Some great comments from #teamhaem, including:
- Hairy cells
- Howell Jolly bodies
- Nucleated red cells
All of the above sound good to us. Some of our followers rightly pointed out that one should not jump to a diagnosis based on one blood film. Common differential for ‘hairy cells’ are hairy cell leukaemia, variant hairy cell leukaemia and splenic marginal zone lymphoma.
This patient had a splenectomy in the past for hairy cell leukaemia! This can be used as a treatment for hairy cell or for diagnosis on rare occasions. The BCSH guidelines state:
“Indications for splenectomy in HCL have changed since the advent of purine analogue therapy. The principal indication for splenectomy is very significant splenomegaly (>10 cm
below costal margin) in the presence of low-level bone marrow infiltration. It should not be forgotten that some patients may remain in clinical remission with normal blood counts for periods of 15–25 years. In these patients, the bone marrow does not improve but remains minimally involved and occasional circulating hairy cells are seen in blood films. It is not clear, however, whether splenectomy, undertaken as a debulking procedure, improves long-term results. If a patient is splenectomized, it is important to wait for the full benefits of splenectomy to be apparent before starting any other therapy. It is therefore recommended that at least 6 months should be allowed to pass after splenectomy before considering any other treatment. A slow rise in circulating hairy cells is a feature suggesting subsequent progression. If blood counts normalize and the patient remains asymptomatic, a decision on further treatment could safely be delayed indefinitely.”