Question

A 58-year-old male college professor sees his family physician because of increasing fatigue and weakness. He also reports pain in his lower back and arms when he walks. Physical examination reveals that the man has pale mucous membranes and hepatosplenomegaly. The physician orders a complete blood count (CBC) and urinalysis. A follow-up appointment is scheduled for the following week.

Laboratory Data:

The CBC reveals that the patient has anemia. His leukocyte count and differential count are normal, except for a rouleaux (rolled coin) appearance of the red blood cells. The result of the urinalysis is normal. The patient is called and requested to return to the laboratory for additional tests. The physician orders the following tests: ESR, kidney screening profile, liver blood profile, and radiographic skeletal survey, with the following results:

ESR: 50 mm/hr

Kidney profile: normal

Liver profile: normal, except for increased globular protein

Skeletal survey: bone lesions in various sites

Questions:

1. What follow-up laboratory tests might be ordered to assist in establishing a definitive diagnosis?

2. What is the nature of the protein found in the urine?

3. What is the most significant laboratory finding in this disorder?

4. What type of immunological defects exist in this disease process?

Case 10

History and Physical Examination

A 27-year-old white female seeks medical attention because of persisting pain in her wrists and ankles and an unexplained skin irritation on her face. On physical examination, swelling of the joints of the hands and ankles is evident, along with erythema of the skin over the bridge of the nose and the upper cheeks. The patient has a slightly elevated temperature.

Laboratory Data:

The following laboratory tests are ordered: CBC, urinalysis (UA), and rheumatoid arthritis screening test(RF). Results are as follows:

Hgb & Hct: normal

WBC count: normal

Differential: normal

Gross and microscopic UA: normal

Rheumatoid arthritis screening test: positive

Follow-up:

An ANA screening test is ordered. The results are positive.

Questions:

1. What is the most probable diagnosis in this case?

2. Does this patient fit into the general characteristics of patients with this disease?

3. What is the principle of the ANA test?

4

Answer 1

Case study 1.

Q. No. 1. Answer :

We need to advise to do HBA1C that is to confirm diabetes mellitus, and fasting blood sugars and random blood sugars should be advised, because rouleaux (rolled coin) red blood cells we can seen in diabetic patients.

So we can advise this laboratory tests to definitive diagnosis.

Q. No. 2. Answer :

Normally urine does not excreat the proteins, if there is a protinuria indicates " chronic kidney disease " due to diabetes mellitus. because here no urinary tract infections, during urinary tract infections also the proteins may excreat through urine.

So we can suspect the chronic kidney disease due to diabetes mellitus, in this diabetic clients there is a damage of kidneys which may leads to decreased functioning of kidneys may cause for protinuria.

Q. No. 3. Answer :

Most significant laboratory findings in this disorder includes :

* rouleaux or rolled coin red blood cells,

* ESR 50 mm per hour,

* increased globular proteins in liver profile,

* bone lesions in various sites.

Case study 2.

Q. No. 1. Answer :

Most probable diagnosis in this case is " Rheumatoid Arthritis"

Q. No. 3. Answer :

Principle of Anti nuclear antibody test :

* here we will use the indirect immunoflourosence technique.

* patient samples and with appropriate controlled we can incubate the slides,

* then see the reaction, unreacted antibodies washed and apply the conjugate.

* then unbound conjugate washed, and then view in the flourosence microscope,

* the positive samples visualize like apple green color.