Which initial investigations should be conducted in a patient suspecte

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Initial investigations for a patient suspected of having Hodgkin lymphoma should include:

An urgent full blood count (FBC) to assess for haematological abnormalities such as anaemia or thrombocytopenia, which may suggest malignancy .
Assessment of symptoms including unexplained lymphadenopathy, fever, night sweats, weight loss, pruritus, and alcohol-induced lymph node pain to guide urgency of referral ,.
Referral for specialist assessment via a suspected cancer pathway (2-week wait) in adults presenting with unexplained lymphadenopathy and associated symptoms, or very urgent referral (within 48 hours) for children and young people ,.
Imaging such as chest X-ray may be considered to exclude other diagnoses like tuberculosis or sarcoidosis if supraclavicular or persistent cervical lymphadenopathy is present, especially in people aged 40 years and over .
Definitive diagnosis requires tissue biopsy, preferably an excision biopsy of the lymph node, to confirm Hodgkin lymphoma histologically .

Which initial investigations should be conducted in a patient suspected of having Hodgkin Lymphoma?