hem to logy

8/9/2019 Hem to Logy

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CBC (Complete Blood Count)

A complete blood count (CBC), also known as full blood count (FBC) orfull

blood exam (FBE) or blood panel, is a test panel requested by a doctor or

othermedical professional that gives information about the cells in a patient's

blood. A scientist or lab technician performs the requested testing and provides

the requesting medical professional with the results of the CBC.

It measures the following:

The number of red blood cells (RBCs)

The number of white blood cells (WBCs)

The total amount of hemoglobin in the blood

The fraction of the blood composed of red blood cells (hematocrit)

The mean corpuscular volume (MCV) the size of the red blood cell

Normal Values:

TEST NORMAL VALUES

Leukocyte (White Blood Cell) X1000 cells/mm (L)

Birth 9.0-30.0

24 hours 9.4-34.0

1 month 5.0-19.5
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1-3 years 6.0-17.5

4-7 years 5.5-15.5

8-13 years 4.5-13.5

Adult 4.5-11.0

Neutrophils Bands 3-5% (total WBCcount)

Segs 54-62%

Lymphocytes 25-33%

Monocytes 3-7%

Eosinophils 1-3%

Basophils 0-0.75%

Erythrocytes (Red Blood Cells)

Cord 3.9-5.5 million/mm

1-3 days 4.0-6.6 million/mm

1 week 3.9-6.3 million/mm

2 weeks 3.6-6.2 million/mm

1 month 3.0-5.4 million/mm

2 months 2.7-4.9 million/mm

3-6 months 3.1-4.5 million/mm0.5-2 years 3.7-5.3 million/mm

2-6 years 3.9-5.3 million/mm

6-12 years 4.0-5.2 million/mm

12-18 years (male) 4.5-5.3 million/mm

12-18 years (female) 4.1-5.1 million/mm

Hemoglobin1-3 days 14.5-22.5 g/dL

2 months 9.0-14.0 g/dL

6-12 years 11.5-15.5 g/dL

12-18 years (male) 13.0-16.0 g/dL

12-18 (female) 12.0-16.0g/dL


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Hematocrit

1 day 48-69%

2 days 48-75%

3 days 44-72%2 months 28-42%

6-12 years 35-45%

12-18 years (male) 37-49%

12-18 years (female) 36-46%

Mean Corpuscular Volume (MCV)

1-3 days 95-121m

0.5-2 years 70-86 m

6-12 years 77-95 m

12-18 years (male) 78-98 m

12-18 years (female) 78-102 m

Mean Corpuscular Hemoglobin (MCH)

Birth 31-37 pg/cell

1-3 days 31-37 pg/cell

1 week-1 month 28-40 pg/cell

2 months 26-34 pg/cell

3-6 months 25-35 pg/cell

0.5-2 years 23-31 pg/cell

2-6 years 24-30 pg/cell



Mean Corpuscular Hemoglobin

Concentration (MCHC)

Birth 30-36 g Hg/dL RBC

1-3 days 29-37 g Hg/dL RBC


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1-2 weeks 28-38 g Hg/dL RBC

1-2 months 29-37 g Hg/dL RBC

3 months-2 years 30-36 g Hg/dL RBC

2-18 years 31-37 g Hg/dL RBC

Reticulocyte Count

Infants 2-5% of RBCs

Children 0.5-4% of RBCs

12-18 years (male) 0.5-1% of RBCs

12-18 years (female) 0.5-2.5% of RBCs

Platelet Count

Birth-1 week 84,000-478,000/mm

Thereafter 150,000-400,000/mm

ERYTHROCYTE SEDIMENTATION

RATE (ESR)

TEST NORMAL VALUE

WestergrenChild 0-10 mm/hour

Adult (male) 0-15 mm/hour

Adult (female) 0-20 mm/hour

Wintrobe

Child 0-13 mm/hour

Adult (male) 0-9 mm/hour Adult (female) 0-20 mm/hour

What Abnormal Results Mean:


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High numbers of RBCs may indicate:

Low oxygen tension in the blood

o Congenital heart disease

o Cor pulmonale

o Pulmonary fibrosis

Polycythemia vera

Dehydration (such as from severe diarrhea)

Renal (kidney) disease with high erythropoietin production

Low numbers of RBCs may indicate:

Blood loss

o Anemia (various types)

o Hemorrhage

Bone marrow failure (for example, from radiation, toxin, fibrosis, tumor)

Erythropoietin deficiency (secondary to renal disease)

Hemolysis (RBC destruction)

Leukemia

Multiple myeloma


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Malnutrition (nutritional deficiencies of iron, folate, vitamin B12, or

vitamin B6)

Low numbers of WBCs (leukopenia) may indicate:

Bone marrow failure (for example, due to infection, tumor or fibrosis)

Presence of cytotoxic substance

Autoimmune/collagen-vascular diseases (such as lupus erythematosus)

Disease of the liver or spleen

Radiation exposure

High numbers of WBCs (leukocytosis) may indicate:

Infectious diseases

Inflammatory disease (such as rheumatoid arthritis or allergy)

Leukemia

Severe emotional or physical stress

Tissue damage (SUCH AS burns)

Low hematocrit may indicate:

Anemia (various types)

Blood loss (hemorrhage)


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Bone marrow failure (for example, due to radiation, toxin, fibrosis,

tumor)

Hemolysis (RBC destruction) related to transfusion reaction

Leukemia

Malnutrition or specific nutritional deficiency

Multiple myeloma

Rheumatoid arthritis

High hematocrit may indicate:

Dehydration

o Burns

o Diarrhea

Polycythemia vera

Low oxygen tension (smoking, congenital heart disease, living at high

altitudes)

Low hemoglobin values may indicate:

Anemia (various types)

Blood loss


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to identify acute and chronic illness, bleeding tendencies, and white blood

cell disorders such as leukemia

to monitor treatment for anemia and other blood diseases

to determine the effects of chemotherapy and radiation therapy on blood

cell production

Preparation:

There is no special preparation needed

How the Test is Performed:

Blood is drawn from a vein, usually from the inside of the elbow or the

back of the hand.

The puncture site is cleaned with antiseptic. An elastic band is placed

around the upper arm to apply pressure and cause the vein to swell with

blood.

A needle is inserted into the vein, and the blood is collected in an air-tight

vial or a syringe.

During the procedure, the band is removed to restore circulation.


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Risk for other than potential bruising at the puncture site, and/or

dizziness, there are no complications associated with this test.

RBC (Red Blood Cells)

Red blood cells (also referred to as erythrocytes) are the most common type

ofblood cell and the vertebrate organism's principal means of delivering

oxygen (O2) to the body tissues via the blood flow through the circulatory

system. They take up oxygen in the lungs orgills and release it while squeezing

through the body's capillaries.

These cells' cytoplasm is rich in hemoglobin, an iron-containingbiomolecule

that can bind oxygen and is responsible for the blood's red color.

Normal levels:
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The ranges for a normal RBC count (expressed in million red cells per

microliter {uL} of blood) are:

Women: 4.2 to 5.4 million/uL

Men: 4.7 to 6.1 million/uL

Children: 4.6 to 4.8 million/uL

INDICATIONS:

Levels of RBCs out of the normal range (higher or lower) can be an

indication of certain conditions.

Polycythemia is the presence of an elevated RBC count;

anemia is a decreased RBC count.

Polycythemia may be caused by several conditions including:

congenital heart disease

cor pulmonale

dehydration (such as from severe diarrhea)

obstructive lung disease

pulmonary fibrosis

excess RBC production (polycythemia vera).


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Anemia may occur as a result of:

bleeding (including internal)

hemolysis

kidney disease

leukemia

multiple myeloma

bone marrow failure

erythropoietin deficiency

or deficiencies in iron, folate, vitamin B12, or vitamin B6.

PURPOSE:

Red blood cell indices help classify types of anemia, a decrease in the

oxygen carrying capacity of the blood. Healthy people have an adequate

number of correctly sized red blood cells containing enough hemoglobin

to carry sufficient oxygen to all the body's tissues. Anemia is diagnosed

when either the hemoglobin orhematocrit of a blood sample is too low.

CONTRAINDICATIONS:

previous malaria or hepatitis.
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history of drug abuse

donors who have received human pituitary hormone.

donors with high risk sexual behaviour

donors who have previously been transfused (depending on geographic

location)

PREPARATION:

RBC indices require 35 mL of blood collected by vein puncture with a

needle. A nurse or phlebotomist usually collects the sample.

After care:

Discomfort or bruising may occur at the puncture site. Pressure to the

puncture site until the bleeding stops reduces bruising

Warm packs relieve discomfort.

Some people feel dizzy or faint after blood has been drawn and should be

allowed to lie down and relax until they are stable.

PROCEDURE:

A blood sample will be taken, normally from the arm. If several tests are

ordered, more than one vial of blood will be taken.


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If your RBC count has been low in the past, taking blood might seem

counterproductive, but the CBC count can be a very useful tool to your

physician in diagnosing and treating many health conditions.

COMPLICATION:

Febrile nonhemolytic and chill-rigor reactions.(most common)

The most serious complications are acute hemolytic reaction due to ABO

incompatible transfusion and transfusion-related acute lung injury

potential bruising at the puncture site, and/or dizziness

CellTrans Post-operative Autologous Blood Transfusion System

Hgb/Hct Determination


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Hematocrit and hemoglobin measurements are blood tests. They are part

of a complete blood count, or CBC. Hematocrit measures the amount of

red blood cells that are in blood.

Hemoglobin is a protein-iron compound in the blood that carries oxygen

from the lungs to all cells. A hemoglobin test determines how much

hemoglobin is in the blood.

Together, the hematocrit and hemoglobin tests help diagnose anemia and

polycythemia. Anemia is a shortage of red blood cells due to reduced

production of red cells, destruction of red cells, or loss of red cells from

internal or external bleeding. Polycythemia is production of too many red

blood cells.

Normal values vary with age and sex. Some representative ranges are:

at birth: 42-60%

six to 12 months: 33-40%

adult males: 42-52%

adult females: 35-47%

PURPOSE:


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The hematocrit is used to screen foranemia, or is measured on a person to

determine the extent of anemia.

A low hematocrit, combined with other abnormal blood tests, confirms

the diagnosis.

The hematocrit is decreased in a variety of common conditions including

chronic and recent acute blood loss, some cancers, kidney and liver

diseases, malnutrition, vitamin B12 and folic acid deficiencies, iron

deficiency, pregnancy, systemic lupus erythematosus, rheumatoid arthritis

andpeptic ulcer disease. An elevated hematocrit is most often associated

with severe burns, diarrhea, shock, Ad dison's disease, and dehydration,

which is a decreased amount of water in the tissues.

An elevated hematocrit may also be caused by an absolute increase in

blood cells, called polycythemia. This may be secondary to a decreased

amount of oxygen, called hypoxia, or the result of aproliferation of blood

forming cells in the bone marrow (polycythemia vera).

The hematocrit is also used as a guide to how many transfusions are

needed. Each unit of packed red blood cells administered to an adult is

expected to increase the hematocrit by approximately 3% to 4%.
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CONTRAINDICATION:

Fluid volume in the blood affects hematocrit values

the blood sample should not be taken from an arm receiving IV fluid or

during hemodialysis

It should be noted that pregnant women have extra fluid, which dilutes

the blood, decreasing the hematocrit

Dehydration concentrates the blood, which increases the hematocrit.

PREPARATION:

These tests require taking a blood sample from the arm.

This is a relatively painless procedure that can occur in a clinic, office,

hospital, or lab.

A nurse or technician wraps a rubber strap tightly around the upper arm.

The needle puncture may cause slight discomfort for a moment. For

infants, blood is usually taken from a finger or heel.

Occasionally, a small amount of blood collects under the skin at the

puncture site.

A cool washcloth held against it will help reduce swelling.
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MATERIALS:

Hematocrit

If the hematocrit must be determined quickly, as is often the case when a

patient hemorrhages, it may be necessary to measure the hematocrit directly

without the use of an automated counter. The materials needed are:

Lancets

Alcohol prep pads

Gauze pads

Microhematocrit tubes (heparinized)

Sealant ("Seal-Ease," "Crit-Seal," etc)

Microhematocrit centrifuge

Microhematocrit reader

If venipuncture is required: tourniquet, syringe, tube containing

anticoagulant (EDTA, citrate)

PROCEDURE:


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For hematocrits obtained by fingerstick, wipe the fingertip pad of the

fourth finger of the nondominant hand with the alcohol prep pad. Make

certain the area is allowed to dry.

Prick the fingertip with the lancet. Place the hematocrit tube near the

incision site and allow the blood to flow via capillary action into the

hematocrit tube until it is two-thirds to three-fourths full or to a

predesignated mark on the tube.

Avoid "milking" the finger if possible; this causes the expression of tissue

fluids and may result in a falsely low hematocrit. Always fill at least three

tubes.

For hematocrits obtained by venipuncture, draw a sample of blood into

the tube containing anticoagulant and mix well.

Dip the hematocrit tube into the blood and allow the blood to rise to the

desired two-thirds to three-quarters level. Because blood cells naturally

sediment, a prior thorough mixing of the blood in the tube is necessary to

ensure accurate reading.

After cleaning the outside of the hematocrit tubes of excess blood, invert

the tube slowly so that the blood migrates just short of the bottom end of

the tube.


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Seal the bottom of the tube with sealant. Make certain that little or no air

is interspersed in the column of blood. If the seal is incomplete, leakage

will occur during centrifugation and false readings will be obtained.

Place the tubes in a microhematocrit centrifuge and spin for 3 to 5

minutes at high speed. A shorter spin will not allow for complete

sedimentation.

Hemoglobin

Hemoglobin determinations will usually be performed by an automated cell

counter from a tube of well-mixed EDTA-anticoagulated blood filled to a

predetermined level.

Ultrasound hematocrit

COMPLICATIONS:


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Other than potential bruising at the puncture site, and/or dizziness, there are no

complications associated with this test.

RBC INDICES

DEFINITION:

Red blood cell (RBC) indices are part of the complete blood count (CBC)

test. They are used to help diagnose the cause of anemia, a condition in

which there are too few red blood cells.

The indices include:

Average red blood cell size (MCV)

Hemoglobin amount per red blood cell (MCH)
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The amount of hemoglobin relative to the size of the cell (hemoglobin

concentration) per red blood cell (MCHC)

Mean corpuscular volume

is a measure of the average red blood cell volume (i.e. size) that is

reported as part of a standard complete blood count.

In patients with anemia, it is the MCV measurement that allows

classification as either a microcytic anemia (MCV below normal range),

normocytic anemia (MCV within normal range) ormacrocytic anemia

(MCV above normal range).

It can be calculated (in litres) by dividing the hematocrit by the red blood

cell count (number of red blood cells per litre). The result is typically

reported in femtolitres.

The normal reference range is typically 80-100 fL[1]

In presence ofhemolytic anaemia, presence ofreticulocytes can increase

MCV. Inpernicious anemia (macrocytic), MCV can range up to 150

femtolitres. An elevated MCV is also associated with alcoholism[2]

Vitamin B12 and/or Folic Acid deficiency has also been associated with

macrocytic anemia (high MCV numbers).
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The most common causes ofmicrocytic anemia are iron deficiency (due

to inadequate dietary intake, gastrointestinal blood loss, ormenstrual

blood loss), thalassemia, orchronic disease.

It can be as low as 60 to 70 femtolitres. In cases of thalassemia, the MCV

may be low even though the patient is not iron deficient.

Mean corpuscular hemoglobin

The mean corpuscular hemoglobin, or "mean cell hemoglobin" (MCH),

is the average mass ofhemoglobin perred blood cell in a sample of

blood. It is reported as part of a standard complete blood count. MCH

value is diminished in hypochromic anemias.

It is calculated by dividing the total mass of hemoglobin by the number of

red blood cells in a volume of blood.

A normal value in humans is 27 to 31 picograms/cell [1]. Conversion to

SI-units: 1pg of hemoglobin = 0,06207 femtomol [3]. Normal value

converted to SI-units: 1,68 - 1,92 fmol/cell.
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Mean corpuscular hemoglobin concentration

The mean corpuscular hemoglobin concentration, orMCHC, is a

measure of the concentration ofhemoglobin in a given volume of packed

red blood cells. It is reported as part of a standard complete blood count.

It is calculated by dividing the hemoglobin by the hematocrit. Reference

ranges for blood tests are 32 to 36 g/dl,[1] or between 4.9 [2] to 5.5[2]

mmol/L. It is thus a mass or molar concentration. Still, many instances[3][4]

measure MCHC inpercentage (%), as if it was a mass fraction (mHb /

mRBC). Numerically, however, the MCHC in g/dl and the mass fraction of

hemoglobin in red blood cells in % are identical, assuming a RBC density

of 1g/mL and negligible hemoglobin in plasma.

MCHC is diminished ("hypochromic") in microcytic anemias, and normal

("normochromic") in macrocytic anemias (due to larger cell size, though

the hemoglobin amount or MCH is high, the concentration remains

normal). MCHC is elevated ("hyperchromic") in hereditary spherocytosis,

sickle cell disease and homozygous hemoglobin C disease.[5]

INDICATION
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Patients experiencing signs and symptoms of anemia such as dyspnea,

koilonychias, pallor, jaundice, bone deformities, body malaise and leg

ulcers.

PURPOSE

These RBC Indices are used to diagnose types of anemia

CONTRAINDICATION:

Patients taking certain prescription medications such as zidovudine

(Retrovir), phenytoin (Dilantin), and azathioprine (Imuran). ( These drugs

might affect the results.)

MATERIALS

syringe with g21 or g22

tourniquet

tubes

clean gloves

antiseptic swabs

dry cotton balls


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small glass tube (pipette), on a slide, onto a test strip, or into a small

container

PREPARATION and PROCEDURE

1. Review the procedure and assemble the equipments at bedside.

2. Explain to the client what you are going to do, why it is necessary, and

how he or she can cooperate. Discuss how the results will be used in

planning further care or treatment.

3. Wash hands and observe other appropriate infection control procedure.

4. Provide privacy.

5. Select and prepare a site for collecting a blood sample.

Choose a site with visible vein (antecubital fossa).

Wrap an elastic band around the upper arm to apply pressure to the

area and make the vein swell with blood.

Clean the site with antiseptic swab and allow it to dry completely.

6. Obtain the blood specimen.

Put on gloves.


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The vein can be anchored by placing the thumb about two

centimeters below the vein and pulling gently to make the skin a

little taut.

The needle is beveled upward, should be pushed smoothly and

quickly into the vein, to minimize the possibility of hemolysis as a

result of vascular damage.

Immediately after the insertion, the tourniquet should be released to

minimize the effect of hemoconcentration.

Asked the client to apply gentle pressure with a piece of gauze or

cotton balls to the place where the needle went in.

The blood collects into a small glass tube called a pipette, or onto a

slide or test strip.

A bandage may be placed over the area if there is any bleeding.

COMPLICATIONS:

Excessive bleeding

Fainting or feeling light-headed

Hematoma (blood accumulating under the skin)

Infection (a slight risk any time the skin is broken)


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Discomfort or bruising may occur at the puncture site

PICTURE:

CELLS

with IRON DEFICIENCY ANEMIA


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PERIPHERAL BLOOD SMEAR

DEFINITION

Examination of the peripheral blood smear should be considered, along

with review of the results of peripheral blood counts and red blood cell

indices, an essential component of the initial evaluation of all patients

with hematologic disorders.

The examination of blood films stained with Wright's stain frequently

provides important clues in the diagnosis of anemias and various

disorders of leukocytes and platelets.

WHY GET TESTED?


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To determine if red blood cells, white blood cells, and platelets are

normal in appearance and number;

to distinguish between different types of white blood cells and to

determine their relative percentages in the blood;

to help diagnose a range of deficiencies, diseases, and disorders

involving blood cell production, function, and destruction;

to monitor cell production and cell maturity in diseases such as leukemia,

sickle cell anemia, malaria, during chemo/radiation therapy, or in the

evaluation for hemoglobin variants.

MATERIALS USED:

- sterilized lancets or needles

- 20 clean microscope slides and coverslips

- Canada balsam or other medium for permanent preparations

- 95% ethyl or methyl alcohol

- distilled water

- Giemsa stain
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- low containers (you can make them with aluminum sheet also) or Petri dishes

- microscope which magnifies 200 times at least

PREPARATION AND PROCEDURE:

1. TAKING BLOOD

Handwashing

Cleanse the fingertip of the client before pricking

Keep all the materials needed ready and protected from dust, particularly

the clean microscope slides

2. MAKING THE SMEAR

Place a small drop of blood near an end of a slide.


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With a single drop of blood, you can make several smears. In fact, to

make a smear, it is enough to leave a spot of blood of 3 mm about in

diameter on the slide. It is useful to perform many smears.

To avoid producing clots, you must make each smear with fresh blood

and straight after having deposited it.

With the microscope, you should observe the smears to check that some

of them are properly made. The red cells must not overlap each other, nor

be so scarce as to be too spread out.

3. FIXING

A simple and effective fixing technique consists of dipping the smear in a

vessel containing 95% ethyl or methyl alcohol for 3-5 minutes. In order to

put alcohol on the smear, you can also use a dropper or a bottle dispenser.

4. STAINING

Normally Giemsa stain is used. It is a mixture of stains, based on

methylene blue and eosin. It consists of a concentrated solution which

you have to dilute in the proportion1/10, that is one part of Giemsa in


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nine of distilled water, or buffer solution (pH = 6,8-7,2). You can buy the

stain in a store of chemicals and laboratory equipment.

To stain a smear:

Take a slide with a fixed and dry smear.

Put on the slide a drop of stain until it is fully covered.

Stain for about 16 minutes, renewing the stain about four times.

Then rinse the slide with distilled water at room temperature. Drain

off the water and leave the slide to dry.

5. CHECKING

With the microscope, verify that the cells are well stained.

If necessary, apply the stain for a few more minutes.

6. COVER-SLIPPING

After drying the slide, place a drop of Canada balsam or another medium

mountant on the smear, then mount the coverslip.

7. OBSERVATION


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RETICULOCYTE COUNT

DEFINITION

The reticulocyte count is used to help determine if thebone marrow is

responding adequately to the bodys need for red blood cells (RBCs).

To help determine the cause of and classify different types ofanemia.

If the number of reticulocytes is not elevated when you are anemic, then

it is likely that there is some degree of bone marrow dysfunction or

failure and/or a deficiency of erythropoietin.

INDICATION

Bleeding
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Hemolytic Anemia

Hemolytic disease of the newborn

Iron deficiency anemia

Pernicious anemia orfolic acid deficiency

Aplastic anemia

Radiation therapy

Bone marrow failure caused by infection or cancer

The Preparation

A health professional will usually draw the blood from a vein

After cleaning the skin surface with antiseptic and placing an elastic band

(tourniquet) around the upper arm to apply pressure and cause veins to

swell with blood.

A needle is inserted into a vein and blood is withdrawn and collected in a

vial or syringe.

THE PROCEDURE

1. Stain Solution (Stains ribosomes)
http://www.labtestsonline.org/understanding/conditions/anemia-2.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia-3.htmlhttp://www.labtestsonline.org/understanding/conditions/vitaminb12.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia-4.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia-2.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia-3.htmlhttp://www.labtestsonline.org/understanding/conditions/vitaminb12.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia-4.html


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New methylene blue or Azure B 1.0 grams

Dissolve stain in 100 ml Citrate-Saline

Tri-sodium citrate 3% (one part)

Saline 0.85% (four parts)

Filter solution

Store at 4 degrees celsius

2. Staining method

Start with 2-3 drops of stain in tube

Add 2-3 drops of patient's blood

Use more blood in anemic patients

Use less blood in polycythemia

Incubate at 37 degrees celsius for 15-20 minutes

Gently mix

Create a thin film on slide

Allow films to dry

3. Counting method


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ANTIGLOBULIN TEST- DIRECT AND INDIRECT

DEFINITION

An antiglobulin test is a laboratory test to identify antibodies that can

bind to the surface ofred blood cells orplatelets and destroy them.

This test is used to diagnose certainblood disorders in which patients

make antibodies to their own redblood cells or platelets. It is also used to

determineblood type.

Also called Coomb's test.

DIRECT ANTIGLOBULIN TEST
http://en.wikipedia.org/w/index.php?title=Laboratory_test&action=edit&redlink=1http://en.wikipedia.org/wiki/Antibodieshttp://en.wikipedia.org/wiki/Red_blood_cellshttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Blood_disordershttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Blood_typehttp://en.wikipedia.org/wiki/Coomb's_testhttp://en.wikipedia.org/w/index.php?title=Laboratory_test&action=edit&redlink=1http://en.wikipedia.org/wiki/Antibodieshttp://en.wikipedia.org/wiki/Red_blood_cellshttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Blood_disordershttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Blood_typehttp://en.wikipedia.org/wiki/Coomb's_test


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The direct antiglobulin test (DAT) is used primarily to help determine if

the cause ofhemolytic anemia, a condition in which red blood cells

(RBCs) are being destroyed more quickly than they can be replaced, is

due to antibodies attached to RBCs.

PROCEDURE

STEP 1. Place one drop of a 2 to 5 percent saline suspension of cells to

test in a labeled 10-x 75-mm tube. Wash 3 or 4 times with saline. After

last wash, decant completely. Add one or two drops of antiglobulin

serum: mix.

STEP 2. Centrifuge and examine for agglutination with an optical aid;

Grade and record results. (The manner in which the RBCs are dislodged

from the bottom of the tube is critical. The tube should be held at an angle

and shaken gently until all cells are dislodged.

Then it should be tilted gently back end forth until an even suspension of

cells or agglutinates is observed.)
http://www.labtestsonline.org/understanding/conditions/anemia-5.htmlhttp://%20optionsdisplay%28%27../glossary/antibody.html')http://www.labtestsonline.org/understanding/conditions/anemia-5.htmlhttp://%20optionsdisplay%28%27../glossary/antibody.html')


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STEP 3. To control for inadvertent contamination of the antiglobulin

serum, add one drop of lgG-sensitized RBCs to any tubes that have been

recorded as negative and recentrlfuge.

If the patient's cells were washed adequately in the first stage of the test,

the control cells should be agglutinated, and the negative result on the

patient is valid

INDICATION

hemolytic anemia

hemolytic disease of the newborn,

when there are signs and symptoms of a blood transfusion reaction

INDIRECT ANTIGLOBULIN TEST

The indirect antiglobulin test is used to demonstrate antibodies that may

cause RBC sensitization "in vitro".
http://www.labtestsonline.org/understanding/conditions/anemia-5.htmlhttp://%20optionsdisplay%28%27../glossary/symptom.html')http://www.labtestsonline.org/understanding/conditions/anemia-5.htmlhttp://%20optionsdisplay%28%27../glossary/symptom.html')


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The antibody-containing serum is incubated with specific RBCs, which,

following washing, are reacted with antiglobulin serum to see whether

RBC sensitization has occurred.

INDICATION

Detection and identification of unexpected antibodies.

Crossmatching.

Detecting RBC antigens not demonstrable by other techniques.

Special studies, (for example, leukocyte and platelet antibody tests

SUMMARY OF INDIRECT ANTIGLOBULIN TEST

1. Incubate cells with serum at 37oC for the recommended time. (Usually 15

to 30 minutes.)

2. After incubation wash the cells three to four times.

3. Add AHG, Coombs reagent, centrifuge and read for agglutination.


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4. If the test is negative, add Coombs Control Check Cells to check for false

negatives.

COMPLICATION

Bruising or excessive bleeding after extraction of blood.

Dizziness or may faint


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Coagulation Screening Test

Definition

It is used to determine if the level of the clotting factor is low or

absent, associated with reduced clot formation and bleeding too much

clot formation and.

Coagulation factor levels may also be measured to monitor the level

during therapy.

It is also used to provide rapid, useful, non-specific information, which

allows an initial broad categorization of the haemostatic problem.

Also used to discern whether the bleeding problem to a platelet,

coagulation or a vascular defect.


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PT with INR

(Prothrombin Time with International Normalized Ratio)

Definition

The prothrombin time (PT) measures the integrity of the extrinsic and

common pathways of coagulation (factors VII, X, V and II).

Evaluates the ability of blood to clot properly

It is used to adjust anticoagulant medications to maintain an INR at 2.0.

Reported INRs that are elevated are increased to reduce the risk of

bleeding or decreased to adjust therapy to be more effective.

The International Normalized Ratio (INR) is used to monitor the

effectiveness of blood thinning drugs such as warfarin (Coumadin).

Used to screen patients for any previously undetected bleeding problems

prior to surgical procedures.

Patients taking anticoagulant drugs should have an INR of 2.0 to 3.0 for

basic blood-thinning needs. For some patients who have a high risk of

clot formation, the INR needs to be higher - about 2.5 to 3.5. the doctor

will use the INR to adjust the drug to get the PT into the range that is

right for the patient.


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Due to manufacturer variation in the production of thromboplastin

leading to different PT times between laboratories, it is standard practice

to convert the PT to the international normalized ratio (INR) and report

that value.

Indication

For patients taking anti-coagulant drug

The PT may be ordered when a patient who is not taking anti-coagulant

drugs has signs or symptoms of a bleeding disorder, which can range

from nosebleeds, bleeding gums, bruising, heavy menstrual periods,

blood in the stool and/or urine to arthritic-type symptoms (damage from

bleeding into joints), loss of vision, and chronic anemia.

Sometimes the PT may be ordered when a patient is to undergo an

invasive medical procedure, such as surgery, to ensure normal clotting

ability.

Purposes

Evaluates the ability of blood to clot properly.

Contraindication


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To patients who are taking drugs that can affect the result of the test,

unless these medications are stopped for about a week.

Materials

Near-patient testing (NPT) /Home INR monitoring example: Roche

Coaguchek device

blood plasma

Test tube

Preparation:

Many medicines can change the results of this test. Interview the client

regarding what medications she is taking.

Ask the client if he have been nauseated, light-headed, or have fainted

during blood tests in the past

Procedure:

Most commonly measured usingblood plasma.

1. Blood is drawn into a test tube containing liquid citrate, which

acts as an anticoagulant by binding the calcium in a sample

2. The blood is mixed, then centrifuged to separate blood cells from

plasma.
http://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Test_tubehttp://en.wikipedia.org/wiki/Citratehttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Test_tubehttp://en.wikipedia.org/wiki/Citrate


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3. The plasma is analyzed by abiomedical scientist on an automated

instrument at 37C, which takes a sample of the plasma.

4. An excess of calcium is added (thereby reversing the effects of

citrate), which enables the blood to clot again.

5. For an accurate measurement the proportion of blood to citrate

needs to be fixed

6. For the prothrombin time test the appropriate sample is the blue

top tube, or sodium citrate tube, which is a liquid anticoagulant.

7. Tissue factor(also known as factor III) is added, and the time the

sample takes to clot is measured optically.

8. The prothrombin ratio is the prothrombin time for a patient,

divided by the result for control plasma

9. To convert to INR : each manufacturer assigns an ISI value

(International Sensitivity Index) for any tissue factor they

manufacture. The ISI value indicates how a particular batch of

tissue factor compares to an internationally standardized sample.

The ISI is usually between 1.0 and 2.0.
http://en.wikipedia.org/wiki/Biomedical_scientisthttp://en.wikipedia.org/wiki/Tissue_factorhttp://en.wikipedia.org/wiki/Biomedical_scientisthttp://en.wikipedia.org/wiki/Tissue_factor


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Complication

During a blood draw, a bruise or infection may occur at the puncture site.

Possible formation of scar tissue.

PTT

Definition

Is a performance indicator measuring the efficacy of both the "intrinsic"

and the common coagulation pathways.

A complex method for testing the normalcy of intrinsic coagulation

process.

Employed to identify deficiencies factors, prothrombin, and fibrinogen

Used to monitor heparin therapy (and other anticoagulants).

Values below 25 seconds or over 39 s (depending on local normal ranges)

are generally abnormal

Normal: 60- 70 seconds

Indication
http://en.wikipedia.org/wiki/Secondhttp://en.wikipedia.org/wiki/Second


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It is also used to monitor the treatment effects with heparin (and other

anticoagulants).

For patients experiencing abnormal bleeding or bruising.

Indicated for patients under heparin therapy to monitor its effectiveness.

Purposes

Used to monitor patients who are taking heparin, a blood thinner.

It is used in measuring the efficacy of both the "intrinsic" and the

common coagulation pathways.

To find the cause of abnormal bleeding or bruising.

To asses for low levels of blood clotting.

To asses blood clotting time before a surgery.

Contraindication



Ongoing bleeding can be a problem for people with bleeding disorders.

Aspirin, warfarin (Coumadin), and other blood-thinning medicines can

make bleeding more likely. If you have bleeding or clotting problems, or


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4. The time is measured until a thrombus (clot) forms. (Present pictures or

gadget)

Pictures:

This is a photo-optical clot detection system for determining prothrombin

times, activated partial thromboplastin times and other related tests

Complication

There is very little chance of a problem from having blood sample taken from a

vein.

Patient may get a small bruise at the site.
http://en.wikipedia.org/wiki/Thrombushttp://en.wikipedia.org/wiki/Thrombus


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In rare cases, the vein may become swollen after the blood sample is

taken. A warm compress can be used several times a day to treat this.

Ongoing bleeding can be a problem for people with bleeding disorders.

Aspirin, warfarin (Coumadin), and other blood-thinning medicines can

make bleeding more likely. Ask the patient if he has bleeding or clotting

problems.

BLEEDING TIME

Definition

Bleeding time is a crude test of hemostasis It indicates how well platelets

interact with blood vessel walls to formblood clots

Normal bleeding time is from 2 to 6 minutes. Bleeding time is increased

in disorders of platelet count, uremia, and ingestion of aspirin and other

anti-inflammatory

Test for determining the time interval required for hemostasis to occur

after a standardized wound has been made in the capillary bed

Indication
http://medical-dictionary.thefreedictionary.com/Blood+Clotshttp://medical-dictionary.thefreedictionary.com/Blood+Clots


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Usually used on patients who have a history of prolonged bleeding after

cuts

Usually used to patients who have a family history of bleeding disorders.

Sometimes performed as a preoperative test to determine a patient's likely

bleeding response during and after surgery.

Purposes

Most often to detect qualitative defects of platelets, such as Von

Willebrand's disease.

The test helps identify people who have defects in their platelet function.

Contraindication:



Materials

1. Stopwatch

2. Sphygmomanometer (blood pressure cuff)

3. Filter paper.


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4. Surgicutt tm Automated Incision Making Instrument (International

Technidyne Corp.)

5. Alcohol prep

6. Butterfly bandages

Preparation

1. Many medicines can change the results of this test. Interview the client

regarding what medications she is taking.

2. The patient must not take aspirin for 10 days before the test

3. Example: Aspirin and other cyclooxygenase inhibitors can prolong

bleeding time significantly. While warfarin and heparin have their major

effects on coagulation factors, an increased bleeding time is sometimes

seen with use of these medications as well.

Procedure

1. Select a site on the patient's arm on the lateral aspect volar surface that is

free of veins, bruises, edematous areas, and scars and is approximately 5 cm

below the antecubital cr

2. Clean the site with the alcohol prep.

3. Place the sphygmomanometer around the patient's arm approximately two

inches above the elbow and maintain 40 mm Hg.
http://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Cyclooxygenasehttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Cyclooxygenasehttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Heparin


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4. Remove the "trigger" safety and place the incision device on the site with

minimal pressure so that both ends of the device touch the skin. Do not press

hard.

5. Depress the "trigger" to make the incision then remove the device.

Discard the device in a "sharps" container.

6. Start the timing device and blot the edge of the incision at 30-second

intervals with the filter paper. Do not touch the incision with the filter paper.

7. Note the time that bleeding stops and report to the nearest 30 seconds.

Complication
http://www.mclno.org/webresources/pathman/BT_web/Trigger%20safety.htmhttp://www.mclno.org/webresources/pathman/BT_web/Trigger%20safety.htm


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Excessive bleeding

Fainting or feeling light-headed

Hematoma (blood accumulating under the skin)

Infection (a slight risk any time the skin is broken)

Multiple punctures to locate veins

Possible formation of scar tissue.

Capillary Fragility Test (tourniquet test, Rumple-Leede Test)

determines capillary fragility

method used to determine hemorrhagic tendency

requisite for diagnosis of dengue fever

is used to identify thrombocytopenia
http://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Capillary


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Clotting time

the time required for blood to clot

also called coagulation time specifically in venous blood

average clotting time in a glass tube is 5-15 minutes

this process is used to diagnose hemophilia

Materials include:

*lancet


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*Capillary tube

Preparation:

1. Verify identity of client and explain the procedure

2. Interview if client is taking medication causing bleeding (heparin,

aspirin)

Procedure:

1. Site is cleaned with anti-septic and is pricked using lancet

2. Blood is collected by phlebotomist/MT using capillary tube and is

placed in glass tube

3. Apply pressure on extracted area

4. Bring specimen directly to the lab


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5. The first appearance of clot is noted and timed (normal coagulation

time is 5-15 minutes)

Clot Retraction

indicates function and number of platelets

measures time needed for blood clot to move away from test tube

is used to identify glandzmanns thromboasthenia (absence of

fibrinogen bridging)

Materials needed:

*airtight vial with needle *timer

*test tube with 2/3 castor oil

*tourniquet

Preparation:

1. Verify identity of client and explain the procedure

2. Interview if client is taking medication causing bleeding (heparin,

aspirin)


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Procedure:

1. Site is cleaned with anti-septic; place tourniquet around the upper arm

to apply pressure to the area and make the vein swell with blood.

2. Health care provider gently inserts a needle into the vein and collects

into an airtight vial or tube attached to the needle. The elastic band is removed

(nursing consideration: bring specimen right away to the laboratory)


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3. A drop of blood is placed in a test tube with castor oil

4. Observe for dimpling in the blood

*normal standing blood clot is completely retracted in about 24

hours

dimpling withing:

2-4 hours = normal

4-24 hours = poor

not at all


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Thrombin time

Definition

Thrombin Time (TT), is a blood test which measures the time it takes

for a clot to form in the plasma from a blood sample in

anticoagulant which had added an excess of thrombin. This test is

repeated with pooled plasma from normal patients.

Normal values and significance

10-15sec Prolonged time indicates DIC or hypofibrinogenemia;

presence in blood of excess heparin or other antigoagulants.

Indication

Afibrinogenaemia or hypofibrinogenaemia.

Dysfibrinogenaemia (a dysfunctional fibrinogen)

DIC

Following thrombolytic therapy

Liver disease

Malignancy
http://en.wikipedia.org/wiki/Clothttp://en.wikipedia.org/wiki/Anticoagulanthttp://en.wikipedia.org/wiki/Clothttp://en.wikipedia.org/wiki/Anticoagulant


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Unfractionated heparin

Heparin-like anticoagulants

Amyloid

Hyperfibrinogenaemia

Hypoalbuminaemia

Purpose

Measures functional fibrinogen available, as ashown by the time needed

to form fibrin clot after thrombin is added.

Contraindication

cardio-pulmonary bypass

receiving high concentrations of heparin (8-10 IU/mL)

Materials

syringe with g21 or g22

tourniquet

tubes

clean gloves


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antiseptic swabs

dry cotton balls

Patient's plasma

Normal control plasma

Barbitone buffered saline, pH 7.4

Bovine Thrombin

Preparation and Procedure

7. Review the procedure and assemble the equipments at bedside.

8. Explain to the client what you are going to do, why it is necessary, and

how he or she can cooperate. Discuss how the results will be used in

planning further care or treatment.

9. Wash hands and observe other appropriate infection control procedure.

10. Provide privacy.

11. Select and prepare a site for collecting a blood sample.

Choose a site with visible vein (antecubital fossa).

Place the tourniquet above the vein.

Clean the site with antiseptic swab and allow it to dry completely.


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12. Obtain the blood specimen.

Put on gloves.

The vein can be anchored by placing the thumb about two

centimeters below the vein and pulling gently to make the skin a

little taut.

The needle is beveled upward, should be pushed smoothly and

quickly into the vein, to minimize the possibility of hemolysis as a

result of vascular damage.

Immediately after the insertion, the tourniquet should be released to

minimize the effect of hemoconcentration.

Asked the client to apply gentle pressure with a piece of gauze or

cotton balls to the place where the needle went in.

13. Perform the thrombin time method.

Add 0.1 ml buffered saline to 0.1 ml normal plasma and leave in the

water-bath at 370

C for four minutes.

Add 0.1 ml thrombin, and mix by shaking and simultaneously start

the stop-watch.

Measure the clotting time.


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Repeat with the patient's plasma in duplicate followed by a second

sample of the normal plasma.

Express results as the mean values for the patient and normal.

Repeat the test if duplicate measurements differ by more than 5%.

14. Document the result on the clients record.

Pictures

Bovine thrombin

Complication

Anxiety

Discomfort

Bruising

Hematoma


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Forced Spirometry

Description

Spirometry is the most common of the Pulmonary FunctionTests (PFTs), measuring lung function, specifically the

measurement of the amount (volume) and/or speed (flow) of

air that can be inhaled and exhaled. Spirometry is an

important tool used for generating pneumotachographs which

are helpful in assessing conditions such as asthma, pulmonary

fibrosis, cystic fibrosis, and COPD.

Name of the test Normal values

Forced vital capacity 4.8 L-M3.7 L-F

Forced Expratory Volume inOne Second/FVC-ratio

Adults:0.75-0.80

Forced Expiratory volume inOne second

Adults:75-80%
http://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Pulmonary_fibrosishttp://en.wikipedia.org/wiki/Pulmonary_fibrosishttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_diseasehttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Pulmonary_fibrosishttp://en.wikipedia.org/wiki/Pulmonary_fibrosishttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease


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Indication

Spirometry is used to establish baseline lung function, evaluatedyspnea, detect pulmonary disease, monitor effects of

therapies used to treat respiratory disease, evaluate

respiratory impairment, evaluate operative risk, and perform

surveillance for occupational-related lung disease.

Purposes

Spirometry is the most commonly performed pulmonaryfunction test (PFT). The test can be performed at the bedside,

in a physician's office, or in a pulmonary laboratory. It is often

the first test performed when a problem with lung function is

suspected. Spirometry may also be suggested by an abnormal

x ray, arterial blood gas analysis, or other diagnostic

I. Moderate

COPD

* FEV1/FVC < 0.7

* 50%


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pulmonary test result. The National Lung Health Education

Program recommends that regular spirometry tests be

performed on persons over 45 years old who have a history of

smoking. Spirometry tests are also recommended for persons

with a family history of lung disease, chronic respiratory

ailments, and advanced age.

Spirometry measures ventilation, the movement of air into and

out of the lungs. The spirogram will identify two different types

of abnormal ventilation patterns, obstructive and restrictive.

Common causes of an obstructive pattern are cystic fibrosis,

asthma, bronchiectasis, bronchitis, and emphysema. These

conditions may be collectively referred to by using theacronym CABBE. Chronic bronchitis, emphysema, and asthma

result in dyspnea (difficulty breathing) and ventilation

deficiency, a condition known as chronic obstructive

pulmonary disease (COPD). COPD is the fourth leading cause of

death among Americans.

Common causes of a restrictive pattern are pneumonia, heart

disease, pregnancy, lung fibrosis, pneumothorax (collapsedlung), and pleural effusion (compression caused by chest fluid).

Contraindications

Relative contraindications for spirometry include hemoptysis of

unknown origin, pneumothorax, unstable angina pectoris,

recent myocardial infarction, thoracic aneurysms, abdominal

aneurysms, cerebral aneurysms, recent eye surgery (increasedintraocular pressure during forced expiration), recent

abdominal or thoracic surgical procedures, and patients with a

history of syncope associated with forced exhalation.

Materials


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Spirometer

Preparations

Two choices are available with respect to bronchodilator and

medication use prior to testing.

Patients may withhold oral and inhaled bronchodilators to

establish baseline lung function and evaluate maximum

bronchodilator response, or they may continue taking

medication as prescribed.

If medications are withheld, a risk of exacerbation of

bronchial spasm exists.

Procedure

The basic forced volume vital capacity (FVC) test varies slightlydepending on the equipment used.

1. Generally, the patient is asked to take the deepest breaththey can, and then exhale into the sensor as hard as

possible, for as long as possible.2. It is sometimes directly followed by a rapid inhalation

(inspiration), in particular when assessing possible upperairway obstruction.

3. Sometimes, the test will be preceded by a period of quietbreathing in and out from the sensor (tidal volume), or therapid breath in (forced inspiratory part) will come beforethe forced exhalation.

4. During the test, soft nose clips may be used to prevent airescaping through the nose. Filter mouthpieces may beused to prevent the spread of microorganisms, particularlyfor inspiratory maneuvers.

Present Pictures & Gadgets
http://en.wikipedia.org/wiki/Upper_airway_obstructionhttp://en.wikipedia.org/wiki/Upper_airway_obstructionhttp://en.wikipedia.org/wiki/Upper_airway_obstructionhttp://en.wikipedia.org/wiki/Upper_airway_obstruction


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Spirometry Device

Modern USB PC-based spirometer

Chamber for Spirometry

Complications

Cross Infections due to the use of the mouthpiece
http://en.wikipedia.org/wiki/File:Body_Plethysmography_chamber_01.jpghttp://en.wikipedia.org/wiki/File:Spiro_solo.jpghttp://en.wikipedia.org/wiki/File:Device_for_Spirometry_or_Body_Plethysmography_02.jpg


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Lung Volume Determination

Description& Procedure

Here are the tests to determine lung volume:

Measurement

Value(Male/Female)

Calculation Description

Total lung

capacity(TLC)

= 6.0 / 4.7 LTLC = IRV + Vt+ ERV + RV

The volume of aircontained in the lungat the end ofmaximal inspiration.

The total volume ofthe lung.

Vitalcapacity(VC)

= 4.6 / 3.6 LVC = IRV + Vt+ ERV

The amount of airthat can be forcedout of the lungs aftera maximalinspiration. Emphasison completeness ofexpiration. Themaximum volume ofair that can bevoluntarily moved inand out of therespiratory system.[3]

Forcedvitalcapacity(FVC)

= 4.8 / 3.7 L measured

The amount of air

that can bemaximally forced outof the lungs after amaximal inspiration.Emphasis on speed.[4][5]
http://en.wikipedia.org/wiki/Litrehttp://en.wikipedia.org/wiki/Vital_capacityhttp://en.wikipedia.org/wiki/Vital_capacityhttp://en.wikipedia.org/wiki/Lung_volumes#cite_note-2http://en.wikipedia.org/wiki/Lung_volumes#cite_note-3http://en.wikipedia.org/wiki/Lung_volumes#cite_note-4http://en.wikipedia.org/wiki/Litrehttp://en.wikipedia.org/wiki/Vital_capacityhttp://en.wikipedia.org/wiki/Vital_capacityhttp://en.wikipedia.org/wiki/Lung_volumes#cite_note-2http://en.wikipedia.org/wiki/Lung_volumes#cite_note-3http://en.wikipedia.org/wiki/Lung_volumes#cite_note-4http://en.wikipedia.org/wiki/Air


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volume (Vt) mL

breathed in or outduring normalrespiration. Thevolume of air anindividual is normally

breathing in and out.

Residualvolume(RV)

= 1.2 / 0.93L

measured

The amount of air leftin the lungs after amaximal exhalation.

The amount of airthat is always in thelungs and can neverbe expired (i.e.: the

amount of air thatstays in the lungsafter maximumexpiration).

Expiratoryreservevolume(ERV)

= 1.2 / 0.93L

measured

The amount ofadditional air thatcan be pushed outafter the end

expiratory level ofnormal breathing. (Atthe end of a normalbreath, the lungscontain the residualvolume plus theexpiratory reservevolume, or around

2.4 litres. If one thengoes on and exhalesas much as possible,only the residualvolume of 1.2 litresremains).

Inspiratory = 3.0 / 2.3 L measured or The additional air
http://en.wikipedia.org/wiki/Exhalationhttp://en.wikipedia.org/wiki/Exhalation


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reservevolume(IRV)

IRV=VC-(Vt+ERV)

that can be inhaledafter a normal tidalbreath in. Themaximum volume ofair that can be

inspired in addition tothe tidal volume.

Functionalresidualcapacity(FRC)

= 2.4 / 1.9 LFRC = ERV +RV

The amount of air leftin the lungs after atidal breath out. Theamount of air thatstays in the lungsduring normal

breathing.

Inspiratorycapacity(IC)

= 3.5 / 2.7 L IC = Vt + IRV

The maximal volumethat can be inspiredfollowing a normalexpiration.

Anatomicaldead space

= 150 / 120mL

measured

The volume of theconducting airways.Measured with

Fowler method.[6]Physiologicdeadvolume

= 155 / 120mL

The anatomic deadspace plus thealveolar dead space.

Abnormal results:

Type Examples Description FEV1/FVC

restrictiv

e

diseases

pulmonary fibrosis,Infant RespiratoryDistress Syndrome,weak respiratory

volumes aredecreased

often in a normalrange (0.8 - 1.0)
http://en.wikipedia.org/wiki/Functional_Residual_Capacityhttp://en.wikipedia.org/wiki/Functional_Residual_Capacityhttp://en.wikipedia.org/wiki/Functional_Residual_Capacityhttp://en.wikipedia.org/wiki/Dead_spacehttp://en.wikipedia.org/wiki/Fowler_methodhttp://en.wikipedia.org/wiki/Lung_volumes#cite_note-5http://en.wikipedia.org/wiki/Pulmonary_fibrosishttp://en.wikipedia.org/wiki/Functional_Residual_Capacityhttp://en.wikipedia.org/wiki/Functional_Residual_Capacityhttp://en.wikipedia.org/wiki/Functional_Residual_Capacityhttp://en.wikipedia.org/wiki/Dead_spacehttp://en.wikipedia.org/wiki/Fowler_methodhttp://en.wikipedia.org/wiki/Lung_volumes#cite_note-5http://en.wikipedia.org/wiki/Pulmonary_fibrosis


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muscles,pneumothorax

obstructiv

e

diseases asthma or COPD

volumes areessentially

normal butflow rates areimpeded

often low (Asthmacan reduce theratio to 0.6,

Emphysema canreduce the ratioto 0.3 - 0.4)

Indications

Lung volumes determinations (CPT code 94240 [FRC or RV],

94260 [thoracic gas volume by body plethysmography]) areused in the evaluation of suspected restrictive lung disease

and the evaluation of hyperinflation.

Contraindications

Inability to follow instructions is a contraindication. Patients

with claustrophobia may not tolerate being closed into a

confined space (body plethysmograph).

Preparations

Use of supplemental oxygen just prior to a nitrogen washout

test may cause underestimation of FRC unless the initial

exhaled nitrogen is considered in the calculations. Duplicate

measurements of FRC by either gas dilution technique should

be delayed until a post-test interval is equivalent to 1.5 timesthe equilibration time to eliminate the effects of residual

oxygen or helium.
http://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_diseasehttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease


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Present Pictures and Gadgets

Device that helps in determining lung

volume( Spirometer)

Complications

No reports of complications adter test is performed.


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Diffusion Capacity

Description

Lung diffusion testing measures how well the lungs exchange

gases. This is an important part of lung testing, because the

major function of the lungs is to allow oxygen to "diffuse" orpass into the blood from the lungs, and to allow carbon dioxide

to "diffuse" from the blood into the lungs.

Contraindication

Inability to follow instructions is a contraindication to a DLCO

test (CPT code 94070). Patients should be alert, oriented, able

to exhale completely and inhale to total lung capacity, able tomaintain an airtight seal on a mouthpiece, and able to hold a

large breath for 10 seconds

Preparations

Do not eat a heavy meal before the test. Do not smoke for at least 4 - 6 hours before the test.

If you use a bronchodilator or inhaler medications, askyour health care provider whether or not you can use thembefore the test.

Procedure


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You breathe in (inhale) air containing a very small amountof a tracer gas, such as carbon monoxide.

You hold your breath for 10 seconds, then rapidly blow itout (exhale).

The exhaled gas is tested to determine how much of the

tracer gas was absorbed during the breath.

Present Pictures and Gadgets

ComplicationsThere is no significant risk in taking this test
http://adam.about.com/encyclopedia/firstaid/Carbon-monoxide.htmhttp://adam.about.com/encyclopedia/firstaid/Carbon-monoxide.htm


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Capnography

DEFINITION:

the measurement of carbon dioxide (CO2) in exhaled breath

direct monitor of the inhaled and exhaled concentration or partial

pressure of CO2, and an indirect monitor of the CO2 partial pressure in

the arterialblood

is usually presented as a graph of expiratory CO 2 plotted against time,

or, less commonly, but more usefully, expired volume

INDICATION:

detect life-threatening conditions (malposition of tracheal tubes,

unsuspected ventilatory failure, circulatory failure and defective

breathing circuits)

asthma, congestive heart failure, diabetes, circulatory shock,

pulmonary embolus, acidosis,
http://www.answers.com/topic/bloodhttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Pulmonary_embolushttp://en.wikipedia.org/wiki/Acidosishttp://www.answers.com/topic/bloodhttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Pulmonary_embolushttp://en.wikipedia.org/wiki/Acidosis


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in patients with normal lung function, upper and lower airway disease,

seizures, and diabetic ketoacidosis

monitor any patients receiving pain management or sedation (enough

to alter their mental status) for evidence of hypoventilation and/or apnea

Patients with head injury

Patients who experience anaphylactic reaction

PURPOSES:

provides a breath by breath measurement of a patient's ventilation

enables paramedics to objectively evaluate a patients ventilatory

status (and indirectly circulatory and metabolic status)

monitors patient ventilation, providing a breath by breath trend of

respirations and an early warning system of impending respiratory crisis

utilized to differentiate the nature of the cardiac arrest


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clinical judgment alone in the early detection of adverse respiratory

events such as hypoventilation, esophageal intubation and circuit

disconnection;

CONTRAINDICATION:

Patients with Atelactasis

Pulmonary embolism or hypovolemia

exacerbation of main disease;

Clinical or laboratory symptoms of endocrine disorder;

coronary deficiency of the 2-3 stage;

breath deficiency of the 3 stage;

chronic pulmonary heart in the stage of sub- or decompensation;

serious disorder of heart rhythms and conductivity;

serious diseases of central nerve system or affective disorders.
http://en.wikipedia.org/wiki/Hypoventilationhttp://en.wikipedia.org/wiki/Oesophagushttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Hypoventilationhttp://en.wikipedia.org/wiki/Oesophagushttp://en.wikipedia.org/wiki/Intubation


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MATERIALS USED:

Capnogram

PREPARATION:

Clinicians administering sedation/analgesia should be familiar with

sedation oriented aspects of the patient's medical history and how these

might alter the patients response to sedation / analgesia

Patients (or their legal guardians in the case of minors or legally

incompetent adults)

should be informed of and agree to the administration of sedation /

analgesia including the benefits,

risks, and limitations associated with this therapy, as well as possible

alternatives.

Recording of LOC, oxygenation, hemodynamics

Recording of the paramaters


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Presence of condensation in the tube

Auscultate the stomach; assess for absence of air movement

8. Apply capnometer or capnography if available.

9. Document use of continuous ETCO2 monitoring and attach wave

form strips to their PCRs.

10. Print a strip on intubation, periodically during care and transport, and

then just prior to moving the patient from your stretcher to the hospital

table and then immediately after transfer. This will timestamp and

document your tube as good

PICTURES/GADGETS:

COMPLICATIONS:


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A patient taking in a large tidal volume can still hyperventilate with a

normal respiratory rate just as a person with a small tidal volume can

hypoventilate with a normal respiratory rate.

Patients with extended down times may have ETCO2 readings so low

that quality of compressions will show little difference in the number.

Some diseases may cause the CO2 to go down, then up, then down.

Imperfect positioning of nasal cannula capnofilters may skew

readings

Unique nasal anatomy, obstructed nares and mouth breathers may

require repositioning of the cannula

oxygen by mask which may lower the reading by 10% or more.

NORMAL VALUES & SIGNIFICANCE:

ETCO2 35-45 mm Hg

The normal wave form appears as straight boxes on the monitor screen:.


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Hypoventilation

When a person hypoventilates, their CO2 goes up.

Hypoventilation can be caused by altered mental status such as

overdose, sedation, intoxication, postictal states, head trauma, or stroke,

or by a tiring CHF patient.

Other reasons CO2 may be high: Increased cardiac output with

increased breathing, fever, sepsis, pain, severe difficulty breathing,

depressed respirations, chronic hypercapnia.

2. Confirming, Maintaining , and Assisting Intubation

Continuous end-tidal CO2 monitoring can confirm a tracheal intubation.


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When exhaled CO2 is detected (positive reading for CO2) in cardiac

arrest, it is usually a reliable indicator of tube position in the trachea.

Reasons ETCO2 is zero: The tube is in the esophagus.*

Reductions in ETCO2 during CPR are associated with comparable

reductions in cardiac output

increase in ETCO2 presumably providing better chest compressions

Pulse Oximetry

DEFINITION:

Pulse oximetry is a simple non-invasive method of monitoring

the percentage of haemoglobin (Hb) which is saturated with

oxygen.


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A sensor is placed on a thin part of the patient's body, usually

a fingertip orearlobe, or in the case of a neonate, across a foot,

INDICATION:

whenever a patient's oxygenation may be unstable, as in intensive

care, critical care, and emergency department areas of a hospital

The need to monitor the adequacy of arterial oxyhemoglobin

saturation

The need to quantitate the response of arterial oxyhemoglobin

saturation to therapeutic interventionor to a diagnostic procedure (eg,

bronchoscopy)

PURPOSES:

The oxygen content of the blood

The amount of oxygen dissolved in the blood

The respiratory rate or tidal volume i.e. ventilation

The cardiac output or blood pressure
http://en.wikipedia.org/wiki/Fingertiphttp://en.wikipedia.org/wiki/Earlobehttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Critical_carehttp://en.wikipedia.org/wiki/Emergency_departmenthttp://en.wikipedia.org/wiki/Fingertiphttp://en.wikipedia.org/wiki/Earlobehttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Critical_carehttp://en.wikipedia.org/wiki/Emergency_department


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as a screening tool that could supplement or supplant respiratory

rate as a 'pulmonary vital sign

screening for respiratory failure

CONTRAINDICATION:

Patient who take vasopressor drugs

highly calloused skin

shivering

carbon monoxide poisoning,

The presence of an ongoing need for measurement of pH,

PaCO2, total hemoglobin, and abnormal hemoglobins

MATERIALS USED:

pulse oximeter and related accessories (probe of appropriate

size)

PREPARATION:

1. Select the appropriate type of pulse oximeter that fits your needs as

well as the use of BP cuff, arterial catheter, and/or peripheral IV line
http://en.wikipedia.org/wiki/Carbon_monoxide_poisoninghttp://en.wikipedia.org/wiki/Carbon_monoxide_poisoninghttp://en.wikipedia.org/wiki/Carbon_monoxide_poisoning


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2. Find a pulse oximeter that is easy to use.

3. Test the pulse oximeter against someone who can manually take

your pulse and oxygen saturation measurements if you have this

opportunity

4. Prepare the client & explain the procedure if necessary

5. Check factors that may affect the result of the procedure

a) Motion artifact

b) Intravascular dyes

c) exposure of measuring probe to ambient light during

measurement

d) low perfusion states

e) skin pigmentation

f) nail polish or nail coverings with finger probe

PROCEDURE:


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1. Perform hand hygiene

2. Select a part of the patients body where you can put the device

(adult: fingertip or earlobe; neonate: across a foot)

D-25 Digit or D-20 Pediatric Sensor:

Place the sensor, adhesive side up, over

the patients finger. Position the dashedcenter line directly above

the fingertip

I-20 and N-25 Sensor

Wrap sensor around finger tip or foot.

Position dashed line at either medial or lateral border of

extremity

3. Make an initial assessment of the patients condition

4. Read & interpret results displayed in the computerized unit

(percentage of Hb saturation, pulse beat, heart rate, blood flow)


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and O2Hb4 (if direct measurement was not simultaneously

performed, an additional, one time statement must be made

explaining that the SpO2 reading has not been validated by

comparison to directly measured values);

f) Stability of readings (length of observation time and

range of fluctuation, for continuous or prolonged studies,

review of recording may be necessary);

g) Clinical appearance of patient--subjective assessment of

perfusion at measuring site (eg, cyanosis, skin temperature);

h) Agreement between patient's heart rate as determined by

pulse oximeter and by palpation and oscilloscope

7. When disparity exists, possible causes should be explored before

results are reported.

COMPLICATIONS:

false-negative results for hypoxemia and/or false-positive results

for normoxemia or hyperoxemia


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tissue injury may occur at the measuring site as a result of probe

misuse

NORMAL VALUES & SIGNIFICANCE:

Normal range Significance

Percentage of arterial

hemoglobin

95 to 100 percent SpO2 < 90%=

desaturation

SpO2 95%=

Common pulsatile signals on a pulse

oximeter. (Top panel) Normal signal

showing the sharp waveform with a

clear dicrotic notch. (Second panel)

Pulsatile signal during low perfusion

showing a typical sine wave.

(Third panel) Pulsatile signal with superimposed
http://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Hemoglobin


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Arterial Blood Gas (ABG)

Definition

An arterial blood gas (ABG) is ablood test that is performed using

blood from an artery. It involves puncturing an artery with a thin needle

and syringe and drawing a small volume of blood. The most common

puncture site is the radial artery at the wrist, but sometimes the femoral

artery in the groin or other sites are used. The blood can also be drawn

from an arterial catheter. Arterial blood gas analysis is used to measure

the partial pressures of oxygen (PaO2) and carbon dioxide (pacO2)' and

the pH of an arterial sample. Oxygen content (O2CT), oxygen saturation

(SaO2) and bicarbonate (RCO3 -) values are also measured.

Indication

The test is used to determine thepH of the blood, thepartial

pressure ofcarbon dioxide and oxygen, and thebicarbonate level. Many

blood gas analyzers will also report concentrations oflactate,

hemoglobin, several electrolytes, oxyhemoglobin, carboxyhemoglobin

and methemoglobin. ABG testing is mainly used inpulmonology, to
http://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Groinhttp://en.wikipedia.org/wiki/Arterial_catheterhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Partial_pressurehttp://en.wikipedia.org/wiki/Partial_pressurehttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Lactatehttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Oxyhemoglobinhttp://en.wikipedia.org/wiki/Carboxyhemoglobinhttp://en.wikipedia.org/wiki/Methemoglobinhttp://en.wikipedia.org/wiki/Pulmonologyhttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Radial_ar

hem to logy

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