Screening is one way to detect hairy cell leukemia (HCL) at the earliest possible point, when options for treatment and cure are best. Screening exams can sometimes even detect the disorder before any symptoms even arise.

Hairy Cell Leukemia Tests

To test for hairy cell leukemia (HCL), your OSUCCC – James experts may conduct a variety of tests, including:

Physical Exam

During a physical exam, your doctor may be able to feel a swollen spleen or liver. Your doctor may also find enlarged lymph nodes or skin changes from low blood counts. You may need a CT scan or ultrasound to better evaluate these changes.

Blood Tests

A small amount of blood can be used to detect low levels of certain blood cells or abnormal ratios of blood cells that indicate HCL. Laboratories also can analyze blood to determine whether certain substances, such as proteins and hormones, released by the body’s tissues and organs indicate disease.

Peripheral Blood Smear

Blood cells can be analyzed in the laboratory to identify the hairy cells that indicate HCL, along with changes to shapes in blood cells.

Bone Marrow Aspiration & Biopsy

During a bone marrow aspiration, your OSUCCC – James specialist will insert a hollow needle into a piece of hip bone to remove a small sample of liquid bone marrow.

For a bone marrow biopsy, a hollow needle is inserted into a piece of hip bone to collect a small sample of bone and marrow.

Flow Cytometry

Once blood and bone marrow samples are collected, experts treat the cells from those samples with special antibodies (artificial proteins), then passed before a laser beam. If substances matching the antibodies are on the sample cells, they will stick to the antibodies, and this helps identify and count the cells in the blood or bone marrow to identify the characteristic hairy cells.

Cytogenetic Analysis

Cytogenetic analysis identifies abnormal chromosomes (where genes are) that contribute to developing leukemia. Identifying these abnormalities can help the OSUCCC – James subspecialists decide the very best kind of personalized treatment for an HCL patient. This testing can also identify genetic mutations that are involved in the disease. Recently, investigators have identified that the majority of patients with HCL have a mutation of a specific gene (called the BRAF gene).  


This process identifies cells based on the kind of specific markers (genetic and molecular identifiers) on the surface of the cells. Immunophenotyping may include special staining of the blood cells.

If you’ve been diagnosed with hairy cell leukemia, would like a second opinion or would like to speak with a leukemia specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

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The James Cancer Hospital and Solove Research Institute

460 West 10th Avenue

Columbus, Ohio 43210