Haematological paraneoplastic syndromes

Red cell disorders

Erythrocytosis Common, often secondary to increased erythropoietin production e.g. renal cell carcinoma, hepatoma. Treat with phlebotomy if required.

Haemolytic anaemia

♦ Autoimmune—secondary to lymphoproliferative disorders (treatment—corticosteroids).

♦ Micro-angiopathic—secondary to vascular tumours, acute pro-myelocytic leukaemia, or widespread metastatic adenocarcinoma. Treat the tumour; replace coagulation factors; IV heparin.

Red cell aplasia Seen in thymoma, CLL; rare in solid tumours.

White cell disorders

Autoimmune neutropenia (rare)

♦ Granulocytosis—secondary to haemopoietic growth factor-secreting tumours (e.g. squamous cell cancers of lung, thyroid).

♦ Eosinophilia—in patients with HD.

Platelet disorders

♦ Thrombocytosis—(>450 x 109/L) is common and usually asymptomatic; in some cases may be secondary to IL-6 production.

♦ Idiopathic thrombocytopenia—is associated with leukaemias and lymphomas.

Coagulopathy

♦ Minor abnormalities of fibrin and fibrinogen degradation products are common.

♦ Overt disseminated intravascular coagulation is rare, associated with Acute Myelocytic Leukaemia and adenocarcinomas.

♦ Diagnosed by triad of thrombocytopenia, abnormal prothrombin time, and hypofibrinoginemia

♦ Treatment is controversial.

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