In a medical-surgical unit, which patient is at the greatest risk for infection?

• A. Patient with shingles
• B. Patient with pancytopenia
• C. Patient with viral pneumonia
• D. Patient with cellulitis

Answer: (B)

The main idea is that infection risk rises most when the immune system is severely suppressed, especially when white blood cell counts are very low. Pancytopenia means a deficiency of all three blood cell lines, and the critical piece here is the low white blood cells, particularly neutrophils, which are the body’s primary defense against bacteria and fungi. When neutrophils are scarce, the patient can’t mount an effective response to even minor pathogens, making infections far more likely and potentially more serious.

Shingles represents reactivation of a latent virus and, while it can be contagious and painful, it doesn’t inherently indicate the same level of systemic immune impairment as profound neutropenia. Viral pneumonia is an established infection; it requires treatment but doesn’t reflect a predisposition to acquire new infections at the same high level as severe neutropenia. Cellulitis is a localized bacterial infection; it signals a problem at the skin level but not the broad, systemic vulnerability that pancytopenia creates.

So, the patient with pancytopenia has the greatest risk for infection because the severely reduced neutrophil count severely compromises the body’s ability to fight off pathogens. This patient would require precautions to reduce infection risk and close monitoring for fever or new infections.