The presence of severe anemia in patients with chronic lymphocytic leukemia or malignant lymphoma is regarded ordinarily as a bad prognostic sign, often indicating advanced disease or extensive involvement of bone marrow. In some patients, however, marked anemia is due to an overt hemolytic process, and recognition of this fact will lead to proper therapy and a more favorable prognosis.
In 1906, Pappenheim 1 stated that the anemia in lymphocytic leukemia was chiefly myelophthisic in nature but that it was possible in some instances for the anemia to be of hemolytic origin and caused by toxic hemolyzing substances from the tumor tissue. The first report of acquired hemolytic anemia associated with chronic lymphocytic leukemia was given by Paschkis,2 in 1927. That same year Holler and Paschkis 3 presented the first report of Hodgkin's disease complicated by acquired hemolytic anemia. Since then other cases of Hodgkin's disease, lymphosarcoma, and chronic