What blood levels are affected by lymphoma in females?

Blood Levels Affected by Lymphoma in Females

Lymphoma commonly affects several key blood parameters in females, with lactate dehydrogenase (LDH) and complete blood count (CBC) abnormalities being the most significant indicators for diagnosis, prognosis, and monitoring of disease activity.

Essential Laboratory Parameters

Complete Blood Count (CBC) Abnormalities

• Anemia (hemoglobin <12 g/dL) occurs in approximately 42% of non-Hodgkin's lymphoma patients at diagnosis and is typically mild to moderate in severity 1
• Leukopenia (low white blood cell count) is present in about 6% of lymphoma patients, particularly those with bone marrow involvement 1
• Leukocytosis (elevated white blood cell count) is seen in 26% of lymphoma patients and may indicate more aggressive disease when counts exceed 20,000/μL 1
• Thrombocytopenia (low platelet count) affects approximately 13% of lymphoma patients and is more common with bone marrow involvement 1
• Thrombocytosis (elevated platelet count) is present in 14% of lymphoma patients 1

Biochemical Markers

• Elevated LDH is a characteristic finding in non-Hodgkin's lymphomas and serves as an early marker of occult lymphoma, even before clinical manifestations 2
• Increased beta-2 microglobulin is an important prognostic marker in follicular lymphoma and should be measured at diagnosis 3
• Elevated uric acid levels may occur due to increased cell turnover 3

Prognostic Significance

Follicular Lymphoma International Prognostic Index (FLIPI)

• FLIPI includes hemoglobin <12 g/dL and elevated LDH as key prognostic factors 3
• FLIPI 2 incorporates beta-2 microglobulin, hemoglobin levels, and bone marrow involvement 3
• PRIMA-PI risk stratification uses beta-2 microglobulin levels and bone marrow involvement 3

Impact on Survival

• Anemia is associated with shorter survival time in lymphoma patients, regardless of bone marrow involvement 1
• High white blood cell count (>20,000/μL) correlates with shorter survival in patients without bone marrow involvement 1
• Multiple cytopenias or leukoerythroblastosis indicate poor prognosis 1

Diagnostic Workup

Essential Laboratory Tests

• Complete blood count with differential to assess for cytopenias, leukocytosis, or abnormal cells 3
• LDH measurement is mandatory in the initial workup 3
• Comprehensive metabolic panel including liver and kidney function tests 3
• Beta-2 microglobulin determination 3
• Immunoglobulin levels should be measured as part of initial assessment 3
• Hepatitis B, C, and HIV screening tests are required before initiating therapy 3

Bone Marrow Assessment

• Bone marrow aspirate and biopsy are essential for staging and detecting involvement 3
• Biopsy should be at least 20 mm in length with appropriate immunohistochemistry 3
• Bone marrow involvement can cause or exacerbate cytopenias 1

Special Considerations

Anemia of Chronic Disease

• Lymphoma-associated anemia often displays characteristics of anemia of chronic disease due to abnormalities in iron metabolism 4
• Inflammatory cytokine IL-6 is frequently upregulated in Hodgkin's lymphoma and associated with hepcidin levels, the main regulator of iron metabolism 4
• Elevated hepcidin results in iron restriction and signs of anemia of chronic disease 4

Hyperleukocytosis

• White blood cell counts >100,000/μL can lead to complications including disseminated intravascular coagulation, tumor lysis syndrome, and leukostasis 5
• Risk factors include T-cell lymphomas and certain cytogenetic abnormalities 5
• Requires urgent intervention to prevent morbidity and mortality 5

Monitoring Disease Activity

• Serial LDH measurements are useful for monitoring disease activity and response to therapy 2
• Persistent or recurrent cytopenias may indicate disease progression or bone marrow involvement 1
• Normalization of blood parameters often correlates with treatment response 3

Potential Pitfalls

• Laboratory test values may differ substantially between testing facilities and among populations, with significant racial/ethnic differences in normal ranges for many parameters 3
• Hemoglobin lower limit of normal is 9.6 g/dL in Black women, which falls below eligibility thresholds for some clinical trials 3
• Advanced age affects laboratory values: alkaline phosphatase increases by 20% between the 3rd and 8th decade, and platelet count decreases by approximately 20,000/mcl between the sixth and eighth decades 3
• Bone marrow involvement assessment may be falsely negative if the biopsy is inadequate in size or from a non-involved site 3