Showing papers on "Phlebotomy published in 2004"

The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health.

Abstract: The decrease in cardiovascular death rates in the United States has been slower in blacks than whites, especially in patients <65 years of age. The Dallas Heart Study was designed as a single-site, multiethnic, population-based probability sample to (1) produce unbiased population estimates of biologic and social variables that pinpoint ethnic differences in cardiovascular health at the community level and (2) support hypothesis-driven research on the mechanisms causing these differences using genetics, advanced imaging modalities, social sciences, and clinical research center methods. A probability-based sample of Dallas County residents aged 18 to 65 years was surveyed with an extensive household health interview. The subset of participants 30 to 65 years of age provided in-home fasting blood and urine samples and underwent multiple imaging studies, including cardiac magnetic resonance imaging and electron beam computed tomography. Completed interviews were obtained for 6,101 subjects (54% black), phlebotomy visits for 3,398 (52% black), and clinic visits for 2,971 (50% black). Participation rates were 80.4% for interviews, 75.1% for phlebotomy visits, and 87.4% for clinic visits. Weighted population estimates of many measured variables agreed closely with those of the United States census and were relatively stable from the interview sample to the phlebotomy and clinic subsamples. Thus, the Dallas Heart Study provides a phenotypically well-characterized probability sample for multidisciplinary research that will be used to improve the mechanistic understanding and prevention of cardiovascular disease, especially in black Americans.

A significant reduction in serum alanine aminotransferase levels after 3-month iron reduction therapy for chronic hepatitis C: a multicenter, prospective, randomized, controlled trial in Japan

Abstract: Background Increasing evidence indicates that iron cytotoxicity plays an important role in the pathogenesis of chronic hepatitis C (CHC). However, the biochemical effects of iron reduction therapy on CHC remain to be confirmed in a controlled study. This study aimed to test whether iron removal by repeated phlebotomy improves serum alanine aminotransferase (ALT) levels in patients with CHC.

Phlebotomy in the intensive care unit: strategies for blood conservation.

Abstract: The quality and economy of critical care could both be improved if blood losses due to phlebotomy and sampling from indwelling catheters for unnecessary diagnostic testing were curtailed. Practice guidelines can help to break bad diagnostic 'habits', such as fever work-ups that require substantial blood to be drawn yet typically yield little useful information. Invasive hemodynamic monitoring is associated with morbidity due to blood loss as well as infection, and newer noninvasive technologies should be encouraged. Several devices allow blood that would otherwise be wasted during sampling to be returned to the patient aseptically. Point-of-care testing uses microliter quantities of blood, has acceptable precision, and can provide valuable diagnostic information while being minimally invasive.

Serum TSH variability in normal individuals: the influence of time of sample collection.

Abstract: Difficulty in treatment decisions can arise when TSH levels measured on the same patient on the same day but at different times show considerable variability. This study was a prospective, observational evaluation of 100 consecutive adult patients who had serum TSH tests ordered by attending physicians at an outpatient clinic. Early morning fasting serum TSH levels were compared to late morning non-fasting serum TSH levels in the same patients on the same day The late morning non-fasting TSH tests declined in 97 of 100 subjects by an average of 26.39% when compared to early morning, fasting, TSH test results. This lead to reclassification of 6% of patients from presumptive subclinical hypothyroidism to "normal." Since the time of day of phlebotomy or the fasting or non-fasting status of the patient, or both, can significantly affect serum TSH test results, the diagnosis of subclinical hypothyroidism should not be made only on a fasting TSH measurement. Further studies are needed to determine the independent effects of the time of phlebotomy and fasting/non-fasting status on TSH levels.

Pharmacokinetic tracer kinetics analysis of changes in erythropoietin receptor population in phlebotomy-induced anemia and bone marrow ablation.

Abstract: Objectives The objective was to study in vivo erythropoietin (Epo) progenitor cell surface receptors (EpoR) in the bone marrow (BM) after phlebotomy and bone marrow ablation. Methods Serial tracer interaction method experiments were conducted in adult sheep at baseline and after phlebotomy (PH) and ablation (AB). PH was done 10 days after phlebotomy (to 3-4 g/dl Hb), and the AB was done 8 days after a 3-day oral treatment with bulsulfan (11 mg/kg/day). Results Bone marrow ablation changed the elimination from non-linear to linear, consistent with an abolition of the non-linear elimination via BM EpoRs. The phlebotomy increased the linear clearance of the ablated elimination pathway (from 63.6+/-12 to 126+/-64 ml/h/kg), consistent with an up-regulation of the erythroid progenitor BM-based EpoR pool, but did not change the clearance of the non-ablated elimination pathway (p>0.05). The EpoR pool size remaining after BM ablation was 7.4+/-2.7% of the pre-ablation pool. Conclusions Erythropoietin elimination via EpoR in the bone marrow was non-linear and increased following phlebotomy-induced anemia. This is consistent with an up-regulation of the erythropoietic EpoR pool in BM. Assuming that the elimination of Epo after BM ablation was via non-hematopoietic EpoR, then this post-ablation EpoR population was not significantly up-regulated by the phlebotomy.

Increased DMT1 but not IREG1 or HFE mRNA following iron depletion therapy in hereditary haemochromatosis

Abstract: Background and aims: While upregulation of divalent metal transporter 1 (DMT1) and iron regulated gene 1 (IREG1) within duodenal enterocytes is reported in patients with hereditary haemochromatosis (HH), these findings are controversial. Furthermore, the effect of HFE, the gene mutated in HH, on expression of these molecules is unclear. This study examines duodenal expression of these three molecules in HH patients (prior to and following phlebotomy), in patients with iron deficiency (ID), and in controls. Methods: DMT1, IREG1, and HFE mRNA were measured in duodenal tissue of C282Y homozygous HH patients, in ID patients negative for the C282Y mutation with a serum ferritin concentration less than 20 μg/l, and in controls negative for C282Y and H63D mutations with normal iron indices, using real time polymerase chain reaction. Results: DMT1 and IREG1 mRNA levels were not significantly different in non-phlebotomised (untreated) HH patients compared with controls. DMT1 expression was significantly increased in HH patients who had undergone phlebotomy therapy (treated) and in patients with ID compared with controls. IREG1 was significantly increased in ID patients relative to controls, and while IREG1 expression was 1.8-fold greater in treated HH patients, this was not statistically significant. HFE mRNA expression was not significantly different in any of the groups investigated relative to controls. Conclusions: These findings demonstrate that untreated HH patients do not have increased duodenal DMT1 and IREG mRNA, but rather phlebotomy increases expression of these molecules, reflecting the effect of phlebotomy induced erythropoiesis. Finally, HFE appears to play a minor role in the regulation of iron absorption by the duodenal enterocyte.

Managing anemia in the critically ill patient.

Abstract: Anemia of critical illness is a multifactorial condition caused by phlebotomy, ongoing blood loss, and inadequate production of red blood cells. It occurs early in the course of critical illness. Although red blood cell transfusion is the treatment of choice for immediate management of anemia in the intensive care unit, controversy surrounds the most appropriate hemoglobin concentration or hematocrit "trigger." Therapeutic options, including blood-conservation tools, minimization of phlebotomy, erythropoietic agents, and investigational oxygen-carrying agents, may be alternatives to red blood cell transfusions in critically ill patients with anemia. Patient selection for erythropoietic agents will depend on further work dealing with outcomes and the total cost of care in managing the anemia of critical illness.

Hemochromatosis, HFE C282Y Homozygosity, and Bariatric Surgery: Report of Three Cases

Abstract: Background: Iron absorption is decreased in some individuals who have undergone bariatric surgery. Methods: We evaluated measures of iron metabolism and therapeutic phlebotomy in 3 adults with hemochromatosis and HFE C282Y homozygosity who underwent bariatric surgery. Results: 1 male and 1 female had surgery before diagnosis of hemochromatosis (jejuno-ileal bypass and Roux-en-Y gastric bypass, respectively); neither had iron overload. Another man was treated with serial phlebotomy to induce iron depletion; later, he underwent Roux-en-Y gastric bypass. His maintenance phlebotomy requirement for hemochromatosis decreased substantially (on average ~1 unit each 71 days before surgery, and ~1 unit each 173 days after surgery). None of these patients developed iron deficiency, and none took supplemental iron. Conclusions: Iron absorption is decreased in some patients with hemochromatosis and HFE C282Y homozygosity after bariatric surgery, but their risk of developing iron deficiency may be diminished.

Erythropoietin production rate in phlebotomy-induced acute anemia.

Abstract: Objective. To estimate the rate of erythropoietin (EPO) production under physiological, conditions and to examine the regulatory mechanism of EPO production in response to acute phlebotomy-induced anemia. Methods. Six sheep each underwent two phlebotomies in which the hemoglobin (Hb) was reduced to 3–4 g/dl over 4–5 h. The EPO plasma level, reticulocytes, Hb and EPO clearance were followed by frequent blood sampling. The EPO production rate was determined by a semi-parametric method based on a disposition decomposition analysis that accounts for the nonlinear disposition kinetics of EPO and corrects for time-dependent changes in the clearance. Results. The controlled drop in hemoglobin resulted in an abrupt increase in the plasma EPO concentration (peak level 812 ± 40 mU/ml, mean ± CV%) that was followed by a rapid drop 2–4 days after the phlebotomy at a time when the sheep were still anemic (Hb = 4.3 ± 16 g/dl). The EPO production rate at baseline was 43 ± 52 U/day/kg and the amounts of EPO produced over an 8 day period resulting from the first and second phlebotomy were 2927 ± 40 U/kg and 3012 ± 31 U/kg, respectively. Conclusions. The rapid reduction in the EPO plasma level observed 2–4 days following the phlebotomy cannot be explained solely by the increase in EPO clearance but also by a reduction in EPO production. Copyright © 2004 John Wiley & Sons, Ltd.

Clinical and hematological effects of serial phlebotomy performed on laboratory beagles.

Abstract: We conducted a study designed to mimic a typical pharmacokinetic study to gain a better understanding of a dog's response to multiple, frequent blood sampling at 15% total blood volume. Ten dogs were randomly assigned to either a control group having sham venipuncture performed or to a blood collection group having 1.5% of their body weight (approximately 15% total blood volume) removed weekly for 4 weeks. Both groups were monitored during a 2-week recovery period immediately after the 4-week collection period. Parameters evaluated were clinical signs, body weight, and hematological and serum biochemical analytes. There were minimal differences in red blood cell morphology between the two groups. Statistically significant differences in hematocrit between the two groups occurred on several days, and this finding was attributed to blood withdrawal in the blood collection group; however, this statistical difference was not deemed to be clinically significant. There were no statistically significant differences in body weight, total protein, reticulocyte count, mean corpuscular volume, mean corpuscular hemoglobin, or red cell distribution width. We conclude that removing 15% blood volume in laboratory beagles is compatible with maintaining the health and well-being of the dog and can be acceptable in laboratory situations when it is scientifically justified.

The situation of phlebotomy and wet cupping in traditional medicine of Iran

Abstract: The traditional and Islamic medicine is based on bringing out the wasted and hazardous materials from the body. For this reason well known ancient physicians used to do phlebotomy, wet cupping, vomiting, administer laxatives, enema and various other methods. Fortunately, wet cupping is known as an effective method in prevention and treatment for numbers of diseases even by medical society nowadays and there are increasing numbers of physicians who use this method. The other method used, is phlebotomy that can be recommended on different regions of the body and each of them has a special therapeutic effect but has not become known as well as wet cupping. The routine phlebotomy is the "blood transfusion" in which only one of the body vessels is used and the aim is to donate blood but the traditional medical aspect of phlebotomy is something completely different, which is applied only for therapeutic reasons (established on special body vessels and taking out significant amount of blood that might be applied of the arms, legs, frontal region or even sublingual vessels etc.) This article presents the effects of phlebotomy and wet cupping in the treatment of some diseases. An opinion for treatment of 43 diseases described by an ancient philosopher and physician named Jorjani is also collected in this article. Jorjani used phlebotomy and wet cupping beside medical treatment to get better results. His comments on the effectiveness of wet cupping and its indications and timing are also mentioned in this article.

[Unclear liver fibrosis in a 42-year-old patient with polycythemia vera].

Abstract: A 42-year-old patient was admitted to hospital because of ascites and polyglobulia. Laboratory tests revealed reduced liver function and a significant elevation of all three hematopoietic cell lines. Liver fibrosis and polycythemia vera were diagnosed by histologic examination. The most frequent causes for liver fibrosis were serologically excluded. Ultrasound combined with Doppler imaging revealed an obstruction of the right hepatic vein, which was indicative of Budd-Chiari syndrome. BCS can occur under fulminant and nonfulminant conditions, which can result in progressive damage of the liver. Phlebotomy and combined therapy with low-dose aspirin and anagrelide achieved permanent reduction of the elevated blood parameters. In the follow-up the patient's clinical course was stable without hepatic decompensation.

Review Phlebotomy in the intensive care unit: strategies for blood

Abstract: The quality and economy of critical care could both be improved if blood losses due to phlebotomy and sampling from indwelling catheters for unnecessary diagnostic testing were curtailed. Practice guidelines can help to break bad diagnostic ‘habits’, such as fever work-ups that require substantial blood to be drawn yet typically yield little useful information. Invasive hemodynamic monitoring is associated with morbidity due to blood loss as well as infection, and newer noninvasive technologies should be encouraged. Several devices allow blood that would otherwise be wasted during sampling to be returned to the patient aseptically. Point-of-care testing uses microliter quantities of blood, has acceptable precision, and can provide valuable diagnostic information while being minimally invasive.

Domiciliary phlebotomy for elderly people with mental illness

Abstract: AIMS AND METHOD This paper reports the evaluation of a pilot domiciliary phlebotomy service provided by an old age psychiatry service to enhance the management of patients in their own homes Clinical and demographic data were collected and the costs of phlebotomy home visits compared with those of ambulance transport RESULTS Of 511 phlebotomy visits made to 307 patients, only 8% were unsuccessful A subgroup analysis indicated that 70% of patients would have been unable to leave home unaccompanied to attend for venepuncture The cost of the phlebotomist’s travel was comparable with the estimated cost of providing ambulance transport for patients who would have required it CLINICAL IMPLICATIONS Domiciliary phlebotomy can be a viable method of performing blood investigations in an old age psychiatry service to support home assessment