Page 30 - Fpgee Question And Answer 2024 Edition

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For initial management of a known or suspected The direct Coombs test is used to test for
benzodiazepine overdose, the recommended initial autoimmune hemolytic anemia; i.e., a condition of a
dose of flumazenil injection is 0.2 mg (2 mL) low count of red blood cells caused by immune
administered intravenously over 30 seconds. If the system lysis or breaking of RBC membranes causing
desired level of consciousness is not obtained after RBC destruction.
waiting 30 seconds, a further dose of 0.3 mg (3 mL)
can be administered over another 30 seconds. In certain diseases or conditions, an individual's
Further doses of 0.5 mg (5 mL) can be administered blood may contain IgG antibodies that can
over 30 seconds at 1-minute intervals up to a specifically bind to antigens on the RBC surface
cumulative dose of 3 mg. membrane, and their circulating RBCs can become
coated with IgG alloantibodies and/or IgG
Most patients with a benzodiazepine overdose will autoantibodies.
respond to a cumulative dose of 1 mg to 3 mg of
flumazenil injection, and doses beyond 3 mg do not Complement proteins may subsequently bind to the
reliably produce additional effects. bound antibodies and cause RBC destruction. The
direct Coombs test is used to detect these
Seizures and arrhythmia are reported side effects of antibodies or complement proteins that are bound
the drug. to the surface of red blood cells; a blood sample is
taken and the RBCs are washed (removing the
785.(a) Activated charcoal is not indicated for the patient's own plasma) and then incubated with anti-
drug intoxication in unconscious patients. It is the human globulin (also known as "Coombs reagent").
carbon residue derived from the organic material by
exposing it to an oxidizing gas compound of steam, If this produces agglutination of RBCs, the direct
in the presence of acid at high temperature. Each Coombs test is positive, a visual indication that
gm of charcoal is capable of binding 100 mg to 1000 antibodies (and/or complement proteins) are
mg of the drug. bound to the surface of red blood cells.

Activated charcoal can be used in cases of food The indirect Coombs test is used in prenatal testing
poisoning when nausea and diarrhea are present. of pregnant women and in testing blood prior to a
Adults take 25 grams at onset of symptoms or when blood transfusion. It detects antibodies against
food poisoning is suspected, and children should be RBCs that are present unbound in the patient's
given 10 grams. serum. In this case, serum is extracted from the
blood sample taken from the patient. Then, the
786.(d) Atenolol (Tenormin), Acebutolol (Sectral), serum is incubated with RBCs of known antigenicity;
Metoprolol (Lopressor) and Betaxolol (Kerlone) are that is, RBCs with known reference values from
cardio selective beta-1 receptors blockers indicated other patient blood samples. If agglutination occurs,
for the treatment of hypertension. the indirect Coombs test is positive.

787.(c) A positive Comb’s Test helps to identify With prolonged methyldopa therapy, 10 to 20
hemolytic anemia associated with Methyldopa. percent of patients develop a positive direct
Coombs test which usually occurs between 6 and 12
A Coombs test is a clinical blood test used in months of methyldopa therapy.
immunology. There are two types:
Prior existence or development of a positive direct
1. The Direct Coombs Coombs test is not in itself a contraindication to use
2. The Indirect Coombs Test of methyldopa. If a positive Coombs test develops
during methyldopa therapy, the physician should
determine whether hemolytic anemia exists and

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