Determination of Hematocrit Value

Hematocrit or erythrocyte volume of the compressed (packed cell volume, PCV) is the percentage volume of erythrocytes in the blood is compressed by playing at a certain speed and in a certain time. The purpose of this test is to determine the concentration of erythrocytes in the blood.

Based on the reproducible and simple, this examination is the most trustworthy among other checks, namely hemoglobin and erythrocyte count. Can be used as a simple filter test against anemia.

Hematocrit or PCV values ​​can be set using the automatic hematology analyzer or manually. Manually hematocrit measurement method known there are two, namely :

Methods makrohematokrit

At the macro method, as much as 1 ml blood samples (EDTA or heparin blood) were included in Wintrobe tubes measuring 110 mm long with a diameter of 2.5-3.0 mm and 0-10 mm scale. The tubes then were centrifuged for 30 minutes at 3,000 rpm. High erythrocyte column is the hematocrit value is expressed in%.

Methods mikrohematokrit

At the micro method, blood samples (capillary blood, blood EDTA, heparin blood or blood-potassium-ammonium oxalate) is inserted in a capillary tube having a length of 75 mm in diameter and 1 mm. Capillary tubes are used there are two kinds, namely containing heparin (marked red) for capillary blood samples (direct), and without anticoagulant (marked blue) blood to EDTA / heparin / ammonium-potassium-oxalate.

Examination procedures are: blood sample is inserted into the capillary tube until 2 / 3 the volume of the tube. One end of the tube is closed with putty (clay) and then centrifuged for 5 minutes at 15,000 rpm. High erythrocytecolumn were measured with a hematocrit reader, its value expressed in%.

Mikrohematokrit method is more widely used because in addition to quite a short time, blood samples required is also small and can be used for samples without anticoagulant that can be obtained directly.

Reference Values

Adult male : 40 - 52%

Adult women : 35-47%

Newborns : 44-72%

Children aged 1-3 years : 35-43%

Children aged 4-5 years : 31-43%

Children aged 6-10 years : 33-45%

Clinical Problems

Decreased levels: acute blood loss, anemia (aplastic, hemolytic, folic acid deficiency, pernicious, sideroblastik, sickle cell), leukemia (lymphocytic, myelogenous, monositik), Hodgkin's disease, limfosarkoma, organ malignancies, multiple myeloma, cirrhosis of the liver, protein malnutrition , deficiency of vitamins (thiamine, vitamin C), gastric or duodenal fistula, peptic ulcer, failure, chronic kidney, pregnancy, SLE. The influence of drugs: antineoplastic, antibiotics (chloramphenicol, penicillin), radioactive medicine.

Increased levels: dehydration / hypovolemia, severe diarrhea, polycythemia vera, eritrositosis, diabetic acidosis, pulmonary emphysema late stage, whereas cerebral ischemia, eclampsia, surgery, burns.

Factors that may affect the laboratory's findings :

If a blood sample taken at the arm that is attached intra-venous lines, tend to be low hematocrit values ​​due to hemodilution. Installation of rope tourniquet that is too long the potential to cause hemoconcentration, so that the hematocrit value can be increased. Capillary blood sampling: punctures lacking in so that the volume gained slightly and squeeze the blood must be squeezed-out, which pierced the skin is still damp with alcohol so that the diluted blood, clots occur in the blood drops because of slow work.

Hematology test, Osmotic fragility erythrocytes

When erythrocytes are in solution hipotonis, osmolalitasnya fluid levels lower than normal plasma or serum (less than 280 mOsm / kg)

Erythrocyte osmotic fragility test (also called erythrocyte osmotic resistance) is done to measure the ability to withstand the occurrence of erythrocyte hemolysis (destruction of red blood cells) in asolution that hipotonis. The trick is as follows: erythrocytes were dissolved in saline solution with various concentrations. If hemolysis occurs at a slightly saline solution hipotonis, this state is called an increase in erythrocyte fragility (= reduction in resistance / durability erythrocytes), and if hemolysis occurs at a very hipotonis salinesolution, this situation indicates decreased osmotic fragility (= increase in erythrocyte resistance).

Hemoglobin out of the cells in each tube containing a solution of NaCl of different levels. Hb then determined fotokolorimetrik. The results are reported in percentages (%) hemolysis. Collection of hemolysis results are plotted in a curve as compared with normal erythrocytes data. In the state of increased fragility, erythrocytes are usually spherical, and the curves seem to shift to the right. While the decrease in fragility, thin and flat-shaped erythrocytes, the curve appears shifted to the left.

Clinical Problems

DECREASE fragility: Thalassemia major and minor (Mediterranean anemia or Cooley's anemia), anemia (iron deficiency, folic acid deficiency, vitamin B6 deficiency, sickle cell) hemoglobin C disease, polycythemia vera, post splenectomy, acute liver necrosis and sub-acute, jaundice obstructive.

IMPROVEMENT fragility: hereditary spherocytosis, transfusions (ABO and Rhesus incompatibility), autoimmune hemolytic anemia (AIHA), hemoglobin C disease, drug toxicity or chemicals, chronic lymphocytic leukemia, burns (thermal).

Procedure

This test is usually performed on fresh blood samples of less than 3 hours and / atu 24-hour blood samples were incubated at 37 ° C. Blood samples used in the form of heparin blood or blood "defibrinated". There are no restrictions on food or beverage intake.

In this test made solution with different concentrations of NaCl. Assessment of results with fotokolorimetri method (using photometer or spectrophotometer).

Prior to testing, provide a first buffer stock solution of NaCl 10% made from 9 grams NaCl, 1.365 g Na2HPO4, and 0.215 grams NaH2PO4.H2O. The material is then diluted with distilled water to 100 ml. Before being used for inspection, make asolution of 1.0% NaCl principal by dissolving 5.0 ml of saline buffer stock of 10% with distilled water to 50.0 ml. Next do the testing as follows :

1. Provide 12 pieces and then make a dilution tube multilevel solution of NaCl concentration: 0.85%, 0.75%, 0.65%, 0.60%, 0.55%, 0.50%, 0.45%, 0, 40%, 0.35%, 0.30%, 0.20% and 0.10%, respectively of 5.0 ml. NaCl solutions were made from the basicsolution of NaCl 1.0%.
2. Add into the canisters each 50 mL blood sample. Mix (homogenization) by way of tossing and turning the tube several times.
3. Inkubasikan for 30 minutes at room temperature.
4. Mix (homogenization) again and then worry about (centrifuges) of each tube for 5 minutes at 3000 rpm.
5. Measure the absorbance (OD) of the supernatant at λ 540 nm with the blank tube to supernatant-1 (0.85% NaCl).
6. Calculate the% hemolysis by dividing the absorbance (OD) of samples with the absorbance (OD) tubing to 12 multiplied by 100%.
7. Create a curve with the concentration of NaCl as the axis (x) and% hemolysis as the ordinate (y). Compare with the curve of normal blood controls.

Normal Value

The beginning of hemolysis on the concentration of NaCl 0.40% - 0.45%

Complete hemolysis at a concentration of 0.30% NaCl - 0.35%

The percentage of hemolysis in normal circumstances are :

97-100% hemolysis in 0.30% NaCl

50-90% hemolysis in 0.40% NaCl

5-45% hemolysis in 0.45% NaCl

0% hemolysis in 0.55% NaCl

Factors Affecting Laboratory Findings

• plasma pH, temperature, glucose concentration, and oxygen saturation in the blood
• Long-lived erythrocytes tend to have high osmotic fragility
• Blood samples taken over 3 hours can show increased osmotic fragility.

Source of the article and continue reading : http://labkesehatan.blogspot.com

Taking Blood Veins With Vacuum Tubes, Vacutainer

bd.com

Vacuum tube was first marketed by U.S. company BD (Becton-Dickinson) under the trade name Vacutainer. This type of tube in the form of a vacuum tube, made of glass or plastic. When the tube is attached to the needle, the blood will flow into the tube and the flow stops when a certain volume has been reached.

Needles used consists of two needles connected by a threaded connection. The needle on the anterior side is used to puncture the vein and the needle on the posterior side of the tubes plugged. Posterior needle encased by the material of rubber so as to prevent the blood from the patient flows out. Threaded connection serves to attachthe needle in a holder and ease when pushing the needle tube mounted directly on the posterior.

The advantage of using this retrieval method is, no need to divide the sample into several tubes of blood. Just one stabbing, can be used for multiple tubes alternately according to the type of tests required. For the purposes of the bacteria culture test, thismethod is also better because the patient's blood can flow directly into the tube containing the bacteria culture media. Thus, the possibility of contamination duringsample transfer to the decision by way of the manual can be avoided.

The drawback difficult decision in the elderly, small children, infants, or if the vein is unreliable (small, fragile), or if the patient is obese. To overcome this may be used needle with wings (winged needle).

Winged needle or needles is often also called "butterfly" needle vakutainer nearly equal as mentioned above. The difference is, betweenthe needle anterior and posterior wings there are two pieces of plastic at the base of the anterior needle and the needle tube that connects the anterior and posterior. If the proper insertion of the vein, blood will look into the hose (flash).

Procedure :

1. Prepare the necessary tools: needles, cotton 70% alcohol, a hedge strap (tourniquet), plaster, vacuum tubes.
2. Attach the needle to the holder, make sure it is firmly.
3. Approach the patient in a calm and friendly; try to patients as comfortable as possible.
4. Identification of patients correctly according to the data at the request sheet.
5. Verification of the patient, such as fasting or consumption of drugs. Record if the patient is taking certain medications, etc. are not fasting.
6. Ask the patient to straighten his arm, select the arm that did a lot of activity.
7. Have the patient make a fist.
8. Attach a rope hedge (tourniquet) is approximately 10 cm above the elbow fold.
9. Select the median cubital or cephalic vein. Do palpability (palpation) to ensure the position of the vein; vein palpable as a small pipe, elastic and has a thick wall. If the veins are not palpable, do the sorting of the wrist to the elbow, or warm compresses for 5 minutes the arm.
10. Clean the skin on the parts to be taken with alcohol 70% cotton and let dry. Skin that has been cleaned do not hold anymore.
11. Puncture the vein with a needle hole position facing up. Insert the tube into the holder and push that needle stuck in the posterior part of the tube, then the blood will flow into the tube. Wait until the blood stops flowing. If you require multiple tubes, having first filled the tube, remove and replace with a second tube, and so on.
12. Remove the tourniquet and ask the patient to open his fist. The volume of blood taken approximately three times the amount of serum or plasma required for the examination.
13. Put the cotton on the injection site and then immediately release / pull the needle. Press the cotton and plasters couple sat for about 15 minutes. Do not pull the needle before the tourniquet was opened.

Accommodate Blood In Tube

Some types of blood sample tubes used in the clinical laboratory practices are as follows :

Tube red cap. This tube without the addition of additives, the blood will be frozen and the serum separated by centrifugation. Commonly used for examination of blood chemistry, immunology, serology and blood bank (crossmatching test)

Tube yellow cap. It contains a gel separator tubes (serum separator tube / SST) whose function is to separate serum and blood cells. After centrifugation, the serum will be at the top of the gel and the blood cells are under the gel. Commonly used forexamination of blood chemistry, immunology and serology

Tube light green lid. It contains a gel separator tube (plasma separator tube / PST) with lithium heparin anticoagulant. After centrifugation, the plasma will be at the top of the gel and the blood cells are under the gel. Commonly used forexamination of blood chemistry.

Purple or lavender tube cap. This tube contains EDTA. Commonly used for complete blood count and blood banks (crossmatch)

Tube blue cap. This tube contains sodium citrate. Commonly used for examination of coagulation (eg PPT, APTT)

Tube green cap. This tube contains sodium or lithium heparin, commonly used for the examination of erythrocyte osmotic fragility, blood chemistry.

Dark blue cap tube. This tube contains EDTA-free metals, generally used for examination of trace elements (zinc, copper, mercury) and toxicology.

Tube light gray cap. This tube contains sodium fluoride and potassium oxalate, were used for examination of glucose.

Black cap tube; containing sodium citrate buffer, used for checking the LED (ESR).

Pink cap tube; containing potassium EDTA, used for examination imunohematologi.

White cap tube; potassium EDTA, used for examination of molecular / PCR and bDNA.

Tube yellow with a black cap at the top; containing culture media, used for microbiological examination - aerobic, anaerobic and fungal

Accommodate some of the important things in the blood sample is :

Blood from syring or injections should be inserted into the tube by removing the needle and the blood flow slowly through the tube wall. Enter the blood by way of spraying, especially without removing the needle, potentially causing hemolysis. Blood entering into the vacuum tube by a needle on the cap tube, allow blood to flow until it stops itself when the volume has been met.

Homogenization of samples if using anticoagulants by twisting the tube 4-5 times or tossing and turning the tube 5-10 times by softly. Whisk thesample potentially cause hemolysis.

The order to enter the blood samples into vacuum tubes are: first - bottle culture (culture) of blood or yellow-black cap tube second - coagulation tests (tube blue cap), third - non-additive tube (red cap), the fourth - the red cap tubes or yellow with separator gel or clot activator, tube cap purple / lavendet (EDTA), green cap tube (heparin), gray cap tubes (NaF and Na oxalate).

Image source : bd.com, Thanks, references from my teachers address : labkesehatan.blogspot.com

Protein C-reactif

Protein C-reactif (C-reactive protein, CRP) are made by the liver and secreted into the bloodstream. CRP circulates in the blood for 6-10 hours after the acute inflammatory process and tissue destruction. Levels peaked within 48-72 hours. As with any test erythrocyte sedimentation rate (erithrocyte sedimentation rate, ESR), CRP is a non-specific test but the existence precedes the CRP increase during inflammation and necrosis of the LED and then immediately return to normal levels.

CRP is one of several proteins that are often referred to as acute phase proteins and used to monitor changes in the acute inflammatory phase is associated with many infectious diseases and autoimmune diseases. Some circumstances in which CRP may increase was found arthritis (rheumatoid arthritis), rheumatic fever, breast cancer, colitis, inflammatory disease stage (pelvic inflammatory disease, PID), Hodgkin's disease, SLE, bacterial infections.

CRP is also elevated in the final trimester of pregnancy, the use of intrauterine contraceptive devices and oral contraceptive drug effect.

CRP test is often performed repeatedly to evaluate and determine whether the treatment is effective. CRP is also used to monitor wound healing and to monitor post-surgical patients, organ transplant, or burns as an early detection system for possible infections.

High-sensitive CRP (hs-CRP)
This test can detect the inflammation that occurs due to the formation of atherosclerotic plaque in coronary arteries. hsCRP is a highly sensitive laboratory test for the risk of cardiovascular disease. This test is often done in conjunction with the test lipid profile (cholesterol, triglycerides, HDL, LDL). Positive hsCRP value is much lower than the standard value of serum CRP so that it becomes more useful test in detecting the risk of coronary heart disease (coronary heart disease, CHD), stroke, and peripheral arterial disease.

American Heart Association and the U.S. Centers for Disease Control and Prevention have defined risk groups as follows :

• Low risk: less than 1.0 mg / L
• Average Risk: 1.0 to 3.0 mg / L
• High risk: above 3.0 mg / L

Those values ​​are only a part of the evaluation process for kardiovaskuler.Tambahan disease risk factors to consider are the elevated levels of cholesterol, LDL, triglycerides, and glucose. In addition, smoking, high blood pressure (hypertension), and diabetes also raise the level of risk.

Procedure
CRP test can be performed manually using agglutination methods or other more advanced methods, such as sandwiches imunometri. Agglutination tests carried out by adding the latex particles coated with anti-CRP antibodies in the serum or plasma agglutination patient so that it will happen. To determine the titer of CRP, serum or plasma diluted with buffer glycine patients with multilevel dilution (1 / 2, 1 / 4, 1 / 8, 1 / 16 and so on) and then reacted with latex. CRP titer is the highest dilution that still occur agglutination.

Imunometri sandwich tests performed by measuring the intensity of colors using Nycocard Reader. Consecutive samples (serum, plasma, whole blood) and conjugate dropped on the coated membrane antibody testsspecific mononklonal CRP. CRP in the sample captured by antibodies bound to colloidal gold particle conjugates. Free conjugate was washed with wash solution (washing solution). If there is at the level of CRP in pathological samples, it will form a red-brown color in the test area with color intensity proportional to the content. Color intensity was measured quantitatively using a reader NycoCard II.

Normal reference value of CRP with imunometri sandwich method is <5 mg / L. This reference value would be different depending on each laboratory reagents and methods used.

hepatitis A (HAV)

What is hepatitis A and how is it transmitted ?

Hepatitis A is caused by the hepatitis A virus (HAV). HAV is spread through food / drink contaminated with fecal matter (stool) of an infected person enter another person's mouth. HAV is mainly transmitted through raw or inadequately cooked, handled or prepared by someone withhepatitis A (although maybe he did not know he was infected).

Drinking water or ice that is contaminated with feces is another source of infection, as well as shellfish that are not cooked enough. HAV can be transmitted through "rimming" (oral-anal sex, or between the mouth and anus). HAV is rarely transmitted through blood-to-blood.

Hepatitis A is an acute form of hepatitis, meaning do not cause chronic infection. Once we've had hepatitis A, we can not be infected again. However, we can still be infected with other hepatitis viruses.

What are the symptoms of hepatitis A?

Not all people infected with HAV will have symptoms. For example, many infants and young children infected with HAV do not experience any symptoms. Symptoms are more likely to occur in older children, adolescents and adults.

Symptoms of hepatitis A (acute hepatitis and in general) can including :

• skin and whites of the eyes become yellow (jaundice)
• Fatigue
• right-upper abdominal pain
• Loss of appetite
• Weight loss
• Fever
• Nausea
• Diarrhoea or diarrhe
• Vomiting
• Water arts such as tea and / or dirt-colored putty
• joint pain

HAV infection can also increase the levels of enzymes made by the liver to be above normal in the blood. The immune system require up to eight weeks to remove the HAV from the body. If symptoms develop, generally within two to four weeks after infection. Symptoms ofhepatitis A is generally only one week, but can be more than a month. Approximately 15 percent of people with hepatitis A have symptoms from six to nine months. Approximately one in 100 people infected with HAV may experience rapid and severe infections (so-called 'fulminant'), which - very rarely - can lead to liver failure and death.

How is hepatitis A diagnosed ?

Diagnosis of hepatitis A is confirmed by blood tests. The doctor will order these tests if we are experiencing symptoms of hepatitis A or if we want to know whether you were infected with HAV in the past. The blood test looks for two types of antibodies to the virus, which referred to as IgM and IgG (Ig stands for immunoglobulin). First, look for IgM antibodies, produced by the immune system of five to ten days before symptoms appear and usually disappear within six months. Tests also search for IgG antibodies, IgM antibodies are replaced and protect against HAV infection.

• When blood tests show negative for IgM antibodies and IgG, we probably have never been infected with HAV, and should consider getting vaccinated against HAV.
• If you are positive for IgM antibodies and negative to IgG, our chances of contracting HAV in six past month, and the immune system is being removing a virus or infection is becoming increasingly severe.
• When the tests showed negative for IgM antibodies and positive for IgG antibodies, we may be infected with HAV in an earlier time, or we already vaccinated against HAV. We are now immune to HAV.

Note : Hepatitis A is endemic in Indonesia. This means that the majority of Indonesian people ever exposed to HAV during childhood, and most likely will be immune to infection again. Because of this, most doctors HAV test is not considered beneficial for people with HIV in

Indonesia.

How to people with HIV ?

People with HIV do not have the risk of becoming infected with HAV higher

than others. However, several studies indicate that people with HIV is more likely to experience symptoms of hepatitis A for Longer term, the meaning may take longer to recover fully from hepatitis A. One other important issue to consider is that many HIV-positive people taking antiretroviral drugs can be bad for the liver. Some of these drugs can worsen the symptoms ofhepatitis A. Because of this, maybe we should stop using all drugs so that the hepatitis A began to recover or liver enzyme levels returned to normal. Talk with your doctor before any medication dismiss.

How is hepatitis A treated ?

The usual treatment for hepatitis A is a break at sleep. There are also important to drink plenty of fluids, especially when we experiencing diarrhea or vomiting. Painkillers which counter, such as ibuprofen can reduce the symptoms hepatitis A, but we should talk more check with your doctor.

When we feel we may have been exposed to HAV - for example when someone in our household recently been diagnosed with hepatitis A - we should see a doctor to discuss the benefits of immune globulin injection (also called as gamma globulin). Immune globulin contains lots of antibodies against HAV, which can help prevent the onset of disease when we are exposed to the virus. Immune globulin must be given within two to six weeks after we might have been exposed to HAV. When we receive immune globulin to preventhepatitis A, we should also receive hepatitis A vaccine (discussed below).

How can hepatitis A be prevented ?

The best way to prevent hepatitis A is vaccination. Vaccination requires two injections, usually given with a time gap of six months. Side effects of hepatitis A vaccination, if it occurs, is usually mild and may include soreness at the injection site and mild flu-like symptoms. Also available is a combination vaccine for viralhepatitis A and B. HAV vaccine is very effective - more than 99 percent of people who receive a vaccination immune to viruses and not be exposed tohepatitis A if exposed. There is little doubt that HAV vaccination in people with very low CD4 counts may not provide immunity (due to very weak immune systems), so it should be vaccinated at a CD4 count is still quite high.

When we feel we have not been infected with hepatitis A, we should discuss with your doctor. Because people with HIV often experience more severe symptoms when infected with HAV, and our heart is essential to remove the remaining end of ARV drugs, HAV vaccination is recommended for people with HIV. Vaccination is especially important for people with HIV and hepatitis B or C.

Although we have not received vaccination against hepatitis A, there are some things we can do to prevent

HAV infection:

• Avoid water, including ice, which could be contaminated with feces
• Avoid raw shellfish or undercooked
• Always wash hands with soap and water after using the room
• bathing, changing diapers and before preparing
• or eating food
• Wearing a latex barrier ('dental dam') to sex oralanal

Anti-cardiolipin Antibodies (ACA) Test

Anticardiolipin Antibodies are proteins found in the body that works against kardiolipin. Kardiolipin and other related phospholipids are lipid molecules that are usually found in cell membranes and platelets as well as having an important role in regulating blood clotting. Whenantibodies produced against kardiolipin, they will increase the risk of blood clots forming an undue (thrombosis) in the arteries and veins.

Anticardiolipin Antibodies belong to a group of antiphospholipid antibodies (APA) in conjunction with lupus anticoagulan (LA). LA causes the elongation of activated partial thromboplastin time (APTT). Clinical manifestations associated with the respective antibody appeared similar, namely thrombosis. Clinical experience suggests that venous thrombosis may be associated with LA, and arterial thrombosis is more likely associated with a high titer of ACAantibodies. Antiphospholipid antibodies are acquired abnormalities; may occur in association with systemic autoimmune disorders or by itself. Patients remain at risk for thrombosis as long as there are autoantibodies.

Clinical Problems

Elevated levels of anticardiolipin antibodies found in antiphospholipid syndrome (thrombosis of arteries and veins are recurrent, recurrent miscarriage), autoimmune diseases (SLE, HIV / AIDS), preterm labor, pre-eclampsia, intrauterine growth retardation, thrombocytopenia, malignancy (leukemia, lymphoproliferative disorders and plasmasitik, solid tumors), infections (bacteria, viruses, protozoa), neurologic events including transient ischemic attack and stroke, liver disease, and disease dermatologik (livedo reticularis, acrocyanosis, pyoderma, extensive skin necrosis). The influence of drugs: chlorpromazine, procainamide, kuinidin, penicillin, many antibiotics, phenytoin.

Procedure

Anticardiolipin antibodies consists of three kinds, namely IgM, IgG, and IgA. Tests for anticardiolipin IgM and IgG antibodies are often asked to help determine the cause of thrombosis, recurrent pregnancy loss, or thrombocytopenia. It may also be requested along with the testing of lupus anticoagulant (LA) to help investigate the cause of APTT prolonged, especially if clinical findings indicate that the patient has SLE or another autoimmune disorder. If the primary test results are normal but clinical suspicion is still there, then testing can be performed IgA anticardiolipinantibodies.

If one or more types Anticardiolipin antibodies are detected, then the same test is usually repeated at least After 6 weeks to help determine whether their presence is persistent or temporary. If the test is negative, may be retested at a later date because theseantibodies can develop at any time.

Anticardiolipin antibody testing was conducted by ELISA (Enzyme linked immunosorbent assay). Testing using an automatic analyzer has an accuracy better.

Serum specimens used were obtained by collecting venous blood in a tube and a red lid with a dizzying centrifuger to separate serum from blood cells. Avoid actions that cause hemolysis in the sample. No special preparations or restrictions on food-beverage intake in patients before sampling.

Venous Blood Sampling in Patients Posted Intravenous (IV) Lines

In order to obtain blood specimens qualified laboratory tests, the blood sampling procedure must be done correctly, from preparation equipment, the choice of anticoagulant, the selection of the location of the vein, taking up with a labeling technique (click here to see the blood sampling procedure) .

Selection of the location of the vein becomes an important concern when the patient is inserted intravenous (IV) line, for example infusion. In principle, bloodsampling should not be undertaken on an arm attached to an IV. If one arm is attached infusion, blood sampling is performed pasa infusion arm that is not installed. If the two arms attached to an IV, did capture the leg vein. So what if the entire venous access is not possible to do blood sampling? Here is a sampling of blood in patients who mounted an IV or IV-lines (examples of cases in patients with burns over 70%).

Alternative 1

If possible, do blood sampling in the arm that is attached to an IV.

Alternative 2

If it is not possible, do blood sampling in the area of ​​the foot.

Alternative 3

If there is no venous access at another location, perform blood sampling in the arm that is attached infusion by way of :

1. Ask the nurse to stop the flow of infusion for at least 2 minutes before the shooting.
2. Attach a tourniquet on the lower portion of the IV needle.
3. Perform blood sampling at a different vein from the attached infusion or at the bottom of the veins attached to the infusion.
4. Ask the nurse to restart the infusion after the specimens were collected.
5. Make a note that the specimens were collected from the terpasangi infusion arm and the type of fluid given intravenously. Write this information on lab request sheet.

Alternative 4

If there is only one venous access alone in a place that is attached infusion, then :

1. Stop the flow of infusion as the above
2. Remove the blood from the veins, discard the first 2-5 ml, and flow capacity in the next blood sample tubes.
3. Ask the nurse to restart the infusion after the specimens were collected.
4. Make a note that the specimens were collected from the terpasangi infusion arm and the type of fluid given intravenously. Write this information on lab request sheet.

Attention : Selection of alternatives 3 and 4 must be with the permission and supervision of a doctor. Phlebotomis can cooperate with the nurses for this decision procedure.

Laboratory examination of health, Rheumatoid Factor

Rheumatoid factor (rheumatoid factor, RF) are immunoglobulins that react with IgG molecules. Because the patient also contain IgG in serum, then the RF including autoantibodies. RF causative factor is not known for sure, although complement activation due to the interaction of RF with IgG play an important role in rheumatoid arthritis (rheumatoid arthritis, RA) and other diseases with positive RF. Most of the RF is IgM, but can also be IgG or IgA.

Positive RF was found in 80% of patients with rheumatoid arthritis. Very high RF levels indicate a poor prognosis with severe joint disorders and possible systemic complications.

RF often found in other autoimmune diseases, such as LE, scleroderma, dermatomyositis, but levels are usually lower than the levels of RF in rheumatoidarthritis. Low levels of RF are also found in non-immunological diseases and the elderly (above 65 years).

RF test is not used for monitoring treatment because the results of common tests remain positive, although there has been a clinical recovery. In addition, it takes about 6 months for a significant increase in titer. For the diagnosis and evaluation of RA is often used CRP test and ANA.

RF test for serum patients examined using the method of latex agglutination or nephelometry.

Reference Values

ADULT : a chronic inflammatory disease; 1/20-1/80 positive for the state of rheumatoid arthritis and other diseases;> 1 / 80 positive for rheumatoid arthritis.

CHILDREN : usually not done

Elderly : slightly increased

* Reference value may be different for each laboratory, depending on the method used.

Clinical Problems

INCREASED CONTENT : rheumatoid arthritis, LE, dermatomyositis, scleroderma, infectious mononucleosis, leukemia, tuberculosis, sarcoidosis, cirrhosis, hepatitis, syphilis, chronic infections, the elderly.

Factors that may affect the laboratory's findings :

• RF test results are often still found to be positive, regardless of whether there has been a clinical recovery.
• RF can be positive test results on a variety of clinical problems, such as collagen disease, cancer, cirrhosis of the liver.
• Elderly may have increased titers of RF, without suffering any illness.
• Due to diversity in the sensitivity and specificity of this screening test, positive findings should be interpreted based on the evidence contained in the clinical status of patients.

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