306) A 32 year old man with history of immune thrombocytopenic purpura is evaluated in your office during a follow up visit. His previous treatments include intravenous immunoglobulin (IVIG) and steroids for his immune thrombocytopenia. He has responded to IVIG in the past however, the response was transient despite steroid maintenance. The patient was maintained on steroids for 2 months initially and achieved a sub-optimal response with peak platelet count reaching 30k/µl. He began very slow steroid taper over the last 4 weeks but his platelets have dropped to 8k/μl again during the taper. Hence, the patient is scheduled for Splenectomy. On examination, he has no bleeding or echymoses. Platelet count today is 10k/μl. Which of the following is the most appropriate step in preparing this patient for surgery?
A) Pneumococcal , Meningococcal and HIB vaccines 1 week prior to surgery
B) Pneumococcal and meningococcal vaccines 2 weeks prior to surgery
C) Pneumococcal, Menigococcal and HIB vaccines 2 weeks prior to surgery
D) Daily oral Penicillin Prophylaxis
E) No vaccines required in adults