Coombs'-positive Hemolytic Anemia in Hodgkin's Disease

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Abstract
Although anemia in Hodgkin''s disease is a common finding, it is rare that red cell coating can be demonstrated by the antiglobulin technique. Of 546 cases of Hodgkin''s disease seen at Memorial Center from 1954 to 1960, only 6 patients showed a positive Coombs test. This report consists of observations on these 6 patients, in addition to 4 others studied since 1960. Overt hemolysis was associated with the positive antiglobulin test in most of the cases. Neither the onset nor the intensity of the hemolytic process was related to the stage of advancement of the Hodgkin''s disease. Two of these patients also had ITP [inosine triphosphate]-like episodes. Remission of hemolysis and restoration to normal of the Cr51 erythro-cyte survival time was not accompanied by any gross diminution in the positive direct Coombs reaction. Serum haptoglobin levels were low during overt hemolysis and correlated well with other parameters of active hemolysis. The prognosis of frank hemolytic episodes in Coombs positive patients was uniformly favorable. In various patients substantial remissions occurred after splenectomy, after splenic irradiation, after radiotherapy to localized abdominal masses, after the administration of corticosteroids, or even without any therapy. In 2 patients who had remission of hemolytic anemia after radiotherapy to localized abdominal masses, surface counting did not indicate sequestration of Cr51-taggedcellsby the enlarged nodes. Long-term survival from the time of diagnosis of Hodgkin''s disease was relatively frequent in this group of patients but, due to the small numbers, was not statistically significant.

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