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IMAGE IN HEMATOLOGY
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 39

Lymphocytes hairy looked: An initial smear finding in the diagnosis of hairy cell leukemia


Clinical Laboratory Division, Pharmacy and Clinical Laboratory Department, University Hospital, University of São Paulo, Sao Paulo, Brazil

Date of Web Publication12-Apr-2017

Correspondence Address:
Ricardo A Fock
Clinical Laboratory Division, Pharmacy and Clinical Laboratory Department, University Hospital, University of São Paulo, Avenida Lineu Prestes, 2565, Sao Paulo, SP 05508-900
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5127.204429

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How to cite this article:
Salgado V, Ramos MC, Rezende D, Fock RA. Lymphocytes hairy looked: An initial smear finding in the diagnosis of hairy cell leukemia. J Appl Hematol 2017;8:39

How to cite this URL:
Salgado V, Ramos MC, Rezende D, Fock RA. Lymphocytes hairy looked: An initial smear finding in the diagnosis of hairy cell leukemia. J Appl Hematol [serial online] 2017 [cited 2019 Dec 14];8:39. Available from: http://www.jahjournal.org/text.asp?2017/8/1/39/204429



A middle-aged man was admitted to the hospital with a complaint of flu symptoms. He had fever, dry cough and weakness associated with mucocutaneous pallor and night sweats. In the physical examination, splenomegaly was observed. The hemogram results showed hemoglobin = 8.6 g/dL and hematocrit = 27.9%. The platelet count was 36,000/μL and the white blood cells = 8620/μL (776 segmented neutrophils; 7586 lymphocytes; 172 monocytes; and 86 eosinophils). The lymphoid lineage showed cells with medium-size to large, with loose chromatin, nucleoli and cytoplasmic projections [Figure 1]. The hairy cell leukemia (HCL) diagnosis was confirmed by bone marrow cells immunophenotype markers positive for CD19, CD20, CD103, and CD79b.
Figure 1: (a and b) Hairy cell − lymphocytes with abnormal cytoplasm and a hairy look (magnification: 1000×; May-Grünwald stain)

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HCL is a lymphoproliferative disorder of B-cells characterized by splenomegaly without lymphadenopathy, presence of lymphocytes with abnormal cytoplasm and bone marrow, liver and spleen infiltrations.[1] The initial diagnostic findings are based on the presence of progressive pancytopenia and lymphocytes with fine projections on their surface that make them hairy looked.[1],[2] HCL confirmation is based on the flow cytometry immunofenotyping, and B-Raf proto-oncogene (BRAF) mutation tests should be performed in all cases before initiation of any therapy.[1],[2] Thus, the presence of lymphocytes hairy looked in the bloodstream is important for the initial and correct investigation of HCL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Grever MR, Blachly JS, Andritsos LA. Hairy cell leukemia: Update on molecular profiling and therapeutic advances. Blood Rev 2014;28:197-203.  Back to cited text no. 1
    
2.
Jain P, Pemmaraju N, Ravandi F. Update on the biology and treatment options for hairy cell leukemia. Curr Treat Options Oncol 2014;15:187-209.  Back to cited text no. 2
    


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