Showing papers on "Phlebotomy published in 1986"

Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements.

Abstract: Although anemia is a frequently observed complication of phlebotomies for laboratory tests in neonates, this problem has received little attention in adult populations. We analyzed the phlebotomy records of 100 hospitalized patients and found that 50 patients who spent all of their hospitalization in general wards had blood samples drawn an average of 1.1 times a day. A mean volume of 12.4 ml a day was drawn, and the total volume drawn during their entire hospitalization was 175.0 ml. In contrast, 50 patients who spent part or all of their hospitalization in an intensive care unit were phlebotomized a mean of 3.4 times a day, for a mean volume of 41.5 ml of blood drawn a day and a total volume of 762.2 ml. Patients in the intensive care unit who had arterial lines had more blood drawn (944.0 ml), more often (4.0 times a day), than patients in the intensive care unit who did not have such lines (300.9 ml; 1.9 times a day). Of 36 patients who received transfusions, 17 (47 percent) had large losses from phlebotomy (greater than 180 ml of red cells) that contributed to their transfusion requirements. We propose the use of sample tubes of the size used in pediatrics, batching of requests for laboratory tests, and review of the cumulative volume of blood removed from individual patients as approaches to reducing blood loss from phlebotomy.

Iron removal therapy in porphyria cutanea tarda: phlebotomy versus slow subcutaneous desferrioxamine infusion

Abstract: Twenty-five patients with overt clinical and biochemical findings of porphyria cutanea tarda took part in a study comparing intensive phlebotomy with slow subcutaneous desferrioxamine treatment. Fifteen male patients (Group A) had intensive venesection therapy. Ten patients (Group B) with associated diseases (minor thalassemia, cardiovascular impairment, pulmonary tuberculosis or severe liver cirrhosis) received 1.5 g of desferrioxamine by slow subcutaneous infusion using an automatic syringe pump 5 days a week. No patient complained of appreciable side effects. Serum iron, ferritin and uroporphyrins were normalized in all subjects by the end of treatment. The mean time necessary for complete recovery was 13.8 months (range 9-19) and 11.2 months (range 6-14) in Groups A and B, respectively. Liver function significantly improved during and after the treatments in both groups. We conclude that recovery from porphyria cutanea tarda can be achieved equally well using phlebotomy or desferrioxamine subcutaneous infusion. Phlebotomy is easily performed and remains the treatment of choice; slow subcutaneous desferrioxamine treatment, although expensive, is recommended when severe associated diseases contra-indicate venesection.

Immunosuppressive effects of burn injury and nonspecific blood transfusion.

Abstract: Burn injuries and blood transfusions both have been implicated as causes of suppressed immune responses. Skin allograft survival in a burned mouse model was studied to determine the relationships among burn injury, blood transfusion, and phlebotomy before transfusion as they affected immunocompetence. At 7 days after 20% TBSA full-thickness burn injury, allograft skin survival was prolonged compared to nonburned control. When increasing volumes of blood were transfused, allograft survival times decreased accordingly. Phlebotomy before transfusion tended to enhance this response. Similar results were seen at 14 days after burn injury, although phlebotomy before transfusion did not further decrease allograft survival time at 14 days. This study demonstrated that blood transfusions were not additively immunosuppressive over burn injury alone. Increased amounts of transfused blood restore allogeneic responsiveness. Phlebotomy may enhance this response when performed early after burn injury.

Hemochromatosis. Treatment to alleviate injury.

Abstract: The treatment of hemochromatosis by repeated phlebotomy has everything to commend it. It is specific, harmless, and inexpensive. It is logical: the removal from the body of a rapidly regenerating, iron-rich tissue, blood, drains iron from the ironsodden organs where the unmanageable excess has been stored away. There is no excretory channel for unneeded iron; the patient with hemochromatosis who absorbs too much is stuck with it. Logical as phlebotomy therapy may be, we took a long time to put two and two together, try it, and learn how to use it. Since the early 18th century we have known that the blood iron resides in hemoglobin. 1 Hemochromatosis was discovered in 1865, and it was soon perceived that the blood pigment (hemochrome) deposited in the injured organs is iron. 2 Yet, not until 1942, was phlebotomy therapy proposed by Balfour et al, 3 specifically by Paul Hahn, PhD, who

Treatment of chronic hepatic porphyria (PCT)

Abstract: PCT, though largely genetically determined, can nevertheless be favorably influenced by several therapeutic methods and prolonged clinical and laboratory remission can be achieved. Two effective and reliable methods exist - repeated phlebotomy therapy and prolonged low-dose chloroquine. Although the exact mechanism underlying serial phlebotomy is not yet known, this therapy seems to be the most successful at present; it does not provoke serious adverse side effects, and extended remission after only one course can be expected. Chloroquine, about as effective in PCT, can cause acute toxic reactions at the beginning of its administration. However, when this occurs treatment need not be discontinued as no permanent ill-effects result. Both kinds of therapy can be used in the same patient consecutively. Although the data are sparse, a favorable effect of hydroxychloroquine has been noted. It can rapidly normalize urinary excretion of porphyrins in relapsing cases. The results of other methods hitherto recommended (i.e., chelators, AMP, desferrioxamine, metabolic alkalinization, plasmapheresis, etc.) have not been sufficiently evaluated either with regard to effectiveness or side effects. The use of some of these has already been abandoned.

[Quantitative liver function tests in porphyria cutanea tarda: improvement under therapeutic phlebotomy].

Abstract: Quantitative liver function was assessed before and after therapy in 4 patients with porphyria cutanea tarda. Three patients underwent phlebotomy, which produced clinical and biochemical remission. Concomitantly, functional liver cell mass, as measured by galactose elimination capacity, normalized. In the last patient, treated with chloroquine, liver function did not improve during therapy. The aminopyrine breath test, a measure of microsomal function, was inconclusive. These results show that decreased hepatic function in porphyria cutanea tarda is reversible and emphasize the potential role of iron accumulation in the pathogenesis of hepatic dysfunction in porphyria cutanea tarda.