Unremitting severe autoimmune haemolytic anaemia as a presenting feature of Hodgkin's disease with minimum tumour load.

Two patients are reported who presented with severe autoimmune haemolytic anaemia (AIHA) of warm antibody type, with poor response to treatment. Extensive investigations failed to find a cause in both cases. In one case therapeutic splenectomy, one year after the initial presentation, showed Hodgkin's disease (HD) in the spleen but nowhere else. The second patient died of unremitting AIHA almost two years after the presentation and HD was found in only one mediastinal lymphnode at autopsy. These cases illustrate that a minimum tumour load of HD undetectable by the usual investigations can be associated with life-threatening AIHA.