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Case study (20)- Hairy cell leukemia

Case study (20)- Hairy cell leukemia 

History and clinical signs and symptoms 

Last year, the 55-year-old man suffered from a complicated deep vein thrombosis in his right leg. 

Splenomegaly was detected by a physical examination.

The routine CBC revealed abnormalities in WBC subpopulations; peripheral smear indicated the presence of abnormal cells. 

The patient was referred to the hematology clinic. 

Laboratory Investigations 

1. Hematologic findings 

RBC:4.49 X 106/μL (4-5.5 X 106/μL) 
HGB: 130 g/dL (120-174 g/dL) 
HCT: 50.7 % (36-52%)
MCV: 112.8 fL (76–96 fL)
MCH: 29.0 pg (27-32 pg)
MCHC: 257 g/L (300-350 g/L) 
RDWsd:52.4 fL (20-42 fL) 
RDWcv: 13.8 % (0-16 %) 
WBC: 13.21 X103/ μL (5–10 X 103/ μL) 
Neutrophils: 1.78 X 103/μL (2-7.5 X 103/μL) 
Lymphocytes: 10.91 X 103/μL (1.08–3.17 X 103/μL) 
Monocytes: 0.40 X 103/μL (0.15-0.7 X 103/μL) 
Eosinophils: 0.07 X 103/μL (0-0.5 X 103/μL) 
Basophils: 0.05 X 103/μL (0-0.15 X 103/μL) 
Neutrophils %: 13.5 % (40-75 %) 
Lymphocytes %: 82.6 % (14.76-45.4 %)
Monocytes %: 3.0 % (3-7 %)
Eosinophils %: 0.5 % (0-5 %) 
Basophils %: 0.4 % (0-1.5 %) 
PLT: 149 X 103/μL (150-400 X 103/μL) 

Warning Flags Q, Interpretive Flags Leukocytosis?, lymphocytosis?, Macrocytic RBC?, Hypochromic?. 


The WBC DIFF show abnormal scattergram, the monocyte-lymphocyte subpopulations are not clearly defined (see warning flag “Q”). The WBC count is just above normal. Marked neutropenia and lymphocytosis are present. 

The RBC and PLT histograms are well separated and normal in characteristics. 

The red cell (RBC) population is homogenous, the cells are somewhat larger (elevated MCV and decreased MCHC). 

The platelet count (PLT) is slightly lower than normal. 

Because of abnormal DIFF scattergram and numerical findings, a microscopic evaluation of the blood smear was recommended. 

Peripheral blood smear

 The feature of the peripheral blood smear is lymphocytes (74.1%). However, 24.1% of lymphocytes are abnormal with a phenotype of ‘hairy cell’

2. Other laboratory findings 

- BRAF V600E mutation was demonstrated. The diagnosis of hairy cell leukemia was established. 


Hairy cell leukemia

Disease course 

- The therapeutic protocol was designed. The patient’s next visit was scheduled.