Sharp Information and Courses from MediaLab, Inc.

A 23-year old man had complained of right lower quadrant abdomonal pain for approximately one week. Initially the pain was sharp and localized to a small area just above the right iliac crest.The pain subsided for approximately two days, but then recurred more diffusely over the lower abdomen, accompanied by cramping and mild diarrhea.The onset of fever and vomiting promted a visit to the emergency room. His temperature was 101 F, pulse was 90/minute, and palpation of the right lower abdomen elicited severe pain.The white blood count was 23,000/mm with a distinct left shift, including 5% metamyelocytes.Emergency surgery was performed for a large peri-appendiceal abscess. During surgery, multiple abscesses were noted in the spleen, which was removed (see photograph).Recovery was uneventful following 5 days of adjuvant clindamycin therapy.

Prevention of HIV exposure is the best line of defense to prevent occupational transmission of HIV as there is no vaccine available to develop specific immunity and the postexposure prophylaxis is toxic. Following appropriate workplace practices in the laboratory focus on preventing needlesticks or other sharps injuries and exposure of mucous membranes and abraded skin to HIV-infected blood or body fluids.

Do not leave test orders or test results in areas where they can be viewed by patients.Do not discuss test results or any patient information in areas where patients can overhear the conversation. Be careful not to discuss confidential information on the telephone where patients can overhear the conversation.Do not provide supplies to physician offices other than those usually provided by the laboratory. Document any supplies given to an office.Do not supply items that the office can use for testing (e.g. urine dipsticks). Do not allow offices to dispose of biohazard waste or sharps in the waste containers paid for by the laboratory.

Hepatitis B most often spreads when certain body fluids from an infected individual come in direct contact with another person.Contact may occur through: a break or sore in the skin a contaminated sharp contact with mucous membranes that line the insides of the mouth, nose, eyes, and the genital organs. HBV is not spread through casual contact, such as handshake, or through sweat.

A sharp is any object which can penetrate the skin.Examples include: Needles Scalpels Broken glass About 800,000 needlestick and sharps injuries occur in the U.S. healthcare workplace each year! It is important to handle and dispose sharps properly.

It is important to always dispose of contaminated wastes properly!Examples of contaminated wastes: Microbiology waste and pathology wasteAll body fluids, such as pleural fluids Contaminated sharps and blood specimens

Put contaminated wastes which do not have the potential to puncture in a red or orange leakproof biohazard labeled bag.If the external surface of this bag is contaminated, place it within a secondary leakproof bag.Always hold full waste bags away from your body to prevent an injury by a protruding sharp.

All biohazard needle disposal containers are marked with a “full” line at about ¾ of the box’s volume. Therefore, needles should never be sticking out of the top of the container. Julie should never have attempted to put the needle into an overly full container. The needlestick safety and prevention act requires the use of butterflies with built in safety devices. However, they are only effective if properly activated. When disposing of a butterfly needle, hold its “wings” with one hand, and the hub at the opposite end of the tubing with your other hand to prevent the needle from recoiling. Butterflies should be used with extra caution since they are the number one cause of needle stick injuries.Relevant topics:Needle disposal, Sharps disposal containers, Butterfly needles with safety 1, Butterfly needles with safety 2, Needle-stick injuries, Built-in safety features, Angel Wing™ safety butterfly, Punctur-Guard™ safety butterfly

All sharps must be disposed in appropriate sharps disposal containers. These are usually available in patient rooms, but may also be available on the phlebotomy tray depending on your institution’s policies and procedures.

Remove the needle from the holder if appropriate, and properly discard it in an approved sharps disposal container.Discard all waste and gloves in a red biohazardous waste container. Wash hands.

After collecting the blood specimen into a syringe, properly activate the appropriate safety device, and dispose of the needle in a sharps container.Attach the syringe to a blood transfer device by twisting the needle tip into the hub of the device.Push a vacuum blood collection tube into the holder of the transfer device, and let the tube fill to the appropriate level.

All needles & other sharps must be disposed of in approved sharps disposal containers. Other contaminated waste must be discarded in an appropriate red biohazard bag or waste receptacle.

This photograph of a peripheral blood smear from an 18-year-old North African woman with anemia reveals sickle cells. Target cells are not conspicuous. This shifts the diagnostic evidence away from HbSC disease. Cells tagged by arrows are variants of sickle cells. These may appear when multiple abnormal hemoglobin combinations are responsible for the clinical problem. The cell marked by the single arrow is an envelope formed not only in HbS disease but in HbC disease as well. Two arrows tag a blister cell, which, when seen in several fields, should prompt a hemoglobin electrophoresis to determine the presence of an undiagnosed hemoglobinopathy. Blister cells with fuzzy edged pseudo-vacuoles (see photo) are to be distinguished from the pseudo-vacuoles (blister)with razor sharp edges suggesting a microangiopathic state.

Several drepanocytes are also seen in this field of a blood smear from a sickle cell patient. Sickle cells may have either the appearance shown in the photomicrograph at S, with sharp points, or may appear with more blunted ends, as in D. Homozygous sickle cell anemia is the condition in which drepanocytes are seen; however other tests are needed to make the diagnosis of sickle cell anemia. Most sickled cells can revert back to the discoid shape when oxygenated. About 10% of sickled cells are unable to revert back to their original shape after repeated sickling episodes.