Question

Part I – Infertility Issues
Jane sat nervously in the examination room. She had no idea what to expect. Her husband, Brian, gave her a

reassuring smile and squeezed her hand. There was a knock on the door and then it opened to admit the physician.

“Hello, Jane. I’m Dr. Klein and I’ll be doing your fertility assessment today.”

“It’s nice to finally meet you Dr. Klein. This is my husband, Brian.” The two men smiled at each other and shook hands.

Dr. Klein sat down on the stool and opened up a thick file. “Jane, I’ve looked over the medical files that you had sent over to our office and I’ve examined the preliminary blood tests you had done at our office last week. I just need to ask you a few questions, and then we’ll do a quick examination to help me try to get to the cause of your fertility issues.”

“Sure, I’ll answer the best I can. Was anything missing from my medical records?” Jane asked, concerned that she had forgotten to send something the doctor would need. “We’ve been trying to get pregnant for two years and nothing has worked. We both want kids so badly, and a friend recommended you, so I hope you can help us.”

Dr. Klein smiled kindly at Jane and Brian. They were young, and there was no obvious explanation in Jane’s file for her infertility. Dr. Klein’s initial notes about Jane’s medical history and recent blood tests included the following:

• 28-year-old Caucasian female.

• Diagnosed at 14 with Irritable Bowel Syndrome (IBS).

• Diagnosed with anemia in her early 20s; current hemoglobin levels at 7 gm/dl.

• Active lifestyle until past year; used to exercise daily and run half marathons until recent joint pain hindered her.

• Broken wrist last year after a minor fall.

• No history or abnormal pelvic exams or PAP smears.

• Hormone levels (estrogen, progesterone, LH, and FSH) in normal ranges.

• Patient reports her menstrual cycles are not very regular.

• Positive for several classes of autoantibodies.

  Looking up from his notes, Dr. Klein asked, “Jane, have you been able to control your IBS symptoms? Do you still have bouts of diarrhea or constipation despite a healthy diet?”

  “I’ve never really been able to control the symptoms as much as I’d like,” Jane said. “It’s something I’ve just learned
  to live with. I’ve tried all sorts of different diets and nothing seems to help. I felt a little better on the new low carbohydrate diet that people have been talking about, but it was really hard to stick to.” She looked questioningly at her husband, silently wondering what her stomach problems could have to do with her fertility issues.

“When Good Antibodies Go Bad” by Cozine and Gripka Page 1

“One of the things we test your blood for are the presence of autoantibodies. Recent studies indicate that women with infertility problems may have higher levels of autoantibodies in their blood. Your test results show that you are positive for several autoantibodies at levels higher than we would expect in a healthy female.” Dr. Klein could see the obvious confusion on Jane and Brian’s faces. “Do either of you know what antibodies or autoantibodies are?”

Questions

1. Pretend you are Dr. Klein and first explain what an antibody is to Jane and Brian.

2. Relate the basic definition of an antibody to explain an autoantibody in terms Jane and Brian will be able to understand.

3. What are three examples of autoantibodies that can be detected and the diseases they are associated with?

4. Given her digestive problems and the presence of autoantibodies (indicating that her condition is autoimmune), what are some possible diseases (besides IBS) that Jane might have?

Answer 1

Antibodies are basically proteins that are produced by our bodies against a pathogen or foreign substance. Antibodies specifically bind to these substances and neutralise them .

In case of bacterial invasion, antibodies present in our cells will recognise bacterial antigen and neutralise them.

they are Y shaped proteins belonging to immunoglobulin family and have a very important role in immunity.

when these antibodies start attacking the self tissues, they are called auto antibodies. This lead to several auto immune disorders such as Graves' disease, IBS, multiple sclerosis, lupus.

Three auto antibodies that can be detected are:-

1. ANA or Antinuclear antibody.

ANA is a marker of auto immune process. It is not specific for a particular disease but associated with variety of diseases. If this comes positive several other tests are performed.

2. Anti-RNP

it is involved with mixed connective tissue disease (MTCD).

diseases like Systemic lupus erythematosus ( SLE) have several auto antibody marker such as anti ds DNA, anti-smith.

3. Anti- CCP

It is targeted for cyclic citrullinated peptide and causes rhematoid arthritis

According to the history of the patient, she is likely to have

Rheumatoid Arthritis as she has suffered joint pain and has weakened bones due to osteoporosis.

another possible disease can be Coeliac disease. It is a protein reaction to gluten. Classic symptom involves diarrhoea, anaemia, osteoporosis.