COMMUNITY
المختبرات العمليةBlood Bank and Blood donation
-2 types: whole blood and separations (RBC concentration, platelet concentration, fresh frozen plasma and cryoprecipitate)APHERESIS PROCEDURE: it is a process in which blood taken a healthy donor can be separated into its component parts during blood donation where the needed component is collected and the "unused" components are returned to the donor. Fluid replacement is usually not needed in this type of collection. The components include: -Plasmapheresis (blood plasma). -Erythrocytapheresis (RBC) -plateletpharesis (platelets) –Leukapheresis (WBC)
Donor blood unit testing:
1-ABO and Rh grouping2-Hep B surface Ag (HBs Ag)
3-Hep C virus Ab
4-test for syphilis
5-HIV Ab
Registration for blood donation: The following information should be taken: Date of donation, name,address,job,phone no. , sex,age and last donation.
Criteria for donor selection:
1-general appearance including vein puncture site2-age:18-65 years old
3-last donation:more than 2 months , 4 donations for males and 3 donations for females during one year
4-blood pressure:not more than 180/100 mmHg
5-pulse:50-100 (regular)
6-medical illness:donors with diseases of the heart,liver or lung or a Hx of cancer or abnormal bleeding tendency should be excluded
7-pregnancy:should not be accepted for donation
8-drug therapy:(anticoagulants, anti hypertensive, insulin)
9-Hb or PCV: not less than 13.5g/dl or 40% for males and 12.5g/dl or 38% for females.
10-Had blood transfusion or major surgery (Defer 6 months) Blood donation rules:
11-Infected with brucellosis, tuberculosis or malaria (Defer 2 years)
12-Have a history of syphilis, HBV, HCV, HIV (Permanently deferred)
13- Have history of blood diseases such as leukemia, lymphoma, thalassemia major, sickle cell anemia and polycythemia.
Rabies
Rabies is a viral disease that causes acute inflammation of the brain in humans and other warm-blooded animals.In 2010, an estimated 26,000 people died from rabies The route of infection is usually, but not always, by a bite of an animal commonly dogs. In many cases, the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behavior.This is an example of a viral pathogen modifying the behavior of its host to facilitate its transmission to other hosts.
Signs and symptoms Early symptoms can include fever and tingling at the site of exposure. These symptoms are followed by one or more of the following symptoms: violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness. Once symptoms appear it nearly always results in death.
Incubation periods as short as four days and longer than six years have been documented
Diagnosis Rabies can be difficult to diagnose, because, in the early stages, it is easily confused with other diseases or with aggressiveness. The reference method for diagnosing rabies is the fluorescent antibody test (FAT, a immunohistochemistry procedure), which is recommended by the World Health Organization
Treatment General considerations in rabies Post-Exposure Prophylaxis which include Immediate washing/flushing and disinfection of the wound plus rapid administration of purified immunoglobulin and vaccine(rabies vaccines prepared on cell culture or embryonate eggs) –If rabies immunoglobulin is not available on first visit its use can be delayed by a maximum of 7 days from date of first vaccine injection -pregnancy and infancy are never contraindications to PEP(Post-Exposure Prophylaxis) 5 dose intramuscular regime: the vaccine should be administered on days 0, 3, 7, 14 and 28 in deltoid region ,in small children , into the anterolateral area of the thigh muscle -Vaccines should not be injected into the gluteal region -in immunosuppressed individuals no modification of the recommended number of doses is advisable and The importance of wound treatment should be further stressed -in previously vaccinated persons Local treatment of wound ,no RIG (rabies immunoglobulin) should be applied ,Two PEP schedules is indicated ,one dose on days 0 and 3. , However full PEP should be given to persons with HIV/AIDS Pre-exposure rabies vaccination indicated for Groups at high risk of exposure to live rabies virus (laboratory staff, veterinarians, animal handlers , wildlife officer and travelers to areas where rabies is common ) three doses of vaccine is given on days 0, 7 and 21 or 28
SCREENING
is a strategy used in pop. To detect diseases in asymptomatic individuals enabling early intervention and reducing morbidity and mortalityEARLY DETECTION OF BEAST CANCER Screening
1.must be for common diseases in that population (chondrosarcoma is rare so not suitable for screening)
2.must be for important health problem
3.there should be treatment for the condition(effective)
4.facilities available for Dx. And Rx
. 5.solid screening program tumor markers CA ovary CA25 can be elevated in benign conditions or even be normal in malignant conditions
6.continuous process and for all
7.time and cost should be acceptable and reasonable
BREAST CA
1.clinical and self examination
False +ve, false –ve ,need educated people(difficult to be applied in IRAQ
) 2.U/S
Advantages 1.differentiate cystic from solid 2.differentiate benign from malignancy ex. fibroadenosis from malignancy so it is diagnostic for malignancy 3.very useful in young women with dense breast 4.localize impalpable pathologies
Disadvantages: 1.cannot detect calcification (which may be the early sign of malignancy) 2.time consuming
3.CT SCAN
Superiority for bone so not used
4.MRI 1.The best diagnostic investigation for soft tissue 2.Very high –ve predictive value so –ve MRI mostly will rule out breast cancer 3. can detect deep tumors 4.useful to detect implants and differentiate scars from recurrence But it is expensive and time consuming, need professional radiologist
5.MAMMOGRAPHY
1.safe 2.sensitive in old age females will less dense breast 3.show the same features of U/S but can detect MICRO CALCIFICATION(CIS begins as micro calcification) .architectural changes and skin changes(ex. Thickening) Not time consuming(rapid), no need for professional ,not costy ,good sensitivity and specificity
6.BRACA 1 & 2
Done for risk groups: Who are those with family history with any one of the following: 1.young age CA breast< 50 years old 2.clusters of CA breast 3.male CA breast 4.breast associated with ovarian and colonic ca. 5.previously identified mutation in BRACA 1 OR 2 in the family Those should be screened at 30 years old with mammography and if not conclusive do US
7.FNA
Done for an apparent lump so not used in screening and can not distinguish invasive CA from CIS
BIRAD system
0.>>>> inconclusive test(do another investigation)1.>>>>normal breast
2.>>>>benign condition (yearly follow up)
3.>>>>benign+ more intensive follow up
4.>>>>be suspicious
5.>>>>malignant 100%
6.>>>>histopathological proof of malignancy
Emergency management of acute poisoning
1- Provide first aid measures
- Ingested poisons:
Clear the mouth Give large amount of water and milk Induce emesis
- Inhaled poisons:
Remove from exposure site - get into fresh air - Give oxygen - Attempt artificial respiration: ex. Using mouth to mouth rescue/ assisted ventilation
- Eye contamination:
Flood with running water for 10 – 15 mins
- Skin contamination:
Remove and discard contaminated clothes - Flood with water for 10 – 15 mins - Wash with a detergent
- Injected poisons / Bites:
Immobilize the patient and the injected part - Apply tourniquet and cold packs - In case of a snake bite use incision and suction
2- Assess the vital function and level of consciousness Assess the vital function (airways, breathing, and circulation) Assess and stabilize the cervical spines Assess the level of consciousness using Glasgow coma scale
3- Reduce absorption
- Emesis - Use Syrup of Ipecac Contraindications: convulsion / coma / petroleum (can cause aspiration pneumonia) / corrosive / sharp objects- Gastric lavage - Use activated charcoal (25 – 50 ml) - Liquid paraffin
- Catheter use - Magnesium sulphate 10 % - Magnesium citrate 10 % - Sodium sulphate 10 %
- Enema
4- Enhance elimination
- Forced dieresis - Forced osmotic dieresis - Forced alkaline dieresis - Forced acid dieresis – Furesemide
- Dialysis
- Haemoperfusion
5- Administer a specific antidote or an antagonist
Acetyl cysteine vs paracetamol
Atropine vs pesticides
Digitalis antidote kit vs Digoxin and Digitoxin
Flumazenil vs Benzodiazepines
Vitamin K vs Warfarin
Contraception
a-breastfeedingb-hormonal
1-combined
(estrogen/progesterone)pills Daily for 21 or 28 days depending on the formulation,and withdrawal bleed will normally occur in the pill free days or during the 7placebo day.
2-progesterone only
Effectiveness is less and cause disturbance of the menstrual cycle ,indicated for patients with estrogen contraindications,hypertension,during lactation.
3-injection
(depo provera)every 3 months (progesterone) suitable for patients who use progesterone only pills and for the avoidance of pill taking. May cause menstrual irregularity and delay in the return of fertility following discontinuation.
4-patch
c-Intrauterine contraceptive device (IUCD) copper containing is small,easy to insert and the menstrual loss is smaller. These IUCDs renewed every 3-4year.
*Contraindications:
1-pelvic inflammatory disease
2-abnormal bleeding (because it increases menstrual loss)
3-previous ectopic pregnancy
4-sever dysmenorrhea There is hormonal IUCD it has advantage over the other by reducing blood loss and return of fertility after removal is faster,(expensive). d-vaginal diaphragm e-condom for male
Tuberculosis:
It is a killer infection in the developing countries Infectious agent: mycobacterium complex(M.tuberculosis,M.bovid,M.africanum)Mode of transmission: -inhalation of airborne droplets -ingestion of unpasteurized milk or diery products -exposure during procedurs such as bronchoscopy
Risk factors: Children and elderly,immunocompromized people,overcrowding and close contact with the infected individuals.
What is the risk of infection and developing the disease after exposure?
Exposure---->70% no infection ---->30%get the infectionFrom those who get the infection,95% develop containment and 5% develop the primary progressive disease.
Diseases of tuberculosis:
1-pulmonary(primary and secondary): fatigue,fever,night sweat and weight loss then develop local symptoms of cough,chest pain,hemoptysis and hoarseness.2. Extra-pulmonary : occurs in 30 % *The most common site is lymph nodes. *But , any organ can be affected.
Incubation period : 2-10 weeks . *Reservoir : Human mainly , Cattle rarely .
Diagnosis :
1) CXR : Pulmonary infiltrates , cavitation in upper lobe .2) Sputum Smear : Acid Fast Bacilli ( 1st step in Dx ) .
3) Culture : Lowenstein - Jensen culture , confirms Dx , but takes 6-8 weeks .
4) Tuberculin skin test : Low sensitivity and specificity , it has no diagnostic value , but it is an important screening tool . *
Tuberculin test results : 1) > 5 mm : +ve in HIV , Immunocompromised , recent contacts and fibrosis on CXR .
2) > 10 mm : +ve in D.M. , Hematological disorders , injection drug users , ESRD and rapid weight loss .
3) > 15 mm : +ve in any body .
Treatment of tuberculosis:
>1st line drugs: isoniazid(INH) ,rifampicin,ethambutol,pyrizinamide6 months regimen: first 2 months give the all 4 drugs The next 4 months give INH and rifampicin -the regimen is extended to 9 months if culture remains positive after the first 2 months of treatment.
>2nd line drugs:
streptomycin,capreomycin,ethionamide,cycloserine,levofloxacillin.