Explaining SCID and the transplant urgency — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the clinic. A six-week-old boy has been referred because his newborn screening dried blood spot returned a low T-cell receptor excision circle (TREC) result. Flow cytometry confirmed a T⁻B⁺NK⁻ pattern and genetic testing confirmed an IL2RG mutation — X-linked severe combined immunodeficiency (SCID). He is clinically well and feeding normally. ^[1]

Your tasks are: ^[2]

1. Explain to the parents what SCID is and why it is a medical emergency, in language they can understand. ^[2]
2. Explain the protections you are putting in place — no live vaccines, irradiated blood products, prophylaxis, immunoglobulin — and why they matter. ^[9]
3. Explain the transplant and why it must happen before infection, and what the expected outcome is. ^[2]
4. Address the mother's fear that her son will die and the father's belief that the family history is just coincidence. ^[1]

You are not expected to organise the donor search or the conditioning regimen in the station, but you should name them as the next steps and explain what they involve. ^[10]