โรคมะเร็งต่อมน้ำเหลืองฮอดจ์กินที่มาด้วยอาการซีดอย่างรุนแรงและตับม้ามโต: รายงานผู้ป่วยเด็ก 2 ราย

Abstract

Although anemia is commonly found among patients with Hodgkin lymphoma, the severity is usually mild. We herein report a 9-year-old Hmong boy and a 5-year-old Tai-Yai girl presenting worsening anemia, prolonged fever and hepatosplenomegaly. The first patient had progressive anemia for 8 months and later required monthly transfusion. Physical examination revealed anemia, left supraclavicular lymphadenopathy, enlarged liver and markedly enlarged spleen. Laboratory investigation showed a hemoglobin level of 5.3 g/dL and normal white blood cell and platelet counts. The direct and indirect antiglobulin tests (DAT and IAT) were negative. The second patient had anemia, bilateral cervical lymphadenopathies and enlarged liver and spleen. The hemoglobin level was 8.0 g/dL while white blood cell and platelet counts were normal. The DAT and IAT were positive. An excisional lymph node biopsy showed Reed-Sternberg cells on hematoxylin and eosin stain. The patients were diagnosed with classical Hodgkin lymphoma stage IIIS-B and stage IVS-B, respectively. The second patient received chemotherapy, corticosteroid and radiotherapy and responded well. Severe anemia and splenomegaly could be one presentation of Hodgkin lymphoma.