#1
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Àíàëèç êðîâè - Âðó÷íóþ èëè íà àíàëèçàòîðå? (òåìà äëÿ âðà÷åé è ñïåöèàëèñòîâ)
êðîâü íóæíî ñäàâàòü èç ïàëüöà è ïîäñ÷èòûâàòü ëåéêîôîðìóëó âðó÷íóþ.ñ àíàëèçàòîðàìè îäíè ïðîáëåìû.
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#2
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Öèòàòà:
"Íàäî ñ÷èòàòü íà ñ÷åòàõ ñ êîñòÿøêàìè, èëè â óìå. À òî ñ êîìïüþòåðàìè îäíè ïðîáëåìû"  õîðîøåé ëàáîðàòîðèè ñ àíàëèçàòîðàìè ïðîáëåì íåò. ß ãàðàíòèðóþ ýòî (c) È, êñòàòè, ñ÷åò êëåòîê âðó÷íóþ íèêòî è íå îòìåíÿåò. Òîëüêî ýòî ñëåäóåò äåëàòü òîãäà, êîãäà åñòü äëÿ òîãî íåîáõîäèìîñòü. |
#3
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Âû,ïðîñòèòå,êòî ïî ñïåö.,ðàç òàê óâåðåííî çàÿâëÿåòå î áåçóêîðèçíåííîñòè ðàáîòû ãåì.àíàëèçàòîðîâ??? Áûâàþò ñèòóàöèè,êîãäà ðàñïå÷àòêà àíàëèçàòîðà â íîðìå,à ïðè èçó÷åíèè ìàçêà âûÿâëÿåòñÿ ïàòîëîãèÿ.Âîò òàê...
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#4
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#5
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ýòî ãîâîðèò î òîì,÷òî ó ãåì.àíàëèçàòîðîâ ïðîáëåìû ñ äèôôåðåíöèðîâêîé êëåòîê è íå ñòîèò äîâåðÿòü ðàñïå÷àòêàì íà 100%.ìàçîê èç âåíîçíîé êðîâè èçó÷àòü ïðîáëåìàòè÷íî,ïîòîìó ÷òî êëåòêè äåôîðìèðóþòñÿ íà ïðåàíàëèòè÷åñêîì ýòàïå è ïðèõîäèòñÿ ïîâòîðíî áðàòü êðîâü èç ïàëüöà.çà÷åì æå ìó÷èòü ïàöèåíòà è âðà÷à ÊËÄ??? êðîâü íà ÎÀÊ íóæíî áðàòü òîëüêî èç ïàëüöà.ýòî ìíåíèå íå òîëüêî ìî¸,à âñåõ âðà÷åé ÊËÄ.
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#6
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Ñî ññûëêîé íà "ìíåíèå âñåõ âðà÷åé ÊÄË" â ôîðìå îáðàùåíèÿ â ÂÎÇ îá îòìåíå àâòîìàòè÷åñêèõ ëàáîðàòîðíûõ èññëåäîâàíèé ìîæíî îçíàêîìèòüñÿ?
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Ñ óâàæåíèåì, Âàëåðèé Âàëåðüåâè÷ Ñàìîéëåíêî |
#7
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à êòî ñêàçàë îá îòìåíå? íå íóæíî ïåðåä¸ðãèâàòü.ÿ îáúÿñíèë ñèòóàöèþ,ò.ê äåéñòâèòåëüíî åñòü ïðîáëåìû ñ ãåì.àíàëèçàòîðàìè.ðå÷ü èä¸ò òîëüêî îá ÎÀÊ.ÿ íå ñîáèðàþñü íè÷åãî Âàì äîêàçûâàòü ññûëêàìè,ìû íå â ñóäå.êàæäûé èç íàñ ñïåö â îïðåäåë¸ííîé îáëàñòè è èìååò ïðàâî âûçêàçûâàòü ñâîè ñîîáðàæåíèÿ ïî òåìå.
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#8
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Óãó.., èìååò... ïðè óñëîâèÿõ, ÷òî
- ðåêîìåíäàöèè ñîîòâåòñòâóþò ïðåäñòàâëåíèÿì äîêàçàòåëüíîé ìåäèöèíû, - ðåêîìåíäóþùèé óæå ïåðåñòàë êè÷èòüñÿ ñâîåé ñïåöèàëüíîñòüþ, îòêàçàëñÿ îò èäåè àðãóìåíòèðîâàòü ñâîå ìíåíèå "òàê äóìàþò âñå" è ãîòîâ îáîñíîâàòü êàæäîå ñâîå çàêëþ÷åíèå íå â "ñóäå", à â óâàæèòåëüíîé áåñåäå ñ êîëëåãàìè. - âîîáùåì http://forums.rusmedserv.com/showthread.php?t=29458
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Ñ óâàæåíèåì, Âàëåðèé Âàëåðüåâè÷ Ñàìîéëåíêî |
#9
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âîò óâàæåíèÿ ñ Âàøåé ñòîðîíû è ÿ íå óâèäåë.íó,äà ëàäíî.. áóäòå òàê ëþáåçíû,åñëè Âàñ íå çàòðóäíèò,ñêàæèòå,êàêàÿ ó Âàñ ñïåöèàëüíîñòü? ÷òî Âû è êîìó ïðåïîäà¸òå?
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#10
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À êàêîå ýòî èìååò çíà÷åíèå â äèñêóññèè? "ß âðà÷ ÊËÄ, à òû íåïîíÿòíî êòî, ïîýòîìó ÿ ïðàâ" - íå àðãóìåíò.
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#11
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Àíàëèç êðîâè íóæíî ñäàâàòü èç âåíû è ñ÷èòàòü àâòîìàòè÷åñêèì àíàëèçàòîðîì. Ïðè íåîáõîäèìîñòè - ïåðåñìîòð ìàçêà âðà÷îì-ëàáîðàíòîì.  êàêèõ?
Evaluation of the peripheral blood smear Author David S Rosenthal, MD Section Editor Stanley L Schrier, MD Deputy Editor Stephen A Landaw, MD, PhD Review of the peripheral smear is not required in all patients with a hematological disorder. Certain straightforward conditions such as iron deficiency anemia can be easily diagnosed on the basis of clinical information and basic laboratory data (eg, mean corpuscular volume, serum iron, ferritin) alone. However, there are a number of settings in which interpretation of the peripheral smear is especially important. Three examples include: Hemolytic anemia, since careful review of red cell morphology may identify the pathophysiologic basis of erythrocyte destruction (eg, the presence of bite cells points to a Heinz body hemolytic anemia) and the ultimate diagnosis (eg, oxidant damage to the red cell secondary to drugs) Thrombocytopenia, where it is critical to distinguish between increased platelet consumption (eg, TTP-HUS, DIC, ITP) and reduced platelet production (eg, aplastic anemia). White cell disorders, in which the precise classification of the disease may rely upon evaluation of abnormal circulating cells (eg, the presence of Auer rods in a blast form in patients with acute myeloid leukemia). |
#12
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Îãî ñêîëüêî ÿ ïðîïóñòèë òî
Óâàæàåìûé patologist. ß ÿâëÿþñü ñïåöèàëèñòîì ïî ëàáîðàòîðíîé àâòîìàòèçàöèè.  ïðîôàéëå â "îáëàñòè èíòåðåñîâ" ó ìåíÿ òàê è íàïèñàíî. ß õî÷ó ñêàçàòü, ÷òî íóæíî ÷åòêî ñåáå ïðåäñòàâëÿòü, ÷òî ìîæåò àíàëèçàòîð, à ÷åãî îí íå ìîæåò. Óâû, â Ðîññèè ÷àñòî â ïîãîíå çà ýêîíîìèåé ïîêóïàþò, íàïðèìåð, ãåìàíàëèçàòîðû 3diff è õîòÿò îò íåãî ïîëíîöåííîãî ñ÷åòà êëåòîê. Òàê ýòî, ÷òî íàçûâàåòñÿ "çà êîïåéêó êàíàðåéêó, ÷òîá íå åëà, à òîëüêî ïåëà". Åñòü âîîáùå òî è 5diff àíàëèçàòîðû. Îíè, ïîíÿòíîå äåëî, äîðîæå, íî èìåííî îíè òî è íóæíû â ðåàëüíîé æèçíè. Ïîòîì, ó íàñ åñòü ïðàêòèêà êóïèòü òåõíèêó èç Ïîäíåáåñíîé, à ïîòîì óäèâëÿòüñÿ ÷åãî é òî îíà áîëüøå ïîëóãîäà íå ðàáîòàåò. Êîðî÷å ãîâîðÿ, àíàëèçàòîð - ýòî åñòü èíñòðóìåíò, êîòîðûé äîëæåí ÄÎÏÎËÍßÒÜ ãîëîâó ñïåöèàëèñòà, à âîâñå íå ÇÀÌÅÍßÒÜ åå. Ãëóïî, îòòÿïàâ ñåáå ïàëåö òîïîðîì, ãîâîðèòü, ÷òî òîïîð íåãîäíàÿ è íåíóæíàÿ âåùü. Ó÷èòåñü èì ïîëüçîâàòüñÿ. |
#13
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ÿ Âàñ ïîíÿë.ñïàñèáî çà ðàçúÿñíåíèÿ.
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#14
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Ó ìåíÿ íåçàâèñèìûé âîïðîñ êîëëåãå Denson.
Ãåìîàíàëèçàòîð Abbott cell-DYN 3700. Ïàöèåíò âíå ÏÂÒ, ïåðâè÷íîå îáñëåäîâàíèå. 25èþëÿ òðîìáîöèòû - 49000, â÷åðà - 11000. Äî òîãî, ãäå-òî ìåæäó 20 è 23 â ÍÈÈ ãåìàòîëîãèè âðó÷íóþ - 112000. Íè îäíîé ïåòåõèè èëè êðîâîèçëèÿíèÿ. Ó äðóãèõ áîëüíûõ (ñìîòðåë àíàëèçû è ñâîèõ íà ÏÂÒ, è ïðîñòî îáðàòèâøèõñÿ ïî äèñïàíñåðíîìó ïëàíó â òîò æå äåíü) ðàçíîáîÿ íåò. Êàê ïîíÿòü è åñòü ëè êàêèå-òî òîíêîñòè, ñâÿçàííûå ñ àïïàðàòîì?
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Ñ óâàæåíèåì, Þñèô Àëõàçîâ. |
#15
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Artifactual Thrombocytopenia
Artifactual thrombocytopenia, or falsely low platelet counts, occurs ex vivo when platelets are not counted accurately. This mechanism should be considered in patients who have thrombocytopenia but no petechiae or ecchymoses. Although inaccurate counting may occur in the presence of giant platelets (2) or with platelet satellitism (3), the most common cause of artifactual thrombocytopenia is platelet clumping (pseudothrombocytopenia) (4). Platelet clumping in pseudothrombocytopenia appears to be caused by anticoagulant-dependent platelet agglutinins that are immunoglobulins (Igs) of IgG, IgA, or IgM subtypes. Although clumping is most commonly seen when blood is collected into ethylenediaminetetraacetic acid anticoagulant, other anticoagulants may cause clumping, even hirudin or Phe-Pro-Arg chloromethyl ketone (5). Platelet clumping is also time dependent and varies with the type of instrumentation used for automatic counting (5). There is evidence that the autoantibodies bind to glycoprotein IIb/IIIa (6), and in one study, there was over 80% concordance between the presence of anticardiolipin antibody and platelet agglutinins in individual patient plasmas (7). These autoantibodies have no known associations with disease or drugs and have been noted in some patients for over 10 years (8). Wintrobe’s Clinical Hematology 12th Edition 2009 Chapter 50 Thrombocytopenia: Pathophysiology and Classification George M. Rodgers |