Counsel a family on rituximab-related secondary hypogammaglobulinaemia and prophylaxis — OSCE

OSCE communication and shared-planning station: explaining secondary immunodeficiency arising from a biologic (rituximab) given for nephrotic syndrome, why immunoglobulin replacement is driven by infection burden rather than a single low number, the role of antimicrobial prophylaxis and safe vaccination, and the generally good prognosis with consistent follow-up — while addressing fear and avoiding the over-treatment trap.

osce communication and shared decision-making1 min readVerification in progress

Prompt

The parents of a six-year-old girl treated with rituximab for frequently-relapsing nephrotic syndrome have been told her immunoglobulins are now low and she has had two chest infections in three months. They are frightened the treatment has 'destroyed her immune system', worried that she will need immunoglobulin for life, and confused about what 'secondary immunodeficiency' means. They have read online that low antibodies can be permanent. Counsel them.

Candidate brief

You have eight minutes to counsel the parents of a six-year-old girl whose immunoglobulins have fallen after rituximab for nephrotic syndrome and who has had recent chest infections. The secondary immunodeficiency is iatrogenic and may be reversible. Use a structured, honest, empathic approach. ^[2] ^[1]

References3Show

[1]Otani IM, Lehman HK, Jongco AM, et al. Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report. J Allergy Clin Immunol, 2022.PMID 35176351
[2]Chan EY, Yap DY, Colucci M, et al. Use of Rituximab in Childhood Idiopathic Nephrotic Syndrome. Clin J Am Soc Nephrol, 2023.PMID 36456193
[3]Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol, 2010.PMID 20042227

Counsel a family on rituximab-related secondary hypogammaglobulinaemia and prophylaxis — OSCE

osce communication and shared decision-making1 min readVerification in progress

Candidate brief

References3Show

[1]Otani IM, Lehman HK, Jongco AM, et al. Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report. J Allergy Clin Immunol, 2022.PMID 35176351
[2]Chan EY, Yap DY, Colucci M, et al. Use of Rituximab in Childhood Idiopathic Nephrotic Syndrome. Clin J Am Soc Nephrol, 2023.PMID 36456193
[3]Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol, 2010.PMID 20042227