{"id":6032,"date":"2018-05-21T21:01:41","date_gmt":"2018-05-21T19:01:41","guid":{"rendered":"http:\/\/agora.xtec.cat\/ies-merce-rodoreda\/?p=6032"},"modified":"2018-05-21T21:01:41","modified_gmt":"2018-05-21T19:01:41","slug":"laboratori-doctors-zaragoza-protocol-per-la-realitzacio-de-proves-creuades-en-la-transfusio-de-preparats-sanguinis","status":"publish","type":"post","link":"https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/modul-b\/laboratori-doctors-zaragoza-protocol-per-la-realitzacio-de-proves-creuades-en-la-transfusio-de-preparats-sanguinis\/","title":{"rendered":"Laboratori Doctors Zaragoza.  Protocol per la realitzaci\u00f3 de proves creuades en la transfusi\u00f3 de preparats sanguinis"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large\" src=\"http:\/\/www.labzaragoza.com\/images\/laboratorio_3.jpg\" width=\"245\" height=\"184\" \/><\/p>\n<p>En el seg\u00fcent protocol s\u2019estudiar\u00e0 la compatibilitat sangu\u00ednia entre una mostra real d\u2019un pacient i un preparat sanguini per una futura transfusi\u00f3.<\/p>\n<p>Per assolir l\u2019objectiu es far\u00e0 un estudi dels anticossos irregulars m\u00e9s comuns, el grup de la sang del pacient, la prova creuada entre les dues sangs, la pacient i del preparat d\u2019hematies, aix\u00ed com l\u2019obtenci\u00f3 del grup s\u00e8ric.<\/p>\n<p>S\u2019utilitzar\u00e0 la t\u00e8cnica de la casa comercial <strong>BioRad<\/strong>, en el qual es far\u00e0 un procediment immunol\u00f2gic partint de la base del <em>test de coombs indirecte.<\/em><\/p>\n<p><!--more--><\/p>\n<ul>\n<li><strong>Material necessari<\/strong><\/li>\n<\/ul>\n<p>Per fer el procediment ser\u00e0 necessari utilitzar aquests materials:<\/p>\n<ul>\n<li>Mostra sangu\u00ednia.<\/li>\n<li>Material per extracci\u00f3 sangu\u00ednia, tub hemograma EDTA tri-pot\u00e0ssic, tub bioqu\u00edmica amb gel separador.<\/li>\n<li>Reactius Anti-A, Anti-B, Anti-D (Rh).<\/li>\n<li>Reactius Ac irregulars Dia cell I, II, III casa<\/li>\n<li>Pipeta autom\u00e0tica de com a m\u00ednim 100\u03bcL regulable.<\/li>\n<li>Pous per grup sanguini.<\/li>\n<li>Bossa de preparat hematol\u00f2gic per transfusi\u00f3(concentrat d\u2019hematies).<\/li>\n<li>Preparaci\u00f3 per diluir de <strong>BioRad<\/strong>.<\/li>\n<li>Incubadora<\/li>\n<li>Centrifugadora<\/li>\n<li>Plaques per<em> coombs indirecte<\/em><\/li>\n<li>Reactiu DiaCell ABO A1, B casa<\/li>\n<li>Tubs de pre-diluci\u00f3.<\/li>\n<li><strong>Procediment<\/strong><\/li>\n<\/ul>\n<p>S\u2019obtindr\u00e0 la mostra sangu\u00ednia mitjan\u00e7ant punci\u00f3 venosa extraient dos tubs de sang, un d\u2019hemograma amb el anticoagulant EDTA tri-pot\u00e0ssic i un altre de bioqu\u00edmica sense anticoagulant i amb gel separador. Un cop extreta la mostra s\u2019etiquetaran i identificaran correctament les mostres per evitar confusions.<\/p>\n<p>En primer lloc, amb el tub EDTA tri-pot\u00e0ssic que contindr\u00e0 sang total farem el grup del pacient, per duu a terme el procediment es possaran 50\u03bcL de sang total en 3 pous per grup sanguini, s\u2019afegeixen 50\u03bcL del reactiu Anti-A al primer pou, 50\u03bcL del reactiu Anti-B al segon pou i per \u00faltim 50\u03bcL de reactiu Anti-D (Rh) al tercer pou. Es barreja i es fa una lectura del resultat per aglutinaci\u00f3 instant\u00e0nia.<\/p>\n<p>Es centrifuga el tub de bioqu\u00edmica de la mostra per obtenir s\u00e8rum.<\/p>\n<p>Un cop es coneix el grup del pacient, es procedeix a preparar les proves creuades, el grup s\u00e8ric i l\u2019estudi dels Ac irregulars.<\/p>\n<p>En segon lloc i comen\u00e7ant per les proves creuades, s\u2019escollir\u00e0 un concentrat d\u2019hematies del grup del pacient, es tallar\u00e0 una cua de la bossa i es trauran 100\u03bcL de sang. Es far\u00e0 una pre-diluci\u00f3 en un tub amb 10\u03bcL de sang de la bossa amb 500\u03bcL del l\u00edquid de diluci\u00f3 barrejant-lo correctament.<\/p>\n<p>En una placa de <em>coombs indirecte<\/em> es dipositaran 50 \u03bcL de la dissoluci\u00f3 esmentada abans amb 25 \u03bcL de s\u00e8rum de la mostra del pacient.<\/p>\n<p><!--more--><\/p>\n<p>Tot seguit, es realitza el grup s\u00e8ric dipositant en dos pous de la placa de <em>coombs indirecte<\/em> 50 \u03bcL del reactiu Dia Cell ABO A1 i B respectivament, al primer pou es posar\u00e0 el reactiu A1 i al segon el reactiu B, correctament identificats i s\u2019afegir\u00e0n 50 \u03bcL del s\u00e8rum del pacient a cada pou.<\/p>\n<p>Per \u00faltim, es realitzar\u00e0 l\u2019estudi dels anticossos irregulars del pacient, per fer aquest procediment s\u2019utilitzar\u00e0 una placa de <em>coombs indirecte<\/em>, s\u2019identificar\u00e0 la placa amb la informaci\u00f3 del pacient i la prova, es dipositen en tres pous diferents 50 \u03bcL de cada reactiu I,II,III. Al primer pou reactiu I, al segon pou reactiu II i al tercer pou reactiu III. Tot seguit s\u2019afegiran a cada pou 25 \u03bcL de s\u00e8rum del pacient.<\/p>\n<p>Tot junt s\u2019incubar\u00e0 15 minuts a 37\u00baC, a excepci\u00f3 de la placa del grup s\u00e8ric que no es necessari,\u00a0 i es centrifugar\u00e0 a 900rpm durant 10 minuts. Es fa lectura dels resultats.<\/p>\n<ul>\n<li><strong>Resultats<\/strong><\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><strong>Grup i Rh: <\/strong>Aquesta t\u00e8cnica dona resultats per aglutinaci\u00f3 instant\u00e0nia, s\u2019ha de ver una aglutinaci\u00f3 clara en el pou on es produeix la reacci\u00f3.<\/p>\n<table width=\"570\">\n<tbody>\n<tr>\n<td width=\"144\"><strong>Reactiu<\/strong><\/p>\n<p><strong>Grup<\/strong><\/td>\n<td width=\"143\"><strong>Anti A<\/strong><\/td>\n<td width=\"143\"><strong>Anti B<\/strong><\/td>\n<td width=\"141\"><strong>Anti D (Rh)<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>A+<\/strong><\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"143\">No<\/td>\n<td width=\"141\">Aglutina<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>A-<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"143\">No<\/td>\n<td width=\"141\">No<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>B+<\/strong><\/td>\n<td width=\"143\">No<\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"141\">Aglutina<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>B-<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/td>\n<td width=\"143\">No<\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"141\">No<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>AB+<\/strong><\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"141\">Aglutina<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>AB-<\/strong><\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"143\">Aglutina<\/td>\n<td width=\"141\">No<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>0+<\/strong><\/td>\n<td width=\"143\">No<\/td>\n<td width=\"143\">No<\/td>\n<td width=\"141\">Aglutina<\/td>\n<\/tr>\n<tr>\n<td width=\"144\"><strong>0-<\/strong><\/td>\n<td width=\"143\">No<\/td>\n<td width=\"143\">No<\/td>\n<td width=\"141\">No<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Prova Creuada<\/strong>: Per llegir els resultats es mirar\u00e0 a contrallum la placa de <em>test de coombs indirecte<\/em>.<\/p>\n<p>Si hi ha reacci\u00f3 es veur\u00e0 un tel d\u2019hematies que no precipita \u00e0 Resultat <strong><em>positiu<\/em><\/strong>.<\/p>\n<p>Si no hi ha reacci\u00f3 el pou es veur\u00e0 amb un precipitat de hematies s\u00f2lid \u00e0 Resultat <strong><em>negatiu.<\/em><\/strong><\/p>\n<p><a href=\"http:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/poxo.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-6033\" src=\"http:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/poxo.jpg\" alt=\"\" width=\"159\" height=\"191\" srcset=\"https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/poxo.jpg 420w, https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/poxo-250x300.jpg 250w\" sizes=\"auto, (max-width: 159px) 100vw, 159px\" \/><\/a><\/p>\n<p><strong>Grup s\u00e8ric: <\/strong>Per valorar el grup s\u00e8ric es miraran a contrallum els pous de la placa de <em>coombs indirecte<\/em> seguint el criteri seg\u00fcent:<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"142\"><strong>\u00a0<\/strong><\/td>\n<td width=\"142\"><strong>A<\/strong><\/td>\n<td width=\"142\"><strong>B <\/strong><\/td>\n<td width=\"142\"><strong>0<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"142\"><strong>A1 <\/strong><\/td>\n<td width=\"142\">Precipita<\/td>\n<td width=\"142\">Aglutina<\/td>\n<td width=\"142\">Aglutina<\/td>\n<\/tr>\n<tr>\n<td width=\"142\"><strong>B<\/strong><\/td>\n<td width=\"142\">Aglutina<\/td>\n<td width=\"142\">Precipita<\/td>\n<td width=\"142\">Aglutina<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Ac irregulars<\/strong>: es far\u00e0 una lectura de la placa a contrallum, si el pacient cont\u00e9 anticossos irregulars a la sang es veur\u00e0 una aglutinaci\u00f3 clara al pou ser\u00e0 un resultat <strong><em>positiu<\/em><\/strong> si la persona no cont\u00e9 cap antic\u00f2s irregular haur\u00e0 una precipitaci\u00f3 s\u00f2lida dels hematies del reactiu al final del pou per tant es donar\u00e0 el resultat com <strong><em>negatiu.<\/em><\/strong><\/p>\n<p>Seguir\u00e0 el mateix patr\u00f3 que les proves creuades.<\/p>\n<p><a href=\"http:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/20150515_104451.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-6035\" src=\"http:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/20150515_104451-1024x614.jpg\" alt=\"\" width=\"542\" height=\"325\" srcset=\"https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/20150515_104451-1024x614.jpg 1024w, https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/20150515_104451-300x180.jpg 300w, https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/20150515_104451-768x461.jpg 768w, https:\/\/agora.xtec.cat\/ies-merce-rodoreda\/wp-content\/uploads\/usu644\/2018\/05\/20150515_104451.jpg 1600w\" sizes=\"auto, (max-width: 542px) 100vw, 542px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>En el seg\u00fcent protocol s\u2019estudiar\u00e0 la compatibilitat sangu\u00ednia entre una mostra real d\u2019un pacient i un preparat sanguini per una [&hellip;]<\/p>\n","protected":false},"author":225,"featured_media":6206,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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