Diagnosis
If you have symptoms of hairy cell leukemia, your doctor will take your medical history and conduct a physical exam. If your doctor suspects hairy cell leukemia, samples of your blood and bone marrow will be taken and checked for signs of the disease. Your doctor may recommend any of the following procedures as part of this process:
Complete Blood Count (CBC)
A complete blood count (CBC) measures the levels of different types of cells in your blood. People with hairy cell leukemia have high levels of abnormal lymphocytes in their blood. These abnormal cells may crowd out healthy blood cells and cause conditions like anemia, leukopenia, and thrombocytopenia.
Peripheral Blood Smear
In this test, a blood specialist will examine a sample of your blood under a microscope. Your doctor will look for abnormal lymphocytes that look hairy under a microscope. Your doctor will also look at the types, amounts, and shapes of cells in the sample.
Click Image to Enlarge.
Bone Marrow Aspiration & Biopsy
Your doctor will perform this procedure to get a sample of your bone marrow for further testing. For this test, a doctor or nurse will numb the patient's hip bone and use a needle to extract some solid bone and some bone marrow. The doctor will then examine the tissue sample under a microscope to check for leukemia cells. This test can be done in the hospital or doctor's office, and most patients can go home right after the test.
Click Image to Enlarge.
Cytochemistry/Immunocytochemistry
In these tests, special stains or antibodies will be applied to a sample of your blood or bone marrow. These substances react with certain types of cells present in leukemia, and produce visible stains that can be seen under a microscope. Your doctor will look for a specific pattern of proteins on the surface of the cells typically present in hairy cell leukemia.
Click Image to Enlarge.
Flow Cytometry
In this procedure, your doctor will expose a sample of your blood or bone marrow to special antibodies that attach themselves only to certain substances in your cancer cells. Your doctor then moves the sample through a laser beam, which causes the antibodies to light up. This test helps your doctor identify the specific types of cells in your leukemia, helping him get a better idea of the maturity and origin of the cancer cells. This test is important in diagnosing the disease (immunophenotype) and may be used with the PCR to monitor minimal residual disease post therapy.
Click Image to Enlarge.
Computed tomography (CT) scan
The doctor may order a CT scan to find areas of cancer spread throughout the body. A CT scan takes many pictures as it rotates around the body. It produces detailed cross-sectional images of the body and allows doctors to study specific areas.
Click Image to Enlarge.
Cytogenetic Tests
Your doctor will examine your cancer cells for chromosome changes in order to determine the specific characteristics and subtype of your disease. For these tests, your doctor will grow a sample of bone marrow cells in the lab and examine the chromosomes under a microscope once the cells start dividing. Cell division is the easiest time to see the chromosomes. In general, no abnormalities are present in patients with hairy cell leukemia.
Click Image to Enlarge.
Fluorescent in situ hybridization (FISH)
Doctors also use this test to detect changes in the chromosomes and DNA of your blood or bone marrow samples. Your doctor will expose the sample to special dyes that will bind to specific parts of certain chromosomes. These dyes help your doctor detect any abnormalities in the chromosomes known to play a role in hairy cell leukemia. This test is much faster than cytogenetics tests because the cell sample doesn't have to be grown in a lab. It is rarely needed in patients with HCL, since we do not see abnormalities reported.
Polymerase Chain Reaction (PCR)
The doctor may perform this DNA test on a sample of your blood or bone marrow. Doctors use this test to detect chromosome abnormalities that cannot be seen under a microscope because they are too small. This test is very sensitive and can detect these abnormalities even if there are very few leukemia cells in the sample. In addition, this test helps identify small mutations, which can help in diagnosis and in monitoring for minimal disease while on therapy.
