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PubMed1987

Treatment of hemodialysis-related porphyria cutanea tarda with small repeated phlebotomies.

Phlebotomy is generally thought to be contraindicated in porphyria cutanea tarda (PTC) associated with hemodialysis for the anemia which is often present in uremic patients. We report a patient with a severe form of hemodialysis-related PTC and biochemical parameters suggestive of iron overload in whom treatment with small repeated phlebotomies was well tolerated without any significant worsening of the anemia and gave marked biochemical improvement and complete clinical remission.

Aged↗
PubMed1993

Management of hemosiderosis complicated by coexistent anemia with recombinant human erythropoietin and phlebotomy.

Patients with hemosiderosis who also suffer from coexistent anemia may be unable to tolerate frequent phlebotomies needed for depletion of body iron stores. Chelation therapy, an alternative approach, may be unsuitable for some patients due to allergic reactions, poor response or intolerance of long-duration subcutaneous administration. The use of recombinant human erythropoietin in such patients could increase the hematocrit and improve exercise tolerance allowing for more frequent phlebotomies. We report the successful use of this combined approach in two such patients.

Aged↗
PubMed1990

Exercise performance of polycythemic chronic obstructive pulmonary disease patients. Effect of phlebotomies.

The purpose of this study was to determine the effects of phlebotomy on the exercise tolerance and right and left ventricular ejection fraction of polycythemic patients with chronic obstructive pulmonary disease. Ten patients with COPD (mean FEV1 = 1.32 +/- 0.55 L) and polycythemia (mean Hct = 62 +/- 3 percent) were studied before and after their hematocrits had been reduced to approximately 50 percent. Post-phlebotomy the maximal oxygen consumption increased from 1.09 +/- 0.34 L/min to 1.26 +/- 0.43 L/min (p less than 0.05) and the maximum workload increased from 56.5 +/- 32.6 watts to 74.5 +/- 23.4 watts (p less than 0.05). The increase in the exercise tolerance appeared to be primarily due to an increased cardiac output at Emax. There was no relationship between the increases in the upright exercise capacity and changes in the supine ejection fractions of the right or left ventricular either at rest or during exercise.

Aged↗
PubMedDate not supplied

Iron content and acid phosphatase activity in hepatic parenchymal lysosomes of patients with hemochromatosis before and after phlebotomy treatment.

Lysosomal structures in liver parenchymal cells of 3 patients with iron overload and of 3 subjects without iron-storage disorders were investigated. A combination of enzyme cytochemistry--with cerium as a captive ion to demonstrate lysosomal acid phosphatase activity--and electron probe X-ray microanalysis (EPMA) was used. We were able (1) to define and quantify lysosomal structures as lysosomes, siderosomes, or residual bodies, (2) to quantify the amount of iron and cerium simultaneously in these structures, and (3) to evaluate a possible relation between iron storage and enzyme activity. With histopathologically increased iron storage, the number of siderosomes had increased at the cost of lysosomes, with a corresponding increase in acid phosphatase activity in both organelles. In histopahtologically severe iron overload, however, acid phosphatase activity was low or not detectable and most of the iron was stored in residual bodies. After phlebotomy treatment, the number of siderosomes had decreased in favor of the lysosomes, approaching values obtained in control subjects, and acid phosphatase activity was present in all iron-containing structures. In this way a relationship between iron storage and enzyme activity was established. The iron content of the individual lysosomal structures per unit area had increased with histopathologically increased iron storage and had decreased after phlebotomy treatment. From this observation, it is concluded that the iron status of the patient is not only reflected by the amount of iron-containing hepatocytes but, as well, by the iron content lysosomal unit area.

Acid Phosphatase↗
PubMed1985

Effect of phlebotomy on reticulocyte numbers in Japanese Quail.

Hematological changes were studied in response to a phlebotomy of 30% of the estimated total blood volume in 5-week-old Coturnix coturnix japonica. Blood samples, femoral bone marrow samples, and blood and marrow erythroid cell differential counts were collected at 0 (nonphlebotomized), 1, 3, 6, 24, and 72 hr postphlebotomy. The samples were collected only once from each bird. Total peripheral erythrocyte numbers, percent hematocrit, and hemoglobin levels were decreased at 1, 3, 6, and 24 hr. The relative percentage of peripheral erythrocytes with little or no reticulum was not affected by phlebotomy. With the exception of mean cellular hemoglobin concentration, all of the hematological values measured in the peripheral blood had returned to nonphlebotomized, 0 hr levels at 72 hr postphlebotomy. However, in the bone marrow, a marked reticulocytosis was found at 72 hr postphlebotomy.

Animals↗
PubMedDate not supplied

Paradigm shift: phlebotomy belongs to nursing.

Defining, analyzing, and changing macro- and micro-processes has become almost a routine part of the TQM efforts of many laboratories as they strive to improve service and reduce costs. Scrutinizing each part of a process can reveal unnecessary steps that, if eliminated, would generate improvements with desired outcomes. This laboratory reviewed the processes associated with phlebotomy, especially for STAT tests, at the same time its administration was planning to establish 11 patient care centers where there previously had been three traditionally operated hospitals. Through process analysis, this laboratory transferred the entire function of in-patient phlebotomy from the laboratory to nursing. The results of an 8-month follow-up study show a significant favorable effect on laboratory turnaround time and related costs but not without some problems.

Blood Specimen Collection↗
PubMed1975

The effect of phlebotomy on canine erythrocyte metabolism.

Enzyme activity declines with erythrocyte age in most mammals. To test this concept in the dog, we decreased the PCV to less than 20 by phlebotomy. The erythrocytes were restored rapidly (1.57 per cent per day). The resulting decline in the mean erythrocyte age was accompanied by increased activity by most of the erythrocyte enzymes studied. Enzymes with lower initial enzymatic activity (hexokinase, pyruvate kinase, 6-phosphogluconate dehydrogenase and glutathione reductase) increased proportionally more than those with higher initial activity (lactate dehydrogenase, 3-phosphoglycerate kinase, glyceraldehyde-3-dehydrogenase and glucose-6-dehydrogenase). Among species, increases in enzyme activity after phlebotomy appear to be related to each species' life span. Most of the metabolites increased concomitantly with the highest reticulocyte period. Diphosphoglycerate concentrations did not change significantly during the experiment.

Adenosine Diphosphate↗
PubMed1991

[Treatment of iron overload with combination of recombinant human erythropoietin and phlebotomy].

A patient of Coombs negative autoimmune hemolytic anemia was massively transfused of 162 units concentrated red blood cells in 3 months and developed iron overload disease which was confirmed by liver biopsy. Hemolysis was successfully treated with high-dose methyl-prednisolone therapy and splenectomy. To treat iron overload, we administered recombinant human erythropoietin (Epo) in combination with phlebotomy. Total iron removed for 5 months was about 4 g. Thus, combination of Epo and phlebotomy was effective for the treatment of iron overload disease. Furthermore, we compared a degree of clinical effect of subcutaneous administration of Epo with that of intravenous administration in the clinical course and found the former more effective.

Adult↗
PubMed1987

Identical complement concentrations in blood obtained from central venous catheters, arterial lines, and antecubital phlebotomy.

In vitro complement activation has been detected during passage of blood through tubing used in hemodialysis and cardiopulmonary bypass surgery, in addition to tubing being investigated for vascular grafts. Because tubing from arterial lines and central venous catheters are composed of similar materials and are used when blood is withdrawn from patients for complement assays, a study was undertaken to assess the degree of complement activation in blood obtained from these sites. Complement activation was determined by a terminal complement complex enzyme-linked immunosorbent assay (ELISA), C1rC1s-C1 inhibitor complex ELISA, and 50% complement hemolytic activity (CH50) assay. Blood simultaneously obtained from the arterial lines and central venous catheters had identical terminal complement complex, C1rC1s-C1 inhibitor complex, and CH50 levels when compared with blood withdrawn by antecubital phlebotomy. Because blood may be obtained from the arterial lines and central venous catheters for complement assays, the pain and possible bruising from antecubital phlebotomy could be eliminated. Furthermore, blood may now be withdrawn from indwelling catheters without fear of in vitro complement activation causing a misinterpretation of results.

Arteries↗
PubMed1977

[Treatment of porphyria cutanea tarda with and without phlebotomy (author's transl)].

Extensive investigations form 1962 to 1973 on 23 patients with porphyria cutanea tarda are reported. Two collectives of patients with different treatments are compared. One collective was treated conventionally with "liver therapy, abstinence from alcohol, and rest in bed", the other collective with "phlebotomy, abstinence from alcohol, and rest in bed". Both collectives showed a nearly equal decrease of uroporphyrin excretion. The unfavourable effect of alcohol in this disease was confirmed. In the post-observation period, minimal excretion of uroporphyrin was found to be more frequent and to persist longer in the collective treated by phlebotomy. In this collective, abstinence from alcohol was more consistently adhered to.

Bed Rest↗
PubMed1981

A comparative study of the results of phlebotomy therapy and low-dose chloroquine treatment in porphyria cutanea tarda.

Longer remissions after the phlebotomy therapy than after the low-dose chloroquine treatment were ascertained by means of the long-term follow-up of a large group of porphyria cutanea tarda patients. An attempt to prove the dependence of the length of laboratory and clinical remission on the values of initial porphyrinuria, on the degree of morphological liver changes, and on the total amount of blood withdrawn at phlebotomy was unsuccessful. On the contrary, a direct relationship was observed between the length of remission and the age of the subject on commencing treatment. At the same time, it was impossible to prove a causal relationship between the length of remission and initial porphyrinuria, the degree of morphological liver changes, and the total dose of drug taken, in the group of patients on the low-dose chloroquine therapy.

Adult↗
PubMed1982

Chloroquine in treatment of porphyria cutanea tarda. Long-term efficacy of combined phlebotomy and high-dose chloroquine therapy.

The combined treatment with phlebotomy and high-dose chloroquine for PCT is described and 21 patients treated were followed up for periods of up to 6 years. Clinical and laboratory remissions were experienced by all patients. The urinary excretion of porphyrin and serum hepatic enzyme levels rose rapidly during therapy and then fell, mostly to levels well below that before treatment. The periods required for normalization of laboratory tests, median value, were 1.5 months for liver enzymes and 7 months for uroporphyrins. Clinical symptoms soon disappeared, blistering within 3 weeks and skin fragility within 12. Mild nausea or subfebrility was noted in some cases, but no other serious acute or chronic adverse reactions were observed. Clinical or biochemical relapse appeared in 9/21 (43%) patients who were then retreated. Relapsing cases showed a symptomfree period of 1-2.5 years after each treatment. Liver biopsy was performed in 4 relapsing cases prior to the repeated treatment and showed only mild siderosis and a mild fatty infiltration consistent with pathological liver findings in PCT but no evidence of chloroquine-induced permanent liver damage. The longest symptomfree period observed up to date was assessed for 7 patients who were followed up for more than 2 years after 1 single treatment. Four (57%) of them were symptomfree 5-6 years and no clinical or biochemical signs of relapse were observed. Our data confirm the efficacy of the high-dose therapeutic procedure, and the combined regimen with 1-2 phlebotomies prior to the chloroquine administration seems to be a safe procedure without any serious side effects. Our findings are discussed in relation to other current therapeutic modalities.

Adult↗
PubMed1982

Idiopathic hemochromatosis: serum ferritin concentrations during therapy by phlebotomy.

We report the case of a 54-year-old man who presented with symptoms of idiopathic hemochromatosis, an inherited disorder involving regulation of iron absorption. These symptoms usually do not appear until total body iron content reaches 15 g, about threefold normal. Therapy involves mobilization and removal of excess stored iron through weekly or twice-weekly phlebotomies of 500 mL, until the hemoglobin concentration becomes less than 110 g/L and remains there for several weeks, or until serum ferritin concentrations indicate that almost all the stored iron has been removed (ferritin less than 12 micrograms/L). Here, concentrations of ferritin in serum were used as an index to iron overload and removal of stored iron. We report changes in hemoglobin, serum ferritin, iron, and total iron-binding capacity during the course of removing by phlebotomy more than 20 g of iron from a patient with idiopathic hemochromatosis.

Bloodletting↗
PubMed1978

Experimental validation of self-instructional modules on the topic of donor phlebotomy.

This validation study investigated the effectiveness of an instructional unit on the topic of donor phlebotomy. The unit consisting of 3 modules based on a videotape and 3 booklets covered (1) donor selection, (2) donor arm preparation, (3) donor phlebotomy. A separate-sample pretest-post-test design was used. All 3 modules were found to be instructionally effective as measured by objective referenced tests. Student appraisal data also was collected for the purpose of revising and improving these materials.

Bloodletting↗
PubMed1980

Utility of serum ferritin as a measure of iron deficiency in normal males undergoing repetitive phlebotomy.

Hematologic indices and iron balance data were obtained on 22 normal male volunteers who were subjected to a mean +/- SD phlebotomy of 164 +/- 34 ml whole blood/mo while living in a controlled environment. Over an average stay of 5 mo, volunteers did not develop anemia, but did display a reduction in iron stores that was quantitated by measurement of serum ferritin and iron balance. The percent saturation of transferrin and the usual erythrocyte parameters did not reflect changes in iron status. Loss of iron, which was calculated from quantitative phlebotomy and iron balance data, showed that a decrease of 1 ng of serum ferritin represented a loss of 4.5 +/- 5.3 mg of iron in 10 men whose initial serum ferritins were greater than 25 ng/ml, and 25.3 +/- 58.8 mg of iron in 7 men whose initial serum ferritins were less than 25 ng/ml. The period required for 3 volunteers who consumed a self-selected mixed diet at home to replace their depleted iron stores to prephlebotomy levels was about 4.5 mo. The sensitivity of serum ferritin as an index of iron stores was affirmed. In addition it was found that normal men who were consuming a mixed diet containing about 15 mg of iron daily and losing blood at a rate of 164 +/- 34 ml/mo did not increase their iron absorption sufficiently to compensate for the iron loss.

Adult↗
PubMed1980

[Unknown danger in phlebotomy with vacuum flasks: air embolism (author's transl)].

A case of nonfatal air embolism during a phlebotomy is reported. It was due to an incorrect procedure and a negligently nonevacuated vacuum flask. The underlying mechanism is theoretically derived and experimentally confirmed. The experiments show that by this mode of phlebotomy hyperbaric pressure occurs in the withdrawal flask which cause the escape of air into the venous system. This inflow of air may be enough to cause fatal air embolism.

Aged↗
PubMed2003

Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter.

CONTEXT: Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. OBJECTIVE: To compare contamination rates in blood culture specimens obtained from separate sites vs through newly inserted intravenous catheters. DESIGN, SETTING, AND PARTICIPANTS: Observational study conducted January 1998 through December 1999 among patients aged 18 years or younger who were seen at a US children's hospital emergency department and had a blood culture obtained as part of their care. Medical records were reviewed in all cases with a positive blood culture. Patients with indwelling vascular catheters were excluded. INTERVENTION: All phlebotomy was performed by emergency department registered nurses. During the baseline phase, blood specimens for culture were obtained simultaneously with intravenous catheter insertion. During the postintervention phase, specimens were obtained by a separate, dedicated procedure. MAIN OUTCOME MEASURE: Contamination rate in the postintervention period compared with the baseline period. RESULTS: A total of 4108 blood cultures were evaluated, including 2108 during the baseline phase and 2000 in the postintervention phase. The false-positive blood culture rate decreased from 9.1% to 2.8% (P<.001). A statistical process control chart demonstrated a steady-state process in the baseline phase and the establishment of a significantly improved steady state in the postintervention phase. Young age was associated with increased contamination rate in both the baseline and postintervention periods. CONCLUSION: Blood culture contamination rates were lower when specimens were drawn from a separate site compared with when they were drawn through a newly inserted intravenous catheter.

Adolescent↗