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A 44 year old person presented with C/O lymphadenopathy. O/E he had generalized lymphadenopathy and no organomegaly. Peripheral smear analysis showed lymphocytosis and smudge cells. Which of the following is the next step in diagnosis?
A. Lymph node biopsy B. Flow cytometry
C. BM examination D. Genetic analysis
Correct Answer - B
Explanation
The clinical presentation described here, including generalized lymphadenopathy, absence of organomegaly, lymphocytosis, and smudge cells, is strongly suggestive of Chronic Lymphocytic Leukemia (CLL).
Here's an analysis of the options:
A. Lymph node biopsy: Though this might provide some useful information, it's not typically the first next step in diagnosing CLL. Other tests can confirm the diagnosis without the need for an invasive procedure like a biopsy.
B. Flow cytometry: This is the correct answer. Flow cytometry is used to identify and characterize the clonal B-cell population in CLL. It examines the surface markers on the lymphocytes and helps confirm the diagnosis, making it an essential step in the diagnostic workup of suspected CLL.
C. BM examination: Bone marrow examination might be performed at some point in the diagnostic workup or staging of CLL but is not usually the next step after finding the clinical features described.
D. Genetic analysis: While genetic analysis can provide additional information about the prognosis and specific genetic mutations associated with CLL, it is typically performed after confirming the diagnosis, not as a next step after clinical presentation.
So, the correct answer is B. Flow cytometry. The identification of clonal B-cell population with characteristic surface markers, such as CD5, CD19, CD20, and CD23, is critical for confirming the diagnosis of CLL. This test is non-invasive compared to a lymph node biopsy and more directly applicable to the suspected diagnosis compared to bone marrow examination or genetic analysis.