DAILY BLOOD CONSUMPTION

ENDORSEMENT
AS OF 6AM TODAY JANUARY 2, 2014
DATE: AS OF JANUARY 1, 2014
RESIDENT: RICHARD S. ROXAS
AVAILABILITY
WHOLE BLOOD

NAME
DELOS REYES, R
DIONIDO, R.
OMBAO, M
DELA CRUZ, G
CAYANGHO, J
REYES, E
PELICA, R
BOY RAPADA
MAGLINAS, S
ZAPANTA, R
BETIC, M
BETIC, M
OLESCO,R

O
22
17
20

A
15
13
13
PRBC
GIVEN
2
1
1
1
1
2
1
35 CC
1
1
1 WB
2 AND 1 WB
1

SUMMARY: JANUARY 1-2 8AM

TOTAL NUMBER PATIENTS
OB
MEDICINE
SURGERY
PEDIA
EMERGENCY
NON-EMERGENCY
A
B
O
AB
DENIED

B
39
37
35

AB
19
19
19

TIME
8 AM
2 PM
5PM

TIME

E/NON-E

HGB

SERVICE

09:00
10:15
10:30
11:05
11:15
12:15
12:30
12:45
04:35
06:20
01:28
02:42
03:53

E
E
E
E
E
E
E
E
E
E
E
E
E

?
?
61
80
94
44
72
115
?
71
PREVIA
PREVIA
65

OB
MED
OB
OB
OB
SUR
OB
PED
OB
MED-PAY
OB-ER
OB-OR
OB

BLOOD
TYPE
O
A
O
A
B
O
B
O
O
A
O
O
AB

11
9
2
1
1
11
0
2
2
9
1
0

TROUBLE SHOOTING REPORTS: JANUARY 1, 2014

9:00 AM

Med Tech Staff Reported Chemistry is not Available because of faulty errors for
Machine. Engineering was informed and fixing was underway.
10:00 AM Dr. Ramos (PROD) endorsed that the Chemistry Studies = Machine is offline but
repair is on-going.
11:15 AM Dr. Rochelle Valino (SHO), asked about the availability of Chemistry Studies.
Noted that, since December 31 (Machine was offline)
Reagents was not available (C3 and Amylase)
11:20 AM Machine Operates Full Functional for Chemistry Studies = Machine is Fixed
Noted that Reagents for C3 and Amylase still not available (MTOD: Mam Chi)
Dr. Valino (SHO) is informed the matter.
Residents at ER (MROD-Evangelista) informed that chemistry is available
ER-RN on duty is informed about the availability.
2:20 PM
Dr. Valino says that Dr. De Leon will send reagents for C3 and Amylase soon.
No date and time confirmed
5:10 PM
Dr. Valino asked about our policy in regards with the distribution of tubes for blood
tests in the ER. The ER Nurses was asking if the tubes can be distributed by
multiple of 10 and not per patient.
Dr. Pascual (Chief) was informed at 5:30PM
The Med Tech on Duty from the Blood Bank is informed 5:30 PM
Accordingly, the policy of the laboratory shall provide the number of tubes as they
want, provided only if complied with a written requisition and well documented.
Unfortunately the distributor has not yet provide supplies of tubes.
Red Caps are being recycled at the moment.
Meanwhile, to avoid loss of tubes, a per-patient/tube is implemented.
The resident/JI/Clerk or Relative fetches the tube at Laboratory with official
request.
NO TUBES will be requested from the patient to purchase outside the hospital
Dr. Pascual
Dr. Valino is informed about the policy.
5:55 PM
Ferning Test = POSITIVE with Crystals
(OR-664613) / Dr. Zapanta
6:20 PM
MROD Umali is informed about the availability of Blood Type A is becoming futile.
Patient Zapanta is given last Bag of PRBC Type A as requested by Dr. Umali
She is has hgb 71 and will be on HD tomorrow AM.
Patient is instructed to buy Blood REDCROSS as assisted by our MedTech in
Blood Banking.
6:40 PM

Dr. Marco, visited the office to fetch the following Books:

1. Surgical Pathology Ackerman
2. Hematology Rodac
3. Pathologic Basis of Disease Robbins
4. Modern Blood Banking Harmening
5. Imununology and Serology Turgeon

7:15 PM

9:45 PM

7:00 AM

6. Diagnostic Microbiology Bailey

7. Cytology Part 1, 2, 3 Cibas
An AST and ALT result findings of elevated values (1,000 up) to a G1P1 patient at
ER-OB.
Dr. Zapanta was called and asked about the clinical picture of the patient (as of
6:15) and correlate with elevated values
The problem was relayed and given the values of 1 st extraction that was 2x test run
- done by MedTech.
Dr.Zapanta mentioned the patient is complaining epigastric pains and apparently
normal vital signs and ECGs.
I asked about the status of patient pertained to history of chest pains for possible
ACS and previous liver diseases or exposures such as Hepatitis A or B and
presence of Jaundice.
All these are not pertinent to clinical picture.
I suggest to repeat extraction and agreed with Dr. Zapanta
Result came out at 7:00 PM and still with elevated results
This was referred to Dr. Marco (Previous Chief) about the case vignettes. He
suggested if Preeclampsia could imminent.
Dr. Zapanta was informed for the persistent elevation AST and ALT and suggested
for possible pre-eclampsia and the she replied that she will study it further. The
result was released.
A referral from MedTech Claire Annette C. Dela Cruz, about the initial reading of
PBS of Patient Gepte, Enrique, 41/M under service of MED ER.
MedTech initial platelet count was 10-11.
Machine platelet count is 50
Extremely low RBC, and Hgb count.
The WBC count was 12
My initial reading was Severe Hypochromic and Microcytic RBC with AnisoPoikilocytotic, Platelet Count is 1-2 per oil, (+) Hypersegmented and Blastic
Neutrophils, (+) Blastic RBC.
Clinically, according to (MROD ER) Dr. Evangelista, patient was previously
diagnosed with Promyeloblastic Leukemia and was sent home. He was rushed on
the ER and now suffering CVD Bleed, GCS 3 and S/P CAB.
Referral was made to Dr. Gloria, and asked me to count the platelets, but
unfortunately I am not yet trained.
Referral was made to MedTech Dela Cruz who is assigned to CBC. And commits
the count was 10-11. (Attached is her signature to initial paper)
Dr. Gloria instructed, to use the initial reading of the MedTech on duty (platelet
count) and the rest is printed for a while but DO NOT RELEASE the Differential
Counts as if it will be to-follow tomorrow.
Dr. Evangelista is informed the about the matter in regards with the low RBC, Hgb,
Hct, Platelets and WBC elevation only. He was also informed that results for the
differential counts is to be followed soon.
Laboratory : No untoward incidents
1. Still no reagent for C3 and Amylase
2. Still number of tubes for CBC test is futile
3. Chemistry Machine is functioning since yesterday