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In this case study, information is presented to students in the form of a dialog between a physician and two parents who have just learned that their child has thalassemia (Cooley’s Anemia). The treatment for this disorder requires a lifetime commitment to whole blood transfusion and chelation therapy (both administered on a daily to weekly basis); the biggest obstacle to long term survival is patient non-compliance. At the end of the dialog there are questions for students to pursue concerning hemoglobin, iron transport and storage, iron overload and chelators. For advanced students a number of articles from the literature are provided. Ultimately the students need to make a recommendation as to what the parents should do.
This case study was originally published by the National Center for Case Study Teaching in the Sciences and is available at http://sciencecases.lib.buffalo.edu/cs/collection/detail.asp?case_id=236&id=236 . Teaching notes and an answer key are available to registered users.
Copyright of the case study is held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. See http://sciencecases.lib.buffalo.edu/cs/collection/uses/ which outlines their policy concerning permissible reproduction of this work.
In working through this case study students should be able to:
- Identify the significance of chemistry to biological systems
- Understand and discuss the causes, symptoms, and treatment of the genetic disorder thalassemia
- Understand and discuss the role of iron in the body
- Understand and discuss the use of chelating agents in the treatment of iron overload, and
- Make an informed decision based on developed critical thinking and reasoning skills.
Students read the case individually and then are placed in small groups. Each group is given until the next class session (or longer) to research answers to the study questions. The class considers each question in turn. Following this discussion, the individual groups reconvene to consider a recommendation to be made to the child’s parents. Each group briefly defends their reasons for making their particular decision.
This activity takes about 10 minutes to present during the initial class session, requires time for students to work outside of class, and then up to a full second class session for reporting and discussion. This reporting and discussion session can be shorter if answers to questions are shared prior to class.
Evaluation
Assessment is via either written or oral presentation of answers to the questions, and then an oral discussion about what the parent’s ultimate decision should be.
I have found that there is often a difference in the ultimate recommendation depending on the age of the student. Traditionally aged students often see the blood transfusion & iron chelation regimen as being a bother and a larger mortality rate as “not bad”. Non-traditionally aged students, particularly those who are parents themselves, tend to opt for more aggressive approaches. This result in and of itself can lead to additional interesting discussions.
I used this case study in a Bio-inorganic class for sophomores, juniors, and seniors, and it worked beautifully. We used this near the end of the course, and it both introduced some new concepts around metal transport and reviewed previous bio-inorganic concepts.
My students had a lot of detailed questions about treatment and prognosis for Cooley's Anemia, so instructors who use this case study might want to have that information handy in case their students have similar questions.