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Introduction: Plasma cell leukemia (PCL) is a rare and clinically aggressive form of plasma cell dyscrasia. Despite the significant role of BRAF mutation in plasma cell neoplasms, this mutation has been rarely considered in these cases. Finding evidence guiding us toward assessing the BRAF mutation in patients with plasma cell neoplasms could help make the suitable decision for targeted therapy. Case Presentation: A 79-year-old man presented with leukocytosis. Peripheral blood smear exhibited marked lymphocytosis and infiltration of about 50% abnormal lymphoid cells with slender cell-surface projections and oval shape nucleus. These findings raised the provisional diagnosis of hairy cell leukemia (HCL) or HCL variants (HCL-v). Molecular analysis confirmed the presence of BRAFV600E mutation, which was in agreement with HCL diagnosis, albeit the flow cytometric assessment of abnormal lymphocytes corroborated PCL. Conclusions: Together with the previous comprehensive analysis regarding the association of cytoplasmic projections and BRAF mutations, our findings could suggest this morphological characteristic in plasma cells (PCs) as an indication for the assessment of BRAF V600E mutation in PC dyscrasias.

Background Peripheral blood smear examination is an invaluable laboratory test which provides the complete hematologic and/or non-hematologic picture of a case. In addition to verifying the results of automated cell counters, it has the potential to identify some pathologic morphologic changes that remain hidden using the cell counters alone. Case presentation A 40-year-old man with a 3 year history of alcohol intake and marijuana abuse presented with severe lower extremities bone pain and abdominal pain. Physical examination showed high blood pressure, high pulse rate and abdominal tenderness. He underwent extensive laboratory and imaging tests, and cholecystectomy and bone marrow study, without any definite diagnosis or improvement. Right after all these invasive, expensive and time consuming investigations during a month, finding a point on the peripheral blood smear by an expert led to the final diagnosis. The finding was coarse basophilic stippling in the red blood cells. Elevated blood lead level and the presence of ring sideroblast in the bone marrow study confirmed the diagnosis of lead poisoning and the patient responded well to chelator therapy in a short period. Conclusion This case clearly shows the value of peripheral blood smear review and its impact on the patient care. In order not to lose the cases, laboratories are recommended to design their own policy for peripheral blood smear review. Peripheral blood smear is the fastest, simplest, and most available screening test which could prevent many misdiagnoses and malpractices. It provides rich morphological information, among which basophilic stippling is highly suggestive of lead poisoning.

Background. Peripheral blood smear examination is an invaluable laboratory test, which provides the complete hematologic and/or nonhematologic picture of a case. In addition to verifying the results of automated cell counters, it has the potential to identify some pathologic and morphologic changes that remain hidden using the cell counters alone. Case Presentation. A 40-year-old man with a three-year history of alcohol intake and marijuana abuse presented with severe lower extremities of the bone and abdominal pain. Physical examination showed high blood pressure, high pulse rate, and abdominal tenderness. He underwent extensive laboratory and imaging tests, and cholecystectomy and bone marrow studies were associated with no definite diagnosis. Right after all these invasive, expensive, and time-consuming investigations during a month, finding coarse basophilic stippling in the red blood cells in the peripheral blood smear by an expert led to the final diagnosis. Elevated blood lead level and the presence of ring sideroblasts in the bone marrow study confirmed the diagnosis of lead poisoning, and the patient responded well to chelator therapy in a short period. Conclusion. This case clearly showed the value of peripheral blood smear review and its impact on patient care. In order not to lose the cases, laboratories are recommended to design their own policy for peripheral blood smear review. The peripheral blood smear is the fastest, simplest, and most available screening test, which can prevent many misdiagnoses and malpractices. It provides rich morphological information, among which basophilic stippling is highly suggestive of lead poisoning.