The 62-year-old man died on Aug. 25 after contracting the CCHF disease during a walk in the Castilla-Leon region, probably from a tick bite he reported - which is one of the main ways it is transmitted - authorities said in a statement.
He also infected the nurse who treated him at a hospital in Madrid and she is now in a stable condition in quarantine at an isolation unit, they said. Authorities are monitoring about 200 other people who had come into contact with the man and nurse.
According to the World Health Organization, CCHF's mortality rate is about 30 percent and it is endemic to Africa, the Balkans and Ukraine, the Middle East and Central Asia.
Read more: First Local Case of Tick-Borne Disease Kills Man in Spain
When Blood is mixed with a solution of potassium cyanide, potassium ferricyanide, and Drabkin’s solution, the erythrocytes are lysed by producing evenly disturbed hemoglobin solution. Potassium ferricyanide transforms hemoglobin into methemoglobin, and methemoglobin combines with potassium cyanide to produce hemiglobincyanide (cyanmethemoglobin). This method is optional for estimation of hemoglobin and this method is recommended by the International Committee for Standardization in hemotology. This is because in this method all type of hemoglobin is transformed to cyanmethemoglobin (except sulfhemoglobin), and a firm and trustworthy standard is available.
- File Name INR Calculator v1.0
- Year 2016
- Author(s) Dayyal Dg.
- Publisher BioScience.pk
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When blood is mixed with an acid solution, the hemoglobin converts into the brown-colored acid hematin. The acid hematin is then diluted with distilled water till the color of the acid hematin matches that of the brown glass standard. The hemoglobin is estimated by reading the value directly from the scale.
• Comprehensive coverage addresses all brain regions, as well as cranial, spinal, and peripheral nerves.
• Detailed discussions address relevant anatomy, followed by a discussion of lesions related to each anatomic feature.
• A new chapter addresses the localization of lesions of the autonomic nervous system.
- File Name Localization in Clinical Neurology, 6th Ed.
- Edition 6th
- Year 2011
- Author(s) Paul W. Brazis MD, Joseph C. Masdeu MD PhD, José Biller MD FACP FAAN FAHA
- ISBN-10 1609132815
- ISBN-13 978-1609132811
- Publisher LWW; Sixth edition (March 29, 2011)
- Size 20 MB
- File Format .pdf
- Password bioscience.pk
Hemoglobin is composed of heme (iron + protoporphyrin) and globin polypeptide chains. It is present in the red blood cells of all vertebrates except Channichthyidae (the family of fish: white-blooded fish also called crocodile fish found in southern South America and the Southern Ocean around Antarctica). It carries oxygen from the lungs to the tissues and carbon dioxide from tissues to the lungs.
In humans, hemoglobin is not homogeneous and normally different variants and derivatives exist. Normal hemoglobin variants are fetal hemoglobin (Hb F), adult hemoglobin (Hb A), Hb A2 and embryonic hemoglobins (Gower I, Gower II and Portland). They differ from each other on the basis of the structure and the type of polypeptide chains.
INDICATION FOR HEMOGLOBIN ESTIMATION
- Screening for polycythemia: Polycythemia is a disease state in which the hemoglobin level and hematocrit (HCT) or packed cell volume (PCV) value is elevated. It may be primary, secondary or relative.
- To determine presence and severity of anemia: Anemia is a disease state in which the hemoglobin concentration or oxygen-carrying capacity of blood is low. Clinical signs and symptoms (conjunctival vessels, polar of skin, mucosal membranes) are unreliable for the diagnosis of anemia. Anemia is best determined by estimation of hemoglobin and hematocrit (HCT) or packed cell volume (PCV).
- To assess response to specific therapy in anemia.
- Estimation of red cell indices (along with hematocrit (HCT) or packed cell volume (PCV) and red cell count) i.e. mean cell volume (MCV), mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC).
- Selection of blood donors in the blood bank.
METHOD FOR ESTIMATION OF HEMOGLOBIN
There are different methods for estimation of hemoglobin. These are:
(1) Colorimetric methods: In these methods, the color comparison is made between the standard and the test sample, either visually or by colorimetric methods.
- Visual methods: Sahli’s acid hematin method, WHO hemoglobin color scale and Tallqvist chart.
- Photoelectric or colorimetric methods: Cyanmethemoglobin (hemoglobin-cyanide) method, oxyhemoglobin method, and alkaline hematin method.
(2) Gasometric method: In this method, oxygen-carrying capacity of red blood cells (RBCs) is measured in a Van Slyke apparatus. The amount of hemoglobin is then derived from the formula that 1 gram of hemoglobin carries 1.34 ml of oxygen. However, this method measures only physiologically active hemoglobin, which can carry oxygen. It does not measure methemoglobin, sulfhemoglobin, and carboxyhemoglobin. Also, this method is expensive and time-consuming, and the result is about 2% less than other methods.
(3) Chemical method: In this method, iron-content of hemoglobin is first evaluated. The value of hemoglobin is then derived indirectly from the formula that 100 grams of hemoglobin contain 374 mg of iron. This method is tiresome and time-consuming.
(4) Specific gravity method: In this method, an approximate value of hemoglobin is estimated from the specific gravity of blood as determined from copper sulfate technique. This method is simple and rapid. This method is useful and most common in mass screening like the selection of blood donors. See procedure.
Tallqvist Hemoglobin Chart
Tallqvist hemoglobin chart consists of a series of lithographed colors said to correspond to hemoglobin values ranging from 10% to 100%. In this method, a drop of blood obtained by finger puncture is placed on a piece of absorbent paper. The color produced is matched against the color on the chart and the corresponding reading is taken. The room of error is 20-50%. Although this method is very cheap and simple.
USES OF RED CELL INDICES
(2) Differentiation of iron deficiency anemia from thalassemia trait: In iron deficiency, MCV, MCH, and MCHC are low, while in thalassemia trait, MCV and MCH are low and MCHC is normal.
RBC count in million/cmm
• Non-megaloblastic macrocytosis: Chronic alcoholism, liver disease, hypothyroidism, normal pregnancy, reticulocytosis
In the presence of large number of abnormal red cells like sickle cells, and in dimorphic anemia (e.g. mixed normocytic and microcytic), MCV may be normal (since it is an average value) and thus unreliable for morphological classification.
Mentzer index is derived by dividing MCV with red cell count. Ratio of less than 13 is seen in thalassemia while ratio is more than 13 in iron deficiency anemia.
RBC count in millions/cmm
MCH is decreased in microcytic hypochromic anemia, and increased in macrocytic anemia and in newborns.
PCV in %
• Mean cell hemoglobin: 27-32 pg
• Mean cell hemoglobin concentra-tion: 30-35 g/dl
• Red cell distribution width: 9.0-14.5
1. Henry JB. Clinical diagnosis and management by laboratory methods (20th Ed). Philadelphia: WB Saunders Company, 2001.
2. Wallach J. Interpretation of Diagnostic Tests (7th Ed). Philadelphia: Lippincott Williams and Wilkins, 2000⁻¹⁵
Abdominal and pelvic masses manifest as swellings in specific areas of the abdomen and pelvis. They are often incidentally picked up on physical examination. Most causes of abdominal masses are benign, but some might indicate a serious underlying pathology.
This video will provide a comprehensive diagnostic approach to a patient with an abdominal/pelvic mass. Critical questions to ask in history, such as intercurrent symptoms of change in bowel habit or urinary difficulties, and important features on physical examination, such as reducible masses and midline pulsatile masses, will be reviewed. Laboratory and imaging investigations, while not absolutely necessary, can be ordered and the significance of findings on these will also be discussed. Lastly, you will learn about the management of some serious causes of abdominal masses, such as abdominal aortic aneurysm and hernias.
“I can focus my slide under 10×, but not under 40×.”
A common reason for this is that the slide is upside down. Double check which side the smear is on (may not be the same side as the label!) and try focusing again. Another cause could be dried immersion oil on the 40× objective that is obstructing your view. When switching from oil immersion (100×) to 40×, there is a good chance that the tip of the 40× objective could be dragged through some immersion oil. If it is not immediately cleaned off, it will dry, producing a thick haze. To fx: Use lens paper and lens cleaner to clean the end of the 40× objective. This may need to be repeated several times depending on how thick the dried oil is. After cleaning, use a dry piece of lens paper to polish the objective. To avoid the problem: Clean up oil immediately after use. Clean the end of the 100× objective and any heavy oil present on the slide before moving back down to 40× objective.
“In hematology, when I focus under 40×, my red blood cells appear shiny.”
This is most likely due to water artifact during the staining and drying process. To make visualization of the cells easier, add a small drop of immersion oil to your slide. Gently spread the drop of oil over the area you will be examining. Wipe of excess oil using the side of your finger. Be very gentle when doing this, and use a clean finger each time you wipe. Wiping too hard or rough will cause your smear to rub off. This technique will leave a very thin layer of oil on your smear. The film is thin enough that you can use the 40× objective without running the risk of the lens becoming contaminated with oil. Try focusing under 40× again, and the shininess should have been resolved.
“There’s no light coming from the illuminator.”
The first assumption is always that the bulb is burnt out, but it is a good idea to check a couple of other possibilities as well. If the iris diaphragm is closed and the brightness of the illuminator is at its lowest, the light may be so small that it appears as if there is no light present. Check to make sure the cord is fully plugged into the back of the microscope. This plug can become dislodged slightly during transport and microscope set up. If your microscope is the type that uses fuses, it may be the fuse—not the bulb—that needs replacing. When the microscope is not in use, be sure to turn it off. This will help prolong the life of the bulb.
When the use of the microscope is complete, following proper clean up procedures will improve the quality of images that are viewed and extend the life of the microscope and its components:
- Remove the slide from the stage and dispose of it properly.
- Clean any oil residue or sample material that may have contaminated the stage surface.
- Lower the stage and move the smallest objective into place.
- Clean the objective lens and oculars after every use. The order in which they are cleaned is important. Cleaning the 100× objective first and then moving onto other parts will result in immersion oil being spread onto all other components. Using lens tissue and lens cleaner, begin with cleaning the oculars, then the 4× objective, the 10× objective, 40× objective, and finish with the 100× objective lens.
- File Name Single Best Answers in Surgery
- Edition 2nd
- Year 2009
- Author(s) Darren K Patten, David Layfield, Shobhit Arya, Daniel R Leff, Paraskevas A. Paraskeva
- Editor(s) Professor Sir Ara Darzi
- ISBN-10 0340972351
- ISBN-13 978-0340972359
- Publisher CRC Press; 1 edition (27 Mar. 2009)
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Anthony Fauci, MD is Director of the National Institutes for Allergy and Infectious Diseases, and recipient of the Lasker Prize for Medicine. He is a leading authority in HIV and AIDS, immunology, and management of Ebola Virus Disease.
Dan Longo, MD is Deputy Editor, New England Journal of Medicine and Professor of Medicine, Brigham and Women's Hospital/Harvard Medical School. Dr. Longo is a highly regarded cancer specialist.
Stephen Hauser MD is Robert A. Fishman Distinguished Professor and Chair, Department of Neurology, UCSF School of Medicine. He is a leading authority on multiple sclerosis.
J. Larry Jameson, MD, PhD is Robert G. Dunlop Professor of Medicine, Dean, University of Pennsylvania School of Medicine, and Executive Vice President, University of Pennsylvania Health System.
Joseph Loscalzo MD, PhD is Hersey Professor of the Theory and Practice of Medicine, Harvard Medicine School and a leading authority in many aspects of cardiovascular medicine.
- File Name Harrison's Principles of Internal Medicine, 19th Ed.
- Edition 19th
- Year 2015
- Editor(s) Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo
- ISBN-10 0071802150
- ISBN-13 978-0071802154
- Publisher McGraw-Hill Education / Medical; 19 edition (April 8, 2015)
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- Year 2015
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When the recipient’s ABO and Rh blood groups are determined, the donor blood unit that is ABO and Rh compatible is selected, and compatibility test is carried out. The purpose of compatibility test is to prevent the transfusion of incompatible red cell units and thus avoidance of hemolytic transfusion reaction in the recipient. Compatibility test detects (i) major ABO grouping error, and (ii) most clinically significant antibodies reactive against donor red cells.
There are two types of cross-match: major cross-match (testing recipient’s serum against donor’s red cells) and minor cross-match (testing donor’s serum against recipient’s red cells). However, minor cross-match is considered as less important since antibodies in donor blood unit get diluted or neutralized in recipient’s plasma. Also, if antibody screening and identification is being carried out, minor cross-matching is not essential. Therefore, only the red cells from the donor unit are tested against the recipient’s serum and the name compatibility test has replaced the term cross-matching. For transfusion of platelets or fresh frozen plasma, cross-matching is not required. However, fresh frozen plasma should be ABO-compatible.
A full cross-matching procedure consists of:
- Immediate spin cross-match at room temperature, and
- Indirect antiglobulin test at 37°C.
IMMEDIATE SPIN CROSS MATCH
The purpose of this test is to detect ABO incompatibility. Equal volumes of 2% saline suspension of red cells of donor and recipient’s serum are mixed, incubated at room temperature for 5 minutes, and centrifuged. Agglutination or hemolysis indicates incompatibility.
Causes of False-negative Test
- A2B donor red cells and group B recipient serum.
- Rapid complement fixation of potent ABO antibodies with bound complement interfering with agglutination.
Causes of False-positive Test
- Rouleaux formation
- Cold-reactive antibodies: If agglutination disappears by keeping the tube at 37°C for 10 minutes, presence of cold agglutinins is confirmed.
INDIRECT ANTIGLOBULIN TEST
Saline-suspended red cells of the donor after being incubated in patient’s serum are washed in saline and antiglobulin reagent is added. Following re-centrifugation, examine for agglutination or hemolysis. This test detects most of the clinically significant IgG antibodies.
If agglutination or hemolysis is not observed in any of the above stages, donor unit is compatible with recipient’s serum. Agglutination or hemolysis at any stage is indicative of incompatibility.
If blood is required urgently, ABO and Rh grouping are carried out by rapid slide test and immediate spin cross match (i.e. the first stage of cross match) is performed (to exclude ABO incompatibility). If the blood unit is compatible, then after issuing it, remaining stage of the cross-match is completed. If any incompatibility is detected, the concerned physician is immediately informed about the incompatibility detected.
ANTIBODY SCREENING AND IDENTIFICATION
Screening for unexpected or irregular antibodies is done during pre-transfusion testing in recipient’s serum and in donor’s blood. In this test, serum of the recipient is tested against a set of three group O screening cells of known antigenic type. If unexpected antibodies are detected, then they are identified and blood unit that lacks the corresponding antigen is selected for compatibility test.
- File Name Parenteral Vaccination Can Be an Effective Means of Inducing Protective Mucosal Responses
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Plasma is incubated with an activator (which initiates intrinsic pathway of coagulation by contact activation). Phospholipid (also called as partial thromboplastin) and calcium are then added and clotting time is measured.
(1) Kaolin 5 gm/liter: This is a contact activator.
(2) Phospholipid: Various APTT reagents are available commercially, which contain phospholipids.
(3) Calcium chloride 0.025 mol/liter.
(1) Mix equal volumes of phospholipid reagent and calcium chloride solution in a glass test tube and keep in a waterbath at 37°C.
(2) Deliver 0.1 ml of plasma in another test tube and add 0.1 ml of kaolin solution. Incubate at 37°C in the waterbath for 10 minutes.
(3) After exactly 10 minutes, add 0.2 ml of phospholipidcalcium chloride mixture, start the stopwatch, and note the clotting time.
(1) Hemophilia A or B.
(2) Deficiencies of other coagulation factors in intrinsic and common pathways.
(3) Presence of coagulation inhibitors
(4) Heparin therapy
(5) Disseminated intravascular coagulation
(6) Liver disease
(1) Screening for hereditary disorders of coagulation: Since deficiencies of F VIII (hemophilia A) and F IX (hemophilia B) are relatively common, APTT is the most important screening test for inherited coagulation disorders. APTT detects deficiencies of all coagulation factors except F VII and F XIII. PT is also performed along with APTT. Prolongation of both PT and APTT is indicative of deficiency of coagulation factors in common pathway. Normal PT with prolongation of APTT is indicative of intrinsic pathway deficiency (particularly of F VIII or IX).
(2) To monitor heparin therapy: Heparin potentiates the action of natural anticoagulant antithrombin III which is an inhibitor of thrombin and activated factors IX, X, and XI. Full dose heparin therapy needs monitoring by APTT to maintain the dose in the therapeutic range (1.5 to 2.5 times the upper reference limit of APTT).
(3) Screening for circulating inhibitors of coagulation: APTT is prolonged in the presence of specific inhibitors (which are directed against specific coagulation factors) and non-specific inhibitors (which interfere with certain coagulation reactions).