The 8-month-old patient has had 4 skin abscesses in the past 3 months that have required draining. Each abscess drains less than 5 mL non-purulent fluid. The infant appears well otherwise and the parents deny respiratory infections. The infant’s complete blood count shows an elevated white blood cell count without bands or segmented cells. Immunoglobulin levels are appropriate for the age of the infant. The patient has a positive nitroblue test. The nurse plans care to include which intervention?

Question

The 8-month-old patient has had 4 skin abscesses in the past 3 months that have required draining. Each abscess drains less than 5 mL non-purulent fluid. The infant appears well otherwise and the parents deny respiratory infections. The infant&rsquo;s complete blood count shows an elevated white blood cell count without bands or segmented cells. Immunoglobulin levels are appropriate for the age of the infant. The patient has a positive nitroblue test. The nurse plans care to include which intervention?

Accepted Answer

Perform the necessary testing for a bone marrow transplant. The infant with frequent skin abscesses, leukocytosis, normal immunoglobulin levels, and a positive nitroblue test (which indicates normal action of the neutrophils) may have leukocyte-adhesion deficiency. In leukocyte-adhesion deficiency, the body recognizes an infection, increases production of white blood cells, but the white blood cells cannot leave the bloodstream to reach the skin to fight the infection. The only treatment (other than supportive therapy) is a bone marrow transplant. A granulocyte macrophage colony-stimulating factor is unhelpful because the body doesn&rsquo;t need to be stimulated to create more white blood cells from the defective cell lines. Broad spectrum antibiotics are helpful for treatment, but antivirals are unnecessary as the skin abscess is likely caused by Staphylococcus aureus. Providing teaching to the parents about the importance of bathing is less helpful than a bone marrow transplant.

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