Showing papers on "Phlebotomy published in 2006"

Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study

Abstract: Introduction Anemia among the critically ill has been described in patients with short to medium length of stay (LOS) in the intensive care unit (ICU), but it has not been described in longstay ICU patients. This study was performed to characterize anemia, transfusion, and phlebotomy practices in patients with prolonged ICU LOS. Methods We conducted a retrospective chart review of consecutive patients admitted to a medical-surgical ICU in a tertiary care university hospital over three years; patients included had a continuous LOS in the ICU of 30 days or longer. Information on transfusion, phlebotomy, and outcomes were collected daily from days 22 to 112 of the ICU stay. Results A total of 155 patients were enrolled. The mean age, admission Acute Physiology and Chronic Health Evaluation II score, and median ICU LOS were 62.3 ± 16.3 years, 23 ± 8, and 49 days (interquartile range 36–70 days), respectively. Mean hemoglobin remained stable at 9.4 ± 1.4 g/dl from day 7 onward. Mean daily phlebotomy volume was 13.3 ± 7.3 ml, and 62% of patients received a mean of 3.4 ± 5.3 units of packed red blood cells at a mean hemoglobin trigger of 7.7 ± 0.9 g/dl after day 21. Transfused patients had significantly greater acuity of illness, phlebotomy volumes, ICU LOS and mortality, and had a lower hemoglobin than did those who were not transfused. Multivariate logistic regression analysis identified the following as independently associated with the likelihood of requiring transfusion in nonbleeding patients: baseline hemoglobin, daily phlebotomy volume, ICU LOS, and erythropoietin therapy (used almost exclusively in dialysis dependent renal failure in this cohort of patients). Small increases in average phlebotomy (3.5 ml/day, 95% confidence interval 2.4–6.8 ml/day) were associated with a doubling in the odds of being transfused after day 21. Conclusion Anemia, phlebotomy, and transfusions, despite low hemoglobin triggers, are common in ICU patients long after admission. Small decreases in phlebotomy volume are associated with significantly reduced transfusion requirements in patients with prolonged ICU LOS.

Phlebotomy issues and quality improvement in results of laboratory testing.

Abstract: Laboratory testing is an integral part of the decision-making process, and results of laboratory testing often strongly influence medical diagnoses and therapies. There is a long history of quality requirements in laboratory medicine, which have mainly concerned the analytic phase of this process. Owing to the substantial advances in technology, laboratory automation and analytic quality, there is increasing evidence that further quality improvements should be targeted to extra-analytic phases of laboratory testing. Objective difficulties to monitor most of the preanalytic variables which lie outside the direct control or supervision of the laboratory personnel, such as phlebotomy, call for effective educational and preventive policies. Owing to high personnel turnover rates, lack of understanding about good laboratory practices, and inadequate training, there are several opportunities for making errors during phlebotomy, which mainly concern patient misidentification and collection of unsuitable specimens for testing due to unsuited venous accesses, venous stasis, inappropriate collection devices and containers. Improved standardization of phlebotomy techniques, along with operative guidelines dissemination, continuous education, certification, and training of health care professionals involved in blood drawing responsibilities would enhance the chance of obtaining specimens of consistent quality, with favorable revenues for the health care system and the patient's outcome.

Highly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial.

Abstract: Anaemia in critically ill patients is common and phlebotomy associated blood loss may contribute towards this anaemia The aims of this study were twofold Firstly, a survey was conducted to provide a summary of current phlebotomy practices within Australian intensive care units A standardized telephone survey was aimed at Australian intensive care units registered with Australia and New Zealand Intensive Care Society (ANZICS) and questions regarding phlebotomy procedures directed at nursing staff Secondly, a prospective randomized controlled trial aimed to assess the impact of a highly conservative phlebotomy procedure on haemoglobin concentration in intensive care patients Patients admitted to our own intensive care unit were randomized using a sealed envelope technique to either a highly conservative phlebotomy group, or standardized controls Blood was taken according to strict protocols and recorded along with haemoglobin concentration daily The survey demonstrated that 16% of Australian units return deadspace volumes from in-line arterial sets and no unit routinely used paediatric-sized blood collection tubes Using our highly conservative protocol, median phlebotomy-associated blood loss was reduced by over 80% (40 ml vs 8 ml P<0001) Mean haemoglobin fell from 137 g/dl to 117 g/dl in controls (P=0002) and from 127 g/dl to 115 g/dl (P=0074) in our study group We conclude that highly conservative phlebotomy is feasible in a critical care unit and is associated with a reduction in blood loss

The efficacy of a medical virtual reality simulator for training phlebotomy.

Abstract: Objective: The present study compared the effectiveness of a virtual reality (VR) simulator for training phlebotomy with that of a more traditional approach using simulated limbs. Background: Phlebotomy, or drawing blood, is one of the most common medical procedures; yet, there are no universal standards for training and assessing performance. The absence of any standards can lead to injuries and inaccurate test results if the procedure is improperly performed. Method: Twenty 3rd-year medical students were trained under one of the two methods and had their performance assessed with a 28-item checklist. Results: The results showed that performance improvements were limited to those who trained with the simulated limbs, and a detailed comparison of the two systems revealed several functional and physical differences that may explain these findings. Conclusion: Participants trained with simulated limbs performed better than those trained with a VR simulator; however, the metrics recorded by the VR system may...

Iron overload and prolonged ingestion of iron supplements: clinical features and mutation analysis of hemochromatosis-associated genes in four cases.

Abstract: We evaluated and treated four white adults (one man, three women) who had iron overload associated with daily ingestion of iron supplements for 7, 15, 35, and 61 years, respectively. We performed HFE mutation analysis to detect C282Y, H63D, and S65C in each patient; in two patients, HFE exons were sequenced. In two patients, direct sequencing was performed to detect coding region mutations of TFR2, HAMP, FPN1, HJV, and ALAS2. Patients 1-4 ingested 153, 547, 1,341, and 4,898 g of inorganic iron as supplements. Patient 1 had hemochromatosis, HFE C282Y homozygosity, and beta-thalassemia minor. Patient 2 had spherocytosis and no HFE coding region mutations. Patient 3 had no anemia, a normal HFE genotype, and no coding region mutations in HAMP, FPN1, HJV, or ALAS2; she was heterozygous for the TFR2 coding region mutation V583I (nt 1,747 G-->A, exon 15). Patient 4 had no anemia and no coding region mutations in HFE, TFR2, HAMP, FPN1, HJV, or ALAS2. Iron removed by phlebotomy was 32.4, 10.4, 15.2, and 4.0 g, respectively. There was a positive correlation of log(10) serum ferritin and the quantity of iron removed by phlebotomy (P = 0.0371). Estimated absorption of iron from supplements in patients 1-4 was 20.9%, 1.9%, 1.1%, and 0.08%. We conclude that the clinical phenotypes and hemochromatosis genotypes of adults who develop iron overload after ingesting iron supplements over long periods are heterogeneous. Therapeutic phlebotomy is feasible and effective, and would prevent complications of iron overload.

Left ventricular systolic function during stress echocardiography exercise in subjects with asymptomatic hereditary hemochromatosis.

Abstract: There is no information available on left ventricular (LV) systolic function and the response to stress echocardiography in asymptomatic subjects with hereditary hemochromatosis (HH). To evaluate this topic, 43 asymptomatic subjects with HH homozygous for the C282Y HFE gene mutation (22 untreated subjects [group A] and 21 long-term treated subjects [group B]) were compared with 21 age- and gender-matched normal volunteers negative for HFE mutations. Contractile reserve, as a measure of LV systolic function, was assessed using continuous echocardiographic imaging and electrocardiography during supine bicycle exercise. Nineteen subjects in group A had repeat tests after 6 months of induction phlebotomy therapy to assess the effect of iron removal. Exercise performance and hemodynamic variables of supine bicycle exercise were comparable between subjects with HH and controls. LV contractile reserve of asymptomatic subjects with HH was not impaired at either a 75-W submaximal exercise level (mean ± SD difference in ejection fraction from baseline 13.8 ± 6.2%, 11.5 ± 6.8%, and 13.4 ± 7.8% in groups A, B, and C, respectively; p = NS for all by analysis of variance) or at peak exercise (difference in ejection fraction from baseline 18.9 ± 6.9%, 18.4 ± 7.8%, and 20.3 ± 8.1% in groups A, B, and C, respectively; p = NS for all by analysis of variance). However, the incidence of abnormal ischemic stress electrocardiographic responses was more frequent in subjects with HH as a whole (33%) compared with normal subjects (10%). Stress imaging revealed no regional wall motion abnormalities, suggesting that these were false-positive results. Iron removal by induction phlebotomy did not affect stress echocardiographic performance. In conclusion, LV systolic function during exercise in asymptomatic subjects with HH is preserved, and 6-month induction phlebotomy does not affect stress echocardiographic performance.

Hereditary hemochromatosis: screening and management.

Abstract: Hereditary hemochromatosis has been redefined over the past century, from a rare (but often fatal) disorder of iron overload known as "bronzed diabetes" to only biochemical evidence of altered iron metabolism, and recently to mere expression of the C282Y homozygous genotype of the HFE gene. The variable definitions of the disease, as well as the variable degree of penetrance of the C282Y homozygous genotype, have made it difficult to determine optimal screening strategies. Multiple studies performed since discovery of the C282Y mutation have led to the conclusion that overall penetrance of the genotype is low and that screening of asymptomatic general populations for hereditary hemochromatosis is not recommended. Screening for HFE mutations among certain patient groups, including patients with cirrhosis, however, may help target those who would benefit most from iron removal. For most patients, phlebotomy is the preferred treatment option; iron chelation therapies are available for patients unable to tolerate phlebotomy.

Iron reduction therapy by phlebotomy reduces lipid peroxidation and oxidative stress in patients with chronic hepatitis C.

Abstract: To the Editor: Lipid peroxidation and oxidative stress play important roles in the pathogenesis of chronic hepatitis C (CHC).1–3 Chronic infection with hepatitis C virus (HCV) is associated with excessive iron deposition in the liver.4 It is believed that that ironassociated free-radical production is involved in liver injury during CHC. Iron reduction therapy by phlebotomy has been reported to improve hepatic inflammation in patients with CHC.5–7 On the other hand, the plasma level of 8-isoprostane has been found to be the most reliable marker of lipid peroxidation and oxidative stress in vivo.3,8–10 Recently, we reported that the plasma level of 8-isoprostane is elevated in patients with CHC and nonalcoholic fatty liver disease.11 In the present study, we investigated whether iron reduction therapy by phlebotomy reduces the plasma level of 8-isoprostane in patients with CHC. This study comprised patients that consulted our clinic department from April 2004 through October 2005. Twenty-five patients with CHC [13 men, 12 women; 58.5 ± 2.17 (mean ± SE) years old], including five smokers and four patients with diabetes mellitus, and 25 matched control patients with CHC [13 men, 12 women; 58.3 ± 2.12 (mean ± SE) years old], including five smokers and four patients with diabetes mellitus were enrolled in the phlebotomy group and in the control group, respectively. The inclusion criteria were as follows: (1) elevation of alanine aminotransferase (ALT) levels above the upper normal limit for 3 months or more; (2) high viral load of more than 100 KIU/ml (Amplicor monitor; Roche Diagnostic Systems, Basel, Switzerland) and HCV genotype 1b; and (3) absence of other causes of chronic hepatitis. All patients had been treated with 600 mg of ursodeoxycholic acid for more than 3 months before entering the study and continued this treatment during the entire observation period. Phlebotomy of 240 ml was performed biweekly or monthly until the serum ferritin level reached the endpoint of 20 ng/ml. The median duration of the phlebotomy treatment was 3 months (range, 2–6 months). The patients of the control group were followed up for 3 months with blood tests. The blood levels of 8-isoprostane,11 aspartate aminotransferase (AST), ALT, albumin, total cholesterol (TCHO), triglycerides, plasma glucose (PG), HCV RNA, iron, ferritin, transferrin, and unsaturated iron binding (UIBC), and complete blood count and body mass index (BMI) were measured to assess liver function and nutrition status, and the data before and immediately and 3 months after phlebotomy were compared. This study was approved by the ethics committee of each institution, and written informed consent was obtained from each patient enrolled in the study. Data are expressed as means ± standard deviation (SD). Student’s t test was used to evaluate statistical differences. P < 0.05 was considered to be statistically significant. Twenty-four patients successfully completed the protocol therapy of phlebotomy. One patient stopped the therapy because of leg edema 6 weeks after entry. The plasma concentration of 8-isoprostane was significantly decreased from 14.2 ± 7.20 to 8.28 ± 3.46 pg/ml after phlebotomy (P < 0.001). In the phlebotomy group, the blood levels of ferritin, iron, transferrin saturation, AST, ALT, albumin, T-CHO, red blood cells, hemoglobin, and hematocrit were significantly decreased after phlebotomy compared with baseline values (Table 1). The blood levels of UIBC, transferrin, and platelets significantly increased after phlebotomy (Table 1). BMI and the blood levels of triglyceride, PG, HCV RNA, and white blood cells did not change after phlebotomy. In the control group, the plasma concentration of 8-isoprostane remained unchanged (12.6 ± 4.05 vs. 13.2 ± 4.80 pg/ml) after 3 months, and the other values did not change after 3 months compared with baseline values (Table 2). These findings suggest that iron reduction therapy by phlebotomy definitely reduces lipid peroxidation and oxidative stress in patients with CHC. Iron reduction therapy by phlebotomy may be useful in other diseases caused by lipid peroxidation and oxidative stress such as nonalcoholic fatty liver disease,11 diabetes mellitus,8 and obesity.10 Table 1. Changes in blood parameters in the phlebotomy group

A Comparison of Four Regimens for Treatment of Iron Storage Disease Using the European Starling (Sturnus vulgaris) as a Model

Abstract: European starlings (Sturnus vulgaris) were fed an iron loading diet (3235 ppm) for 31 days to induce nonheme liver iron concentrations approaching those in birds that died with iron storage disease. All birds then were fed a low-iron diet (32–48 ppm) and assigned to 4 treatment groups: 1) low-iron diet only, 2) low-iron diet with phytate (inositol) and tannic acid, 3) low-iron diet and deferoxamine (100 mg/kg SC q24h), and 4) low-iron diet and phlebotomy (1% of body weight q7d). Starlings were treated for 16 weeks. In the groups treated with phlebotomy or with deferoxamine and a low-iron diet, nonheme liver iron concentrations decreased to safe levels after 16 weeks of treatment at similar rates (190 ppm/wk and 163 ppm/wk, respectively). The low-iron diet alone reduced stored liver iron levels at a slower rate (45 ppm/wk). The addition of inositol and tannic acid to the low-iron diet had no impact on stored liver iron concentrations. These results suggest that both phlebotomy and treatment with d...

Iron burden and liver fibrosis decrease during a long-term phlebotomy program and iron chelating treatment after bone marrow transplantation.

Abstract: In this retrospective study, we report the results of the association of a combined phlebotomy program and chelation in hereditary sideroblastic anemia (HSA) to reduce iron overload after bone marrow transplantation (BMT). A male HSA patient, not responding to pyridoxine treatment, was submitted to successful allogeneic BMT. As there was a persistence of a tissue iron overload, a regular phlebotomy program was started followed by chelation. A significant decrease of iron burden was obtained using a combined treatment with deferoxamine (DFO) and deferiprone (L1) in addition to the phlebotomy program. A 10-year follow-up shows a marked decrease in the concentration of serum ferritin, non-transferrin-bound iron (NTBI), liver iron and normal hemoglobin (Hb), which allows the patient to reach and maintain a good quality of life.

Effects of phlebotomy therapy on cytochrome P450 2e1 activity and oxidative stress markers in dysmetabolic iron overload syndrome: a randomized trial.

Abstract: Summary Aim To assess the effects of iron removal on cytochrome P450 2E1 activity and oxidative stress in dysmetabolic iron overload syndrome. Methods Forty-eight patients were randomized to phlebotomy therapy consisting of removal of 300–500 mL of blood every 14 days until serum ferritin levels dropped under 100 μg/L or to follow-up without phlebotomy therapy. Cytochrome P450 2E1 activity was measured at baseline and at the end of treatment by using the 6-hydroxychlorzoxazone/chlorzoxazone blood metabolic ratio, 2 h after the intake of 500 mg of chlorzoxazone. Results In the treatment group, a mean of 3.9 ± 1.3 L of blood was removed and serum ferritin levels dropped from 715 ± 397 to 74 ± 34 μg/L. Variation of cytochrome P450 2E1 activity was not significantly different between the 2 groups (0.07 ± 0.26 vs. 0.03 ± 0.19, P = 0.36). In the treatment group, low-density lipoprotein cholesterol and vitamin E were lowered after treatment compared with control group (−0.15 ± 0.51 vs. 0.24 ± 0.58, P = 0.002 and −1.3 ± 4.4 vs. 2.3 ± 5.2, P = 0.03, respectively). Inversely, vitamin C was increased (0.5 ± 3.5 vs. −1.8 ± 3.9, P = 0.03). Conclusions In dysmetabolic iron overload syndrome, reduction of iron stores does not significantly influence cytochrome P450 2E1 activity but is associated with a significant decrease of low-density lipoprotein cholesterol, suggesting that venesection therapy may be a suitable option in these patients.

Hereditary hemochromatosis: a review of the genetics, mechanism, diagnosis, and treatment of iron overload.

Abstract: Hereditary hemochromatosis is a relatively common genetic disorder characterized by excess dietary iron absorption and deposition in tissues with resulting end-organ damage. Early diagnosis and initiation of therapeutic phlebotomy can provide a normal life expectancy for affected individuals.

Causes of anaemia in very low birth weight infants. phlebotomy losses are not the first accused

Abstract: Aim The specific aim of the study was to determine the correlation between the severity of pathology, the amount of blood removed for diagnostic purposes in the 1st week of life and the incidence of early anaemia in very low birth weight (VLBW) infants. Methods We recorded the level of haemoglobin (Hb) and haematocrit (Ht) in each of the 50 infants entered in the study at their admission in our neonatal intensive care unit (NICU) and at the age of 8 days. We quantified for each infant the blood drawn for clinical purpose during the 1(st)week of life, using microanalytic techniques for all types of analysis performed. Using the neonatal therapeutic intensive score system (NTISS) we divided all patients into 2 groups: group A= mild light pathology; group B= severe pathology. Results There was statistically significant difference between the percent decrease of Hb and Ht with reference to the birth weight in the 2 groups. Logistic regression analysis indicated a strong correlation (P = 0.009) between higher degree of illness severity and higher percent decrease of Hb and Ht. The difference due to the amount of phlebotomy losses was not significant. Conclusions To our knowledge, this study is the first that strongly suggest that phlebotomy losses is not the main cause of anaemia in VLBW preterm infants in the 1st week of life, when a policy of strictly attention to the amount of blood removed is performed.

Iron removal with phlebotomy and recombinant human erythropoietin in secondary hemochromatosis after allogeneic bone marrow transplantation

Abstract: Correspondence: Kyung-Ha Ryu, Department of Pediatrics, Ewha Womans University College of Medicine, 911 – 1 Mok – 6 – Dong, Yangchon-gu, Seoul 158 – 710, Korea. Email: ykh@ewha.ac.kr Received 4 March 2004; accepted 9 February 2005. Hemochromatosis, the deposition of ferritin and hemosiderin, causes liver, pancreas and heart failure. This may be caused by a congenital enzymatic defect or it can occur after multiple transfusions of packed red cells. 1 We report here a girl, 4 years after autologous peripheral blood stem cell transplantation (PBSCT) for acute myelogenous leukemia (AML) M2, who was diagnosed with secondary hypoplastic myelodysplastic syndrome (MDS). Allogeneic bone marrow transplantation (BMT) was done for the hypoplastic MDS and she received 400 mL of transfusions during that time. After the allogeneic BMT, secondary hemochromatosis and chronic graft versus host disease (GVHD) was diagnosed. She was treated with cyclosporin A and prednisone for the treatment of GVHD, and regular phelobotomy and recombinant human erythropoietin (rhEPO) were used to remove the iron while maintaining the hemoglobin level above 8 mg/dL. We sought an explanation for the high level of ferritin and came up with the following hypotheses. There have been reports of hemochromatosis in patients with MDS from ineffective erythropoiesis causing an excess of ineffectively used iron. Another possibility is that it could have become overt incidentally after the allogeneic BMT, or a new mutation in the gene might have been induced by the cytotoxic therapy. Hemochromatosis also could have evolved as a manifestation of the chronic GVHD in the liver. Possibly an underlying liver dysfunction could have caused a disturbance in the iron metabolism as well. All of these plausible causes might have been acting alone or in synergistic combination in our patient. Case report

[A case of hemochromatosis diagnosed in a middle-aged patient with diabetes mellitus].

Abstract: The authors present the case of a 60-year-old patient admitted for diabetes mellitus. Primary (hereditary) hemochromatosis was diagnosed as the pathological background of diabetes as well as the associated symptoms (weight loss, arthrosis, erectile dysfunction, supraventricular arrhythmia, hepatic cirrhosis). To eliminate the accumulated excess iron, phlebotomy cycles were started. Family screening revealed two other affected patients who contrary to the index-patient were free of complaints. Phlebotomy was, however, started in one of these patients because of abnormal laboratory values consistent with iron-overload. For the prevention of the symptoms early diagnosis is important. Although some of the symptoms can disappear, the most severe changes (cirrhosis, diabetes) are irreversible. Latest knowledge about the pathophysiology including the genetic background and the practice of diagnosis and treatment of the disease are discussed as well.

Audit of phlebotomy turnaround time in a private hospital setting.

Abstract: An audit on the turnaround time (TAT) of a hospital phlebotomy service was undertaken to assess whether or not the existing service standards can satisfy the needs and expectations of both the external and internal customers. A job request survey form was designed and implemented in June 2005 to be used by the day shift to record the number of phlebotomy cases and the corresponding TAT. The success rate and complaints related to phlebotomy were also recorded. Phlebotomists provided the data for this study on an honor system basis. Out of 2,118 test requests received by the laboratory, 1,867 (88.1 percent) were phlebotomy requests. Approximately 62 phlebotomy requests were recorded, on average, per day shift. The average time, expressed in mean +/- standard deviation (SD) needed for response, arrival, and job completion was 7.4 +/- 1.5 minutes, 5.6 +/- 1.6 minutes, and 10.4 +/- 2.4 minutes respectively, with an average overall TAT of 23.4 +/- 4.1 minutes per phlebotomy request. The success rate at first phlebotomy attempt was 97 percent, and only one complaint was received during the audit period. This study may help hospital management identify possible bottlenecks that delay phlebotomy TAT, thus improving service standards in this area.

Evaluation of Arterial Compliance in Polycythemia Vera Patients: Short and Long-Term Influence of Phlebotomy

Abstract: Background: Thrombosis is a major cause of morbidity and mortality in polycythemia vera. Hypercoagulability is principally due to hyperviscosity of the whole blood, an exponential function of the hematocrit. PV is also associated with endothelial dysfunction that can predispose to arterial disease. Reduction of the red cell mass to a safe level by phlebotomy is the first principle of therapy in PV. This therapy may have some effect on the arterial compliance in PV patients. Objectives: To estimate the influence of phlebotomies on large artery (C1) and small artery compliance (C2) in PV patients by using non-invasive methods. Methods: Short-term hemodynamic effects of phlebotomy were studied by pulse wave analysis using the HDI-Pulse Wave CR2000 (Minneapolis, MN, USA) before and immediately after venesection (350–500 ml of blood). We repeated the evaluation after 1 month to measure the long-term effects. Results: Seventeen PV patients were included in the study and 47 measurements of arterial compliance were performed: 37 for short-term effects and 10 for long-term effects. The mean large artery compliance (C1) before phlebotomy was 12.0 ml/mmHg x 10 (range 4.5–28.6), and 12.6 ml/mmHg x 10 (range 5.2–20.1) immediately after phlebotomy (NS). The mean small artery compliance (C2) before and immediately after phlebotomy were 4.4 mg/mmHg x 10 (range 1.2–14.3) and 5.5 mg/mmHg x 10 (range 1.2–15.6) respectively (delta C2–1.1, P < 0.001). No difference in these parameters could be demonstrated in the long-term arm. Conclusions: Phlebotomy immediately improves arterial compliance in small vessels of PV patients, but this effect is short lived.

[A novel method for the self-collection of blood, "thenar lancing phlebotomy" and investigation of its accuracy].

Abstract: "Thenar lancing phlebotomy" is a novel method for the self-collection of blood using a special phlebotomy device for the thenar and a self-collection blood kit. The thenar is punctured with a special lancet, the vein is subjected to automatic avascularization at the wrist and at the same time, a small centrifuge tube, attached to the suction cylinder of the device, is applied to the puncture and the blood is collected by suction. The small centrifuge tube containing the whole blood is centrifuged with a portable centrifugal separator to obtain plasma. In comparison with conventional finger prick phlebotomy, there is less pain and sufficient blood may be obtained. To investigate the accuracy of the method, we collected blood from the antecubital vein of 140 subjects and thenar lancing phlebotomy was simultaneously carried out on the same 140 subjects. The results of many blood tests currently included in medical check-ups were almost identical in the blood samples of both groups, suggesting that this method can be utilized in medical check-ups using self-collected blood sampies.

How and why to start in-house phlebotomy training.

Abstract: Solving the staffi ng crisis in the phlebotomy department involved establishing an innovative, unique, and comprehensive phlebotomy-training program, incorporating clinical externship with traditional didactic instruction in a 16week program. Students at the Medical Center of Central Georgia do not pay tuition; they are hired as full-time temporary employees. Student trainees receive a total of 115 hours of classroom instruction and 475 hours of clinical experience. Classroom instruction in-

Procedures in Phlebotomy - 3rd Edition [Book Review]

Abstract: Review(s) of: John C Flynn Jr, Procedures in Phlebotomy - 3rd Edition, Elsevier Australia ,Softcover, 304 pages ISBN: 0721606385, A$57.20.