Autoimmune hemolytic anemia in childhood Hodgkin's disease

Autoimmune hemolytic anemia (AIHA) is very rarely associated with neoplasia in childhood. However, we have observed AIHA in three children with Hodgkin's disease (HD) in the past 7 years. AIHA presented either prior to, simultaneously with, or years after the diagnosis of HD. Antibodies against erythrocytes were nonspecific. The relationship of AIHA to the activity of underlying HD was quite varied among these three patients. Surgery, radiation therapy, and chemotherapy all may alter the course of AIHA. Coombs' tests may continue to be persistently positive when anemia is absent. Currently, all three patients have no evidence of recurrence of HD, no anemia, negative Coombs' tests 5 years, 22 months, and 14 years 10 months after the initial diagnosis of HD. AIHA should be considered in a child with HD who develops anemia and HD should also be considered in the differential diagnosis in a child with chronic AIHA.