sickle disease case

sickle disease case

• 1.
  DEPARMENT OF BIOCHEMISTRY LABORATORY SHAH, NITI KUMAR CASE-5 SAPKOTA,RAJITA RAJBANSI,BIJAY PATEL,BIR BAHADUR RAI,NAKUL SAH,PANKAJ SAID,ABDIKANI SHIRE,AHMED ROSAURO GOLDEE MEIR CHARLINE S. PEPITO GROUP – FIVE SECTION - F
• 2.
  CASE  A15-year old African-American female presents to the emergency room with complaints of bilateral thigh and him pain. The has been present been present for one day and is steadily increasing in severity. Acetaminophen and ibuprofen have not relieved her symptoms. she denies any recent trauma or excessive exercise . She does report feeling fatigued and has been having burning with urination along with urinating frequently. She reports having similar pain episode in the past, sometimes requiring hospitalization. On examination, she 2
• 3.
  In no acutedistress. No one in her family has similar episode. Her conjunctiva and mucosal membrane are slightly pale in coloration. She has nonspecific bilateral anterior with no abnormalities appreciated. The remainder of her examination is completely normal. Her white blood count is elevated at 17,000/m m 3 , and her hemoglobin(Hb) level is decreased at 7.1g/dl. The urinalysis demonstrated an abnormal number of numerous bacteria.
• 4.
   What islikely diagnosis?  What is the molecular genetics behind thus disorder ?  What is the pathophysiology mechanism of her symptoms ?
• 5.
  Answers  Mostlikely diagnosis: Sickle cell disease (pain crisis).  Biochemical mechanism of disease: Single amino acid substitution on hemoglobin beta chain, inherited in an autosomal recessive fashion (1 of 12 African Americans in United States are carriers of the trait).  Pathophysiologic mechanism of symptoms: The sickled red blood cells cause infarction of bone, lung, kidney, and other tissue from vasoocclusion.
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  Clinical correlation This 15-year-old female’s description of her pain is typical of a sickle cell pain crisis.  This case is consistent with a urinary tract infection, indicated by her symptoms of urinary frequency, and burning with urination (dysuria).  Her white blood cell count is elevated in response to the infection. The low hemoglobin level is consistent with sickle cell anemia.
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  Discussion  Sicklecell anemia is a disease in which the body makes sickle-shaped red blood cells  Red blood cells contain an iron-rich protein called hemoglobin. This protein carries oxygen from the lungs to the rest of the body  Normal hemoglobin has four subunits called globins. Adult hemoglobin has two a (a1 and a2) and two b (b1 and b2) globin chains.  Each globin chain has an associated heme prosthetic group, which is the site of oxygen binding and release.
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  Pathophysiology  Sicklecell anemia results from the nonconservative substitution of valine for glutamate at residue 6 (Val-6) in the b-chain of hemoglobin.  The β-globin gene is found on the short arm of chromosome11.  The association of two wild-type α-globin subunits with two mutant β-globin subunits forms haemoglobin S (HbS).  Under low-oxygen conditions (being at high altitude, for example), the absence of a polar amino acid (Glutamate) at position six of the β-globin chain promotes the non-covalent polymerisation (aggregation) of haemoglobin, which distorts red blood cells into a sickle shape and decreases their elasticity.
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  Loss of oxygen. Polymers or rigid rodsleading to sickled RBCs RBCs Stick to blood vessels Stasis Hypoxia Pain ( vaso-occlusive crisis)
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  Diagnosis  Diagnosisof sickle cell disease and sickle cell trait can be done through blood testing.  A special technique is also used called hemoglobin electrophoresis  Hemoglobin Electrophoresis: A small blood sample is taken and sent to a laboratory where the percentage of normal and abnormal hemoglobin is measured.
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  Signs and symptoms  The most common symptom of anemia is fatigue (feeling tired or weak). Other signs and symptoms of anemia include:  Shortness of breath  Headaches  Coldness in the hands and feet  Jaundice (a yellowish color of the skin or whites of the eyes)  Hand –foot syndrome due to the blockage of blood vessels in the hands and feet.  Organs like spleen and liver also damages.
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  Treatment  Treatmentof sickle cell anemia includes:  pain medications (for example, morphine).  Anti-inflammatory medications (for example, ibuprofen).  Antibiotics for infection.  Intravenous or oral fluids.  Transfusions of red blood cells are given for anemia.  Stem cell transplant is performed in young patients with severe sickle cell disease.
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  Prevention  Geneticscreening  Testing for sickle cells in babies. Chronic vill sampling Amniotic fluid sampling Fetal blood samplin  Daily penicillin for newborn babies with the disease.
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  Prognosis  Patientsreceiving proper medical care may learn to lead relatively normal life.  Average life expectancy of patients suffering from is Male = 42 years Female = 48 years