leukemia case 5

Case 1 73 years old male patient, black ethnicity from Comayagua, Honduras (north central), former worker of a soap factory, with a history of fatigue & malaise , weight loss , Repeated infection and bruising. Clinically he presented high fever 40°C, bilateral crackles in both lungs, increase in abdominal circumstances due to massive splenomegaly , but not lymphadenopathy.

CBC REASLUT : Pancytopenia Parameters PATIENT REASLUT NORMAL RANGE RBCS 2 *10*12\L M(4.2-5.5) \ F(3.5-5.0) * 10*12\L WBCS 1.59 × 103/mm3 ( 4.0 – 10.0 ) * 10*9\L PLT 86,000/mm3 ( 100-300) * 10*9\L HB 7.7 g/dl )12 – 18 ) g\dl HCT 23.5% M (45% to 52%) F ( 37% to 48% ) Pancytopenia

Peripheral blood smear: shows atypical mononuclear lymphocytoid cells with hairy projections on their surfaces

Bone marrow smear: The bone marrow yields a dry tap because the malignant cells are often surrounded by fibrosis.

Immunophenotyping: cell expresses CD19, CD20, CD22, HLA DR, SIgM and show immunoglobulin light chain restriction. CD5 is absent, but express antigen not normally expected like CD11c, a monocyte-associated marker, and CD25, the IL2 receptor.

Cytochemistry: Staining peripheral blood with acid phosphatase is positive. The addition of tartaric acid to the reaction mixture inhibits all of the common isoenzymes of acid phosphatase, except isoenzyme 5, which is found in hairy cells. Tartrate resistance acid phosphatase (TRAP) is positive and is characteristic in HCL.

Treatment: Splenectomy and interferon as well as new chemotherapeutic drugs are successful in promoting long lasting remissions.

Thanks for your attention