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ட 8:57 Learning Objectives Case Bl&Blue.tif 3Douth 20 The Case of the Black and Blue Bodybuilder Explain the origin line of 3.Brpitee bou and afy the fore tete sad a teboofy Diafiourfooப்பட்ட Case Presentation Waterpiue o () that this was apd by a comentada, and omni Traat aad ofo dood being in contact with a mical tal and symal Hooding with eye and pol pilly Swing vil pr (t as onc duce bo or suoring chaing payof i y me igh-de from pril y vivia, ips vie), anil gemக க் Jo poe I euரேன்ன paாதவprandiadoerdion of guirisentir Je's guit of having nlagpoe ti socytopenie papers. Stethe A ameirela modaliary, retotemperatoed thers askyoணsy wand phonthis woe weet rtack it, and bloody from the prys. The badg ingvinal lymph nod ே 22 d enlaneofy
9:20 ◄ Search 6. With damage to all blood cellular elements, with clinical and laboratory changes would you expect to see? 7. What might have led to Joe's immune system attacking his own platelets and blood cell elements? Explain your answer 8. Why do Joe's relapses tend to occur following viral infections? 9. Why did Joe have gastrointestinal pain during his relapse? Why did he have eye pain during his current relapse? 10. What purpose does the cytotoxic drug serve for Joe's treatment? The prednisone? The acyclovir? The gamma globulin 11. What is plasmapheresis and why was it done as part of Joe's treatment regimen? 12. Why would splenectomy help in the treatment of Joe's disease? With splenectomy, what disease(s) would Joe be especially at risk of getting?
20 The Case of the Black and Blue Bodybuilder Learning Objectives 1. Explain the origin and function of platelets. 2. Describe physical findings that commonly occur with insufficient production of bone marrow blood cell elements. 3. Explain how and why the body's own immune system might attack and harm blood cell elements. State the term used when the immune system attacks its own body cells. 4. Define the following terms: petechiae, ecchymoses, epistaxis. 5. State how the spleen functions as part of the immune system. Case Presentation Joe Wenthorp is a 34-year-old college student and ex-champion bodybuilder. He has a lengthy history of low platelet counts and of frequent nosebleeds. He came to the clinic recently complaining of malaise, eye pain, ecchymoses (bruises), and epistaxis (nosebleed). Joe said he caught a virus from his girlfriend last week, and that this was accompanied by a congested nose, and muscle aches. Ten years ago Joe started noticing small black spots in his arms, which then spread over his body. A nosebleed and eye pain also developed then. At that time he was working as a salesman and had a history of being in contact with a musical instrument cleaning spray of some sort. Joe has had multiple relapses of petechial and ecchymosal bleeding with eye and gastrointestinal pain, usually following a viral upper respiratory infection (URI). During such relapses, his hemoglobin drops from 14 gm/dl to 10 gm/dl, his reticulocyte count increases, and his platelet count is markedly low. His medication treatments have included cytotoxic drugs (cytoxan, vincristine, vinblastine), steroidal anti-inflammatory medication (high-dose prednisone), acyclovir (for Herpes virus), and gamma globulin. Joe is known to have used anabolic steroids during his bodybuilding career. Joe's family history is positive for autoimmune disease. His brother died of Evans Syndrome. Joe's cousin has idiopathic thrombocytopenic purpura (TTP), his grandfather died of some sort of nephritis, and his grandmother had lymphoma. Joe has been treated with experimental ProSorba staphylococcal protein A columns. He has also received multiple sessions of plasmapheresis. Splenectomy was also performed in the past as a treatment modality. 73 A current exam revealed that Joe had hemorrhagic conjunctivitis, ecchymoses on the inner eyelids and buccal cavities, and bloody secretions from the nasopharynx. He had enlarged cervical and inguinal lymph nodes. Petechiae were widespread over the skin surface. A complete blood count (CBC) showed a platelet count of 60,000. A blood cell differential showed 44 segs (segmented leukocytes, or neutrophils), 44 lymphs (lympho- cytes), 8 monos (monocytes), 2 eos (eosinophils), 2 bands (band forms, or immature granulocytic leukocytes), occasional Howell-Jolly bodies, and some toxic granulation of poly-morphonucleocytes (PMN's, neutrophils). Joe's diagnosis was that of having a relapse of idiopathic thrombocytopenic purpura.