View Full Version : Int Med chat: Hematology

04-07-2005, 08:28 PM
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[chandra] hello
[chandra] anyone here
[chandra] persianprincess
[nasrin06] hi
[lightshade99] hello
[nasrin06] hi
[nasrin06] any body here
[duttycup82] hi
[hehe] hi
[hehe] is anybody here
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[dua_frank] hey sammy
[dua_frank] be right back
[samantha] hi dua
[samantha] ok
[samantha] hi lanny
[samantha] hi megs
[lanny] hello sammy dua and megs
[megs] there was a logging prb...
[megs] sorry...hi all
[lanny] thanks for today dua
[dua_frank] hi all
[dua_frank] back too
[samantha] wc
[dua_frank] welcome lanny, it was a good discussion :)
[lanny] i hoooopppeeee i got it lol
[dua_frank] lol
[samantha] did you have a discussion today?
[megs] thats what i wonder
[lanny] no i just asked dua about a q i had
[dua_frank] no sammy not on chat, it was just something we discussed in email
[megs] ok
[samantha] oh...
[dua_frank] so hematology today
[samantha] yes
[lanny] yes dua were kinda late lets start
[dua_frank] what kind of anemia in malabsorption syndromes?
[lanny] B12 def
[dua_frank] iron
[dua_frank] same in alcoholis
[dua_frank] cancers?
[lanny] normocytic
[dua_frank] yes
[lanny] chronic dz
[megs] a 78 yr old pt with fatigue, breatlessness on walking...work up done...hb..9.8 pcv 28 ...hypochromic anemia suggestive of fe def wbc platelets normal;....what investigation will u do next???1. sr. feritin.2.bone marrow examination3.urine analysis4.colonoscopy5.x ray chest
[dua_frank] iron def
[lanny] ferritin
[dua_frank] ferritin
[ash] i hate this,i have been trying to gain access here for atleast 20 mins now
[megs] nope...
[samantha] colonoscopy
[ash] hi all
[ash] sorry i am late
[dua_frank] hi ash
[megs] yes sammy right
[ash] hi dua
[megs] hi ash
[samantha] hi ash
[ash] hi all
[lanny] hi ash
[ash] hi
[ash] whats going on?
[megs] hemat
[ash] ok thanks
[megs] always rule out ca colon is elderly pt as a cause of fe def anemia
[megs] as in q already mentioned finings suggestive of fe deficiency no need of further confirming it by doing sr ferritin
[dua_frank] what kind of anemia in acholorhydria?
[samantha] yes megs especially in elderly pts
[dua_frank] right megs, thanks
[ash] dua b12 def
[lanny] B 12 def
[megs] macrocytic dua
[ash] pernicious an
[samantha] pernious
[samantha] macrocytic du
[dua_frank] yes ash and lanny
[ash] what anemia is also associated with vitiligo?
[dua_frank] also iron def maybe seen
[dua_frank] chronic?
[samantha] pernicious ash
[ash] right sammy
[megs] pernecious or autoinnune haemolytic anemia ash
[ash] what anemia may have positive babinski sign?
[lanny] B12 ash
[ash] right megs and lanny
[megs] agree lanny
[samantha] agree lanny
[ash] right again
[ash] what anemia with hypothyroidism?
[samantha] macrocytic?
[ash] yes
[ash] ans is again b12
[samantha] why ash?
[lanny] degeneration of neurons sammy
[lanny] B12
[ash] pernicious anemia is sometimes associated with other autoimmune disorders like vitiligo and hypothyroidism
[dua_frank] what drugs dec absorption of fe?
[samantha] so why B12 lanny?
[ash] chelating agents like antacids
[lanny] my answer was for babinski
[dua_frank] yes
[lanny] sammy
[ash] sammy b12 is needed for mylin generation
[megs] calcium.,phytanic acid
[megs] impairs fe absorption
[dua_frank] dunno about calcium
[dua_frank] is it true megs?
[ash] so if b12 def then mylin degeneration occurs and therefore neuropathy.hence positive babinski
[dua_frank] i know only of antacids and PPIs
[samantha] ok ash and lanny thanx
[megs] i think i am right...so u dont precribe ca tablets along with fe for pregnant women
[dua_frank] how will you diff anemia of chronic disease from iron def anemia, labwise/
[dua_frank] oh ok, thanks megs
[ash] diagnosis of sickle cell in a newborn is by?
[ash] in fe def the tibc is high but low in chr.
[lanny] measure ferritin
[ash] ferritin is high in chr. but low in fe def
[lanny] s
[ash] do you give iron in anemia of chronic disorder?
[megs] no we dont
[megs] it wont help
[lanny] not needed
[ash] right megs
[megs] just treat the cause
[dua_frank] yes also retics are low in chronic and high in iron def anemias
[ash] yes
[megs] cromosomal study in newborn...ash???
[dua_frank] karyotyping
[megs] for dx of sickel cell??
[ash] yes megs
[ash] and dua
[ash] why?
[ash] i mean why not hb electrophoresis?
[dua_frank] why is serum ferritin high in chronic?
[megs] anemia associated with graying of hair, burning sensation of tongue?1. fe def2. b12 def3.folate def???
[dua_frank] fe
[megs] sr ferritin is acute reactant substance...so incr is chronic anemia
[ash] megs b12?
[megs] yes ash...
[dua_frank] oh
[dua_frank] but glossitis also in fe
[dua_frank] so why can't it be fe too?
[lanny] ferritin is acute phase reactant that usu increases in chronic states and bind Fe
[ash] graying of hair is b12
[dua_frank] oh ok
[ash] when do you give washed RBCs?
[lanny] in allergic rxn to blood transfuse
[lanny] IgA def
[ash] good lanny
[dua_frank] nic
[dua_frank] nice
[ash] do you give platelets to a patient with thrombotic thrombocytopenic purpura?
[dua_frank] no
[dua_frank] you give igs
[ash] why?
[megs] pt came with following lab investigation.s..hb 10 gm, pcv 28 ..sr bilirubin total 2 sr heptaglobulin low, bone'marrow show..hypocellular marrow, wbc and paletlets decreased..g6pd levels normal...what is dx???
[megs] which anemia???
[dua_frank] no thats ITP
[dua_frank] aplastic?
[ash] megs aplastic?
[ash] with autoimmune?
[megs] nope try again
[dua_frank] crisis
[samantha] hemolytic anemia
[megs] its PND
[dua_frank] sickle cell crisis, maybe
[dua_frank] ah
[dua_frank] thanks nice q
[ash] oh thanks megs.nice question
[dua_frank] whats ans to your q ash
[ash] u mean PNH?
[megs] YES PNH
[lanny] ash why dont we hive platelets in TTP?
[ash] dua because they cause thrombosis
[dua_frank] oh right
[ash] i think so megs
[dua_frank] good q again
[dua_frank] you said hypothyroidism with b12 def type of anemia right?
[dua_frank] my book says chronic
[ash] yes dua
[dua_frank] which is right/
[dua_frank] anemias due to endocrine failures come under an of chronic inflam disease
[dua_frank] says the book
[dua_frank] hypothyroidism, addisons, hypogonadism, panhypopituararism
[ash] oh!!!if it is kaplan lets follow it cos my answer is from crush the boards
[ash] well it could be both
[dua_frank] lol ash
[ash] :)
[dua_frank] lanny and megs? any inputs on this?
[dua_frank] lets confirm with them before accepting it
[ash] ok
[lanny] not sure dua
[lanny] i will think B 12 is more with hypothyroidism than ACD
[dua_frank] lets leave it for later and come back to it again sometime
[ash] lets hope both dont come as options in one question
[dua_frank] hope not ash
[dua_frank] ALA synthase def
[dua_frank] anemia with this?
[lanny] sideroblastic
[megs] agree
[ash] agree
[ash] what inhibits it?
[dua_frank] yes
[dua_frank] dunno
[ash] what inhibits ala synthetase?
[dua_frank] i thought it was a congenital defect
[lanny] its heriditary ash
[ash] lead inhibits ala synthetase
[lanny] oh you mean drugs??
[dua_frank] you mean alcohol?
[ash] right alcohol too
[dua_frank] oh yeah :)
[megs] how do we rx sideroblastic anemia???
[lanny] INH can
[dua_frank] b6
[ash] yes inh too
[ash] pyridoxine
[lanny] agree dua
[megs] yes
[megs] pyrodoxine
[ash] why do massive transfusions lead to bleeding diasthesis?
[dua_frank] capillary rupture?
[dua_frank] due to RBCs?
[lanny] iron overload??
[ash] nope
[dua_frank] heinz bodies seen in g6pd def, also in?
[dua_frank] tell us ash
[dua_frank] volume overload?
[megs] it it palelets lacks??
[ash] it is due to the citrate
[dua_frank] ohhhhhhhh
[dua_frank] nice q
[ash] yes megs also due to the relative thrombocytopenia
[megs] .is it really???
[ash] aha
[megs] what is massive blood transfusion ash???
[dua_frank] alpha thallasemias with 3-4 gene deletions
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[ash] what metabolic abnormality will the patients with massive transfusions have?
[dua_frank] what kind of Hb accumulates in 3 gene deletions?
[megs] hyperkalemia
[dua_frank] agree
[ash] right megs
[lanny] slphs thsllsemisa
[lanny] alpha thallasemia
[lanny] in 3 deletions dua
[megs] hb bart dua??
[dua_frank] yes lanny
[ash] megs i dont know wht value is massive transfusion.do you?
[dua_frank] hb H
[dua_frank] what two anemias are resistant to malaria?
[ash] dua g6pd and sickle
[ash] also bld gr duff
[samantha] sickle cell
[lanny] sickle
[dua_frank] and thallasemias
[dua_frank] yes
[dua_frank] good
[lanny] asians and africans a way nature did it so they can be malaria resistant
[ash] how do you differentiate on lab values vonwillebrandts and hemophilia?
[megs] bt
[lanny] fac 8 normal
[dua_frank] PTT inc in vwd
[dua_frank] along with BT
[ash] right
[ash] what abt heparin and warfarin?
[dua_frank] PTT and PT
[dua_frank] why does beta thall show up only after 6 months?
[ash] right
[ash] dua because hbf before that
[dua_frank] right
[dua_frank] retics high or low in beta thalla?
[ash] 2 conditions with parasites inside rbcs
[lanny] malaria
[ash] dua high?
[dua_frank] low
[samantha] filaria
[ash] oops
[ash] no the second condition is babesiosis
[megs] OK
[ash] why low dua?
[megs] this is seen in us
[ash] yes
[dua_frank] dunno
[dua_frank] says reticulopenia
[ash] oh
[dua_frank] its globin chain formation defect
[dua_frank] probably coz of that
[ash] does anyone know?please tell
[ash] oh ok thanks dua
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[dua_frank] ppts of beta4 seen in?
[ash] ok i have to go now .goodnight everyone
[dua_frank] good night
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[dua_frank] alpha 3 deletions
[dua_frank] ppts of alpha4 seen in?
[megs] hydrops fetalis dua??
[lanny] im bk
[megs] wb lanny
[dua_frank] beta thall major
[dua_frank] wb lanny
[dua_frank] high A2 in?
[lanny] beta
[megs] in thalacemia beta
[samantha] beta thalasemia
[dua_frank] beta minor
[dua_frank] low or absent hbA2?
[samantha] alpha thalasemia
[dua_frank] beta major
[lanny] barts
[megs] alfa thal
[dua_frank] oops HbA low or absent
[dua_frank] in beta major
[dua_frank] Hb F high in?
[lanny] beta minor
[samantha] beta minor?
[dua_frank] beta major
[megs] b major
[dua_frank] shall we go through this again if you want?
[samantha] ok
[dua_frank] Hb A is alpha2+beta2, Hb F is alpha2+gamma2, Hb A2 is alpha2+delta2
[dua_frank] if everybody got this clear, let me know and i will go ahead
[dua_frank] Hb A is the normal that we should be making
[lanny] right
[samantha] yup
[dua_frank] now imagine alpha thallasemias, if alpha is defective, what kinds of chain productions would inc?
[samantha] beta
[megs] b and gamma
[samantha] yes
[dua_frank] right b and you will see b4 ppts
[dua_frank] those are the heinz bodies in alpha 3 deletions
[dua_frank] clear?
[samantha] why alpha 3 deletion dua
[lanny] whats b4ppts dua
[dua_frank] b4 is a type of beta chain lanny
[dua_frank] lets just say in general they are beta chain inc ppts
[dua_frank] don't worry about the number 4
[lanny] oh you mean precipitates>??
[dua_frank] alpha 3 is when it starts manifesting sammy
[dua_frank] yes precipitates
[samantha] got it dua
[dua_frank] barts Hb that you see in alpha 4 deletions are the G4 type
[dua_frank] just know that you will not see any alpha ppts
[dua_frank] in alpha thallasemias
[dua_frank] next comes beta thallasemias, what will you expect to see absent in beta major?
[dua_frank] look at the type of Hb that requires beta chain, that should be absent
[dua_frank] Hb A coz its alpha2+beta2
[dua_frank] no beta no Hb A production
[dua_frank] ok?
[dua_frank] waky waky
[lanny] im with you dua
[lanny] so far so good
[samantha] beta thalassemia major is homozygous dia
[dua_frank] *choochoo*
[dua_frank] ok good lanny
[dua_frank] what ppts will you expect to see in beta thals?
[lanny] alpha
[dua_frank] good a4
[dua_frank] coz those are in plenty and have nowhere to go
[dua_frank] now lets consider beta major and minor
[lanny] so they come together
[dua_frank] major is homozygous yes which will be severe and thus you will see Hb F elevation
[lanny] cause Fis 2 alpha and 2 gamma
[dua_frank] minor is heterozygous in which you will see Hb A2 elevation and not so severe as Hb A2 has taken over the functions of Hb A as normal
[dua_frank] right
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[dua_frank] ok so everybody with me and clear on this?
[samantha] yes dua
[lanny] agree
[samantha] got it so far
[dua_frank] great, now if they try to give us some picture of thallasemias and want us to tell which type
[dua_frank] we will be able to do so
[dua_frank] going by the ppts and levels of Hb A A2 and F
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[lanny] under normal circumstances yes
[dua_frank] lets hope so at least
[lanny] i think you sent megs off to bed dua
[dua_frank] lol lanny
[dua_frank] i bet megs already knew all this anyway, i'm just making it more detailed for me to remember this with you all
[lanny] its well explained dua
[samantha] i read it long time ago i forgot dua
[dua_frank] i know sammy, ive read it three times too and i keep forgetting too
[dua_frank] i thought my talking with you all i will reinforce it more in my brain
[samantha] your explanation is clear i understood it more clearly
[lanny] in sickle cell dz you do smear how do you diff trait from dz??
[dua_frank] thats good sammy :)
[samantha] :) dua
[samantha] the different Hb A A2 and F is clear now
[dua_frank] great :)
[dua_frank] the other type is Hb S which is seen only in SC
[dua_frank] dunno lanny, tell us
[dua_frank] i thought it was a clinical differentiation
[dua_frank] Hb F levels?
[dua_frank] high in SCA disease
[dua_frank] not trait
[samantha] lanny in trait there is no other symptoms except for renal?
[lanny] me too but in last chat someone said smear can teoo you but didnt know how i thought you may know
[megs] sorry guys was on ph
[lanny] maybe the shape or no of ceoos sickle??
[dua_frank] i can only think of Hb F levels lanny
[dua_frank] just like Hb F levels are high in beta major
[dua_frank] they will be high in SCD too
[lanny] yes dua i know its a clinical diff but in last chat i remeeber someone say smear to diff trait from dz??
[dua_frank] and like beta minor has compensatory high Hb A2, SC trait will have HBA + HbS 50/50%
[megs] lanny do u mean to say na metabisulphate test???
[dua_frank] sickle cell prep and solubility tests only show if sickle cells are present or not, and they are present in both, trait and disease, so i don't know how my smear
[megs] to differnetiate betn trait and disesea??
[lanny] i am chk now in CMDT
[dua_frank] tell us if you know megs
[megs] the peripheral smear will tell about the sickle cells present or not
[lanny] ok in trait you see normal cells
[megs] if u suspect tarit or diesee from family history
[dua_frank] and sickle cells in diease lanny?
[lanny] in dz you see 5 -50 % of RBC with sickle shape
[megs] if disease + ..sickels cells
[dua_frank] and put metabisulfite, they sickle?
[dua_frank] great thanks
[lanny] yes so my guess wwas right its the abnormal shape that diiff them
[lanny] yes dua metabis sickles them
[megs] what will happen to ESR IN sickle cell??
[dua_frank] low
[megs] yes
[dua_frank] what other conditions have low esr?
[megs] spherocytosis ..
[dua_frank] really?
[dua_frank] i don't know thats why i'm asking you :P
[dua_frank] i know of only SCD
[megs] dunno not sure...just thinking that way ceels can not for roulex so low ESR
[dua_frank] just checked
[dua_frank] polycythemia and CHF too
[dua_frank] both beta major and SCD do not manifest before 6 months due to presence of Hb F
[yeswhy] hi
[megs] hi yeswhy
[dua_frank] what about serum haptoglobulin levels in SCD? high or low?
[dua_frank] hi whyyes?
[yeswhy] hi
[megs] may vary lany
[yeswhy] i just am starting to study for step 2 and have nothing to study what do all of u suggest i buy to study?
[megs] because splenic as well as intravascular sequestration of cells
[dua_frank] kaplan stuff
[megs] what is ans lanny???
[lanny] think low
[yeswhy] can i just get the step 2 books or do i have to attend lectures?
[dua_frank] yes low
[dua_frank] i don't know why though
[megs] why lanny
[dua_frank] get everything you can
[lanny] cant think dunno megs
[lanny] maybe because of ongoing hemolysys
[yeswhy] yeah i know..everything is so expencive tho
[dua_frank] try the forums, most sell their old books and material
[yeswhy] ok thnks
[dua_frank] welcome
[dua_frank] book says confirmation by hemoglobin eletrophoresis
[dua_frank] did't ash say karyotying and not electro megs?
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[megs] she said for newborn
[dua_frank] oh
[lanny] or associated iron defkaryotpong for what dua
[lanny] karyotyping for what dua
[lanny] oh i got it dua
[dua_frank] rx for scd?
[megs] hydroxyurea
[dua_frank] right and prophylactin pens?
[lanny] hydroxurea
[dua_frank] can we give that too megs?
[dua_frank] says give folate too
[megs] agree folate too
[dua_frank] rx of aplastic crisis with pain?
[lanny] exchange transfusions
[megs] analgesics , oxygen
[dua_frank] yes packed RBCs
[dua_frank] pain medication like morphine or meperidene
[dua_frank] IVFs and o2
[dua_frank] retics high or low here?
[samantha] high?
[dua_frank] yes
[dua_frank] and larger in size for some reason too
[dua_frank] what vaccines to you give to scd pts?
[megs] why we give folate in sickel cell??
[samantha] pneumoccocal and influenza
[megs] agree sam
[samantha] for the regeneration of cells megs
[dua_frank] to keep making more rbcs megs?
[dua_frank] yes asmmy and megs
[lanny] megs we do
[dua_frank] h influenza
[megs] if we wont give folate to what pt is prone is sickle cell anemia???
[samantha] with trait?
[lanny] pt with aplastic crisis
[megs] aplastic crisis ...if we wont give folate...so folate is given to prevent aplastic crisis
[megs] yup lanny
[dua_frank] great
[samantha] oh thanx
[lanny] how is aplastic crisis manifest
[dua_frank] like hypoBM synd
[dua_frank] low counts of everything
[megs] infections and bleeding lanny
[lanny] i mean clinical
[lanny] right megs
[samantha] parvo B19 lanny
[dua_frank] can also result in strokes
[dua_frank] and PE
[lanny] right all infections and bleeding thrombosis problems
[dua_frank] you know i don't mind adding ten more days for IM
[dua_frank] there is a lot more that we can cover in detail
[megs] a black american male with positive family history of sickel cell disese...but in pt no sickels cells...but pt had haematuria...whats dx???
[dua_frank] what do you say we have a cycle of IM again before peds next?
[lanny] sickle trait
[megs] yes lanny
[dua_frank] yeah isothenuria with trait
[samantha] sounds gr8 to me
[lanny] trait presents as UTI's
[megs] yesh
[dua_frank] isothenuria is just failure to conc urine right?
[dua_frank] so why not in trait too?
[lanny] sorry trait predisposes to UTI
[lanny] dua there is isothen in trait
[dua_frank] ok
[dua_frank] thanks
[megs] ok
[megs] what lymphoma hiv causes???
[dua_frank] NHL?
[megs] b cell lymphoma....
[dua_frank] oh :0
[samantha] any idea why LDH is elevated in certain conditions?
[dua_frank] :)
[megs] ldh is incresed in cell lysis i guess...
[samantha] is it because of cell lysis?
[lanny] b cell
[samantha] so in hemolysis it is increased rt?
[lanny] whsnever cells lyse they release LDH its found in cells
[megs] what type of lymphoma...is caused by maleria??
[lanny] right wammy
[lanny] sammy
[dua_frank] what is histidine loading test?
[megs] burkitts lymphoma due to maleria...
[megs] dunno dua whats it??
[samantha] yes lanny i guess thanx
[samantha] thanx megs
[dua_frank] it differentiates megaloblastic anemia from folate
[lanny] guys im leaving it was a good one today too..dua plz post dear..thankyou
[megs] bye lanny
[dua_frank] when you give histidine, histidine is metabolised by vit b21
[dua_frank] will do lanny,bye and welcome
[lanny] thanks again
[megs] ok
[dua_frank] so if you see normal MMA level its folic acid and if raised its vit b12 def
[lanny] guys keep it up we are doing fine just need to run out quickly
[megs] thanx dua
[dua_frank] welcome
[megs] got to guys bye
[megs] all
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[samantha] dua we haven;'t discussed more than half
[dua_frank] yes
[dua_frank] which is why i wanted to extend the days for im
[samantha] i think it is good idea to repeat med
[dua_frank] yeah me too
[dua_frank] lets ask the others again tomorrow if they want to do that
[samantha] yes let us see what everyone wants
[dua_frank] do you want to continue ?
[samantha] how about you?
[dua_frank] i don't mind
[samantha] ok how about 10 more mins?
[dua_frank] sure
[dua_frank] lets complete anemias
[samantha] ok
[dua_frank] methotrexate and phenytoin cause what def?
[samantha] folate def dua
[dua_frank] yes
[dua_frank] woman on bactrim, delvelops jaundice, dx?
[samantha] sulpha allergy?
[dua_frank] G6PD def leading to hemolysis
[dua_frank] causing jaundice
[samantha] sulph induce hemolytic anemia
[dua_frank] right
[samantha] ok dua due to g6pd def
[dua_frank] how is direct coombs test diff from indirect?
[samantha] direct detects conjugated bilirubin
[dua_frank] direct detects antigens on patients Rbcs
[dua_frank] so they take blood from patient add anti antibody
[samantha] indirect coombs detects unconjugated hb
[dua_frank] patients Rbcs have attached antibody on them
[dua_frank] the new anti antibody added goes and attaches to fc portion of the antibody on the rbc antibody complex
[dua_frank] indirect you take serum to look for presence of antibodies
[dua_frank] you add sheep rbcs then antiantibody
[dua_frank] direct coombs positive detects extravascular hemolysis
[samantha] so in direct you add antibody
[samantha] rt
[dua_frank] right
[dua_frank] in indirect you add rbcs plus antiantibody
[dua_frank] when is MCV high?
[dua_frank] which anemias
[samantha] megaloblastic anemias
[samantha] thanx dua
[samantha] B12 and folate
[dua_frank] right
[dua_frank] welcome
[dua_frank] low in?
[samantha] iron def and sideroblastic
[dua_frank] yes
[dua_frank] and chronic and lead
[dua_frank] normal in?
[samantha] anemia of chronic disease
[dua_frank] hemolytic anemias
[samantha] lead is sideroblastic also dua
[samantha] rt dua
[dua_frank] what is normal blood incompatibility?
[dua_frank] yes
[dua_frank] which group?
[dua_frank] blood transfusion i mean
[dua_frank] mc
[samantha] ABO
[dua_frank] right
[samantha] Rh?
[dua_frank] the coombs we do here is indirect
[dua_frank] before giving blood transfusion
[samantha] yes
[dua_frank] to check for abo antibodies
[dua_frank] i guess thats it
[dua_frank] shall we call it a day then?
[samantha] ok thanx c u tom
[samantha] bye dua
[dua_frank] welcome bye
samantha has left the chat.

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