Hairy Cell Leukemia

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Hairy Cell Leukemia
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Patient details

• 50 year old Fiji Indian male.
• Pancytopenia splenomegaly- months.
• No Hepatomegaly or lymphadenopathy.

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Full Blood Counts

• Blood CBC
• WBC - 7.07
• RBC - 3.12
• Hb - 9.0gm
• HCT - 25.7
• MCV - 82.4
• RDW - 14.2
• PLT - 120

• Neut - 29.7 (2.10)
• Lymp - 56.0 (3.96)
• mono - 11.2 (0.79)
• Eos - 2.3 (0.16)
• Baso - 0.8 (0.06)

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Blood film morphology

• Done on 26-1-2004
• Normocytic normochromic.
• WBC - There are abnormal lymphocytes with
  irregular moderately large size, hyperchromatic
  nucleus. cytoplasm shows irregular hairy
  projections.
• Platelets Mild thrombocytopenia.

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Bone Marrow Trephine

• Dry marrow Aspiration, trephine biopsy done
• Marked marrow hyperplasia.
• Thin bone trabeculae.
• Focal collections of abnormal lymphocytes. Oval
  to round nuclei with moderate amounts of
  cytoplasm.
• positive pan B cell marker ( (Immunoperoxidase)
• Scattered giant cells osteoclasts also seen.

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Hairy cells in blood film
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Hairy cells in blood film
Dead cells common in leukemia
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Bone marrow trephine biopsy

• Markedly hypercellular marrow no fat spaces.
• Thin bone trabeculae.

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Bone marrow trephine biopsy

• Thin bone trabeculae.
• Markedly hypercellular marrow no fat spaces.

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Bone marrow trephine biopsy

• Markedly hypercellular marrow no fat spaces.
• Focal Lymphocyte collection (small round dark
  cells)

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BM biopsy B cell marker (ipx)

• Focal clusters of B cells
• (forming follicles like in lymph nodes as seen
  here is common in B cell neoplasms)

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BM biopsy B cell marker (ipx)

• Focal clusters of B cells
• (forming follicles like in lymph nodes as seen
  here is common in B cell neoplasms)

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BM biopsy Collagen stain (VG)

• Collagen (pink) is not seen in the marrow (bone
  trabeculae are positive)
• No marrow fibrosis.

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BM biopsy Collagen stain (VG)

• Collagen (pink) is not seen in the marrow (bone
  trabeculae are positive)
• No marrow fibrosis.

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Discussion

• 50 year old male presenting with pancytopenia
  splenomegaly no lymph nodes.
• Blood film shows abnormal lymphocytes with
  irregular cytoplasmic hairy projections.
• Mild thrombocytopenia, anemia leukopenia (over
  50 abnormal cells)
• All cell line Marrow hyperplasia suggests
  hyperactivity due to hypersplenism.
• Focal follicular infiltration of abnormal B
  lymphocytes in the marrow.
• Features suggest a rare form of B cell neoplasm
  Hairy cell leukemia

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Hairy Cell Leukemia

• Hairy cell leukemia is a chronic
  lymphoproliferative disorder that is easily
  controlled. The decision to treat is based on
  symptomatic cytopenias, massive splenomegaly, or
  the presence of other complications. About one
  tenth of all patients will never require therapy.

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General Information

• splenomegaly, varying degrees of leukopenia
  (occasionally leukocytosis) and/or pancytopenia,
  and bone marrow infiltration by an atypical cell
  with prominent cytoplasmic projections (hairy
  cells). The bone marrow is usually fibrotic and
  is not easily aspirated. Bone marrow biopsies are
  therefore required for diagnosis and evaluation
  of the degree of hairy cell infiltration.