Showing papers on "Phlebotomy published in 1992"

Complications occurring from diagnostic venipuncture.

Abstract: Background Venipuncture is the most common invasive medical procedure performed by health care providers. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. Methods Venipuncture was performed on insurance applicants at their home or place of work. Four thousand fifty venipunctures were performed over a 3-year period. Minor complications were defined as bruising and hematoma at the venipuncture site. Serious complications were defined as cellulitis, phlebitis, diaphoresis, hypotension, near syncope, syncope, and seizure activity. Results Minor bruising and hematoma were fairly common, involving 12.3% of venipunctures, with minor bruising being the most common reaction. Serious complications were observed in 3.4% of patients. Diaphoresis with hypotension occurred in 2.6%. Syncope occurred in less than 1% of patients. There were no serious local reactions such as cellulitis or phlebitis observed in this study. Conclusions Serious complications can occur as a result of venipuncture even when only a small volume of blood is withdrawn; therefore, medical personnel should be prepared to provide appropriate care.

Cardiovascular Responses to Phlebotomy and Sitting in Middle-aged and Elderly Subjects

Abstract: Background.— Responding appropriately to hypotensive challenges is an important determinant of health and functional independence in elderly individuals. Cardiovascular responses to phlebotomy and postural change were evaluated using a large database developed in a study designed to establish the safety of blood donation by older individuals. Methods.— The groups studied included 464 subjects aged 65 years and younger (range, 52 to 65 years) and 532 subjects more than 65 years old (range, 66 to 78 years old). Blood pressure and pulse rate measurements were followed by the withdrawal of 500 mL of blood. These measurements were repeated, first in the supine and then in the sitting position. Results.— Nearly all individuals studied remained hemodynamically stable after these two challenges. Age was not an independent predictor of blood pressure change after either phlebotomy or postural change. Large decreases in diastolic blood pressure were equally rare in both age groups. However, more older subjects (15.2%) exhibited a decline of 20 mm Hg or more in systolic blood pressure following phlebotomy, compared with the middle-aged group (6.9%). These age-related differences did not persist after controlling for the higher initial systolic blood pressures observed in the older subjects. Postphlebotomy postural change to the sitting position had little additional effect. Conclusions.— These results indicate that the ability to respond to hypovolemia and postural change remains relatively intact in healthy elderly individuals. The higher prevalence of a significant drop in systolic blood pressure after phlebotomy, orthostasis, and possibly other homeostatic challenges in older subjects is probably due to the presence of higher basal blood pressure readings, including hypertension. In spite of these differences, blood donation is appropriate and should be encouraged in healthy elderly individuals in this age group. (Arch Intern Med.1992;152:366-370)

Primary hemochromatosis in children: report of three newly diagnosed cases and review of the pediatric literature.

Abstract: Hereditary hemochromatosis was diagnosed in three asymptomatic siblings following the unexpected finding of elevated serum iron concentrations. This diagnosis was confirmed by hepatic biopsy. Repeated phlebotomies resulted in a significant decline of serum iron and ferritin concentrations and a decrease of hepatic iron content. This report and a review of the literature indicate that the diagnosis of hereditary hemochromatosis must be considered more frequently in childhood. Organ dysfunction from iron overload may be minimized in children by the early commencement of regular phlebotomy.

The effect of phlebotomy on serum erythropoietin levels in normal healthy subjects.

Abstract: We evaluated endogenous serum erythropoietin (Epo) levels in 14 normal subjects (eight males and six females) after a single 400-ml phlebotomy. The subjects were followed up for 56 days. The hemoglobin (Hb) values of both males and females decreased to a nadir on days 3 to 7 post-phlebotomy. Hb values gradually increased, but did not completely recover to pre-phlebotomy levels by day 56. Serum Epo levels increased after 6 h post-phlebotomy, to 20.1 +/- 5.4 (mU/ml) in males and 20.7 +/- 7.0 in females, from the pre-phlebotomy levels of 14.6 +/- 4.0 in males and 13.4 +/- 4.1 in females, respectively. Epo levels continued to increase to peak levels of 25.5 +/- 6.3 in males and 28.7 +/- 11.5 in females on days 7 to 14 and thereafter decreased until day 56. Thus, the Epo response to a 400-ml phlebotomy was relatively small in magnitude and was not sufficient to initiate a significant increase in erythropoiesis. This finding suggests that the administration of recombinant human erythropoietin (rHu-Epo) may be effective for the prompt correction of anemia induced by autologous blood donation and for increasing the volume of predonated autologous blood.

Nonpharmacokinetic Clinical Factors Affecting Aminoglycoside Therapeutic Precision

Abstract: A Monte Carlo simulation study evaluated the effects of a simulated ‘good’ or ‘poor’ ward care setting, pharmacy, laboratory and phlebotomy service on the resulting precision of control of serum tobramycin concentrations in a representative (theoretical) patient receiving the drug. The ward care (precise dose administration and recording of times given) and the pharmacy (precise dosage preparation) played significant roles in achieving precise serum concentrations whereas laboratory (assay precision) and the phlebotomy service (precise labelling of blood specimen times) were considerably less important. However, use of a simulated ‘smart’ infusion pump contributed most to therapeutic precision.

Phlebotomy practices/needles stick injuries/hepatitis B status/among interns in a Dublin hospital.

Abstract: Needlestick injury is the most important risk event for human immunodeficiency virus (HIV) and hepatitis B Virus (HBV) transmission to health-care workers We examined phlebotomy practices, the frequency of needle stick injuries, the reporting of such injuries and hepatitis B status among interns in St James's Hospital during a six month period This study took the form of a questionnaire The response rate was 100% 72% had at least one needlestick injury during this time period, 23% had injuries from known HIV sero-positive or hepatitis B surface antigen positive patients, less than 5% of all injuries were reported and only 41% of interns were definitely hepatitis B immune The majority (77%) resheated needles by hand

Case 39-1992

Abstract: Presentation of Case A 49-year-old woman was admitted to the hospital because of severe abdominal pain, vomiting, and weight loss. The patient was well until six years earlier, when splenomegaly was found. The hematocrit ranged up to 55.1 percent, the white-cell count to 11,500 ( 11.5× 109 per liter), and the platelet count to 717,000 (717×109 per liter). A nephrotomographic examination and echocardiographic study were negative. A diagnosis of polycythemia vera was made; phlebotomy was performed on three occasions, and the hematocrit thereafter remained normal. Five years before admission alopecia developed. One year later the patient began to experience progressive . . .

Treatment of proximal aortic hypertension after thoracic aortic cross-clamping in dogs. Phlebotomy versus sodium nitroprusside/isoflurane.

Abstract: Thoracic aortic cross-clamping causes proximal aortic hypertension. Theoretically, the method used to treat hypertension can influence spinal cord perfusion pressure and neurologic outcome. Phlebotomy was compared to sodium nitroprusside/isoflurane in terms of ability to treat increased proximal mean aortic pressure (MAPp) after thoracic aortic cross-clamping in dogs. Dogs were assigned randomly to one of three groups depending on the method used to treat hypertension after cross clamping: 1) phlebotomy (n = 10); 2) sodium nitroprusside/isoflurane (n = 11); and 3) control (no treatment) (n = 8). In each dog, anesthesia was maintained with isoflurane in oxygen, 1.4% end-tidal. The thoracic aorta was occluded 2.5 cm distal to the left subclavian artery for 50 min and then was released. Hemodynamics, cerebrospinal fluid pressure (CSFP), and regional blood flows by the radioactive microsphere technique, were measured at 1) baseline; 2) 2 min after aortic cross-clamping; 3) after treatment of proximal aortic hypertension; 4) 5 min after aortic unclamping; and 5) 30 min after resuscitation. At 24 h, a neurologic assessment was performed. Thoracic aortic cross-clamping increased MAPp, decreased distal MAP (MAPd), and reduced lumbar spinal cord perfusion pressure (SCPP1), [SCPP1 = MAPd - CSFP], in all three groups. Control of increased MAPp necessitated removal of 36 ± 9 ml/kg of blood in the phlebotomy group. In the sodium nitroprusside/isoflurane group, sodium nitroprusside (16 μg·kg-1. min-1) was infused and end-tidal isoflurane concentration increased to 2.5 ± 0.7%, restoring MAPp to baseline level. After treatment of increased MAPp in the phlebotomy and sodium nitroprusside/isoflurane groups and nontreatment in controls, SCPP1 was similar in the control and phlebotomy groups (7 ± 3 vs. 5 ± 6 mmHg) but significantly lower in the sodium nitroprusside/isoflurane group (–12 ± 5 mmHg, P = 0.04; group X time interaction). The uniformly negative SCPP1 after sodium nitroprusside/isoflurane was associated with significant increases in total cerebral blood flow, cervical spinal cord blood flow, and CSFP. In contrast, phlebotomy decreased central venous pressure and, secondarily, CSFP, without changing cerebral blood flow or cervical spinal cord blood flow. The intergroup differences in SCPP1 were not associated with measurable differences in lumbar spinal cord blood flow. After aortic unclamping, lumbar spinal cord blood flow exhibited a hyperemic response in all three groups. Higher MAPd in the control group during the period of aortic cross-clamping was associated with significantly more favorable acid-base status immediately after unclamping. Twenty-five dogs survived for 24 h. Eight of eight dogs in the sodium nitroprusside/isoflurane group and seven of eight in the control group had spastic paraplegia. In the phlebotomy group, three of nine dogs could walk. Neurologic outcome did not differ significantly between groups. In this experimental model (50 min of thoracic aortic cross-clamping in isoflurane-anesthetized dogs), the method of treating proximal aortic hypertension did not significantly influence either lumbar spinal cord blood flow or neurologic outcome.

Phlebotomy for Erythropoietin-Induced Malignant Hypertension

Abstract: Four patients on regular dialysis treatment whose blood pressure was well controlled, developed malignant hypertension while receiving maintenance recombinant human erythropoietin (r-Hu-EPO). None of these patients had a haematocrit greater than 35% at any stage, and clinically, none had any evidence of fluid overload. Initially, they were all managed by stopping r-Hu-EPO and intensification of antihypertensive therapy. However, none of the patients responded, and venesection of 500 ml of blood was performed in each case with swift and sustained response.

A double stopcock technique for repeated sampling of venous blood.

Abstract: Repeated sampling for measurement of venous blood levels of hemoglobin, hematocrit, plasma hemoglobin, potassium and ibuprofen with a novel method of phlebotomy, the double stopcock technique (DST), was compared to heparin lock (HPL), Angiocath with obturator (AOB) and direct venipuncture (DVP) techniques. There were 12 normal subjects in this randomized, three-way crossover trial. During each portion of the crossover, simultaneous samples for hemoglobin, hematocrit, plasma hemoglobin, potassium and ibuprofen were taken from each phlebotomy site prior to and after oral dosing with 400 mg ibuprofen. The DST was the best acceptable method based on the assessment of comfort by the subjects, followed by the AOB, HPL and DVP techniques. The least amount of blood waste was with the DST. The degree of hemolysis (as shown by plasma hemoglobin and potassium) was comparable across all techniques. Across all of the techniques, measurement of hemoglobin, hematocrit and ibuprofen levels using DST, HPL and AOB yielded lower levels than DVP. These changes were small and were not clinically significant, although statistically significant in some cases. The authors conclude that when there is need for frequent, rapid and repetitive venous blood sampling with minimal blood wastage and patient discomfort, the DST should be considered.

Phlebotomy for polycythemia associated with acquired cystic renal disease in a patient on hemodialysis.

Abstract: Fernando Liaño, MD, Department of Nephrology, Hospital Ramón y Cajal, Carr. Colmenar, Km. 9,100, E-28034 Madrid (Spain), Dear Sir, Human erythropoietin (EPO) deficiency is considered a decisive factor in the development of anemia of chronic renal failure [1]. The presence of normal hemoglobin (Hb) and hematocrit (Ht) levels is not frequent in patients on hemodialysis [2] and levels above the normal range are exceedingly rare, usually associated with policythemia vera, lung or liver disease, malignant tumors, nephroan-giosclerosis and acquired cystic kidney disease (ACKD) [1,3-5]. We report a patient on hemodialysis who developed ACKD and polycythemia who needed phlebotomy to mantain Ht levels within an adequate range. A 61-year-old male nonsmoker presented in June 1980 with hypertension, edema, heavy proteinuria and microscopic hematuria. Renal biopsy showed advanced glomerular sclerosis and interstitial fibrosis with angio-sclerosis at the small vessel level. Renal size and outline were normal on tomography. Several months later, terminal renal failure made periodic hemodialysis necessary. Hb was 10.1 g/dl and Ht 30.3%. Bone marrow aspirate showed alterations compatible with anemia secondary to chronic renal failure. During the next years, the patient did well on our hemodialysis program except for several episodes of supraventricular tachycardia finally diagnosed as Wolff-Parkinson-White syndrome. In October 1989, he suffered the breaking of his arterio-venous fistula due to local infection. In January 1990, Hb was 16.5 g/dl and Ht 54%, and a therapeutic phlebotomy (400 ml) was indicated. Since August 1990, Hb has been between 15 and 17 g/dl and Ht between 48 and 50%. Liver and pulmonary function tests were normal, as was α-fetoprotein and carcinoem-bryonic antigen. Abdominal computed tomography showed bilateral renal cysts and he was diagnosed having ACKD. Serum EPO levels were progressively elevated (fig. 1). In an attempt to lower them, oral theophylline (400 mg/day) was started, but intense headache obliged us to withdraw this drug. In December 1990, Hb was 18.5 g/dl and Ht 56.5%, and therapeutic phlebotomy was necessary. The hematologic evolution is depicted in figure 1. During the first 10 years on periodic hemodialysis, our patient maintained Hb levels below normal values, as it is the rule in these populations [2]. In the last 2 years, slow but progressive Ht elevation was noted and finally, exceedingly high Ht levels required therapeutic phlebotomy. Extrarenal causes of erythrocytosis were excluded, and high EPO levels

Phlebotomy practices/needles stick injuries/hepatitis B status/among interns in a Dublin hospital

Abstract: Needlestick injury is the most important risk event for human immunodeficiency virus (HIV) and hepatitis B Virus (HBV) transmission to health-care workers. We examined phlebotomy practices, the frequency of needle stick injuries, the reporting of such injuries and hepatitis B status among interns in St James's Hospital during a six month period. This study took the form of a questionnaire. The response rate was 100%. 72% had at least one needlestick injury during this time period, 23% had injuries from known HIV sero-positive or hepatitis B surface antigen positive patients, less than 5% of all injuries were reported and only 41% of interns were definitely hepatitis B immune. The majority (77%) resheated needles by hand.

Transient erythrocytosis (primary polycythaemia) in a dog

Abstract: The clinical findings in a dog with transient erythrocytosis (primary polycythaemia) are described. The dog was initially presented for neurological signs induced by exercise. The diagnosis was based on PCV (74%), clinically normal hydration, normal arterial blood gas determination, and exclusion of reported causes of secondary polycythaemia. Serum erythropoietin concentration was normal. Phlebotomy decreased the PCV to 45%. During the next 18 months, the PCV remained in the normal range without further treatment, and there was no recurrence of clinical signs.