Showing papers on "Phlebotomy published in 2005"

Do Blood Tests Cause Anemia in Hospitalized Patients?: The Effect of Diagnostic Phlebotomy on Hemoglobin and Hematocrit Levels

Abstract: CONCLUSIONS: Phlebotomy is highly associated with changes in hemoglobin and hematocrit levels for patients admitted to an internal medicine service and can contribute to anemia. This anemia, in turn, may have significant consequences, especially for patients with cardiorespiratory diseases. Knowing the expected changes in hemoglobin and hematocrit due to diagnostic phlebotomy will help guide when to investigate anemia in hospitalized patients.

Clinical aspects of hemochromatosis

Abstract: The term hemochromatosis is commonly used as synonymous with HFE-associated genetic iron overload but several rarer causes of an identical clinicopathological syndrome have been described in recent years. The most common symptoms are lethargy and arthralgia, and the major complications of end-stage disease are cirrhosis, diabetes, and cardiac and endocrine manifestations. However, with the development of cascade screening for family members of affected probands as well as screening for common diseases at health checks, hemochromatosis is being detected at increasingly early stages, often when there are only biochemical abnormalities. The available evidence from screening studies strongly suggests that approximately 75% of C282Y homozygous subjects have biochemical expression. Hepatic iron overload is present in approximately 56% and 34% of men and women, respectively, advanced hepatic fibrosis in 18.7% and 5.4%, respectively, and cirrhosis in 5.8% and 1.9%, respectively. In subjects with severe expression of the disease, additional modifying genetic mutations have been described including those in hepcidin and hemojuvelin. Treatment is by regular phlebotomy which, if instituted before the development of cirrhosis, results in normal life expectancy.

Erythrocytapheresis plus erythropoietin: an alternative therapy for selected patients with hemochromatosis and severe organ damage

Abstract: We report the efficacy, tolerability and cost of erythocytoapheresis plus recombinant human erythropoietin (rHuEPO) in three patients with severe hereditary hemochromatosis (HH). Results indicate that this regimen could be a valid therapeutic alternative in complicated HH patients. Its cost, however, limits its use to patients whose clinical conditions prevent a proper phlebotomy regimen.

Hepatic expression of hemochromatosis genes in two mouse strains after phlebotomy and iron overload.

Abstract: Our results indicate that regulation of hepatic Fpn1 differs from that reported for duodenal Fpn1. Furthermore, taken the differences in gene expression in dietary overload (increased Hfe but not Tfr2), distinct roles are suggested for Hfe and Tfr2 in Hepc activation.

Recent advances in hereditary hemochromatosis

Abstract: Hereditary hemochromatosis, a very common genetic defect in the Caucasian population, is characterized by progressive tissue iron overload which leads to irreversible organ damage if it is not treated in a timely manner. Recent developments in the field of molecular medicine have radically improved the understanding of the physiopathology and diagnosis of this disease. However, transferrin saturation and serum ferritin are still the most reliable tests for identifying subjects with hereditary hemochromatosis. Therapeutic phlebotomy is the mainstay of the treatment of this disease and the life expectancy of these patients is similar to that of the normal population if phlebotomy is started before the onset of irreversible organ damage. In this review we discuss the genetics, pathophysiology, diagnosis, clinical features, and management of hereditary hemochromatosis.

Determinants of serum ALT normalization after phlebotomy in patients with chronic hepatitis C infection.

Abstract: Background Phlebotomy is performed to reduce excessive iron accumulation in hepatic tissue. We studied serum alanine aminotransferase (ALT) normalization rates and 50% reduction in initial serum ALT (ALT50% reduction rate) in patients with hepatitis C viral (HCV) infection and investigated the factors that influenced the response to phlebotomy therapy.

Phlebotomy Puncture Juncture Preventing Phlebotomy Errors—Potential For Harming Your Patients

Abstract: The number of patients that may be harmed while undergoing phlebotomy 1 procedures is enormous based on a consideration of sheer numbers alone. In this country, we estimate more than 1 billion venipunctures are performed annually. The Fall 2004 BOR Newsletter lists the fact that 26,773 phlebotomy technicians have been certified since the PBT registry examination was introduced in 1989. Prior to the introduction of safety devices, 2 phlebotomists suffered an estimated 600,000 needlestick injuries or more annually. One can imagine, therefore, the potential for harm to patients who, after all, are on the receiving end of every venipuncture. Phlebotomists enjoy the privilege of patient trust, as they are being permitted to perform an invasive procedure that no healthy individual would ordinarily volunteer to undergo. The dictum “first, do no harm” 3 applies to phlebotomists as well as to physicians. Indeed, the etymology of “safety” is salvus, meaning “freedom from harm.” Phlebotomy errors may cause serious harm to patients—up to and including death, either directly or indirectly. This statement might sound radical until we investigate the many possible errors that might occur while performing a blood collection procedure. It is essential, therefore, to establish, implement, and practice quality control in phlebotomy. Phlebotomists who normally work independently and without direct supervision in the hospital setting or in the outpatient facility must take the responsibility for performing quality control on their own work. Quality control consists of those materials and methods practiced in real time in every venipuncture to promote intended outcomes. First let’s take a look at the errors that could occur in a typical phlebotomy setting 4 :  identifying the patient  communicating with the patient  selecting the venipuncture site  sites for capillary skin puncture  choosing the “right stuff”  special considerations related to patients

Management of patients with polycythaemia vera: results of a survey among Swedish haematologists.

Abstract: The prevailing attitudes regarding diagnostic and therapeutic procedures in patients with polycythaemia vera (PV) among Swedish haematologists were surveyed by way of a mailed questionnaire in August 2002. Among diagnostic procedures frequent use is reported for arterial O-2 saturation, spleen size determination, bone marrow histology, serum erythropoietin, serum cobalamins and leukocyte alkaline phosphatase score, while direct determination of the red blood cell mass is used infrequently (seldom or never by 82%). Among therapeutic modalities hydroxyurea and phlebotomy alone were most frequently used. The P-32 therapy was used at least sometimes by 57% of the physicians, and more widely in the university clinics. Anagrelide and alfa-interferon was used in a minority of patients only. The use of prophylactic acetylsalicylic acid was very variable. The majority of the physicians had an aim for their phlebotomy treatment at a level of 0.45 or less, but 21% used a level of 0.46-0.49 and 8% a level of 0.55-0.60 (in younger patients). The platelet level, at which myelosuppressive therapy was initiated, also varied, from 400 x 10(9)/L to > 1500 x 10(9)/L. It can be concluded that in practical clinical work in Sweden the diagnosis of PV is established by frequent use of serum erythropoietin, bone marrow examination and spleen size determination. The use of different therapeutic modalities is very variable. Many physicians carry out their phlebotomy treatment with less intensity compared with national and international recommendations. (Less)

Therapy of porphyria cutanea tarda.

Abstract: Porphyria cutanea tarda (PCT) is the most common type of porphyria. There is an association of PCT with haemochromatosis, diabetes mellitus and hepatitis C infection. The basis of treatment of PCT consists of three elements: avoidance of triggering factors, iron depletion and porphyrin elimination. Alcohol and certain systemic medical drugs, such as oestrogens (or tuberculostatics), should be considered as triggering factors, and as far as possible, avoided. Other triggering factors, such as chronic haemodialysis in renal insufficiency, need a different approach. The hallmark in iron depletion is phlebotomy. Porphyrin elimination is achieved using low-dose chloroquin therapy. The treatment is safe and effective but has its limits in cases with haemochromatosis (HFE) gene mutations. Here iron depletion needs additional phlebotomy. In patients with chronic haemodialysis-associated PCT, chloroquine is ineffective. Erythropoietin, desferroxamine and small-volume phlebotomy have been employed to control the disease. Childhood PCT is very rare. No controlled studies are available, but published experience suggests that body weight-adapted chloroquine therapy or small volume phlebotomy might be useful.

Restless legs syndrome in patients with hereditary hemochromatosis

Abstract: Iron deficiency is important in the pathogenesis of restless legs syndrome (RLS), and iron supplementation improves its symptoms.1,2 Hereditary hemochromatosis (HH) is an autosomal recessive condition caused by mutations of the HFE gene in which excessive intestinal iron absorption leads to iron deposition in multiple organs.3 Iron therapy for RLS precipitated symptoms of iron overload in one patient with previously unrecognized HH,4 suggesting that monitoring of iron indexes may be required during iron therapy in RLS. We investigated the frequency of RLS and the relationship between RLS and iron indexes in consecutive adult patients with HH attending a large teaching hospital for therapeutic phlebotomy over a 3-month period. All 61 HH patients seen agreed to participate; 48 (79%) were men, and the median (range) age was 53 (24 to 82) years. The median (range) duration of phlebotomy was 12 (2 to 108) months, and 35 (62%) had serum ferritin level of <50 ng/mL. …

What happens when cutaneous nerves are injured during venipuncture

Abstract: Phlebotomy, or venipuncture, is, by far, the most common invasive procedure in the practice of medicine. Venipuncture is necessary for blood donation, blood sampling, insertion of intravenous lines, and intravenous administration of medication. The procedure itself is ordinarily innocuous, but complications do occur, one of which is peripheral nerve injury.9 Estimates of the incidence of nerve injury following venipuncture vary, depending upon how the data are acquired. Of 1,000 randomly selected whole-blood donors who were interviewed 3 weeks after donation, 9 (0.9%) reported sensory changes (numbness and tingling in all and burning in one) distal to the venipuncture site at the antecubital fossa.9 Alternatively, in 7 million blood donations during 2003, 1:4,400 donors contacted the American Red Cross with complaints of sensory symptoms and 1:22,000 visited a physician for their complaints.10 The latter estimates are comparable to those cited previously.2,7 Presumably, data sets of donors who report sensory symptoms only when questioned will include more, but less severe, cases, whereas data gathered only from donors seeking medical treatment represent the most severely affected. Thus, most donors who develop post-venipuncture sensory symptoms experience mild and transient discomfort; fortunately, severe chronic pain as a sequela is extremely rare—perhaps 1:1,500,000.8 No data exist regarding the frequency of complications when venipuncture is performed for reasons other than blood donation. At the usual sites of venipuncture, cutaneous sensory nerves are at risk of needle injury: the medial and lateral antebrachial cutaneous nerves in the antecubital fossa, the superficial radial nerve at the wrist, and the dorsal sensory nerve branches of the hand. Whereas veins are usually visible or palpable at these sites, cutaneous nerves are not. Standard anatomy textbooks typically depict venipuncture-accessible veins superficial to and overlying these cutaneous nerves (see Horowitz3 for list of examples). However, that representation appears too simplistic. A cadaver dissection study has shown that the nerve/vein relationships are much more complex: (1) there is a great deal of variability in the location of nerves and veins; (2) although each individual nerve may be a single trunk, often multiple branches are distributed over a fairly wide area, especially for nerves coursing through the antecubital fossa; (3) nerve branches are often superficial to and overlie veins; (4) nerves and veins are frequently intertwined, exhibiting common pathways and fascial connections; and (5) on occasion, the nerve/vein relationship may change in the same specimen, e.g., from forearm to antecubital fossa, either the lateral antebrachial cutaneous nerve or the cephalic vein can be superficial at various points.3 The early clinical presentation of venipunctureinduced nerve injury is stereotypic. Almost all patients ( 90%) date the onset of symptoms to needle movement in situ.4 The characteristic symptoms are immediate numbness and tingling that persist after the needle has been removed. On examination, perceptions of pin and touch are decreased in the affected nerve distribution. In many patients, these sensory symptoms resolve spontaneously; however, mild sensory deficits elicitable by examination can persist for years. Rarely, much more serious symptoms occur at the time of phlebotomy: burning, lancinating, shooting, or electrical sensations and pain. In almost all patients so affected, stimulus-evoked discomfort, allodynia and hyperalgesia, in the affected nerve distribution develops early and persists (it is helpful to ask the patient to outline the margins of the painful area). A chronic pain syndrome invariably follows, the characteristics of the pain changing over time. Initially, spontaneous, constant and intense, the burning, electrical, lancinating qualities gradually Correspondence to: S. H. Horowitz; e-mail: shhorowitz@partners.org

Additional effect of low iron diet on iron reduction therapy by phlebotomy for chronic hepatitis C.

Abstract: BACKGROUND/AIMS Iron-induced oxidative stress plays an important role in the pathogenesis of chronic hepatitis C. Both phlebotomy for removing body iron stores and low iron diet for minimizing portal iron supply to the liver have been shown to improve serum transaminase levels in patients with the disease. However, the cooperative effects of phlebotomy and low iron diet have not yet been elucidated in detail. METHODOLOGY A pilot study was undertaken to investigate whether a low iron diet could improve the efficacy of phlebotomy in iron reduction therapy. Of 21 patients diagnosed with chronic hepatitis C, 10 patients were treated with phlebotomy alone (group A) while 11 patients were treated with a low iron plus phlebotomy (group B). Phlebotomy was repeated biweekly until serum ferritin levels reached 10 ng/mL in both A and B groups. In addition, a low iron diet (iron intake of 8 mg/day or less) was recommended for group B, followed by estimation of iron intake from daily diet records. RESULTS Serum alanine aminotransferase levels were significantly improved from 106+/-30 to 68+/-22 IU/L (p<0.005, paired t-test) in group A and from 100+/-33 to 46+/-10 IU/L (p<0.002, paired t-test) in group B. The enzyme levels after treatment were significantly higher in group A (p<0.02, non-paired t-test), which showed a higher upward distribution of the enzyme activity. The estimated dietary iron intake in group B was reduced from 17.6+/-6.1 to 8.2+/-3.7 mg/day. CONCLUSIONS These findings suggest that phlebotomy alone does not completely remove iron-induced oxidative stress and a low iron diet induces an additional effect in iron reduction therapy for chronic hepatitis C.

[Side effects of phlebotomy: pathophysiology, diagnosis, treatment and prophylaxis].

Abstract: Although phlebotomy is on the whole a safe procedure, the frequency of side effects being low and their severity weak, there have still been rare incidents of serious accidents such as nerve injury, vasovagal reaction and infections. Medical staff performing phlebotomy must be aware of the pathophysiology of these side effects, be careful in avoiding them, and be trained to properly treat them. Nerve injury is the complication of which phlebotomists should take the greatest caution. It sometimes causes permanent motor and/or sensory nerve dysfunction of arms and hands. Appropriate selection of vein and careful procedure of venipuncture are required. Vasovagal reaction is a relatively common complication causing hypotension, palor and occasional syncope. For emergency cases, a bed, oxygen tanks, and a utility cart with drug supplies should be provided in the phlebotomy room. Infections, especially those by blood-borne pathogen, are rare but serious complications. When performing evacuated tube venipuncture procedure, blood collecting tubes sterilized on the inside and single-use holders must be used to avoid infections through backflow of blood. Phlebotomists must follow the procedure presented in the guidelines to avoid backflow. Hematoma, allergy, hyperventilation, air embolism, anemia and thrombosis are other side effects occasionally caused by phlebotomy. Finally, medical staff should recognize that sincere communication with patients receiving phlebotomy is essential and efforts to inform them of the possibility of these side effects are becoming increasingly necessary in the current medical environment.

Bacterial contamination in blood and blood products

Abstract: Skin disinfection during phlebotomy is a critical step for bacterial contamination of blood and blood products. The aim of this study was to investigate the bacterial contamination rates during phlebotomy and to detect the probable microorganisms present. Skin disinfections of 100 blood donors were performed by using povidone iodine solution with standard procedure. Fifteen mililiters of blood samples were drawn from the transfusion set and inoculated into culture flasks of automated Bact/Alert (BioMerieux) system. Blood cultures were monitorized for one week, and bacteria in positive cultures were identified by using classical microbiological methods in addition with API identification system (BioMerieux; ID32 Staph, 20 Strep). As a result, bacterial growth was detected in four (4%) of the blood samples, whereas 96% of the samples were found sterile. Staphylococcus epidermidis was the microorganism which had been grown in three of the samples, and Streptococcus mutans in one. The positivity rate detected in our study was considered high, since expected bacterial contamination rates in blood transfusions were between 0.2-0.5%. This data indicated that the procedures used in phlebotomy such as the choice of phlebotomy region, disinfectant use and disinfection time should be re-evaluated in our blood centre.

Hemochromatose et diabete sucre: approche diagnostique et evolution clinique.

Abstract: We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a recent article. Early diagnosis and treatment by phlebotomy can improve blood glucose control in the early stages of the disease. If diagnosis occurs later, when the patient already needs insulin therapy, diabetes will not be improved by phlebotomy anymore.

JCCLS phlebotomy standards

Abstract: In 2004, the Japanese Committee of Clinical Laboratory Standards (JCCLS) published a standard phlebotomy guideline, which not only ensures the safety of the patients and phlebotomists but is adopted to the healthcare setting in Japan. This phlebotomy standard is also essential for the standardization of clinical laboratory tests. This guideline was completed on the basis of current phlebotomy procedures widely in use in Japan using phlebotomy standards in the USA as references, while reconsidering their scientific reasoning as far as possible. At the same time, factors such as practicality and cost benefit were taken into account. The content of the guideline includes necessary facilities and equipment, a step by step safe but practical venipuncture procedure, an explanation of the individual steps, and other supplementary information such as alternative methods. The first edition, published as tentative guideline, is planned to be revised after a set period of time based on the comments and suggestions from a wide range of people concerned, so that it can be published as an approved guideline.

Management of hepatitis C virus in patients with porphyria cutanea tarda

Abstract: Extrahepatic manifestations associated with chronic hepatitis C virus (HCV) infection are increasingly recognized and often complicate HCV therapy. Porphyria cutanea tarda (PCT), an uncommon phenotypic expression of a defect in the uroporphyrinogen decarboxylase enzyme, is 12 times more likely to occur in those with HCV compared with the general population in the United States. It is hypothesized that increased free intrahepatic iron levels and chronic HCV infection can accelerate the pathogenesis of liver injury in patients with phenotypic expression of PCT. Symptomatic treatment of PCT has traditionally revolved around phlebotomy to control total body iron levels. However, phlebotomy for PCT management poses a challenge to concomitant treatment of HCV with combination therapy, ribavirin, and interferon. This article highlights the pathogenesis of PCT and discusses its impact on the management of HCV in individuals with this uncommon extrahepatic disease.

Recentralizing phlebotomy back into the laboratory.

Abstract: In many hospitals, the responsibility for performing phlebotomy has shifted from the laboratory to the nursing unit. However, few nursing programs have incorporated phlebotomy instruction into their employee training. As a result, organizations have experienced varying degrees of success with this shift. This article shares the experiences of one hospital that recentralized phlebotomy duties one year ago, including information on data collection, financial analysis, and training orientation.