Splenic Red Cell Pooling in Hairy Cell Leukaemia

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Abstract
The splenic red cell volume was measured directly by an isotope method with quantitative scanning in 10 patients with leukemic reticuloendotheliosis (hairy cell leukemia). The volume ranged between 211 and 726 ml (mean 410 ml, SD 158) and this constituted 15-48% (mean 28.1%, SD 9.5) of the total circulating red cell volume. This is an exceptionally large pool when compared with that found in myeloproliferative and lymphoproliferative disorders with the same degree of splenomegaly. It is consistent with the histological features which show marked red cell accumulation in the splenic cord areas. Red cell pooling in the spleen thus appears to be a significant factor in anemia, and there was fairly good correlation between the percentage of improvement in anemia and the percentage of red cell volume contained in the spleen. By direct measurement of the splenic red cell pool, it is possible to predict the extent to which splenectomy will benefit anemia and this may also provide an indirect measure of the extent of bone marrow dysfunction in the causation anemia.