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However rabeprazole 20 mg line gastritis diet , it is best to tell • can take 26 weeks’ leave from the your employer as soon as possible • you have a pregnancy-related end of their Ordinary Maternity to make sure that you have health illness/absence in the last four Leave buy 10 mg rabeprazole with mastercard gastritis disease definition, and and safety protection during your weeks of your pregnancy generic rabeprazole 20 mg visa gastritis diet . If that is not reasonably start your maternity leave even protects you from being dismissed practicable cheap 10mg rabeprazole gastritis stress, then you have the if you are off sick for only one or discriminated against because right to a suitable job on very day. In this case leave will start 167 Giving notice for statutory Working out the 15th week to either Statutory Maternity Pay maternity leave before your baby is due or Maternity Allowance (see pages To give notice that you will be Find the Sunday before your baby 165 and 163). After that your leave taking maternity leave, you must tell is due (or the due date if it is a will be unpaid. Some employers your employer the following in or Sunday) and count back 15 Sundays also offer extra maternity pay: check before the 15th week before your from there. It is probably best to 15th week before the expected resources department or your union put this in writing: week when your baby is due. Also, your employer notice of the new date at least 28 contractual rights (that is, any must not discriminate against days before either the new date or special rights that apply to your you by failing to consider you for the old date – whichever is earliest. If there is a good reason why that is company car) continue throughout not possible, tell your employer as For more information visit your maternity leave (Ordinary soon as you reasonably can. After that your leave will time workers) whether you are on employer must write to you within usually be unpaid. This does 28 days and state the date you offer extra (or contractual) maternity not include your normal pay. During the first 39 weeks of your the human resources department leave you will probably be entitled or your union representative. The timing of your rights and benefits in pregnancy is very complicated, so use this chart as a rough guide only. This means If you don’t give this notice and just maternity leave has ended, you will that they have to consider you for turn up at work before the end of lose your right to return to the same opportunities such as promotion. If you need more time off you If you are made redundant while on can refuse to allow you to work for could do one of the following: maternity leave, your employer must up to eight weeks or until the end • Ask your employer if you can take offer you any suitable alternative of your leave, whichever is earlier. Your paid none, they must pay you any notice to continue taking your maternity holiday continues to accrue during and redundancy pay that you are leave, you must give your employer maternity leave so you may have entitled to. You must give 21 days’ if you work in a factory) after notice to take parental leave, and Giving notice about childbirth. You will not be allowed to return to Your employer should assume • If you cannot return because you work during this time. But if your employer leave and don’t have enough can show that this is not reasonably If you want to take all of your notice to ask for parental leave, you practicable, you have the right to leave, you simply go back to work can still ask your employer if they be offered a suitable alternative on that day. You should apply for Maternity If you qualify for a Sure Start Maternity Grant the date your Allowance about now. You may also If you are an employee, you have a contract, you should give qualify for Statutory Maternity have the right to take reasonable at least a week’s notice. Your notice period £95 per week from your You should let your employer can run at the same time as your employer, worked out over know when you need time off. Your employer is entitled to return to exactly the same job rights to make reasonable contact with as you normally would at the end If you are pregnant, have recently you during maternity leave. This is the that the kind of work you do and work, or to update you on any right to return to the same job or, your working conditions will not significant changes in the workplace if that is not reasonably practicable, put your health or your baby’s while you have been away. This applies be used for any form of work and even if you only returned to should make it easier to return to work for one day. You must husband or your partner, including • are the baby’s father or your provide a medical certificate. It can be any working pattern Time off for other than the normal working Parental leave dependants pattern in an organisation. Parental leave is designed to give Every employee is also entitled to Most people are familiar with parents more time with their young emergency unpaid leave to make working part time for pro-rata children. It entitles you to take arrangements for the care of a pay or working different shift 13 weeks’ leave per parent per child, child who falls ill, gives birth or is patterns. Employees may be are entitled to 18 weeks’ leave, to care arrangements for your required to work within core be taken before the child is 18. For child – for example, if your hours, but outside these times parental leave, a disabled child is childminder falls ill. Typically, you can take it either within five two employees share the Parents have the right to years of the placement for adoption work normally done by one ask for flexible working or before your child’s 18th birthday, employee. An Follow the procedure outlined You cannot usually take all your employee on a permanent on page 173. Your employer contract takes paid or unpaid refused, you should get advice may limit the amount of leave you leave during school holidays. Your employer can flexible working arrangements Employees work their total postpone the leave, but only if you have or expect to have agreed hours over fewer if their business would be parental responsibility for: working days – for example, disrupted unduly. Your employer must providing they give seriously consider your request Parental responsibility means their employers 21 days’ and can only refuse for one of that you are a: notice of the expected the business reasons set out in week of childbirth. Any reduction in An employer the number of hours worked will • father cannot postpone result in pay being reduced. Your employer must: • private foster carer, or How do I ask to change • hold a meeting with you within • person who has been granted my hours? Find out if your someone who is not employed partner or civil partner of, employer has a standard form by them. If your sample letters can be downloaded employer does not think that the change that you ask for can from www. The proposed • you have parental responsibility date should allow time for the request for one of the following for a child under 17 (from April application to be considered and business reasons: 2009) or a disabled child under 18 implemented. Sex discrimination law applies to all the legal help scheme allows employers and all employed parents people on a low income to get free with childcare responsibilities. Funding for Appeal disadvantaged by not being allowed general legal advice (not advocacy) You have the right to appeal within to work the child-friendly hours you is available, to those who qualify 14 days of receiving notification of need.

Therapeutic management of bleeding disorders requires prompt treatment of bleeding episodes to minimize complications arising from blood accumulating in joint spaces and/or other tissues and organs generic 10 mg rabeprazole otc chronic gastritis symptoms uk. Various treatment regimens for non-complicated and complicated bleeding episodes are currently available cheap rabeprazole 10mg with mastercard gastritis diet 90x. Although the cell lines used in fermentation are considered t o b e free of viruses purchase rabeprazole 20mg mastercard gastritis diet , these concentrates are still subjected to a combination of viral clearance and inactivation steps to ensure safety and purity buy rabeprazole 10mg line gastritis diet . During the manufacturing process of plasma-derived blood products, the plasma is subjected to viral inactivation methods as well as elimination steps to kill viruses and remove foreign proteins. Plasma viral inactivation is achieved by heat treatment, pasteurization, solvent/detergent treatment, monoclonal antibody separation, and/or ultra-filtration. Many considerations including efficacy, cost, safety, vial size, and ease of administration are important to patients and families. By seeking up-to-date information and having frank and open discussions with patients and families about factor products and treatment, we can help ease some of the stress associated with these decisions. The reader is advised to consult the product information inserts supplied by the manufacturers for the most current information about all products discussed in this chapter. Bleeding disorders care providers are strongly encouraged to notify and provide information to patients and families when new factor products are licensed. Individuals with moderate hemophilia have baseline factor levels of approximately 1% to 5%, and those with levels that are 6 to 49% are considered to have mild hemophilia. Depending on the severity of the bleeding episode, the desired initial factor activity level may range from 30% or 40% to approximately 100%. Emergency situations require different treatment strategies, as do inhibitor patients; these will be discussed in Chapters 8 and 12 of this Nursing Handbook. A single dose of factor concentrate may be sufficient to achieve hemostasis and resolve a minor bleeding episode. These hemorrhages, indicated by swelling, warmth, limited motion, and tenderness in joints and soft tissue, require higher levels of circulating factor levels to stop the bleeding. Additionally, subsequent infusions of factor concentrates may be necessary to maintain hemostasis and prevent re-bleeding. Delays in treatment may result in prolonged recovery and the need for more factor infusions to control bleeding, as well as permanent damage to joints, muscles, and other organs. Itis not essential to administer exact doses; doses within 10% above the ordered n u m b er o f units are acceptable. Always choose a vial size that is as close as possible to the desired dose, but always round up to the nearest whole vial size, never down. Although the activity level is expressed as a percentage, it is used in calculation as a whole number. The following formula may be used as a general guide in determining the number of units to be administered. Factor recovery and half-life studies also provide important information for development of patient- specific dosing guidelines. Since allergic reactions can occur at any time, Benadryl should be kept on hand at home even for patients who have not shown an allergic reaction. Stimate has been shown to be efficacious in the treatment of mild Hemophilia A and von Willebrand Disease. A test dose should be administered ( s e e d o s a g e g u i d e l i n e s b e l o w ) to the patient while in a non-bleeding state. Stimate Nasal Spray for Bleeding is a convenient way to administer a high concentration of desmopressin acetate in a nasal spray. Each vial contains approximately 24 sprays; exceeding this number of sprays in the vial will result in inadequate delivery of Stimate. The patient or a family member should be taught to keep track of total number of doses administered per vial. Peak values are reached within 30 to 45 minutes, but it may require as much as an hour to achieve them. Stimate education for home use should include: steps for administration, indications for use, frequency of administration, home documentation, fluid restriction and adverse events 9. In addition, most factor replacement manufacturers offer a wide variety of patient educational materials regarding their products and the treatment of bleeding disorders. For permission to reproduce or translate this document, please contact the Communications Department at the address below. Deputy Chair: Sukesh Nair, Vellore, India This edition was reviewed by the following, who at the time of writing were members of the World Federation of Hemophilia Laboratory Sciences Committee: Mansoor Ahmed Clarence Lam Norma de Bosch Sukesh Nair Ampaiwan Chuansumrit Alison Street Marión Echenagucia Alok Srivastava Andreas Hillarp Some sections were also reviewed by members of the World Federation of Hemophilia von Willebrand Disease and Rare Bleeding Disorders Committee. Acknowledgement: Several of the methods described are based on laboratory standard operating procedures drafted by Annette Bowyer at the Sheffeld Haemophilia Centre, whose contribution is therefore gratefully acknowledged. Cautionary Note: Where a commercial source is given in this manual, it is an example suitable at the time of writing. Note that evaluation and use of semi-automated and fully automated coagulometers are dealt with in Section 41. Freezers of -20°C are typically inadequate for storage of plasmas and reagents for many tests of hemostasis. Re-use of laboratory test tubes and pipette tips after washing should be avoided, since residual material can adversely affect results, causing wastage of reagents and time. Apparatus signifcantly out of calibration should be immediately removed from use until recalibration has been done. Note: If a pipette is inaccurate beyond the following limits (mean weight), it must be taken out of use immediately. In recent years, there has been an increasing appreciation of the importance of safe working practices in industry, for both health and environmental reasons.

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The incidence of cystic fibrosis gene mutations in patients with congenital bilateral absence of the vas deferens in Scotland buy generic rabeprazole 20 mg gastritis diet pdf. Vaso-epididymostomy-a survey of techniques and results with considerations of delay of appearance of spermatozoa after surgery discount rabeprazole 10 mg online gastritis jello. Adverse effects on vasoepididymostomy outcomes for men with concomitant abnormalities in the prostate and seminal vesicle purchase 20mg rabeprazole free shipping gastritis symptoms yahoo answers. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia 20 mg rabeprazole fast delivery gastritis diet recommendations. Surgical therapy in infertile men with ejaculatory duct obstruction: technique and outcome of a standardized surgical approach. Pregnancy with sperm aspiration from the proximal head of the epididymis: a new treatment for congenital absence of the vas deferens. Microsurgical epididymal sperm aspiration: aspirate analysis and straws available after cryopreservation in patients with non-reconstructable obstructive azoospermia. Microsurgical vasoepididymostomy is an effective treatment for azoospermic patients with epididymal obstruction and prior failure to achieve pregnancy by sperm retrieval with intracytoplasmic sperm injection. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. Comparison of gonadotropin-releasing hormone and gonadotropin therapy in male patients with idiopathic hypothalamic hypogonadism. Impaired Leydig cell function in infertile men: a study of 357 idiopathic infertile men and 318 proven fertile controls. Decrease in testosterone blood concentrations after testicular sperm extraction for intracytoplasmic sperm injection in azoospermic men. Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects. Fertility potential: a comparison of intra-abdominal and intracanalicular testes by age groups in children. Prevalence of carcinoma in situ and other histopathological abnormalities in testes of men with a history of cryptorchidism. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Review of clinical trials on effects of oral antioxidants on basic semen and other parameters in idiopathic oligoasthenoteratozoospermia. Clearance after vasectomy with a single semen sample containing < than 100 000 immotile sperm/mL: analysis of 1073 patients. A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition. Vasectomy techniques for male sterilization: systematic Cochrane review of randomized controlled trials and controlled clinical trials. Microsurgical vasovasostomy versus microsurgical epididymal sperm aspiration/testicular extraction of sperm combined with intracytoplasmic sperm injection. Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis. Antibiotic treatment based on seminal cultures from asymptomatic male partners in in-vitro fertilization is unnecessary and may be detrimental. Impact of clinically silent inflammation on male genital tract organs as reflected by biochemical markers in semen. Distinct expression levels of cytokines and soluble cytokine receptors in seminal plasma of fertile and infertile men. Evaluation of beta-endorphin and interleukin-6 in seminal plasma of patients with certain andrological diseases. Elevated levels of proinflammatory cytokines in the semen of patients with chronic prostatitis/chronic pelvic pain syndrome. The relation between reactive oxygen species and cytokines in andrological patients with or without male accessory gland infection. The effect of doxycycline in infertile couples with male accessory gland infection: a double blind prospective study. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). Carcinoma in situ of the testis: frequency and relationship to invasive germ cell tumours in infertile men. Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer: study of 27 cases in 500 patients. Impact of therapy and androgen receptor polymorphism on sperm concentration in men treated for testicular germ cell cancer: a longitudinal study. Altered Leydig cell function in patients with testicular cancer: evidence for bilateral testicular defect. Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men.

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The membranes form a protective • A course of two steroid injections barrier around the baby and purchase rabeprazole 10 mg gastritis diet alkaline, after (corticosteroids) to help with your these have broken 20mg rabeprazole with amex gastritis vs ulcer, there is a risk of baby’s development and reduce infection getting into the womb generic 20mg rabeprazole with amex gastritis test. If Premature babies (born before 37 you do go home discount rabeprazole 20 mg without prescription gastritis diet australia, your doctor will weeks) can have an increased risk of discuss with you the signs of infection health problems, particularly with to look for. The Check that your temperature is normal earlier your baby is born, the more every 4–8 hours (a normal likely that this is the case. The possible treatment and outcomes for your baby in your individual situation will be discussed with you. Contact your doctor or midwife and Once your waters have broken, return to the hospital immediately if carrying on with the pregnancy you experience any of the following: reduces the risk of your baby having • raised temperature (more than problems by being born prematurely 37. Your shivery) obstetrician should discuss with you • vaginal bleeding the benefits and risks of both early • if the leaking fluid becomes delivery and continuing with the greenish or smelly pregnancy in your situation, but • contractions delivery will usually be between 34 • abdominal pain and 37 weeks. During these having a premature birth in a future check-ups, your baby’s heart rate will pregnancy compared with women be monitored. However, you are still more likely of amniotic fluid around the baby and to have a baby born at more than 37 the blood flow to the baby. You will be advised have follow-up appointment with your to be under the care of a consultant consultant obstetrician, who will check obstetrician in your next pregnancy, that there are no problems with your who will discuss with you a plan for pregnancy and discuss with you a your pregnancy. Corticosteroids are given by an Corticosteroids help most if they are injection into the muscle of your thigh given to you between 24 weeks and or upper arm. They may be given Corticosteroids have been used for earlier than 24 weeks, but the many years in women who are thought evidence that they will be helpful for to have a high chance of having their your baby in that situation is less baby early (before 34 weeks). There may still be serious complications after birth such benefit even if your baby as breathing problems owing to the lungs not being fully developed, is born within 24 hours of bleeding into the brain, serious infection or bowel inflammation. If you have diabetes or gestational A single course is considered to be diabetes, you may need to be in safe for you and your baby. More hospital for 2 or 3 days monitoring evidence is needed to say whether since corticosteroids increase the two or more courses of corticosteroids blood sugar level. If you have previously had For example: a baby born early, have a multiple • if you are in premature labour pregnancy or have had treatment to • if you are suspected to be in your cervix (entrance to the womb), premature labour but this has not prophylactic treatment with been confirmed yet corticosteroids early in pregnancy is • if your waters break even if you are not recommended because there is not having contractions no evidence that it will help your baby. Corticosteroids can suppress • If you are having a planned the mother’s immune system, but there caesarean section before 39 is no evidence that a single course of weeks of pregnancy, corticosteroids will cause harm even if corticosteroids are recommended you have a severe infection. If you have had one course of corticosteroids, you are unlikely to be recommended further courses later in the same pregnancy. It is normally inserted into the uterus through the abdominal almost closed, with just a small opening through wall to take a sample of the fluid surrounding the which blood passes during monthly periods. This can be carried out from 15 weeks to During labour, your cervix will dilate (open up) to test for certain chromosomal and genetic 10cm to let your baby move from your uterus disorders. Amniotic sac the bag of fluid that surrounds and Chorionic villus sample A test to detect genetic cushions your baby in the uterus. Before or disorders, particularly chromosomal disorders during labour the sac breaks and the fluid drains such as Down’s syndrome. It is very concentrated and full of antibodies to Augmentation of labour the process of protect your baby against infections. Colostrum increasing the strength, length and frequency of has a rich, creamy appearance and is your contractions and help your cervix to dilate. Baby blues Feeling sad or mildly depressed a Cot death the sudden and unexpected death of few days after your baby is born. They can be caused by Down’s syndrome A lifelong condition caused by hormone changes, tiredness or discomfort and an abnormal number of chromosomes. More severe depression with Down’s syndrome have some degree of or anxiety that lasts longer than a week could be learning disability and an increased risk of some postnatal depression. Coping with a bereavement can be particularly difficult if you Ectopic pregnancy An ectopic pregnancy is are pregnant or have just had a baby, and even when a fertilised egg begins to grow in the harder if it is your baby who has died. The fertilised egg cannot Birth plan A written record of what you would like develop properly and has to be removed. Elective caesarean A caesarean section which is planned for a specific date (usually after 39 Breech birth When a baby is born bottom rather weeks of pregnancy). Embryo the term used for the developing baby Caesarean section An operation to deliver a in very early pregnancy. If you have a Emergency caesarean A caesarean section that caesarean, you will be given an epidural or is not planned for that date but is needed general anaesthetic. Entonox is a mixture of oxygen and used to perform various diagnostic and/or another gas called nitrous oxide. Catheters may be used for the injection of fluids or medications Epidural An anaesthetic that numbs the lower into an area of the body or for drainage, such half of the body. A midwife or doctor breaking your waters followed thin catheter is placed between the vertebrae so by an intravenous drip (containing a drug called that medicine can be delivered to the nerves in oxytocin). Jaundice the development of a yellow colour on Episiotomy A cut made in the area between the a baby’s skin and a yellowness in the whites of vagina and anus (perineum). It is caused by an excess of the the last stages of labour and delivery to expand pigment bilirubin in the blood. Jaundice is the opening of the vagina to prevent tearing common in newborn babies and usually occurs during the birth of the baby. It can last for up to two weeks after birth or up to three Fetal alcohol syndrome A syndrome that can weeks in premature babies.

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Time-dependent inhibitors cheap 20mg rabeprazole with visa chronic superficial gastritis diet, on the other hand buy generic rabeprazole 10mg line gastritis juicing, require a period of incubation with normal plasma before they can be detected rabeprazole 10mg fast delivery gastritis vitamins. Normal plasma and test plasma are incubated at 37°C for 1–2 hours cheap rabeprazole 20 mg with visa severe gastritis diet plan, both separately and as a 50:50 mixture. Poor correction in the mixture prepared after separate incubation is suggestive of an immediate-acting inhibitor. Before commencing an assay, remove the storage solution from above the platelets and replace with an equal volume of suspending solution. The dilution of antibody suggested below may vary according to the source and batch number of antibody used. If a multi-channel pipette is used, it is convenient to add substrate to each row of wells in turn at 10-second intervals, and then to add sulphuric acid in the same sequence at 10-second intervals. It is also important in primary hemostasis, acting as a mediator between platelets and the sub-endothelium. Prior to dilution, any crystalline precipitates present can be dissolved by incubating at 37°C for 10 minutes. When sample After colour out of well, development ll wells with (45–60 minutes), running gel stop reaction by buffer and rinsing several reduce the times in H2O. Place gel face down in face down in 25 ml primary 25 ml secondary antibody antibody overnight in overnight in glass trough. Re-melt when ready to pour, allowing to cool to 65°C before pouring (with foil on top to avoid evaporation). Wet one glass plate and lay the gel bond on top with the side next to the paper (hydrophilic side) on top. Place the spacer on top, then place the second glass plate on top and hold with bulldog clips around the side and bottom. Store in a wet box if not for immediate use, but seal open edges with paraflm to prevent drying out (the gel can be stored overnight if necessary). Moisten the electrophoresis plate with distilled water and position the gel in the centre of the white/blue cooling plate in the tank, with the samples wells to the far side (cathode). Bend in a sharp crease and tear off (this usually gives a neater line than cutting) so that you have three to fve layers in total for each side. Wet the flter paper with electrophoresis buffer, then place each flter paper wick over each end of the gel, overlapping by about 5 mm. If the voltage is too high, the resistance of the wicks needs to be adjusted (Ohm’s Law), so add a wick to the cathode end until voltage is acceptable. Day 4: Visualization of the multimers 34 Remove the gel from the secondary antibody solution and rinse briefly in several changes of distilled water. If previous information in relation to the expected inhibitor titre is available, dilutions for testing should span either side of this. The precise concentration is not important, because the same source is added to all incubation mixtures. Note: If the patient has had an inhibitor assay performed previously, the level may provide a rough guide as to which dilutions should be used. Therefore, porcine concentrate diluted in hemophilic plasma (human) to a concentration of 1 U/ml is used. Note that other activity assays are available from other manufacturers, including the Berichrom kit (Dade Behring, Marburg, Germany), which employ different principles of analysis. However, the substrate, activator reagent parts A and B, calibrators, and controls should not be frozen. Partial reagent kits containing these latter materials can be purchased for use with any partially used reagents that have been frozen. It is now clear that so called anti-phospholipid antibodies are a heterogenous family of antibodies that react with epitopes on proteins that are themselves complexed with negatively charged phospholipids. Paradoxically, these antibodies are clearly associated with venous and arterial thrombosis by mechanisms not well understood. One way to remove the maximum number of platelets is to flter the centrifuged plasma (prepared as for other clotting tests) through a 0. Since fltration may affect other coagulation assays and may be expensive, the preferred option is to remove the platelet-poor plasma from the cells after the frst centrifugation (minimum of 1700 g for minimum of 10 minutes) and then centrifuge the secondary container with plasma for a second time under the same conditions. After the second centrifugation, the plasma is carefully removed, leaving the bottom layer undisturbed, since this will contain the majority of the few additional platelets not removed during the frst centrifugation. Plasma prepared by double centrifugation in this way will normally have residual platelet counts well below 10 × 109/l and are suitable for deep-freezing prior to analysis for lupus anticoagulant testing. Other snake venom–based specifc tests, such as the Textarin time or taipan snake venom time, have been used, as well as the dilute thromboplastin time. We include a method for preparation of washed platelets here for centres that may continue to use this approach. Correction of the abnormal result, when platelets replace phospholipid, indicates the presence of anti-phospholipid antibodies. It may be convenient to use the pooled normal plasma described in Section 7, provided that the pooled plasma is centrifuged twice prior to deep freezing. The presence of heparin in the sample can lead to results similar to those when anti-phospholipid antibody is present. Quantitative or qualitative platelet defects may result in a signifcant bleeding tendency, mainly due to failure of platelet plug formation, but also to a lesser extent to the sub-optimal activation of blood coagulation. Defective platelet function, or thrombocytopenia, may present clinically with a variety of symptoms strongly suggestive of primary hemostatic failure (e.

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