Invalidation of antiglobulin tests by a high thermal amplitude cryoglobulin

A multiply transfused patient was referred for evaluation of a transfusion reaction. The direct and indirect antiglobulin tests (DAT, IAT) for alloantibody were negative. However, IgG-coated control cells failed to agglutinate in the negative reactions, casting doubt on their validity. At 4 degrees C, the patient's serum exhibited a large cryoprecipitate (2.9 mg/mL), made up predominantly of an IgG kappa paraprotein and having trace amounts of IgM and C3. Clear serum separated at 37 degrees C became cloudy within 10 minutes at room temperature (RT); within 4 hours, approximately 60 percent of the total precipitable cryoprotein had precipitated. Red cells (RBCs) incubated in fresh serum that had cooled to RT or RBCs obtained from RT or refrigerated samples contained cryoprecipitate that sedimented with the RBCs during washing with RT saline. On resuspension, enough IgG cryoglobulin redissolved to neutralize completely the commercial anti-IgG reagents. If the patient's samples were maintained at 37 degrees C, cryoprecipitate did not form, and RBCs washed four times at 37 degrees C gave valid DAT and IAT reactions. The removal of all cryoprecipitate from the patient's serum by centrifugation after overnight incubation at 4 degrees C also made possible valid antibody screening and compatibility tests.     

保存血小板的体外评估:是否有希望预见输入后血小板的生存和功能

输入病人体内的血小板的循环能力和功能与体外保存损害和受者的体内环境有关。患有血小板减少症的住院病人,体内影响血小板存活和功能的因素比体外保存损害的影响更重要。然而人们长久以来一直认为,预测血小板成分在体内的作用可以为现行的输血措施提供有价值的参考,也可能进一步提高临床疗效,同时更有效的管理血小板贮存。确实,新的病原菌灭活方法推动了临床应用,同时可能使浓缩血小板保存更安全、保存时间更长,精确评定临床有意义的浓缩血小板质量。 保存血小板在输血后的存活和功能差异较大。如果血小板处理小心,也没有长时间保存(采集后24—48小时内)便很快     

CAUSES OF 425 DEATlIS DURING THE LAST FIVE ,YEARS ON TIIE SURGICAL SERVICE OF THX , FIRST HOSPITAL OF THE RED CROSS SOCIETY OF CHINA, SHANGHAI

First Hos声ital o! the Red Crnss Society of China, Shanghai A prominent feature of the monthly staff meeting at the First Hospital of the Red Cross Society of China is a survey of the months work. Each department reports the number of p.atients heated and the clinical results. Particular attention is given to unsatisfactory results, and aIl deaths are subjected to critical scrutiny.     

Interdisciplinary interactions,social systems and technical infrastructure required for successful implementation of mobile stroke units: A qualitative process evaluation

Rationale

Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken.

Aim

To identify successes and challenges in the pre- and initial operations of the first Australian MSU service from an interdisciplinary perspective.

Methods

Process evaluation of the Melbourne MSU with a mixed-methods design. Purposive sampling targeted key stakeholder groups. Online surveys (administered June–September 2019) and semistructured interviews (October–November 2019) explored experiences. Directed content analysis (raters' agreement 85%) and thematic analysis results are presented using the Interactive Sociotechnical Analysis framework.

Results

Participants representing executive/program operations, MSU clinicians and hospital-based clinicians completed 135 surveys and 38 interviews. Results converged, with major themes addressing successes and challenges: stakeholders, vehicle, knowledge, training/education, communication, work processes and working relationships.

Conclusions

Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments.