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PubMed1997

Score for neonatal acute physiology and phlebotomy blood loss predict erythrocyte transfusions in premature infants.

OBJECTIVE: To test the hypothesis that utilization of a previously described measure of acuity (ie, the score for neonatal acute physiology [SNAP]) during the first 7 postnatal days predicts which infants with a birth weight of 1500 g or less received erythrocyte transfusion during the initial hospitalization. DESIGN: Retrospective chart review. SETTING: A regional tertiary care newborn intensive care unit at the Arizona Health Sciences Center, University Medical Center, Tucson. MATERIALS: Medical records of premature infants (birth weight, < or = 1500 g) who were admitted from October 1993 to January 1995. MAIN OUTCOME MEASURES: Occurrence or nonoccurrence of erythrocyte transfusion was determined in 47 infants who were compared for demographic information, phlebotomy blood loss, diagnoses, medications, and the SNAP at 0, 1, 2, and 7 days of life. RESULTS: Infants with a birth weight of 1500 g or less received a mean +/- SD of 1.9 +/- 2.9 transfusions with 22 (47%) of the infants given transfusions Infants who were given transfusions vs those who were not given transfusions were of a lower mean +/- SD birth weight (971 +/- 238 g vs 1272 +/- 144 g; P < .001) and a lower gestational age (27.7 +/- 1.6 weeks vs 30.7 +/- 2.8 weeks; P < .001), and they had a greater mean phlebotomy blood loss (3.3 +/- 1.6 mL/kg per day vs 1.4 +/- 0.5 mL/kg per day; P < .001) during the first postnatal week. The SNAP indexes in those who received transfusions were higher at 1, 2, and 7 days of life (P = .03, P = .001, and P < .001, respectively). Using stepwise logistic regression, phlebotomy blood loss and the SNAP at 7 days of life were significant predictors of the number of transfusions. The logistic model predicted which infants had been administered transfusions with 86% sensitivity and 88% specificity. CONCLUSIONS: The efficacy and cost-effectiveness of recombinant human erythropoietin therapy in premature infants remain under study. As earlier treatment with recombinant human erythropoietin may be more efficacious, early identification of which infants currently undergo transfusion may identify those who will receive the greatest benefit from recombinant human erythropoietin therapy. The SNAP distinguished those infants who were given transfusions from those who did not receive transfusions, even after adjusting for phlebotomy blood loss.

Birth Weight↗
PubMed2004

Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers.

BACKGROUND: Use of protective devices has become a common intervention to decrease sharps injuries in the hospitals; however few studies have examined the results of implementation of the different protective devices available. OBJECTIVE: To determine the effectiveness of 2 protective devices in preventing needlestick injuries to health care workers. METHODS: Sharps injury data were collected over a 7-year period (1993-1999) in a 3600-bed tertiary care university hospital in France. Pre- and postinterventional rates were compared after the implementation of 2 safety devices for preventing percutaneous injuries (PIs) related to phlebotomy procedures. RESULTS: From 1993 to 1999, an overall decrease in the needlestick-related injuries was noted. Since 1996, the incidence of phlebotomy-related PIs has significantly decreased. Phlebotomy procedures accounted for 19.4% of all percutaneous injuries in the preintervention period and 12% in the postintervention period (RR, O.62; 95% CI, 0.51-0.72; P < .001). Needlestick-related injuries incidence rate decreased significantly after the implementation of the 2 safety devices, representing a 48% decline in incidence rate overall. CONCLUSIONS: The implementation of these safety devices apparently contributed to a significant decrease in the percutaneous injuries related to phlebotomy procedures, but they constitute only part of a strategy that includes education of health care workers and collection of appropriate data that allow analysis of residuals percutaneous injuries.

Health Personnel↗
PubMed2004

Prevention of secondary stroke and resolution of transfusional iron overload in children with sickle cell anemia using hydroxyurea and phlebotomy.

OBJECTIVE: Transfusions prevent secondary stroke in children with sickle cell anemia (SCA) but also cause iron overload. Alternatives for stroke prophylaxis with effective therapy to reduce iron burden are needed. STUDY DESIGN: For 35 children with SCA and stroke, transfusions were prospectively discontinued. Hydroxyurea was prescribed for stroke prophylaxis, and phlebotomy removed excess iron. Initial patients discontinued transfusions before hydroxyurea therapy, but later patients overlapped transfusions with hydroxyurea until tolerating full-dose therapy. RESULTS: Children received hydroxyurea for 42 +/- 30 months (range, 3-104 months). Hydroxyurea (26.7 +/- 4.8 mg/kg per day) led to mild neutropenia (3.9 +/- 2.3 x 10(9)/L) with significant increases in hemoglobin concentration, mean corpuscular volume, and fetal hemoglobin. Stroke recurrence rate was 5.7 events per 100 patient-years, but children receiving overlapping hydroxyurea therapy had only 3.6 events per 100 patient-years. For 26 children with >6 months of phlebotomy, 14,311 +/- 12,459 mL blood (315 +/- 214 mL/kg) was removed, with serum ferritin decreasing from a median of 2722 to 298 ng/mL. Among patients completing phlebotomy, liver biopsy documented normal histology and no excess iron deposition. CONCLUSIONS: For children with SCA and stroke, hydroxyurea effectively prevents secondary stroke and serial phlebotomy leads to complete resolution of transfusional iron overload.

Adolescent↗
PubMed1998

Accidental needlesticks in the phlebotomy service of the Department of Laboratory Medicine and Pathology at Mayo Clinic Rochester.

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.

Accidents, Occupational↗
PubMed2003

Platelet count increase following phlebotomy in iron overloaded patients with liver cirrhosis.

Thrombocytopenia is a frequent hematological complication in patients with liver cirrhosis, but its pathogenesis is not clearly understood. We evaluated the effect of iron depletion by phlebotomy on platelet count in 62 consecutive iron overloaded patients with liver cirrhosis and thrombocytopenia. After a median follow-up of 30.2 months we observed a significant increase of platelet count in all patients (from mean baseline levels of 110.1 up to 168.22109/l at the end of follow-up, P<0.001) with platelet count normalization in 42 of them (67.7%). In addition, we observed a significant improvement of serum ALT levels (from pretreatment mean values of 126.7 up to 59.7 U/l at the end of follow-up, P<0.001) along with the reduction of serum ferritin levels and transferrin saturation during phlebotomy. Different pathogenetic mechanisms involving both humoral (erythropoietin and thrombopoietin, TPO) and physical (portal hypertension and hypersplenism) factors are here discussed to explain the platelet count increase following phlebotomy. Our results show that phlebotomy is effective not only in lowering iron overload, but also in improving liver function and thrombocytopenia in patients with liver cirrhosis.

Aged↗
PubMed2003

A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicenter study, 1993-1995.

OBJECTIVE: To examine a comprehensive approach for preventing percutaneous injuries associated with phlebotomy procedures. DESIGN AND SETTING: From 1993 through 1995, personnel at 10 university-affiliated hospitals enhanced surveillance and assessed underreporting of percutaneous injuries; selected, implemented, and evaluated the efficacy of phlebotomy devices with safety features (ie, engineered sharps injury prevention devices [ESIPDs]); and assessed healthcare worker satisfaction with ESIPDs. Investigators also evaluated the preventability of a subset of percutaneous injuries and conducted an audit of sharps disposal containers to quantify activation rates for devices with safety features. RESULTS: The three selected phlebotomy devices with safety features reduced percutaneous injury rates compared with conventional devices. Activation rates varied according to ease of use, healthcare worker preference for ESIPDs, perceived "patient adverse events," and device-specific training. CONCLUSIONS: Device-specific features and healthcare worker training and involvement in the selection of ESIPDs affect the activation rates for ESIPDs and therefore their efficacy. The implementation of ESIPDs is a useful measure in a comprehensive program to reduce percutaneous injuries associated with phlebotomy procedures.

Attitude of Health Personnel↗
PubMed2001

Phlebotomy-related lateral antebrachial cutaneous nerve injury.

Although phlebotomy is a common and widespread procedure, the medical literature provides limited information in terms of the documented complications of venipuncture. Documentation of phlebotomy-related nerve injuries is even more limited. The authors present a case report of a phlebotomy-induced lesion of the lateral antebrachial cutaneous nerve. According to our literature search, this is the first case in which electrodiagnostic studies were used to document venipuncture-related injury of the lateral antebrachial cutaneous nerve. Specific electrodiagnostic testing is used to definitively diagnose this rare injury and to track recovery. Electrodiagnostic testing can be helpful in evaluating cases of sensory disturbance after phlebotomy.

Action Potentials↗
PubMed2005

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

BACKGROUND AND OBJECTIVES: Iron homeostasis is tightly regulated in mammals according to the needs of erythropoiesis and the iron stores present. This regulation is disrupted in hereditary hemochromatosis (HH), a genetic disorder characterized by increased intestinal iron absorption, leading to iron overload. The genes coding for HFE, transferrin receptor 2 (TFR2), ferroportin (SLC40A1 or FPN1), hepcidin (HEPC) and hemojuvelin (HJV or RGMC) are responsible for different types of genetic iron overload. All these genes are highly expressed in the liver and their protein products are likely components of a single hepcidin-related pathway. In order to gain insights into the molecular relationship among the HH proteins we evaluated the hepatic expression of HH genes in conditions of iron restriction or overload. DESIGN AND METHODS: Data were obtained after phlebotomy, to activate the erythroid regulators and following parenteral iron dextran loading, to activate the store regulators, in two mice strains (C57BL/6 and DBA/2). HH genes and proteins expression were analyzed by quantitative real time polymerase chain reaction and by Western blotting, respectively. RESULTS: Hepc RNA was reduced after phlebotomy and increased in iron overload. A statistically significant reduction of hepatic Fpn1 RNA expression was observed after phlebotomy; this effect was more evident in the DBA/2 strain. Fpn1 increased in C57BL/6 mice, but not in the DBA/2 ones in parenteral iron loading. Fpn1 protein did not change substantially in either condition. Hfe, Rgmc and Tfr2 expression was not influenced by phlebotomy. In parenteral iron overload, Tfr2 gene and protein expression decreased concomitant to the increase in Hepc, while Hfe RNA remained constant. INTERPRETATION AND CONCLUSIONS: 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.

Animals↗
PubMed2005

[JCCLS phlebotomy standards].

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.

Clinical Laboratory Techniques↗
PubMed2006

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

"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.

Female↗
PubMed1995

Human recombinant erythropoietin and phlebotomy in the treatment of iron overload in uremic patients.

Six chronic hemodialysis patients suffering from iron overload (serum ferritin ranged between 2053-15704 mu g/L) were treated with human recombinant erythropoietin (EPO) alone for eighteen months. An initial rapid decrease of serum ferritin was observed in all six patients when the loading dose of EPO was given. Three patients (Cases 4, 5, 6) who suffered from chronic blood loss maintained a continuous decline of serum ferritin in the subsequent stage of maintenance dose EPO therapy, however, the decrease of serum ferritin became sluggish under a maintenance dose in the other three patients (Cases 1, 2 and 3). The serum ferritin eventually decreased to a satisfactory level (975-1761 mu g/L) in Cases 4, 5 and 6, whereas it remained high (4232-8196 mu g/L) in Cases 1, 2, and 3 who had higher basal levels of serum ferritin (5641-15704 mu g/L) and a plateau of response under a maintenance dose of EPO. These three patients were then treated with EPO and phlebotomy. Their serum ferritin decreased quickly from 6752 +/- 1264 mu g/L to 2454 +/- 482 mu g/L after six months of phlebotomy therapy; it was a dramatic improvement in contrast to the stagnant response under a maintenance dose of EPO alone. Our experience indicates that EPO therapy alone has its limitations in treating severe iron overload. Although there is an initial rapid decrease of serum ferritin during the period of the loading dose, the response might become stagnant during the period of maintenance dose. Phlebotomy effectively eliminated the excessive iron stores in these refractory cases. Therefore, we suggest that phlebotomy be considered in severe iron overload if a stagnant response is observed under a maintenance dose EPO therapy.

Adult↗
PubMed1991

Phlebotomy in inoculation risk patients: a questionnaire survey of knowledge and practices of hospital doctors in Liverpool.

To assess the knowledge of hospital doctors about patients at increased risk of infection with human immunodeficiency virus (HIV) or hepatitis B virus, and the precautions they took during phlebotomy in such patients, an anonymous postal questionnaire was sent to all 307 hospital doctors working at two District General Hospitals in Liverpool, UK. Two hundred and thirty-eight (77.5%) of the questionnaires were returned. More than 90% of respondents considered a history of male homosexuality, intravenous drug abuse, prostitution or a child of a prostitute to indicate an inoculation risk. There was uncertainty about a previous prison sentence in the 1980s, residence in a home for the mentally handicapped, previous residence in the tropics and hospital treatment in the tropics. Thirty-eight percent of doctors would never enquire about sexual preference, 54.1% about a previous prison sentence and 15.7% about intravenous drug abuse in their clinical history. Although 97.4% of doctors would sometimes or always wear gloves during phlebotomy of an inoculation risk patient, 25.5% always resheathed the needle after phlebotomy and 20.8% would never take the sharps box to the patient. More effort is required to identify accurately inoculation risk patients and greater care is needed in phlebotomy techniques.

Blood Specimen Collection↗
PubMed2006

Iron removal by phlebotomy for the prophylaxis of fulminant hepatitis in a Wilson disease model of Long-Evans Cinnamon Rats.

Long-Evans Cinnamon rats are an animal model of Wilson disease with a compound load of copper and iron. However, the mechanisms of the high mortality rate from fulminant hepatitis in the rats remain undetermined. In this study, phlebotomy as an alternative for an iron-deficient diet was investigated to modify hepatitis in the rats. One group of female rats was treated with phlebotomy twice a week, and the other group received blood tests only every 2 weeks. Liver specimens were examined for biochemical non-heme iron and copper, and histochemical trivalent iron. Although all rats examined had icteric hepatitis around the age of 20 weeks, the mortality of fulminant hepatitis was lower in phlebotomized rats than in control rats (1/18 versus 8/20, p<0.05). Phlebotomy not only ameliorated the severity of hepatitis, but also reduced serum malondialdehyde. Non-heme iron in the liver was the greatest in victims of fulminant hepatitis in the control group. There was no difference in the hepatic copper content between the two groups. The prognosis of hepatitis in the rats with Wilson disease was hepatic non-heme iron-dependent, and iron removal by phlebotomy was an effective prophylaxis against fulminant hepatitis.

Journal Article↗
PubMed2006

Effect of iron reduction by phlebotomy in Japanese patients with nonalcoholic steatohepatitis: A pilot study.

Increased hepatic iron deposition may play a role in the pathogenesis of nonalcoholic steatohepatitis (NASH). This study aimed to test whether iron removal by phlebotomy improves serum transaminase activities in patients with NASH. Eleven patients (six males and five females) with biopsy-proven NASH underwent phlebotomy biweekly until they reached near-iron deficiency (NID) (serum ferritin concentration lower than or equal to 30ng/ml). Nine patients completed this study. Serum ferritin levels in these patients fell from 563+/-322 to 18+/-9ng/ml (p=0.001). The treatment reduced mean serum alanine aminotransferase (ALT) activity from 126+/-47 to 56+/-17IU/l (p=0.002). Their weight did not change significantly throughout the study period. Although two patients withdrew from the study, none was affected by any side effects of repeated phlebotomy that required discontinuing the treatment. In conclusion, this pilot study suggests that iron reduction therapy by phlebotomy will be one of the promising therapies for NASH.

Journal Article↗
PubMed1990

Recombinant human erythropoietin and phlebotomy in the treatment of iron overload in chronic hemodialysis patients.

Five long-term hemodialysis patients with clinical iron overload were treated with 300 U/kg of recombinant human erythropoietin (rHuEPO) intravenously (IV) after each hemodialysis. The patients were phlebotomized after each hemodialysis at any time the predialysis hematocrit was 35% or greater. Over a period of 1 year, the average phlebotomy rate varied from 0.5 to 1.1 U/wk with a mean phlebotomy rate of 45.8 +/- 5.6 U/yr (range, 27 to 57 U). The mean serum ferritin decreased from 8,412 +/- 1,599 micrograms/L (ng/mL) to 3,007 +/- 1,129 micrograms/L (ng/mL), and the mean iron removal over this period was 9.5 g. Liver iron deposition, as measured by density on computed tomographic (CT) scan, improved, while skin color lightened significantly. Patients tolerated phlebotomy with no major symptoms or complications and exhibited no change in the hemogram or serum chemistries. In patients with severe iron overload, changes in serum ferritin with erythropoietin treatment alone may not reflect true change in iron burden. Use of high-dose erythropoietin and phlebotomy is an effective and safe (at least for 1 year) method of reducing iron overload in long-term hemodialysis patients.

Adult↗
PubMed1986

Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements.

Although anemia is a frequently observed complication of phlebotomies for laboratory tests in neonates, this problem has received little attention in adult populations. We analyzed the phlebotomy records of 100 hospitalized patients and found that 50 patients who spent all of their hospitalization in general wards had blood samples drawn an average of 1.1 times a day. A mean volume of 12.4 ml a day was drawn, and the total volume drawn during their entire hospitalization was 175.0 ml. In contrast, 50 patients who spent part or all of their hospitalization in an intensive care unit were phlebotomized a mean of 3.4 times a day, for a mean volume of 41.5 ml of blood drawn a day and a total volume of 762.2 ml. Patients in the intensive care unit who had arterial lines had more blood drawn (944.0 ml), more often (4.0 times a day), than patients in the intensive care unit who did not have such lines (300.9 ml; 1.9 times a day). Of 36 patients who received transfusions, 17 (47 percent) had large losses from phlebotomy (greater than 180 ml of red cells) that contributed to their transfusion requirements. We propose the use of sample tubes of the size used in pediatrics, batching of requests for laboratory tests, and review of the cumulative volume of blood removed from individual patients as approaches to reducing blood loss from phlebotomy.

Adult↗
PubMed1991

Phlebotomy reverses the hemodynamic consequences of thoracic aortic cross-clamping: relationships between central venous pressure and cerebrospinal fluid pressure.

In dogs (n = 11) anesthetized with sodium pentobarbital (to an isoelectric EEG), the authors investigated the influence of thoracic aortic cross-clamping (AXC) on systemic hemodynamics and cerebrospinal fluid pressure (CSFP) with concurrent measurement of total brain flow (tCBF) and regional (cervical, thoracic, and lumbar) spinal cord blood flow (SCBF). The effect of phlebotomy (to control the hemodynamic consequences of AXC) on tCBF and SCBF was assessed. Radioactive microspheres were injected at four time periods in each animal: 1) at baseline; 2) with application of the AXC; 3) after phlebotomy, to reduce the proximal mean arterial pressure (MAPp) to baseline values; and 4) 2 min after removal of the AXC (mean AXC time 68 +/- 6 min). With application of the AXC, the MAPp, central venous pressure (CVP), and CSFP significantly increased (104 +/- 6 to 156 +/- 6 mmHg, 3.4 +/- 0.4 to 5.2 +/- 0.7 mmHg, and 3.3 +/- 0.7 to 5.2 +/- 0.8 mmHg, respectively), while distal mean aortic pressure (MAPd) significantly decreased (98 +/- 6 to 14 +/- 1 1 mmHg). Phlebotomy (24 +/- 3 ml.kg-1) significantly decreased MAPp (to 106 +/- 6 mmHg), CVP (to 1.6 +/- 0.6 mmHg), and CSFP (to 1.2 +/- 1.1 mmHg). The CSFP changed in parallel with the changes in CVP, a result suggesting that the alterations in CSFP depended on cardiac preload. The spinal cord perfusion pressure (SCPP; SCPP = MAPd - CSFP) was unchanged after phlebotomy, since both MAPd and CSFP decreased. The tCBF and cervical SCBF were unchanged when MAPp increased by 50% with application of the AXC; this indicated that autoregulation was intact.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1977

The absorption and availability of iron from iron-poly(sorbitol-gluconic acid) complex in rats as measured by phlebotomy.

The local and systemic availability of the iron in an iron-poly(sorbitol-gluconic acid) complex (Ferastral) has been studied in rats. The animals were treated intramuscularly with the complex in a dose corresponding to 10 mg of iron per animal. The technique of repeated phlebotomy was used to induce and maintain constant levels of anaemia. The phlebotomies were started immediately after injection and at 14 and 28 days after dosing. At the end of the appropriate interval, the remaining amount of iron at the injection sites as well as the degree of utilization of the iron retained in the animals were estimated. It was shown that the amount of iron at the site of injection of these anaemic animals was less than 3% regardless of the time when the series of phlebotomies were started. It was also shown that the degree of utilization of the iron from the complex was 90% of the retained amount of iron when the phlebotomies immediately followed dosing, and 86% and 79% when initiated 14 days and 28 days respectively. The significance of the decrease in utilization is discussed.

Absorption↗