A 25-year old woman is taking her former boyfriend to court and suing for child

Question

A 25-year old woman is taking her former boyfriend to court and suing for child support, claiming he is the father of her 3-year old daughter, the former boyfriend states that the child can’t possibly be his. The HLA antigen types of the father, mother and the child are submitted as evidence. They are as follows:

Mother            HLA   A1A9/B5B12/CW3CW5

Child               HLA   A9A11/B5B18/Cw3Cw8

Father              HLA   A9A11/B5B18/Cw5Cw8

Questions:

What are the two likely haplotypes of this child’s HLA antigens? (5 pts)

Does one of the haplotypes match that of the alleged father? (5 pts)

Should this man pay child support? (4 pts)

Part IV:

History and Physical Examination

Ms. A.A., a 25-year-old complaining of joint pain, fatigue, and significant weight loss, was seen by her primary care provider. Physical examination demonstrated a maculopapular rash on her face (Figure 1) and chest. Several joints in her hands were swollen. Her temperature was 37.8° C.

Laboratory Data

            Assay                          Patient’s Result         Reference Values

Complete blood count

            Hemoglobin                10.5 mg/dL                 12.0-16.0

            Hematocrit                  32%                             35%-45%

            Total WBC                 9.5 × 109/L                  4.5-10.3

            Platelet count              190 × 109/L                 150-450

            Sedimentation rate      45 mm/hr                    0-20

Urinalysis

            Color                           Red-brown                  straw-yellow

            Protein                         4+                                0-trace

            RBCs                          Large                           Negative

            Microscopic examination

            Many RBCs/hpf, few granular casts, moderate number of RBC and granular casts.

Antinuclear antibody (ANA): positive (a speckled nuclear staining pattern without staining of the nucleoli)

Questions:

1. The patient’s urinalysis results suggest: (5 pts)

a. urinary infection.

b. nephritic condition.

c. renal insufficiency.

d. No significant abnormalities.

2. What rheumatologic disorder is suggested by the patient’s laboratory findings? (5 pts)

3. The speckled antinuclear antibody staining pattern is associated with the following antibody (antibodies): (5 pts)

4. What type(s) of serum antibody (antibodies) can be significant in establishing a diagnosis of a specific rheumatoid disorder? (5 pts)

Explanation / Answer

Two sets Haplotypes are inherited by a child, one from the father and the other from the mother.

Mother            HLA   A1A9/B5B12/CW3CW5

Child               HLA   A9A11/B5B18/Cw3Cw8

Father              HLA   A9A11/B5B18/Cw5Cw8

The set that has been inherited by mother: A9B5CW3

The set that has been inherited by father: A11B18CW8

A11B18CW8 this haplotype matches the father and father should pay the child support since the daughter is his.

1. The urine analysis of the patient suggests nephritic condition

2. systemic lupus erythematosus because in 99% of cases ANA comes out to be positive.

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