Blood Donation Criteria and Procedure

BLOOD DONATION

PRE-DONATION

HISTORY:

• Men can donate safely once in every three months while women can donate every four months.

• Age between 18 and 60 years 

• The donor should be in a healthy state of mind and body.

• Past one year - not been treated for Rabies or received Hepatitis B immune globulin

• Past six months - not had a tattoo, ear or skin piercing or acupuncture, not received blood or blood products, no serious illness or major surgery, no contact with a person with hepatitis or yellow jaundice.

• Past three months - not donated blood or been treated for Malaria. 

• Past one month - had any immunizations.

• Past 72 hours - had dental work or taken Aspirin 

• Past 48 hours - taken any antibiotics or any other medications (Allopathic or Ayurveda or Siddha or Homeopathy)

• Past 24 hours - taken alcoholic beverages

• Presently - not suffering from cough, influenza or sore throat, common cold

• Women should not be pregnant or breast feeding her child or menstruating.

• No diabetes, chest pain, heart disease or high BP, cancer, blood clotting problem or blood disease, unexplained fever weight loss, fatigue, night sweats, enlarged lymph nodes in armpits, neck or groin, white patches in the mouth etc. 

• No history of TB, bronchial asthma or allergic disorder, liver disease, kidney disease, fits or fainting, blue or purple spots on the skin or mucous membranes, received human pituitary - growth hormones etc.

EXAMINATION:

• Temperature - Normal (oral temperature not exceeding 37.50 C)

• Pulse - between 50 and 100/minute with no irregularities

• Blood Pressure -Systolic 100-180 mm Hg and Diastolic 50 - 100 mm Hg

• Body weight - not less than 45 Kg

• Haemoglobin - not less than 12.5 g/dL- 

Procedure to measure Hb using CuSO4:

1. Massage the finger to be pricked (preferably ring finger)

2. Disinfect it

3. Prick using disposable needle/ lancet

4. Put the drop of blood in CuSO4 containing beaker

5. If the blood drop sinks, Hb is more than 12.5, hence the person can donate blood (provided no other contraindication).

   

   
   

   
   

   PROCEDURE:

• Identify donor and label blood collection bag and test tubes 

• Ask the donor to state their full name.

• Ensure that: 

1. the blood collection bag is of the correct type;

2. the labels on the blood collection bag and all its satellite bags, sample tubes and donor records have the correct patient name and number;

3. the information on the labels matches with the donor's information.

• Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars.

• Clean the site of venepuncture by alcohol and let it dry.

• Perform phlebotomy using a 16-gauge needle, which is usually attached to the blood collection bag. Use of a retractable needle or safety needle with a needle cover is preferred if available, but all should be cut off at the end of the procedure.

• Ask the donor to open and close the fist slowly every 10–12 seconds during collection.

• Remove the tourniquet when the blood flow is established or after 2 minutes, whichever comes first. 

• Ask the patient to squeeze a ball intermittently during the procedure.

• Monitor the donor and the donated unit.

• Remove the needle and collect samples.

• Cut off the needle using a sterile pair of scissors. 

• Collect blood samples for laboratory testing

POST-PROCEDURE:

DONOR CARE:

• ask the donor to remain in the chair and relax for a few minutes; 

• inspect the venepuncture site; if it is not bleeding, apply a bandage to the site; if it is bleeding, apply further pressure;

 • ask the donor to sit up slowly and ask how the person is feeling; 

• before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a drop in blood pressure;

 • offer the donor some refreshments

BLOOD UNIT AND SAMPLES:

Transfer the blood unit to a proper storage container according to the blood centre requirements and the product 

• Ensure that collected blood samples are stored and delivered to the laboratory with completed documentation, at the recommended temperature, and in a leakproof, closed container

Reference: http://naco.gov.in/blood-transfusion-services-publications 

Written by our guest author - Harsh Jogi and Ayushi Gupta

Illustration by Devi Bavishi

#Ae(ONE)INTERN

 

Cardiotocography

 CARDIOTOCOGRAPHY

CTG machine has two sensors:

 

• Cardio probe: placed on the mother’s abdomen at the foetal anterior shoulder to measure the foetal heart rate. 

• Toco probe: placed on the mother’s fundus to record uterine muscle contraction.  

(Jelly is to be applied between the probe and the site of application of the probe)

 

CTG paper moves at rate of 3cm/min 

Therefore 1cm = 20 sec on x-axis

        

Also 1 cm = 10 bpm on Y axis

To be taken every 2 hours towards the end of pregnancy.

 When analysing a CTG look for 4 things: 

     1.      Baseline heart rate

     2.      Beat to Beat variability 

     3.      Accelerations

     4.      Decelerations 

1. Foetal Heart rate: Normal: 110-160 bpm 

2. Beat to beat variability:  Normal: 5-25bpm showing saw tooth pattern      

3. Foetal accelerations: 

• Abrupt increase in FHR above baseline. 

• If a rise of 15 bpm persists for 15 sec or more but less than 2 mins is seen twice during a 20 min period then this is adequate contractions or REACTIVE (after 32 weeks). 

 

4. Foetal decelerations: 

• Decrease of 15 bpm in FHR for ≥15 seconds  

• Time from onset of the deceleration to the lowest point of the deceleration >30 seconds in variable decelerations.

  
  

  
  
  

• Early decelerations: Cause: pressure on the foetal head during labour (normal)

 

• If late or variable decelerations are present, call a senior. 

 

    If all 4 parameters normal: REASSURING NST 

    If any 1 abnormal: SUSPICIOUS NST  

    If any 2 or more abnormal: PATHOLOGICAL NST 

 

If CTG is non-reassuring: 

• Set up IV line

• Start RL/Oxygen 

• Give left lateral position

• Call the resident

• Stop oxytocin

• Ask sister to give OT changes/scrubs  

Written by our guest author - Yash Bandewar and Anveshi Nayan

Illustration by Devi Bavishi

#Ae(ONE)INTERN

 

 

 

  

DTaP Vs. Tdap

What is the difference between DTaP & Tdap ? 

Both provides protection against tetanus, diphtheria, and whooping cough

But.... 

Tetanus Prophylaxis algorithm

 

Modified Duke criteria for Infective endocarditis | Mnemonic

Risk factors of Acute otitis media in child

 

Why Foot imaging is essential for Diabetic foot ulcer ?

Because osteomyelitis can arise without evidence of soft tissue infection due to neuropathy (diminished pain) and poor peripheral blood flow (diminished erythema, warmth, and purulence).  Therefore, foot imaging (eg, x-ray, MRI) is generally recommended for all diabetic foot ulcers that are:

How to identify Necrotizing surgical site infection ?

OET Speaking

Speaking : (15-20 mins)

Speaking test is conducted on the same day for paper-based test while for the computer-based test it's one day before or after. How is it conducted? Speaking test has two role-plays.

OET Writing

---

Writing : (45 mins)

Unlike IELTS, in OET, writing test includes letter writing for 45mins. The letter can be a referral, a transfer or a discharge according to the given case notes. But mostly for doctors ,it's a referral letter. Out of the 45 mins first 5 mins are to read the case notes and only after that we are allowed to write the letter.

OET Reading

Reading: (60mins)

Reading test has 3 parts where Part-A is for 15 mins and 45 mins is for Part-B,Part-C combined. All articles are related to healthcare scenarios.

OET Listening

Listening : (45 mins)

Listening test will be for around 45mins and has three parts,each part more difficult than the one before.The extracts are either monologues or conversations and are related to healthcare workplaces.

Algorithm 3 : Community acquired pneumonia management

Auto-brewery Syndrome

 I heard about auto-brewery syndrome today!

It is a condition in which ethanol is produced through endogenous fermentation by fungi or bacteria in the gastrointestinal (GI) tract.

Algorithm 2 : CSF report | Step 2 CK

Algorithm 1: Acute Pharyngitis

Topiramate mnemonic

How I remember that the anti-epileptic drug (AED) topiramate is associated with kidney stones:
To-pee-ra-mate can cause you "to pee rocks, mate." Rocks = stones, pee = urine.

How I remember that the AED topiramate is associated with mild cognitive impairment:
toPIRAmATE can make you a "pirate" and make you forget "Tom"! (This one is a stretch but can work lol)

-IkaN

Mnemonic for Thanatophoric dysplasia (thanatophoric dwarfism)

Welcome! 

A lethal skeletal dysplasia. It is the most common lethal skeletal dysplasia followed by osteogenesis imperfecta type II. 

Mutation of fibroblast growth receptor 3 (FGFR3) gene 

Type 1 : telephone handle like femurs

Type 2 : presence of a cloverleaf skull. Limb shortening milder and bowing is not there. 

Mnemonic : PCR

P = Platyspondyly (flattened vertebral bodies) 

C = Cloverleaf skull

R = Rhizomelic dwarfism , Rib cage is small 

Rhizomelic dwarfism Proximal (i.e. femoral, humeral) limb shortening.

Present as Nonviable fetus ....so do spontaneous vaginal delivery!

Thank you!

Medications contraindicated in Myasthenia gravis | Mnemonic | Step 2 CK

The moderator band of the right ventricle

The moderator band is an intra-cavitary structure in the right ventricle (RV) spanning from the lower limit of the inflow tract of the RV anterior septum to the base of the anterior papillary muscle of the RV free wall.

It carries a fascicle of the right bundle that allows for rapid activation of the RV free wall.

That's all!

-IkaN

Why von Willebrand disease has normal aPTT sometimes ?

VWF acts as a carrier protein for factor VIII.  Factor VIII is more rapidly degraded when unbound, and VWF deficiency can therefore lead to impairment of the intrinsic coagulation pathway leading to a prolonged activated PTT.  

Etiology of Fetal hydrops Mnemonic

Mnemonic for pregnancy complications with short inter pregnancy interval

Definition : <6-18 months from delivery to next pregnancy

During pregnancy, maternal folate and iron are depleted for fetal development, and the resulting maternal anemia is exacerbated by normal blood loss during delivery (eg, up to 10%-20% of blood volume).  In breastfeeding women, continued nutritional demands from the newborn prevent repletion of normal folate and iron stores, resulting in prolonged anemia!

Anti-epileptics in pregnancy mnemonic

 The choice of antiepileptic drugs for women with epilepsy of childbearing age who are planning a pregnancy are

High Yield mnemonics | Pulmonary System | Uworld | Step 2 CK

Tricyclic antidepressants (TCA) mnemonic

Medications that can cause depression

Did you know that the medications we prescribe can be associated with depression?

Beta-blockers and reserpine should also be considered as the cause of depression in those newly started on the medication.

Other such medications include:

Tripod position mnemonic

Hi everyone!

Short mnemonic is here..

“Tripod TONE is forwarding air into the Lungs” 

Mnemonic | Major risk factors for Ventilator associated pneumonia | Step2 CK

 

Mnemonic for an opioid intoxication | Step 2 CK

Mnemonic for LAB evaluations for SSRI overdose

Hii! 

Short mnemonic!

Isolated SSRI overdose = Asx / mild CNS Depression 

If symptomatic SSRI overdose with altered mental status & abnormal physical findings. 

Then Check for “ECG” 

Mnemonic = ECG! 

E  = ECG ( As Citalopram & Escitalopram can cause QT prolongation ) 

MOST IMPORTANT 

C = Coingestants (Ethanol , Benzodiazepines, Acetaminophen )& biCarbonate Levels ( assess for Metabolic acidosis ) 

G = Glucose levels ( rule out hypoglycemia as a cause of altered mental status) 

Mnemonic for Caustic Esophageal injury

Hi everyone! 

Here is a short mnemonic! 

ACidic Substance = Coagulation Necrosis ( Protein denaturation) - 

results in Eschar - prevents further acid penetration & thereby severe injury.

ALakaline Substance = Liquefactive Necrosis (Cell membrane dissolution) - deeper penetration results in more severe injuries. 

1st step = Serial CXR & abdominal x-ray to identify perforation

If no perforation or respiratory distress then Upper GI endoscopy within 24 hours to assess severity for esophageal damage. 

Thank you! 

The Moderna Vaccine: End of Pandemic?

 

The Moderna (mRNA-1273) SARS-CoV-2 vaccine is the second vaccine to receive emergency use authorisation (EUA) by the FDA. Like the Pfizer vaccine, it is also a lipid nanoparticle encapsulated mRNA vaccine, and therefore has the same mechanism of action. Please read about the brief mechanism from the Pfizer vaccine article: https://www.medicowesome.com/2020/12/the-bnt162b2-covid-19-vaccine-pfizer.html I will try to avoid big numbers and statistics in this article. 

Both Moderna and Pfizer vaccines start protecting their recipients 10 days after the first dose, with maximum protection two weeks after the second dose. They both have efficacy ranging from 94-95% in protecting against symptomatic Covid-19. However, studies haven't yet evaluated their role in preventing asymptomatic Covid-19, a substantial missing link. 

Can Covid-19 vaccines mitigate the pandemic? 

People picture vaccines as a way back to normalcy, as before the pandemic; unless these mRNA vaccines' role in controlling asymptomatic SARS-CoV-2 infection is studied, normalcy is out of our reach. The other issues concerning the above question are -

1. Since the phase 3 studies of these vaccines are relatively 'young', we don't have sufficient knowledge about the nature and duration of immunological protection. Animal studies have shown that neutralizing antibodies confer protection and CD4 and CD8 T cells also amplify the immunological response. We don't know how long will the neutralizing antibodies last in our plasma after receiving the vaccine. 

2. With both these vaccines, there is an inevitable study flaw. Vaccine recipients faced more systemic adverse events, such as fever, fatigue, headache, myalgia than the placebo group. These symptoms can also occur with Covid-19. Therefore, it is not unlikely that vaccine recipients could have designated their symptoms to the 'shot', and hesitated to refer themselves to be tested for Covid-19.

3. The third issue is quite popular in the daily news. What if the virus mutates and renders itself 'immune' to the vaccine? Some new strains have come up worldwide, and expectedly, the diaspora has started panicking. People need answers quickly while science takes time. So we cannot rule out the possibility that the virus devises a way to escape from the vaccine-induced immunological response. 

4. Vaccine-associated enhanced disease (VAED). Earlier preclinical studies with SARS and MERS have demonstrated that low-level neutralizing antibodies in the plasma can trigger a severe form of the disease. Both the Moderna and Pfizer vaccines are 100% effective in protecting against severe Covid-19, notwithstanding this fact, the regulatory authorities should monitor these and other vaccine candidates for this adverse event. 

5. Anti-Vaxxers! The anti-vaccine sentiment is appalling, and there have been 'anti-vaccine' protests in many parts of the world, including the US, Germany, Poland, and others. There are numerous fake news and misinformation in social media platforms that misguide people and tarnish their perspective about the vaccines. And this phenomenon has even affected the medical professionals. The healthcare authorities have an onerous task to incite confidence in the general public and safeguard them from misinformation. 

Safety

The adverse effect profile of both the vaccines is similar, with the most common being local injection-site reactions. Systemic side effects are more common in the vaccine group and comprise mainly of fatigue and headache. Bell's palsy occurred in three (out of 15,210) vaccine recipients within 28 days of administration. This anecdotal risk would be studied in the planned two-year follow-up. 

Being a physician in the Indian subcontinent, there are various reasons to mistrust this vaccine. Both the mRNA vaccines have been studied primarily in the US population (mainly whites), and we don't have any data on its long-term effects. Recently, I have come across various tweets and posts in my social media feed with the headline - " Doctors and nurses are declining the vaccine." I am unaware of these posts' credibility; however, this isn't false in my experience. Well for what it's worth, we haven't seen a whole lot of polio, diphtheria or smallpox recently. 

Thanks for reading!

-VM

 

 

Perspective: My ideology and philosophy about medicine

 

 

The three O's of GI bleeding : Overt, obscure, and occult

GI bleeding can be classified into three O's: Overt, obscure, and occult! Can you define these terms?

If not, I'll help you out

Pediatrics | Pulmonary & Critical Care | CK Uworld

The BNT162b2 Covid-19 Vaccine: Pfizer-BioNTech Vaccine

 

The BNT162b2 mRNA Covid-19 vaccine, popularly known as the Pfizer vaccine is the first Covid-19 vaccine to receive authorization for use in the general public. The first jab was given to a 90-year old lady in the UK on December 8, 2020; a monumental event that brought hope to billions of people all across the globe. In this article, I will discuss this vaccine’s clinical trial and potential future implications.

 

How does it act?

The BNT162B2 is a lipid nanoparticle-formulated, nucleoside-modified mRNA that encodes the SARS-CoV-2 full-length spike protein, modified by two proline mutations to lock it in the prefusion conformation. This means that this is an mRNA that has been modified to resist disintegration by nucleases and that translates into the SARS-CoV-2 spike protein. However, this spike protein has also been modified to lock it into its pre-fusion conformation; so that it doesn’t fuse with the target cell’s plasma membrane and remain exposed to immunogenic stimulation.

 

Who is it for?

This primarily depends on the characteristics of the population included in the vaccine’s clinical trial. This trial randomised 43,458 persons from six countries: USA, Argentina, Brazil, South Africa, Germany, and Turkey. More than three-fourth of the study population (76.7%) belonged to the USA. Moving on to the representation of race or ethnicity in the study population - 82.9% were white, 27.9% were Hispanic, while African Americans, Asians, and Native Americans comprised 9.2%, 4.2%, and 0.5% of the study group. Males and females were almost equally included. The age range is from 16 years to 89 years in the intervention group. This trial did not evaluate the efficacy of the vaccine in children, adolescents, and pregnant women.  

 

Is it effective?

Define effective; it depends on the trial’s efficacy end points. The primary endpoint was the efficacy of the vaccine to prevent Covid-19 infection 7 days after the second dose in participants who had no serologic (antigen and antibodies) or virologic (RT-PCR) evidence of SARS-CoV-2 infection up to 7 days after the second dose; the second primary endpoint was to prevent infection in those with and without evidence of prior infection. Confirmed Covid-19 was defined as – the presence of at least one symptom (fever, new or worsened cough, new or worsened dyspnoea, chills, new or worsened muscle pain, new loss of taste or smell, sore throat, diarrhoea or vomiting combined with a positive RT-PCR test within 4 days).    

Efficacy End Point	BNT162b2 Group		Placebo Group		Vaccine efficacy, % (95% credible interval)
	Covid-19 Cases	N	Covid-19 Cases	N
1st Primary	8	18,198	162	18,325	95(90.3-97.6)
2nd Primary	9	19,965	169	20,172	94.6(89.9-97.3

 This trial showed that a two-dose regimen of BNT162b2 (30 micrograms per dose, given 21 days apart) was 95% effective in preventing symptomatic Covid-19 infection 7 days after its course. The efficacy was 52% after the first dose, and 91% in the first 7 days after the second dose.

However, the trial results did not show the efficacy in preventing asymptomatic infection. We don’t know if this vaccine can safeguard against transmissible asymptomatic infection; therefore, people who have taken the vaccine should not stop wearing masks for the sake of the people around them.

 

Is it safe?

The vaccine group reported more local reactions, such as pain, redness, and swelling at the injection site than the placebo group. In general, these were mild-to-moderate in severity and resolved within 1-2 days. The systemic adverse effects were also reported more in the intervention group, especially in the younger population (16 to 55 years of age), and more after the second dose. These included – fever (11%), fatigue (51%), headache (39%), chills (23%), muscle pain (29%), joint pain (19%), and 38% of the vaccine group needed to use antipyretic medication. These were generally mild and resolved within 1-2 days. Two deaths happened in the vaccine group, one from arteriosclerosis, and one from cardiac arrest. These deaths weren’t related to the vaccine or Covid-19. The investigators plan to continue the surveillance for adverse events for further 2 years.  

 

This study has importance beyond the efficacy of the BNT162b2 vaccine candidate. It demonstrates the utility of RNA-based vaccines, its speed of development, and its promising efficacy in preventing infectious diseases. The success of this clinical trial immensely improves our preparedness for a future pandemic.

Reference:

Polack, FP, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. New England Journal of Medicine. Dec 10, 2020. 10.1056/NEJMoa2034577. C4591001 Clinical Trial group

-Vinayak

All mnemonics for how to determine axis deviation of EKG

Hello Everybody! 

Before reading this post I would like to suggest please see both the videos of How to determine axis deviation in real scenarios... Then come back here for summary & some extra mnemonics. 

Hope it’ll definitely helps you! 

https://youtu.be/306jxLzyyag

https://youtu.be/7FHNmM-V2c0

How to remember numbers...? 

“Isoelectric Method” 

You are in front of me ... as arrows in the image..... 

I is perpendicular to avF ..

II  to avL 

III to  avR .....

So finally I & you are the leads 😂. 

Thank you..!! 

-Dr. Drashtant!