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Hemoglobin (Hb) is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained. The amount of hemoglobin in whole blood is expressed in grams per deciliter (g/dl). The normal Hb level for males is 14 to 18 g/dl; that for females is 12 to 16 g/dl. When the hemoglobin level is low, the patient has anemia. An erythrocytosis is the consequence of too many red cells; this results in hemoglobin levels above normal.
The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. Automated cell counters calculate the hematocrit by multiplying the red cell number (in millions/mm3) by the mean cell volume (MCV, in femtoliters). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152).
Both the hemoglobin and the hematocrit are based on whole blood and are therefore dependent on plasma volume. If a patient is severely dehydrated, the hemoglobin and hematocrit will appear higher than if the patient were normovolemic; if the patient is fluid overloaded, they will be lower than their actual level. To assess true red cell mass, independent radionuclide evaluation of the red cells and plasma (by 51Cr and 131I respectively) must be performed.


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Technique

Hematocrit
If the hematocrit must be determined quickly, as is often the case when a patient hemorrhages, it may be necessary to measure the hematocrit directly without the use of an automated counter. The materials needed are:


Lancets


Alcohol prep pads


Gauze pads


Microhematocrit tubes (heparinized)


Sealant ("Seal-Ease," "Crit-Seal," etc)


Microhematocrit centrifuge


Microhematocrit reader


If venipuncture is required: tourniquet, syringe, tube containing anticoagulant (EDTA, citrate)


For hematocrits obtained by fingerstick, wipe the fingertip pad of the fourth finger of the nondominant hand with the alcohol prep pad. Make certain the area is allowed to dry. Prick the fingertip with the lancet. Place the hematocrit tube near the incision site and allow the blood to flow via capillary action into the hematocrit tube until it is two-thirds to three-fourths full or to a predesignated mark on the tube. Avoid "milking" the finger if possible; this causes the expression of tissue fluids and may result in a falsely low hematocrit. Always fill at least three tubes. For hematocrits obtained by venipuncture, draw a sample of blood into the tube containing anticoagulant and mix well. Dip the hematocrit tube into the blood and allow the blood to rise to the desired two-thirds to three-quarters level. Because blood cells naturally sediment, a prior thorough mixing of the blood in the tube is necessary to ensure accurate reading.
After cleaning the outside of the hematocrit tubes of excess blood, invert the tube slowly so that the blood migrates just short of the bottom end of the tube. Seal the bottom of the tube with sealant. Make certain that little or no air is interspersed in the column of blood. If the seal is incomplete, leakage will occur during centrifugation and false readings will be obtained.
Place the tubes in a microhematocrit centrifuge and spin for 3 to 5 minutes at high speed. A shorter spin will not allow for complete sedimentation.
Using either a hematocrit reader or any ruled apparatus, measure the length of the column of the packed red cells and divide it by the length of the whole column of blood (cells and plasma), as in Figure 151.1. To obtain the hematocrit, multiply this number by 100%. Average all readings obtained from the different microhematocrit tubes.


Figure 151.1
Microhematocrit tube after sedimentation. The hematocrit is a ratio of the packed cells to total volume.


Example: If the column of packed red cells measures 20 mm and the whole blood column measures 50 mm, the hematocrit is 20/50 = 0.4 or (0.4 × 100%) = 40%.


Hemoglobin
Hemoglobin determinations will usually be performed by an automated cell counter from a tube of well-mixed EDTA-anticoagulated blood filled to a predetermined level. In this assay, all forms of hemoglobins are converted to the colored protein cyanomethemoglobin and measured by a colorimeter. An inadequate sample, whether due to insufficient volume or inadequate anticoagulation, may give false readings. If it is necessary to determine the level of anemia quickly, the hematocrit is an easier, more convenient test.


Hemoglobin Electrophoresis
Hemoglobin electrophoresis measures the mobility of hemoglobin in an electric field; it can therefore detect only those abnormalities in hemoglobin that alter the charge. Electrophoretic mobilities are affected by pH and by the medium in which the test is conducted. Screening tests typically use a hemolysate of anticoagulated blood electrophoresed on cellulose acetate at pH 8.6 to 8.8. If necessary, a further electrophoresis in starch gel at pH 6.2 to 6.8 is performed. At that stage, the work will usually be performed by a specialized laboratory.
Hemoglobin electrophoresis will not readily assess situations where there are neutral amino acid substitutions or where the hemoglobin is normal but the constituent chains are not produced in equal numbers (thalassemias). The diagnosis of alpha thalassemia of a mild to moderate degree cannot be made by hemoglobin electrophoresis; the diagnosis of beta thalassemia may be made by inference from an increase in the Hb A2.
A standard electrophoresis would look like Figure 151.2.


Figure 151.2
A standard hemoglobin electrophoresis (cellulose acetate, pH 8.6).





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Basic Science
The molecular weight of hemoglobin is approximately 64,500 daltons. Hb is composed of two pairs of dissimilar chains, α and β, each defined by a specific amino acid sequence and incorporating an iron-containing heme group. Two α–β dimers combine to form a hemoglobin tetramer. This allows for the "heme–heme" interaction necessary for effective oxygen uptake (deoxyhemoglobin → oxyhemoglobin) and delivery (oxyhemoglobin → deoxyhemoglobin). The oxygen affinity of hemoglobin is a function of this heme–heme interaction and of pH (Bohr effect), and is a measure of how many hemoglobin molecules have oxygen bound to them for a given level of oxygen tension. In a normal individual the major hemoglobin is Hb A, constituting approximately 97% of the total hemoglobin. Variations and/or amino acid substitutions in these chains exist. Some are deleterious to the normal function of hemoglobin, whereas others may have relatively normal oxygen affinity and stability. Hemoglobins containing different types of chains make up the remainder of the hemoglobin content in red cells (α2δ2 = Hb A2 approximately 2%; α2γ2 = Hb F approximately 1%).
Substitutions in the normal hemoglobin amino acid sequence may result in hemoglobins that have different sub-unit interactions and varying affinities for oxygen. For example, a substitution of the sixth amino acid on the beta chain causes Hb S, or sickle hemoglobin. Hb S has a lower oxygen affinity and surrenders its oxygen more readily. Hb F, a normal minor hemoglobin constituent, has a higher oxygen affinity.
If the oxygen dissociation curve is abnormal, the body will adjust the hemoglobin level to ensure adequate oxygen distribution to the tissues. Thus in a rare disease like hemoglobin Hotel Dieu, the difficulty in extracting oxygen from a variant hemoglobin with increased oxygen affinity could result in a lack of oxygen for the tissues (tissue hypoxia) and a compensatory erythrocytosis. The smaller fraction of oxygen released from the hemoglobin is thereby offset by the increased number of hemoglobin molecules. Similarly, in sickle cell anemia, the decreased oxygen affinity allows these patients more tissue oxygen at any given hemoglobin level.Testing.

The degree to which attention impacts a student’s academic and social performance is related to the interactions between the student’s academic and behavioral needs and the environmentaldemands. Therefore, it is not unusual for the student to perform differently across settings. For example, a student with ADHD may experience academic success in elementary school;however, when he enters middle school, the increased academic and organizational demandsmay increase his need for additional academic and behavioral supports.

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A heart attack occurs when an artery that sends blood and oxygen to the heart is blocked. Fatty, cholesterol-containing deposits build up over time, forming plaques in the heart's arteries. If a plaque ruptures, a blood clot can form. The clot can block arteries, causing a heart attack. During a heart attack, a lack of blood flow causes the tissue in the heart muscle to die.








A heart attack is also called a myocardial infarction.
Prompt treatment is needed for a heart attack to prevent death. Call 911 or emergency medical help if you think you might be having a heart attack.








Symptoms





Symptoms of a heart attack vary. Some people have mild symptoms. Others have severe symptoms. Some people have no symptoms.
Common heart attack symptoms include:

Chest pain that may feel like pressure, tightness, pain, squeezing or aching
Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly
Cold sweat
Fatigue
Heartburn or indigestion
Lightheadedness or sudden dizziness
Nausea
Shortness of breath

Women may have atypical symptoms such as brief or sharp pain felt in the neck, arm or back. Sometimes, the first symptom sign of a heart attack is sudden cardiac arrest.
Some heart attacks strike suddenly. But many people have warning signs and symptoms hours, days or weeks in advance. Chest pain or pressure (angina) that keeps happening and doesn't go away with rest may be an early warning sign. Angina is caused by a temporary decrease in blood flow to the heart.





 




 


 
 
 


 




 


 

Eating a healthy diet is not about strict limitations, staying unrealistically thin, or depriving yourself of the foods you love. Rather, it’s about feeling great, having more energy, improving your health, and boosting your mood.
Healthy eating doesn’t have to be overly complicated. If you feel overwhelmed by all the conflicting nutrition and diet advice out there, you’re not alone. It seems that for every expert who tells you a certain food is good for you, you’ll find another saying exactly the opposite. The truth is that while some specific foods or nutrients have been shown to have a beneficial effect on mood, it’s your overall dietary pattern that is most important. The cornerstone of a healthy diet should be to replace processed food with real food whenever possible. Eating food that is as close as possible to the way nature made it can make a huge difference to the way you think, look, and feel.
By using these simple tips, you can cut through the confusion and learn how to create—and stick to—a tasty, varied, and nutritious diet that is as good for your mind as it is for your body.Table:



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Establishing deadlines can help your team members complete their assigned tasks before the project's due date. Doing this can keep them engaged and productive. You can also set multiple team deadlines before the final project deadline to keep team members accountable. Consider using a time tracker app and time management techniques. Doing this can help you understand how everyone works to meet deadlines.

Manual Software Testing
Manual testing is carried out by a tester manually without the use of any kind of automation tool. It can identify visible and hidden defects. This kind of software testing often involves the testers trying the software from the perspective of the end-users. It is among the most fundamental testing processes, and the strategies can range from being fully scripted test cases to high-level guides for exploratory testing sessions.
For newly developed software, manual testing is mandatory before automated testing. Manual testing may require great effort and time, but the result will be bug-free software. Manual testers will require an understanding of manual testing techniques and need not have any automated testing skills. Several sophisticated tools are available but a simple and flexible one to try out is Testpad.
Are you preparing for job interviews? Check out the top Software Testing Interview Questions.
 
Automation Software Testing
Automation testing involves the use of special automation tools and requires a huge investment of money and resources. It is among the types of testing that aim to minimize manual test cases. Here, testers handle test scripts and return the result automatically. Test suites are recorded by using tools, and these can be played again by the testers as per the requirement. No human intervention is required for automation testing. Some popular automation tools are QTP/UFT and Selenium.
Check out the key differences between Manual Testing and Software Testing in our comparison guide, Manual Testing vs Automation testing.
 
Types of Manual Testing
There are three types of testing approaches:

White-box Testing
Black-box Testing
Grey-box Testing

White-box Testing
White-box testing is also known as structural testing, glass-box testing, transparent-box testing, or clear-box testing. This kind of testing is executed at the unit level and is based on the internal code structure. The test cases are designed based on the internal perspective of the system and programming skills such as code statements, conditions, branches, paths, etc.

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Black-box Testing
Black-box testing is also known as behavioral testing, specification-based testing, or input-output testing. It is a testing method where testers, without looking at the internal code structure, test the functionality of the software. The tests are based on the requirements and functionality alone. The internal system design is not taken into consideration.
Black-box testing is again divided into two different types of testing: Functional Testing and Non-Functional Testing.
Functional Testing
Functional testing focuses only on the output to verify the functionality of the software and how it fares against the specified requirements. This testing does not involve looking at the actual code. Each function is given a value, and then, the output is determined and verified with the expected value.
Types of Functional Testing
Function Testing has three types of testing viz- unit testing, integration testing, and system testing.

Unit Testing

Unit testing involves a developer separately testing each and every unit of an application. Each source code module is tested in the developer’s environment. This testing is also known as module testing or component testing. Unit testing reduces the cost of bug fixes since the diagnosis is done at an early phase of the development life cycle.

Integration Testing

Integration testing, also known as I&T testing or string testing, involves the testing of the connectivity or transfer of data between unit-tested modules. This type of testing includes the top-down approach, the bottom-up approach, and the sandwich approach.
Integration testing is divided into Incremental Integration Testing and Non-Incremental Integration Testing.

Incremental Integration Testing: Incremental integration testing is a form of testing in which a module is tested before being merged with another module. The integration is then tested before adding another module or component.
Non-Incremental Integration Testing/ Big Bang Method: For integrated testing, this non-incremental technique is referred to as a big band approach. Non-incremental integration, in which all components are merged ahead of time and the complete programme is tested, is sometimes attempted.


System Testing

Also known as end-to-end system testing (E2E testing) is a type of black-box testing that is done on a fully integrated application. Every input in the application is thoroughly verified for the desired output. System testing is the testing of a user’s experiences with the application.
Invest in your dream to become a professional tester, and take up this Selenium Certification by Intellipaat.
Non-functional Testing
Every organization has a separate team for this kind of testing called the non-functional testing (NFT) team or the performance team. Here, the testing is done for non-functional parameters such as stress testing, load testing, recovery testing, volume, security, accountability, etc. These parameters are, however, never tested without first executing functional testing. The main objective is to know whether the software’s response time is as per the requirement as it plays a crucial role in customer satisfaction.
Non-functional Testing Types
1. Performance Testing: Performance testing examines the functionality of software components. These tests uncover flaws in software architecture and design.
2. Usability Testing: Non-functional testing includes usability testing as one of the testing methods. Usability testing is all about ensuring that the software is simple to use for consumers.
3. Compatibility Testing: Customer satisfaction is ensured by compatibility testing, which is also non-functional testing. Its purpose is to see if your software program or product can run in a variety of browsers, databases, hardware, operating systems, mobile devices, and networks.
Grey-box Testing
Grey-box testing, as you may have already guessed, is the combination of both white-box and black-box testing. The testers will have access to design documents and internal coding for the purpose of designing test cases. The testing process here is executed at a functionality level.
Grey-box testing is good at diagnosing context-specific errors of web systems and pays attention to all the layers of any complex system. This helps increase testing coverage. Grey-box testing is primarily implemented in penetration testing and integration testing.

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L

Eat a balanced diet

Exercise regularly
Get enough good sleepStay well hydratedTable:



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