Case Study #5 2 iings Review View Help ENormal 1No Spa.. Heading 1 Heading 2 Tit
ID: 136300 • Letter: C
Question
Case Study #5 2 iings Review View Help ENormal 1No Spa.. Heading 1 Heading 2 Title Subtitle Subtle En Paragraph Styles Martin developed a fever of 101.5F on the second day of his hospitalization for acute alcoholism. He had a cough productive of gray sputum. A chest x-ray revealed a right lower lobe pneumonia. A stain of his sputum revealed many small pleomorphic Gram- negative bacilli. Sputum was sent for culture and a determination of which antibiotics would be effective in treating the causative organism. Because his wife stated that he had an allergy to penicillin, he was started on a course of the antibiotic combination of been treated with a sulfa drug previously. On the third day of therapy with TMP/sulfa for his pneumonia, Martin was slightly was red-brown in color due to the presence of free hemoglobin. trimethorprim and sulfamethoxazole (TMP/sulfa). To his wife knowledge, he had never jaundiced. His hemoglobin level was 3.5 g/dL from his value on admission and his urine What do you think is the diagnosis of Martin's symptoms? Why do you think the symptoms occurred? What is the pathway involved? 1. Martin's sputum culture sent after he was admitted grew out H. influenzae. This organism is sensitive to a variety of antibiotics. How is this related to him finding blood in his urinei? 2. When red blood cells are stored in the blood bank, the hexokinase activity is lost and the cells are unable to generate ATP from glucose metabolism in the glycolytic pathway. How would the red blood cells generate ATP now? 3. 4. If the patient had a thiamine deficiency, how would this affect which pathway involved and how? Explain. What is the significance of Martin taking the antibiotics TMP/sulfa affecting the red blood cells? What are other causes that affect the red blood cells as it is related to his condition? 5. 6. Are there any significant features of red blood cells found after oxidative stress and why?Explanation / Answer
1. The gram negative pleomorphic bacilli with the symptoms of lobar pneumonia is the cause of pneumonia due to Haemophilus influenzae. The hemolytic anemia is common in this infection ( specially in type b infection) as we can see Martin's hemoglobin level is low, this is due to absorption of PRP(polyribosyl ribitol phosphate) to red cells and immune destruction of sensitized erythrocytes. Due to the lysis of the erythrocytes free hemoglobin can be seen in urine. Heme is utilized by the bacteria for its growth. The pathway involved is biosynthetic pathway for porphyrin ring, the bacteria lacks enzyme so unable to synthesize protoporphyrin IX (PPIX).
2. The hemolytic anemia causes rupture of erythrocytes which in turn causes free hemoglobin to circulate which can be seen in urine. Free hemoglobins can be utilized by bacteria to supplement hemin deficiency.
3. Red cells will be able to generate ATP through lactic acid fermentation on the resulting pyruvate. Furthermore, pentose phosphate pathway helps in the glucose oxidation and serves as alternative of glycolysis
4. Thiamine deficiency is common in alcoholic patients as in our case too. Thiamine is cofactor for pentose phosphate pathway which is important for carbohydrate metabolism. It is cofactor for transketolase. The deficiency will disrupt the pathway.
5. The drug can reduce the number of red blood cells causing anemia.
Free hemoglobin in urine indicates red cell rupture. Red cells rupture can be the cause of G6PD deficiency which may be responsible for dark urine colour and jaundice in the patient.
6. The oxidative stress causes impaired oxygen delivery and red cell deformities.