Question

A 64-year-old female diagnosed with B-cell lymphoma is to start on combination chemotherapy with rituximab. Besides the lymphoma, the only medical condition the patient has is osteoporosis. Her pre-treatment lab values and Hepatitis B serology testing results are below: 

WBC: 5.1 × 109 cells/L (ref. 4.5 - 11 × 109/L) 

Hgb: 11.2 g/dL (ref. 12.1-15.1 g/dL) 

Creatinine clearance: 40 mL/min (ref. > 60 mL/min) 

Alanine transaminease ("ALT"): 35 IU/L (ref. 10-40 IU/L) 

Hepatitis B surface antigen ("HBsAg"): (-) 

Hepatitis B surface antibody (“Anti-HBs"): (-) 

Hepatitis B core antibody (“Anti-HBc"): (+) 

a) Please describe to the patient her Hepatitis B serology results and any suggestions you may have regarding her Hepatitis B status. (6 marks) 

b) The oncologist is also prescribing tenofovir for this patient along with her cancer treatment. Please state the rationale for doing this. 

(5 marks) 

c) For the tenofovir prescription, please indicate whether the tenofovir alafenamide ("TAF") or the tenofovir disoproxil ("TDF") form is more suitable for this patient, and why. (4 marks) 

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