What would a Complete Blood Count (CBC) look like in a patient with a diagnosis of lymphoma?

CBC Findings in Lymphoma

A complete blood count (CBC) in lymphoma typically shows anemia, thrombocytopenia, and abnormal white blood cell counts, with specific patterns varying by lymphoma type and stage of disease. 1

Common CBC Abnormalities in Lymphoma

Anemia

• Present in approximately 66% of non-Hodgkin lymphoma patients at diagnosis 2
• Often multifactorial (39.1% of cases) with potential causes including:
  • Inflammatory cytokines
  • Bone marrow infiltration
  • Iron deficiency
  • Autoimmune hemolytic anemia
  • Vitamin B12/folate deficiency 1
• Serves as an independent adverse prognostic factor for overall survival and progression-free survival

White Blood Cell Abnormalities

• Leukocytosis (elevated WBC count)

  • Severe leukocytosis (>20×10^9/L) correlates with shorter survival in patients without bone marrow involvement 1
  • May see abnormal lymphocytes in peripheral blood, particularly in lymphoblastic lymphoma 2

• Leukopenia (decreased WBC count)

  • More common with bone marrow involvement 1
  • Lymphocytopenia occurs in approximately 41.3% of non-Hodgkin lymphoma patients 2

• Altered cell ratios with prognostic significance:

  • Lymphocyte-monocyte ratio (LMR) ≤2.8
  • Neutrophil-lymphocyte ratio (NLR) ≥3.3
  • Platelet-lymphocyte ratio (PLR) ≥200 3

Platelet Abnormalities

• Thrombocytopenia

  • Present in many lymphoma cases, particularly with bone marrow involvement
  • Associated with shorter survival 1
  • May be seen in approximately 40% of cases 2

• Thrombocytosis

  • Usually reactive due to inflammatory cytokines 1

Lymphoma-Specific CBC Patterns

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)

• Characteristic finding: Lymphocytosis with ≥5000 clonal B cells/mcL (5 × 10^9/L) in peripheral blood 4
• Progressive cytopenias common as disease advances 1
• In SLL: Lymphadenopathy and/or splenomegaly with <5000 B lymphocytes/mcL in peripheral blood 4

Intravascular Large B-cell Lymphoma

• Typically presents with:
  • Anemia (80% of cases)
  • Thrombocytopenia (80% of cases)
  • Mild leukopenia (20% of cases)
  • Lymphoma cells may be detected in peripheral blood smears 5

Bone Marrow Involvement and CBC Changes

• Marrow involvement occurs in approximately 46.8% of non-Hodgkin lymphoma patients 2
• Diffuse infiltration pattern is common (71.4% of cases with marrow involvement) 2
• Associated with more severe cytopenias, particularly:
  • Anemia
  • Thrombocytopenia
  • Leukopenia 1

Prognostic Significance of CBC Abnormalities

• A "CBC score" model integrating LMR, NLR, and PLR can stratify patients into risk groups:

  • Low-risk: 3-year overall survival of 84%
  • Intermediate-risk: 3-year overall survival of 53%
  • High-risk: 3-year overall survival of 30% 3

• Combination of three CBC parameters (LMR <1.6, hemoglobin <100 g/L, and platelet counts <150 × 10^9/L) has been shown to be a useful prognostic tool in diffuse large B-cell lymphoma 6

Clinical Implications

• CBC abnormalities should prompt further evaluation, including bone marrow examination, especially with:

  • Unexplained cytopenias
  • Progressive worsening of blood counts
  • Presence of atypical cells in peripheral blood 4

• Regular CBC monitoring is recommended for lymphoma patients:

  • At diagnosis
  • During treatment
  • During follow-up (at least annually for those with normal counts or stable single cytopenias) 4

• More frequent CBC evaluations (every 3-4 months) are suggested for high-risk patients to determine the trajectory of blood counts 4