3. The patient is a 60-year-old, white male with multiple medical problems. His
ID: 245592 • Letter: 3
Question
3. The patient is a 60-year-old, white male with multiple medical problems. His past surgical history is remarkable for multiple lumbar back surgeries, cholecystectomy, and numerous sinonasal surgeries for recurrent sinusitis. His past medical history is significant for recurrent nasopharyngeal, bronchial and urinary tract infections. On this admission, he presented to the Emergency Department with severe back pain. He was scheduled for L2-LS decompression and fusion surgery. Significant blood loss was anticipated during surgery and the transfusion medicine service was asked to arrange for his blood component needs. Several years ago, he had a severe allergic reaction to blood products. An investigation of that problem led to his requiring special precautions when receiving transfusions Blood Group O Positive NegativeExplanation / Answer
Serum IgA deficiency is noted.
IgA deficiency is defined as a serum IgA concentration in blood lower than 7 mg/dL, with normal serum levels of IgM and IgG.
DIFFERENTIAL DIAGNOSIS is IgA deficiency
Less IgG2/IgG4 or IgG4 serum levels in blood with IgA deficiency may be an etiology for IgA-deficient patients leading more severe and recurrent sinopulmonary infections.But here only IgA level is deficient.
IgA is present in the blood and in the secretions of the mucosal surfaces, including tears, saliva, colostrum, genital, respiratory and gastrointestinal secretions.The IgA antibodies in the secretions play a major role in protection.The deficiency may also be a precursor to autoimmune diseases .
Around 1 in 600 people this deficiency is noted in western countries.20%are inherited and genetically acquired.
Asthma , sinonasal allergies,rhinitis, food allergies occur repeatedly in these patients.
IgA deficiency places them at risk for developing an anaphylactic reaction when receiving blood products containing even small amounts of IgA immunoglobulin. So necessary precautions to be taken before administering blood products in patients with this deficiency.
Management
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.