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When a patient has not been transfused in the past 3 months Blood bank/Apply principles of basic laboratory procedures/Crossmatch/1 4 blood sugar 80 purchase 10 mg forxiga overnight delivery. The medical laboratory scientist began the laboratory investigation of the transfusion reaction by assembling pre- and post-transfusion specimens and all paperwork and computer printouts diabetes mellitus y xerostomia order genuine forxiga. Perform an antibody screen on the posttransfusion sample Blood bank/Apply knowledge of standard operating procedures/Transfusion reactions/2 anaphylactic and anaphylactoid reactions? Antibody in patient serum is detected 37 days after transfusion diabetic candy discount forxiga express, and is attached to donor red blood cells B. Donor plasma has reagins (IgE or IgA) that combine with allergens in patient plasma C. Patient is deficient in IgE and develops IgE antibodies via sensitization from transfusion or pregnancy D. Patient is deficient in IgA and develops IgA antibodies via sensitization from transfusion or pregnancy Blood bank/Apply knowledge of fundamental biological principles/Transfusion reactions/1 4. Allergen Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/1 Answers to Questions 14 1. The most time-saving approach would be to check all paperwork before performing any laboratory testing. D Anaphylactic or anaphylactoid reactions are the most severe form of allergic transfusion reaction and are associated with deficient or absent IgA in the patients, allowing them the capability to form antiIgA. These patients must be transfused with washed cellular products where the plasma has been removed. B A transfusion reaction that occurs several days after a transfusion of blood products is probably a delayed immunologic reaction due to an antibody formed against donor antigens. Transfusion-related acute lung injury Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/1 to an O patient? Febrile nonhemolytic transfusion reaction Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/2 9. During the transfusion, her pulse was 94, and blood pressure rose from 114/59 to 132/64. Delayed hemolytic Blood bank/Correlation of laboratory and clinical data/Transfusion reactions/3 red cells 2 days ago. An antibody screen and panel studies revealed the presence of anti-Jkb (postspecimen). The recipient cells were likely positive for the Jkb antigen Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/3 evaluation of a transfusion reaction, except: A. Panel on pre- and post-transfusion samples Blood bank/Apply knowledge of standard operating procedures/Transfusion reactions/1 Answers to Questions 59 5. B Group A blood given to a group O patient would cause an immediate hemolytic transfusion reaction because a group O patient has anti-A and anti-B antibodies and would destroy A cells. C this is an example of an anamnestic reaction where the patient was most likely exposed to the Jkb antigen at some point in his life, and upon re-exposure to the antigen, the antibody titer rose to detectable levels. A febrile nonhemolytic reaction is highly consistent with both symptoms and posttransfusion test results. A 92-year-old male diagnosed with anemia 147 and episodes of frequent falling was typed as B negative and transfused 1 unit of packed red blood cells, also B negative. Volume overload Blood bank/Correlation of laboratory and clinical data/Transfusion reaction/3 transfused 2 units of packed red blood cells. The technologist attributed the reaction to the Fya antigen being present on the A1 cells. Two units of A-positive packed cells were crossmatched that were Fya negative, and were compatible. D the tachycardia, increased pulse, and volume transfused before a reaction was called are consistent with volume overload. The temperature change did not meet criteria for a febrile reaction, and evidence for a hemolytic reaction is lacking. B this case emphasizes the statistic that not all causes of death are related to transfusion. A this case represents an acute hemolytic reaction where the patient had previous sensitization to E and c antigens.
The corpora cavernosa penis begin as separate bodies along the rami of the pubis on either side and join at the pubic angle to definition of gestational diabetes mellitus cheap forxiga 10 mg free shipping form the shaft of the penis diabetes mellitus related to cystic fibrosis purchase cheapest forxiga and forxiga. They are united by a common connective tissue septum called the pectiniform septum blood glucose uptake by muscle buy discount forxiga 10 mg on line, and each corpus is surrounded by a thick, primarily collagenous sheath, the tunica albuginea. Trabeculae of collagenous and elastic fibers with numerous smooth muscle cells extend into the corpora from the tunica albuginea and divide the central regions of the corpora cavernosa into numerous cavernous spaces, those near the center being the larger. These spaces are endothelial-lined vascular spaces and are continuous with the arteries that supply them and with draining veins. The cavernous tissue of each corpus cavernosum penis communicates with the other through numerous slitlike openings in the pectiniform septum. The ventrally placed corpus cavernosum urethrae (corpus spongiosum) ends in an enlargement, the glans penis, which forms a cap over the ends of the corpora cavernosa penis. Structurally, corpus spongiosum is similar to the corpora cavernosa penis, but the tunica albuginea is thinner and contains more elastic fibers and smooth muscle cells, and the trabeculae are thinner and contain more elastic tissue. The three corpora are bound together by subcutaneous connective tissue that contains numerous smooth muscle cells but is devoid of fat. It is divided into two compartments, each of which houses a testis, an epididymis, and the lower part of the spermatic cord. It contains many sweat glands, sebaceous glands that produce an odorous secretion, and some coarse hairs, the follicles of which are visible through the thin skin. The tunica dartos underlies the skin and forms the septum that divides the scrotum into its two compartments. It is firmly attached to the skin and consists largely of smooth muscle cells and collagenous connective tissue. The appearance of the scrotum varies with the state of contraction of the smooth muscle. Under influence of cold, exercise, or sexual stimulation, the muscle contracts and the scrotum becomes short and wrinkled. The spermatic cord consists of several thin layers of connective tissue that are acquired from the anterior abdominal wall as the testes descend from the abdominal cavity into the scrotal sac during development. It contains the ductus deferens, nerve fibers, lymphatic channels, testicular artery, and a pampiniform plexus of testicular veins. As the testicular artery nears the testis, it becomes highly convoluted and is surrounded by the venous plexus. The proximity of the surrounding, cooler venous blood causes the arterial blood to lose heat and provides a thermoregulatory (counter-current heat exchange) mechanism for precooling incoming arterial blood. In this way the temperature of the testes is maintained a few degrees (2-3єC) below body temperature, a condition necessary for production of sperm. The temperature can be elevated by 233 the shaft of the penis is covered by a thin, mobile skin that shows a slight increase in pigmentation. The skin of the distal shaft, unlike that of the root, lacks hair but does contain scattered sweat glands. The hairless skin of the glans penis is fused to the underlying connective tissue and is nonmobile. The glans penis is covered by a fold of skin called the prepuce or foreskin, the inner surface of which is moist and resembles a mucous membrane. Numerous free nerve endings are present in the epithelium of the glans penis, prepuce, and subepithelial connective tissue of the urethra and skin. Branches from the dorsal arteries penetrate the tunica albuginea and enter the cavernous tissue, where the arteries branch and either form capillary plexuses or course distally in the cavernous tissue. These helicine arteries are highly convoluted in the flaccid penis and take a spiral course through the trabeculae of the cavernous tissue. The intima of most of these arteries, even before they enter the cavernous tissue, have long, ridgelike thickenings that project into and partially occlude the lumina. Blood from the large central lacunae drains peripherally toward the smaller vascular spaces and finally into a plexus of veins at the periphery. The veins run along the interior of the tunica albuginea, pierce the limiting tunica, and drain into the deep dorsal vein of the penis.
