VII. System of educational tasks for verification of eventual level of knowledge. Situation tasks for verification of eventual level of knowledge.

1. A patient with ulcerous illness of 12-falling bowel which was complicated by bleeding acted in the surgical separation. A deficit VCB makes 35%. With the purpose of renewal of blood loss the shown blood transfusion. Which is needed minimum of laboratory researches and tests which hemotransfusion is impossible without?

Answer:It is necessary for the exception of hemotransfusion complications and reactions:

а) to define the blood type of donor and recipient

b) to define Rh -factor-factor of donor and recipient

c) to conduct a test on group compatibility of donor and recipient on the system ABO

d) to conduct a test on Rh-compatibility of donor and recipient

e) to conduct a biological test

2. Under surveillance of doctor in a manipulation cabinet the two trained nurses determine the blood types of four patients. For this purpose they on the white plates made of delft the ware with the proper marks inflicted on 2 series of standard wheys. The explored blood was well mixed up with the drops of standard wheys. Plates rocked and left min on 1-2, then rocked again. Not early than 3 hv, in places, where agglutination was brought in on 1 drops of 0.9% solution sodium of chloride. Through 5 min from the beginning of research a doctor conducted estimation of results, writing down them in a hospital chart. What a doctor did not paid attention on, violating the same the requirements „Instructions on determination of blood types on the system ABO”?

Answer:Accordant „Instructions” before determination of blood type on plates inflict the last name and initials of patient, or number to the small bottle of donor of blood.

3. Patient with the massive internal bleeding on to the vital shows is taken in an operating-room. Under endotracheal anesthesia the operative interference directed on the eventual stop of bleeding is executed. With the purpose of renewal of blood loss during the operation there was a necessity in blood transfusion. How to conduct a biological test on compatibility to the patient, that is found under anesthesia?

Answer:During conducting of biological test during the surgical operation, when a patient is found under anesthesia, the change of pulse and arterial pressure can rely not only on blood transfusion, but also from operative interference, blood loss, introduction of medications and anesthesia. For this purpose after transfusion the first 100 g preparations of blood in a dry test tube with a few drops of geparin collect a 5 ml blood from the vein of patient and centrifugalize. The presence of the rose color of plasma (frequent pulse, decline of AT) indicates on that the poured incompatible blood. If plasma has the ordinary color, preparations of blood compatible and it is possible to continue hemotransfusion.

4. During conducting of test on group compatibility the got agglutination. What must be executed and what this reaction indicates on?

Answer:The reaction indicates on absence of compatibility of blood a donor and recipient on the system ABO. At mixing of whey of donor and red corpuscles of recipient of one group such reaction is impossible. The reaction of agglutination during conducting of test on group compatibility indicates on that blood types are definite more incorrect. It is necessary to get back to determination of blood types as at a donor, so at a recipient.

5. At a recipient Rh-factor was determined by an express-method. During conducting of test on Rh-compatibility the got agglutination. What this reaction indicates on and that it is necessary to execute?

Answer: The reaction of agglutination during conducting of test on Rh-compatibility indicates that blood incompatible on a Rh -factor. Consequently, at determination to the Rh-factor there was an error. More frequent all an error arises up at a recipient, at a donor she is determined on the station of blood transfusion by more exact laboratory methods, and at a recipient – by an express-method.

6. To the patient with the massive gastric bleeding (Hb 48 g/l, red corpuscles 1,8*10¹²/l, Ht 20% transfusion of red corpuscles mass is shown. Same blood red corpuscles mass is delivered from the station of transfusion to the blood. During conducting of test on compatibility on the system ABO there was agglutination. What this reaction indicates on? What must be done by a doctor?

Answer: This test indicates that blood incompatible on to the groups ABO. Pouring such red corpuscles mass not impossible. Agglutination does not pass, if blood of donor and recipient of one group. Thus there was an error at determination of blood type at a donor or recipient. It is needed to repeat determination of blood type.

7. To the patient that prepares to operative interference concerning the gastro-intestinal bleeding the trained nurse defined a blood type by the wheys of one series and showed to the doctor. Agglutination arose up with the whey of the first and third group. What blood type at a patient and whether a medical sister assumed an error?

Answer:A blood type after the method of standard wheys, in obedience to instruction on blood transfusion, is determined by two series of standard wheys. On to data of research by one series at a patient A (ІІ) blood type.

8. Determination of blood type by standard wheys was conducted in plate at a temperature 14 ^oC. At determination of result there was agglutination with all wheys. How possible to interpret a research result?

Answer: Interpreting a research result not impossible in this case, possible cold unspecific agglutination. It is needed to create the proper temperature condition for research (18 – 20 ^oC).

9. Determination of blood type by standard wheys was conducted in plate at a temperature 35 ^oC. At determination of result agglutination in wheys did not arise up. Is it possible to interpret a research result as the first blood type?

Answer: Interpreting a research result at such temperature not impossible, so as agglutination can arise not up. It is needed to create the proper temperature condition in a room for research (18 – 20 ^oC).

10. At a patient with the internal peritoneum bleeding the trained nurse determines a blood type by means Coliclon. Agglutination arose up with Coliclon anti A also anti B. Is it possible to interpret result as blood type AB (ІV)?

Answer:Interpreting a research result not impossible, possible unspecific agglutination which it is possible to eliminate by addition 0,9 % solution of chloride of sodium.

11. At research of blood type by two series of standard wheys agglutination did not arise up through 3 min. A result interprets by a doctor, how the first blood type is. How right interpreting result?

Answer: A result can be interpreted only through 5 min after the beginning of research, present antigen A₂ gives the reaction of agglutination only through 5 min.

12. At research of blood types by two series of standard wheys a research result was estimated by a doctor through 10 min. Agglutination happened in wheys O (І), A (ІІ), B (ІІІ). A result interprets, how a fourth blood type is. How is research correctly conducted?

Answer:A research result interprets more incorrect, because pseudoagglutination happened in this case. A result needs to be interpreted through a 5 min research.

13. During conducting of test on group compatibility on the system ABO to mix up the whey of donor with the red corpuscles of recipient. Estimated a research result it is not exposed through 5 min agglutinations. Does mean it, that blood of donor and recipient compatible on the system ABO?

Answer:A test on group compatibility is executed not correctly, it is necessary to mix the whey of recipient up with the red corpuscles of donor.

14. During conducting of test on Rh-compatibility in a test tube a 1 drop of red corpuscles of donor, which before it washed 0.9% NaCl solution, was placed, 2 drops 10 were added % solution of gelatin and 2-3 drops of whey of recipient. The table of contents of test tube was mixed up. Estimated the result of test through 10 min, added in the test tube of a 5-8 ml 0.9% NaCl solution. Agglutination in a test tube is not exposed. Does testify it to that blood compatible on Rh-factor?

Answer: During conducting of test on Rh-compatibility with gelatin the assumed error. Test tubes are needed to place in an aquatic bath-house at a temperature 46 – 48 ^oC on 10 min and only then to estimate a research result.

15. To the patient with the knife wound in a stomach and bleeding before the operation a blood type was determined by two series of standard wheys with the title of antibodies 1:32, with the term of good, that ended a 1 month ago. At estimation of agglutination it is not exposed in wheys O (І), A (ІІ), B (ІІІ) blood types. Does testify it to that at a patient the first blood type?

Answer:Weak standard wheys with the title of antibodies 1:32 and by the finished term of fitness can cause late and weak agglutination and not faithful interpretation of results of determination of blood type, which is needed to repeat.