#16
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Íó êîìó, êàê íè Âàì, âðà÷ó ëàáîðàòîðèè äîëæíî áûòü èçâåñòíî: ñðàâíèâàòü â äèíàìèêå êîððåêòíî àíàëèçû îäíîé ëàáîðàòîðèè!
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#17
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#18
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ß íà ñàìîì äåëå ïîíèìàþ ÷óâñòâà Àññàíðäû î÷åíü õîðîøî. Ïîëó÷èâ ïîäîáíûå ðåçóëüòàòû, ïåðâûì äåëîì õî÷åòñÿ ñõâàòèòüñÿ çà ãîëîâó è ñêàçàòü "¨-ìî¸. È ÂÎÒ ÝÒÎ ìû âûäàåì â êà÷åñòâå êîëè÷åñòâåííûõ ðåçóëüòàòîâ? Íà êîé ëÿä ìû (ëàáîðàòîðèÿ) âîîáùå ðàáîòàåì è êàêîé â ýòîì ñìûñë?" Äîëæåí ñêàçàòü, ÷òî ó êàæäîãî ëàáîðàòîðùèêà òàêàÿ ìûñëü ðàíî èëè ïîçäíî â ãîëîâå ïðîñêî÷èò.
Íî íå âñå òàê ïëîõî. Èçíà÷àëüíî âîïðîñ çâó÷àë òàê: Öèòàòà:
Öèòàòà:
Ìîæåò ëè ýòî áûòü àíàëèòèêà? Îòâåò òàê æå ïîëîæèòåëüíûé. Ìîæåò áûòü îäíî ïëþñ äðóãîå. Ïðîáëåìà òîëüêî â òîì, ÷òî êîíêðåòíî è îäíîçíà÷íî ìû ñêàçàòü íå ñìîæåì â ÷åì ïðè÷èíà, èìåÿ òîëüêî ïðåäñòàâëåííóþ òîïèêñòàðòåðîì èíôîðìàöèþ. Ìîæåì òîëüêî äîãàäûâàòüñÿ. |
#19
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Öèòàòà:
Ê ïðèìåðó, êàê àíàëèòè÷åñêóþ îøèáêó ìû ðàññìàòðèâàëè "èñêóññòâåííóþ ãåìîêîíöåíòðàöèþ" êðîâè â ïðîáèðêå - ò.å. îíà ñëåãêà îòñòîÿëàñü íà ìîìåíò èçìåðåíèÿ â àíàëèçàòîðå, ÷òî íå âëèÿåò íà öâåòîâûå èíäåêñû è MPV, çàòî âëèÿåò íà êîíöåíòðàöèþ ýðèòðîöèòîâ (ñîîòâåòñòâåííî Hb è Ht). Âàðèàíò? |
#20
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Öèòàòà:
Äîïóñòèì, ïðè îïðåäåëåíèè ôåðìåíòîâ íîðìû ñèëüíî çàâèñÿò îò ìåòîäèêè, òåìïåðàòóðû èíêóáàöèè, åäèíèö èçìåðåíèÿ, èõ ëîãè÷íî ìîíèòîðèðîâàòü â îäíîé ëàáîðàòîðèè. Ñ ÎÀÊ - èíàÿ ñèòóàöèÿ: âñå àâòîìàòû ðàáîòàþò íà îäíîì ïðèíöèïå, ïîýòîìó âïîëíå ëîãè÷íî, êîððåêòíî è åñòåñòâåííî îæèäàòü îò íèõ î÷åíü áëèçêèõ ðåçóëüòàòîâ. Åùå, ýòî ê ñâåäåíèþ. Ñóùåñòâóþò ìåæäóíàðîäíûå ïðîãðàììû êîíòðîëÿ êà÷åñòâà ëàáîðàòîðíûõ èññëåäîâàíèé, ò.í. ìåæëàáîðàòîðíûå ñðàâíåíèÿ.  íèõ ó÷àñòâóþò ëàáîðàòîðèè ðàçíûõ ñòðàí, ðàáîòàþùèå íà ðàçíûõ ðåàêòèâàõ è àíàëèçàòîðàõ. Òàê âîò, ðåçóëüòàòû ó÷àñòíèêîâ äîâîëüíî òàêè ñðàâíèìû, ÷òî ïîäòâåðæäàåòñÿ ñòàòèñòè÷åñêè. |
#21
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Öèòàòà:
Êñòàòè, ìåòîäèêè èçìåðåíèé, â ÷àñòíîñòè êëåòîê, â ðàçíûõ ãåìîàíàëèçàòîðàõ ìîãóò îòëè÷àòüñÿ. |
#22
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Öèòàòà:
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#23
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Öèòàòà:
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#24
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#25
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òàêîé ôåíîìåí åùå áûë îïèñàí â 80-õ - ñíèæåíèå ãåìîãëîáèíà ó äåòåé íà 13% âî âðåìÿ îñòðîãî âîñïàëåíèÿ è åãî ïîâûøåíèå íà 24% ïîñëå âûçäîðîâëåíèÿ áåç âñÿêîãî âìåøàòåëüñòâà:
Anemia of acute inflammation in children The Journal of Pediatrics Volume 103, Issue 6, December 1983, Pages 868-871 M.D.Thomas C. Abshire and M.D.Jerry D. Reeves Department of Pediatrics, David Grant USAF Medical Center, Travis AFB, USA We measured sequential changes in hemoglobin concentration and erythrocyte sedimentation rate in 27 previously healthy children hospitalized for a variety of moderately severe acute inflammatory processes. Among 18 retrospectively studied children, 61% had mild anemia for age on admission, and Hgb values dropped >2 SD in 83% during active inflammation. During recovery, Hgb concentrations spontaneously rose >1.3 gm/dl in 79% of the children. Mean Hgb drop was 1.8 gm/dl in 5.6 days, representing an average noniatrogenic blood loss of 107 ml, among nine prospectively studied children. Only one of these had laboratory evidence of hemolysis, and none had clinical evidence of bleeding or overhydration. Results of both studies combined showed that a mean 13% Hgb drop during active inflammation was followed by a mean 24% Hgb rise during resolution of acute inflammation. We conclude that most children with moderately severe acute inflammation experience a significant drop in Hgb within 1 week of illness onset, regardless of the specific cause of inflammation. In general, this mild to moderate anemia resolves without hematinic therapy.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#26
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Ñïàñèáî, Dr.Vad.
Äåéñòâèòåëüíî, áûë íåäàâíî ýòî ìàëü÷èê, çäîðîâ íà ìîìåíò îáñëåäîâàíèÿ. Hb 104, ýð. íå ïîìíþ, íî òîæå ñðåäíåå ìåæäó äâóìÿ ïåðâûìè àíàëèçàìè. MCV 78 (ñíèæàåòñÿ). Íàçíà÷èëè ïðåïàðàòû æåëåçî. |