Approach to immunocompromised patients

Causes:

• Congenital

• Acquired

Age

Immunosuppressive medication

Malignancy

• Hodgkin's disease
• Chronic lymphocytic leukemia
• Multiple myeloma
• Solid tumors
  

Microbial infection

• HIV, AIDS
• Measles
  

Disorder of biochemical haemostasis

• Diabetes mellitus
• Renal insufficiency/dialysis
• Hepatic insufficiency/cirrhosis
• Malnutrition

Other

• Stress
• Asplenia/hyposplenism

General Recommendation for the care of the transplant recipient:

Immunization and prophylaxis

• Yearly influenza and pneumovax vaccine every 5 years
• PCP prophylaxis if necessary

Cancer Surveillance

• Male - Prostrate cancer screening
• Female - Mammogram, Pap smear yearly
• Both - Colonoscopy in patients over 50 years and annual dermatology screening

Cardiovascular

• Aggressive risk factors modification
• Aspirin unless contraindicated

Bone disease

• Calcium and vitamin D supplementation
• DEXA scan within 6 mths of transplantation and then yearly