American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is a common indication for splenectomy in patients with chronic lymphocytic leukemia (CLL)?

Cachexia associated with chemotherapy
Marked splenomegaly or profound cytopenias
Presence of mediastinal mass
Non-responsiveness to pain management

The correct answer is: Marked splenomegaly or profound cytopenias

A common indication for splenectomy in patients with chronic lymphocytic leukemia (CLL) is marked splenomegaly or profound cytopenias. In CLL, the spleen often becomes enlarged due to the accumulation of malignant lymphocytes. This splenomegaly can lead to significant complications, including splenic sequestration of blood cells, which contributes to cytopenias—conditions in which there are lower than normal levels of red blood cells, white blood cells, or platelets. Removing the spleen can alleviate symptoms associated with these complications and improve the patient's blood counts. Additionally, splenectomy may provide relief from symptoms related to splenomegaly, such as discomfort or fullness in the abdomen. Therefore, this situation represents a clear and justifiable reason for considering a splenectomy in a patient with CLL.