岚哥岚嫂说病例第2季第05期（解析部分）

岚哥岚嫂说病例第2季第05期（病例部分）

岚哥英文解析

The patient presents with increasing several fatigue, night sweat, nonproductive cough and bruises on extremities without injuries. Lab exmination indicates low RBC, PLT and anemia. Physical examination shows hepatosplenomegaly without lymphsdenopathy.

According to the symptoms and clinical manifestations, we know something wrong in his blood system. The most likely diagnosis is leukemia. But what kind of leukemia ?

Peripheral blood smear reveals irregular nuclei and cell membranes, as well as cytoplasmic projections.

That is the specific cytomorphological present of acute hairy cell leukemia, a rare malignancy of B-lymphocytes. Patients generally present with the symptoms of pancytopenia, namely fatigue, easy bruising,and recurrent infection, as well as splenomegaly (and hepatomegaly in 50% of patients).

Mycobacterial infections are common due to a striking monocytopenia that is nearly universal in these patients.

There is a problem:why not operate bone marrow smear? Because you will get nothing, which is another specific indication of hairy cell leukemia, because of reticular fiber dysplasia in his bone marrow.

Splenomegaly caused by infiltration of the red pulp by these cells,so the splenicstomy is the initial treatment.

More than 90% of patients will live longer than 10 years with treatment.

本病例由岚哥岚逸筠篁解析。