In case there are doubts about the presence of hairy cell leukemia then the doctor would be observant for the following three signs:

• Spleen enlargement.
• Lower count of all the types of blood cells.
• Presence of hairy cell leukemia in the blood.

In order to look out for these indicators the doctor would carry out several tests and examinations that would comprise of:

• Physical Examination
  The doctor would palpate the ellipsoidal-shaped organ placed to the left side of the upper part of the abdomen to check whether there is any kind of enlargement. An enlargement in the spleen could lead to feeling full in the abdomen that could cause discomfort during eating. The doctor might additionally look out for any enlargement in the lymph nodes that could point to the presence of cancer.
• Blood Analysis
  The blood sample collected is tested for CBC or complete blood count for gauging the blood count as those individuals with hairy cell leukemia have depleted counts of all kinds of blood cells namely red blood cells, white blood cells and platelets. Another type of blood test known as peripheral blood smear is conducted for checking the presence of hairy cell leukemia cells in the blood sample.
• Biopsy of the bone marrow
  During the course of a bone marrow biopsy, a minuscule quantity of bone marrow is extracted from the hip region. This sample is analysed for the presence of hairy cell leukemia and for keeping a watch on the normal, healthy blood cells.
• Computerised Tomography or CT or CAT scan
  A CAT scan reveals in-depth imagery of the internal parts of the body. The doctor would recommend undergoing a CAT scan for detecting whether the spleen and lymph nodes are having any kind of enlargement.

Possible Complications:

Hairy cell leukemia has a slow progression rate and at times, stay stabilised for several years. Hence due to this aspect there are fewer complications occurring. But, when not treated, hairy cell leukemia could advance and cause grave complications, like:

• Susceptibility to infection
  Depleted white blood cell count could make one more vulnerable to infections as the body’s infection combating capability is hindered due the presence of the disease.
• Easy Bruising and Blood clotting Problems
  Lowered platelet count could obstruct blood clotting. Hence, in case one is having a slightly lower platelet count, then one might observe being bruised more easily. Depleted platelet count could lead to unprompted blood loss from the nose or the gums.
• Low Haemoglobin Count
  A sapped red blood cell count would translate to lesser presence of cells for transporting oxygen all through the body leading to anemia that is known to cause immense weariness.
• Splenic Burst or Rupture
  A ruptured spleen could turn out to be a life-threatening situation the needs urgent surgical intervention for removal of the spleen. Hairy cell leukemia could inundate the spleen leading to its enlargement. Ultimately, the surplus cells lead to the spleen rupturing; however this kind of complication is quite atypical.

Physical Examination

During the course of the physical examination, the body is checked for overall health condition inclusive of looking for signs of any ailment like lumps or any dubious appearance. The patient’s history is probed to identify health habits, any previous asbestos exposure, past infirmity and treatments undergone.

Chest X-ray

An x-ray is an energy shaft that could pass via the body and onto film, capturing images of inner organs and bones of the body. The chest x-ray is performed for obtaining x-rays of the organs and bones within the chest region.

Complete Blood Count or CBC

A procedure involving the withdrawal of a blood sample to check for the below stated:

• The red blood cells (RBC), white blood cells (WBC) and platelets count.
• The haemoglobin (the oxygen-carrying protein) content in the red blood cells.
• The part of the blood sample that constitute the red blood cells.

Sedimentation Rate

During the procedure the blood sample drawn is evaluated for the settling rate of the red blood cells to the base of the test tube.

Biopsy

The extraction of cells or tissues is done from the pleura or peritoneum to be sent for microscopic analysis for spotting malignant growth. Procedures employed for collection of tissue or cell samples involve the following:

Fine-needle aspiration (FNA) biopsy of the lung

With the guidance offered by the imaging procedure, through a small incision done on the skin, a fine needle is passed for drawing out tissue or fluid samples from dubious or abnormal tissues or fluid accumulation in the lung.

Thoracoscopy

Through a small slit made in the inter-rib area, a thoracoscope – a fine, tubular illuminated device fixed with a viewing lens is inserted within the chest.

Peritoneoscopy

A tiny opening made on the abdominal wall is made thorough which a slender, tube-alike, light and lens fitted device is passed into the abdomen.

Laparotomy

Through a small cut made in the abdominal wall, the interiors of the abdomen are examined for any presence of disease.

Thoracotomy

An inter-rib slit is done for observing the chest interiors for presence of ailment.

Bronchoscopy

In this procedure the interiors of the trachea and the large air passages in the lung are examined for irregular growths. With the assistance of a bronchoscope (a slender, tubular, illuminated and lens-attached device) passed nasally or orally into the trachea and lungs for viewing and removal of tissue samples to be analysed microscopically for cancer signs.

Cytologic examination

In case of mesothelioma, the fluid build-up in the region around the lungs or abdominal region is drawn to be forwarded to the pathologist for microscopic analysis for checking the cells present in the fluid.

The tests and procedures comprise of:

• Physical examination – An examination of the body is done for checking the presence of any indications of disease like formations of lumps or any irregular finding. The patient’s past health patterns and history of ailments are also delved in detail.
• CBC  or Complete blood count – During this procedure, the blood sample is taken and scanned for:
  • The amount of red blood cells (RBC), white blood cells (WBC) and platelets.
  • The haemoglobin content (the protein carrying oxygen) in the RBCs.
  • The part of the blood sample comprising of RBCs.
• Blood chemistry studies – During this procedure, the blood sample is analysed for checking the quantity of particular substances like LDH or lactate dehydrogenase that is produced by the organs and tissues in the body. An abnormal (elevated or depleted level than normal) amount of certain substances could be an indicator of a disease in that particular organ or tissue that constitutes it.
• Sedimentation rate – The rate of settling of the RBCs to the base of the test tube is known as the Sedimentation rate. A blood sample needs to be drawn for this procedure.
• X-ray – A form of energy ray that could pass via the body and onto film producing images of the interiors of the body.
• Magnetic resonance imaging or MRI – In this procedure also known as NMRI (Nuclear magnetic resonance imaging) a magnet, radio waves and a computer is employed for developing a sequence of comprehensive images of locations within the body.
• CT or CAT scan – In this procedure also known as computed/ computerized/computerized axial tomography, a sequence of in-depth pictures of the interiors of the body are shot from varied angles by employing a computer connected to an x-ray machine. A dye might be either intravenously administered or swallowed so that the organs or tissues could appear more distinctly in the scan.
• Bone marrow aspiration and biopsy procedure – During aspiration, the bone marrow, blood and a tiny part of the bone is removed by introducing a fine, hollow needle within the hipbone following which samples are drawn that are sent for microscopic analysis for checking for any indications of cancer.
• Bone Scan – A procedure for checking the presence of rapidly proliferating cells like the cancer cells in the bone. An infinitesimal amount of radioactive material is intravenously administered which passes through the blood stream and finally accumulating in the bones which can be diagnosed by a scanner.
• PET or Positron emission tomography scan – A procedure for detecting malignant tumor cells in the body by using a small quantity of radioactive glucose or sugar that is intravenously administered. The rotary motion of the PET scanner around the body produces simultaneous images of locations where glucose is getting utilised in the body. Malignant or cancerous growths appear brighter in the PET scans as they are increasingly active and taking up major amounts of glucose as compared to normal cells would usually do.