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A woman is admitted to the hospital after a motor vehicle accident and has sustained a splenic laceration that requires a blood transfusion. The woman tells the nurse that she has type O blood. During the transfusion, she develops a fever, back pain, and flushing. The woman’s spleen continues to bleed despite bedrest and blood transfusion. She is taken to the OR for an exlap and her spleen is successfully removed. One week after recovering from the transfusion reaction, the woman develops pneumonia that may be caused by poor inspiration and cough as a result of pain from her splenic laceration. The woman is administered several antibiotics to assist her body in fighting the infection. The goal of antibiotic therapy is the elimination of the pathogen. 1. What is the reason for her fever, back pain and flushing during the transfusion? What type of hypersensitivity reaction is occurring? 2. What is the pathophysiology behind this type of reaction? 3. What is the consequence of having a spleen removed? CASE 2: A 19-year-old male presents with complaints of intermittent dysphagia and food impaction. He states that his symptoms have become progressively worse during the past 2 years. Two days ago, he got a piece of steak lodged in his esophagus and states that it took him over an hour to dislodge the meat; he accomplished this by self-induced vomiting. VS: 127/82; HR 82; RR 18; T 98.6; O2 saturation on room air 99%. An endoscopy with biopsy was performed, revealing suggestion of feline esophagus and possible widely patent distal esophageal ring. Four biopsies were taken, and dilation was performed. Pathology report:  Esophagus non-neoplastic, basal cell hyperplasia: absent number and distribution of  Eosinophils: highest number in one: HPF 38; presence of neutrophils: absent  Epithelial spongiosis (intracellular edema): present 1. What is the most likely diagnosis consistent with the above history and findings? Why? 2. Discuss the immune dysfunction and pathogenesis of the above diagnosis. CASE 3: Mrs. C is a 50-year-old woman who presents with joint pain. She reports the pain has been present for about 2 years. The pain affects her hands and her wrists. She describes the pain as a “dull aching” and “a stiffness.” It is worse in the morning and improves over 2 to 3 hours. She says that on particularly bad days she uses aspirin with moderate relief. She is otherwise well, except for a history of mild hypertension managed with angiotensin-receptor blocker. She reports no other joint pain. She does not have a history of psoriasis. Her vital signs are: 37.1 C; B/P 128/84; P 84; R 14. There is a 2/6 systolic ejection murmur. Joint exam revealed limited range of motion of the MCPs and wrists bilaterally. There is swelling of the third and fourth MCP on the right and the third on the left. There is pain at the extremes of motion and a boggy quality to the joints. A detailed skin exam is normal. Rheumatoid arthritis (RA) is suspected. 1. What type of hypersensitivity is rheumatoid arthritis? 2. Discuss the pathogenesis related to this particular type of hypersensitivity. 3. What manifestations are exhibited due to the immune dysfunction and why? CASE 4: Elena is an 8-year-old girl with a history of asthma and allergy to bee stings. She has been brought to the clinic complaining of a throat infection. Her health care provider prescribes a course of penicillin to manage her current infection and cautions her parents to watch her closely for a reaction. 1. Explain the role of IgE and mast cells in type I hypersensitivity reactions at the cellular level. 2. With the release of histamine, what changes will occur at the cellular and tissue levels? 3. What manifestations will be exhibited as a result of the histamine release? CASE 5: James is a 19-year-old who presented to the student health clinic with a 2-week history of intermittent hematuria that has become progressively worse. A urine sample was obtained. His urine revealed hematuria with red cell casts and proteinuria (5 g/day). His physical exam reveals lower extremity edema and periorbital edema. His past medical history is significant for group-A beta-hemolytic streptococcus pharyngitis 3 weeks ago; he was treated with amoxicillin but can’t remember if he finished the entire prescription. 1. Based on the above history and diagnostic results, what is the most likely diagnosis? 2. What type of hypersensitivity is related to this diagnosis? 3. Discuss the pathogenesis related to the above hypersensitivity.

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