By J. Marus. University of North Dakota--Lake Region.

An attempt is also made to match Rh status of donor and recipient; Rh negative can usually be given to an RH+ recipient safely 10 BASIC PRINCIPLES OF BLOOD COMPONENT THERAPY Table 10–3 provides some common indications and uses for transfusion products paxil 20 mg on line. Red Cell Transfusions Acute Blood Loss: Normal cheap paxil 20 mg line, healthy individuals can usually tolerate up to 30% blood loss without need for transfusion; patients may manifest tachycardia, mild hypotension without evidence of hypovolemic shock. However, transfusion is generally indicated if Hgb < 6 g/dL or in the face of symptoms due to low hemoglobin. T A B L E 1 0 – 3 B l o o d B a n k P r o d u c t s P r o d u c t D e s c r i p t i o n C o m m o n I n d i c a t i o n s W h o l e b l o o d N o e l e m e n t s r e m o v e d N o t f o r r o u t i n e u s e ( s e e a l s o p a g e 1 9 6 ) 1 u n i t = 4 5 0 m L ± 4 5 m L ( H C T ≈ 4 0 % ) A c u t e, m a s s i v e b l e e d i n g C o n t a i n s R B C, W B C, p l a s m a a n d O p e n h e a r t s u r g e r y p l a t e l e t s ( W B C & p l a t e l e t s m a y b e N e o n a t a l t o t a l e x c h a n g e n o n f u n c t i o n a l ) D e f i c i e n t i n f a c t o r s V & V I I P a c k e d R e d C e l l s ( P R B C ) M o s t p l a s m a, W B C, p l a t e l e t s r e m o v e d ; u n i t = R e p l a c e m e n t i n c h r o n i c a n d a c u t e ( s e e a l s o p a g e 1 9 6 ) 2 5 0 – 3 0 0 m L. T H E F O L L O W I N G P R O D U C T S A R E U S U A L L Y D I S P E N S E D B Y M O S T H O S P I T A L P H A R M A C I E S A N D A R E U S U A L L Y O R D E R E D A S A M E D I C A T I O N. F a c t o r V I I ( p u r i f i e d F r o m p o o l e d p l a s m a, p u r e F a c t o r V I I I R o u t i n e f o r h e m o p h i l i a A ( f a c t o r V I I d e f i c i e n c y ) a n t i h e m o p h i l i c f a c t o r ) I n c r e a s e d h e p a t i t i s r i s k F a c t o r I X c o n c e n t r a t e I n c r e a s e d h e p a t i t i s r i s k A c t i v e b l e e d i n g i n C h r i s t m a s d i s e a s e ( p r o t h r o m b i n c o m p l e x ) F a c t o r s I I, V I I, I X, a n d X ( H e m o p h i l i a B o r f a c t o r I X d e f i c i e n c y ) E q u i v a l e n t t o 2 u n i t s o f p l a s m a I m m u n e s e r u m g l o b u l i n P r e c i p i t a t e f r o m p l a s m a “ g a m m a g l o b u l i n ” I m m u n e g l o b u l i n d e f i c i e n c y D i s e a s e p r o p h y l a x i s ( h e p a t i t i s A, m e a s l e s, e t c. To roughly determine the volume of whole blood or packed red cells needed to raise a hematocrit to a known amount, use the following formula: Total blood volume of patient (Desired HCT Actual HCT) Volume of cells = HCT of transfusion product where total blood volume is 70 mL/kg in adults, 80 mL/kg in children; the HCT of packed cells is approximately 70, and that of whole blood is approximately 40. White Cell Transfusions • The use of white cell transfusions is rarely indicated today due to the use of geneti- cally engineered myeloid growth factors such as GM-CSF (see Chapter 22) • Indicated for patients being treated for overwhelming sepsis and severe neutropenia (<500 PMN/µL) Platelet Transfusions For indications, see Table 10–3 Platelet Transfusion Formula: Platelets are often transfused at a dose of 1 unit/10 kg of body weight. After administration of 1 unit of multiple-donor platelets, the count should 10 rise 5000–8000/mm3 within 1 h of transfusion and 4500 mm3 within 24 h. Normally, stored platelets that are transfused survive in vivo 6–8 d after infusion. Clinical factors (DIC, al- loimmunization) can significantly shorten these intervals. To standardize the corrected platelet count to an individual patient, use the CCI. Measure the platelet count immediately before and 1 h after the platelet infusion.

T A B L E 1 0 – 3 B l o o d B a n k P r o d u c t s P r o d u c t D e s c r i p t i o n C o m m o n I n d i c a t i o n s W h o l e b l o o d N o e l e m e n t s r e m o v e d N o t f o r r o u t i n e u s e ( s e e a l s o p a g e 1 9 6 ) 1 u n i t = 4 5 0 m L ± 4 5 m L ( H C T ≈ 4 0 % ) A c u t e 10mg paxil amex, m a s s i v e b l e e d i n g C o n t a i n s R B C generic paxil 20mg visa, W B C, p l a s m a a n d O p e n h e a r t s u r g e r y p l a t e l e t s ( W B C & p l a t e l e t s m a y b e N e o n a t a l t o t a l e x c h a n g e n o n f u n c t i o n a l ) D e f i c i e n t i n f a c t o r s V & V I I P a c k e d R e d C e l l s ( P R B C ) M o s t p l a s m a, W B C, p l a t e l e t s r e m o v e d ; u n i t = R e p l a c e m e n t i n c h r o n i c a n d a c u t e ( s e e a l s o p a g e 1 9 6 ) 2 5 0 – 3 0 0 m L. T H E F O L L O W I N G P R O D U C T S A R E U S U A L L Y D I S P E N S E D B Y M O S T H O S P I T A L P H A R M A C I E S A N D A R E U S U A L L Y O R D E R E D A S A M E D I C A T I O N. F a c t o r V I I ( p u r i f i e d F r o m p o o l e d p l a s m a, p u r e F a c t o r V I I I R o u t i n e f o r h e m o p h i l i a A ( f a c t o r V I I d e f i c i e n c y ) a n t i h e m o p h i l i c f a c t o r ) I n c r e a s e d h e p a t i t i s r i s k F a c t o r I X c o n c e n t r a t e I n c r e a s e d h e p a t i t i s r i s k A c t i v e b l e e d i n g i n C h r i s t m a s d i s e a s e ( p r o t h r o m b i n c o m p l e x ) F a c t o r s I I, V I I, I X, a n d X ( H e m o p h i l i a B o r f a c t o r I X d e f i c i e n c y ) E q u i v a l e n t t o 2 u n i t s o f p l a s m a I m m u n e s e r u m g l o b u l i n P r e c i p i t a t e f r o m p l a s m a “ g a m m a g l o b u l i n ” I m m u n e g l o b u l i n d e f i c i e n c y D i s e a s e p r o p h y l a x i s ( h e p a t i t i s A, m e a s l e s, e t c. To roughly determine the volume of whole blood or packed red cells needed to raise a hematocrit to a known amount, use the following formula: Total blood volume of patient (Desired HCT Actual HCT) Volume of cells = HCT of transfusion product where total blood volume is 70 mL/kg in adults, 80 mL/kg in children; the HCT of packed cells is approximately 70, and that of whole blood is approximately 40. White Cell Transfusions • The use of white cell transfusions is rarely indicated today due to the use of geneti- cally engineered myeloid growth factors such as GM-CSF (see Chapter 22) • Indicated for patients being treated for overwhelming sepsis and severe neutropenia (<500 PMN/µL) Platelet Transfusions For indications, see Table 10–3 Platelet Transfusion Formula: Platelets are often transfused at a dose of 1 unit/10 kg of body weight. After administration of 1 unit of multiple-donor platelets, the count should 10 rise 5000–8000/mm3 within 1 h of transfusion and 4500 mm3 within 24 h. Normally, stored platelets that are transfused survive in vivo 6–8 d after infusion. Clinical factors (DIC, al- loimmunization) can significantly shorten these intervals. To standardize the corrected platelet count to an individual patient, use the CCI. Measure the platelet count immediately before and 1 h after the platelet infusion. If the correction is less than expected, do a workup to determine the possible cause (antibodies, splenomegaly, etc). One platelet pheresis unit has enough platelets to raise the count by 6000–8000/mm3. Using a single unit has the advantage of exposing the patient to only one donor versus possibly six to eight. Posttransfusion platelet count Pretransfusion count Body surface area (m2) CCI = 11 Platelets given × 10 BLOOD BANK PRODUCTS Table10–3 describes products used in blood component therapy and gives recommendations for use of these products.

Your doctor will want to know if you or anyone in your family has had any of these conditions: nervous system disease purchase 10mg paxil fast delivery, previous skull fracture 10 mg paxil free shipping, migraine headaches, cluster headaches, emotional problems, sinus disease. Your doctor will want to know if your headache wakes you up from sleep, if it occurs more often at night, if it began suddenly, or if it recurs. Your doctor will do a physical examination including the fol- lowing: blood pressure, temperature, thorough eye exam, thorough ear exam, checking sinuses for tenderness, looking for discharge from the nose, checking the throat, examining the neck for stiffness, thorough examination of your reflexes and movement, a series of exercises to reproduce the pain. COMMON CAUSES OF HEADACHE CAUSE WHAT IS IT YPICAL SYMPTOMS Muscle tension Tightness in the muscles Constant band-like pres- of the shoulders, scalp, sure that lasts days to neck, and jaw weeks, pain often centers at the back of the head and worsens at the end of the day, triggered or worsened by anxiety Classic Severe form of headache Throbbing pain that can migraine last several days, often experience typical “funny” feelings before pain kicks in, headache often centers in the front of the head, often preceded by nausea and vomiting, family histo- ry of migraine, may be caused by alcohol or stress Common Severe form of headache Resembles classic migraine migraine (see above), often appears without typical “funny” feeling beforehand Cluster Recurring form of Brief pain centered in the headache headache front of the head, occurs often at night, tearing, nasal stuffiness, sometimes go for months with no symptoms HEADACHE 111 WHAT CAN CAUSE HEADACHES, AND WHAT IS TYPICAL FOR EACH CAUSE? Anxiety can produce symptoms of heart pounding in people with- out heart conditions. If you also lose consciousness, see the chapter on Loss of Consciousness for more information. If the heart pound- ing comes with chest pain, see the chapter on Chest Pain for more information. Your Doctor Visit What your doctor will ask you about: anxiety, depression, giddi- ness, weakness, tingling in hands or around mouth, fever, chills, chest pain, trouble breathing, loss of consciousness, pulse rate dur- ing palpitations, results of previous heart monitoring, the rhythm of heartbeats during palpitations. Your doctor will want to know if you or anyone in your family has had any of these conditions: heart disease, diabetes, high blood pres- sure, thyroid disease, blood disease, emotional problems, alcoholism. Your doctor will want to know how long each episode of heart palpitations lasts, if each episode begins and ends gradually or abruptly, and if you have experienced palpitations before. Your doctor will ask if you smoke cigarettes or drink alcohol, and how much caffeine you drink. CAUSE WHAT IS IT YPICAL SYMPTOMS Anxiety or Chronic feelings of a low Numbness in both hands, depression (See mood or anxiety faintness, pins and needles chapter on around lips, trouble breath- Depression, ing, occurs in people con- Suicidal cerned about their heart Thoughts, or health, can be a “panic Anxiety. If you are experiencing chest pain other than heartburn, refer to the chapter on Chest Pain for more information.

Cortical neuronal mechanisms in flutter-vibration studied in unanesthetized monkeys purchase paxil 30mg with amex. Sensations evoked by intraneural microstimulation of single mechanoreceptor units innervating the human hand proven paxil 30 mg. Some aspects of the functional organization of the cortex of the postcentral gyrus of the monkey: a correlation of findings obtained in a single unit analysis with cytoarchitecture. Changes in the distributed temporal response properties of SI cortical neurons reflect improvements in perfor- mance on a temporally based tactile discrimination task. Sensing without touching: psychophysical performance based on cortical microstimulation. Correlated neuronal discharges that increase coding efficiency during perceptual discrimination. Periodicity and firing rate as candidate neural codes for the frequency of vibrotactile stimuli. Modular distribution of neurons with slowly adapting and rapidly adapting responses in area 3b of somatosensory cortex in monkeys. The sense of flutter-vibration: comparison of the human capacity response patterns of mecha- noreceptive afferents from the monkey hand. Properties of cutaneous mechanoreceptors in the human hand related to touch sensations. How well do response changes of striate neurons signal differences in orientation: a study in the discriminating monkey. Neural activity in mechanoreceptive cutaneous afferents: stimulus-response relations, Weber functions, and information transmission.