A 68-year-old man has an absolute lymphocyte count of 26,000/µL with a typical CLL immunophenotype. Examination shows a spleen palpable 4 cm below the left costal margin and no peripheral lymphadenopathy. Hemoglobin is 13.2 g/dL and platelet count is 190,000/µL. According to the Rai staging system, what is his stage?

• A Stage II ✓
• B Stage I
• C Stage 0
• D Stage III

Explanation

Rai staging progresses from lymphocytosis alone (stage 0), to lymphadenopathy (stage I), to splenomegaly or hepatomegaly (stage II), then anemia (stage III), and finally thrombocytopenia (stage IV). This patient has lymphocytosis with splenomegaly but preserved hemoglobin and platelets, placing him at stage II, an intermediate-risk category. Stage I requires nodes, and stage III requires hemoglobin below 11 g/dL, neither of which is present here.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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