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    md90's Avatar
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    type II or type IV?

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    Woman postpartum who has had a difficult breathing, had abruptio placenta; and needed three units of blood; Is doing well, no other complications. Left hospital with a hgb 10; One week later, looks in the mirror, appears yellow in the skin and the white of her eyes, feels tired and weak; goes to the doctor.. found to have unconjugated bilirubinemia and a hgb 8; what is the most likely diagnosis? and what test do you do to confirm?



    Diagnosis: Delayed hemolytic transfusion reaction, and the test to confirm is the indirect Coombs.

    My question is: Is this Type II or Type IV? The answer reads Type II, but I thought that it would be Type IV; Both reactions are related to antibodies..and type IV is delayed.. so why is type II the better answer? Could someone please explain this to me.. thank you.

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    aframe's Avatar
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    Isn't Type IV a Tc cell response? Type II would make sense if there was no prior sensitization to the Antigen as an Ab response to a foreign Ag takes about a week.

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    md90's Avatar
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    Isn't Type IV a Tc cell response? Type II would make sense if there was no prior sensitization to the Antigen as an Ab response to a foreign Ag takes about a week.
    So is it because of the different types of cells involved within the two hypersensitivities? Type IV is CD4 and CD8 cells, and macrophages; whereas Type II is more related to the complement system. Am I thinking right?

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    I am not expert but the pathway of activation and the cells activated distinguishes the two hypersentivities. Complement may play a role but the real activators in Type II are APC presenting to Type II CD4 TH cells which then activate B cells with IL-2,4,6.... Type IV is like the intracellular response. APC presented to Th or Tc cells. MP activated inducing inflammation. B cells and Ig are not present in this response. Thanks for making me think.

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    md90's Avatar
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    Thank you for the clarification.. I always get confused between the two.. but it does make sense now, and why type II is the better answer...and you are welcome..



    Let's "slam dunk" the step 1!!! )

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