Question

just need the last 3 questions answered, the answers to the first teo questions are attached to help you solve the rest, please be as detailed as you can, Thank you!!

John Fitzgerald was well for the first 10 months of his life. In the next year he had pneumonia once, several episodes of otitis media, and on one occasion developed erysipelas (streptococcal skin infection) on his right cheek. These infections were all treated successfully with antibiotics. John's mom was a nurse in Norwalk OH, and to her it seemed like John was always on antibiotics. John's mom worried about such things, as she had had two brothers, each of whom died of pneumonia before they were two years old, and one sister, who lost one of her boys (Bobby, a 3-year-old male) to pneumonia just the previous year. John was a bright and active child who gained weight, grew, and developed normally, but continued to have ear and sinus infections, and twice again had pneumonia. At 2 years and 3 months his pediatrician tested his serum immunoglobulins. He found 80 mg/dl IgG (normal is 600-1500 mg/dl), no IgA, and only 10 mg/dl IgM (normalis 75-150 mg/dl). John was started on monthly intramuscular injections of gamma globulin; his serum IgG level was maintained at 200 mg/dl. He started school at age 5 and performed well. At 9 years of age he was referred to the Children's Hospital because of atelectasis (collapse of a portion of a lung) and a chronic cough. Upon physical examination, he was found to be alert and well-developed. He weighed 33.5 kg and was 146 cm in height (normal for his age). The doctor noted that he had no visible tonsils (he had never had a tonsillectomy). With a stethoscope, the doctor also heard rales (moist crackles) at the base of each lung. Further family history revealed that John had a younger brother, 7-year old Ted, who had also contracted pneumonia on three occasions. Ted had a serum IgG level of 150 mg/dl. Laboratory studies at the Cleveland Clinic gave a white blood count of 5100 cells/l (normal) of which 45% were neutrophils (normal), 43% lymphocytes (normal), 11% monocytes (elevated) and 2% eosinophils (normal). Further examination by flow cytometry showed that 85% of John's lymphocytes had the T-cell protein CD3 (normal), but only 2% had the B-cell protein CD19 (normal is 12%). T-cell function, measured by proliferation in response to tetanus toxoid, was normal, but IgG levels remained low (155 mg/dl), with IgM and IgA not detected. John was started on a preparation of gamma globulin (purified from pooled human serum donors) rendered suitable for intravenous administration. He was given a dose so as to maintain his IgG level at 600 mg/dl. He improved remarkably. The rales at his lung base disappeared. He continued to perform well in school and ultimately entered dental school at OSU. Except for occasional bouts of conjunctivitis or sinusitis, which respond well to oral antibiotic treatment, he remains in good health and leads an active life. He bec at inserting a needle into a vein on the back of his hand and he infuses himself with 10 g gamma globulin every weekend.

Answer 1

3.4.This medication is used to strengthen the body's natural defense system (immune system) to lower the risk of infection in persons with a weakened immune system. This medication is made from healthy human blood that has a high level of certain defensive substances (antibodies), which help fight infections. It is also used to increase the blood count (platelets) in persons with a certain blood disorder (idiopathic thrombocytopenia purpura-ITP). Platelets are needed to stop bleeding and form blood clots.Now the factors which we have to keep in mind which administrating IgG are ....

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1.The dosage and frequency depends on your medical condition, weight, and response to treatment.

2.Lab and/or medical tests (such as complete blood count, kidney/liver function tests, urine volume, blood pressure) should be done before you start using this medication and while you are using it. Keep all medical and lab appointments.

3.When prescribing IG, the
first clinical consideration
is the patient’s disease.:In part to assess
whether the dose was working, great reliance was placed
on trough levels (the amount of serum IgG concentration
immediately preceding the next infusion) as indicators of
effectiveness.

4.Clinical trials and scientific
studies help to establish
maximum and minimum
IG dosing standards:Because a patient’s IG dose is directly related to their
body weight, obesity is one variable that may warrant a
deviation from the dosing formula. Fat tissue contains
proportionally more fluid than other tissues. In addition,
IG has very little distribution into the fluid in fat tissue.
Therefore, the dose should be adjusted down for a person when fat is a larger part of their overall body
weight.

5.• Patient tolerance to treatment
6• Patient compliance

5.
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