Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Haemophilus Infections Hairy Cell Leukemia 653

the house is incomplete; chemoprophylaxis is indicated in daycare

settings if there is an outbreak (2 cases of invasive disease within 60

d) and unvaccinated or incompletely vaccinated children attend the

center.

Hairy Cell Leukemia..................................

KANTI R. RAI, MD

history & physical

Clinical features

■Rare lymphoproliferative disorder

■Median age at diagnosis is 52 years

■Male:female – 4:1

■Usually has an indolent course

Signs & Symptoms

■Patients may be asymptomatic

■May have “B” symptoms and abdominal fullness (secondary to

splenomegaly)

■May have any or all of the following

■Pallor, lymphadenopathy, splenomegaly, skin involvement (pyo-

derma gangrenosum, scleroderma)

tests

Splenomegaly

Blood

■Pancytopenia (50% of the patients)

■Characteristic large lymphocytes with

■hairy projections on peripheral blood smear

Bone Marrow

■Inaspirable marrow (“Dry tap”) is common

■Hypercellular, occasionally hypocellular

■Diffuse or focal infiltration with hairy cells

■Residual hematopoietic cells are decreased

■TRAP (tartrate resistant acid phosphatase) positive

■Flow Cytometry: CD5 (−), CD19, CD20, CD11c, CD25 and CD103 (+)

differential diagnosis

■Lymphoproliferative disorders (see table under CLL)