Warmer Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Warmer and links to relevant pages within the course.
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Most are IgM and not clinically significant May interfere with detection of clinically significant antibodies if they react at AHG phase. Screen cells and panel cells will have positive reactions in IS phase and strength will diminish or antibody will not be detected at AHG phase. Auto control will be positive if the cold antibody is an autoantibody. Binding of antibody to antigen occurs at room or colder temperatures and may start to disassociate from the red cell membrane at warmer temperatures. Reactions will appear weaker or be negative at warmer temperatures. (Example: 4+ at IS phase and W (weak)+ at AHG phase.) PrewarmingIf a non specific cold antibody or cold agglutinin is suspected, warm the sample and testing reagents, including saline, to 37° C. Only do reaction readings at AHG; bypassing the optimum reaction temperature prevents activation and binding of the cold antibody .
|Cold Autoantibody Example|
Reactions are occurring strongly in IS phase but are weaker in AHG phase which could be due to some disassociation of the cold antibody occurring at the warmer testing phase.Prewarming of all reagents and sample will prevent binding of cold antibody. If the W+ reactions at AHG are due to residual cold antibody, the reactions should be negative with a prewarmed panel. No IS phase reading is performed. Prewarmed Panel
Once the phlebotomist has successfully identified the patient, the next step of the dermal puncture procedure is to locate and determine a site suitable for puncture. If a heel stick in an infant is being performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel to increase blood flow to the area, which will faciliate the collection of the capillary specimen. The use of a warming device is also recommended when a finger stick is performed, if the hands are cool to the touch.A heat-standardized, pre-packaged, chemically activated heel warmer, or comparable heating agent should always be used to warm the heel of an infant to prevent scalding or burning. The temperature of the heating device should not exceed 42°C.Caution-- do not use a cloth that has been moistened and warmed in a microwave oven. This may have hot spots that could cause injury to the patient. It is also not advisable for the phlebotomist to hold a patient's hand under hot running water. This again could cause an injury. If feasible, the patient could be instructed to warm his or her own hands under running water, but allow the patient to adjust the water temperature.
In addition to the puncture device, additional equipment may be required when performing a successful dermal puncture.Plastic microcollection devices: Plastic microcollection devices are small plastic tubes designed to collect capillary blood from a dermal puncture wound. Each small collection tube is color-coded in the same manner as blood collection tubes used for venipuncture. The color of the cap of each container tube corresponds to the type of additive inside the tube, most often an anticoagulant. The additive coats the inside of the tube. Examples of microcollection devices are shown below. Heel warmer: It is best practice to warm the heel of an infant with a warming device known as a heel warmer. The heel warmer, when activated, is designed to warm its contents to a standardized temperature. This temperature will be hot enough to effectively warm the heel and facilitate blood flow to the area without causing heat injury to the patient. It is unacceptable to warm a cloth using a microwave. There may be "hot spots" on the cloth that could potentially burn the patient. Keep in mind, what may feel warm to you, the phlebotomist, may feel hot to your patient!Plastic or Mylar-wrapped capillary tube: In some facilities blood from a capillary puncture is collected directly into a capillary tube. These tubes are very delicate and must be used with great caution. As soon as the tube is two thirds to three-fourths filled, one end is sealed to prevent blood from leaking out.Glass microscope slides: In some facilities, the person collecting the capillary specimen may also be required to prepare a blood smear for laboratory examination. A drop of blood is placed directly on a glass slide and spread to create an area for cell examination. If you are required to prepare blood smears, remember that the slide is considered infectious until fixed or stained. It is also important to remember that glass is a sharps hazard. If not used correctly, the glass may cause injury to both the patient and the phlebotomist. Be as cautious with a glass slide containing blood as you are with a contaminated needle. Dispose of glass slides that will not be used for testing in approved sharps containers.Alcohol and gauze pads: Alcohol is the disinfectant of choice for dermal puncture. The alcohol must be allowed to air dry, which will prevent hemolysis of the specimen and discomfort for the patient. A piece of clean or sterile gauze is used to wipe away the first drop of blood. Gauze is also used to apply pressure to the wound after the specimen collection is complete to stop the wound from bleeding.Iodine or other approved cleaning agents may be used as an alternative to alcohol.Bandage: It may be necessary to apply a bandage to the puncture wound on a finger or heel if the site continues to bleed. However, it is NOT recommended to bandage the finger of a child who is 2-years-old or younger since the bandage may become a choking hazard if the child puts that finger in his/her mouth.Personal protective equipment (PPE): All healthcare professionals that may come in contact with blood and/or body fluids while performing a laboratory procedure are required to wear intact gloves. It is against safety guidelines to alter gloves in any way that may compromise the integrity of the gloves. Eye protection, such as safety goggles, is recommended if there is the possibility of a splash of blood while collecting a capillary blood specimen. In many facilities, special gowns are required in some patient areas such as special-care nurseries. Always follow the policies of your facility in regard to PPE.
|How 2009 H1N1 Differs from Seasonal Flu Viruses|
The 2009 Influenza A H1N1 virus is both similar and different from previous influenza A viruses that have caused seasonal flu in recent years. The symptoms associated with the H1N1 virus are very similar to those of other influenza A viruses causing seasonal flu. One difference between the influenza A 2009 H1N1 virus and seasonal influenza A viruses is the time of year in which the infection is at its peak. The influenza 2009 H1N1 virus was prevalent during warmer weather months in 2009, whereas the peak time for seasonal influenza viruses is winter months.Another way in which the H1N1 virus differs from seasonal flu viruses is the age group that is most affected. The number of cases and severity of the disease has been greater in the younger population, whereas most seasonal influenza virus-related deaths have been reported in those age 65 and older.
|Febrile Nonhemolytic Transfusion Reactions: Definition/Manifestation/Prevalence|
A febrile non-hemolytic transfusion reactions (FNHTR) is defined as a temperature increase of 1oC over 37oC occurring during or after the transfusion of blood components. FNHTRs are more common in the transfusion of platelets. Multiply-transfused patients and multiparous women make up the largest populations experiencing this type of reaction. There are two mechanisms involved in the manifestation of a FNHTR. The first one involves the presence of a white cell antibody in the patient's plasma that interacts with the white cells in the blood product. These antibodies may be directed against granulocyte antigens or human leukocyte antigens (HLA). This interaction causes endotoxins to be released, which act on the hypothalamus and stimulate a fever. The second mechanism involves the generation of leukocyte cytokines during product storage. The production of cytokines usually occurs during storage in warmer temperatures, which is why non-leukoreduced platelets are commonly implicated.