MCQ#01
CORRECT OPTION 'D'
Explanation:
This patient's history and presentation are consistent with sickle cell anemia complicated by an acute bacterial infection. We can assume he has sickle cell anemia based upon his anemia with a high reticulocyte count, previous admissions for pain, hematuria, and ethnicity. Patients with sickle cell anemia become functionally hyposplenic at an early age due to splenic auto-infarction. Thus, they are more susceptible than other patients to infection with encapsulated organisms, such as S. pneumoniae, H. influenzae, and N. meningitidis. Vaccination with the conjugated S. pneumoniae vaccine decreases the incidence of invasive infections caused by this organism. Twice daily administration of prophylactic penicillin should also be given to children with sickle cell disease until they reach five years of age.
(Choice A) Folic acid supplementation has often been recommended for patients
suffering from sickle cell anemia. This practice has recently come into question over fears that folic acid supplementation may conceal vitamin 812 deficiency. However, regardless of this controversy, folic acid administration would not have prevented this patient's infection.
(Choice B) The common vaccinations of childhood that use live attenuated viruses are those for measles, mumps, rubella, and chicken pox.
(Choice C) The common vaccinations of childhood that use bacterial toxoids include tetanus and diphtheria. This patient is not presenting with signs or symptoms consistent with tetanus or diphtheria.
(Choice E) Periodic blood transfusions do not decrease the incidence of infection in patients with sickle cell anemia.
Educational Objective:
Pneumococcal vaccination plus penicillin prophylaxis can prevent almost all cases of pneumococcal sepsis in patients with sickle cell anemia.
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