A 66-year-old man found to have a WBC of 28,000/uL with mature lymphocytosis is examined. He has palpable cervical and axillary lymph nodes and a spleen palpable 3 cm below the costal margin. Hemoglobin is 13.2 g/dL and platelet count is 190,000/uL. According to the Rai staging system, what is his stage?
- A Stage 0
- B Stage II ✓
- C Stage I
- D Stage III
Correct answer: B. Stage II
Explanation
Rai staging progresses from lymphocytosis alone (stage 0), to lymphadenopathy (stage I), then organomegaly with or without lymphadenopathy (stage II), then anemia (stage III), then thrombocytopenia (stage IV). This patient has lymphocytosis with both lymphadenopathy and splenomegaly but normal hemoglobin and platelets, placing him at stage II. Stage I requires nodes without hepatosplenomegaly, and stage III requires hemoglobin below 11 g/dL.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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