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  #1  
Old 09-03-2015
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Default Need help: NBME 16 Questions

1)A 29 yr old man who is being treated for Hodgkin's lymphoma receives a bone marrow transplant from his first cousin.Two weeks after the transplant he develops a generalized erythematous, maculopapular rash, diarrhoea and elevated conc of liver enzymes and bilirubin. No evidence of infection or drug reaction was found. Which of the following mechanisms is the most likely cause of these symptoms?
A)Donor macrophages secreting cytokines and affecting host cells
B)Donor plasma cells elaborating antibodies against host cells
C)Donor T-lymphocytes reacting against host cells
D)Host macrophages secreting cytokines and affecting donor cells
E)Host plasma cells elaborating antibodies against donor cells
F)Host T-lymphocytes reacting against donor cells



Isnt this "Acute" since its within weeks to months. Which makes it a T-cell response from the Host against Donor MHCs?

(I picked F) The answer is C? How?
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Old 09-03-2015
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Keyword here is "bone marrow" because its a source of mature T lymphocytes its always necessary to remove these cells before transplantation to avoid graft vs host disease in the recipient (from cousin to the patient in this case)

Mature T cells from the cousins bone marrow are transplanted and proceed to attack allogenic MHC bearing cells in the 29 yr old patient, thus causing all those symptoms.

Testing to avoid this could involve a One-way mixed lymphocyte response test.

Thanks for the review, good luck with the rest.
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Old 09-04-2015
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Quote:
Originally Posted by khobts22 View Post
Keyword here is "bone marrow" because its a source of mature T lymphocytes its always necessary to remove these cells before transplantation to avoid graft vs host disease in the recipient (from cousin to the patient in this case)

Mature T cells from the cousins bone marrow are transplanted and proceed to attack allogenic MHC bearing cells in the 29 yr old patient, thus causing all those symptoms.

Testing to avoid this could involve a One-way mixed lymphocyte response test.

Thanks for the review, good luck with the rest.


Sorry but I still don't understand how this isn't "acute"

And isn't graft vs host dependent on antibody formation
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Old 09-04-2015
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Quote:
Originally Posted by jawbreaker13o View Post
Sorry but I still don't understand how this isn't "acute"

And isn't graft vs host dependent on antibody formation

Thats just the thing, it is an acute reaction, just not the one one you are thinking, like i said, keyword is "bone marrow" which is packed with mature T cells from the donor. Any website has info on graft vs host, here's an example http://www.cancerresearchuk.org/abou...s-host-disease
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Old 09-04-2015
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Quote:
Originally Posted by jawbreaker13o View Post
Sorry but I still don't understand how this isn't "acute"

And isn't graft vs host dependent on antibody formation
When you transplant something rich in lympphtocytes like bone marrow or liver then there will be a graft vs host reaction.. The grafed tissue will attack the host

It's different that the "acute transplant rejection" .. In the sense because its "bone marrow" and not any other tissue lile kidney or heart in which case u WOULD have acute if its between 2weeks-6months
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