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At least 217 records · Page 12Linked to original sources
PubMed1993

Determination of rebreathing oxygen consumption and derivation of oxygen delivery in intubated mongrel dogs after phlebotomy and isoproterenol infusion.

This study attempted to determine the correlation between oxygen consumption (VO2), pulmonary-capillary blood flow (QEPC), and oxygen delivery (DO2) by rebreathing and invasive techniques obtained over a range of hemoglobin concentration and cardiac output. Twenty mongrel dogs were instrumented with central arterial and venous catheters to determine DO2 by thermodilution cardiac output and standard formulas. The animals were administered isoproterenol in doses that increased DO2 and subsequently were serially phlebotomized by 30%, 40%, and 50% to decrease DO2. All animals were studied using a rebreathing technique to determine noninvasively VO2, QEPC, and DO2. Sixteen dogs completed the experimental protocol. A correlation analysis was carried out for VO2, QEPC, and DO2 obtained by the rebreathing and invasive methods. Thermodilution cardiac output increased from 3.91 +/- 1.77 L/min at baseline to 8.19 +/- 2.50 L/min during isoproterenol infusion. Hemoglobin varied from 12.21 +/- 1.26 gm% at baseline to 5.21 +/- 1.36 g% at 50% phlebotomy. Over this range of conditions, significant correlations were obtained between rebreathing VO2 and invasive VO2 (r = 0.80, p < 0.0001), rebreathing QEPC and invasive QEPC (r = 0.79, p < 0.0001), and rebreathing DO2 and invasive DO2 (r = 0.82 p < 0.0001). These data demonstrate that the rebreathing technique can be used to monitor oxygen metabolism over wide ranges of DO2.

Acetylene↗
PubMed1980

Fetal Hb production during acute erythroid expansion. I. Observations in patients with transient erythroblastopenia and post-phlebotomy.

In order to study fetal haemoglobin production during acute erythroid expansion we did sequential measurements of Hb F-containing erythrocytes (F-cells) and of relevant haematological parameters in 10 subjects recovering from eyrthroid aplasia, iron deficiency anaemia or following phlebotomy. An increased production of F-cells was consistently observed during the acute marrow expansion, but there were significant differences in the maximum F-cell response among individuals. These differences could not be explained by differences in the degree of anaemia alone, nor could they be correlated with the level of peak reticulocytosis. Two patients who reached the highest F-cell numbers were probably carriers of heterocellular hereditary persistence of Hb F, suggesting that this gene may play a role in determining the magnitude of F-cell production in anaemic patients. It is speculated that the main reason for the consistently observed increase in F cell production during acute marrow expansion is the premature terminal differentiation of earlier erythroid precursos (burst forming units; BFUe). This proposition is in accord with observations in vitro which suggest that Hb F is expressed en eyrthroid clones derived from BFUne's. It is further proposed that differences in the degree of BFUe recruitment may underly the disparities in Hb F response among individuals subjected to similar anaemic stimuli.

Adolescent↗
PubMed1983

125I fibrinogen turnover in polycythaemia: the effect of phlebotomy.

Patients with polycythaemia vera and secondary polycythaemia studied with 125I-labelled fibrinogen, had a significantly increased plasma fibrinogen turnover. The abnormalities were greater in polycythaemia vera and correlated with platelet count but not with packed cell volume. In six patients with polycythaemia vera, phlebotomy reduced the packed cell volume to 0.46 or less. Although fibrinogen turnover decreased significantly in all patients, it remained outside the normal range in four cases. The concept of a prothrombotic state is discussed, and also the importance of these observations with respect to various forms of treatment.

Adult↗
PubMed1992

Serum erythropoietin in the diagnosis of polycythaemia and after phlebotomy treatment.

Serum erythropoietin (S-Epo) was measured with a radiommunoassay method in 36 patients with polycythaemia vera, 17 patients with secondary polycythaemia and 14 patients with relative polycythaemia. The diagnoses were made without the aid of the S-Epo values. It was found that S-Epo was below the reference range in 34/36 patients with polycythaemia vera (mean 2.1 +/- 1.0 U/l), elevated in all cases of secondary polycythaemia (mean 121.7 +/- 242 U/l) and normal in all but one of the cases with relative polycythaemia (mean 7.0 +/- 2.5 U/l). Previous studies of S-Epo levels in the differential diagnosis of polycythaemia have shown significant differences between the means of the groups but a considerable overlap. After phlebotomy treatment to normal haematocrit levels, the S-Epo levels remained subnormal in most of the polycythaemia vera patients even after 18 months at a haematocrit around 45%. Two patients who had been kept at normal haematocrit for 6 and 7 years both had subnormal S-Epo. We conclude that with an Epo assay method of high sensitivity and specificity it is possible to differentiate between different forms of polycythaemia with a high degree of certainty, even between patients with relative polycythaemia and polycythaemia vera patients. The reason why S-Epo remains low in spite of a normal haematocrit in treated polycythaemia vera patients is not known.

Bloodletting↗
PubMed1991

A study of changes in red cell volume and haemoglobin concentration during phlebotomy induced iron deficiency and iron repletion using the Technicon H1.

The recently introduced Technicon H1 analyser uses an improved optical principle to measure the size and haemoglobin concentration of erythrocytes. We have made a serial study of ten patients undergoing phlebotomy to induce mild iron deficiency. The instrument showed the early development of anisohypochromia with subsequent fall in the mean cell haemoglobin concentration (MCHC). Cell volume was preserved until relatively late and during early iron deficient erythropoiesis cell volume would appear to be maintained at the expense of haemoglobin concentration. The Technicon H6000 (conventional technology) used in parallel produced contrasting results indicating anisomicrocytosis with preservation of cell haemoglobin concentration until relatively late. Five cases of severe iron deficiency treated with iron were similarly studied and showed comparable changes on both instruments, with characteristically bimodal cell volume histograms and large increases in red cell distribution width. Our results indicate that the new generation of instruments will generate red cell data of additional clinical value.

Anemia, Hypochromic↗
PubMed1977

Serum ferritin and erythrocyte 2,3-DPG during quantitated phlebotomy and iron treatment.

Serum ferritin and erythrocyte 2,3-DPG levels were followed in 3 healthy males who were phlebotomized to iron depletion and a moderate anaemia. In 2 of the subjects, the expected rise in DPG levels was seen but not in the third, in spite of a Hb concentration of 95 g/1. Serum ferritin levels were found to reflect changes in iron stores, and subnormal serum ferritin indicated depleted iron stores. However, there was no correlation between pre-phlebotomy ferritin levels and calculated iron stores. The conclusion is that no fixed ratio can be established between serum ferritin and iron stores. A single ferritin value within the normal range does not tell how large iron stores a person has. Changes in an individual's iron stores can, however, be detected by repeated ferritin estimations.

Adult↗
PubMed1985

The effect of three phlebotomy techniques on hematological and clinical chemical evaluation in sprague-dawley rats.

The effects of three phlebotomy techniques - periorbital sinus puncture, tail vein incision and cardiac puncture - were determined on seven hematological parameters and seven clinical chemical parameters in female Sprague-Dawley rats. The mean erythrocyte count, leukocyte count, hemoglobin and hematocrit were reduced with cardiac puncture as compared to the other two techniques. There was a statistically significant increase in the variance of each of these parameters except the leukocyte count. The mean serum lactate dehydrogenase, aspartate animotransferase, alanine aminotransferase, gamma-glutamyl transferase and creatinine were greater in samples collected by cardiac puncture than with the periorbital sinus and tail vein techniques. A statistically significant difference in variance was observed between the orbital sinus puncture and the cardiac puncture for each of these parameters. In all cases except lactate dehydrogenase, the values from the orbital sinus and tail vein techniques were comparable for both hematology and clinical chemistry. A large variance was found by all three techniques for both alkaline phosphatase and lactate dehydrogenase in the rat. Over 60% of the serum samples were hemolyzed from the cardiac puncture technique while approximately 25% of the serum samples from tail vein incision were hemolyzed. In this laboratory the lack of hemolysis and the lower variance make the periorbital sinus venipuncture technique the method of choice for collection of blood samples from rats.

Journal Article↗
PubMed1990

Treatment of a patient with end-stage renal disease, severe iron overload and ascites by weekly phlebotomy combined with recombinant human erythropoietin.

A 41-year-old hemodialyzed woman developed ascites and was found to have secondary iron overload. The dose of administered iron was approximately 11-12 g, and her serum ferritin level was 15,000 ng/ml (15,000 micrograms/l). There were no signs of congestive heart failure, fluid overload, or liver cirrhosis. A program of weekly phlebotomy combined with recombinant human erythropoietin (rhEPO) therapy was tried to eliminate the iron congestion. After 9 months of this therapy, about 5 g of iron had been removed. The ascites completely disappeared, and her serum ferritin level fell to 5,800 ng/ml (5,800 micrograms/l). This suggests that such combined therapy would be useful when iron overload must be corrected rapidly. Before therapy, the sterile ascitic fluid showed exudative characteristics with 3.7 g/dl (37 g/l) of total protein. The serum-ascites albumin difference was 0.6 g/dl (6 g/l), and the fluid contained 1,400 inflammatory cells/mm3 (1.4 X 10(9)/l). Notably, the serum-ascites albumin difference increased in parallel with iron elimination. These findings suggested that iron deposition may have played a role in changing the permeability of the peritoneum, or in impairing lymphatic drainage, both of which are presumed to be pathogenetic factors of nephrogenic ascites.

Adult↗
PubMed1984

Phlebotomy treatment in porphyria cutanea tarda combined with beta-thalassaemia.

In 74 patients with porphyria cutanea tarda, 11 (14.9%) cases of beta-thalassaemia were found. The incidence of beta-thalassaemia in porphyrics is not greater than in non-porphyrics and it seems that beta-thalassaemia is not a factor triggering the development of porphyria cutanea tarda. The phlebotomy treatment is also a convenient method for porphyria cutanea tarda combined with beta-thalassaemia.

Bloodletting↗
PubMedDate not supplied

Use of a phlebotomy service in a paediatric unit.

This article evaluates the literature and research concerning venepuncture and the use of a phlebotomy service in an acute paediatric setting. It also highlights concerns expressed by nursing and medical staff about the introduction of such a service.

Bloodletting↗
PubMed1975

The effects of phlebotomy, hemodilution and autologous transfusion on systemic oxygenation and whole blood utilization in open heart surgery.

Blood utilization in 400 consecutive adult patients undergoing a wide variety of cardiovascular operations requiring cardiopulmonary bypass was documented following institution of: 1) complete oxygenator hemodilution; 2) intraoperative phlebotomy and autologous transfusion; 3) infusion of residual oxygenator red cells; and 4) use of reconstituted frozen cells in patients whose blood type was uncommon. These techniques have resulted in an average utilization of 4.8 units of blood per adult patient. Fourteen patients required no blood at all and a total of 259 patients required less than 5 units of blood during their entire hospital course. Physiologic effects of this blood program and hemodilution were evaluated in ten patients and the results indicate that marked reduction of red cell mass by hemodilution with hypothermia and low flow perfusion is not detrimental to satisfactory whole blood oxygenation during open heart surgery.

Adolescent↗
PubMed1990

Blood culture phlebotomy: switching needles does not prevent contamination.

OBJECTIVE: To determine how switching to a sterile needle after phlebotomy and before the inoculation of blood culture bottles affects the rate of skin flora contamination. DESIGN: A randomized trial. SETTING: Medical inpatient services and the emergency department of a large university hospital. PARTICIPANTS: Housestaff, medical students, nurses, and physician assistants who draw blood cultures on the general medicine, cardiology, and renal transplant units and in the emergency department. INTERVENTIONS: Phlebotomists were randomly assigned to draw blood cultures by either the conventional method or an alternative method in which the blood culture bottles were inoculated without switching needles. MEASUREMENTS AND MAIN RESULTS: There was no difference in the rate of contamination between the conventional technique (6 of 462 cases, 1.30%) and the alternative technique (7 of 451 cases, 1.55%) (95% CI for the difference in rates, -1.8% to 1.2%). CONCLUSIONS: The needle switch in the conventional blood culture technique does not reduce the rate of skin flora contamination. Blood cultures should no longer be obtained by switching needles.

Blood Specimen Collection↗
PubMed1976

Sideroblastic anaemia associated with iron overload treated by repeated phlebotomy.

Iron overload with prominent skin pigmentation and hepatic parenchymal siderosis is reported in a patient with refractory sideroblastic anaemia. Failure to reverse the sideroblastic changes or the anaemia with conventional therapy prompted us to use a graded phlebotomy programme. The rising haemoglobin level in spite of repeated venesections is support for this approach in selected patients with this diagnosis.

Aged↗
PubMed1992

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

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.

Accidents, Occupational↗
PubMed1990

Prevalence of human immunodeficiency virus seropositivity in pediatric emergency room patients undergoing phlebotomy.

Information on the prevalence of human immunodeficiency virus (HIV) infection among children and adolescents requiring medical care is sparse. A small but significant risk of seroconversion occurs in health care workers who handle blood and body fluids of patients infected with HIV. The prevalence of HIV seropositivity in children who had phlebotomy as part of emergency care was measured. Of 749 blood samples, 21 (2.8%) tested positive for HIV antibody by enzyme-linked immunosorbent assay and Western Blot analysis: 14 samples from 6 patients with hemophilia, 6 from 3 patients with acquired immunodeficiency syndrome/acquired immunodeficiency syndrome-related complex, and 1 from a patient with asthma. Of these 21 blood samples, 10 were from 4 children previously known to be HIV positive, 4 were from patients with a known parental risk factor, and 16 were from patients with known history of blood transfusion. One sample was from a children with unknown HIV status and no documented risk factors. Procedures included 9 venipunctures, 17 intravenous line placements, 1 lumbar puncture, and 1 pelvic examination. Most patients with HIV seropositivity had been known to be HIV seropositive or at significant risk for HIV seropositivity. Although the potential risk to health care workers from children without known risk factors for HIV seropositivity was small in this population, the currently recommended infection-control precautions should always be observed.

Adolescent↗
PubMed1990

[Fatal air embolism following erroneous phlebotomy technique].

An 62 years old patient suffering of polycythemia was treated by phlebotomy. To accelerate the blood flow the collecting apparatus was connected to a pump supplying suction. Of the two pump outlets, providing suction and pressure, the one supplying pressurized air was connected erroneously. Air was insufflated into the arm vein causing cardiac arrest. Reanimation was unsuccessful. The findings are discussed, as well as the difficulties in interpretation.

Bloodletting↗
PubMed1990

Response of various indices of iron status to acute iron depletion produced in menstruating women by low iron intake and phlebotomy.

We investigated response sensitivities of indices of iron status to controlled iron depletion and repletion in 11 premenopausal women. The women were depleted of storage iron (as reflected by serum ferritin) through a combination of a low-iron diet and phlebotomy. They then consumed a diet containing 13.7 mg of iron per 2000 kcal, supplemented with either ascorbic acid or placebo (for 5 1/2 weeks) and a daily 50-mg iron supplement (for the subsequent 17 days). The relative sensitivities of different indices for detecting iron depletion were as follows: ferritin greater than % transferrin saturation greater than plasma iron greater than hemoglobin greater than hematocrit greater than zinc protoporphyrin (ZnPP) and erythrocyte protoporphyrin (EP). Ascorbic acid treatment during repletion, before iron supplementation, significantly (P less than 0.05) affected changes in hemoglobin, ZnPP, ZnPP/heme, and EP/heme. Changes in heme synthesis evidently do not occur until iron stores are depleted and, conversely, during iron repletion hematopoiesis must be satisfied before iron stores, as reflected by ferritin, increase. Thus, the use of only one index of iron status is of limited value for detecting iron depletion.

Adult↗
PubMed1986

[Quantitative liver function tests in porphyria cutanea tarda: improvement under therapeutic phlebotomy].

Quantitative liver function was assessed before and after therapy in 4 patients with porphyria cutanea tarda. Three patients underwent phlebotomy, which produced clinical and biochemical remission. Concomitantly, functional liver cell mass, as measured by galactose elimination capacity, normalized. In the last patient, treated with chloroquine, liver function did not improve during therapy. The aminopyrine breath test, a measure of microsomal function, was inconclusive. These results show that decreased hepatic function in porphyria cutanea tarda is reversible and emphasize the potential role of iron accumulation in the pathogenesis of hepatic dysfunction in porphyria cutanea tarda.

Adult↗