Misplaced Lens Cap
he wasn't even looking at me and he found me
❣ Chile in a Photography ❣
almost home
occasionally subtle
"I'm Dorothy Gale from Kansas"
d e v o n
#extradirty
PR's Tumblrdome
we're not kids anymore.
PUT YOUR BEARD IN MY MOUTH
DEAR READER
dirt enthusiast
Love Begins
roma★
Peter Solarz
Acquired Stardust
oozey mess
TVSTRANGERTHINGS
Claire Keane
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@agararcana
VASCULAR DISORDERS
Osler-Weber-Rendu disease (Hereditary hemorrhagic)
Kasabach-Merrit syndrome (Congenital hemangiomata)
Ehlers-Danlos syndrome
Marfan's syndrome
Pseudoxanthoma elasticum
Senile purpura
Scurvy
Henoch-Schonlein purpura
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🩹 Platelet Granules Disorders 🩹
ALPHA-GRANULE DEFICIENCY - Gray platelet syndrome DENSE-GRANULE DEFICIENCY - Hermansky-Pudlak syndrome - Chediak-Higashi syndrome - Wiskott-Aldrich syndrome
Common NEGATIVE APR's
T - Transferrin ⭐ A - Albumin ⭐ R - Retinol-Binding protein A - Antithrombin P - Prealbumin ⭐
" TARAP "
🧪 "Association of HLA Alleles and Diseases"
HLA-B27 : Ankylosing spondylitis ⭐ HLA-DQ2 : Celiac Disease, Type 1 DM HLA-DR4 : Rheumatoid arthritis ⭐ HLA-DR5 : Hashimoto thyroiditis, Pernicious anemia HLA-DR2 : Goodpasture's Syndrome, Multiple sclerosis HLA-DR3 : SLE ⭐ HLA-B8 : Grave's disease, Myasthenia gravis, Addison's disease HLA-B5 : Behcet's syndrome HLA-DQ2 / DQ8 : Celiac disease ⭐
🩸 Blood Bag Anticoagulants & Expiration Dates
ACD (Acid Citrate Dextrose) - Citrate + Dextrose - 21 days
CPD (Citrate Phosphate Dextrose) - Citrate + Phosphate + Dextrose - 21 days
CP2D - CPD + more dextrose - 21 days
CPDA-1 ⭐ CPD + Adenine 35 days
Additive Solutions ⭐⭐ - (added to RBCs after plasma removal) - 42 days Additive Solution: - AS-1 : Adsol - AS-3 : Nutricel - AS-5 : Optisol
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🩸 ABO DISCREPANCIES
🅰️ Type I – Weak or Missing Antibodies Problem: Reverse typing is weak or absent Seen in: - Newborns - Elderly - Immunodeficiency - Hypogammaglobulinemia Resolution: - Incubate serum at room temperature for 30 mins. - Further incubation at 4 degrees Celsius for 30 minutes
🅱️ Type II – Weak or Missing Antigens Problem: Forward typing is weak or negative Seen in: - Leukemia - Hodgkin lymphoma - Acquired B Phenomenon Resolution: - Wash RBC cells. - Use monoclonal anti-A, B - Test with lectins (Dolichos biflorus or Bandeireae simplicifolia) - Incubate serum at room temperature for 30 mins. - Further incubation at 4 degrees Celsius for 30 minutes
🆎 Type III – Plasma/Protein Abnormalities Problem: Rouleaux → false agglutination Seen in: - Multiple myeloma - Waldenström macroglobulinemia - High fibrinogen Resolution: - Wash RBCs 2-3x - Wash Cord 6-8x Note: How to differentiate agglutination from rouleaux formation. - Add NSS to disintegrate rouleaux formation
🅾️ Type IV – Miscellaneous Problem: Unexpected reactions Causes include: - Cold autoantibodies - Alloantibodies - Bombay phenotype (Oh) - Polyagglutination Resolution: - Antibody screen - Test at 37 °C - Use O cells - Advanced serologic workup
H-antigen - Greatest to Least O > A2 > B > A2B > A1 > A1B
Immunogenicity of Common Rh Antigens - Most to Least D > c > E > C > e
ABO ANTIBODIES
🩸 IgM in ABO (MAJOR ANTIBODY) - Blood groups A, B, and AB - Naturally occurring - React at Room Temperature - Cold-reactive (4–25 °C) - Causes intravascular hemolysis - Does NOT cross placenta - Does NOT cause HDN Clinical significance: - Responsible for acute hemolytic transfusion reactions (AHTR) - Most dangerous ABO incompatibility antibody
🩸 IgG in ABO (MINOR but IMPORTANT) - Group O individuals (Anti-A, Anti-B) - Immune Antibody - React at 37 degrees Celsiusus - Warm-reactive (37 °C) - Causes extravascular hemolysis - Requires AHG (IAT) for detection - Crosses placenta Clinical significance: - Causes mild ABO Hemolytic Disease of the Newborn Treatment: Phototherapy - Important in plasma transfusions
Acquired A phenomenon - Type B or O - Proteus Mirabilis - Tn-activated erythrocytes 🌟 Aquired B Phenomenon 🌟 - Proteus vulgaris - Escherichia coli O86 Note: - Occurs only in Group A Individuals - Mistyped as AB in forward grouping - Under Group 2 discrepancies Mnemonics : EPIC E - E. coli O86 P - Proteus vulgaris I - Intestinal Obstruction C - Carcinoma of the Colon, Rectum Test/s: 1. use Monoclonal anti-B 2. use Acidified anti-B 3. add ACETIC ANHYDRIDE 4. determine the Secretor Status 5. Anti-B lectin (Bandeiraea simpliciforia)
Crossmatch Types
Major crossmatch - Patient serum vs donor RBC Minor crossmatch - Donor serum vs patient RBC (obsolete)
Coombs (AHG) Test
DAT - Antibody/complement on RBC in vivo IAT - Free antibodies in vitro Used in: - HDN - Autoimmune hemolytic anemia - Transfusion reactions
Hemolytic Disease of the Newborn (HDN)
Mother: Rh negative Fetus: Rh positive Antibody: IgG anti-D Prevention: RhIG at 28 weeks & postpartum
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Other Important Blood Group Systems (Must Know!)
Antibodies & Immunoglobulins
Reagent Strip
Reading Time 30s - GinaBi (Glucose & Bilirubin ) 40s - Ka (Ketones) 45s - Saan Galing (SG) 60s - Pa Uwi Na Ba (pH, Protein, Urobilinogen, Nitrite, Blood) 120S - or Layas (Leukocyte)
False NEGATIVE due to ASCORBIC ACID "BB LNG" - Blood/ Bilirubin/ Leukocyte/ Nitrite/ Glucose
Parameters w purple (+) Reaction "BKL barney" - Bilirubin/ Ketones/ Leukocyte = Purple
Reagent Strip
Leukocyte (120s) - Leukocyte esterase - (+) Purple
Nitrite (60s) - Greiss Reaction - (+) Uniform Pink color
Urobilinogen (60s) - Ehrlich's Reaction - (+) Red Multistick : Light to dark pink Chemstrip : White to pink
Protein (60s) - Sorensen's error of Indicator - (+) 30 (++) 100 (+++) 300 (++++) 2000
pH (60s) - Double Indicator System : Methyl Red/ Bromthymol Blue -Acidic : Red to Yellow -Alkaline : Green to Blue
Blood (60s) -Pseudoperoxidase activity of Hgb - (+) Green to Blue
Specific Gravity (45s) - pka change of electrolytes - Concentrated yellow 1.000 - 1.030
Ketones (40s) - Sodium Nitroprusside - (+) Purple
Bilirubin (30s) - Diazo Reaction Multistick : Degrees of tan Chemstrip : Pink to Violet
Glucose (30s) -Double sequential enzyme Multistick : Green to brown Chemstrip : Yellow to Green
Nice to know!
O blood has the MOST H antigen A₁ has the LEAST H antigen Bombay = no H antigen Dolichos biflorus → A₁ Ulex europaeus → H
Blood Banking (Pioneers and Discoveries)
Karl Landsteiner - Discovered ABO blood group system (1901) - Book : The Specificity of Serological Reactions (1917) Sturtle & Von Descatello - AB blood group (1902) Alexander Wiener - Co-discovered the Rh blood group system Albert Hustin - Sodium citrate as an anticoagulant Richard Lewisohn -Determined minimum amount of sodium citrate Braxton Hicks - Recommended Sodium Phosphate Loutit & Mollison (1943) - Acid Citrate Dextrose Pope Innocent - First recorded blood transfusion Dr. Yves Lapierre - Gel Technology (1985) Gregor Mendel - Father of Genetics - 1st: The Law of Segregation - 2nd: The Law of Independent Assortment
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Microbiology Tests
Bacitracin Susceptibility Test - aka. Taxo A Positive result : >10mm (Susceptible) Positive Bacteria : S. pyogenes (GAS) beta-hemolytic
Bile Esculin Test - differentiate Enteroccoci to Group D strep Positive result : Blackening of the agar slant Positive Bacteria : Enterococcus faecalis
Bile Solubility Test - differentiate S. pneumonia to alpha-hemolytic strep Positive result : lysed colony Positive Bacteria : S. pnemoniae (alpha-hemolytic) Rgt: 10% sodium deoxycholate - plate 2% sodium deoxycholate - tube
CAMP - Christie, Atkins, and Munch-Peterson test -differentiate group B strep Positive result : arrowhead shaped zone Positive Bacteria : S. agalactiae (GBS) beta-hemolytic Rgt: beta-lysin producing strain S. aureus
Catalase Test -differentiate micrococcal and staphylococcal from streptococcal Positive result : copious bubbles Positive Bacteria : S. aureus Rgt: 30% hydrogen peroxide
Coagulase Test - Staphylococcus aureus vs. CoNS (Coagulase-Neg Staph) Positive result : Slide method - 10s or less macroscopic clumping Tube method - Clot formation Positive Bacteria : S. aureus Rgt: Rabbit plasma with EDTA
Urine Turbidity
Soluble with Heat - Amorphous urates - Uric acid crystals
Soluble in Dilute Acetic acid - RBC's - Amorphous phosphates - Carbonates
Insoluble in Dilute Acetic acid - WBC's - Bacteria - Yeast - Spermatozoa
Soluble in Ether - Lipids - Lymphatic fluid - Chyle