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Code Crimson in Trauma Triage
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
A complete crossmatching process takes 45 minutes to 1 hour. It is sometimes very difficult to wait in emergencies where type-specific blood can be requested with informed consent and it is a life-saving measure. However, in emergency situations like Code Crimson, uncrossed matched packs are asked for.
Clinical Approach to Case of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Blood replacement: Packed cells must be transfused if there is major blood loss. Losing 30% of blood volume can cause hemodynamic instability and shock. Blood transfusion decision is balanced to prevent shock and at the same time prevent overzealous resuscitation. The decision should be clinical and quick as the first hour (golden hour) management determines the short- and long-term outcome of the woman. Waiting for laboratory values to decide is not prudent in major blood losses, especially when the loss is continuing as lab processing takes time. Quantification of blood loss and the pulse rate and blood pressure are the most critical dictating factors for initiating blood product transfusion during major postpartum haemorrhage episodes. Blood should be crossmatched and transfused. However, crossmatching takes 30–40 minutes. To tide over this delay, group-specific blood within 15 minutes or O negative blood should be immediately available and transfused. There should be no delay in initiating blood transfusion when there is a felt need. It is better than allowing her to progress to shock or dilution coagulopathy. If blood loss exceeds 1,000 mL or tachycardia has set in (pulse rate more than 100 per minute) or the bleeding continues, then blood transfusion should be embarked on as early as possible. When four or more blood is given in 2 hours, it is a massive transfusion, and the other components need to be transfused.
Sickle cell disease
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Marc R. Parrish, John C. Morrison
Obviously, most of the complications associated with this approach are related to the risk of the blood products. Blood products given to these patients should be from cytomegalo-virus-seronegative donors or leukoreduced. Careful cross-matching to minimize minor blood incompatibilities and alloimmunization is critical in avoiding problems later for these patients who may need blood products at various points during their life. The use of blood from family members or friends matched for recipient and donor red cell antigens are clinically helpful in reducing the number of post-transfusion crises. Such episodes are known as delayed hemolytic transfusion reactions. The exact mechanism of hemolytic transfusion reaction is not well understood, and the pathophysiology seems to be far more complex because it involves the destruction of both patient and donor RBCs. A subcategory of this problem is known as a delayed transfusion reaction. It is classically characterized by a clinical triad of fever, hyperbilirubinemia, and anemia occurring 3–10 days after transfusion. Laboratory tests that aid diagnosis include increased reticulocyte count, free hemoglobin in the urine, fragmented RBCs on peripheral smear, decreased post-transfusion Hb A on electrophoresis, or discovery of previously undetected alloantibodies (47).
The development and application of a novel reagent for fixing red blood cells with glutaraldehyde and paraformaldehyde
Published in Hematology, 2023
Xinyang Li, Miyang Li, Yuhong Wang, Shengbao Duan, Hongmei Wang, Yong Li, Zhonghe Cai, Ruiyao Wang, Shuang Gao, Yan Qu, Tianxia Wang, Fei Cheng, Tiemei Liu
When the blood types of blood donors and recipients are incompatible, such as when the red blood cells of type B blood donors are transfused into patients with type A blood, the anti -A antibodies of type B blood donors will also enter the patients and destroy the red blood cells, which can cause acute or delayed blood transfusion reactions and, in extreme cases, threaten the health and life of patients. Consequently, blood type identification prior to transfusion is crucial [1–4]. The British Pharmacopoeia highlights the significance of results of ‘forward type’ and ‘reverse type’ prior to blood transfusion [5]. The cross-matching and antibody screening experiment can only be conducted when the results of ‘forward type’ and ‘reverse type’ are consistent. The term ‘forward type’ refers to the detection of A/B antigens on the surface of RBCs(red blood cells), whereas ‘reverse type’ refers to the detection of anti-A/B antibodies in plasma using RBC reagent [6,7]. Red blood cell reagent is an anti-type detection reagent used to identify blood groups.
HIV TB coinfection - perspectives from India
Published in Expert Review of Respiratory Medicine, 2021
Bharat Bhushan Rewari, Amitabh Kumar, Partha Pratim Mandal, Anoop Kumar Puri
In the initial phase of joint framework there were a number of challenges in terms of infrastructure, capacity building, inadequate coordination between two programs. The number of HIV testing sites were very limited (around 5000) while TB testing sites (Designated microscopy centers-DMC) were more than 16,000. Hence there were losses while referring TB patients to HIV sites for testing. Gradually lab technician at DMC were trained in HIV testing and HIV program agreed to provide HIV test kits at DMC also. The feedback of patients referred from HIV site to TB site for TB testing was many a time delayed or was incomplete. This was sorted out by a mechanism of exchanging a ‘line list’ of patients from both sides and cross-matching patients’ details. The network of outreach workers of HIV NGOs and TB field staff helped in better retention of patients. In 2014, HIV program-built capacity of ART centers on provision of ATT also and anti-TB drugs were supplied by TB program to ART centers. This single window service for ART and ATT led to reduction in number of patients visits and consequently reduced loss of follow up. The results are seen in increasing detection of coinfected persons and more than 90% coinfected persons receiving ART and CPT in addition to ATT. WHO Regional office for South East Asia has developed a Regional response plan for TB-HIV (2017–21) to guide countries on increasing the linkages between two programs [80].
The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems
Published in Acta Orthopaedica, 2019
Georgios Chatziagorou, Hans Lindahl, Johan Kärrholm
Data for the primary THRs and the reoperations were derived from the SHAR. The reporting of primary hip arthroplasties is almost complete (98%) (Karrholm et al. 2017), whereas the reporting of reoperations is poorer (Söderman et al. 2000, Lindgren et al. 2014). Therefore, data linking was done between the SHAR and the National Patient Register (NPR), in order to detect even PPFFs not registered with the SHAR. Cross-matching for the other types of reoperations was not done. The NPR holds information on all inpatient care since 1987, and all outpatient care since 2001. Both private and public healthcare providers have had to report to the NPR since 2001. All medical records of reoperations due to fracture were collected and scrutinized to detect all femoral fractures in patients with a primary THR. The information provided in the case records was also used for fracture classification by GC, according to the Vancouver classification system (Brady et al. 1999). A detailed description of the classification process, as well as its validation, is described in a previous publication (Chatziagorou et al. 2018). Bilateral observations were included as previous studies have indicated that this will not cause significant problems related to dependency (Ranstam et al. 2011).