Question 1

All of the following are features of CLL except:

Accepted Answer

Chronic Lymphocytic Leukemia (CLL) is characterized by the accumulation of monoclonal B lymphocytes, not polyclonal cells. This means that the lymphocytes are all clones of a single parent cell, which is a hallmark of CLL and differentiates it from conditions where polyclonal proliferation occurs.

Question 2

The final diagnosis of any lymphoproliferative disorder encompasses clinical data obtained from __________ analysis.

Accepted Answer

The final diagnosis of any lymphoproliferative disorder encompasses clinical data obtained from morphologic, histologic, and immunologic analysis. Morphology provides information on the appearance and characteristics of the cells, while histology helps in identifying the tissue architecture and pattern. Immunophenotyping helps in determining the lineage and subtype of the cells, as well as assessing the expression of various markers. Therefore, a comprehensive evaluation that includes all three types of analysis is necessary for an accurate diagnosis.

Question 3

What age group does CLL primarily affect?

Accepted Answer

CLL primarily affects individuals over the age of 50. It is rare in younger individuals and most commonly diagnosed in older adults.

Question 4

Diagnosis of CLL can be confirmed immunologically by the use of monoclonal antibodies that detect __________ antigens.

Accepted Answer

CLL can be confirmed immunologically by the use of monoclonal antibodies that detect specific cell surface antigens, known as cluster differentiation (CD) antigens. These antigens are used to identify and classify different types of leukocytes. The most commonly used CD antigens for CLL diagnosis are CD5, CD19, CD20, and CD23.

Question 5

Clinical features of CLL include all of the following except:

Accepted Answer

Thrombocytosis is not a clinical feature of CLL. The other options are commonly seen in CLL.

Question 6

What is the classification of anemia in CLL?

Accepted Answer

Anemia in Chronic Lymphocytic Leukemia (CLL) is typically normocytic/normochromic, which means the red blood cells are of normal size and color, indicating a normal concentration of hemoglobin within the cells. This type of anemia is often caused by the disease itself through bone marrow infiltration or by autoimmune destruction of red blood cells.

Question 7

A cell that could suggest that lymphocytes in CLL are not normal is a:

Accepted Answer

A smudge cell, also known as a basket cell or a "smear" cell, is a fragile lymphocyte that has ruptured during the preparation of a blood smear. Smudge cells are commonly seen in patients with chronic lymphocytic leukemia (CLL) and their presence suggests that the lymphocytes in the patient's blood are not normal. The other choices, lymphoblasts and monoblasts, are not specific to CLL and can be seen in other types of leukemia or lymphoma.

Question 8

CLL has been known to occur simultaneously with what hematologic disorder?

Accepted Answer

The answer of CLL has been known to occur simultaneously...

Question 9

The laboratory test for detecting minimal residual disease in patients who have previously been treated for CLL but currently lack histopathologic evidence of relapse is the:

Accepted Answer

PCR is a sensitive laboratory technique that allows for the detection of small amounts of DNA, making it useful for detecting minimal residual disease. CBC and differential and electrophoresis are not specific tests for detecting CLL and are not sensitive enough for detecting minimal residual disease.

Question 10

In CLL, all of the following might result from the autoimmune phenomenon except:

Accepted Answer

Thalassemia is not a known manifestation of CLL-related autoimmune phenomenon. Autoimmune hemolytic anemia, ITP, and immune neutropenia are all known complications of CLL.

Question 11

What is meant by monoclonality?

Accepted Answer

Monoclonality refers to the presence of only one type of light chain (either kappa or lambda) in a sample of plasma cells or antibodies. This is important in the diagnosis of certain lymphoid neoplasms, where the presence of a monoclonal population of cells indicates a malignant process.

Question 12

Which morphologic factors distinguish the lymphocytes of CLL from normal mature lymphocytes?

Accepted Answer

The exaggerated nuclear chromatin is one of the most distinguishing morphologic factors of CLL lymphocytes compared to normal mature lymphocytes. CLL lymphocytes also have a higher N/C ratio, but this is not as specific as the exaggerated nuclear chromatin. Nucleoli and secondary granules are not typically present in CLL lymphocytes.

Question 13

Required hematologic findings for a diagnosis of CLL include:

Accepted Answer

The required hematologic findings for a diagnosis of Chronic Lymphocytic Leukemia (CLL) include having at least 5000/µL lymphocytes in the peripheral blood and at least 30% lymphocytosis in the bone marrow.

Question 14

What are the consequences of the accumulation of the lymphocytes in the peripheral blood and bone marrow in a patient with CLL?

Accepted Answer

The accumulation of lymphocytes in the peripheral blood and bone marrow in a patient with CLL can lead to suppression of normal blood cell production, resulting in neutropenia (low white blood cell count), anemia (low red blood cell count), and thrombocytopenia (low platelet count). Therefore, all three options (A, B, and C) are correct, and the answer is D.

Question 15

Autoimmune hemolytic anemia in CLL is characterized by the following:

Accepted Answer

Autoimmune hemolytic anemia in CLL is characterized by all of the following: a positive direct Coombs' test, increased indirect serum bilirubin, and reticulocytosis. The direct Coombs' test detects the presence of antibodies or complement proteins attached to the surface of red blood cells, indicating an autoimmune response. The increase in indirect serum bilirubin is due to the breakdown of red blood cells, and reticulocytosis is an increase in the number of immature red blood cells being produced by the bone marrow in response to the anemia.

Question 16

In CLL there is a malignant proliferation of which cell?

Accepted Answer

CLL stands for chronic lymphocytic leukemia which is a type of leukemia involving the abnormal proliferation of B lymphocytes. Therefore, the correct answer is A) B lymphocytes.

Question 17

Immune dysfunction within proliferating B cells of CLL is indicated by:

Accepted Answer

Immune dysfunction within proliferating B cells of CLL is indicated by hypogammaglobulinemia and monoclonal gammopathy.

Question 18

Which immunologic technique is helpful in detecting very small numbers of malignant cells or amplifying gene rearrangements in malignant clones?

Accepted Answer

PCR (polymerase chain reaction) technology is highly sensitive and can amplify small quantities of DNA from a sample, including gene rearrangements in malignant cells. This makes it a powerful tool for detecting very small numbers of malignant cells in a sample, even when they are present in very low levels. Monoclonal and polyclonal antibodies can be used to target specific antigens on malignant cells, but they may not be as sensitive as PCR in detecting low levels of cells. DNA probes can also be used to detect specific DNA sequences, but they are not as flexible or widely applicable as PCR technology.

Question 19

Suppression of all classes of immunoglobulin is evident in CLL, resulting in:

Accepted Answer

The answer of Suppression of all classes of immunoglobulin is...

Question 20

The demonstration of SIg (surface immunoglobulin) is the classic marker for __________.

Accepted Answer

SIg (surface immunoglobulin) is a B cell receptor for antigen recognition and its demonstration is a classic marker for B cells. T cells do not express surface immunoglobulin and null cells and NK cells do not have B cell receptors.

Quiz 20: Chronic Lymphocytic Leukemia and Related Lymphoproliferative Disorders