Platelet Rich Plasma-platelet Concentrate (PRP-PC) Analysis

Platelet Rich Plasma-platelet Concentrate (PRP-PC) Analysis Quality assessment of platelet concentrates prepared at Dr. Pinnameneni Institute of Medical Sciences and Research Foundation Dr. Anusha A.M Background Platelet rich plasma-platelet concentrate (PRP-PC) were prepared and their quality variables were evaluated. Material and methods In this study platelet products were prepared using platelet rich plasma method. After preparation the products were transferred to platelet incubator and agitated. Their quality was assessed after 24 hours of preparation using the following parameters: volume of the platelet concentrate, platelet count, RBC contamination, morphology and pH. Results Volume 90% of the RDP was weighing between 50 to 70 ml, 4% below 50 and 6% above 70 ml. The count correlated well in both the methods and 85% of RDP had a count of above 5.5 x 1010, 15% had below 5 x 1010. Ph: 56% of the RDP had of 6.3 to 6.5, 33% had 6.6 to 7.0 and 6% at 6.2 and 5% above 7.0. Appearance: 86% was light straw colored, 3% light pint, 6% pink and 5% red. Conclusion During the storage of platelet concentrates there is progressive loss in capacity of survival and function of platelets. In order to maximize the preservation of platelet viability it is best to allow PRP to repose at room temperature for 1-2 hours and then transfuse as soon as possible. To maximize the therapeutic values of platelet concentrates quality control is essential and helps to identify trouble shooting in procedures. In conclusion more than 95% of the RDPs prepared meet the standard. Keywords:Platelet rich plasma-platelet concentrate, quality parameters, platelet count Introduction Transfusion medicine has over the years evolved to assume a complex medical discipline that aided or modified patient care. Blood donation culture has not been fully imbibed in our society and homologous blood is usually in short supply in the blood banks with its attendant consequences in patient management1. Platelet transfusion therapy has played an important role in the management of patients 2,3]. Today, platelet concentrates are prepared from whole blood either by differential centrifugation buffy coat-derived platelet concentrates (BC) or by platelet rich plasma- platelet concentrates (PRP-PC) and plateletpheresis (4,5). There are several methods for quality control of platelet components including cell counting, pH, volume and morphology.[6.7.8]. The aim of this study was to evaluate the quality of platelets during the storage of platelet concentrates derived from PRP-PCs and whether patients got adequate therapeutically useful amount of platelets. Materials and Methods The present study was conducted at blood bank, PSIMS RF, Andhra Pradesh, India. The study was carried out on 100 patients. Platelet products were prepared from whole blood using platelet rich plasma method. After preparation these were stored in platelet incubator and agitated. Their quality was assessed after 24 hours of preparation using the following parameters: volume of the platelet concentrate, platelet count, RBC contamination, morphology and pH. For the study, samples were taken from the segment of tubing in the platelet concentrate bag to maintain sterility inside the bag. Volume The volume of the platelet concentrates were measured by deducting the volume of the empty bag from the volume of the platelets concentrate bag in ml. The measurements were recorded. pH p H of the platelet concentrate units were checked by the use of semi-quantitative dipsticks ( Bayers multistix strips) Total Platelet Count Platelet count was done by 2 methods Automated method by using fully automated analyzer Sysmex KX-21 to assess the quality o the platelets. Counting was based on impedance technology. Manual method using counting chamber. RBC contamination Platelet concentrate unit was checked by visual inspection or various colours. Morphology Morphology was analyzed by staining smear by leishman stain. Results 1. Volume 95% of PRP-PC was weighing between 55 to 75 ml and 5% below 55. pH 76% of the PRP-PC had of 6.3 to 6.5, 20% had 6.6 to 7.0 and 4% below 6.3. Total Platelet Count The count correlated well in both the methods and 90% of PRP-PC had a count of above 5.0 x 1010 and 10% below 5 x 1010. 4. RBC contamination 92% was light straw colored, 4% light pint and 4% pink. Morphology 94% of the platelets were discoid, 4% spherical and 1% fragmented. Discussion The potential of transfused platelets to circulate and function is dependent on ex-vivo and in-vivo factors. The percentage of platelets that maintain discoid form is a primary and simple indicator for the quality of the stored platelet concentrates. PCs been gently prepared and then immediately transfused without a storage interval have high retrieval, good survival and conserved function. Quality assessment of platelet concentrates is an important step to evaluateex-vivofunctional viability of platelet concentrates and post transfusion recovery and survival in donee. Various variables are used for routinequality assessment of platelet concentrates such as volume, platelet count, morphology, RBC contamination and pH. Conclusion During storage, platelet concentrates gradually lose the capacity to survive and function. In order to preserve platelet viability, PRP should be allowed to rest at room temperature, for 1-2 hours and transfused as soon as possible thereafter. There is a need to improve the quality of the platelet concentrates being prepared to get maximum therapeutic values. Doing quality control is essential and it is not only valuable in itself but also helps in identify trouble shooting of the procedures. In conclusion more than 95% of the PRP-PC prepared met the standards. References Olaitan PB, Onah I I, Ogbonnaya I S. Preliminary reports of autologous blood transfusion in a plastic surgery unit. Tropical Doctor.2006; 36: 20-21 Snyder EL, Hezzey A, Katz AJ, Bock J (1981) Occurrence of the release reaction during preparation and storage of platelet concentrates. Vox Sang 41:172-177. Heaton WA, Rebulla P, Pappalettera M, Dzik WH (1997) A comparative analysis of different methods for routine blood component preparation. Transfus MedRev 11:116-129. Fijnheer R, Pietersz RN, de Korte D, Gouwerok CW, Dekker WJ, et al. (1990)Platelet activation during preparation of Platelet Concentrate: A comparison of Platelet Rich Plasma and the buffy coat methods. Transfusion 30: 634-638. Jerad S, Prane K (1997) The Platelet Storage lesions. Transfusion Medicine Reviews 2: 130-144. Dijkstra-Tiekstra MJ, Pietersz RN, Huijgens PC (2004) Correlation Between the extent of platelet activation in platelet concentrates and in vitro and in vivo parameters. Vox Sang 87: 257-263. Kamath S, Blann AD, Lip GY (2001) Platelet activation: assessment andquantification. Eur Heart J 22: 1561–1571. Albanyan AM, Murphy MF, Rasmussen JT, Heegaard CW, Harrison P (2009)Measurement of phosphatidylserine exposure during storage of platelet concentrates using the novel probe lactadherin: a comparison study with annexin V. Transfusion 49: 99-107. Rinder HM, Smith BR. In vitro evaluation of stored platelets: Is there hope for predicting post-transfusion platelet survival and function?Transfusion.2003;43:2–6 Holme S. Storage and quality assessment of platelets.Vox Sang.1998;74:207–16.

Malignant Hyperthermia: What You Need to Know

Malignant Hyperthermia: What You Need to Know Ivy O. Corlew, BSN, RN, CNOR Conneaut Medical Center–OR Malignant Hyperthermia: What You Need to Know What is Malignant Hyperthermia or MH Malignant Hyperthermia (MH) is a rare, life threatening, pharmacogenetic disorder characterized by hypermetabolic state of skeletal muscle induced by inhalation anesthetics like halothane, sevoflurane, desflurane and the depolarizing muscle relaxant agent like succinylcholine (Rosenberg et al, 2007).Clinical signs are; Increased end tidal CO2 production which is an early sign, tachycardia, tachypnea, trunk or total body rigidity, masseter (jaw) muscle rigidity after succinylcholine which occurs commonly in children, marked temperature elevation (maybe a late sign), respiratory and metabolic acidosis, myoglobinuria(MHAUS, 2011). If left untreated the patient will experience cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, and possibly death (slideshare, 2010) Nursi ng AssessmentNurses taking care of surgical patients must be knowledgeable regarding MH so they can identify clinical signs and symptoms early on, its emergent treatment, and be able to respond promptly and appropriately. Preoperative assessment by nurses are crucial in identifying the patient, who could be at high risk for Malignant Hyperthermia, so MH triggering agents can be avoided during anesthesia. Example of questions to ask to help screen for MH susceptibility are (AORN 2012): 1. Has anyone ever told you that you had a â€Å"bad† reaction to anesthesia? 2. Has anyone ever told you that you or your family member had a problem with anesthesia? . Have you or a family member experienced a high fever while under anesthesia? 4. Has anyone ever told you or a family member they had a difficult time opening your jaw during general anesthetic? 5. Has anyone in your family died unexpectedly in the operating room? 6. Have you or anyone in your family experienced sunstroke or heat stroke resulting in hospitalization? 7. Have you ever noticed dark â€Å"cola-colored† urine after a general anesthetic or after experiencing a heat-related illness? Treating MH Dantrolene IV is the only drug available in the market to treat Malignant Hyperthermia.It is difficult to mix and is time consuming to reconstitute. It comes in yellowish colored powder that when fully mix with non-bacteriostatic sterile water, the color stays the same. The new brand Dantrium IV (dantrolene sodium for injection) mixes in just 20 seconds (MHAUS, 2011). However, this is not what we have stocked in our cart. According to MHAUS (2011), dantrolene suppresses the exaggerated rise in muscle cell calcium that seems to trigger MH by binding to the calcium channel site in muscle that is responsible both for calcium release and, likely, calcium entry into the cell.Dantrolene may cause significant muscle weakness in patients with preexisting muscle disease and should be used with extreme caution in those patients. When used with calcium channel blockers (verapamil or diltiazem), dantrolene may produce life-threatening hyperkalemia and myocardial depression. Once a patient has been successfully treated for 36 hours with intravenous dantrolene, he/she may be switched to oral dantrolene until the CK or Creatine Kinase level is trending down and there is no further evidence of acidosis or hypermetabolism and temperature spikes. A recommended 36 vials be stocked.Treating Malignant Hyperthermia crisis is a complex nature, and it involves several staff members. The first thing to do in the event of suspected MH crisis is to recruit extra staff. The following steps are outline by role (MHAUS, 2011): The surgeon should stop or complete the procedure as soon as possible. The anesthesia provider stops inhalation agents; stops warming blanket; increase minute ventilation; inserts esophageal temp probe; inserts NG tube for lavage as needed; administers dantrolene IV; inserts an arteria l line; draws blood for chemistry, ck, coagulation, ABG.If peaked T waves on ECG, administers calcium then glucose and insulin. If T waves are not peaked and arrhythmia present, injects bicarbonate. The circulating nurse brings in MH cart; mixes dantrolene based on 2. 5 mg/kg with 60 ml of non-bacteriostatic sterile water, repeat dose until the signs are controlled. The circulating nurse should document the event. A second nurse assist in mixing dantrolene and hands syringe to anesthesia provider. A third nurse brings in emergency crash cart; places urinary catheter; assist in drawing blood or with other task.A fourth nurse brings in plastic bags with ice and cold IV fluids; places ice bags on exposed parts like groin, axilla, and neck (without compromising sterility); iced saline lavage of any open body cavities such as the stomach, bladder, or rectum. Cold I. V. fluids are administered using 0. 9% sodium chloride, but Lactated Ringer’s is avoided so that acidosis is not wor sened (Martin, 2009). Stop cooling measures when temperature falls to 38 °C (MHAUS, 2011). A laminated copy of MHAUS dantrolene dosage chart is located on top of MH cart to minimize precious time wasted in calculating dosage per kilogram.As soon as patient is stabilized, transfer patient to ICU or call transfer center for an emergent transfer to UH Case SICU or ED. Knowing your Role All staff involved in the MH crisis response should conduct a debriefing meeting as early as possible. Points to consider including (AORN, 2012): 8. Was the MH cart adequately stocked and immediately available? 9. Were enough staff members available to manage the crisis effectively? 10. When staff members responded, were they familiar with task expected in MH crisis? 11. Was MHAUS appropriately notified? 12. Do staff members have other ideas about planning care for a future MH crisis? 3. Has a root-cause analysis been done (MH is considered a sentinel event)? Staff Competency By using the mannequin as our patient, and mixing the expired dantrolene from MHAUS, perioperative staff did fairly well during the MH mock drill simulation by following thru with the expected roles. MH drill should be held at least quarterly to help perioperative staff practice early recognition of MH crisis and how to act accordingly. MH drill also improve OR (operating room) team coordination and provides opportunities to serve in each of the four roles mentioned (Martin, 2009). PreventionEarly detection of clinical signs and symptoms of MH, knowing your role and a prompt response to this emergent crisis can save your patient’s life. MH crisis prevention is the key and the best treatment you can provide to your patient. Knowledge about MH is a must for nurses taking care of a patient before, during and after operative care. Armed with this knowledge, you can make a difference in your patient’s lives. References AORN (2012). AORN Malignant Hyperthermia Guideline. In Perioperative Standards an d Recommended Practices: For Inpatient and Ambulatory Settings (pp. 5,8-9). Retrieved from http://online. statref. om/titleinfo/fxid-234. html Martin, C. L. (2009). A Practical Guide for Malignant Hyperthermia Management. OR NURSE 2009, 24. Retrieved from www. ORNurseJournal. com Rosenberg, H. , Davis, M. , James, D. , Pollock, N. , & Stowell, K. (2007). Malignant Hyperthermia. ORPHANET JOURNAL OF RARE DISEASES. doi:10. 1186/1750-1172-2-21 Malignant Hyperthermia Mock Drill Kit. (2011). Healthcare Professionals. Retrieved from http://www. mhaus. org/healthcare-professionals/#. T6rV3VI2cTY Malignant Hyperthermia (2010, January 28). [Video File]. Retrieved from http://www. slideshare. net/wright958/malignant-hyperthermia-3015604

Pay Determination Free Essay Example, 3000 words

Bach (2010) stated that the state is an entity that sets example and role model for the private sector by support the principles and standards of fairness, equity and involvement in the treatment of its workforce. This is directly in relation with the encouragement of the membership of trade unions and endorses the centralized system and order of collective bargaining. On the other hand, Coffey and Thornley (2009) argued over the concept of â€Å"model employer†. According to them, a model employer needs to assess historically in contrast with all sectors as well as at the international level. It needs to look at the processes, as well as the outcomes. The model employer should need to distinguish legitimating and rhetoric from the reality. Role of trade unions Trade unions play an integral role in the labor market and all the related aspect of it. Trade union is defined as a continuous and consistent association for improving and maintaining the conditions of the individuals working lives (Webb and Webb, 1920). According to Webb and Webb (1920), the trade unions at the early British times has adopted and executed several different strategies that were dependent on the classification of membership they used to organize. We will write a custom essay sample on Pay Determination or any topic specifically for you Only $17.96 $11.86/pageorder now These have changed with the changes in the labor market. The role of trade unions has seen in the controlling the supply of labor. They have got great influence on the training requirements for allowing a certain entry in a job. For example, the professions related to medical studies look for influencing the state and the employers for fulfilling their training and development requirements. Trade unions are found regulating the content of the job; they have an influence over the job content to distinguish and differentiate that particular job other ones (Jackson, Schuler, & Werner, 2009). This influence was very much practiced previously but with the passage of time this control of trade unions on job content was overhauled by the improved control of employers as well as technology. Another influence that trade unions put on employers is through collective bargain. They search for negotiating the employers on the terms and conditions of trade union members. In the labor market, these negotiations often strengthen by some threats and/or some industrial actions. The collective arguments of trade unions with the employers often vary over several issues. Trade union discusses and bargains over rates of basic pay to the comprehensive agreements on employees’ productivity and other several issues (Balkin, & Gomez†Mejia, 1990).

Crime Scene Investigator Vs. Criminal Investigator

Crime Scene Investigator vs. Criminal Investigator For the lecture on Crime Scene Investigation and Criminal Investigation we were assigned a cold case reading. This cold case reading entitled â€Å"Cold Case Models for Evaluating Unresolved Homicides† written by James Adcock PhD and Sarah Stein PhD outlines cold cases and their nature as well as providing possible protocol for cold case scenarios. Within these cold cases, the main goal is to ultimately solve the investigation. However, it is never that simple. Where Crime Scene and Criminal Investigators come into play is in the fact that they are involved with any ongoing investigation; whether it be a cold case or hot one. In most cases these two positions are equally important, these two work hand in hand to paint the entire picture of the crime that took place and the criminal that is to be apprehended. Cold case investigations are similar and different at the same time to any standard investigation. The main difference r ests in the fact that these cases have been unsolved for so long and therefore, the dynamic of the investigation must change. To tie this reading into the lecture, we look at the different roles that are played by the same people in the two varying types of cases: cold cases and hot cases. One of the first facts put out there by Professor Dadio to differentiate between the two is that you don’t need a crime scene for a criminal investigation to take place. This seemed odd to me, because a criminal must haveShow MoreRelatedPrivate And Public Criminal Investigation1308 Words   |  6 PagesPrivate and Public Criminal Investigation Comparison Paper Police officers are public officials that have a legal and ethical duty to members of the public including the suspect in a criminal investigation. 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