Immunology Haematology Cellular Pathology
Case 1 immunology Haematology Cellular Pathology
A 53- year- old woman with long standing ulcerative colitis, presented to her GP with a 5 -month history of weakness & fatigue. She also reported  a weight loss of 16lbs over the time period. Her physical examination was unremarkable; her abdomen was soft and non-tender with no hepatosplenomegaly. Rectal exam did not reveal any masses or haemorrhoids.
Her laboratory findings were:WBC 5200 cells/mm3(4500-11000); Hb 7.5 g/dL(13.5-17.5);Hct 26%(35-48);RBC count 3.5 x 106 cells/mm3(4-6);platelet count 650000 cells per mm3(150000-450000); MCV 55mm3(80-100); reticulocyte count 1.5%(0.5-1.5); urea 15 mg/dL(7-21); creatinine 1.1 mg/dL(0.6-1.1) ;total bilirubin 0.9 umol/dL(0.5-2.5); total calcium 9.2 mg/dL(8-10) Ferritin 8 ng/ml(12-150);CEA 6 ng/ml( 13 mEq/L ( 106 colony forming units/ml (CFU). She was finally diagnosed with urinary tract infection precipitating DKA.
Further investigations revealed a haemoglobin A1c 13.8%(4-5.3) , and C-peptide (premeal) 0.441 ng/mL (1.1-4.4 ng/mL).  Immunological testing revealed positivity for anti-GAD65, anti-IA2, anti-insulin, anti-ICA, and antiZnT8 antibodies.She was therefore diagnosed as suffering from type 1 diabetes.
She made an uneventful recovery with the above management and was discharged with instructions to continue subcutaneous insulin injections for glycemic control.
 
1.Microbiology questions(20 Marks)
The case study states that a pure culture of Escherichia coli was obtained from a urine sample given by the patient.  Explain the predisposing factors for urinary tract infection with this organism particularly in patients with diabetes.
(10 marks)
How could bacterial organisms that could cause urinary tract infections be differentiated in the laboratory? How would this vary depending on the organism if a different pathogen was suspected?
(10 marks)
 
2  Biochemistry questions(20 marks)
Explain the abbreviation DKA. Outline the biochemical processes leading from insulin deficiency in type 1 diabetes to DKA.
(10 marks)
Why was C-peptide measured and what does the low level indicate?  What may be deduced about the duration of the patient’s diabetes from the HbA1c measurement?
(10 marks)
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