What initial blood work is recommended for patients with suspected or diagnosed Hodgkin lymphoma?

Initial Blood Work for Hodgkin Lymphoma

All patients with suspected or diagnosed Hodgkin lymphoma should undergo a comprehensive panel of blood tests including complete blood count, erythrocyte sedimentation rate, liver and renal function tests, serum albumin, lactate dehydrogenase, and mandatory viral screening for hepatitis B, hepatitis C, and HIV. 1

Essential Laboratory Tests

Core Hematologic and Chemistry Panel

• Complete blood count (CBC) with differential and platelets is mandatory to assess for cytopenias, which may indicate bone marrow involvement or anemia of chronic disease 1, 2
• Erythrocyte sedimentation rate (ESR) must be obtained as it serves as both a prognostic factor and helps stratify patients into favorable versus unfavorable risk groups 1, 2
• Serum albumin is required as hypoalbuminemia is an important adverse prognostic factor in the International Prognostic Score 1
• Lactate dehydrogenase (LDH) should be measured as elevated levels correlate with tumor burden and prognosis 1

Hepatic and Renal Function

• Liver function tests including alkaline phosphatase and liver enzymes are essential to assess hepatic involvement and establish baseline organ function before chemotherapy 1, 2
• Renal function tests (BUN, creatinine) must be performed to ensure safe administration of chemotherapy agents 1

Mandatory Infectious Disease Screening

• Hepatitis B (HBV), hepatitis C (HCV), and HIV serology are compulsory before initiating treatment, as reactivation of viral hepatitis can occur with immunosuppressive chemotherapy 1, 2

Additional Laboratory Studies

Inflammatory Markers

• C-reactive protein (CRP) provides additional information about disease activity and inflammation 1, 2

Optional Tests in Specific Contexts

• Beta-2 microglobulin may be obtained in advanced-stage disease or within therapeutic trials, though it is optional 1
• Protein electrophoresis can be considered in advanced-stage disease 1

Pre-Treatment Assessments

Reproductive Health

• Pregnancy test is mandatory for all women of reproductive age before initiating therapy 1
• Fertility counseling should be documented, though this is not a blood test per se 1, 2

Thyroid Function (Conditional)

• Thyroid function tests (TSH, FT3, FT4) are recommended specifically for patients who are candidates for neck irradiation 1

Important Clinical Context

The Italian Society of Hematology guidelines emphasize that bone marrow biopsy should be performed in patients with B symptoms, advanced stage disease (III/IV), or blood count abnormalities, as these features increase the likelihood of marrow involvement 1. However, with the advent of PET-CT, bone marrow biopsy is no longer routinely indicated if baseline PET-CT is performed, given PET's high sensitivity for detecting marrow involvement 1, 2.

Common Pitfalls to Avoid

• Failing to obtain viral screening before treatment can lead to life-threatening hepatitis reactivation during chemotherapy 1, 2
• Omitting ESR and albumin removes critical prognostic information needed for risk stratification and treatment planning 1
• Not performing pregnancy testing in women of reproductive age can result in fetal exposure to teratogenic chemotherapy 1

The blood work serves dual purposes: establishing baseline organ function to ensure safe chemotherapy administration and identifying prognostic factors that guide treatment intensity 1, 2.