What is the role of complete blood cell count (CBC) in the workup of hairy cell leukemia (HCL)?

Updated: Sep 16, 2018
  • Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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A complete blood cell count (CBC) and careful review of a peripheral blood smear are the first steps in the identification of hairy cells. The typical hairy cells of hairy cell leukemia (HCL) are so named because of their characteristic cytoplasmic projections, which appear as fine (hairlike) microvilli when seen by light microscopy, phase-contrast microscopy, and electron microscopy. These are mononuclear cells with eccentric or centrally placed nuclei.

The CBC in patients with HCL typically shows pancytopenia, with decreased cell counts in all three cell lines, as follows:

  • Anemia is usually severe and normochromic-normocytic in character

  • Neutropenia and monocytopenia are usually present, but an elevated white blood cell count (hairy cells) is found in 20% of cases

  • Thrombocytopenia is found in more than 80% of patients

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