Clinical Manifestations

About 25 percent of patients present with fatigue, 25 percent with repeated infections, and 25 percent with splenomegaly, which in a minority of patients may be massive, or with cytope-nias41 (Table 8-1). In 102 newly diagnosed HCL patients, 86 had anemia, 84 thrombocytopenia, and 78 neutropenia.42 Splenomegaly was present in 93 patients. Hepatomegaly is present in 20 percent of patients. Although peripheral adenopathy is rarely found clinically, less than 10 percent of patients have peripheral lymphadenopathy larger than 2 cm; now with the frequent use of computed tomographic (CT) scans in the initial evaluation, internal lymphadenopathy is increasingly recognized. Of 43 consecutive patients studied with CT scans, 6 (14 percent) had significant internal adenopathy; 3 had massive abdominal adenopathy (larger than 10 cm), and 1 had bulky adenopathy (5 to 10 cm).43 Hairy cell leukemia is typically associated with leukopenia, but up to 20 percent of patients may develop a leukemic phase,44 and 10 percent may present without discernible circulating hairy cells on light microscopy. Other laboratory findings may include liver function test

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