A 52-year-old woman with long-standing seropositive RA inadequately controlled on methotrexate 20 mg/week develops Felty's syndrome. Which haematological finding is characteristic of Felty's syndrome?

• A Thrombocytosis
• B Eosinophilia
• C Polycythaemia
• D Neutropenia ✓

Explanation

Felty's syndrome is the triad of seropositive RA, splenomegaly, and neutropenia (ANC < 2000/µL). It occurs in fewer than 1% of RA patients, typically with severe, long-standing seropositive disease. Neutropenia predisposes to recurrent infections. Thrombocytosis is seen in active inflammation but not specific to Felty's. Eosinophilia can be an extra-articular feature of RA but is not part of Felty's triad.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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