Sickle cell anemia (hemoglobin SS) status post haploidentical bone marrow transplant

A 17-year-old female with sickle cell anemia (hemoglobin SS) status post haploidentical bone marrow transplant from her biological mother 48 days prior and on tacrolimus for GVHD prophylaxis presented with acute onset expressive aphasia with associated drooling and dysphagia upon waking up from a 4-hour nap. After she arrived at the medical center, a stroke alert was activated. She scored 4 on the NIH stroke scale for her severe expressive aphasia and dysarthria. The mother denied any recent history of infection, chills, fever, loss of consciousness, or head trauma

Results

a) Discontinuation of tacrolimus Tacrolimus serum concentration was found high in this patient at 19.3 ng/ml (ref 9-12 ng/ml) for which tacrolimus was discontinued. She was neurologically back at baseline 2 days later with the tacrolimus level improving to 8.2 ng/mL. Following discontinuation and the declining trend of her tacrolimus levels the patient returned to her neurologic baseline and was subsequently switched to mycophenolate mofetil for GVHD immunosuppression

a) Discontinuation of tacrolimus

Tacrolimus serum concentration was found high in this patient at 19.3 ng/ml (ref 9-12 ng/ml) for which tacrolimus was discontinued. She was neurologically back at baseline 2 days later with the tacrolimus level improving to 8.2 ng/mL. Following discontinuation and the declining trend of her tacrolimus levels the patient returned to her neurologic baseline and was subsequently switched to mycophenolate mofetil for GVHD immunosuppression

#1. What should be the further course of intervention for this patient?

Discontinuation of tacrolimus

Discontinuation of tacrolimus

Admisinstration of adalimumab

Admisinstration of adalimumab

Administration of busulphan

Administration of busulphan

Both b and c

Both b and c

Finish