Follow Up After one month , you see the patient in follow up. She is according t
ID: 3509205 • Letter: F
Question
Follow Up After one month , you see the patient in follow up. She is according to your prescribed taper. She complains of difficulty sleeping and says that she broke up with her boyfriend because of marked irritability. She is extremely unhappy with the side h effects of the prednisone. On exam, she has gained 10 kg and appears Cushingoid. She now has facial acne. A few bruises are noted over the anterior tib present. Her platelet count in the office is 12,000, liver function tests are normal; and HIV antibody is negative. ial areas and a few palatal petechiac are What therapy would be appropriate at this time? Select all that apply. Increase the steroid dose Administer intravenous immunoglobulin Administer anti-RhD immunoglobulin Cyclophosphamide Splenectomy Plasmapheresis Rituximab munize the patient against pneumococcal pneumonia Thrombopoietin receptor agonistsExplanation / Answer
Answer:- Increase the steroid dose.
The patient is suffering from side effects of prednisone. The side effects observed in the patient though major are not severe. The platelet count of the patient is 12000, which is well below normal lower level of 150,000. The lowering of platelet count may occur because body’s immune system mistakenly destroys the platelets. Prednisone can help in boosting the platelet count by suppressing the immune system.
Thus, the tapering dose of prednisone might have caused decrease in the platelet count. Also, as the patient is not suffering from any hepatic side effects, the increase in the dose of prednisone is advisable.
Once the platelet count has been restored, the dose of the steroid can be tapered underperoidic observation.
Note:- Since the question does not include the condition (cancer, infection, rheumatism, organ transplant etc) for which the patient was treated before the follow-up and why prednisone was started, the use of other drugs such as cyclophosphamide, rituximab or administration of intravenous immunoglobulin cannot be answered.
Also, splenectomy is the major surgery, which leaves the patient highly immunocompromised. As no mention in the question about spleen cancer or any other underlying condition for that matter, splenectomy is not an option.