Haematology: CLL complication: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: CLL complication

Sample item

A 68-year-old man with known chronic lymphocytic leukaemia has new fatigue and jaundice. Haemoglobin has fallen from 12 to 7.5 g/dL, reticulocytes are 9 percent, the smear shows spherocytes and the direct Coombs test is positive for IgG. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Warm autoimmune haemolytic anaemia complicating CLL

Autoimmune haemolytic anaemia, usually of the warm IgG type, is a recognised complication of CLL, and the high reticulocyte count, spherocytes and positive Coombs test establish it. Treatment is with corticosteroids, and treatment of the underlying CLL if needed. Pure red cell aplasia also occurs in CLL, but reticulocytes are very low.

Option by option

  • A. Marrow replacement by leukaemic cells

    Marrow infiltration gives a low reticulocyte count with a leukoerythroblastic or cytopenic picture.

  • B. Richter transformation to diffuse large B-cell lymphoma

    Richter transformation presents with rapid node growth, fever and raised LDH, not primarily with Coombs-positive haemolysis.

  • C. Pure red cell aplasia

    Pure red cell aplasia gives a very low reticulocyte count and a negative Coombs test.

  • D. Warm autoimmune haemolytic anaemia complicating CLL (correct)

    Correct. Reticulocytosis, spherocytes and IgG on red cells establish immune haemolysis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Warm autoimmune haemolytic anaemia complicating CLL. Autoimmune haemolytic anaemia, usually of the warm IgG type, is a recognised complication of CLL, and the high reticulocyte count, spherocytes and positive Coombs test establish it.

Why is "Marrow replacement by leukaemic cells" not the answer?

Marrow infiltration gives a low reticulocyte count with a leukoerythroblastic or cytopenic picture.

Why is "Richter transformation to diffuse large B-cell lymphoma" not the answer?

Richter transformation presents with rapid node growth, fever and raised LDH, not primarily with Coombs-positive haemolysis.

Why is "Pure red cell aplasia" not the answer?

Pure red cell aplasia gives a very low reticulocyte count and a negative Coombs test.

What concept does this question test?

It tests Haematology: CLL complication in Pathology. Treatment is with corticosteroids, and treatment of the underlying CLL if needed. Pure red cell aplasia also occurs in CLL, but reticulocytes are very low.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: CLL complication?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.