Unfortunately on day four of PEX the platelet count falls to 19, LDH rises and he spikes a temperature.  Antibiotics for presumed sepsis are started.  PEX is increased to BD with no improvement in platelet count and he starts to become confused again.  Steroids are re-started and PEX is continued BD.

Questions:

Rituximab has been mentioned by the team.  Is this everyone’s first line?  What abor ciclosporin or vincristine?

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