[b]A 56-year-old white executive is admitted to the hospital from the emergency department following a severe nosebleed. One month ago he had a brief viral illness after being exposed to an exanthem eruption of one of his grandchildren. At that time the patient was also referred to a urologist because of fatigue, low back pain, and urinary frequency. He was diagnosed with prostatitis, for which he has been taking sulfamethoxazole-trimethoprim for the past 12 days. He does not take any other medications. On arrival in the emergency department vital signs were: temperature 36.8°C (98.2°F), pulse 100/min, respirations 16/min, and blood pressure 120/66 mm Hg. The patient appeared pale with scattered areas of bruising on his limbs and body and a few petechiae. No lymphadenopathy or organomegaly was found. Results of laboratory studies obtained in the emergency department are shown: [/b]

Blood
Urine
Hematocrit 21%
WBC 0/hpf
Hemoglobin 5.6 g/dL
RBC 10-20/hpf
WBC 2000/mm3
MCV 102 μm3
Partial thromboplastin time 26 sec
Platelet count 20,000/mm3
Prothrombin time 12.8 sec
INR 1.3

Bone marrow biopsy shows marked hypocellularity.
Item 1 of 2

25. Which of the following is the most appropriate management?

A) Administer granulocyte colony-stimulating factor
B) Administer high-dose short-term corticosteroids
C) Administer parenteral broad-spectrum antibiotics
D) Begin transfusion with whole blood
[E) Discontinue sulfamethoxazole-trimethoprim]

Item 2 of 2

26. Supportive measures are provided for the patient.

Which of the following is the most appropriate treatment recommendation for this patient at this time?

A) Chemotherapy
[B) Follow-up evaluation in 1 week]
C) Glucocorticoid therapy
D) Hematopoietic growth factor therapy
E) Stem cell transplant