rcurrie Posted June 1, 2007 Share Posted June 1, 2007 it was one of those days when everything that could go wrong does. A patient with 6 known antibodies comes into the ER with an HGB of 4.5. The Cath \Lab puts a catheter through a cardiac artery, requiring emergency open heart surgery. We get the specimen and centrifuge it. The specimen looks like it was centrifuged upside down. RBCs on top, plasma on the bottom. The tech recentrifuges. Same result: RBCs on top, plasma on the bottom. When she showed it to me, I knew what it was within about 5 seconds. Been there- done that. My question to the group is: What tha' heck is goin' on hyar!?You have all the info I had when I solved the problem. Put your Tom Terrific Thinking Caps on and tell me what the problem is.BC Link to comment Share on other sites More sharing options...
Mabel Adams Posted June 1, 2007 Share Posted June 1, 2007 OK, I,ll bite. It has to be something that would make the plasma more dense than the red cells or the red cells less dense than the plasma. If the former, it would have to be in solution, because anything in suspension would spin out below the red cells.I am betting on a plasma expander or maybe the cardiac cath dye. What's the half-life of these anyway?Regardless of the cause, is the sample okay for testing? Did it do weird things in tube, in gel??? Would you get the same results with serum? Did the patient survive? Link to comment Share on other sites More sharing options...
rcurrie Posted June 1, 2007 Author Share Posted June 1, 2007 Mabel,I figured you would be the one to get it first. Yes, it was the cath dye: Omnipaque, also known as Iohexol, N,N -Bis ( 2,3-dihydroxypropyl)-5-[N-(2,3-dihydroxypropyl )-acetamido]-2,4,6-triiodo-isophthalamide. I have pushed this drug several times in the past. It is used for all kinds of imaging, including intravenous pyelograms (IVPs). So, what is a Med Tech doing pushing drugs? I was the only one in the hospital who could get the IV started. Next step would have been a cut down.It is never just "one thing." Omnipaque normally clears very quickly. However, whenever there is renal impairment, it is cleared by the gall bladder. This patient had end stage renal disease. I told the tech to tell the cath lab to wait 30 minutes and recollect. Sure enough, the red cells were right where they needed to be.Renal clearance can be as quick as 15 minutes. But, with renal impairment, it can take as long as 24 hours. This specimen was collected 59 minutes after the Omnipaque injection. Thirty minutes later, the plasma was straw-colored and on top of the red cells. I will probably publish this. Hey- Transfusion liked my SCID picture (see page 1, January 2007 issue)!No way would I test this sample. Patient is fine, if you call ESRD with a 29% ejection fraction okay. He is a non-compliant diabetic who is paying the price.BC Link to comment Share on other sites More sharing options...
John C. Staley Posted June 1, 2007 Share Posted June 1, 2007 Hey don't give Mabel all the credit. I had the same thoughts, she just beat me to the key board. I was busy saving lives while she was surfing the net. HAHAHAHAHAHA Some times I just crack me up.Good work Mabel and thanks for the info Bob. We have a cath lab but have never seen this. Maybe if we do I'll have the rare good fortune of remembering. Link to comment Share on other sites More sharing options...
Karen Olsen Posted June 1, 2007 Share Posted June 1, 2007 Very Interesting!! Thanks for sharing! I like John will be lucky to remember this discussion if I am ever so unfortunate to find myself in this nightmare situation!Does this discussion mean that you do not routiinely have a T&S or at least an "extra" specimen on your Cath Lab patients. I have polled various sites to inquire about this and have received mixed reviews. We are trying to get a specimen on Cath Lab patients prior to procedure but have had no sucess as of yet. Link to comment Share on other sites More sharing options...
Mary Posted June 1, 2007 Share Posted June 1, 2007 We don't get a specimen routinely. 99.9% of the Caths don't need us. Link to comment Share on other sites More sharing options...
janet Posted June 4, 2007 Share Posted June 4, 2007 We used to do a G&S on all caths......they decided to drop it (by 'they' I mean the cath lab - said they looked at the statistics and thought it wasn't needed - didn't ask for our input).Over the 15 years we've been doing them I only recall 2 bleeds. Link to comment Share on other sites More sharing options...
rcurrie Posted June 4, 2007 Author Share Posted June 4, 2007 I have so few requests from the cath lab that I don't even know where it is. I have since found out it wasn't an artery. This patient was a CABG with stenosis of a venous graft. Venous grafts just aren't that hearty, and the angioplasty didn't work. So, they set him up for emergency bypass. No blood was needed in the cath lab.BC Link to comment Share on other sites More sharing options...
Mabel Adams Posted June 4, 2007 Share Posted June 4, 2007 Bob, you I can harass. Hardy, not hearty, right? Link to comment Share on other sites More sharing options...
rcurrie Posted June 4, 2007 Author Share Posted June 4, 2007 Mabel, pun intended. If I ever have a bypass, I am asking for an artery for an artery. No leg veins.BC Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted February 17, 2010 Share Posted February 17, 2010 Hey, and there was I thinking it might just be sample from one of TimOz's countrymen!!!!!!!!!!!!!!!:rolleyes::rolleyes: Link to comment Share on other sites More sharing options...
TimOz Posted February 17, 2010 Share Posted February 17, 2010 Malcolm,Nice idea but our plasma spins to the top. It does have a nice frothy head on it. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted February 17, 2010 Share Posted February 17, 2010 Malcolm,Nice idea but our plasma spins to the top. It does have a nice frothy head on it.Tee hee!!!!!!!!!!!!!!:haha::giggle::haha: Link to comment Share on other sites More sharing options...
Abdulhameed Al-Attas Posted February 18, 2010 Share Posted February 18, 2010 Thanks Bob,for the NEW information. Link to comment Share on other sites More sharing options...
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