Clinical Scenario:
A 7-year-old boy with steroid-dependent nephrotic syndrome has been receiving oral cyclophosphamide for 8 weeks. He is in remission and is asymptomatic. Routine investigations show:
Total leukocyte count: 2.1 × 10⁹/L
Absolute neutrophil count (ANC): 700/µL
What is the most appropriate management?
A. Continue cyclophosphamide
B. Stop cyclophosphamide
C. Increase prednisolone dose
D. Start G-CSF and continue cyclophosphamide
E. Switch to tacrolimus immediately
Correct Answer & Explanation:
Correct answer : B Stop cyclophosphamide
Cyclophosphamide-induced neutropenia requires immediate discontinuation of the drug. Blood counts should be monitored until recovery, and the patient should be advised to seek urgent care if fever develops. Routine G-CSF is not indicated in an asymptomatic child, and alternative immunosuppressive therapy should be considered only after recovery.
This style is more appropriate for postgraduate examinations, where the clinical scenario is detailed but the options are brief and focused.
