Increased production of hemoglobin F in a child or adult can be a paraneoplastic process.


Hematologic disorders with production of hemoglobin F:

(1) erythroleukemia

(2) juvenile chronic myeloid leukemia

(3) malignant lymphoma, including Burkitt's lymphoma

(4) myelodysplastic syndrome

(5) multiple myeloma


Non-hematologic disorders with production of hemoglobin F:

(1) germ cell tumors (embryonal carcinoma, teratoma)

(2) colorectal carcinoma

(3) transitional cell carcinoma

(4) lung cancer

(5) breast cancer

(6) endometrial cancer

(7) brain tumor



(1) unexplained presence of increased hemoglobin F (including increase from previously documented level)

(2) decrease in hemoglobin F on successful therapy of the triggering neoplasm

(3) exclusion of drugs or other causes for an elevated hemoglobin F


One mechanism for the production of hemoglobin F is extramedullary hematopoiesis with hemoglobin F being produced in red blood cell precursors. These can be demonstrated using immunohistochemistry.


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