Laboratory personnel provide extensive clinical testing and support to all the Michigan Medicine hospitals and clinics as well as the Pathology MLabs reference laboratory program.
The division also provides personally designed residency and fellowship training. The division of Education provides many opportunities for trainees within the department. Residents can obtain training in Anatomic and Clinical Pathology. Clinical Fellowships are offered in 17 subspecialties.
Research is a core component of our graduate medical education programs. Graduate students can pursue their PhD in Cellular and Molecular Pathology, while the many research laboratories provide Post-doctoral training. In addition, our faculty are integrally involved in teaching both medical and dental students. Michal Warner ph. Ann Arbor, MI The Experimental Pathology research faculty focus on understanding the pathobiologic basis of human disease from basic science to translational projects and the development of therapies.
Aided by laboratory staff, graduate students and postdocs, the labs work in multiple areas, including cancer biology, development, neuroscience, epigenetics, aging, mucosal biology, immunology and inflammation, and therapeutics.
Medical Center Dr. The division of Molecular Pathology strives to unite the multiple molecular diagnostic and research endeavors within the department. Clinical applications generally include diagnostic, prognostic and therapeutic applications while striving to be on the cutting edge of qualitative and quantitative nucleic acid analyses for genetics and oncology.
The division of Quality and Health Improvement strives to transform the patient experience for the better by drawing on extensive experience in laboratory science, quality management, change management, information systems and project management. Using a customer-focused approach, the division strives to improve processes and ensure an innovative mindset across the department. Cho Shirley Hoffman Assistant to Dr. Myers ph. The Department of Pathology is composed of a large and diverse group of faculty, representing all disciplines of Pathology, many laboratory, administrative and research staff, as well as trainees and students.
The focus is always on excellence in service, education and research. Phase Two includes renovations at University Hospital UH creating creation of an automated core laboratory and other critical laboratory and support spaces.
Innovation drives this project, which affects about , gross square feet and will drive positive trends related to growth, expenses, and opportunities for collaboration. When fully functional, new laboratories will transform the patient experience and produce better outcomes. MSC stock number Mix well to prevent clotting. If I don't have any pink tubes, can I use another color tube? A large 7 mL Llavender top tube contains the same anticolagulant as the Pink top tube. In order to provide enough specimen for testing, use the larger size Lavender top tube and fill the tube completely.
We cannot accept plastic Red Top tubes as they contain a clot activator. The hospital changed to plastic red top tubes in late November. A plastic tube can be identifed by the light blue diagonal stripes on the tube label and the mold marks on the bottom of the tube. A glass tube is smooth. The effective date of the change was September 8, The new tubes are made of plastic so they are safer for patients and staff. Either one can be drawn before or after the other as they both contain EDTA and they both require mixing immediately after collection.
Blood Cultures are drawn first, then the order from left to right is:. Blood culture bottles; blue; yellow, Red glass, red plastic, green; lavender and pink; and finally gray.
For a more extensive discussion of tube collection sequences, see question 6. What tube should I use for Pediatrics? A pink top tube filled with at least 2.
Failure to provide enough specimen will delay patient care as a new specimen will need to be collected. In addition, the waste specimen would contribute to the blood loss for the patient.
What is the minimum amout of blood for adults and pediatric specimens? In what order should I draw specimens? Tubes are drawn in the order shown below. This order is only for tubes used at the University of Michigan Hospitals as the stopper color and design changes with the manufacturer. The order within a group is not important.
For example, in group 5, either the gold or the red can be drawn first. The navy blue tubes in the photos below are different. The order of draw is set in order to prevent contamination of the blood specimen with anticoagulants that may cause incorrect test results. Reference: for additional instructions on identifying a patient and labeling a tube for blood bank testing refer to page 4 of the Blood Transfusion Policies Booklet.
A type and screen specimen is good for 3 days. It is good until 12midnight on the third day. Note that the date of collection is day 0. If a a specimen is collected on Monday red blood cells crossmatched using that specimen may be transfused until midnight on Thursday. Can I draw a blood specimen while the patient is being transfused? If a patient is receiving a blood transfusion, blood specimens may be collected during the infusion from the other arm where blood is not being infused.
If a platelet count or hemoglobin value is being measured, the standard time for a specimen to be collected is 1 hour post infusion. In some cases, a 10 minute posttransfusion pletelet count may be needed to evaluate refractoriness to platelet transfusions. If it is necessary to draw a specimen from the same IV line that fluids are being infused: 1 stop the infusion, 2 collect a tube of blood and discard it as it will be contaminated with IV fluid and test results will not be valid and 3 collect and label tubes as required for testing, and 4 reinitiate the infusion.
Why must I throw away the first tube when collecting a blood specimen for laboratory testing from a catheter or central line? Can Alaris infusion pumps be used with blood components? Yes, the pumps are approved for use with plasma, platelets and red blood cell infusions. There are blood sets for the pump. There is no exact number of units that can transfused through a single blood administration set.
Regular blood filters can be used for multiple units. However, transfusion of more than three units of red blood cells through a single tubing set increases the risk of clogging the filter with cellular debris or clots. The filter should be observed at regular intervals during the transfusion for evidence of accumulated debris and changed as needed. The specific manufacturer's instructions for the transfusion set should be followed.
Alaris blood tubing should be changed at least every 24 hours accourding to the manufacturer's instructions. Although they are not often used now, Leukocyte-removal filters are intended for use with a single blood component. All blood components must be transfused through a filter. A standard generally micron filter may be used in most circumstances. The only exception is when blood and blood components arrive in a syringe and are labeled "prefiltered".
The blood bank technologist has filtered these components at the time they are drawn into the syringe and the component must be transfused within 4 hours of preparation. How long can Red Blood Cells and Plasma be outside of a blood bank refrigerator?
If a unit of blood is returned to the blood bank, the red blood cells or plasma can be reissued under limited circumstances. The red cells and plasma must have been maintained at C. If a unit is out more than 30 minutes, the temperature has likely exceeded 10C. It is still usable for the original patient for up to 4 hours but cannot be returned for reissue later.
Once the component is spiked for transfusion it should be infused in no more than 4 hours. How frequently should vital signs be taken during a transfusion? Complete VS should be taken 15 minutes after initiating the transfusion and the nurse must stay at the bedside for this first 15 minutes. VS should be repeated 30 minutes after initiation and hourly as long as the component is infusing. Note the time of completion of the transfusion and a repeat set of VS should be obtained an hour after completion.
Yes, red blood cells, platelets, and plasma may be administered through an automated pump using specially made pump Blood administration tubing. See manufacturer's recommendations for details. How fast can we give blood components? Should Platelets be Transfused Slowly? The remainder of the blood can be infused to adults at a rate of ml per hour. Complete the transfusion within two hours unless the patient can tolerate only gradual expansion of the intravascular volume.
The infusion time should not exceed 4 hours. Platelets, plasma and cryoprecipitate generally are transfused at a rate of 10 ml per minute. In order for a patient to receive maximum benefit platelets need to be transfused rapidly to get control of bleeding.
Transfusion as soon as possible after they are available is optimum since platelet function deteriorates during storage. To assess the effectiveness of the platelet transfusion, a one hour post transfusion platelet count is needed. If the transfusion of platelets occurs over a hour time span and the one hour post platelet count is obtained, an accurate assessment of effectiveness of the platelet transfusion is impossible and may lead to recommendation of an inappropriate product.
What is the smallest needle we can use to transfuse blood components? The size of the needle is not an issue. The amount of pressure exerted on the red blood cells is the limiting factor.
Blood can be infused through the smallest of needles as long as great pressure is not needed to get the blood to flow. Excessive pressure causes lysis of the red blood cells. If a patient has a fever, can I transfuse blood components?
With physician approval, a transfusion may be administered to a febrile patient. However, if a patient is febrile, consideration should be given to postponement of the blood transfusion, since the fever may mask the development of a febrile reaction to the blood component itself. What is the policy for transporting patients with blood hanging? Patients should not be transported to appointments with blood components infusing unless there is a nurse that can travel with the patient and monitor the patient and the blood.
Many clinic and appointment areas are not staffed to monitor a patient while they are receiving blood components. Can we give Rh positive components to Rh negative patients? It may be advisable to administer Rho D immune globulin to selected Rh-negative patients who receive platelets from Rh-positive donors, since sensitization to red cell antigens may occur from the few red cells present in platelets.
There are a large number of product abbreviations for blood components. If a blood product has been double checked at the bedside and it is removed from the bedside, do I need to double check the blood again when the blood is brought back to the patient's bedside? Yes, a blood product must always be re-checked following the normal procedure if , for any reason, the product is removed from the bedside. If there are signatures already on the form documenting the double check, sign above the original signatures.
July, version. Immediately Prior to Blood Transfusion. Can I transfuse different products through regular blood tubing? Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. JAMA ; PubMed Citation 9. Anesthesiology ; Full Text Expert Working Group. Guidelines for red blood cell and plasma transfusion for adults and children. Dempfle CE. Coagulopathy of sepsis.
Thromb Haemost ; PubMed Abstract Full Text Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med ; PubMed Abstract Cryosupernatant as replacement fluid for plasma exchange in thrombotic thrombocytopenic purpura. Members of the Canadian Apheresis Group. Cryoprecipitate poor plasma does not improve early response in primary adult thrombotic thrombocytopenic purpura TTP. J Clin Apher ; Does cryosupernatant plasma improve outcome in thrombotic thrombocytopenic purpura?
No answer yet. A comparison of the efficacy and rate of response to oral and intravenous Vitamin K in reversal of over-anticoagulation with warfarin. Emergency oral anticoagulant reversal: The relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin.
Correction of INR by prothrombin complex concentrate and vitamin K in patients with warfarin related hemorrhagic complication. Thromb Res ; Vitamin K deficiency and D-dimer levels in the intensive care unit: A prospective cohort study. Blood Coagul Fibrinolysis ; Evaluation and survey of intravenous vitamin K1 for treatment of coagulopathy in critically ill patients. Pharmacotherapy ; Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: A dual phase study.
Am J Gastroenterol ; A year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology ; Bleeding complications after percutaneous liver biopsy. An analysis of risk factors. Digestion ; Dzik WH.
Component therapy before bedside procedures. In: Mintz PD ed. Transfusion Therapy: Clinical Principles and Practice. The role of prophylactic fresh frozen plasma in decreasing blood loss and correcting coagulopathy in cardiac surgery. A systematic review. Anaesthesia ; Plasma and plasma products in the treatment of massive haemorrhage. Best Pract Res Clin Haematol ; Randomised controlled trial of colloid infusions in hypotensive preterm infants. Arch Dis Child ;67 10 Spec No RBC T activation and hemolysis in a neonatal intensive care population: Implications for transfusion practice.
Randomised trial of prophylactic early fresh-frozen plasma or gelatin or glucose in preterm babies: Outcome at 2 years. Lancet ; Neonatal polycythemia: Effects of partial exchange transfusion using fresh frozen plasma, Haemaccel and normal saline. J Med Assoc Thai ;82 suppl 1 :S PubMed Abstract. Michelle P. Above is the information needed to cite this article in your paper or presentation. Solid-organ transplantation in HIV-infected patients. N Engl J Med.
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U. An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference.
The NLM now lists all authors. Skip to main content. Issue: BCMJ, vol. How the guidelines were developed A comprehensive literature search was undertaken on PubMed using combinations of keywords, including the following: plasma, fresh-frozen plasma, guidelines, transfusion, trial, randomized, liver, cardiac surgery, surgical bleeding, thawing, storage, massive transfusion, thrombotic thrombocytopenic purpura TTP , disseminated intravascular coagulopathy DIC , and neonate.
General considerations Although most plasma products are prepared from whole blood, a small proportion are prepared with plasma collected by apheresis. Clinical indications for use of frozen plasma in neonates In addition to the clinical circumstances already described, it may be appropriate to use frozen plasma in the following situations.
Possible use for frozen plasma The use of frozen plasma may be considered in the following situation. Inappropriate uses for frozen plasma Because there are many alternatives available for the treatment of the clinical conditions listed below, and because of the risks involved in transfusion, use of frozen plasma products is not indicated in the following situations.
References 1. Home Help me! Before you transfuse Does my patient need blood? Note: the volume of each unit varies. For paediatric patients, For paediatric patients, request the number of mL prescribed from Blood Bank. Although frozen plasma components may contain small amounts of red cell stroma, sensitisation following transfusion of Rh D positive units is most unlikely, as stroma is less immunogenic than intact red cells.
Therefore Cryoprecipitate of any Rh D type may be given regardless of the Rh D type of the recipient. Contact Blood Bank if you are not sure. Never store in a drug or food fridge.
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