Immune Hemolytic Anemia in Patients with Lymphoid Malignancy in Tanzania

Abstract

Background: Hematological malignancies of the lymphoid lineage such as multiple myeloma, lymphomas and lymphoid leukemia are a burden to the world especially in Tanzania; anaemia is one of the presenting symptoms of these conditions and is found in almost 100% of the patients at diagnosis. Of particular importance Immune Hemolytic Anemia (IHA) which has a poor response to treatment and subsequently poor prognosis when it is associated with lymphoid malignancies. The aim of this study is to determine the magnitude of immune hemolytic anemia in lymphoid malignancies in Tanzania Methods: This was a cross sectional study that recruited 86 patients with lymphoid malignancies attending both Ocean Road Cancer Institute (ORCI) and Muhimbili National Hospital (MNH). The clinical features were captured using a well-structured questionnaire. Laboratory results for Full Blood Count (FBC), reticulocytes count, total, indirect and direct bilirubin and Lactate Dehydrogenase (LDH) were retrieved from the laboratory reporting system. Additionally, a blood sample for the Direct Antiglobulin Test (DAT) was taken from all participants. This test was performed at the Central Pathology Laboratory (CPL) of MNH. Data analysis was performed using Statistical Package for the Social Sciences (SPSS 20.0) and Microsoft excel 2010. Data analysis was performed using South Texas Art Therapy Association (STATA 15.0). Results: IHA, indicated by a positive DAT, was found in 10% of patients with lymphoid malignancies. Analysis of DAT among patients never exposed to chemotherapy showed a prevalence of 22%. Among 9 IHA cases, 2 were CLL (Chronic Lymphoid Leukaemia), 2 were MM (Multiple Myeloma), 3 was NHL (Non-Hodgkin Lymphoma), 1 was HL (Hodgkin Lymphoma) and 1 SLL (Small Lymphocytic Lymphoma). All 9 cases had decompensated hemolytic anemia. Conclusion: IHA is a real complication of chronic lymphoid malignancies and DAT should be included in tests done during the course of management.