Hematology Case Study - Hairy Cell Leukemia

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Hairy cell leukemia is a B-lymphocyte chronic leukemia where lymphocytes often present with hair-like, irregular cytoplasmic projections. Pancytopenia and bone marrow fibrosis (dry tap) are often associated with the disease.

This sample (see PDF) is from a 67 year-old male who presented with leukocytosis and thrombocytopenia. The lymphocyte and monocyte populations could not be adequately separated as demonstrated by the gray cluster on the WDF scattergram and the associated “WBC Abn Scattergram” flag. The inadequate separation is due to the abnormal lymphocytes/hairy cells. The asterisk next to the automated di erential parameters indicates that the results may be inaccurate and require further con rmation prior to reporting. The laboratory performed a smear review using a DI-60TM Automated Digital Cell Morphology System and saw many lymphocytes with abnormal projections. Immunophenotyping using flow cytometry was used to con rm a diagnosis of hairy cell leukemia. If clinically indicated, BRAF mutational analysis can also be performed in such patients.

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