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Table 1 Timeline of case report

From: Neutropenia caused by hairy cell leukemia in a patient with myelofibrosis secondary to polycythemia vera: a case report

Date Summaries of visits and treatments Diagnostic testing
1995 Polycythemia vera
Phlebotomy
Hb 22.2 g/dl, Hct 0.64, WBC 10.1 × 109/L, TPK 162 × 109/L
2008 Stable Hb
Phlebotomy stopped
Hb 13.3 g/dl
2009 Mouth ulcers, prednisolone without effect Mouth biopsy showed “acute and chronic inflammation.”
March 2012 Leukopenia, thrombocytopenia Bone marrow biopsy showed fibrosis grade 1, “spent phase” polycythemia vera; in retrospect, also hairy cell leukemia.
Hb 13.2 g/dl, WBC 2.7 × 109/L, neutrophils 1.4 × 109/L, monocytes 0.1 × 109/L, lymphocytes 1.20.1 × 109/L, TPK 102 × 109/L
April–May 2013 Worsening of leukopenia, thrombocytopenia
Temporary effect of filgrastim on neutrophils and partly on mouth ulcers
Bone marrow biopsy: increased cellularity and fibrosis grade 2–3; in retrospect, also hairy cell leukemia
Hb 11.6 g/dl, WBC 2.4 × 109/L, neutrophils 1.1 × 109/L, monocytes 0.1 × 109/L, lymphocytes 1.20.1 × 109/L, TPK 98 × 109/L
April 2014 Myelofibrosis
Pancytopenia
Bone marrow biopsy with fibrosis grade 3, osteosclerosis; in retrospect, also AML and hairy cell leukemia
Complex cytogenetics
Hb 9.7 g/dl, WBC 2.3 × 109/L, neutrophils 0.8 × 109/L, monocytes < 0.1 × 109/L, lymphocytes 1.40.1 × 109/L, TPK 41 × 109/L
May–August 2014 Repeated hospitalizations with febrile neutropenia
Thalidomide and prednisolone without effect
 
October 2014 Cladribine, temporary effect Bone marrow biopsy with suggested AML and hairy cell leukemia
March 2015 Death  
  1. Abbreviations: Hb Hemoglobin, Hct Hematocrit, TPK Platelet count, AML Acute myeloid leukemia, WBC White blood cells