This patient was diagnosed with hairy cell leukemia after the above workup and began treatment with Cladribine. After 3 months, his splenomegaly has resolved, however, his labs are as follows:

Admission:  WBC 1.4 (ANC 100), HGB 4.6, PLT 21

One month after Cladribine initiation:  WBC 0.4 (ANC 100), HGB 8.9, PLT 43

Three months after Cladribine treatment:  WBC 0.6 (ANC 430), HGB 11.9, PLT 78

As you can see, his anemia and thrombocytopenia have improved; however, his neutropenia has been persistent, despite G-CSF support. Due to this persistence, he underwent a repeat Bone marrow biopsy 3 months after initial treatment, which showed residual disease:

The patient was started on Rituximab.

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