Paeds SAQs · allergy-and-immunology
Secondary immunodeficiency — formative SAQs
Formative SAQs on recognising secondary immunodeficiency, sorting the cause into the six mechanism-based categories, linking cause to immune arm to organism to prophylaxis, applying the five-step management ladder, and deciding who needs immunoglobulin replacement.
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SAQ 1 (10)
A seven-year-old boy with acute lymphoblastic leukaemia, day twelve of induction chemotherapy, presents with fever of 39 °C. His absolute neutrophil count is 0.2 × 10⁹ per litre. He looks flushed and tachycardic but is normotensive. [1] [4]
a) Define secondary immunodeficiency and state why this child is immunodeficient. (2 marks) [1]
b) Outline your immediate management, including the timing of key interventions. (3 marks) [1] [4]
c) Explain how the cause predicts the infecting organism, giving the predicted organism class for chemotherapy-induced neutropenia. (2 marks) [1]
d) Describe the prophylaxis and vaccination principles that belong in his long-term plan as he proceeds through treatment. (3 marks) [4] [1]
You have read the opening of this SAQ. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.
References5Show ledgerHide ledger
- [1]Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol, 2010.PMID 20042227
- [2]Tuano KS, Seth N, Chinen J. Secondary immunodeficiencies: An overview. Ann Allergy Asthma Immunol, 2021.PMID 34481993
- [3]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
- [4]Maertens J, Cesaro S, Maschmeyer G, et al. ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother, 2016.PMID 27550992
- [5]Lee GM. Preventing infections in children and adults with asplenia. Hematology Am Soc Hematol Educ Program, 2020.PMID 33275684