FRCPath Haem Part 1 MCQs-Gen Haem 504

A 68-year-old man underwent splenectomy 6 years ago for primary myelofibrosis. He subsequently underwent allogeneic haematopoietic stem cell transplantation and remains on immunosuppression for chronic graft-versus-host disease.

He has no history of invasive pneumococcal disease. His vaccination records confirm previous pneumococcal vaccination with PPV23, MenACWY and MenB, and he receives annual influenza vaccination. He takes daily oral penicillin prophylaxis but has not been prescribed rescue antibiotics. He presents to the emergency department with a temperature of 38.7°C, rigors and rapidly worsening malaise.

His blood pressure is 96/58 mmHg, heart rate 118/min and lactate 3.2 mmol/L. He has no localising symptoms. His blood film shows Howell–Jolly bodies.

Which is the single most appropriate management and long-term preventive strategy?

A. Give oral amoxicillin, arrange outpatient review and discontinue penicillin because he has completed more than 5 years of prophylaxis.

B. Administer parenteral antibiotics and admit urgently; continue lifelong antibiotic prophylaxis, prescribe rescue antibiotics for future emergencies.

C. Give parenteral antibiotics and admit, but stop prophylaxis permanently because previous pneumococcal vaccination provides adequate long-term protection.

D. Give rescue oral antibiotics and observe for 4 hours; arrange pneumococcal antibody titres before deciding whether admission is necessary.

E. Admit and administer parenteral antibiotics, but discontinue prophylaxis after recovery because the highest infection risk occurs within the first 3 years after splenectomy.