FRCPath Haem Part 1 EMQs-Transfusion 05

Theme: Granulocyte Transfusion

Options (Each option may be used once, more than once, or not at all)

A. Start granulocyte transfusion immediately

B. Do not give granulocytes – infection not refractory

C. Not indicated – no expectation of neutrophil recovery

D. Consider granulocytes after further optimisation

E. Indicated due to neutrophil functional defect

F. Not indicated – infection type inappropriate

G. Needs MDT discussion with Microbiology and NHSBT about Prophylactic Granulocytes

H. Seek specialist discussion but unlikely to proceed

I. Contraindicated due to risk outweighing benefit

J. Continue standard therapy without granulocytes

1.

A 46-year-old man with newly diagnosed AML is on day 14 following induction chemotherapy. His neutrophil count has been persistently <0.1 ×10⁹/L. He developed fever on day 5 and was started on piperacillin-tazobactam, escalated to meropenem and vancomycin due to persistent fevers. Liposomal amphotericin B was started 4 days ago. The treating team expects neutrophil recovery within 7–10 days. Answer:

2.

A 72-year-old woman with relapsed AML has declined further chemotherapy and is receiving best supportive care. She presents with neutropenic sepsis (ANC 0.2 ×10⁹/L) and blood cultures grow ESBL-producing E. coli. She is started on meropenem and shows partial haemodynamic improvement after 48 hours, but remains febrile. The ICU team asks whether granulocyte transfusions may improve survival. Answer:

3.

A 28-year-old man with chronic granulomatous disease presents with fever, pleuritic chest pain, and multiple pulmonary nodules. He has a normal neutrophil count (5.0 ×10⁹/L), but oxidative burst testing confirms defective neutrophil function. Despite 7 days of appropriate antifungal and antibacterial therapy, he continues to deteriorate clinically with enlarging lesions on CT. Answer:

4.

A 61-year-old patient with MDS is receiving azacitidine. He develops neutropenia (ANC 0.4 ×10⁹/L) and fever. Chest X-ray shows right lower lobe consolidation. He is started on IV antibiotics and improves clinically over 72 hours, with defervescence and improving inflammatory markers, although neutropenia persists. Answer:

5.

A 53-year-old woman undergoing consolidation chemotherapy for AML previously had invasive pulmonary aspergillosis during induction. She is now planned for further intensive chemotherapy. The team is concerned about recurrence of fungal infection during the upcoming period of expected prolonged neutropenia and considering Granulocytes as prophylaxis. Answer: