Laboratory parameters of 1st order – obligatory laboratory tests.
- Small blood count [anemia (anemia); thrombocytopenia.
- Differential blood count
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- Calcium [plasmocytoma/multiple myeloma: ↑]
- Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, urine culture if necessary (pathogen detection and resistogram, that is, testing of appropriate antibiotics for sensitivity/resistance).
- Fasting glucose (fasting blood glucose).
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT), alkaline phosphatase, bilirubin.
- Renal parameters – urea, creatinine, cystatin C or creatinine clearance, if necessary.
- Coagulation parameters – PTT, Quick
- LDH [elevated in fast-growing NHL or large NHL tumor mass]
- Beta-2-microglobulin (β2-microglobulin) [high levels tend to be prognostically unfavorable; frequently but not always elevated]
- Quantitative immunoglobulin determination (IgA, IgD, IgE, IgG, IgM).
- Coombs test
- Monoclonal gammopathy (see below the disease of the same name due tolaboratory diagnostics) – suspected B-cell lymphoma (plasmocytoma, Waldenström’s disease and others).
- Genetic diagnostics (see below etiology).
- Histologic (fine tissue)/immunohistologic and molecular genetic examination.
- Blood smear for Sézary cells; flow cytometry (method of laboratory medicine used to analyze cells flowing individually at high speed past an electric voltage or light beam): Determination of CD4/CD8 ratio; Clonality analysis in blood (PCR) – for erythrodermic T-cell lymphomas.
- Bone marrow biopsy – for primary diagnosis of diffuse large B-cell lymphoma of the leg type (DLBCL, LT) and intravascular large B-cell lymphoma.
Laboratory parameters 2nd order – (follow-up/therapy control).
- Small blood count*
- Differential blood count* (determination of absolute lymphocyte count (ALC) and lymphocyte to monocyte ratio (LMR)).
- ESR (erythrocyte sedimentation rate)* .
- LDH* [elevated in rapidly growing NHL or large NHL tumor mass]
* Sensitivity and positive predictive value of routine blood tests for relapse are low. The aforementioned laboratory parameters also do not appear to influence survival after relapse.
