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Rare Occurrence of 3 “H”: Hypercalcemia, Hemolytic Anemia and Hodgkin’s Lymphoma

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Clinicians in hematology practice commonly encounter anemia, hypercalcemia and renal failure, which when present in combination evoke a diagnostic workup for multiple myeloma. We report a 71-years old lady who presented to our hematology clinic with fever and easy fatiguability of 3 months duration and on investigations was found to have anemia and hypercalcemia. Direct Coomb’s test characterized the anemia as complement mediated (anti-C3d) hemolysis. Biochemical investigations revealed normal 25(OH) Vitamin D3 and suppressed Parathormone levels and a negative workup for plasma cell dyscrasias, sarcoidosis and autoimmune disorders. CT scan revealed a paravertebral mass with cervical, supraclavicular and abdominal lymphadenopathy along with splenomegaly and left pleural effusion. Biopsy from the paravertebral mass confirmed the diagnosis of Hodgkin’s disease (nodular sclerosis) using immunohistochemistry. Bone marrow examination suggested infiltration by lymphoma. Hypercalcemia was managed with saline and zoledronic acid. Administration of prednisolone (1 mg/kg/day) along with chemotherapy (ABVD regimen) led to normalization of calcium and hemoglobin levels. However, hemolysis recurred 2 weeks later and hence, Rituximab (375 mg/m2) was administered on a weekly schedule for 4 doses and ABVD (2 weekly) was continued, which brought hemolysis under control. Co-occurrence of two paraneoplastic manifestations (complement mediated hemolytic anemia and hypercalcemia) in Hodgkin’s lymphoma is very unusual. Present report aims not only to highlight a rare presentation of Hodgkin’s lymphoma but also focus on the role of Rituximab in controlling hemolysis associated with this disease.

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Authors and Affiliations

  1. Department of Hematology, 4th Floor, Nehru Hospital, PGIMER, Chandigarh, India

    Ankur Jain, Pankaj Malhotra, Gaurav Prakash & Subhash Varma

  2. Department of Hematopathology, 5th Floor, Research Block A, Nehru Hospital, PGIMER, Chandigarh, India

    Narender Kumar

  3. Department of Histopathology, 5th Floor, Research Block A, Nehru Hospital, PGIMER, Chandigarh, India

    Asim Das

Authors
  1. Ankur Jain
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  2. Pankaj Malhotra
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  3. Gaurav Prakash
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  4. Subhash Varma
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  5. Narender Kumar
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  6. Asim Das
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Correspondence to Pankaj Malhotra.

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The authors declare no conflicts of interests.

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The authors declare that the manuscript submitted is in accordance with the ethical guidelines as under Helsinki Declaration 1976.

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The authors hereby declare that appropriate written and informed consent was obtained from the patient prior to publication of any material.

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Jain, A., Malhotra, P., Prakash, G. et al. Rare Occurrence of 3 “H”: Hypercalcemia, Hemolytic Anemia and Hodgkin’s Lymphoma. Indian J Hematol Blood Transfus 32 (Suppl 1), 163–167 (2016). https://doi.org/10.1007/s12288-016-0672-0

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  • DOI: https://doi.org/10.1007/s12288-016-0672-0

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