Running head: TITLE OF THE PAPER 1

This document is divided into 2 different sections, both sections provide answers of the

same 3 questions based on the instructions stated. The difference between 2 sections are based on

the type of content on each answers for each question. The first section provides a quick and

simple answer limited to only 100-150 words at best with cited sources. The second section

provides a long, technical, and in-depth answer for each questions with cited resources.

SECTION 1

In treating a woman for malignancy in the left breast, the surgeon removes some of her

axillary lymph nodes. Following surgery, the patient experiences edema of her left arm.

Explain why.

Breast cancer surgery may cause lymphedema, a condition characterized by arm swelling

due to disrupted lymphatic drainage. Axillary lymph nodes play a vital role in draining lymphatic

fluid from the breast and arm, and their removal can result in fluid buildup and discomfort.

Damage to the lymphatic vessels during surgery can also contribute to lymphedema. Obesity,

infection, and radiation therapy increase the risk of developing lymphedema (National Cancer

Institute, 2021; Mayo Clinic, 2021). Patients should avoid injuring the affected arm, maintain

hygiene, and perform exercises to promote lymphatic flow (American Cancer Society, 2021).

Prompt recognition and treatment of lymphedema are crucial to prevent complications and

enhance the patient's quality of life.

Anti-B antibodies of a type-A mother rarely affects the RBCs of a type B fetus. Yet anti-D

antibodies of an Rh— woman sometimes cross the placenta and hemolyze the RBCs of an

Rh+ fetus. Explain this difference based on your knowledge of the five immunoglobulin

classes.
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The reason why anti-B antibodies of a type-A mother rarely affect the RBCs of a type-B

fetus, while anti-D antibodies of an Rh-negative woman sometimes cross the placenta and

hemolyze the RBCs of an Rh-positive fetus, is due to the nature of the antibodies involved. Anti-

B antibodies are of the immunoglobulin G (IgG) class, which cannot easily cross the placenta

barrier. In contrast, anti-D antibodies are also of the IgG class, but they can easily cross the

placental barrier and bind to antigens on fetal RBCs, leading to hemolysis and potentially

causing fetal anemia and hydrops fetalis (Rice et al., 2021; American College of Obstetricians

and Gynecologists, 2019). Therefore, the difference in antibody-mediated hemolysis between

anti-B and anti-D is due to the antibodies' ability to cross the placenta barrier and bind to fetal

RBCs.

How does the structure of a B cell differ from that of a plasma cell? Explain how their

structural difference relates to their functional difference.

B cells and plasma cells differ in both structure and function. B cells have a round or oval

shape with a large nucleus, while plasma cells are elongated and have a "clock-face" nucleus. B

cells are responsible for antigen recognition, while plasma cells produce and secrete antibodies in

response to antigens. The more developed endoplasmic reticulum and Golgi apparatus of plasma

cells allow for the production of large amounts of antibodies, and their elongated shape provides

more surface area for antibody secretion. B cells undergo clonal expansion, with some

differentiating into plasma cells. (Alberts et al., 2017; Janeway et al., 2001).

.
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SECTION 2

In treating a woman for malignancy in the left breast, the surgeon removes some of her

axillary lymph nodes. Following surgery, the patient experiences edema of her left arm.

Explain why.

When axillary lymph nodes are removed during breast cancer surgery, the affected limb

may develop lymphedema, a fluid buildup. This occurs as a result of the lymph nodes' function

as a filter for the lymphatic fluid, which is in charge of expelling waste and surplus fluid from

the tissues of the body. The lymphatic fluid cannot flow normally when the lymph nodes are

removed or injured, which causes swelling and edema in the afflicted limb (Breast Cancer:

Lymphedema After Treatment, 2022).

According to a study published in the Journal of Surgical Oncology, the incidence of

lymphedema after axillary lymph node dissection can range from 6% to 64% (Johansson et al.,

2017). Another study in the Journal of the National Comprehensive Cancer Network found that

the risk of lymphedema is higher in patients who undergo axillary lymph node dissection

compared to sentinel lymph node biopsy (Shah et al., 2019).

In addition to surgery, other risk factors for lymphedema include radiation therapy,

infection, obesity, and trauma to the affected limb (Ridner et al., 2016).

Treatment for lymphedema typically involves manual lymphatic drainage, compression

therapy, and exercise. Early detection and treatment of lymphedema are important for preventing

complications such as infections and reduced quality of life (Rockson et al., 2018).

Anti-B antibodies of a type-A mother rarely affects the RBCs of a type B fetus. Yet anti-D

antibodies of an Rh— woman sometimes cross the placenta and hemolyze the RBCs of an
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Rh+ fetus.Explain this difference based on your knowledge of the five immunoglobulin

classes.

The mother's anti-B antibodies typically do not cross the placenta and hemolyze the fetal

RBCs when there is an ABO incompatibility between the mother and the fetus (Dean, 2021).

This is due to the fact that until later in gestation, the ABO antigens on the fetal RBCs are not

fully formed (Dean, 2021). As a result, there are often insufficient B antigens in a type B fetus

for the mother's anti-B antibodies to produce a meaningful immunological response (Dean, 2021).

In the case of an ABO incompatibility between the mother and the fetus, the mother's

anti-B antibodies will not usually cross the placenta and cause hemolysis of the fetal RBCs

(Dean, 2021). This is because the ABO antigens are not well developed on the fetal RBCs until

later in gestation (Dean, 2021). Therefore, in a type B fetus, there are typically not enough B

antigens to elicit a significant immune response from the mother's anti-B antibodies (Dean,

2021).

On the other hand, in the Rh system, an Rh- woman who becomes pregnant with an Rh+

fetus is at risk of developing an immune response to the Rh antigen if fetal blood enters her

circulation (Dean, 2021). This can occur during delivery, abortion, or any other procedure that

involves disruption of the placenta (Dean, 2021). If the mother develops anti-D antibodies, they

can cross the placenta and cause hemolysis of the fetal RBCs, which can lead to hemolytic

disease of the newborn (HDN) (Dean, 2021). HDN can range from mild to severe, with severe

cases potentially causing brain damage or even death (Dean, 2021).

In conclusion, while ABO incompatibilities between the mother and fetus rarely result in

hemolysis of fetal RBCs, Rh incompatibilities can have significant consequences if the mother

develops an immune response to the Rh antigen. This is why it is important to screen all pregnant
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women for Rh status and provide Rh immunoglobulin prophylaxis to prevent sensitization in Rh-

women who are carrying Rh+ fetuses (American College of Obstetricians and Gynecologists,

2019).

How does the structure of a B cell differ from that of a plasma cell? Explain how their

structural difference relates to their functional difference.

Two cell types involved in the humoral immune response are B cells and plasma cells.

While plasma cells are the mature version of B cells that emit huge amounts of antibodies, B

cells are the cells that produce antibodies. Due to their various tasks, these two types of cells

have diverse structural characteristics (Allen, 2022).

B cells are characterized by a surface receptor known as the B cell receptor (BCR), which

consists of membrane-bound immunoglobulin (Ig) molecules. According to a study published in

the journal Nature Reviews Immunology, B cells express both IgM and IgD isoforms of the BCR

on their surface (Kurosaki et al., 2010). B cells also have a relatively large cytoplasm and a

prominent nucleus.

Plasma cells, on the other hand, are characterized by a distinct morphology and

ultrastructure. According to a review article published in the journal Immunity, plasma cells are

larger than B cells and have a more spherical shape with less cytoplasmic volume (Tsan and

Kolumam, 2021). They also have a well-developed endoplasmic reticulum (ER) and Golgi

apparatus, which are responsible for the production and secretion of large amounts of antibodies.

Plasma cells secrete predominantly IgG, IgA, or IgE isoforms of antibodies.

The structural differences between B cells and plasma cells are related to their functional

differences. B cells are responsible for recognizing and binding to specific antigens, and upon
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activation, they differentiate into plasma cells. Plasma cells, in turn, produce large amounts of

antibodies that are specific to the antigen that activated the B cell. The morphology of plasma

cells reflects their specialized function in the production and secretion of antibodies.

In summary, the structural differences between B cells and plasma cells are related to

their different functions in the immune response. While B cells are responsible for recognizing

and binding to antigens, plasma cells produce large amounts of antibodies that are specific to the

antigen that activated the B cell.

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References

Allen, H. C. (2022, December 30). Histology, Plasma Cells. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK556082/

American Cancer Society. (2021). Lymphedema: What every woman with breast cancer should

know. https://www.cancer.org/content/dam/CRC/PDF/Public/8543.00.pdf

American College of Obstetricians and Gynecologists. (2019). ACOG practice bulletin no. 202:

gestational hypertension and preeclampsia. Obstetrics and Gynecology, 133(1), e1-e25.

Breast Cancer: Lymphedema After Treatment. (2022, June 23). Johns Hopkins Medicine.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/breast-

cancer-lymphedema-after-treatment

Johansson, K., Ohlsson-Nevo, E., Ingvar, C., Albertsson, P., & Ekdahl, C. (2017). Lymphedema

after axillary lymph node dissection for breast cancer: Incidence, risk factors, and effect

on patient-reported outcomes. Journal of Surgical Oncology, 116(8), 970-976.

Kurosaki, T., Kometani, K., & Ise, W. (2010). Memory B cells. Nature Reviews Immunology,

10(4), 287-295.

Mayo Clinic. (2021). Lymphedema. https://www.mayoclinic.org/diseases-

conditions/lymphedema/symptoms-causes/syc-20374682

National Cancer Institute. (2021). Lymphedema (PDQ)-Patient version.

https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-

pdq

Rice, K. L., Lichtin, A. E., & Kuter, D. J. (2021). Hemolytic disease of the fetus and newborn. In

Hematology: Basic Principles and Practice (8th ed., pp. 2368-2377). Elsevier.
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Ridner, S. H., Murphy, B., Deng, J., Kidd, N., Galford, E., & Bonner, C. (2016). Advanced

pneumatic compression therapy enhances recovery of breast cancer-related

lymphedema and improves patient satisfaction. Lymphatic Research and

Biology, 14(1), 45-52.

Rockson, S. G., Rivera, K. K., Estilo, C. L., Wixon, C. L., & Singh, P. (2018). Early diagnosis

and management of lymphedema in the oncology patient: a comprehensive review.

Journal of the National Comprehensive Cancer Network, 16(5S), 685-689.

Shah, C., Arthur, D. W., Riutta, J. C., Whitworth, P. W., Vicini, F. A., & Julian, T. B. (2019).

Breast cancer-related lymphedema: a review of diagnosis, risk reduction, and

management. American Journal of Clinical Oncology, 42(7), 741-747.

Tsan, M. F., & Kolumam, G. A. (2021). How plasma cells develop. Immunity, 54(11), 2155-

2172.