Counsel a family on rituximab-related secondary hypogammaglobulinaemia and prophylaxis — OSCE

Candidate brief

You have eight minutes to counsel the parents of a six-year-old girl whose immunoglobulins have fallen after rituximab for nephrotic syndrome and who has had recent chest infections. The secondary immunodeficiency is iatrogenic and may be reversible. Use a structured, honest, empathic approach. [2] [1]

Key teaching and communication objectives

Acknowledge and validate the parents' fear before delivering information. Explain that "secondary immunodeficiency" means her immunity has been temporarily affected by a treatment, not that she was born with a permanent immune condition, and that the affected cells usually recover over many months. [2] [3]

Explain the next steps in plain language: confirm whether the low level is causing real infection susceptibility with a functional vaccine response and a careful infection history, because immunoglobulin replacement is decided by infection burden, not by the number alone. Address the online concern honestly: some forms of low antibody are permanent, but rituximab-related depletion usually recovers as B cells return, so a lifelong commitment is not assumed. [1] [3]

Describe the protection plan: prompt treatment of any new infection, consideration of antibiotic prophylaxis if infections continue, and safe vaccination (she can have her routine inactivated vaccines, but live vaccines are held while her immunity is suppressed, and her household contacts stay fully up to date). [1]

Close with a shared plan and a clear next appointment, framed around surveillance as her B cells recover, and an offer of written information and contact with a patient-support organisation. [2]