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rravkin@aol.com last won the day on June 24

rravkin@aol.com had the most liked content!

About rravkin@aol.com

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    Seasoned poster
  • Birthday 08/01/1961

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    Acoustic Guitar, Congas, Oil on Canvas
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    Medical Technologist

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  1. rravkin@aol.com

    Cold Agglutinin incubation phases

    So Treemoss, do you know if rbc agglutination, and the damage it can do to the microvasculature, is a concern with this surgical patient group if a cold antibody is demonstrating?
  2. rravkin@aol.com

    Transport or Storage?

    Let's not forget that we are dealing with a perishable product, packed rbc's, and not a non-perishable product like a book or a refrigerator.
  3. rravkin@aol.com

    Cold Agglutinin incubation phases

    Hey Exlimey, very well put.
  4. rravkin@aol.com

    Transport or Storage?

    David, I am not sure if there is a difference between transported and delivered, outside of potential semantics. If a package is delivered it was certainly transported. But I think that the FDA's thinking is based on the stored conditions during the transport; thus taking the transport part of the equation out of consideration. If you are familiar with the convenience retail chain, Wawa, one of their limitations on expansion is the safe storage of perishable products being delivered directly from their farm to surrounding stores. With advancement in storage capability they are able to expand; but notice that Wawa is only present on the east coast and not the west coast. This is because of the limitations on storage capability during transport. I believe that this may be the FDA's logic when addressing packed red blood cells.
  5. rravkin@aol.com

    Cold Agglutinin incubation phases

    Hi Scott and Exlimey, perhaps the idea of a hemolytic reaction is remote when considering cold agglutinins but if the patients body temp and OR temp are below normal body temp and room temp respectively, and, if the cold agglutinin is strong enough, either by way of concentration therein of bonding strength, does the cold agglutinin not have the capability of causing rbc agglutinins to form and remain stable long enough to cause damage to the microvasculature in the same manner as with Lupis Erythmatosis.?
  6. rravkin@aol.com

    Cold Agglutinin incubation phases

    Hi TreeMoss, I gather that you and your crew were not real inspired by this line of testing. When the practice was first explained to me it seemed like a good practice, the idea being that if the patient had a cold reacting antibody and needed transfusion during the procedure when their body temp was less than normal, perhaps the OR staff would be better prepared in treating any adversities. I guess that your new surgeons do not agree with this practice. But can I ask what kind of incubators were used in your blood bank to test at 10, 15, and 20C? The reason for my question is that I have only done cold incubations at BB Room Temp and 1-6C BB Refrig temp.
  7. rravkin@aol.com

    Transport or Storage?

    Hi Dansket, can you explain what you mean when you say "level of control"?
  8. rravkin@aol.com

    Transport or Storage?

    I was going to ask if distance traveled had anything to do with this distinction, transported or stored. But it is actually the container that is being transported and the blood is stored within this container. If the container is sealed such that the stored blood is not in any contact with the elements then the stored blood would be good until it's expiration provided the temp is maintained in this container. I think that the container's ability to maintain the appropriate temper for a given time and the time it takes to travel a given distance is probably where the question of transport and storage originates. But the temperature maintenance is a container issue and not the units of blood "stored within." If a pregnant woman travels a given distance can we think that the fetus she is carrying is transported or stored?
  9. rravkin@aol.com

    Cold Agglutinin incubation phases

    Hi Malcom, not withstanding the reference given, if there is indeed any contradiction, but I had a co-worker who practiced Blood Bank at a hospital where part of their type an screen practice was a 4C incubation for all open heart pre surgical patients. The idea being that the docs wanted to be aware of any cold agglutinins because during the surgery, and as a consequence of the proceedings, the patient's body temp would drop. To what degree, and how it compares to the referenced recommendation you site I do not know. I hope that retirement is treating you well and best wishes, Ronald.
  10. rravkin@aol.com

    Body Fluid Differential

    Hi Dcamp67, I wonder if the question of QC for body fluid diffs and not whole blood manual diffs, arise because WBC's are not nearly as common to body fluids as compared to whole blood and as such perhaps a broader empirical understanding of variables of the resolution of WBC's in the matrix of whole blood is by far better noted and therefore removes the consideration for the practice of QC for manual whole blood diffs as compared to body fluid diffs. In other words the variables of WBC resolution in the matrix of body fluids may not be as well noted or understood or as practiced as compared to whole blood. I hope this helps some even though, for me, it just raises more questions.
  11. rravkin@aol.com

    Criteria for Pathology Review

    Hi kholshoe, I would agree that the slide review criteria is set primarily by the medical director/ pathologist and as each may help to treat varying patient demographics and each pathologist has their own manner of practice, the criteria for the slide review would, indeed, be somewhat subjective. I have practiced in a number of hematology labs with each having their own criteria for slide review based on the practice of the pathologist signing off on the procedure. The establishment of the criteria seems to be mostly a top down decision with some influence by the supervisors who are closer to the actual work flow. In other words, the work flow of the lab, and technical staff practicing, may have some influence on this decision as well. I hope this helps.
  12. rravkin@aol.com

    Strong Cold Agglutinins and CBC results

    Thank you for the info kimannez. I was not sure if the strong cold agglutinin would alter the distribution of rbc's prior to the lysing step significantly enough as compared to the diluted aliquot specimen. But I can see where a "harsh lyse" would be more useful. Can I ask, what instrument was in use for this testing?
  13. rravkin@aol.com

    Strong Cold Agglutinins and CBC results

    Hi Kimmannez, I was curious to know what your acceptable range is between the neat hgb result and the diluted hgb result. Given that the strong cold agglutinin would significantly alter the rbc distribution of the neat specimen as compared to the diluted specimen my guess is that your range is broad. How was this range established and do you know of any references? Thanks for any info.
  14. rravkin@aol.com

    anion gap reference ranges and to use K+ or not

    Scott, do you know the reason why the K result is considered negligible in the anion gap calculation? Is it because the K result is usually a much smaller number in comparison? And if this is the case then when the anion gap is at the border of the range, would the K result not make a difference there, at least numerically, but with questionable clinical relevance?
  15. rravkin@aol.com

    Chronic Reactive Lymphocytosis

    Thank you Scott. Multiple Myeloma is what I was thinking of.

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