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Hairy cell leukemia

Leukemic reticuloendotheliosis; HCL; Leukemia - hairy cell

 

Hairy cell leukemia (HCL) is an unusual cancer of the blood. It affects B cells, a type of white blood cell (lymphocyte).

Causes

 

HCL is caused by the abnormal growth of B cells. The cells look "hairy" under the microscope because they have fine projections extending from their surface.

HCL usually leads to a low number of normal blood cells.

The cause of this disease is unknown. Certain genetic changes (mutations) in the cancer cells may be the cause. It affects men more often than women. The average age of diagnosis is 55.

 

Symptoms

 

Symptoms of HCL may include any of the following:

  • Easy bruising or bleeding
  • Heavy sweating (especially at night)
  • Fatigue and weakness
  • Feeling full after eating only a small amount
  • Recurrent infections and fevers
  • Pain or fullness in the upper left belly (enlarged spleen)
  • Swollen lymph glands
  • Weight loss

 

Exams and Tests

 

During a physical exam, the health care provider may be able to feel a swollen spleen or liver. An abdominal CT scan or ultrasound may be done to evaluate this swelling.

Blood tests that may be done include:

  • Complete blood count (CBC) to check low levels of white and red blood cells, as well as platelets.
  • Blood tests and a bone marrow biopsy to check for hairy cells.

 

Treatment

 

Treatment may not be needed for the early stages of this disease. Some people may need an occasional blood transfusion.

If treatment is needed because of very low blood counts, chemotherapy drugs can be used.

In most cases, chemotherapy can relieve the symptoms for many years. When the signs and symptoms go away, you are said to be in remission.

Removing the spleen may improve blood counts, but is unlikely to cure the disease. Antibiotics can be used to treat infections. People with low blood counts may receive growth factors and, possibly, transfusions.

 

Outlook (Prognosis)

 

Most people with HCL can expect to live 10 years or longer after diagnosis and treatment.

 

Possible Complications

 

The low blood counts caused by hairy cell leukemia can lead to:

  • Infections
  • Fatigue
  • Excessive bleeding

 

When to Contact a Medical Professional

 

Call your provider if you have major bleeding. Also call if you have signs of infection, such as a persistent fever, cough, or general ill feeling.

 

Prevention

 

There is no known way to prevent this disease.

 

 

References

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): hairy cell leukemia. Updated May 3, 2016. Version 3. 2016. www.nccn.org/professionals/physician_gls/pdf/nhl.pdf. Accessed July 11, 2016.

Park JH, Tallman MS. Hairy cell leukemia. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 103.

Ravandi F. Hairy cell leukemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 77.

 
  • Bone marrow aspiration

    Bone marrow aspiration - illustration

    A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

    Bone marrow aspiration

    illustration

  • Auer rods

    Auer rods - illustration

    Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

    Auer rods

    illustration

  • Hairy cell leukemia - microscopic view

    Hairy cell leukemia - microscopic view - illustration

    All the cells in this field are hairy cells. The cell membranes appear irregular and serrated. The cytoplasm stains light blue (black arrows). The nuclei tend to be irregular (red arrows).

    Hairy cell leukemia - microscopic view

    illustration

  • Formed elements of blood

    Formed elements of blood - illustration

    Blood transports oxygen and nutrients to body tissues and returns waste and carbon dioxide. Blood distributes nearly everything that is carried from one area in the body to another place within the body. For example, blood transports hormones from endocrine organs to their target organs and tissues. Blood helps maintain body temperature and normal pH levels in body tissues. The protective functions of blood include clot formation and the prevention of infection.

    Formed elements of blood

    illustration

  • Enlarged spleen

    Enlarged spleen - illustration

    Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system, and by infection, malignancies, liver disease, and parasites.

    Enlarged spleen

    illustration

    • Bone marrow aspiration

      Bone marrow aspiration - illustration

      A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

      Bone marrow aspiration

      illustration

    • Auer rods

      Auer rods - illustration

      Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

      Auer rods

      illustration

    • Hairy cell leukemia - microscopic view

      Hairy cell leukemia - microscopic view - illustration

      All the cells in this field are hairy cells. The cell membranes appear irregular and serrated. The cytoplasm stains light blue (black arrows). The nuclei tend to be irregular (red arrows).

      Hairy cell leukemia - microscopic view

      illustration

    • Formed elements of blood

      Formed elements of blood - illustration

      Blood transports oxygen and nutrients to body tissues and returns waste and carbon dioxide. Blood distributes nearly everything that is carried from one area in the body to another place within the body. For example, blood transports hormones from endocrine organs to their target organs and tissues. Blood helps maintain body temperature and normal pH levels in body tissues. The protective functions of blood include clot formation and the prevention of infection.

      Formed elements of blood

      illustration

    • Enlarged spleen

      Enlarged spleen - illustration

      Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system, and by infection, malignancies, liver disease, and parasites.

      Enlarged spleen

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Hairy cell leukemia

           

             

            Review Date: 5/20/2016

            Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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