

Eosinophilic syndrome with organ infiltration has been observed with HD and T-cell lymphoma. IL-5 is the principle cytokine that is believed to mediate this process.101102 Other rarer paraneoplastic hematologic syndromes associated with the lymphomas include hemophagocytic syndrome,103 autoimmune neutrope-nia,104 pure red cell aplasia,105 and amegakaryocytic thrombocytopenic purpura.106

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