51 year old male.
Seen by local physician for routine preoperative exam prior to dental surgery. Found to have low hemoglobin and a large left upper quadrant mass.
Physical ExamMarked splenomegaly (subsequently confirmed by CT scan) extending from the left costal margin to just above the iliac crest.
No other organomegaly.
(with microscopic differential)
RBC3.36 x 1012/L
HGB 10.9 g/dL
HCT 31.2 %
MCV 92.8 fL
MCH 32.4 pg
MCHC 34.9 g/dL
WBC 9.3 x 109/L
abnormal cells 71
PLT 59 x 109/L
What morphologic alterations are seen in this blood smear field?
Results of the blood smear exam were:
The abnormal cells have round or indented nuclei with afairly coarse chromatin pattern. They have variable amounts of grainy blue-gray cytoplasm with irregular ragged borders and numerous projections.
Within normal limits
Question 2What further laboratory studies, if any, are indicated?
Further Laboratory Studies
Bone marrow biopsy:
Marrow was difficult to obtain. A small amount of fluid wasaspirated, and the differential showed 78.1% abnormal cells similar to those in the blood.
Hypocellular with a diffuse loosely structured infiltrate of mononuclear cells. Increased areasof fibrosis.
Tartrate resistant acid phosphatase (TRAP) stain of abnormal cells: positive
What is the most likely diagnosis?Answer 3
Hairy cell leukemia
The patient was treated with appropriate therapeutic agents and responded well. He was referred back to the care of his local physician.