Direct-antiglobulin-test-negative immune haemolytic anaemia and thrombocytopenia in a patient with Hodgkin's disease

A case of direct-antiglobulin-test (DAT)-negative autoimmune haemolytic ana emia (AIHA) and immune thrombocytopenia (ITP) associated with Hodgkin's dis ease (HD) is reported. A 52-year-old male was admitted with anaemia, thromb ocytopenia, and lymphadenopathy. The patient was DAT negative, although he exhibited the clinical features of warm-type ANA and elevated levels of red -blood-cell-associated IgG (RBC-IgG). The serum level of platelet-associate d IgG (PA-IgG) was markedly increased. A biopsy specimen of the inguinal ly mph nodes showed HD of mixed cellularity. Marked improvement of subjective symptoms, normalization of haematological values and a decrease in the leve l of both RBC- and PA-IgG were observed after the start of combination chem otherapy for HID. Although the association of HID, ITP, and/or ANA has been infrequently reported, the measurement of RBC-IgG is recommended in cases of HID with anaemia even though DAT is negative, since HID is known to be a ssociated with various protean immunological abnormalities. Copyright (C) 2 001 S. Karger AG, Basel.