DISCUSSION OF CASE STUDY 5.2
Peter has most likely had an anaphylactic shock reaction to the wasp sting.
It is possible that he has been stung previously, but the speed of the collapse
and the symptoms look likely to be due to a severe Type I hypersensitivity.
Peter should be treated as a medical emergency. Signs of cardiac arrest need
to be checked and Peter needs to be given intramuscular adrenaline. He
would be advised to carry an adrenaline ‘gun’ in future.
DISCUSSION OF CASE STUDY 5.3
The tiredness, cold intolerance, weight gain and goiter all point towards an
autoimmune disease of the thyroid. Tests to confirm this diagnosis would
include an indirect immunofluorescence test on her serum, to demonstrate
autoantibodies to thyroid antigens. ELISA tests would demonstrate antibodies
to thyroglobulin, and a biopsy of her thyroid would show infiltration of the
tissue with small lymphocytes. If confirmed, Jane should be treated with
thyroxine to replace the deficiency caused by her autoimmune thyroiditis.
CHAPTER 6
DISCUSSION OF CASE STUDY 6.1
Given Maria is blood group O, she has anti-A antibodies in her plasma.
These will destroy any fetal erythrocytes that enter her circulation. Thus
she is unlikely to become sensitized and there is little chance of her baby
developing hemolytic disease of the newborn. As Marie has never become
sensitized despite several pregnancies, it is likely that each previous fetus
was O negative, A negative or A positive. An O negative fetus would not
sensitize Marie as the Rh group is identical to hers. If a fetus was A negative,
Marie would not become sensitized, and any A cells would be destroyed
immediately by the Anti-A in her plasma. Similarly, any A positive cells would
be destroyed before Marie could be sensitized to the Rh antigen. Marie is
only likely to become sensitized, following the birth of the present fetus, if
that fetus is O positive.
DISCUSSION OF CASE STUDY 6.2
There are two approaches that could be made. First, John should be
tissue typed and a search made on any available bone marrow registries.
Alternatively, John could have an autologous transplant, with tumor cells
eliminated from the bone marrow prior to reinfusion. John would avoid any
likelihood of GVHD with this procedure.
DISCUSSION OF CASE STUDY 6.3
Michael has probably suffered a transfusion related acute lung injury (TRALI),
possibly caused by antileukocyte antibodies in the transfused plasma. This
should not be confused with an anaphylactic reaction (Chapter 5), which
would also cause respiratory distress, but where pulmonary edema would
not be expected.
CHAPTER 7
DISCUSSION OF CASE STUDY 7.1
Sarah could be suffering from some form of diabetes. However, her symptoms
of frequent thirst and urination are not due to diabetes mellitus because of
absence of glycosuria. The clinical features together with a finding of a raised
plasma osmolality combined with a dilute urine, suggests diabetes insipidus.
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