Hematologic Manifestations

• Myelosuppression in HD may be caused by hypersplenism or bone marrow infiltration. Bone marrow aplasia in patients with HD has been reported and may respond to therapy.

• A positive Coombs' test may or may not be associated with overt hemolysis. Patients with a positive Coombs' test frequently have advanced-stage disease and systemic symptoms. Cyclic hemolysis with exacerbations coinciding with Pel-Ebstein fever has been described.

• Immune thrombocytopenia may accompany HD in 1-2% of cases. Thrombocytopenia may develop before, concurrently with, or after the diagnosis of HD.

• Thrombotic thrombocytopenic purpura (TTP) has also been described in HD, and microangiopathic hemolytic anemia must be considered in any patient with thrombocytopenia.

• Autoimmune neutropenia has also been described in patients with HD. Neutropenia may occur before the diagnosis.

• Eosinophilia is frequently associated with HD. This occurs in 15% of patients. The presence of eosinophilia is not related to stage or histology. Interleukin-5 (IL-5) production by Reed-Sternberg cells may explain the etiology of eosinophilia accompanying HD.

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