Page 1 of 1: lab findings point towards

decembermist · Credits: 41121 My Scrapbook

A 15 year old male underwent bone marrow transplantation, with marrow donated from a sibling, with a 5 out of 6 antigen match. He later developed a fine, scaling skin rash as well as diarrhea. The laboratory finding most likely to accompany this microscopic appearance is:
A Hyperamylasemia
B yperbilirubinemia
C Hypocomplementemia
D Neutrophilia
E Elevated creatine kinase

pratik · Credits: 11374 My Scrapbook

this is the example of graft versus host reaction and which is an auto immune reaction.

thus c or d may be the anwer

pratik · Credits: 11374 My Scrapbook

this is the example of graft versus host reaction and which is an auto immune reaction.

thus c or d may be the anwer

decembermist · Credits: 41121 My Scrapbook

can it be hyperbilirubinemia

decembermist · Credits: 41121 My Scrapbook

pratik · Credits: 11374 My Scrapbook

pratik · Credits: 11374 My Scrapbook

Acute GVHD occurs within the first 100 days of transplantation and consists of the triad of dermatitis, enteritis, and hepatitis. Chronic GVHD develops after day 100 and consists of an autoimmune syndrome directed toward multiple organs. Because the skin often is the earliest organ affected in GVHD

o A staging system for the skin involvement in acute GVHD has been outlined, as follows:

+ Stage 1 - Involvement of less than 25% of the body surface

+ Stage 2 - Involvement of 25-50% of the body surface

+ Stage 3 - Involvement of 50-100% of the body surface (erythroderma)

+ Stage 4 - Vesicles and [bleep]

Lab Studies:

* Liver function studies: Routinely monitor liver enzyme and bilirubin levels to assess the development of hepatic GVHD.

* Serum electrolytes: Monitor electrolyte levels because GVHD of the gastrointestinal tract can lead to severe diarrhea.

* Blood and stool cultures: Perform cultures periodically because immunosuppressed recipients of hematopoietic stem cell are at risk for opportunistic infections.

Imaging Studies:

* No specific imaging studies aid the diagnosis of GVHD.

Histologic Findings: Skin biopsy with routine hematoxylin and eosin staining is the primary tool for evaluating suspected GVHD skin eruptions.

A grading system describes the histologic changes of acute GVHD as follows:

* Grade 0 - Normal skin or changes not consistent with GVHD

* Grade 1 - Basal vacuolization of the dermal-epidermal junction

* Grade 2 - Basal vacuolization, necrotic epidermal cells, and lymphocytic infiltrate in superficial dermis (see Image 1)

* Grade 3 - Changes of grade 2 plus clefting at the basement membrane

* Grade 4 - Changes of grade 2 plus [bleep] formation

Chronic GVHD exhibits basement membrane changes similar to those of acute GVHD (eg, vacuolar changes, necrotic epidermal cells, presence of lymphocytes). In addition, chronic disease can result in features such as thickened epidermis (acanthosis), thickened granular layer (hypergranulosis), thickened stratum corneum (hyperkeratosis), and rete ridges with a pointed or sawtooth appearance.

thus the most appropriate here is hyperbilirubinemia

bhavu · Credits: 9481 My Scrapbook

it is hyperbillirubinemia.even staging of gvhdis done thorugh billirubin lveve see harrison 15th edi page 741

draditithegreat · Credits: 1247960 My Scrapbook

Clinical Stage Skin ----------------------------Liver—Bilirubin, mol/L (mg/dL) ---------Gut
1---- Rash <25% body surface -------------34–51 (2–3) ----------------------------Diarrhea 500–1000 mL/d
2---- Rash 25–50% body surface---------- 51–103 (3–6) ----------------------------Diarrhea 1000–1500 mL/d
3 ----Generalized erythroderma------------ 103–257 (6–15)------------------------ Diarrhea >1500 mL/d --
4---- Desquamation and [bleep] ------------->257 (> 15) ----------------------------Ileus

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