Kwolek S.,Laboratory Services
Clinical laboratory science : journal of the American Society for Medical Technology | Year: 2012
A 53 year old female who was maintained on long-term warfarin therapy due to history of pulmonary embolism, repeatedly presents with an abnormally prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT). After many asymptomatic episodes were corrected with Vitamin K therapy to temporarily reverse the effects of the warfarin, the cause of the apparent coagulopathy was further investigated. Factor Activity Assays of the common pathway factors II, IX, and X all revealed critically low values; below the threshold even a loading dose of warfarin is typically capable of eliciting. The patient tested strongly positive for Tissue Transglutaminase IgA, which is highly suggestive of a gluten-sensitive enteropathy. One effect of this condition is malabsorption due to flattened intestinal villi. The patient was determined to have an acquired vitamin K deficiency secondary to gluten-sensitive enteropathy. Her condition was exacerbated by the long-term warfarin therapy, resulting in the prolonged PT and PTT. The patient was treated with vitamin K therapy, which reversed the deficiency and corrected her abnormal coagulation results. Source
Monagle P.,University of Melbourne |
Ignjatovic V.,Murdoch Childrens Research Institute |
Savoia H.,Laboratory Services
Blood Reviews | Year: 2010
Developmental Hemostasis refers to the age-related changes in the coagulation system that are most marked during neonatal life and childhood. An understanding of these changes is crucial to the accurate diagnosis of hemostatic abnormalities in neonates and children. This paper explains the current understanding of developmental hemostasis and describes the common pitfalls observed in clinical practice through failure to implement the principles into routine diagnostic work. Finally, there is a brief discussion as to a potential physiological rationale for developmental hemostasis and the implications of this for hemostatic interventions in neonates and children. There remains a need for further study to improve our understanding of the implications of developmental hemostasis in normal growth and development. © 2009 Elsevier Ltd. All rights reserved. Source
Dogan S.,Sloan Kettering Cancer Center |
Barnes L.,University of Pittsburgh |
Cruz-Vetrano W.P.,Laboratory Services
Head and Neck Pathology | Year: 2012
We report a case of crystal storing histiocytosis (CSH) of the upper lip and cheek in a 51-year-old woman and review the clinicopathologic features of 80 cases in the literature. These occurred in 41 men and 39 women with a respective mean age of 59 and 61 years (range 17-81 years). Forty-six patients (58%) had localized CSH, and, of these, 16 (35%) occurred in the head and neck, with the most common site being the eye/orbit. The remaining 34 patients (42%) had generalized CSH primarily involving bone marrow, liver, lymph nodes, spleen and/or kidney. Regardless of whether the CSH was localized or generalized, the vast majority of patients (90%) had an underlying lymphoproliferative or plasma cell disorder, especially multiple myeloma, lymphoplasmacytic lymphoma, or monoclonal gammopathy of undetermined significance. In 7 cases (8.8%), the CSH was associated with a variety of benign disorders, often with an inflammatory background, and no evidence of a clonal lymphoproliferative or plasma cell disorder. Treatment and prognosis varied according to the underlying disease. A classification of CSH based on etiology and/or associated disease and chemical composition of the crystal is proposed, rare non-immunoglobulin variants of CSH are discussed, and a differential diagnosis of other potentially confusing lesions is provided. © 2012 Springer Science+Business Media, LLC. Source
When designing an ante room, be sure to use low level returns near the wash sink and the gowning stool/bench. The dirtiest operation in an ante room is the washing of hands and gowning procedure. The location of returns near the processes will remove contaminates generated during these operations. Placing HEPA filters strategically to move clean air across the process areas toward the returns will limit the migration of these particles to less desirable areas. Use gravity and air flow to remove particulates from high generation areas, since these personnel carried or generated particles can attach to garments and be transported into the main cleanroom/buffer room. It does no good to clean without removing the dirty particles you have generated immediately. This cleanroom tip was contributed by Rick Meyer, President of Superior Laboratory Services Inc. in Pasadena, Texas. Rick has 35 years of experience in the business. He is an inspector for Texas State Board of Pharmacy, an ISO-14644 TAG team member, and IEST Education VP. firstname.lastname@example.org; www.slsi.net This cleanroom tip appeared in the issue of Controlled Environments.
Never put hoods under HEPA filters, as the filter can disrupt airflows of the hood — it then becomes nearly impossible to properly test the HEPA filter for leaks or volumetric flow with a flow hood. Larger rooms with more hoods and HEPA filters need additional returns to help remove the particles that people shed and carry in, despite our best efforts to wash, gown, and glove. Understanding the dynamics of airflow will allow your facility to remove particulate better, as will increased air changes. Please be aware that the ISO 14644.1 standard does not recommend ACPH, so the charts you see are from yesteryear and usually produced by cleanroom manufacturers as their way of designing cleanrooms via cookie cutter sys- tems. All cleanrooms are unique and require an approach of questions to better understand for what, and how, the facility is being used; the number of people in the rooms; and so on. Always ask yourself: Can I clean the item I am putting in the room? If not, find something else to use instead. This cleanroom tip was contributed by Rick Meyer, who is president of Superior Laboratory Services Inc. in Pasadena, Texas. www.slsi.net; email@example.com. For Part I of Rick’s advice, see the July/August 2016 issue of Controlled Environments Magazine® (ISSN #1556-9268, USPS #021-493), is published six times a year. Bi-monthly Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sep/Oct, Nov/Dec with an Annual Buyer’s Guide in Mar/Apr by Advantage Business Media, 100 Enterprise Drive, Suite 600, Box 912, Rockaway, NJ 07866-0912. No part of this publication may be reproduced in any form without prior written permission of the publisher. Opinions expressed in articles are those of the authors and do not necessarily re;ect those of Advantage Business Media. Periodicals Mail postage paid at Rockaway, NJ 07866 and at additional mailing o;ces. POS TMAS TER: Send address changes/cancellations to Controlled Environments Magazine, P. O. Box 3574, Northbrook, IL 60065-3574, 847-559-7560, Fax: 847-291-4816, email: firstname.lastname@example.org. Publications Mail Agreement No. 41336030. Return undeliverable Canadian addresses to: Imex/Pitney Bowes, P.O. Box 1632, Windsor Ontario N9A 7C9. Subscriptions are free to quali;ed individuals. Non-quali;ed subscription rates per year are: USA $105, Canada, Mexico & Foreign $150, single copy USA $17.50, single copy Canada, Mexico & Foreign $25, prepaid in USA funds drawn on a USA branch bank. Printed in USA: Every attempt is made to ensure the accuracy of the information contained herein, however Advantage Business Media and its employees cannot accept responsibility for the correctness of information supplied, advertisements, or opinions expressed. Copyright ©2016 Advantage Business Media. All rights reserved.