Case Studies

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Case Study 10-1: Latex Allergy

M.R., a 36-year-old certified registered nurse anesthetist (CRNA), was diagnosed 7 years ago with latex allergy. She first noticed that she developed contact dermatitis when she wore powdered latex gloves. She soon developed tachycardia, hypotension, bronchospasm, urticaria, and rhinitis with contact or proximity to latex in surgery. She had one frightening episode of anaphylaxis. Her allergy is of the type I hypersensitivity, IgE T-cell-mediated latex allergy, which was diagnosed by both a radioallergosor-bent test (RAST) and a skin-prick test.

M.R. avoids all contact with any natural rubber latex in her home and at work. She can only work in a pediatric OR because they are latex-free, since many children with congenital disorders are latex allergic. She wears a medical alert bracelet, uses a bronchodilator inhaler at the first symptom of bron-chospasm, and carries a syringe of epinephrine at all times.

Case Study 10-2: Blood Replacement

C.L., a 16-year-old girl, sustained a ruptured liver when she hit a tree while sledding. Emergency surgery was needed to stop the internal bleeding. During surgery, the ruptured segment of the liver was

Case Studies, continued removed and the laceration was sutured with a heavy, absorbable suture on a large smooth needle. Before surgery, her hemoglobin was 10.2 g/dL, but the reading decreased to 7.6 g/dL before hemostasis was attained. Cell salvage, or autotransfusion, was set up. In this procedure, the free blood was suc-tioned from her abdomen and mixed with an anticoagulant (heparin). The RBCs were washed in a sterile centrifuge with NSS and transfused back to her through tubing fitted with a filter. She also received 6 units of homologous, leukocyte-reduced whole blood, 5 units of fresh frozen plasma, and 2 units of platelets. During the surgery, the CRNA repeatedly tested her Hgb and Hct as well as prothrombin time and partial thromboplastin time to monitor her clotting mechanisms.

C.L. is B positive. Fortunately, there was enough B-positive blood in the hospital blood bank for her surgery. The lab informed her surgeon that they had 2 units of B-negative and 6 units of O-negative blood, which she could have received safely if she needed more blood during the night. However, her hemoglobin level increased to 12 g/dL, and she was stable during her recovery. She was monitored for DIC and pulmonary emboli.

Case Study 10-3: Myelofibrosis

A.Y., a 52-year-old kindergarten teacher, had myelofibrosis that had been in remission for 25 years. She had seen her hematologist regularly and had had routine blood testing since the age of 27. After several weeks of fatigue, idiopathic joint and muscle aching, weakness, and a frightening episode of syncope, she saw her hematologist for evaluation. Her hemoglobin was 9.0 g/dL and her hematocrit was 29%. Concerned that she was having an exacerbation, her doctor scheduled a bone marrow aspiration, and the results were positive for myelofibrosis.

A.Y. went through a 6-month therapy regimen of iron supplements in the form of ferrous sulfate tablets and received weekly vitamin B12 injections. Interferon was given every other week in addition to erythropoiesis therapy, which was unsuccessful. She was treated for presumed aplastic anemia. During treatment, she developed splenomegaly, which compromised her abdominal organs and pulmonary function. She continued to lose weight, and her hemoglobin dropped as low as 6.0 g/dL. Weekly transfusions of packed RBCs did not improve her hemoglobin and hematocrit.

After a regimen of high-dose chemotherapy to shrink the fibers in her bone marrow and a splenec-tomy, A.Y. received a stem cell transplant. The stems cells were obtained from blood donated by her brother, who was a perfect immunologic match. After a 6-month period of recovery in a protected environment, required because of her immunocompromised state, A.Y. returned home and has been free of disease symptoms for over 1 year.

CASE STUDY QUESTIONS

Multiple choice: Select the best answer and write the letter of your choice to the left of each number.

_ 1. The natural latex protein in latex gloves may act as a(n):

a. antibody b. allergen c. lymphocyte d. purpura e. immunocyte

Case Studies, continued

2. Urticaria is commonly called:

a. rhinitis b. dermatitis c. hives d. ELISA

e. congenital

3. The cells involved in a T-cell-mediated allergic response are:

a. basophils b. monocytes c. antigen d. T lymphocytes e. B cells

4. Anaphylaxis, a life-threatening physiological response, is an extreme form of:

a. remission b. hypersensitivity c. hemostasis d. exacerbation e. homeostasis

5. The common name for epinephrine is:

a. heparin b. adrenaline c. cortisone d. apheresis e. antihistamine

6. The removal of part of the liver is called:

a. partial hepatectomy b. hepatomegaly c. resection of the liver d. a and b e. a and c

7. The unit for measurement of hemoglobin (g/dL) means:

a. grams in decimal point b. grains in a decathlon c. drops in 50 cc d. grams in 100 cc e. grains in deciliter

8. Heparin, an anticoagulant, is a drug that:

a. increases the rate of blood clotting b. takes the place of fibrin c. supports thrombin d. interferes with blood clotting e. makes blood thinner than water

Case Studies, continued

9. The RBCs were washed with NSS. This means: the _ were washed with a. reticulocytes, heparin b. red blood cells, nutritional solution c. red blood cells, normal salt solution (saline)

d. reticulocytes, normal salt solution (saline)

e. red blood cells, heparin

10. Autotransfusion is transfusion of autologous blood, that is, the patient's own blood. Homologous blood is taken from:

a. another human b. synthetic chemicals c. plasma with clotting factors d. an animal with similar antibodies as humans e. IV fluid with electrolytes

11. Patients who lose a significant amount of blood may lose clotting ability. Effective therapy in such cases would be replacement of:

a. IV solution with electrolytes b. iron supplements c. platelets d. heparin e. packed RBCs

12. C.L.'s blood type is B positive. The best blood for her to receive is:

a. positive b. negative c. AB positive d. B negative e. B positive

13. Myelofibrosis, like aplastic anemia, is a disease in which there is:

a. overgrowth of RBCs b. destruction of the bone marrow c. dangerously high hemoglobin and hematocrit d. absence of bone marrow e. lymphatic tissue in the bone marrow

14. Erythropoiesis is:

a. production of blood b. production of red cells c. production of plasma d. destruction of white cells e. destruction of platelets

Case Studies, continued

_ 15. The "ferrous" in ferrous sulfate represents:

a. electrolytes b. RBCs c. iron d. oxygen e. B vitamins

_ 16. Hemoglobin and hematocrit values pertain to:

a. leukocytes b. immune response c. granulocytes d. red blood cells e. fibrinogen

_ 17. Splenomegaly is:

a. prolapse of the spleen b. movement of the spleen c. enlargement of the lymph glands d. destruction of the bone marrow e. enlargement of the spleen

_ 18. The stem cells A.Y. received were expected to develop into new:

a. spleen cells b. bone marrow cells c. hemoglobin d. abdominal organs e. cartilage

_ 19. A.Y.'s health was compromised because the high-dose chemotherapy caused:

a. immunodeficiency b. electrolyte imbalance c. anoxia d. Rh incompatibility e. autoimmunity

Abbreviations. Define the following abbreviations:

20.

Ig

21.

Hgb

22.

Hct

23.

FFP

24.

PT

25.

PTT

Chapter 10 Crossword Blood and Immunity

Blood Crossword

ACROSS

DOWN

1.

Alternate name for antibody (abbreviation)

1.

Prefix meaning "not"

4.

Cold: prefix

2.

Fraction of the blood that contains antibodies:

6.

Chemical symbol for sodium

globulin

7.

Antibody (abbreviation)

3.

Common blood type system

9.

Bone marrow: combining form

4.

Blood clotting

11.

Oxygen-carrying pigment of red cells

5.

Prescription (abbreviation)

(abbreviation)

7.

Protein found in the blood

12.

Antigen (abbreviation)

10.

Potassium: combining form

14.

The substance that is deficient in cases of anemia

13.

Iron: combining form

17.

Most numerous type of white blood cell: combin-

14.

Blood: root

ing form

15.

Fluid that brings oxygen and nutrients to the cells

18.

Immature form of red blood cell: combining form

16.

New: prefix

20.

Type of widespread coagulation disorder

19.

Form of lymphocytic leukemia (abbreviation)

(abbreviation)

21.

Comprehensive blood study (abbreviation)

22.

Name used for a hereditary type of anemia

23.

A mineral found in the blood (root)

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