NBME 21 Granulocyte colony-stimulating factor (NBME Answers)

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Retired NBME 21 Answers

nbme21/Block 3/Question#38 (reveal difficulty score)
A 28-year-old man develops a temperature of ...
Granulocyte colony-stimulating factor 🔍 / 📺 / 🌳 / 📖
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submitted by ∗yotsubato(1208)

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The patient has Neutropenic fever. GSCF will restore his neutrophils.

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yotsubato His RBC and platelets are low, but at acceptable levels for someone undergoing chemotherapy. +22

fatboyslim Plus you can always give someone RBCs and platelets, but you can't give them WBCs, so you aim to up their WBCs count via GCSF +

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submitted by ∗rainlad(33)

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would we be worried about using G-CSF given that he has acute leukemia? would it stimulate growth of his cancer cells?

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suckitnbme I think we're assuming that we eradicated the leukemia with the chemo. However at the same time a lot of normal stem cells were also killed off so we give GCSF to help recovery especially since they have an infection. +1

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submitted by ∗haliburton(224)

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I chose G-CSF because the granulocytes seemed to me more of a risk than the moderate anemia. Erythropoietin seems like an appropriate choice as well but G-CSF more critical.

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kentuckyfan I think it's also because he has an infection (since he was prescribed antibiotics) boosting the immune system is more important than increasing platelet count E) or RBC count A) +6

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submitted by ∗anjum(36)

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EPO --> RBC's

TPO (romiplostim --> Platelets

G-CSF (filgrastim)--> Myeloblasts (neutrophil, basophil, eosinophil)

INFy --> granulomas

IL-8 --> neutrophil chemotaKxis

As @yotsubato mentioned, pt has neutropenic fever. That is priority for someone undergoing chemo.

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djeffs1 I just didn't know which was more important, fixing his low hemoglobin or his leukopenia +

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