Showing papers on "Phlebotomy published in 1998"

Management of hemochromatosis. Hemochromatosis Management Working Group.

Abstract: The complications of iron overload in hemochromatosis can be avoided by early diagnosis and appropriate management. Therapeutic phlebotomy is used to remove excess iron and maintain low normal body iron stores, and it should be initiated in men with serum ferritin levels of 300 microg/L or more and in women with serum ferritin levels of 200 microg/L or more, regardless of the presence or absence of symptoms. Typically, therapeutic phlebotomy consists of 1) removal of 1 unit (450 to 500 mL) of blood weekly until the serum ferritin level is 10 to 20 microg/L and 2) maintenance of the serum ferritin level at 50 microg/L or less thereafter by periodic removal of blood. Hyperferritinemia attributable to iron overload is resolved by therapeutic phlebotomy. When applied before iron overload becomes severe, this treatment also prevents complications of iron overload, including hepatic cirrhosis, primary liver cancer, diabetes mellitus, hypogonadotrophic hypogonadism, joint disease, and cardiomyopathy. In patients with established iron overload disease, weakness, fatigue, increased hepatic enzyme concentrations, right upper quadrant pain, and hyperpigmentation are often substantially alleviated by therapeutic phlebotomy. Patients with liver disease, joint disease, diabetes mellitus and other endocrinopathic abnormalities, and cardiac abnormalities often require additional, specific management. Dietary management of hemochromatosis includes avoidance of medicinal iron, mineral supplements, excess vitamin C, and uncooked seafoods. This can reduce the rate of iron reaccumulation; reduce retention of nonferrous metals; and help reduce complications of liver disease, diabetes mellitus, and Vibrio infection. This comprehensive approach to the management of hemochromatosis can decrease the frequency and severity of iron overload, improve quality of life, and increase longevity.

Management of hemochromatosis

Abstract: The complications of iron overload in hemochromatosis can be avoided by early diagnosis and appropriate management.Therapeutic phlebotomy is used to remove excess iron and maintain low normal body ...

Variations in Transfusion Practice in Neonatal Intensive Care

Abstract: Objective. To compare the transfusion practices between two neonatal intensive care units (NICUs) to assess the impact of local practice styles on the timing, number, and total volume of packed red cell transfusions in very low birth weight infants. To derive multivariate models to describe practice and to identify potential areas for improvement in the future. Methodology. We reviewed phlebotomy losses and transfusion rates between two NICUs (A and B) for 270 consecutive admissions of birth weight <1500 g. We stratified for birth weight and for illness severity by the Score for Neonatal Acute Physiology (SNAP). Measures of short-term outcome were compared. We derived multivariate models to describe and compare the practices in the two NICUs. Results. Patients in NICU A had smaller phlebotomy losses than those in NICU B. A lower percentage of the patients in NICU A (65% vs 87%) received transfusions, but they tended to receive a greater total volume per kg per patient (67 mL/kg vs 54.8 mL/kg). Transfusion timing differed between the NICUs; in NICU A only approximately one-half of their transfusions occurred in the first 2 weeks, whereas in NICU B almost 70% of the transfusions were given in this time period. Multivariate models showed that phlebotomy losses were significantly related to lower gestational age (GA) and higher SNAP. Hospitalization in NICU B resulted in 10.7 cc of additional losses relative to NICU A for a comparable GA and illness severity score. The volume of blood transfused per kilogram of body weight was a function of GA, SNAP, and hospital. Care practices in NICU A added an additional 19 cc of transfused volume in the first 14 days of life, and an additional 26 cc thereafter when adjusted for GA and SNAP. These differences in phlebotomy and transfusion were not associated with differences in the days of oxygen therapy or mechanical ventilation, the oxygen requirement at 28 days, the incidence of chronic lung disease, or the rate of growth by day 28. Conclusions. We identified significant differences in phlebotomy and transfusion practices between two NICUs. We found no differences in short-term outcome, suggesting that the additional use of blood in one of the NICUs was discretionary rather than necessary. Our multivariate models can be used to characterize and quantify transfusion and phlebotomy practices. By predicting which patients are likely to require multiple transfusions, clinicians can target patients for erythropoietin therapy and identify those patients for whom donor exposure can be reduced by a unit of blood for multiple use. The models may help in monitoring changes in practice as they occur.

Effect of Phlebotomy on Plasma Glucose and Insulin Concentrations

Abstract: Two recent reports in Diabetes Care (1,2) showed that iron stores, as assessed by serum ferritin concentration (3), are associated with plasma glucose and insulin concentrations, i.e., the greater the serum ferritin concentration, the greater the plasma glucose and insulin concentrations. Greater plasma glucose and insulin concentrations indicate a more severe degree of insulin resistance (4). Complementary findings were described by Moirand et al. (5), who detected a high prevalence of insulin-resistant states such as obesity, glucose intolerance, and type 2 diabetes in individuals with normal to high iron stores but without the genetic traits of hemochromatosis. In this context, it is possible that insulin-resistant individuals might have a tendency to synthesize more ferritin and/or to accumulate more iron. However, this hypothesis is not supported by studies in polytransfused thalassemic children, who eventually become severely insulin resistant (6), or by findings in Sprague-Dawley rats, in which progressive iron depletion enhances, in a dose-dependent fashion, insulin-mediated glucose uptake (7,8). Thus, the alternative hypothesis is that iron excess or even sufficiency might worsen glucose tolerance, whereas iron deficiency or lowering should induce the opposite phenomenon.

Phlebotomy teams reduce blood-culture contamination rate and save money.

Abstract: Objective To determine the extent of resource utilization due to contaminated blood cultures. Design Case-control retrospective analysis. Twenty-three patients who had contaminated blood cultures were matched by age, underlying diseases, and discharge diagnoses with 23 patients who had negative blood cultures. Setting St Luke's Medical Center, a community teaching hospital in Cleveland, Ohio. The phlebotomy team was eliminated in November 1993 to reduce the costs. Results Blood cultures drawn by the phlebotomy team had a lower contamination rate compared with those drawn by nonphlebotomists (2.6% vs 5.6%). Patients with contaminated blood cultures were compared to those with negative blood cultures. The following parameters were found to be statistically significant: total hospital length of stay (LOS; 13.9 vs 5.5 days; P = .002), postculture LOS (8.9 vs 4.6; P = .01), postculture number of days on antibiotics (5.9 vs 2.9; P = .03), vancomycin use (9 vs 2 patients; P = .03), postculture cost of antibiotics ($762 vs $121; P = .004), and postculture hospital cost per patient ($10,515 vs $4,213; P = .001). Conclusions This study demonstrated a substantial increase in resource utilization in our hospital due to contaminated blood cultures. The reinstitution of a phlebotomy team could be a cost-effective solution with savings between $950,000 and $1.5 million per year for our hospital.

Evaluation of cardiac status in iron‐loaded thalassaemia patients following bone marrow transplantation: improvement in cardiac function during reduction in body iron burden

Abstract: Iron-induced cardiac disease is the primary cause of death in transfused patients with thalassaemia major. The beneficial effects of deferoxamine mesylate on clinical cardiac disease have been well described but the impact of therapy on subclinical cardiac dysfunction is unknown. To assess the reversibility of subclinical cardiac dysfunction we studied the cardiac status during iron depletion treatment (phlebotomy) in iron overloaded patients, cured of thalassaemia by marrow transplantation, without clinical manifestation of heart failure but with alteration in both left ventricular diastolic function and in contractility property. 32 patients were studied and demonstrated a slight but significant impairment in the morphology and function if compared with matched normal controls. 17 of these patients were submitted to sequential echocardiographic evaluations during the phlebotomy programme. Following completion of the programme, normalization of the indices of contractility and normalization of diastolic function were observed. This study indicates that transplanted thalassaemia patients with subclinical left ventricular diastolic dysfunction and impaired left ventricular contractility may reverse these processes with an effective regimen of iron reduction such as phlebotomy.

Treatment of Iron Overload in the “Ex-Thalassemic”: Report from the Phlebotomy Programa

Abstract: After successful marrow transplantation (BMT) iron overload remains an important cause of morbidity in Thalassemia. After BMT, patients have normal erythropoiesis capable of producing a hyperplastic response to phlebotomy so that this procedure can be contemplated as a method of mobilizing iron from overloaded tissues. Forty-one patients (mean age 16 +/- 2.9 years) with prolonged follow-up (range 2-7 years) after BMT were submitted to a moderate intensity phlebotomy program (6 ml/kg blood withdrawal at 14-day intervals) to reduce iron overload. Values are expressed as mean +/- SD or as median with a range (25th-75th percentile). Serum ferritin decreased from 2,587 (2,129-4,817) to 280 (132-920) micrograms/l (p < 0.0001), total transferrin increased from 2.34 +/- 0.37 to 2.9 +/- 0.66 g/l (p = 0.0001), transferrin saturation decreased from 90% +/- 14% to 39% +/- 34% (p < 0.0001). Liver iron concentration evaluated on liver biopsy specimens decreased from 20.8 (15.5-28.1) to 3 (0.9-14.6) mg/g dry weight (p < 0.0001). Alanine amino-transaminase from 5.2 +/- 3.4 to 1.6 +/- 1.2 (p < 0.0001) times the upper level of normality. The histological grading for chronic hepatitis (Histology Activity Index) decreased from 4.2 +/- 2.4 to 2.3 +/- 1.8 (p < 0.0001). Phlebotomy is a safe, efficient, and widely applicable method to decrease iron overload in "ex-thalassemic."

Accidental Needlesticks in the Phlebotomy Service of the Department of Laboratory Medicine and Pathology at Mayo Clinic Rochester

Abstract: Objective To determine the change in accidental needlestick rates in the Phlebotomy Service at Mayo Clinic Rochester and to identify safety practices implemented from 1983 through 1996. Material and Methods We retrospectively reviewed yearly Phlebotomy Service accidental needlestick rates from 1983 through 1996. Interviews were conducted with representatives of the Infection Control Committee and the management team for the Phlebotomy Service, and minutes of meetings of these two groups were reviewed to identify implemented safety improvements that may have had an effect on accidental needlestick exposures. Results Accidental needlestick exposures in the Phlebotomy Service declined from a high of 1.5/10,000 venipunctures to 0.2/10,000 venipunctures. Several safety improvements were made during that time, including the implementation of a one-handed recapping block, change to single-use evacuated tube holders, increased number and improved locations of disposal containers for needles, implementation of resheathing needles and retractable capillary puncture devices, discontinuation of the practice of changing needles before inoculation of blood culture bottles, increased emphasis on safety for new and experienced phlebotomists, and improved exposure reporting tools. Conclusion We believe that the decrease in our accidental needlestick exposure rate is correlated with the changes in education, practices, and products that we have implemented.

Role of iron in the natural history and clinical course of hepatitis C disease.

Abstract: The following review evaluates the current data implicating a role for hepatic iron in enhancing the liver injury in patients with chronic hepatitis C infection. Iron removal lowers transaminases, but doesn't appear to improve responsiveness to interferon-alpha therapy. An important effect of iron removal might be to delay progression of liver injury to fibrosis and cirrhosis. Until such a hypothesis is disproven, phlebotomy therapy for even mildly iron-loaded HCV patients is recommended.

Effect of enalapril on exaggerated erythropoietin response to phlebotomy in erythrocytosic renal transplant patients.

Abstract: graft recipients with normal renal function and can Background. Exaggerated erythropoietin ( EPO) res- result in serious thromboembolic complications [1]. In ponse to phlebotomy regardless of the baseline EPO contrast to the well-known clinical features of postlevels have been shown in patients with post-transplant transplant erythrocytosis (PTE ), the pathogenesis is erythrocytosis (PTE ) and administration of angio- still vague. Although some authors suggested that it is tensin-converting enzyme inhibitors (ACE-I ) seems to due to elevated serum erythropoietin (EPO) levels of be eVective in controlling PTE. However, the mechan- either native kidney or allograft origin [2‐5], PTE can ism of this ACE-I induced reduction in haematocrit occur with low or undetectable levels of serum EPO (Hct) is not well known. Although some authors have [6,7]. Although baseline plasma EPO levels are highly suggested that ACE-I may reduce EPO secretion, this variable, exaggerated EPO response to phlebotomy, is still controversial. The aim of the present study was regardless of the baseline EPO levels have been shown to assess the eVect of a single dose ACE-I on exagger- in patients with PTE [8]. ated EPO response to phlebotomy. PTE was originally treated with repeated phlebotMethods. In this study, we compared serum EPO and omy, later it was found that medical treatment with renin (PRA) levels of 10 PTE patients, 10 non-PTE angiotensin-converting enzyme inhibitors (ACE-I ) also patients and 10 healthy blood donors before and after had a beneficial eVect [9]. Although its mechanism(s) phlebotomy. The eVects of a single dose of ACE-I of action are not completely known, it has been (enalapril, 5 mg p.o.) in PTE patients were also evalu- suggested that this eVect of ACE-I could be related to ated in the second phlebotomy. the known property of angiotensin II to stimulate EPO Results. While the mean basal serum EPO level was production, so that, conceivably, ACE-I would depress significantly higher in the PTE group than the other EPO release [10,11]. On the other hand, eVective two groups (P<0.01), the mean basal PRA levels did therapy of PTE with ACE-I has not been accompanied not diVer significantly between these groups. Serum by a decline in serum EPO levels in some patients, EPO and PRA levels increased significantly after the while ACE-I also eVectively reduced haematocrit (Hct) phlebotomy (P<0.001) and exaggerated EPO response levels in PTE patients with undetectable EPO levels as to phlebotomy was suppressed by single dose enalapril in those with higher levels, suggesting that ACE-I may (P<0.001) in the PTE patients. Conclusion. The present study has shown that the reduce Hct levels by other than through reduction of renin‐angiotensin system plays an important role in serum EPO mechanisms [12,13]. EPO formation and the Hct lowering eVect of the Most published studies have shown that serum EPO ACE-I is through reduction of EPO in PTE patients. levels and the relationship between ACE-I and serum EPO levels were highly variable in patients with PTE.

Primary polycythaemia vera in the elderly

Abstract: We present an 86-years-old woman's case with paralysis in her left hand of abrupt apparition, accompanied by arterial hypertension and dizziness. The investigation revealed erythrocytosis, leukocytosis, thrombocytosis, with normal arterial O2 saturation (O2 SAT), increased of his red cell volume and blood viscosity. The polycythaemia vera (PV) was diagnose and the paralysis disappeared, when 24 hours before a phlebotomy was practiced, and the function was recovered by the hand. We analysed the presents diagnostics criteria of the disease defined by Polycythaemia Vera Study Group (PVSG). The different treatments for PV are discussed; in addition to venesection, conventional treatment include chemotherapy with hydroxyurea and pipobroman, as well as the erythropheresis, -interferon and aspirin. All of the treatments are associated with complications; thrombotic in the case of phlebotomy; malignancies and gastrointestinal bleeding in the case of myelosuppressive treatments and aspirin. We think the optimal treatment for PV is a judicious combination of the available alternatives, depending on the phase of the disease, and the age of the patient.

Four indefensible phlebotomy errors and how to prevent them

Abstract: The author identifies four errors in phlebotomy that are effectively indefensible in a court of law: patient misidentification, improper angle of insertion, improper vein selection, and ineffective training and evaluation of those performing venipunctures. Strategies to avoid these errors include the implementation and enforcement of specific administrative and procedural policies. A side bar on the "Ten Commandments of Phlebotomy Liability" accompanies this article.

Handbook of Phlebotomy and Patient Service Techniques

Abstract: This concise book is designed to train students in phlebotomy. The updated text incorporates information which helps the phlebotomist become a patient service technician, moving them away from the laboratory setting and into bedside health care. By providing information on "multi-skill" training, the text helps prepare students for future responsibilities.

Medicinal composition for treating liver disease

Abstract: PROBLEM TO BE SOLVED: To obtain the subject composition capable of accelerating release of iron from a liver cell, lowering excess iron ion in the liver and improving liver function of patients of liver disease such as chronic hepatitis, liver cancer or hepatocirrhosis thereby by including erithropoietin as an active ingredient. SOLUTION: This composition contains erithropoietin [e.g. natural erithropoietin obtained from human urine or recombinant erithropoietin (modifier)] as an active ingredient. Furthermore, administration of the composition is preferably carried out by combinedly using a phlebotomy therapy. For example, phlebotomy in an amount of about 200ml/time is applied to a patient and then, the composition in an amount of 10-2,000 unit/kg weight based on recombinant erithropoietin is administered to the patient. Thereby, anemia of the patient accompanied by phlebotomy is prevented and excretion of excess iron ion from the liver cell can be promoted.

[Septic phlebitis: origin of severe septic condition].

Abstract: We report two patients, an 82 years old female and a 71 years old male, who had a severe sepsis with positive blood cultures for Staphylococcus aureus and a superficial phlebitis as the only probable focus. In both the diagnosis of septic phlebitis was reached and an emergency phlebotomy was performed under local anesthesia. The clinical response was satisfactory and the pathological examination of excised veins showed an acute exudative leukocytic thrombophlebitis.