Educational Pearls (last week)

Good afternoon all, here are some points from our last academic activity entitled (The Immunocompromised Patient):

  • There are 2 types of immunity: innate which does not need previous exposure and acquired (adaptive) immunity which needs pervious antigen exposure .

 

  • The stem cell of bone marrow contains 3 times the number of WBC found in the circulation .

 

  • Pregnancy causes immunosuppression .

 

  • Cyclosporine is metabolized by cytochrome P-450, so try to avoid prescribing any medication that shares the same enzyme for metabolism, for example, a concomitant macrolide can cause hepatotoxicity or even rejection .

 

  • Corticosteroids:
    1. May cause change in WBC count as early as 6 hours from administration.
    2. Any abdominal pain in a patient who is on corticosteroid should be taken seriously and needs to be investigated for serious complications  such as perforated viscous and intra-abdominal abscess.
    3. Sutured wounds in patients on corticosteroids need double the time to heal (it affects healing).

 

  • Febrile Neutropenia:     ANC = WBC count * ((PMNs/100) + (Bands/100)).

Initiation of monotherapy with an anti-pseudomonal beta-lactam agent, such as cefepime, meropenem, imipenem/cilastatin or piperacillin-tazobactamCeftazidime monotherapy has also been shown to be as effective as other regimens .

  • HIV-positive patients: if CD4 is below 200 then this patient needs a prophylactic antibiotic for PCP.

 

  • 30% of elderly patients with infection will present without fever. Thus, absence of fever does not rule out infection.

 

  • 89% of elderly patients coming with fever will have an infection. (so deal with fever seriously in this group of patients).

One thought on “Educational Pearls (last week)”

  1. Thanks Muhammad!
    Great examples…
    Immunosuppression is not simply a reduction in WBC count. It is a deficiency of any of the following:
    -neutropenia
    -T cells
    -humoral immunity eg. B cell, antibodies, plasma cells
    -asplenia
    -complement

    That’s why for example a sickler who has functional asplenia is immunocompromised even with a normal WBC count, or in AIDS we look at the CD4 count and not the WBC count.
    Good job

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