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COMMUNITY
المختبرات العملية

Blood Bank and Blood donation

-2 types: whole blood and separations (RBC concentration, platelet
concentration, fresh frozen plasma and cryoprecipitate)

APHERESIS PROCEDURE

: it is a process in which blood taken a

healthy donor can be separated into its component parts during
blood donation where the needed component is collected and the
"unused" components are returned to the donor. Fluid replacement
is usually not needed in this type of collection. The components
include: -Plasmapheresis (blood plasma). -Erythrocytapheresis
(RBC) -plateletpharesis (platelets)

–Leukapheresis (WBC)

Donor blood unit testing

1-ABO and Rh grouping

2-Hep B surface Ag (HBs Ag)

3-Hep C virus Ab

4-test for syphilis

5-HIV Ab

Registration for blood donation

: The following information

should be taken: Date of donation, name,address,job,phone no. ,
sex,age and last donation.

Criteria for donor selection

1-general appearance including vein puncture site

2-age:18-65 years old

3-last donation:more than 2 months , 4 donations for males and 3
donations for females during one year

4-blood pressure:not more than 180/100 mmHg

5-pulse:50-100 (regular)

6-medical illness:donors with diseases of the heart,liver or lung or
a Hx of cancer or abnormal bleeding tendency should be excluded

7-pregnancy:should not be accepted for donation

8-drug therapy:(anticoagulants, anti hypertensive, insulin)

9-Hb or PCV: not less than 13.5g/dl or 40% for males and 12.5g/dl
or 38% for females.

10-Had blood transfusion or major surgery (Defer 6 months) Blood
donation rules:

11-Infected with brucellosis, tuberculosis or malaria (Defer 2 years)

12-Have a history of syphilis, HBV, HCV, HIV (Permanently
deferred)

13- Have history of blood diseases such as leukemia, lymphoma,
thalassemia major, sickle cell anemia and polycythemia.

Rabies

Rabies is a viral disease that causes acute inflammation of the
brain in humans and other warm-blooded animals.In 2010, an
estimated 26,000 people died from rabies The route of infection is
usually, but not always, by a bite of an animal commonly dogs. In
many cases, the infected animal is exceptionally aggressive, may
attack without provocation, and exhibits otherwise uncharacteristic
behavior.This is an example of a viral pathogen modifying the
behavior of its host to facilitate its transmission to other hosts.

Signs and symptoms

Early symptoms can include fever and

tingling at the site of exposure. These symptoms are followed by
one or more of the following symptoms: violent movements,
uncontrolled excitement, fear of water, an inability to move parts of
the body, confusion, and loss of consciousness. Once symptoms
appear it nearly always results in death.

Incubation periods

as short as four days and longer than six

years have been documented

Diagnosis

Rabies can be difficult to diagnose, because, in the

early stages, it is easily confused with other diseases or with
aggressiveness. The reference method for diagnosing rabies is the
fluorescent antibody test (FAT, a immunohistochemistry
procedure), which is recommended by the World Health
Organization

Treatment

General considerations in rabies Post-Exposure

Prophylaxis which include Immediate washing/flushing and
disinfection of the wound plus rapid administration of purified
immunoglobulin and vaccine(rabies vaccines prepared on cell
culture or embryonate eggs)

–If rabies immunoglobulin is not

available on first visit its use can be delayed by a maximum of 7
days from date of first vaccine injection -

pregnancy and infancy are

never contraindications

to PEP(Post-Exposure Prophylaxis)

5 dose

intramuscular regime

: the vaccine should be administered on days

0, 3, 7, 14 and 28 in deltoid region ,in small children , into the
anterolateral area of the thigh muscle -Vaccines should not be
injected into the gluteal region -in immunosuppressed individuals
no modification of the recommended number of doses is advisable
and The importance of wound treatment should be further stressed
-in previously vaccinated persons Local treatment of wound ,no
RIG (rabies immunoglobulin) should be applied ,Two PEP
schedules is indicated ,one dose on days 0 and 3. , However full
PEP should be given to persons with HIV/AIDS Pre-exposure
rabies vaccination indicated for Groups at high risk of exposure to
live rabies virus (

laboratory staff, veterinarians, animal handlers ,

wildlife officer and travelers to areas where rabies is common

)

three doses of vaccine is given on days 0, 7 and 21 or 28

SCREENING

a strategy used in pop. To detect diseases in asymptomatic

individuals enabling early intervention and reducing morbidity and
mortality

EARLY DETECTION OF BEAST CANCER Screening

1.must be for common diseases in that population

not suitable for screening)

ondrosarcoma is rare so

2.must be for important health problem

3.there should be treatment for the condition(effective)

4.facilities available for Dx. And

ovary CA25 can be

reening program tumor markers CA

. 5.solid sc

ons or even be normal in malignant

elevated in benign conditi
conditions

6.continuous process and for all

7.time and cost should be acceptable and reasonable

BREAST CA

clinical and self examination

ve ,need educated people(difficult to be applied

–

False +ve, false

in IRAQ

.U/S

)

Advantages 1.differentiate cystic from solid 2.differentiate benign

from malignancy ex. fibroadenosis from malignancy so it is
diagnostic for malignancy 3.very useful in young women with
dense breast 4.localize impalpable pathologies

which may be the

calcification (

Disadvantages: 1.cannot detect

early sign of malignancy) 2.time consuming

CT SCAN

Superiority for bone so not used

1.The best diagnostic investigation for soft tissue 2.Very

MRI

MRI mostly will rule out breast

–

ve predictive value so

–

high
cancer 3. can detect deep tumors 4.useful to detect implants and

But it is expensive and time

recurrence

differentiate scars from

consuming, need professional radiologis

MAMMOGRAPHY

1.safe 2.sensitive in old age females will less dense breast 3.show

the same features of U/S but can detect MICRO
CALCIFICATION(CIS begins as micro calcification) .architectural
changes and skin changes(ex. Thickening) Not time

or professional ,not costy ,good

consuming(rapid), no need f
sensitivity and specificity

BRACA 1 & 2

Done for risk groups: Who are those with family history with any

breast< 50 years old

one of the following: 1.young age

ated with

breast 4.breast associ

breast 3.male

2.clusters of
ovarian and colonic ca. 5.previously identified mutation in BRACA
1 OR 2 in the family Those should be screened at 30 years old
with mammography and if not conclusive do US

FNA

and can not

Done for an apparent lump so not used in screening

from CIS

stinguish invasive CA

BIRAD system

0.>>>> inconclusive test(do another investigation)

1.>>>>normal breast

2.>>>>benign condition (yearly follow up)

3.>>>>benign+ more intensive follow up

4.>>>>be suspicious

5.>>>>malignant 100%

of malignancy

histopathological proof

6.>>>>

Emergency management of acute
poisoning

Provide first aid measures

Ingested poisons:

Clear the mouth Give large amount of water and milk Induce

emesis

Inhaled poisons:

Give oxygen

get into fresh air

Remove from exposure site

Attempt artificial respiration: ex. Using mouth to mouth rescue/
assisted ventilation

Eye contamination:

15 mins

–

Flood with running water for 10

Skin contamination:

Flood with water for

contaminated clothes

Remove and discard

Wash with a detergent

15 mins

–

Injected poisons / Bites:

Apply tourniquet and

Immobilize the patient and the injected part

In case of a snake bite use incision and suction

cold packs

vital function and level of consciousness

Assess the

Assess the vital function (airways, breathing, and circulation)
Assess and stabilize the cervical spines Assess the level of
consciousness using Glasgow coma scale

Reduce absorption

Ipecac Contraindications: convulsion /

Use Syrup of

Emesis

-
coma / petroleum (can cause aspiration pneumonia) / corrosive /
sharp objects

Liquid

50 ml)

–

Use activated charcoal (25

Gastric lavage

-
paraffin

Magnesium citrate 10

Magnesium sulphate 10 %

Catheter use

Sodium sulphate 10 %

Enema

Enhance elimination

Forced alkaline

Forced osmotic dieresis

Forced dieresis

Furesemide

–

Forced acid dieresis

dieresis

Dialysis

Haemoperfusion

Administer a specific antidote or an antagonist

paracetamol

Acetyl cysteine

pesticides

Atropine

Digoxin and Digitoxin

Digitalis antidote kit

Benzodiazepines

Flumazenil

Warfarin

Vitamin K

Contraception

breastfeeding

hormonal

combined

Daily for 21 or 28 days depending on

(estrogen/progesterone)pills

the formulation,and withdrawal bleed will normally occur in the pill
free days or during the 7placebo day.

progesterone only

Effectiveness is less and cause disturbance of the menstrual cycle

s with estrogen

,indicated for patient
contraindications,hypertension,during lactation.

injection

(depo provera)every 3 months (progesterone) suitable for patients

who use progesterone only pills and for the avoidance of pill

y in the return of

taking. May cause menstrual irregularity and dela
fertility following discontinuation.

patch

Intrauterine contraceptive device (IUCD) copper containing is

small,easy to insert and the menstrual loss is smaller. These

4year.

IUCDs renewed every 3

*Contraindications:

inflammatory disease

pelvic

abnormal bleeding (because it increases menstrual loss)

previous ectopic pregnancy

sever dysmenorrhea There is hormonal IUCD it has advantage

over the other by reducing blood loss and return of fertility after

condom for

vaginal diaphragm e

r,(expensive). d

removal is faste
male

Tuberculosis

It is a killer infection in the developing countries Infectious agent:
mycobacterium complex(M.tuberculosis,M.bovid,M.africanum)

Mode of transmission

: -inhalation of airborne droplets -ingestion

of unpasteurized milk or diery products -exposure during
procedurs such as bronchoscopy

Risk factors

: Children and elderly,immunocompromized

people,overcrowding and close contact with the infected
individuals.

What is the risk of infection and developing the disease after
exposure?

Exposure---->70% no infection ---->30%get the infection

From those who get the infection,95% develop containment and
5% develop the primary progressive disease.

Diseases of tuberculosis

1-pulmonary(primary and secondary): fatigue,fever,night sweat
and weight loss then develop local symptoms of cough,chest
pain,hemoptysis and hoarseness.

2. Extra-pulmonary : occurs in 30 % *The most common site is
lymph nodes. *But , any organ can be affected.

Incubation period

: 2-10 weeks . *Reservoir : Human mainly ,

Cattle rarely .

Diagnosis

1) CXR : Pulmonary infiltrates , cavitation in upper lobe .

2) Sputum Smear : Acid Fast Bacilli ( 1st step in Dx ) .

3) Culture : Lowenstein - Jensen culture , confirms Dx , but takes
6-8 weeks .

4) Tuberculin skin test : Low sensitivity and specificity , it has no
diagnostic value , but it is an important screening tool . *

Tuberculin test results : 1) > 5 mm : +ve in HIV ,
Immunocompromised , recent contacts and fibrosis on CXR .

2) > 10 mm : +ve in D.M. , Hematological disorders , injection drug
users , ESRD and rapid weight loss .

3) > 15 mm : +ve in any body .

Treatment of tuberculosis

>1st line drugs: isoniazid(INH) ,rifampicin,ethambutol,pyrizinamide

6 months regimen: first 2 months give the all 4 drugs The next 4
months give INH and rifampicin -the regimen is extended to 9
months if culture remains positive after the first 2 months of
treatment.

>2nd line drugs:

streptomycin,capreomycin,ethionamide,cycloserine,levofloxacillin.

MDR-TB: is a resistance to both INH and rifampicin

BCG vaccine

: a live attenuated vaccine derived from M.bovis. it is

effective in children but not in adults.