scholarly journals Point-of-care versus central testing of hemoglobin during large volume blood transfusion

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Justin Herman ◽  
Brian Park ◽  
Bharat Awsare ◽  
Frances West ◽  
Denine Crittendon ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Clinical Laboratory ◽  
Complete Blood Count ◽  
Point Of Care ◽  
Tertiary Care ◽  
Absolute Difference ◽  
Care Hospital ◽  
Specific Patient ◽  
Paired Samples ◽  
Clinically Significant

Abstract Background Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. Methods We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics. Results Fifty one percent (86 of 170) of paired samples’ hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of − 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was < 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. Conclusions The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was < 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is < 7 g/dL until further prospective trials are performed in this population.

scholarly journals Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

2018 ◽  
Vol 39 (11) ◽  
pp. 1330-1333 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
Candice Cass ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Patient Population ◽  
Tertiary Care ◽  
Clinical Microbiology Laboratory ◽  
Care Hospital ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Stool Specimens ◽  
Clinically Significant ◽  
Culture Negative

AbstractObjectiveTo determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing.DesignRetrospective cohort.SettingTertiary-care hospital in St. Louis, Missouri.PatientsPatients whose diarrheal stool samples were submitted to the hospital’s clinical microbiology laboratory for C. difficile testing (toxin EIA) from August 2014 to September 2016.InterventionsElectronic and manual chart review were used to determine whether patients tested for C. difficile toxin had clinically significant diarrhea and/or any alternate cause for diarrhea. Toxigenic C. difficile culture was performed on all stool specimens from patients with clinically significant diarrhea and no known alternate cause for their diarrhea.ResultsA total of 8,931 patients with stool specimens submitted were evaluated: 570 stool specimens were EIA positive (+) and 8,361 stool specimens were EIA negative (−). Among the EIA+stool specimens, 107 (19% of total) were deemed eligible for culture. Among the EIA− stool specimens, 515 (6%) were eligible for culture. One EIA+stool specimen (1%) was toxigenic culture negative. Among the EIA− stool specimens that underwent culture, toxigenic C. difficile was isolated from 63 (12%).ConclusionsMost patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA− patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

Correlation of COVID-19 antigen test and CBNAAT results at a single tertiary care hospital in North India: an experience

2021 ◽  
Vol 8 (5) ◽  
pp. 2427
Author(s):  
Surbhi Gupta ◽  
Anju Shukla ◽  
Poonam Singh ◽  
Areena H. Siddiqui
Keyword(s):  
Tertiary Care Hospital ◽  
Point Of Care ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Nucleic Acid Amplification ◽  
North India ◽  
Care Hospital ◽  
Antigen Test ◽  
Discordant Group ◽  
Antigen Tests

Background: Nucleic acid amplification test (NAAT) is considered gold standard in the molecular diagnosis of CoV-2 infection but since it is costly, labor intensive and needs technical expertise, rapid chromatographic immunoassay for the qualitative detection of specific antigens to SARS CoV-2 have been devised. Objectives of this study was to compare the results of Antigen test and NAAT for CoV-2 infection carried out during the months of July and August 2020 by single tertiary care hospital in Lucknow, Uttar Pradesh and to determine the utility of rapid antigen test in the SARS CoV-2 diagnosis.Methods: All the patients who came to our hospital seeking admission during July 2020 and August 2020 were included in the study. A total of 1000 patients were included in this study.Results: Out of a total 1000 cases which were included in the study, 769 cases (76.9%) were found to be SARS CoV-2 negative by both antigen and CBNAAT, 100 cases (10.0%) were SARS CoV-2 positive by both antigen and CBNAAT tests. But in 131 cases (13.1%), antigen was not able to pick up the disease. It was also found that the Cycle Threshold (Ct) value for the discordant group was higher (Mean E= 28, Mean N2=33) when compared to the group where antigen was positive.Conclusions: The present study establishes the role of rapid antigen tests in contributing to the quick, point of care diagnosis of SARS CoV-2. These assays are safe, simple, and fast and can be used in local clinics and hospitals. These tests are very important for real-time patient management and infection control decision.

scholarly journals Utility of Peripheral Film Findings and its Correlation with Automated Analyzer – An Audit from Tertiary Care Hospital

2017 ◽  
Vol 9 (01) ◽  
pp. 001-004
Author(s):  
Sidra Asad ◽  
Imran Ahmed ◽  
Natasha Ali
Keyword(s):  
Complete Blood Count ◽  
Tertiary Care ◽  
Age Groups ◽  
Peripheral Blood Smear ◽  
Blood Film ◽  
Care Hospital ◽  
Peripheral Smear ◽  
Nucleated Red Blood Cells ◽  
Hematology Analyzer ◽  
Automated Hematology Analyzer

ABSTRACT Background and Objective: With the advent of automated hematology analyzer, the use of traditional microscopy of blood film has become limited. The objective of our study was to determine the percentage of peripheral blood smear review in our institution in the era of automation and to identify reasons of manual review. Materials and Methods: This was a prospective audit from January 1, 2015, to January 15, 2015. Consecutive complete blood count (CBC) samples and peripheral smear requests made up the sample size. All age groups and genders were included. CBCs were performed on Sysmex XE-5000. The variables to be analyzed included inpatient and outpatient samples, frequency of peripheral film review, identifying reasons of smear review, and addition of information missed by the automated analyzer. Results: We analyzed 1200 consecutive CBC samples. Peripheral smear was reviewed in 500 (42%) of the cases of which, 241 were inpatient, and 259 were outpatient samples. In 384/500, the findings of hematology analyzer correlated with peripheral smear review. Flags identified included nucleated red blood cells (NRBCs) in 155 (40%), immature white blood cell (WBC) 129 (34%), and atypical lymphocytes 100 (26%). In 23% of the cases, the analyzer missed important findings. The sensitivity of abnormal histogram in our study was 91.3%, while the sensitivity of abnormal parameters was 100%. Conclusion: Peripheral smear review was performed in 42% of the cases. The analyzer identified NRBC, immature WBC precursors, and atypical lymphocytes as the most common abnormality. The information correlated in 77% of the cases.

scholarly journals Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital

2017 ◽  
Vol 23 (1) ◽  
pp. 60-64 ◽  
Author(s):  
David L Ain ◽  
Mazen Albaghdadi ◽  
Jay Giri ◽  
Farhad Abtahian ◽  
Michael R Jaff ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Disease Process ◽  
Circulatory Support ◽  
Care Hospital ◽  
Imaging Data ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation

Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in relation to high-risk PE treatment and mortality. A single-center retrospective chart review was conducted of high-risk PE patients. High-risk PE was defined as acute PE and cardiac arrest or shock. A total of 60 patients were identified, 31 in the pre-ECMO era and 29 in the post-ECMO era. Mean age was 56.1±21.1 years and 51.7% were women. More patients in the post-ECMO era were identified with computed tomography (82.8% vs 51.6%, p=0.011) and more patients in the post-ECMO era had right ventricular dysfunction on echocardiography (96.4% vs 78.3%, p=0.045). No other differences were noted in baseline characteristics or clinical, laboratory and imaging data between the two groups. In total, ECMO was used in 13 (44.8%) patients in the post-ECMO era. There was greater utilization of catheter-directed therapies in the post-ECMO era compared to the pre-ECMO era ( n = 7 (24.1%) vs n = 1 (3.2%), p=0.024). Thirty-day survival increased from 17.2% in patients who presented in the pre-ECMO era to 41.4% in the post-ECMO era ( p=0.043). While more work is necessary to better identify those PE patients who stand to benefit from mechanical circulatory support, our findings have important implications for the management of such patients.

scholarly journals Prevalence and clonal relatedness of NDM and OXA-48-producing Klebsiella pneumoniae in a tertiary care hospital in South India

2019 ◽  
Vol 11 (04) ◽  
pp. 312-316
Author(s):  
Poothakuzhiyil Remya ◽  
Mariappan Shanthi ◽  
Uma Sekar
Keyword(s):  
Klebsiella Pneumoniae ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Genomic Diversity ◽  
Major Type ◽  
Care Hospital ◽  
Clonal Relatedness ◽  
Genes Encoding ◽  
Clinically Significant ◽  
Pfge Profiles

Abstract BACKGROUND: Carbapenems are used for the treatment of serious infections caused by multidrug-resistant Klebsiella pneumoniae. Resistance to carbapenems in K. pneumoniae is mainly due to metallo-beta-lactamases (NDM, IMP, and VIM) and class D oxacillinase (OXA-48-like). AIM AND OBJECTIVE: This study was undertaken to detect the genes encoding for carbapenemase in K. pneumoniae and to determine the clonal relatedness of selected isolates of K. pneumoniae producing NDM and OXA-48 by pulsed-field gel electrophoresis method (PFGE). MATERIALS AND METHODS: The isolates were collected over a period of 1 year. A total of 370 clinically significant, nonduplicate isolates of K. pneumoniae were included in this study. Phenotypic tests for the detection of carbapenemases were performed for all the isolates. Polymerase chain reaction (PCR) was carried out for the detection of carbapenemase genes such as blaKPC, blaIMP, blaVIM,blaNDM, and blaOXA-48. PFGE was performed, and the PFGE profiles were analyzed and compared using BioNumerics version 7.6. RESULTS: Of the 370 isolates of K. pneumoniae, carbapenemase genes were detected in 13.78% (51/370). blaOXA-48was the prevalent gene detected followed by blaNDMand blaKPC. Thirty strains of K. pneumoniae selected by PFGE analysis were divided into five clusters (A, B, C, D, and E). Cluster C was the major type detected carrying blaNDMand blaOXA-48genes.CONCLUSION:blaOXA-48was the most prevalent gene detected in this study. PCR is useful in detecting carbapenemase genes, especially blaNDM, which may show false susceptibility to carbapenems. There was no direct correlation detected between PFGE profiles and antibiotic susceptibility pattern. PFGE has revealed the genomic diversity among isolates, thereby suggesting heterogeneity in strain circulation within intensive care unit and wards of the hospital. Monitoring and molecular typing is essential to curtail the spread of multidrug-resistant strains and control the outbreaks of infection.

A minimalist electronic health record-based intervention to reduce standing lab utilisation

2020 ◽  
pp. postgradmedj-2019-136992
Author(s):  
Kuo-Kai Chin ◽  
Amrita Krishnamurthy ◽  
Talhah Zubair ◽  
Tara Ramaswamy ◽  
Jason Hom ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Complete Blood Count ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Health Record ◽  
Care Hospital ◽  
Before And After ◽  
Electronic Health ◽  
One Year

BackgroundRepetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.ObjectiveTo evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.SettingOne year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).InterventionProviders were required to specify the number of times each test should occur instead of being able to order them indefinitely.MeasurementsFor eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.ResultsUtilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.ConclusionsRequiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

scholarly journals Antimicrobial Resistance Patterns in Clinically Significant Isolates from Medical Wards of a Tertiary Care Hospital in North India

2020 ◽  
Vol 12 (03) ◽  
pp. 196-202
Author(s):  
Venkatesh Sudharsan Vaithiyam ◽  
Neha Rastogi ◽  
Piyush Ranjan ◽  
Niranjan Mahishi ◽  
Arti Kapil ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
North India ◽  
Resistance Pattern ◽  
Resistant Organism ◽  
Care Hospital ◽  
Cross Sectional ◽  
Drug Resistance Pattern ◽  
Clinically Significant ◽  
Medical Wards

Abstract Background The global burden of infections due to multidrug-resistant organism (MDRO) has a significant impact on patients’ morbidity and mortality along with increased healthcare expenditure. Aim This article estimates the prevalence of MDRO and the spectrum of clinical infectious syndromes caused by these organisms in medical wards of a tertiary care hospital in India. Design and Methods A cross-sectional observational study was performed among patients admitted in medicine wards diagnosed with the various infectious syndromes and one or more clinically significant positive culture at a tertiary care hospital in North India over a period of 18 months. Results Out of 323 clinically significant microbiological culture isolates from 229 patients included in the study, 86 (27%) isolates showed multidrug resistance (MDR) pattern, 197 (61%) isolates showed possible extremely drug-resistance pattern, and only 40 (12%) isolates showed nonmultidrug-resistance pattern of antibiogram. Conclusion The prevalence of MRDOs is high in clinically significant culture isolates from medicine wards in India. This emphasizes the importance of appropriate antibiotic usage and implementation of antibiotic stewardship programs in this part of the world.

Study of hematological indices in neonates admitted with non-obstructive jaundice and its outcome in a tertiary care hospital

2017 ◽  
Vol 4 (5) ◽  
pp. 1827
Author(s):  
Vikram R. ◽  
C. S. Balachandran
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Serum Bilirubin ◽  
Complete Blood Count ◽  
Tertiary Care ◽  
Serum Bilirubin Level ◽  
P Value ◽  
Serum Total Bilirubin ◽  
Care Hospital ◽  
Hematological Indices

Background: To study non-obstructive causes and laboratory profile of neonatal hyperbilirubinemia. Design: prospective study.Methods: Selection of cases were done from routine cases reporting to newborn unit in the department of paediatrics, with clinical evidence of jaundice in neonates. Blood group of the mother and baby, Serum bilirubin estimation, Complete blood count with peripheral smear examination, Reticulocyte count, Direct coomb’s test and C-reactive protein of the baby were done.Results: Study includes 89 cases of newborn admitted in our tertiary care institute. Out of 89 neonates, 52 (58.42%) were male while 37 (41.57%) were females. Total number of Pre-term babies was 35 (39.32%). Neonates having low birth weight were 30 (33.7%) and very low birth were 10 (11.23%). Physiological jaundice constituted majority cases. Septicemia was the commonest cause of pathological jaundice and ABO incompatibility is second commonest cause of pathological jaundice. Pre-term and low birth weight babies were having higher levels of serum total bilirubin but the difference was not significant (P >0.05). The rise in serum bilirubin level was found to be more in pathological jaundice as compare to physiological jaundice. Difference was significant statistically with p value of <0.05.Conclusions: Most of the cases were having physiological jaundice although septicemia and ABO-Rh incompatibility were not exceptional. Peak serum bilirubin levels were found to be more among the pathological jaundice. Also, prematurity and low birth weight were having higher levels of serum bilirubin. Special care must be given to them in order to avoid future complications of hyperbilirubinemia.

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