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A 3-year-old child was admitted to the pediatric ward complaining of dizziness and fatigue. The patient also has a history of anemia. A complete blood count (CBC) was performed, and the results showed mild leukocytosis of 17 and anemia with a hemoglobin (Hb) level of 5.43.

The *CBC RESULTS*
WBC 17.0 10e3/mL
NEU 10.2 103/mL 59.8.%
LYM 4.92 10e3mL 29.0.%
MONO 1.16 10e3/mL 6.84.%
EOS 0.575 10e3/mL 3.38 %
BASO .066 10e3/Ml 0.39 %

RBCs 2.50 10e6/mL
HGB 5.43 g/dl
HCT 16.5 %
MCV 65.9 fl
MCH 21.7 pg
MCHC 32.9 g/dl
RDW 17.7

PLT 281 10e3/mL
MPV 10.4 fl

The peripheral blood smear results
🩸 RBCS; Microcytic hypochromic with majority blister cells, bite cells, ovalocytes, fragmentocytes, Polychromasia, Howell joly bodies and basophilic stippling were seen🩸
WBCs; normal in morphology.
🩸 PLTs; Normal in morphology

What is your Suggestive diagnosis.
1. Iron deficiency anemia
2. G6PD deficiency
3. Vitamin B12/ folate deficiency
4. other diagnosis.... suggest

Hairy cell leukemia
Definition, histopathology and peripheral smear

Definition
Hairy cell leukemia (HCL) is a rare, indolent lymphoproliferative neoplasm of mature B cells with a distinct clinical presentation that includes peripheral blood cytopenias, splenomegaly and a small number of circulating neoplastic cells with hair-like cytoplasmic projections.

Histopathology
Extensive marrow fibrosis as demonstrable by reticulin stain; however, neoplastic hairy cells, as described in the peripheral blood description, can be seen. (first image)

Peripheral smear
Pancytopenia with rare hairy cells that are medium in size with moderately abundant pale blue cytoplasm, reniform nuclei, open chromatin, absent nucleoli and a characteristic serrated cytoplasmic border. (last three images)