Haematological aspects of lymphomas.

Anaemia, leucopenia and thrombocytopenia in various combinations develop during the course of the various lymphomas either before and almost always after treatment. Basic haematological investigations viz. full blood count, peripheral blood film and ESR, may provide clues to the extent (spread) of disease in lymphomas. Thus, anaemia would suggest widespread disease, and is rare in the early stages. Thrombocytopenia is even rarer, so is leucopenia. The presence of either or both, at presentation, i s bad prognostically, since it suggests bone marrow infiltration and therefore widespread disease. High ESR again suggests active or widespread disease, or the presence of monoclonal proteins Which may result in clinical complications. Trephine biopsy is absolutely essential. Some centres require bilateral marrow biopsy, usually takenfrom the posterior illac spines.' Bone marrow involvement is one of the commonest events in early spread of the disease. It is also the most easily detectable. The work of Bloomfield and his colleagues shows that various haematological parameters serve as indicators of bone marrow involvement to varying degrees of reliability. Table I summarises the work of Bloomf ield et al. It is apparent that more than half of the cases with bone marrow involvement at presentation have anaemia, and nearly half have lymphopenia. Presence of lymphocytes which are suspicious of "lymphosarcoma cells" is noted in half of those with bone marrow involvement All cases with thrombocytopenia, neutropenia or "lymphosarcoma cells" in the peripheral blood show evidence of bone marrow involvement on trephine biopsy examination. The implication of this work i s farreaching. It i s obvious that an especially vigorous search for bone marrow involvement is indicated in patients with these haematological abnormalities. Brunning and his colleagues suggest that bilateral posterior iliac spine trephine biopsies should be done if lymphoma is not demonstrated on the initial trephine in patients who are initially stage I or II but have these haematological abnormalities. The presence of haematological abnormalities i s not in itself an indicator of bad prognosis. I t s presence is merely an indicator of bone marrow involvement, which is synonymous with widespread disease. Bone marrow involvement is, of course, related to survival. Lymphocytopenia may be given a slightly