Direct-antiglobulin-test-negative immune haemolytic anaemia and thrombocytopenia in a patient with Hodgkin's disease.
A case of direct-antiglobulin-test (DAT)-negative auto-immune haemolytic anaemia (AIHA) and immune thrombocytopenia (ITP) associated with Hodgkin's disease (HD) is reported. A 52-year-old male was admitted with anaemia, thrombocytopenia, and lymphadenopathy. The patient was DAT negative, although he exhibited the clinical features of warm-type AIHA and elevated levels of red-blood-cell-associated IgG (RBC-IgG). The serum level of platelet-associated IgG (PA-IgG) was markedly increased. A biopsy specimen of the inguinal lymph nodes showed HD of mixed cellularity. Marked improvement of subjective symptoms, normalization of haematological values and a decrease in the level of both RBC- and PA-IgG were observed after the start of combination chemotherapy for HD. Although the association of HD, ITP, and/or AIHA has been infrequently reported, the measurement of RBC-IgG is recommended in cases of HD with anaemia even though DAT is negative, since HD is known to be associated with various protean immunological abnormalities.
Kondo
H
H
Division of Haematology and Oncology, Department of Medicine, Shimizu Kohsei Hospital, 578-1 Ihara-cho, Shimuzu-city, Shizuoka 424-0114, Japan. hakondo@minuet.plala.or.jp
Oyamada
T
T
Mori
A
A
Sumi
H
H
Kurosu
K
K
Kajii
E
E
Mikata
A
A
D000743:Anemia, Hemolytic; D003298:Coombs Test; D006689:Hodgkin Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia