G6PD case

Question 1

If a person is immunocompromised what can occur?

Answer 1

Opportunistic infections 
Possible pneumonia (tachypnea and lung sounds)

Question 2

If a person has hypoxia, cough, fatigue and dyspnea they could have…..

Answer 2

An anemia

Question 3

What organisms are responsible for pneumonia?

Answer 3

Pneumocystis, nocardia, CMV, klebsiella, S. pneumo, mycoplasma, haemophilus, pseudomonas, S. aureus

Question 4

3 opportunistic pathogens associated with pneumonia in the immune-compromised pt.

Answer 4

Pneumocystis, CMV, nocardia, mycobacterium avium intracellulare

Question 5

What diagnostic test would be done to identify pneumocystis jirovecii?

Answer 5

Methenamine silver stain

Question 6

What is the mechanism for sulfadrugs?

Answer 6

Inhibit folic acid synthesis: TMP acts on dihydrofolate reductase (stops dihydrofolic acid from converting to tetrahydrofolic acid) and SMX acts on dihydropteroate synthase (stops PABA from converting to dihydrofolic acid)

Question 7

What is the biochemical pathway in which the G6PD enzyme functions?

Answer 7

Goes through the PPP

Question 8

What enzyme reacts and catalyzes G6PD?

Answer 8

Oxidative step that produces NADPH

Question 9

Why would a deficiency in G6PD contribute to hemolytic anemia?

Answer 9

Oxidative damage inside the RBCs, they don’t have nuclei and can’t turn on gene transcription to repair problems

Question 10

What are the morphological features of a blood smear from a G6PD deficient pt?

Answer 10

Presence of Heinz bodies on the blood smear

Question 11

How does the pentose phosphate pathway work to protect erythrocytes from damage?

Answer 11

PPP produces NADPH as a byproduct, which is needed to maintain the glutathione pool for the RBCs

Question 12

What are the five triggers of hemolytic anemia in a pt with G6PD

Answer 12

Drugs (sulfa drugs, quinolones, aspirin), foods (like fava beans), chemicals, diabetic ketoacidosis, vitamin K derivatives, infections, stress, menthol,