1. Immune System Clinical Case Problem
Review the case history and lab findings presented to answer the diagnosis questions. Provide all responses to your diagnosis questions in a word document or on a sheet of paper. Be sure to justify your responses to the diagnosis questions.

2. Patient History
Justin Mather, a 23-year-old man, presented to the physician with a long medical history dating back to 1983 when, as a 6-year-old, he was referred to a pediatrician by a dentist. At that time, the dentist was about to administer an anesthetic drug by injection prior to extracting a tooth when he elicited a history of easy bruising in the boy as well as a history of a brother who died at age one from an intracranial hemorrhage after falling from a crib. In addition, Justin has had several instances of severe bruising following minor trauma and progressively worsening arthritis of both knee joints over the past four years. Interestingly, Justin's maternal grandfather died at age 27 of a bleeding complication following an appendectomy. Justin's maternal grandmother remarried, and Justin's mother lost complete touch with her deceased father's family. Justin's mother's three half-brothers are alive and well.

3. Lab findings in Justin at that time (1983)
platelet = count 280,000 / mm3 of blood (normal = 150, ,000 / mm3) bleeding time = 6 minutes (normal = minutes) prothrombin time (PT) = 11 seconds (normal = seconds) partial thromboplastin time (PTT) = 58 seconds (normal = seconds) fibrin split-products = 22 µg / ml (normal = µg / ml) hematocrit and white blood cell count were both normal Note: Justin was told at that time that he had a "blood disease" and would require close medical attention.

4. Recent Symptoms
In the past two years, Justin's health has deteriorated, starting with a mono-like illness which resulted in fatigue, a sore throat, and swollen lymph nodes in the neck and groin. This was followed a few weeks later by a diarrheal illness marked by a 23-pound weight loss. Six months ago, Justin developed a severe parasitic pneumonia which subsided only after intensive antibiotic treatment. Three months ago, he noted the appearance of silver-dollar-sized purple blotches on his skin (unlike any he had seen on his skin in the past) that have still not gone away. In the past week, Justin has progressively weakened, suffering from chills, weakness, and a high fever that has left him bedridden. 

5. Recent Lab Findings white blood cell count of 2.8 (2,800 WBCs per mm3)
- normal range is 4,500 to 11,000 WBCs per mm3)
reduced number of T-helper cells

6. Diagnosis Questions
Why does Justin bleed so easily? What is significant in his family history? (feel free to draw a pedigree to reinforce your answer).
Why is the PTT elevated? Why isn’t the PT elevated? In your answer, be sure to explain exactly what is assessed by these tests.
The bleeding time was normal. What general types of disorders are ruled out by the normal value of this test?
What precautions do you think were taken prior to extracting Justin’s tooth?
What has been the primary cause of Justin’s poor health in the past two years? Is his illness of the past two years related in any way to the “blood disease” diagnosed in 1983? Explain your answer.
What specifically might have caused the following:
Pneumonia
Most recent dark purple blotches on the skin
How is Justin’s immune system affected by a deficiency in T-helper cells?
What might be done to treat Justin’s T-helper cell deficiency? Explain the mechanisms for such treatments.
What is your final diagnosis of Justin? Be sure to justify your responses for both his “blood disease” diagnosed in 1983 and diagnosis for recent poor health.