Haematology: hairy cell leukaemia: 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.

Try it

Pathology · Haematology: hairy cell leukaemia

Sample item

A 55-year-old man has pancytopenia and massive splenomegaly without lymphadenopathy, and marrow aspiration gives a dry tap. Flow cytometry shows CD25 and CD103 positive B cells with cytoplasmic projections that stain tartrate-resistant acid phosphatase positive. What is the drug of choice?

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

The answer and the reasoning

C. Cladribine

Hairy cell leukaemia is an indolent B-cell neoplasm with a BRAF V600E mutation. The cells infiltrate the marrow and red pulp of the spleen, causing pancytopenia and splenomegaly. Purine analogues, most commonly cladribine, produce long remissions and are first-line.

Option by option

  • A. Hydroxyurea

    Hydroxyurea is a cytoreductive drug used in polycythaemia vera, sickle cell disease and CML, not first-line for this disease.

  • B. Imatinib

    Imatinib is used for BCR-ABL positive chronic myeloid leukaemia and is not effective here.

  • C. Cladribine (correct)

    Correct. Cladribine, a purine analogue, induces durable remission in most patients.

  • D. All-trans retinoic acid

    All-trans retinoic acid treats acute promyelocytic leukaemia with PML-RARA.

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.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Cladribine. Hairy cell leukaemia is an indolent B-cell neoplasm with a BRAF V600E mutation.

Why is "Hydroxyurea" not the answer?

Hydroxyurea is a cytoreductive drug used in polycythaemia vera, sickle cell disease and CML, not first-line for this disease.

Why is "Imatinib" not the answer?

Imatinib is used for BCR-ABL positive chronic myeloid leukaemia and is not effective here.

Why is "All-trans retinoic acid" not the answer?

All-trans retinoic acid treats acute promyelocytic leukaemia with PML-RARA.

What concept does this question test?

It tests Haematology: hairy cell leukaemia in Pathology. The cells infiltrate the marrow and red pulp of the spleen, causing pancytopenia and splenomegaly. Purine analogues, most commonly cladribine, produce long remissions and are first-line.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: hairy cell leukaemia?

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.