More about lymphocytes, their impostors and varied faces from White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions, presented by MediaLab

White Blood Cell Disorders and Platelets:: 6. Non Granulocytic White Blood Cells

More about lymphocytes, their impostors and varied faces

In this photograph of blood cells from yet another submitted slide, we find cells resembling lymphoblasts with increased nuclear/cytoplasmic ratios and dense, finely meshed nuclear chromatin.
In addition, note the extrusion of delicate strands of cytoplasm from the outer cell membranes (blue arrow). These are cells connoting hairy cell leukemia (HCL).
Under scanning electron microscopy, the cytoplasmic extensions appear to be either slender microvilli or delicate pseudopods.
The most helpful confirmatory finding is the detection of acid phosphatase isoenzymne 5 in the cytoplasm of suspected hairy cells by staining.
The enzyme concentrates primarily in golgi bodies and in the nuclear membrane and its staining is not inhibited by the addition of tartrate.
Stated in another way, hairy cells on the peripheral smears are detected by their staining positively for tartrate-resistant acid phosphatase.
Be suspicious of HCL if marrow resists aspiration-a consequence of reticulin fibrosis of the marrow in HCL.

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