FRCPath Haem Part 1 EMQs-Transfusion 06

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 (Microbiology). Too early for Granulocytes

I. Contraindicated due to risk outweighing benefit

J. Continue standard therapy without granulocytes

1

A 45-year-old man with ALL post-induction chemotherapy has persistent fever for 3 days. ANC is 0.2 ×10⁹/L. Blood cultures are negative. CT scan is normal. He is on broad-spectrum antibiotics and antifungals empirically. The team is considering early granulocyte transfusion “to prevent deterioration.” Answer:

2

A 64-year-old man with AML post induction has persistent neutropenia (ANC 0.1 ×10⁹/L) and worsening cellulitis with expanding erythema despite 4 days of appropriate IV antibiotics. Surgical review confirms progressive soft tissue infection. Neutrophil recovery is expected in ~5 days. Answer:

3

A 58-year-old woman with metastatic breast cancer develops chemotherapy-induced neutropenia (ANC 0.3 ×10⁹/L) and influenza A infection confirmed on PCR. She has no evidence of bacterial or fungal co-infection but is febrile. Answer:

4

A 67-year-old patient with MDS has prolonged neutropenia and invasive fungal infection. He is not currently receiving treatment due to poor performance status, but the team is considering restarting azacitidine if infection improves. Answer:

5

A 50-year-old man with AML in remission develops febrile neutropenia (ANC 0.4 ×10⁹/L) after chemotherapy. After 5 days of antibiotics, he is clinically stable but remains febrile. CT scan shows no focus, and cultures are negative. Answer: