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8/3/2019 Hema Nursing Anatomy (2)
http://slidepdf.com/reader/full/hema-nursing-anatomy-2 1/85
Joaquin P. Venus III,MD,RN
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PUTLA MO.
ANEMIC KA
NOH?!
IKAW NANGI-
NGITIM KA NA!
CYANOTIC KA!
INTUBATE KITA!
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LumayasCecil: Mare, pwede ba, dito muna ako sa
inyo? Lumayas ako sa amin. Kasi, buntis
ako.
Rain: Dapat, sa taong nakabuntis sa ‘yo
ka pumunta!
Cecil: Kaya nga rito ako pumunta, eh.
Nandiyan ba si pare?
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Functions of Blood
Transport of: Gases, nutrients, waste products
Processed molecules
Regulatory molecules
Regulation of pH and osmosis
Maintenance of body temperature
Protection against foreign substances
Clot formation
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Composition of Blood
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Plasma
Liquid part of blood Pale yellow made up of 91% water, 9%
other
Colloid: Liquid containing suspended
substances that don’t settle out Albumin: Important in regulation of water
movement between tissues and blood
Globulins: Immune system or transportmolecules
Fibrinogen: Responsible for formation ofblood clots
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Formed Elements
Red blood cells (erythrocytes)
White blood cells (leukocytes) Granulocytes
Neutrophils Eosinophils
Basophils
Agranulocytes Lymphocytes
Monocytes
Platelets (thrombocytes)
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Production of FormedElements
Hematopoiesis or hemopoiesis: Process of blood cell production
Stem cells: All formed elements
derived from single population Proerythroblasts: Develop into red blood
cells
Myeloblasts: Develop into basophils,
neutrophils, eosinophils Lymphoblasts: Develop into lymphocytes
Monoblasts: Develop into monocytes
Megakaryoblasts: Develop into platelets
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Hematopoiesis
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Erythrocytes Structure
Biconcave,anucleate
Components
Hemoglobin
Lipids, ATP,carbonic anhydrase
Function
Transport oxygenfrom lungs totissues and a fewcarbon dioxidefrom tissues to
lungs
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Hemoglobin
Consists of:
4 globin molecules: Transport carbon dioxide(carbonic anhydrase involved), nitric oxide
4 heme molecules: Transport oxygen
Iron is required for oxygen transport
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Erythropoiesis
Production of red blood cells Stem cells proerythroblasts early
erythroblasts intermediate late reticulocytes
Erythropoietin: Hormone to stimulate RBC
production
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Hemoglobin Breakdown
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Leukocytes
Protect bodyagainstmicroorganisms
and remove deadcells and debris
Movements
AmeboidDiapedesis
Chemotaxis
Types Neutrophils: Small
phagocytic cells
Eosinophils: Reduce
inflammation, allergy Basophils: Release
histamine and increaseinflammatory response
Lymphocytes: Immunity Monocytes: Become
macrophages
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Thrombocytes
Cell fragmentspinched off frommegakaryocytes in
red bone marrow Important in
preventing bloodloss
Platelet plugs
Promotingformation andcontraction of clots
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Sige lang!Tsugi ka
sa akinmamaya!
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LAUGH BREAK
ANAK: ITAY SA SWELDO NYO PUNTATAYO NG SN?
TATAY: ANG LAKI-LAKI MO NA BULOLKA PA? PARA SN LANG!
ANAK: ANO PO BA ANG TAMA?
TATAY: SHOENART! NARYUSIP!
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Hemostasis
Arrest of bleeding Events preventing excessive blood
loss
Vascular spasm: Vasoconstrictionof damaged blood vesselsfollowed immediately by
vasodilationPlatelet plug formation
Coagulation or blood clotting
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Platelet Plug Formation
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Coagulation
Pathways
Extrinsic
Intrinsic
Stages
Activation ofprothrombinase
Conversion of
prothrombin tothrombin
Conversion offibrinogen to fibrin
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Clot Formation
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Fibrinolysis
Clotdissolved by
activity ofplasmin, anenzyme
whichhydrolyzesfibrin
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MOMMY TAPOS
NA PO AKO
LIGO!
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LAUGH BREAK
AMO: “DAY BAKIT MAY BUKOL SI JUNIOR?” INDAY: “COMPROMISING SAFETY WITH
USELES AESTHETICS, THE NOT-SO-
WELL ENGINEERED ARCHITECTURALDESIGN OF OUR KITCHEN LAVATORY AFFECTED THE BOY’S CRANIUM WITH A
SLIGHT BOIL AT THE LEFT TEMPLE NEARTHE AUDITORY ORGAN...”
AMO: NAGNONOSEBLEED AKO!!!!
INDAY: OH, IT’S CALLED EPISTAXIS ATI!
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Blood Grouping
Determined by antigens(agglutinogens) on surface of RBCs
Antibodies (agglutinins) can bind toRBC antigens, resulting inagglutination (clumping) and
hemolysis (rupture) of RBCs Groups
ABO and Rh
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BLOOD CLASSIFICATION
MAJOR BLOOD GROUPS
A, B, AB, O
Blood compatibility andsystems of classification arebased on the presence or
absence of specific antigenspresent on RBC’s as well as
specific antibodies in the
plasma
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BLOOD CLASSIFICATION
If the antigen A on the RBC’s of the
donors comes in contact with the
Antibody A of the recipient andvice versa, agglutination andclumping will occur.
E.g.Type A blood transfused into Brecipient
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BLOOD CLASSIFICATION
O negative is called the
UNIVERSAL DONOR because
there are no antigens on theRBC’s and the Rh factor is notpresent
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BLOOD CLASSIFICATION
AB positive is called the
UNIVERSAL RECIPIENT
because there are noantibodies in the serum, andthe Rh factor is present.
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BLOOD CLASSIFICATION
In agglutination and clumpingof RBC’s, hemolysis occurs,
and releases hemoglobin intothe plasma.
Problems occur with thedestruction of the donor’s
RBC’s by the plasma of the
recipient’s cells.
O G
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ABO Blood Groups
A l ti ti R ti
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Agglutination Reaction
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Rh Blood Group
First studied in rhesus monkeys Types
Rh positive: Have these antigens presenton surface of RBCs
Rh negative: Do not have these antigenspresent
Hemolytic Disease of the Newborn(HDN)
Mother produces anti-Rh antibodies thatcross placenta and cause agglutination
and hemolysis of fetal RBCs
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Rh factor
Rh is positive, or factor is present, in85% to 95% of the population
Rh is negative, or factor is absent , in 5% to 15% of the population
Normal plasma does not contain Rhantibodies. Antibodies are formed in Rhnegative blood if transfused with Rh
positive blood; thus, the recipient issensitized to the Rh factor andsubsequent Rh positive blood mightresult in a severe transfusion reaction
E th bl t i F t li
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Erythroblastosis Fetalis
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Diagnostic Blood Tests
Type and crossmatch Complete blood
count
Red blood count
Hemoglobinmeasurement
Hematocritmeasurement
White blood count
Differential whiteblood count
Clotting
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MAMA MAYAMOY ISDA!
PARANGNASALOOBNITO!
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LAUGH BREAK
BATA 1: ALAM BA NINYO ANG TAPANGNG DAGA SA AMIN. KUMAKAIN NGLASON SA DAGA!
BATA 2: WALA YAN SA DAGA SA AMIN,ANG KINAKAIN NIYA KINUKUHA NIYASA MOUSE TRAP!
BATA 3: WALA PALA IYANG MGA DAGASA AMIN. NANGRE-RAPE NG PUSA!!!
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ASSESSMENT
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HISTORY
HistoryDisease of bone marrow and/or
producing organs
Treatment that depressed bonemarrow activity (especiallychemotherapy or radiation
therapy)Family history of problems
(inheritance pattern)
Blood transfusion
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HISTORY
Bleeding problems occurringduring pregnancy, labor anddelivery, or immediately afterdelivery in both mother andinfant
Presence of chronic disorders ordisease processes
Effects of aging
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EFFECTS OF AGING
Assessment areaNail beds ( check for capillary refill)
Pallor, cyanosis, and decreased
capillary refill is often noted inhematologic disorders
In elderly:
Nails are typically thickened anddiscolored. Need to use anotherbody area, such as the lips to
assess capillary refill
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EFFECTS OF AGING
HAIR DISTRIBUTION
Thin or absent hair on trunk andextremities may indicate poor oxygenation
and blood supply In elderly:
Older adults are losing body hair, but
often is an even pattern distribution thathas occurred slowly overtime. Lack ofhair on lower legs and toes may indicatepoor circulation
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EFFECTS OF AGING
SKIN MOISTURE AND COLOR Skin dryness, pallor and jaundice may occur with
anemia, leukemia, etc
In elderly: Dry skin is a normal aspect of aging and thus
becomes an unreliable indicator of skinmoisture
Pigment loss and skin changes along withsome yellowing occur with aging.
Pallor that is not associated with anemia maybe noted in older adults, because they tend notto go outdoors and get exposed to sunlight
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EFFECTS OF AGING
Evaluate effect of hematologic disorderhas on client’s activities of daily living? How long has client experienced
symptoms? What are current activities and metabolic
requirements of the client?
Presence or absence of bleeding episodes
Ability to control pain Presence of appropriate coping or defense
mechanism
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EFFECTS OF AGING
Evaluate effect of hematologic disorderhas on client’s activities of daily living?
Assess client’s current nutritional
status
Evaluate current blood values
Evaluate status of respiratory andcardiovascular systems in maintaininghomeostasis
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LAUGH BREAK
KONDUKTOR: SAAN PO KAYO BABAMISIS?
MISIS: CUBAO LANG!
KONDUKTOR: ANAK PO BA NINYO IYAN?
BAKIT ANG PANGIT?
MISIS: BUWISIT NA KONDUKTOR IYON.SOBRA KUNG MAMINTAS. ANG TAGALNG INSPECTOR. MAIREKLAMO NGA!
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LAUGH BREAK
UMAKYAT ANG INSPECTOR NG BUS....MISIS: SOBRANG MANLAIT ANG
KUNDOKTOR NYO! GUSTO KONG
IREKLAMO!INSPEKTOR: TAMA PO ANG GAGAWIN
NINYO! ETO PO ANG LAPIS AT PAPEL.
ISULAT NINYO ANG INYONGREKLAMO. PARA MAKASULAT KAYOAKIN MUNA ANG UNGGOY NINYO...
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DIAGNOSTICS
ACTIVATED PARTIAL
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ACTIVATED PARTIALTHROMBOPLASTIN TIME
Evaluates how well the coagulationsequence (INTRINSIC PATHWAY) isfunctioning by measuring the amount of
time it takes for recalcified, citratedplasma to clot after partial thromboplastinis added to it.
The test screens for deficiencies andinhibitors of all factors except VII and XIII
Value : 20 to 36 seconds, depending on
the type of activator used
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aPTT Nursing consideration If the client is receiving intermittent
heparin therapy, draw the blood
sample 1 hour before the nextscheduled dose
Do not draw samples from an arminto which heparin is infusing
Transport specimen to the lab
immediately
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PROTHROMBIN TIMEand INR
Prothrombin is a Vitamin Kdependent glycoprotein
produced by the liver that isnecessary for firm fibrin clotformation
Each laboratory establishes anormal value or control valuebased on the method used toperform the PT test.
PROTHROMBIN TIME
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PROTHROMBIN TIMEand INR
The Pt measures the amount of timeit takes for clot formation and is used
to monitor response to warfarinsodium (Coumadin) therapy or toscreen for dysfunction of theextrinsic system resulting from liver
disease, vitamin K deficiency, or DIC Value: 2 seconds (plus or minus) of
the control is considered normal
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PT and INR cont’n
The INR standardized the PT ratioand is calculated in the lab settingby raising the observed PT ratio tothe power of The InternationalSensitivity Index specific to the
thromboplastin reagent used The INR measures the effects of
oral anticoagulants
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PT and INR
Values:PT : 9.6 to 11.8 seconds (male
adult ) and 9.5 to 11.3 seconds
( female adult)
INR: 2.0 to 3.0 for standard
warfarin therapy INR: 3.0 to 4.5 for high dose
warfarin therapy
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PT and INR
Nursing consideration:A baseline PT should be drawn
before anticouagulation therapy isstarted; note the time of collection onlab form
Provide direct pressure to thevenipuncture site for 3 to 5 minutes ifa coagulation defect is present
Concurrent warfarin therapy withheparin therapy can lengthen the PTfor up to 5 hours after dosing
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PT and INR
Nursing consideration: Orally administered anticoagulation
therapy usually maintains the PT at1.5 to 2 times the lab control value
Diets high in green leafy vegetablescan increase the absorption ofVitamin K which shortens the PT
A Pt that is greater than 30 secplaces the client at risk forhemorrhage
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CLOTTING TIME
The time required for the interaction of allfactors involved in the clotting process
Value: 8 to 15 min
Nursing considerations: The client should not receive heparin
therapy for 3 hours before specimencollection because the heparin therapy will
affect the results The test results is prolonged by any
anticoagulant therapy, test tube agitation,high temperature changes that may affect
the specimen
SPECIAL HAT (mexican style)
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SPECIAL HAT (mexican style)
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Religious Daddy: Anak, mabait ba ang boyfriend
mo?Anak: Opo, Tatay.
Daddy: Religious ba siya?Anak: Naku, Sobra talagang religious!Daddy: Saan ba siya nakatira?
Anak: Nandoon po sa simbahan,nagmimisa ngayon!!
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PLATELET COUNT Platelet function in hemostatic plug
formation, clot retraction, and coagulationfactor activation
Platelets are produced by the bone marrowto function in hemostasis
Value: 150,000 to 400, 000 cells/ml
Nursing considerations: Monitor venipuncture site for bleeding in clients
with known thrombocytopenia High altitudes, chronic cold weather and exercise
increase platelet counts
Bleeding precautions should be instituted inclients with a low platelet count
ERYTHROCYTE STUDIES
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ERYTHROCYTE STUDIES1. ERYTHROCYTE SEDIMENTATION
RATEA. The rate at which erythrocytes settle out of
anti-coagulated blood in 1 hour
B. Not diagnostic of any particular diseasebut indicative that a disease process isongoing
C. Normal Value: 0 to 30 mm/hr, depending onthe age of patient
D. Nursing consideration:
-Fasting is not necessary, but a fatty meal
may cause plasma alterations
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ERYTHROCYTE STUDIES
2. HEMOGLOBIN AND HEMATOCRIT Hemoglobin is the main component of
erythrocytes and serves as thevehicle for the transportation of
oxygen and CO2 Hemoglobin determinations are
important in identifying anemia
Hematocrit represents red blood cellmass and is an importantmeasurement in the identification ofanemia and polycythemia
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Hemoglobin and Hematocrit
Hemoglobin – Normal value: 14 – 16.5 g/dl (male)
: 12 - 15 g/dl (female)
Hematocrit –
Normal value: 42% - 52% (male): 35% - 47 % (female)
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ERYTHROCYTE STUDIES
3. Serum Iron Iron is found mostly in hemoglobin
Acts as a carrier of oxygen from the lungsto the tissues and indirectly aids in the
return of carbon dioxide to the lungs Aids in diagnosing anemias and hemolytic
disorders
Values: male adult : 65 to 175 mcg/dl
Female adult : 50 to 170 mcg/dl
Nursing consideration:
Level of iron will be increased if the client
has ingested iron before the test
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ERYHROCYTE STUDIES
RBC COUNTRBC functions in hemoglobin
transport which results in delivery of
oxygen to the body tissuesRBC’s are formed by red bone
marrow, have a life span of 120 daysand are removed from the blood bythe liver, spleen, and bone marrow
RBC COUNT
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RBC COUNT
Aids in diagnosing anemia and blooddyscrasias
Evaluates the ability of the body toproduce rbc in sufficient number
Value: female adult : 4 million to 5.5million cells/ul
male adult : 4.5 million to 6.2
million cells/ulNursing consideration:
Fasting not required
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LAUGH BREAK
ANAK: INAY, TINGIN KO PO HINDI NANINYO AKO MAHAL. LAHAT NA LANGNG SABIHIN KO AY MALI!
INAY: NAGKAKAMALI KA ANAK! MAHALNA MAHAL KA NAMIN NI TATAY MO!
ANAK: KITA NA NINYO! MALI NA NAMAN
AKO! HMP!
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WHITE BLOOD CELL COUNT
Function in the immune defensesystem of the body
Assesses each leukocytedistribution
Value : 4500 to 11000 cells/ul
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White blood cell count
Nursing consideration:A shift to the left means that an
increased number of immatureneutrophils are in the peripheral blood
A low wbc count with a left shiftindicates a recovery from the bonemarrow depression or an infection ofsuch intensity that the demand for
neutrophils in the tissue is greater thanthe capacity of the bone marrow torelease them into the circulation
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White blood cell count
Nursing consideration:A high wbc count with a left shift
indicates an increased release ofneutrophils by the bone marrow inresponse to an overwhelminginfection or inflammation
A shift to the right means that mature
cells have more than the usualnumber of nuclear segments; foundin liver disease, Down syndrome; ormegaloblastic and pernicious anemia
BONE MARROW
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BONE MARROWASPIRATION/BIOPSY
All formed cell elements withinnormal range (erythrocytes,
leukocytes, and platelets) Evaluates presence, absence or
ratio of cells characteristic of asuspected disease
Preferable site: Posterior iliaccrest
BONE MARROW
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BONE MARROWASPIRATION/BIOPSY
Client preparation: Local anesthetic is used, as well as
analgesics Feeling of pressure when bone marrow is
entered; pain occurs as marrow is beingwithdrawn After test:
Observe for bleeding at site
Apply pressure to site Bed rest for approximately 30 min
afterward
Analgesics indicated
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SICKLE CELL TEST/DEX
Number of hemoglobin S present
Routine screening test for sickle celltrait or disorder
False negative result in infants < 3months
False positive result can occur for up to
4 months after a transfusion of RBCs that are positive for the trait
HEMOGLOBIN
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HEMOGLOBINELECTROPHORESIS
Separates various hemoglobins andallows for identification of specific
problem Differentiates between trait or disorder
in sickle cell anemia
Diagnosis of thalassemia andhemolytic anemia
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FIBRIN SPLIT PRODUCTS
Increased destruction in DIC
Fibrinolysis occurs in intravascularcoagulation
Abnormally high levels in DIC
LAUGH END
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AMO: Sagutin mo ang telepon inday!INDAY: (baligtad ang hawak ng telephone
receiver) Hilo? Hilo?
AMO: Baligtarin mo!INDAY: Lohi? Lohi?
AMO: Tanga, baligtarin mo ang
telepono!!!!INDAY: Puntili, puntili
ANAK
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ANAKANO YAN?
MAMATUTUTULOGNA PO KO...!
LAUGH END
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Have you seen the sexiest star inhollywood today?
A. Paris Hilton?
B. J. Lopez?
C. Beyonce Knowles?
Naaaaahh!........... ALL WRONG PO!
MS. BEAN!
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LAUGH END!
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LAUGH END!
Sabi Airforce: "No Guts No Glory!"Sabi Marines: "No Retreat NoSurrender!"
Sabi Army: "No Pain, No Gain!"Security Guards: "No I.D.No Entry!“
AU Nursing Students: “No Audit, no
diploma!”
LAW OF THE SEED
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LAW OF THE SEED
MOST SEEDS NEVER GROW. FOR 1APPLE TREE TO BEAR 500 APPLES,YOU NEED 10 SEEDS.
IN LIFE, THIS PRINCIPLE MIGHT MEANYOU’LL NEED TO GET 1 JOB, TALK TO
50 PEOPLE TO SELL ONE HOUSE,
MEET 1000 ACQUINTANCES TO HAVE1 SPECIAL PERSON
LAW OF THE SEED
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LAW OF THE SEED
IF WE REALLY WANT TO MAKE THINGSHAPPEN, WE USUALLY NEED TO TRYMORE THAN ONCE....
THAT’S THE LAW OF NATURE, JUSTUNDERSTAND AND WORK WITH IT!