What CBC (Complete Blood Count) abnormalities are associated with lymphoma?

CBC Abnormalities in Lymphoma

The most common CBC abnormalities in lymphoma include anemia (seen in 32-42% of patients), thrombocytopenia (13%), leukopenia (6%), leukocytosis (26%), and thrombocytosis (14%). 1

Common CBC Findings in Lymphoma

Red Blood Cell Abnormalities

• Anemia:
  • Present in 32-42% of non-Hodgkin lymphoma patients at diagnosis 2, 1
  • Usually mild with hemoglobin levels between 10-12 g/dL 3
  • Typically presents as anemia of chronic disease (71.7% of cases) 2
  • Often caused by inflammatory cytokines like IL-6 which increase hepcidin production, leading to iron restriction 3
  • Other causes include:
    • Iron deficiency (39.1% of cases) 2
    • Vitamin B12/folate deficiency (21.7% of cases) 2
    • Autoimmune hemolytic anemia (10.9% of cases) 2
    • Bone marrow infiltration (rarely the sole cause) 3, 2

White Blood Cell Abnormalities

• Leukopenia: Found in 6% of NHL patients 1

  • More common with bone marrow involvement
  • May affect neutrophils, lymphocytes, or both

• Leukocytosis: Present in 26% of NHL patients 1

  • Severe leukocytosis (WBC >20×10^9/L) associated with poor prognosis
  • May represent:
    • Reactive leukocytosis due to inflammation
    • Circulating lymphoma cells (seen in 9.5% of cases) 1

Platelet Abnormalities

• Thrombocytopenia: Found in 13% of NHL patients 1

  • More common with bone marrow involvement
  • Associated with shorter survival in patients with bone marrow involvement

• Thrombocytosis: Present in 14% of NHL patients 1

  • Usually reactive due to inflammatory cytokines

Multiple Cytopenias

• Multiple cytopenias (affecting 2 or more cell lines) occur in approximately 8% of lymphoma patients 1
• Leukoerythroblastosis (immature WBCs and nucleated RBCs in peripheral blood) seen in 2% of cases 1
• Both findings are associated with poor prognosis

Prognostic Significance

• Anemia is an independent adverse prognostic factor for overall survival and progression-free survival 4
• Adding anemia to the International Prognostic Index improves prognostic accuracy 4
• Severe leukocytosis (>20×10^9/L) correlates with shorter survival in patients without bone marrow involvement 1
• Thrombocytopenia is associated with shorter survival in patients with bone marrow involvement 1

Specific Lymphoma Types and CBC Findings

• Hodgkin Lymphoma: Anemia is common and typically presents as anemia of chronic disease 3
• Chronic Lymphocytic Leukemia: Progressive cytopenias are common as disease advances 5
• Intravascular Large B-cell Lymphoma: Often presents with cytopenias including anemia, thrombocytopenia, and mild leukopenia 6

Important Considerations

• Anemia in lymphoma is often multifactorial (39.1% of cases) 2
• Nutritional deficiencies are present in nearly half (47.8%) of anemic lymphoma patients 2
• CBC abnormalities should be evaluated in the context of other clinical and laboratory findings
• Bone marrow examination is essential when cytopenias are present to determine if lymphoma infiltration is contributing to the abnormalities

Remember that CBC abnormalities in lymphoma can reflect both direct effects of the disease (bone marrow infiltration) and indirect effects (cytokine-mediated changes, autoimmune phenomena, and nutritional deficiencies). The pattern and severity of these abnormalities provide valuable diagnostic and prognostic information.