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  #1  
Old 02-22-2011
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Blood No Blood Transfusion Reaction!

An 82 y/o woman with blood group A inadvertently receives blood group B blood. She does not develop a hemolytic transfusion reaction. This is most likely due to ?

A. absence of isohemagglutinins with old age
B. a defect in cellular immunity
C. Bruton's agamaglobulinemia
D. antithrombin III deficiency
E. absent anti-A IgM titers in the donor unit

Think twice b4 click on the ans...lol
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  #2  
Old 02-22-2011
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Smile

A. absence of isohemagglutinins with old age - Dr.Goljan specifically mentioned that after 70-80 yrs of age, one loses Ab to non-self heme groups.
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  #3  
Old 02-22-2011
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Quote:
Originally Posted by donofitaly View Post
A. absence of isohemagglutinins with old age - Dr.Goljan specifically mentioned that after 70-80 yrs of age, one loses Ab to non-self heme groups.
Well, the fortunate old man has no iso-antibodies against B antigen, but the donor has antibodies against his A antigen. Thus a hemolytic reaction can still occur, though not that much severe. i think, it is E. This is Why he gives us a such big precaution. I wish that usmle gave us such precautions!
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  #4  
Old 02-22-2011
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Quote:
Originally Posted by drahmednawaz View Post
Well, the fortunate old man has no iso-antibodies against B antigen, but the donor has antibodies against his A antigen. Thus a hemolytic reaction can still occur, though not that much severe. i think, it is E. This is Why he gives us a such big precaution. I wish that usmle gave us such precautions!
But when a blood is transfused, isn't just the RBCs transferred which negates the problem of Ab-containing serum?
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Old 02-22-2011
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Well! A may be the correct answer. AB is the universal recipient. when we give A blood to AB, A has antibodies against B; but there is no reaction. The explanation i found in the book is that iso-antibodies in the donor are diluted in the reciepient, so they need not be considered.
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Old 02-22-2011
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Default B ??

i think i have read this somewhere in Immunology, i am not sure.
I think the answer could be B, a defect in cellular immunity. My explanation is there is no antibody response to received B Ags, as the pt has a defect in CMI, maybe absent CD4 T cells..!!
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Old 02-22-2011
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Originally Posted by mle2resident View Post
i think i have read this somewhere in Immunology, i am not sure.
I think the answer could be B, a defect in cellular immunity. My explanation is there is no antibody response to received B Ags, as the pt has a defect in CMI, maybe absent CD4 T cells..!!
Blood reaction doesn't require CMI. It is antibody-dependent comlement-mediated cytolysis. Antibody attaches to the antigen, fixes complement, makes membrane attack complex, and there goes cytolysis.
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Old 02-22-2011
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Default i will go with A

its the AGE factor.
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  #9  
Old 02-22-2011
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I think the answer is A- due to her age.

E seems like a good choice, but in an acute hemolysis reaction it is never the donor cells that are attacking the host. So even if the donor does not have anti-A, the patient is still receiving B blood and she should have anti-B antibodies.
So regardless of the ANTIBODIES on the donor's blood- the patient will still have a reaction to the B antigen it receives...

Good question...very tricky, looking forward to explanation
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Old 02-22-2011
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Arrow A) absence of isohemagglutinins with old age

Correct ans is A) absence of isohemagglutinins with old age

"donofitaly A. absence of isohemagglutinins with old age - Dr.Goljan specifically mentioned that after 70-80 yrs of age, one loses Ab to non-self heme groups. "

He's absolutely right. Dr. Goljan mentioned on his hematology lecture.

The absence of isohemagglutinins is a significant finding in elderly, therefore they may not develop hemolytic transfusion reaction even with an ABO mismatch.

These pts have been considered "universal recipients" because of the absence of isohemagglutinins on routine laboratory tests.
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  #11  
Old 02-23-2011
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If this was a male, can C be a possibility?
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Old 02-23-2011
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DoctorB, Bruton's is an X-linked disorder so you would see it mostly in males, but it generally presents in infant boys after the first 6 months of life with recurrent pyogenic infections. Since the question does not state any indication of previous medical history related to immunodeficiency, Bruton's would not be likely.
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  #13  
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Arrow

Quote:
Originally Posted by DoctorB View Post
If this was a male, can C be a possibility?
yes, it's possible. It happens in male and female equally after age 70-80.
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Old 02-23-2011
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Ohhh... I'm sorry wrong information...
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Old 02-23-2011
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Quote:
Originally Posted by apx85 View Post
DoctorB, Bruton's is an X-linked disorder so you would see it mostly in males, but it generally presents in infant boys after the first 6 months of life with recurrent pyogenic infections. Since the question does not state any indication of previous medical history related to immunodeficiency, Bruton's would not be likely.
yes ... you are correct. I was thinking something else while I was answering "DoctorB" qn
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  #16  
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haha aktorque, when you posted your initial response i had to go on uptodate to find out if i was missing something major about Bruton's.

Good question, keep them coming!
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Hematology-, Immunology-, Pathology-, Step-1-Questions

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