FRCPath Haem Part 1 MCQ-Gen Haem 444

A 68-year-old man is reviewed in a haematology clinic. Ten years previously he underwent splenectomy for splenic involvement by a low-grade B-cell lymphoma. He completed post-splenectomy vaccinations at the time of surgery and has remained clinically well. His current medications include phenoxymethylpenicillin 250 mg twice daily.

He is planning a 3-month trip to sub-Saharan Africa. Blood film examination demonstrates Howell-Jolly bodies, target cells and occasional Pappenheimer bodies. The trainee suggests that because the splenectomy occurred more than 10 years ago and the patient has remained infection-free, antibiotic prophylaxis can safely be discontinued.

Which ONE of the following is the most appropriate management recommendation according to current BSH guidance?

A. Discontinue antibiotic prophylaxis because infection risk is highest only during the first 3 years after splenectomy

B. Continue lifelong antibiotic prophylaxis because he is high risk

C. Stop antibiotic prophylaxis but administer MenACWY and Hib boosters before travel;

D. Continue antibiotic prophylaxis only during travel; routine rescue antibiotics are unnecessary because he has remained infection-free for 10 years.

E. Discontinue prophylaxis and perform annual blood films to assess splenic recovery before deciding on future vaccinations.