What is the role of lab testing in the evaluation of Hodgkin lymphoma (Hodgkin disease)?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Complete blood cell (CBC) count studies for anemia (low red blood cell [RBC] count), lymphopenia (low white blood cell [WBC] count), excess neutrophils (neutrophilia), or eosinophils (eosinophilia) should be performed. Some of these factors have prognostic implications, as noted under Prognosis. Hodgkin lymphoma–associated anemia is most commonly the anemia of chronic disease. However, it may result from bone marrow involvement by tumor or, rarely, from the presence of an autoantibody (as indicated by a positive warm-agglutinin on a Coombs test). Platelet counts may be increased or decreased.

The erythrocyte sedimentation rate (ESR)—a general marker of inflammation—may be elevated in Hodgkin lymphoma. An elevated ESR has been associated with worse prognosis. However, the ESR is a nonspecific test that should not be used for Hodgkin lymphoma screening.

Lactate dehydrogenase (LDH) may be increased. LDH levels may correlate with the bulk of disease.

Serum creatinine may be elevated in the rare cases of nephrotic syndrome associated with Hodgkin lymphoma. Levels of alkaline phosphatase (ALP) may be increased due to the presence of liver or bone involvement. Other uncommon laboratory findings include hypercalcemia, hypernatremia, and hypoglycemia (due to the presence of insulin autoantibodies).

A test for human immunodeficiency virus (HIV) is important in the workup of Hodgkin lymphoma, because antiretroviral therapies can improve disease outcomes in HIV-positive patients. [3] Screening for hepatitis B and C should also be considered.

Serum levels of cytokines (interleukin [IL]-6, IL-10) and soluble CD25 (IL-2 receptor) correlate with tumor burden, systemic symptoms, and prognosis, but these studies are generally obtained only in special situations or in the context of a clinical trial.

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