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Hematology


Answer 1
  1. Admit the patient to the hospital for administration of IV antibiotic drugs, blood and platelet transfusions, and a bone marrow biopsy. This patient requires urgent management of 2 potentially life-threatening conditions. First, he needs inpatient management for neutropenic fever (defined as an ANC < 1000 cells/µL and a temperature ≥ 100.5°F). Patients with neutropenic fever should be hospitalized and given IV antibiotic drugs to cover gram-negative bacteria, particularly Pseudomonas aeruginosa. Single-agent empiric antimicrobial agents (eg, cefepime, meropenem/imipenem, piperacillin/tazobactam) can be administered because of their anti-pseudomonal activity. Second, this patient’s severe thrombocytopenia requires urgent treatment. Spontaneous bleeding can occur in patients with a platelet count less than 10,000 cells/µL, and patients with mucosal bleeding are at higher risk for severe bleeding. Therefore, a platetet transfusion is required in this case, and given his profound anemia and tachycardia, a blood transfusion should be considered as well. During hospitalization, results of the peripheral smear can be reviewed and red blood cell transfusion and a bone marrow biopsy can be performed. Given this patient’s leukopenia, blood products should be irradiated, filtered, and cytomegalovirus-safe to prevent transfusion-associated graft-versus-host disease (GVHD).

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