Essential Components of a Detailed Blood Workup for Lymphoma
A comprehensive blood workup for lymphoma should include complete blood count with differential, serum lactate dehydrogenase, hepatitis B testing, and a comprehensive metabolic panel as essential components. 1
Core Laboratory Tests
- Complete Blood Count (CBC) with differential and platelets - Essential for evaluating potential bone marrow involvement, cytopenias, and abnormal lymphocyte populations 1
- Serum Lactate Dehydrogenase (LDH) - Critical prognostic marker and component of the International Prognostic Index (IPI) for non-Hodgkin lymphoma 1
- Comprehensive Metabolic Panel - Evaluates organ function and potential involvement 1
- Hepatitis B testing - Required before initiating anti-CD20 monoclonal antibody therapy (HBsAg and HBcAb); essential due to risk of hepatitis B reactivation 1
Additional Required Tests
- Hepatitis C testing - Particularly important for high-risk patients and those with splenic marginal zone lymphoma 1
- Coagulation studies - Including prothrombin time, partial thromboplastin time, and fibrinogen to assess for disseminated intravascular coagulation 1
- Uric acid levels - Part of tumor lysis syndrome panel, especially important before initiating treatment 1
Immunophenotyping
- Flow cytometry - Essential for determining lymphoma subtype and clonality 1
- Initial immunophenotyping panel should include:
Bone Marrow Evaluation
- Bone marrow biopsy with or without aspirate - Essential component of staging in most lymphomas 1
- Bone marrow involvement occurs in:
Optional Laboratory Tests Based on Lymphoma Subtype
- β2-microglobulin - Important prognostic marker, especially in follicular lymphoma 1
- Protein electrophoresis - Recommended for evaluation of potential paraproteinemia 1
- Specific genetic/molecular testing - Based on suspected lymphoma subtype 1
Common Pitfalls to Avoid
- Relying solely on routine blood tests for surveillance - Blood tests alone have poor sensitivity (39%) and positive predictive value (9%) for detecting disease progression in asymptomatic patients with indolent lymphoma 2
- Omitting hepatitis testing - Critical before initiating immunotherapy, as reactivation can occur even with chemotherapy alone 1
- Inadequate immunophenotyping - Flow cytometry requires sufficient cell quantity and quality; inadequate samples may miss up to 15% of lymphomas 3
- Overlooking bone marrow evaluation - Essential for staging and prognostication in most lymphoma subtypes, though may be deferred in certain circumstances 1
Special Considerations
- For pediatric patients - Additional tests include tumor lysis syndrome panel (LDH, uric acid, potassium, phosphates, calcium) 1
- For suspected CNS involvement - Lumbar puncture with cerebrospinal fluid analysis should be performed 1
- For patients receiving anthracycline-based regimens - Cardiac function evaluation with MUGA scan or echocardiogram is recommended 1