Autoimmune hemolytic anemia is a blood disorder where red blood cells in the bloodstream are damaged by antibodies (proteins) produced by the immune system of the body.
When the red blood cells are targeted and destroyed by these antibodies, affected individuals experience symptoms of anemia such as fatigue, dizziness, heart palpitations, shortness of breath, and having a pale skin due to hemoglobin being released from the red blood cells. When this happens, hemoglobin can’t function properly and oxygen cannot be carried to the tissues and organs of the body requiring this gas to function properly.1
Characteristic signs of autoimmune hemolytic anemia include jaundice (yellow discoloration of the eyes and/or skin) due to the release of bile from the damaged red cells and dark discoloration of the urine due to hemoglobin being present in this bodily fluid.
Hodgkin’s lymphoma is a blood cancer that originates from the lymphatic system of the body which is the network that produces antibodies that fight foreign organisms. The condition occurs when the lymphatic system produces too many abnormal lymphocytes, specifically B-cells.2
Usually, old white cells are naturally supposed to die and new ones are created to replace them. In Hodgkin’s lymphoma, the lymphocytes do not die off but rather continue to grow and divide. The result is an increased amount of lymphocytes because production remains unaffected and these cells crowd up in the lymph nodes of the body causing them to swell.
Symptoms and signs associated with Hodgkin’s lymphoma include swollen lymph glands that are painless, fatigue, fevers, night sweats, chest pain, coughing, shortness of breath, and weight loss.
Association between the two conditions
Clinical studies reveal that autoimmune hemolytic anemia and Hodgkin’s lymphoma are rarely seen together in the same patient, but the presence of both conditions does occur. The reported cases of both these conditions affecting the same individual are sporadic with an incidence of between 0.5 and 4 percent.
The usual scenario is that autoimmune hemolytic anemia seems to occur as a complication of Hodgkin’s lymphoma during stage 3 or 4 of specific conditions such as nodular sclerosis Hodgkin’s lymphoma or mixed cellularity Hodgkin’s lymphoma. In other words, the former is diagnosed after the patient was known to have one of the latterly mentioned conditions. However, there are cases where autoimmune hemolytic anemia was diagnosed at the same in patients who were confirmed to have Hodgkin’s lymphoma.3
In any case, the association between the two conditions seems to be in that Hodgkin’s lymphoma triggers an increased autoimmune response from the body’s immune system which leads to the production of antibodies that target red blood cells.
Further research suggests that the development of autoimmune hemolytic anemia can occur at any stage of Hodgkin’s lymphoma, with the most common time occurring in late stage 3 to 4 of the disease, especially in patients presenting with constitutional symptoms such as weight loss, fevers, increased perspiration, fatigue, chronic pain, shortness of breath, and malaise.
The mainstay therapy for treating autoimmune hemolytic anemia is to try and suppress the immune system from producing antibodies with the administration of steroid medications.
In some cases, the anemia caused by autoimmune hemolytic anemia in patients with Hodgkin’s lymphoma resolves after the surgical excision of affected lymph nodes. This just strengthens the correlation of Hodgkin’s lymphoma being the cause of the anemia disorder.
In Hodgkin’s lymphoma cases where the spleen was involved, anemia caused by autoimmune hemolytic anemia resolved after the organ was surgically removed (splenectomy).
Researchers state that diagnosing patients with Hodgkin’s lymphoma who initially present with signs and symptoms of autoimmune hemolytic anemia is challenging. The reason being that the blood disorder is the primary clinical presentation in up to 40 percent of patients with Hodgkin’s lymphoma, but it precedes the latter by between eight to 36 months in 20 percent of cases.
The development of autoimmune hemolytic anemia in patients who were previously treated for Hodgkin’s lymphoma indicates relapse of the disease. Therefore, researchers suggest that patients who are diagnosed with autoimmune hemolytic anemia and are refractory to steroid treatment, a malignancy such as Hodgkin’s lymphoma should be considered and investigated for further.
Although autoimmune hemolytic anemia is an autoimmune disorder that can occur in patients with Hodgkin’s lymphoma, it is found that it doesn’t necessarily worsen the outcome of the patient with this malignancy.