Question

please answer all but 3 and 4 are most confusing, especially 4

Part I –

Infertility Issues Jane sat nervously in the examination room. She had no idea what to expect. Her husband, Brian, gave her a reassuring smile and squeezed her hand. Th ere was a knock on the door and then it opened to admit the physician.

“Hello, Jane. I’m Dr. Klein and I’ll be doing your fertility assessment today.”

“It’s nice to finally meet you Dr. Klein. Th is is my husband, Brian.” The two men smiled at each other and shook hands.

Dr. Klein sat down on the stool and opened up a thick file. “Jane, I’ve looked over the medical files that you had sent over to our office and I’ve examined the preliminary blood tests you had done at our office last week. I just need to ask you a few questions, and then we’ll do a quick examination to help me try to get to the cause of your fertility issues.”

“Sure, I’ll answer the best I can. Was anything missing from my medical records?” Jane asked, concerned that she had forgotten to send something the doctor would need. “We’ve been trying to get pregnant for two years and nothing has worked. We both want kids so badly, and a friend recommended you, so I hope you can help us.”

Dr. Klein smiled kindly at Jane and Brian. Th ey were young, and there was no obvious explanation in Jane’s fi le for her infertility. Dr. Klein’s initial notes about Jane’s medical history and recent blood tests included the following:

• 28-year-old Caucasian female.

• Diagnosed at 14 with Irritable Bowel Syndrome (IBS).

• Diagnosed with anemia in her early 20s; current hemoglobin levels at 7 gm/dl.

• Active lifestyle until past year; used to exercise daily and run half marathons until recent joint pain hindered her.

• Broken wrist last year after a minor fall.

• No history or abnormal pelvic exams or PAP smears.

• Hormone levels (estrogen, progesterone, LH, and FSH) in normal ranges.

• Patient reports her menstrual cycles are not very regular.

• Positive for several classes of autoantibodies.

Looking up from his notes, Dr. Klein asked, “Jane, have you been able to control your IBS symptoms? Do you still have bouts of diarrhea or constipation despite a healthy diet?”

“I’ve never really been able to control the symptoms as much as I’d like,” Jane said. “It’s something I’ve just learned to live with. I’ve tried all sorts of different diets and nothing seems to help. I felt a little better on the new low carbohydrate diet that people have been talking about, but it was really hard to stick to.” She looked questioningly at her husband, silently wondering what her stomach problems could have to do with her fertility issues.

“One of the things we test your blood for are the presence of autoantibodies. Recent studies indicate that women with infertility problems may have higher levels of autoantibodies in their blood. Your test results show that you are positive for several autoantibodies at levels higher than we would expect in a healthy female.” Dr. Klein could see the obvious confusion on Jane and Brian’s faces. “Do either of you know what antibodies or autoantibodies are?”

Questions

1. Pretend you are Dr. Klein and first explain what an antibody is to Jane and Brian.

2. Relate the basic definition of an antibody to explain an autoantibody in terms Jane and Brian will be able to understand.

3. What are three examples of autoantibodies that can be detected and the diseases they are associated with?

4. Given her digestive problems and the presence of autoantibodies (indicating that her condition is autoimmune), what are some possible diseases (besides IBS) that Jane might have?

Answer 1

1.

• Immune system is the ability of the body to protect itself from invasion of foreign molecules such as pathogens. Immunity is the protective state of the body against infection.
• Antibodies are components of immune system.
• When the body encounters any foreign molecules, the protection system is activated.
• The foreign molecules are called antigens, while proteins that bind to antigen as lock and key mechanism. The foreign molecule is then targeted for destroying.

2.

• B-lymphocytes (designated from Bursa of Fabricus in birds, which matures within bone marrow) bears B-cell receptors or BCRs.
• Each B lymphocyte expresses a unique antigen-binding receptor on their surface membrane called immunoglobulin (Ig) molecule or antibody.
• If the membrane bounded antibody encounters an antigen (with corresponding antigen determinant or epitope), the naïve B-lymphocytes differentiates into memory B-cells and effector B cells (or plasma cells). Plasma cells release antibodies.Antibodies, released to the plasma, tissue fluid and lymph, contribute to humoral immunity.
• The humoral immunity is part of acquired immunity.
• Acquired immunity is also called adaptive immunity.
• Acquired immunity is not present from birth and is initiated on exposure to a foreign molecule or non-self-substance, or antigen of microorganisms, pathogens, or any foreign molecules. Hence it is also sometimes designated as “specific immunity”.
• Autoimmunity: This condition arises, when the body’s defense mechanism, lacks the ability to distinguish between self and non-self-components. The type and symptom of autoimmune disease differs on the type of tissue or part of the body affected.

3.

• Some major autoimmune diseases are, Rheumatoid arthritis, Hashimoto’s thyroiditis, systemic lupus erythematous (SLE), auto immune hemolytic anemias.
• Autoimmunity may result in sensitized red blood cells, or autoantibodies.
• Direct antiglobulin test (DAT) or direct Coomb’s test may be used.

• Examples of autoantibodies: Antinuclear antibodies (ANA), Antineutrophil Cytoplasmic Antibodies (ANCA), Antihistone antibodies.

4.

• Condition and symptoms indicate a condition called inflammatory bowel disease (IBD).
• It is an autoimmune response. May cause Chron’s disease or ulcerative colitis.