A 64-year-old man with seropositive rheumatoid arthritis has persistent neutrophil count of 900/µL and moderate splenomegaly. Peripheral blood shows large granular lymphocytes that are CD3+, CD8+, CD57+, and T-cell receptor alpha-beta positive, with clonal TCR gene rearrangement. Which complication is this patient particularly predisposed to develop?

• A Pure red cell aplasia due to parvovirus B19 infection
• B Hemolytic anemia from warm-reactive IgG autoantibodies
• C Progression to acute promyelocytic leukemia within 2 years
• D Neutropenic infections and aplastic anemia associated with clonal cytotoxic T-cell expansion ✓

Explanation

T-cell large granular lymphocyte leukemia is an indolent clonal expansion of cytotoxic CD8-positive T cells, strongly associated with rheumatoid arthritis, and presents with chronic neutropenia, splenomegaly, and sometimes pure red cell aplasia. The neutropenia results from Fas ligand mediated suppression of myeloid precursors, leading to recurrent bacterial infections. Parvovirus-associated PRCA is a differential cause of anemia here, not the characteristic complication of the clone itself.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.