Further Inpatient Care
- Admission is mandatory for patients with serious life-threatening infections. Patients need cultures and parenteral antibiotics.
- Acknowledge the possibility of infection with encapsulated organisms because splenomegaly may be a marker for a dysfunctional reticuloendothelial system incapable of clearing these organisms. Staphylococcus aureus, streptococcal species, and gram-negative rods are potential infecting organisms.
Further Outpatient Care
- Schedule patients with Felty syndrome for regular follow-up with a rheumatologist to monitor therapy and to assess progress.
- No firm guidelines address immunization practice in patients with Felty syndrome, but ensuring vaccination against encapsulated organisms seems prudent.
Complications
- Life-threatening infection
- Toxicity due to immunosuppressive regimens
- Portal hypertension and gastrointestinal bleeding due to nodular regenerative hyperplasia of the liver
Prognosis
- Granulocytopenia is defined as an absolute neutrophil count (ANC) of less than 2000/µL, and the infection risk increases as the ANC drops. Infection incidence increases significantly when the polymorphonuclear leukocyte (PMN) count is less than 1000/µL.
- Lymphoproliferative malignancies were more prevalent in a retrospective study of male patients with Felty syndrome treated at the Department of Veterans Affairs. In particular, the patients had an increased prevalence of non-Hodgkin lymphoma.[11]
Patient Education
- Educate patients with Felty syndrome about the warning signs of infection and ensure that they have ready access to medical care.
- Some practitioners supply patients with Felty syndrome with a broad-spectrum oral antibiotic to take at the first signs of a bacterial infection. Instruct patients that this is an individualized decision and advise them to contact their physician immediately if such a situation develops.
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