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Journal articles on the topic 'Phlebotomy'
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1
Goh, Irving. "Phlebotomo-graphy, or Phlebotomy and Writing in Flaubert." MLN 129, no. 4 (2014): 936–54. http://dx.doi.org/10.1353/mln.2014.0079.
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Yannone, Sandra. "Phlebotomy." Women's Review of Books 15, no. 9 (June 1998): 24. http://dx.doi.org/10.2307/4022954.
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Ellis, Harold. "Phlebotomy." Journal of Perioperative Practice 28, no. 10 (July 23, 2018): 283–84. http://dx.doi.org/10.1177/1750458918790182.
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Blackwell, Will H. "Phlebotomy." Chest 143, no. 6 (June 2013): 1831. http://dx.doi.org/10.1378/chest.12-2537.
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Wehrmacher, William H., and Harry Messmore. "Book Review: Phlebotomy Essentials; Phlebotomy Examination Review." Clinical and Applied Thrombosis/Hemostasis 10, no. 1 (January 2004): 87. http://dx.doi.org/10.1177/107602960401000117.
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Billings-Berg, Sarah M. "Phlebotomy basics." Nursing Made Incredibly Easy! 14, no. 4 (2016): 32–41. http://dx.doi.org/10.1097/01.nme.0000484078.58877.9c.
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&NA;. "Phlebotomy Essentials." Medicine & Science in Sports & Exercise 44, no. 2 (February 2012): 370. http://dx.doi.org/10.1249/01.mss.0000411073.30749.01.
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Cook, Lynda S. "Therapeutic Phlebotomy." Journal of Infusion Nursing 33, no. 2 (March 2010): 81–88. http://dx.doi.org/10.1097/nan.0b013e3181d00010.
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&NA;. "66. PHLEBOTOMY." Journal of Infusion Nursing 29, Supplement (January 2006): S71—S73. http://dx.doi.org/10.1097/00129804-200601001-00071.
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Sikdar, Sudip. "Domiciliary phlebotomy." Psychiatric Bulletin 28, no. 7 (July 2004): 266. http://dx.doi.org/10.1192/pb.28.7.266.
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Zubair, Abba. "Therapeutic phlebotomy." Clinical Liver Disease 4, no. 5 (November 2014): 102–6. http://dx.doi.org/10.1002/cld.408.
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Gerçeker, Gülçin Özalp, Dijle Ayar, Emine Zahide Özdemir, and Murat Bektaş. "The impact of the difficult vascular access, fear, and anxiety level in children on the success of first-time phlebotomy." Journal of Vascular Access 19, no. 6 (March 22, 2018): 620–25. http://dx.doi.org/10.1177/1129729818765598.
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Purpose: This study aimed to investigate the success of first-time phlebotomy and the affecting factors in children between 4 and 10 years of age. Methods: This descriptive, comparative, and cross-sectional study was conducted on 155 children who underwent phlebotomy. The Sociodemographic Data Form, the Children’s Anxiety Meter–State, the Children’s Fear Scale, and the Difficult Intravenous Access score were used to collect the data for the study. The relationship between the success of first-time phlebotomy, mean pre-phlebotomy fear and anxiety score, and Difficult Intravenous Access score were examined. The variables affecting the success of first-time phlebotomy were assessed by regression analysis. Results: Phlebotomies failed in 18.1% of children. A statistically significant relationship was found between the success of first-time phlebotomy, Children’s Anxiety Meter–State, Children’s Fear Scale mean scores assessed by the researchers, and Difficult Intravenous Access score. Factors affecting the success of first-time phlebotomy include difficult vascular access, age, mean Children’s Anxiety Meter–State score, mean Difficult Intravenous Access score, and duration of the last phlebotomy performed. These factors explain 42% of the total factors affecting the success of first-time phlebotomy. Conclusion: Child’s fear, anxiety before phlebotomy, and difficult vascular access affects the first-time phlebotomy success.
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Muniroh, Nur An-Nuha, Arif Mulyanto, Kusnanto Mukti Wibowo, and Royan Royan. "RANCANG BANGUN KURSI PHLEBOTOMY BERBASIS IOT." Teknika 7, no. 3 (April 30, 2022): 152–56. http://dx.doi.org/10.52561/teknika.v7i3.190.
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Dewasa ini telah ditetapkan standar operasional prosedur untuk praktik venipuncture. Phlebotomyst yang melakukan tindakan tersebut harus memberi suatu alat pada area bawah siku pasien sebelum melakukan tindakan venipuncture. Fungsi alat ini salah satunya untuk memberikan kenyamanan pada pasien serta memudahkan akses flebotomis mencari pembuluh darah vena. Fakta di lapangan menunjukkan belum ada suatu alat fungsional yang khusus digunakan untuk phlebotomyst melakukan pengambilan darah vena secara efektif dan efisien. Alat yang biasa digunakan oleh phlebotomyst dapat berupa benda-benda apa saja yang difungsikan untuk meluruskan tangan pasien dan terkadang menggunakan benda-benda seadanya yang dapat menimbulkan ketidaknyamanan, kecemasan, menyebabkan terjadinya hematom dan media untuk menularkan penyakit serta kualitas dari sampel yang kurang baik. Tujuan dari penlitian ini adalah untuk membuat suatu alat yang dapat digunakan untuk memberikan kenyamanan pada pasien, serta mengurangi risiko terjadinya hematom (pecahnya pembuluh darah) saat dilakukan tindakan venepuncture. Pada penelitian ini, kursi phlebotomy berbasis IoT telah berhasil dibuat menggunakan Node MCU tsp 8266 serta linier actuator hidrolik. Bagian lengan pada kursi tersebut diberikan bantalan yang lembut serta dapat diatur ketingggiannya sesuai dengan kenyamanan tangan pasien. Pengaturan ketinggian dapat dilakukan secara otomatis menggunakan smartphone. Dengan adanya alat ini diharapkan pengambilan sampel darah pasien lebih efisen, efektif, serta memenuhi syarat dan standar, sehingga pasien merasa puas terhadap pelayanan laboratorium yang diberikan.
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Fazal, Salman, Carole B. Miller, John O. Mascarenhas, Maureen Thyne, Sara Goldberger, Dilan C. Paranagama, Shreekant V. Parasuraman, Ahmad B. Naim, James Mangan, and Ruben A. Mesa. "Phlebotomy Frequency and Quality of Life and Productivity in Patients with Polycythemia Vera: Results from the MPN Landmark Survey in the United States." Blood 126, no. 23 (December 3, 2015): 5184. http://dx.doi.org/10.1182/blood.v126.23.5184.5184.
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Abstract Background: Phlebotomy is a common and established treatment in patients diagnosed with polycythemia vera (PV) to reduce the risk of thromboembolic events, in both acute and chronic settings. However, phlebotomy may not alleviate all PV-related symptoms and its frequent application can cause moderate to profound iron deficiency, which may worsen PV-related symptoms. This analysis of MPN Landmark survey data examined patient-reported quality of life (QoL) and productivity outcomes in patients with PV based on phlebotomy treatment history. Methods: Patients who were diagnosed with a myeloproliferative neoplasm (MPN) were recruited to participate in the MPN Landmark survey in the US (fielded May - July 2014). This analysis describes responses from patients with PV on questions regarding PV-related symptom burden, QoL, and productivity. Patient responses were analyzed based on phlebotomy treatment history and included patients who were actively receiving phlebotomy within the last 3 months (≥1 per month, every other month, and every 3 months or longer), had discontinued phlebotomy, or were phlebotomy-naive. Descriptive statistical analyses were used to evaluate these outcomes based on phlebotomy frequency, as appropriate. Results: Overall, 813 patients completed the Landmark survey, and 274 out of the 380 patients with PV who completed the survey were evaluable for this analysis. Mean age ranged from 61.6-65.4 years among phlebotomy subgroups (Table 1). The average duration of PV was longest among patients with PV who had discontinued phlebotomy (12.0 years) compared with phlebotomy-naive patients (6.3 years) and patients actively treated with phlebotomy (5.9-8.9 years). The percentage of patients diagnosed within 1 year of the survey ranged from 4.1% to 11.5% among the patients who had been treated with phlebotomy and was 15.4% in the phlebotomy-naive subgroup. Most patients reported PV-related symptoms; symptom burden was similar in all phlebotomy subgroups. Fatigue was the most common symptom reported in all subgroups (range, 71.4%-80.8%). QoL measures were generally worse with higher phlebotomy frequency (Table 1). Similarly, more frequent phlebotomy procedures was found to be associated with reduced productivity: patients who received ≥1 phlebotomy per month had the highest mean number (in the preceding 30 days) of sick days (among patients employed), days spent in bed, and days with plans canceled. Of note, approximately one third of patients receiving more frequent phlebotomy procedures were also receiving concomitant hydroxyurea to manage their PV (≥1 per month, 38.5%; every other month, 36.4%). Conclusion: Patients with PV may experience disease-related symptoms and reductions in QoL and work productivity. Frequent phlebotomy procedures were associated with increasingly worsened QoL and decreased work productivity. Further research is needed to better understand the impact of phlebotomy on patient-reported outcomes in patients with PV. Disclosures Fazal: Bristol Myers Squibb: Consultancy, Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Ariad: Consultancy, Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau. Miller:Incyte Corporation: Honoraria, Research Funding. Mascarenhas:Promedior: Research Funding; Roche: Research Funding; CTI Biopharma: Research Funding; Kalobios: Research Funding; Novartis Pharmaceuticals Corporation: Research Funding; Incyte Corporation: Research Funding. Thyne:Incyte Corporation: Speakers Bureau. Paranagama:Incyte Corporation: Employment, Equity Ownership. Parasuraman:Incyte Corporation: Employment, Equity Ownership. Naim:Incyte Corporation: Employment, Equity Ownership. Mangan:Incyte Corporation: Membership on an entity's Board of Directors or advisory committees. Mesa:Promedior: Research Funding; Genentech: Research Funding; Gilead: Research Funding; NS Pharma: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; CTI Biopharma: Research Funding; Pfizer: Research Funding; Incyte Corporation: Research Funding.
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Machhi, Rushad, Ashley M. Cunningham, Kenneth Hennrick, Karen A. Schaser, Eliot C. Williams, and William Nicholas Rose. "Unexplained Hematocrit Increase after Therapeutic Phlebotomy in a Patient with Marked Erythrocytosis." Case Reports in Hematology 2022 (August 11, 2022): 1–3. http://dx.doi.org/10.1155/2022/5018388.
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We report a patient with hereditary erythrocytosis who underwent a therapeutic phlebotomy and had a post-phlebotomy hematocrit that was higher than the pre-phlebotomy hematocrit. We could not discern a reason for this hematocrit increase after phlebotomy. Instead of performing another phlebotomy, we performed an automated red cell depletion via an apheresis instrument. This procedure is essentially a red cell exchange, but 5% albumin is used as the replacement fluid instead of red blood cells. The patient’s hematocrit decreased from 80% to 39% after three consecutive daily red cell depletion procedures. We share our experience to report the unusual finding of a patient’s hematocrit that increased with phlebotomy and to raise awareness of the red cell depletion procedure.
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Newham, Benjamin JC, and Rahul Khanna. "The effect of therapeutic phlebotomy for hemochromatosis on non-suicidal self-injury: A case report." International Journal of Psychiatry in Medicine 54, no. 1 (July 30, 2018): 74–79. http://dx.doi.org/10.1177/0091217418791451.
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Background Self-phlebotomy has been described as a form of non-suicidal self-injury. However, a relationship between non-suicidal self-injury and therapeutic phlebotomy for hemochromatosis has not previously been described. Case presentation: We present a case of a 52-year-old man in whom the frequency of his therapeutic phlebotomy and non-suicidal self-injury were inversely linked, leading to adverse outcomes when his phlebotomy was suspended. Conclusions This is the first report describing the relationship between non-suicidal self-injury and therapeutic phlebotomy. This case highlights the need for risk assessment and monitoring of self-harm in patients who are undergoing therapeutic phlebotomy in order to prevent adverse outcomes.
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Boccia, Ralph V., Brady Stein, Ruben A. Mesa, Ahmad B. Naim, Joseph A. Cordaro, Wei Peng, Hao Sun, Shreekant V. Parasuraman, and Alison Moliterno. "Burden of Phlebotomy in Patients with Polycythemia Vera in the United States: Baseline Data from the REVEAL Study." Blood 126, no. 23 (December 3, 2015): 5187. http://dx.doi.org/10.1182/blood.v126.23.5187.5187.
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Abstract Background: Phlebotomy to maintain hematocrit <45% is considered one of the cornerstones for the management of polycythemia vera (PV). However, phlebotomy procedures may be inconvenient for or poorly tolerated by some patients, and often result in iron deficiency, which may be associated with additional quality-of-life burden, such as fatigue, impaired cognitive function and restless leg syndrome. The REVEAL study (ClinicalTrials.gov, NCT02252159) is being conducted to describe contemporary demographics, burden of disease, clinical management, patient-reported outcomes, and healthcare resource utilization among patients with PV in the US. This early analysis describes the patient self-reported burden of phlebotomy at the time of enrollment. Methods: REVEAL is a multicenter, noninterventional, nonrandomized, prospective, observational study of adult patients with PV who are currently under the care of a US physician. REVEAL collects physician assessments and patient-reported outcomes during a 36-month observation period. Phlebotomy-related burden is being assessed with a new 21-item phlebotomy burden questionnaire (PBQ-21) at enrollment and every 90 days thereafter; it assesses patient-reported phlebotomy frequency, practice setting, time required for phlebotomy, inconvenience, and phlebotomy-related adverse effects. Phlebotomy-related effects and bother/inconvenience (if experienced within 24 hours after a phlebotomy procedure) are graded on a 4-point scale of 1 (not at all) to 4 (extremely). Analyses of these preliminary data were descriptive. Results: At the time of data cutoff, 865 patients were enrolled (total planned enrollment, n=2000). Median age was 67 (range, 22-95) years, 55.5% were male, and 89.5% were white. Median time from PV diagnosis to study enrollment was 53 months. Overall, 748 patients completed the PBQ-21 at enrollment and 400 (53.5%) had received a phlebotomy within 3 months prior to enrollment. Mean number of phlebotomies in the past 3 months was 2.2 (SD, 1.7). Phlebotomy was most commonly performed at a doctor's office during a regular medical visit (37.8%), at an infusion center or special cancer care center (26.8%), or at a hospital (18.3%). Patients who had phlebotomy procedures within 90 days before enrollment reported a mean total treatment time of 4.2 (SD, 4.7) hours per phlebotomy procedure; for employed patients, the mean amount of work time missed was 4.6 (SD, 15.6) hours per procedure. Fatigue, bruising, dehydration, and dizziness were among the most commonly reported adverse effects of phlebotomy (Table 1). Twenty percent of patients reported that phlebotomy procedures were moderately or extremely bothersome, inconvenient (18.3%), or painful or physically uncomfortable (16.3%). Furthermore, some patients (8.8%) reported that their family and friends were moderately or severely inconvenienced by phlebotomy procedures. Conclusion: The PBQ-21 collects important and relevant patient-reported information to systematically assess the impact of phlebotomy on patients and caregivers. From the early view of REVEAL enrollment data, a considerable proportion of patients reported fatigue, bruising, dehydration, and dizziness resulting from phlebotomy procedures. Furthermore, patients reported spending a considerable amount of time (4 hours on average) per phlebotomy procedure, which is a sizeable burden for patients who are employed. In addition, some patients reported that phlebotomy procedures may be inconvenient, painful or uncomfortable, and bothersome. REVEAL provides important information for providers to understand and address when to prescribe phlebotomy for patients with PV. Disclosures Boccia: Incyte Corporation: Honoraria. Stein:Incyte Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees. Mesa:Genentech: Research Funding; Promedior: Research Funding; NS Pharma: Research Funding; CTI Biopharma: Research Funding; Gilead: Research Funding; Incyte Corporation: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; Pfizer: Research Funding. Naim:Incyte Corporation: Employment, Equity Ownership. Cordaro:Incyte Corporation: Employment, Equity Ownership. Peng:Incyte Corporation: Employment, Equity Ownership. Sun:Incyte Corporation: Employment, Equity Ownership. Parasuraman:Incyte Corporation: Employment, Equity Ownership. Moliterno:Incyte Corporation: Membership on an entity's Board of Directors or advisory committees.
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Sari, Indah. "FLEBOTOMY EDUCATION TO INDO HEALTH SCHOOL STUDENTS IN PALEMBANG DEPARTMENT OF MEDICAL LABORATORY TECHNOLOGY." Khidmah 3, no. 2 (January 11, 2022): 320–25. http://dx.doi.org/10.52523/khidmah.v3i2.349.
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A clinical laboratory is a health laboratory that carries out clinical specimen examination services to obtain information about individual health, especially to support efforts to diagnose disease, cure disease, and restore health. The results of laboratory tests are strongly influenced by the pre-analytical, analytical and post-analytic stages. The biggest error contribution in the laboratory, namely in the pre-analytic stage, occurred at 77.1%. One of the health services at the forefront of laboratory services is phlebotomy. Phlebotomy is one of the main reasons behind pre analytic errors. Currently medical laboratory technology experts pay less attention to pre-analytical processes in the laboratory such as the process of taking blood samples (phlebotomy) so it is necessary to socialize and educate about phlebotomy for students of SMK Indo Health School (IHS) majoring in medical laboratory technology which aims to increase knowledge and understanding students regarding the pre-analytic stage, especially in blood sampling (phlebotomy) so as to prevent errors in the post-analytic stage. Solutions that can answer the problems faced by medical laboratory technology experts, it is necessary to carry out socialization and education about phlebotomy, so as to increase the knowledge and understanding of students of SMK Indo Health School (IHS) majoring in medical laboratory technology, totaling 30 participants at the pre-analytic stage, especially in taking blood samples (phlebotomy) as well as the selection of poster education media aims to explain about phlebotomy, demonstrate the stages of phlebotomy and the importance of a good phlebotomy stage in laboratory examination.
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Bodley, Thomas, Maverick Chan, Olga Levi, Lauren Clarfield, Drake Yip, Orla Smith, Jan O. Friedrich, and Lisa K. Hicks. "Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study." PLOS ONE 16, no. 1 (January 13, 2021): e0243782. http://dx.doi.org/10.1371/journal.pone.0243782.
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BackgroundIntensive care unit (ICU) patients are at high risk of anemia, and phlebotomy is a potentially modifiable source of blood loss. Our objective was to quantify daily phlebotomy volume for ICU patients, including blood discarded as waste during vascular access, and evaluate the impact of phlebotomy volume on patient outcomes.MethodsThis was a retrospective observational cohort study between September 2014 and August 2015 at a tertiary care academic medical-surgical ICU. A prospective audit of phlebotomy practices in March 2018 was used to estimate blood waste during vascular access. Multivariable logistic regression was used to evaluate phlebotomy volume as a predictor of ICU nadir hemoglobin < 80 g/L, and red blood cell transfusion.ResultsThere were 428 index ICU admissions, median age 64.4 yr, 41% female. Forty-four patients (10%) with major bleeding events were excluded. Mean bedside waste per blood draw (144 draws) was: 3.9 mL from arterial lines, 5.5 mL central venous lines, and 6.3 mL from peripherally inserted central catheters. Mean phlebotomy volume per patient day was 48.1 ± 22.2 mL; 33.1 ± 15.0 mL received by the lab and 15.0 ± 8.1 mL discarded as bedside waste. Multivariable regression, including age, sex, admission hemoglobin, sequential organ failure assessment score, and ICU length of stay, showed total daily phlebotomy volume was predictive of hemoglobin <80 g/L (p = 0.002), red blood cell transfusion (p<0.001), and inpatient mortality (p = 0.002). For every 5 mL increase in average daily phlebotomy the odds ratio for nadir hemoglobin <80 g/L was 1.18 (95% CI 1.07–1.31) and for red blood cell transfusion was 1.17 (95% CI 1.07–1.28).ConclusionA substantial portion of daily ICU phlebotomy is waste discarded during vascular access. Average ICU phlebotomy volume is independently associated with ICU acquired anemia and red blood cell transfusion which supports the need for phlebotomy stewardship programs.
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Wray, Donna, and Gail Wells. "Procedures in Phlebotomy." Archives of Pathology & Laboratory Medicine 124, no. 4 (April 1, 2000): 640. http://dx.doi.org/10.5858/2000-124-640b-pip.
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Togoev, O. O., I. V. Khokhlov, D. M. Gribkov, L. B. Shubina, and A. V. Rogoschenkova. "Phlebotomy educational interventions." Virtual Technologies in Medicine 1, no. 3 (September 17, 2021): 184–85. http://dx.doi.org/10.46594/2687-0037_2021_3_1383.
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The teaching of the standard operating procedure (SOP), taking venous blood (venipuncture, phlebotomy), for a long time proceeded according to the classical model, in which the teacher explained and showed the cadets how to take blood from a vein correctly, and then the trainers repeated the whole sequence after him (4- x in stages). In 2014, substitute teacher technologies such as the TutorMan virtual complex began to appear in the training system. And what if the students already have their own experience. We turned to educational intervention technologies.
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Benjamin, Denis. "Editorial: Pediatric Phlebotomy." Fetal and Pediatric Pathology 16, no. 5 (September 1, 1996): 3–4. http://dx.doi.org/10.3109/15513819609169296.
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Elliott, William J. "Switching Phlebotomy Needles." Annals of Internal Medicine 114, no. 1 (January 1, 1991): 94. http://dx.doi.org/10.7326/0003-4819-114-1-94.
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Kumar, Vikram S., and Molly Webster. "Push-button Phlebotomy." Clinical Chemistry 62, no. 5 (May 1, 2016): 785–87. http://dx.doi.org/10.1373/clinchem.2016.256867.
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Benjamin, Denis R. "EDITORIAL: Pediatric Phlebotomy." Pediatric Pathology & Laboratory Medicine 16, no. 5 (October 1, 1996): 1–2. http://dx.doi.org/10.1080/107710496175318.
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Ogden-Grable, Helen, and Gary W. Gill. "Phlebotomy Puncture Juncture." Laboratory Medicine 36, no. 7 (July 2005): 430–33. http://dx.doi.org/10.1309/extw9lbm0cd7p9ev.
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Benjamin, Denis. "EDITORIAL: Pediatric Phlebotomy." Fetal and Pediatric Pathology 16, no. 5 (October 1, 1996): 1–2. http://dx.doi.org/10.1080/713601213.
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Benjamin, Denis R. "Editorial: Pediatric Phlebotomy." Pediatric Pathology & Laboratory Medicine 16, no. 5 (January 1996): iii—iv. http://dx.doi.org/10.1080/15513819609169296.
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Morrison, Aileen P., Milenko J. Tanasijevic, Joi N. Torrence-Hill, Ellen M. Goonan, Michael L. Gustafson, and Stacy E. F. Melanson. "A Strategy for Optimizing Staffing to Improve the Timeliness of Inpatient Phlebotomy Collections." Archives of Pathology & Laboratory Medicine 135, no. 12 (December 1, 2011): 1576–80. http://dx.doi.org/10.5858/arpa.2011-0061-oa.
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Context.—The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model. Objective.—To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections. Design.—We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period. Results.—The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27–8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20–8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days. Conclusion.—Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.
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Kawamura, Itta, Genzou Takemura, Hiromitsu Kanamori, Toshiaki Takeyama, Tomonori Kawaguchi, Akiko Tsujimoto, Kazuko Goto, et al. "Repeated phlebotomy augments angiogenesis to improve blood flow in murine ischemic legs." American Journal of Physiology-Heart and Circulatory Physiology 299, no. 2 (August 2010): H372—H378. http://dx.doi.org/10.1152/ajpheart.00035.2010.
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Anemia may accelerate angiogenesis in ischemic organs through its ability to augment tissue hypoxia-induced generation of several known angiogenic factors and to increase erythropoietin levels, which are also potently angiogenic. We examined the effect of controlled phlebotomy (bloodletting) on blood flow in a mouse ischemic leg model. We ligated the right femoral artery of BALB/c mice. In the phlebotomy group, 200 μl of blood were drawn from the tail vein once a week. After 4 wk, blood flow in the ischemic leg was significantly better in the phlebotomy group (flow ratio of the ischemic to nonischemic leg, 0.87 ± 0.04) than the control group (0.59 ± 0.05, P < 0.05), and capillary density was significantly higher. Repeated phlebotomy increased serum erythropoietin levels as well as the expression of hypoxia-inducible transcription factor-1α and vascular endothelial growth factor and both the expression and activity of Akt and endothelial nitric oxide synthase (eNOS) in ischemic legs. Treatment with wortmannin or Nω-nitro-l-arginine methyl ester significantly attenuated the phlebotomy-induced improvement of blood flow. In addition, fluorescence-activated cell sorting analysis revealed an increase in circulating peripheral endothelial progenitor cells in the phlebotomy group, and treatment with AMD3100, a specific inhibitor of the chemokine receptor CXCR4, blocked the beneficial effect of phlebotomy. These findings suggest that repeated phlebotomy improves blood flow in ischemic legs through an angiogenic action that involves the Akt/eNOS pathway, endothelial progenitor cell mobilization, and their complicated cross talk. An adequately controlled phlebotomy might be one method by which to induce therapeutic angiogenesis.
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Podoltsev, Nikolai A., Mengxin Zhu, Amer M. Zeidan, Rong Wang, Xiaoyi Wang, Amy J. Davidoff, Scott F. Huntington, Smith Giri, Steven D. Gore, and Xiaomei Ma. "The impact of phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera." Blood Advances 2, no. 20 (October 17, 2018): 2681–90. http://dx.doi.org/10.1182/bloodadvances.2018021436.
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Abstract Current guidelines recommend therapeutic phlebotomy for all polycythemia vera (PV) patients and additional cytoreductive therapy (eg, hydroxyurea [HU]) for high-risk PV patients. Little is known about the impact of these therapies in the real-world setting. We conducted a retrospective cohort study of older adults diagnosed with PV from 2007 to 2013 using the linked Surveillance, Epidemiology, and End Results–Medicare database. Multivariable Cox proportional hazards models were used to assess the effect of phlebotomy and HU on overall survival (OS) and the occurrence of thrombotic events. Of 820 PV patients (median age = 77 years), 16.3% received neither phlebotomy nor HU, 23.0% were managed with phlebotomy only, 19.6% with HU only, and 41.1% with both treatments. After a median follow-up of 2.83 years, 37.2% (n = 305) of the patients died. Phlebotomy (yes/no; hazard ratio [HR] = 0.65; 95% confidence interval [CI], 0.51-0.81; P < .01), increasing phlebotomy intensity (HR = 0.71; 95% CI, 0.65-0.79; P < .01), and a higher proportion of days covered (PDC) by HU were all significantly associated with lower mortality. When thrombosis was the outcome of interest, phlebotomy (yes/no; HR = 0.52; 95% CI, 0.42-0.66; P < .01) and increasing phlebotomy intensity (HR = 0.46; 95% CI, 0.29-0.74; P < .01) were significantly associated with a lower risk of thrombotic events, so was a higher HU PDC. In this population-based study of older adults with PV reflecting contemporary clinical practice, phlebotomy and HU were associated with improved OS and decreased risk of thrombosis. However, both treatment modalities were underused in this cohort of older PV patients.
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Ahmad, Dr Sharique, Dr Shriya Arora, and Dr Tanish Baqar. "Therapeutic Phlebotomy Revisited: A Review." Saudi Journal of Medicine 8, no. 04 (April 4, 2023): 152–58. http://dx.doi.org/10.36348/sjm.2023.v08i04.004.
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Therapeutic phlebotomy is the removal of red blood cells or serum iron from the blood. It is one of the preferred treatments for blood disorders. In ancient times this process was known as bloodletting. Generalized method included were venesection and arteriotomy and systemic methods included were cupping and by leeches. It stimulates bone marrow stem cells to generate new red blood cells (RBCs). Iron for hemoglobin synthesis is taken from the body thus reducing serum iron. Different indications of therapeutic phlebotomy include Polycythemia Vera, Hemochromatosis, Porphyria cutanea tarda, Sickle cell disease, Non-Alcoholic Fatty liver disease (NAFLD) with hyperferritinemia. Other methods available for reducing RBC and iron level include apheresis and administration of desferroxamine. Phlebotomy can cause rare adverse effects, such as thrombosis, mostly seen in patients with polycythemia Vera. Other adverse effects include Hematoma at phlebotomy site. Usually hematoma is mild but in severe cases can cause damage in nerves and surrounding tissue. Haemoconcentration, extravasation, Syncope and Fainting, petechiae, Excessive Bleeding, edema, arterial puncture, pain and anemia are some of the adverse effects caused by therapeutic phlebotomy. Unsafe phlebotomy can expose patients and health workers to various infections like Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV); syphilis and malaria. Different countries have approved allogenic use of blood units obtained from therapeutic phlebotomy. Mostly blood collected from patients with hemochromatosis is permitted. The article also discusses criteria for initiating therapeutic phlebotomy and various regimen followed in different diseases.
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Bodley, Thomas, Maverick Chan, Lauren Clarfield, Olga Levi, Avery Longmore, Wendy Lin, Drake Yip, Smith Orla, Jan O. Friedrich, and Lisa K. Hicks. "Patient Harm from Repetitive Blood Draws and Blood Waste in the ICU: A Retrospective Cohort Study." Blood 134, Supplement_1 (November 13, 2019): 57. http://dx.doi.org/10.1182/blood-2019-127394.
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Introduction: Frequent blood testing in the intensive care unit (ICU) is instrumental to patient diagnosis, monitoring, and titration of invasive therapies. However, there is a growing appreciation that a significant proportion of ICU blood tests are reflexive and unnecessary.1,2 Serial phlebotomy is associated with extended hospital length of stay and acquired anemia in the general hospital population.3 Since patients in the ICU are prone to developing anemia,4,5 they are likely at increased risk of harm from serial phlebotomy. In response, multiple recent campaigns advocate for physician restraint in laboratory test ordering.6,7 However, relatively little is known about the effect of excessive phlebotomy on outcomes in critically ill patients. Better understanding of ICU phlebotomy practices, and harms associated with serial testing, is important in planning, implementing, and evaluating phlebotomy reduction interventions. Objectives: 1) Quantify average daily phlebotomy volume for ICU patients including blood discarded as waste when accessing vascular devices. 2) Identify if average daily phlebotomy volume is an independent risk factor for ICU acquired anemia (hemoglobin < 80 g/L) or the need for red blood cell transfusion. 3) Explore the relationship between daily phlebotomy volume and hospital mortality. Methods: This was a retrospective cohort study at an academic tertiary care center in Toronto, Ontario, utilizing hospital administrative data, laboratory data, and select chart review. Index Medical Surgical ICU admissions between September 2014 and August 2015 with an ICU stay of three days or greater were included. Major bleeding events were defined as a hemoglobin drop of 30 g/L within a 24 hour period. Average daily phlebotomy volumes were calculated using the number of samples received by the lab multiplied by standard blood volumes required for each sample type. A bedside prospective audit was conducted in March 2018 to quantify average blood volume discarded as waste during phlebotomy. Blood discard/waste data were summarized with descriptive statistics, but not included in further analysis. Multivariable logistic regression was used to study the association between average daily phlebotomy volume and each of: nadir hemoglobin (< 80 g/L), the need for red blood cell transfusion, and hospital mortality. Patients with a major bleeding event were excluded from the regression. Control variables included sex, age, ICU length of stay, admission hemoglobin, and admission Sequential Organ Failure Assessment (SOFA) score. Results: There were a total of 525 index patient admissions, mean age 62.1 yr, 41% female (Table 1). Fifty-two (52) patients had a major bleeding event in the ICU. Mean phlebotomy volume per patient day was 28.3 mL (95% CI 27.4 - 29.1 mL, stdev 10.1 mL). Mean bedside waste during the phlebotomy audit (total of 144 blood draws) varied by vascular access: 3.9 mL for arterial, 5.5 mL for central venous, and 6.25 mL for peripherally inserted catheters. The mean estimated daily bedside waste for phlebotomy was 14.8 mL per patient day. Outcomes of logistical regression, excluding patients with major bleeding events, are summarized in Table 2. Average daily phlebotomy volume (mL) was predictive of nadir hemoglobin < 80 g/L (parameter estimate 0.091, p <0.001), the need for red blood cell transfusion (0.092, p<0.001), and inpatient mortality (0.053, <0.001). For every 5 mL increase in average daily phlebotomy, the odds ratio (OR) for nadir hemoglobin < 80 g/L was 1.58 (95% CI 1.31 - 1.90) and the OR for a red cell transfusion was 1.58 (95% CI 1.33 - 1.87). Conclusion: Daily ICU phlebotomy volume is associated with ICU acquired anemia and the need for red blood cell transfusion, including in a multivariable model with patient demographics, major bleeding events, and severity of illness as estimated by day 1 SOFA score. However, the ICU admission SOFA score was only weakly predictive of mortality, and the unexpected association between average daily phlebotomy and mortality needs to be further explored. It is possible that in this data set day 1 SOFA score did not completely control for severity of illness. Our findings support the need for ongoing phlebotomy stewardship interventions in the ICU. We suggest ICU acquired anemia and the need for red blood cell transfusion are appropriate patient outcome measures to evaluate stewardship interventions. Disclosures No relevant conflicts of interest to declare.
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Noreen, Nosheena, Syeda Wajeeha Jalil, Rabeea Irfan, and Farah Hanif. "Analysis of Therapeutic Phlebotomy in Patients of Polycythemia: A Single Center Study." Journal of Islamabad Medical & Dental College 12, no. 3 (October 17, 2023): 199–203. http://dx.doi.org/10.35787/jimdc.v12i3.955.
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Introduction: Polycythemia is increased red cell mass according to age and sex of the individual. It could be primary (Polycythemia Vera), or secondary, due to chronic hypoxia or increased erythropoietic drive. Polycythemia is managed with therapeutic phlebotomy along with treating the underlying cause if determined. Phlebotomy of one unit whole blood should result in fall of Hb of at least 1g/dl. This study was conducted to see the effect of phlebotomy on fall in Hb level.Different parameters which can affect Hb levels in polycythemia patients, like age, JAK-2 mutation status and underlying cause were also studied.Methodology: A cross sectional study was conducted at blood bank of Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad Pakistan January 2020 to December 2020. Data were collected from 121 patients of Polycythemia vera who reported in blood bank for phlebotomy.Results: The average pre phlebotomy hemoglobin of the patients was 17.45g/dl, which dropped to 15.97g/dl after phlebotomy. In total, 89 (73.5%) patients who underwent phlebotomy had a fall in Hb of greater than or equal to 1g/dl, while in 32 (26.4%) patients, Hb drop was less than 1g/dl. One hundred and five patients underwent multiple therapeutic phlebotomies to maintain their hemoglobin within normal range.Conclusion: This study has shown that there is fall in Hb as result of recommended phlebotomy leading to relief in symptoms due to Polycythemia. Phlebotomy is the basis of treating polycythemia, although in secondary polycythemia the underlying cause should also be diagnosed and treated.
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Schloemer, Nathan, Melissa Acquazzino, Rachel Phelan, Debra Schmidt, Lynnette Anderson, Sandra Steffes, Richard L. Tower, and J. Paul Scott. "Phlebotomy for Pediatric and Young Adult Oncology Patients Treats Transfusional Iron Overload." Blood 130, Suppl_1 (December 7, 2017): 941. http://dx.doi.org/10.1182/blood.v130.suppl_1.941.941.
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Abstract Introduction: Pediatric and young adult oncology patients treated with intense chemotherapy and stem cell transplant regimens have a high incidence of transfusional iron overload.(Acquazzino and Schloemer et al, ASH 2015). Iron deposition can lead to significant complications including heart failure, arrhythmias, liver abnormalities, endocrine dysfunction and ineffective erythropoiesis, as well as increased cancer and mortality risk. However there is a paucity of data regarding recommendations for management of transfusionial iron overload in childhood cancer survivors. Consequently, long-term complications of transfusional iron overload specific to pediatric cancer survivors have not been assessed. We have instituted screening and phlebotomy based treatment algorithms for pediatric and young adult oncology patients with transfusional iron overload. Methods: We conducted a retrospective chart review of pediatric and young adults who after having completed oncology management, were diagnosed with transfusional iron overload through a screening algorithm, and then initiated phlebotomy treatment. Tiered screening occurred in patients who received at least 5 packed red blood cell (pRBC) transfusions. Patients were recommended for further evaluation and discussion of possible phlebotomy treatment if they had: (1) liver iron concentration (LIC) greater than 5 mg of iron/gram dry weight liver tissue as measured by ferriscan and/or (2) cardiac MRI T2* < 20 ms. Management of phlebotomy treatment was conducted according to Table 1. During phlebotomy patient iron status was assessed at least quarterly and phlebotomy discontinued with achievement of LIC <5 or normalization of ferritin and followed by imaging LIC assessment verification. Inclusion criteria: (1) diagnosis of childhood malignancy, (2) completed active cancer therapy, (3) received phlebotomy treatment for transfusional iron overload. Exclusion criteria included: Patients with known hereditary hemochromatosis and patients who received photopheresis. Descriptive statistics were employed to report the characteristics of the study population. Spearman correlations were utilized to describe the association between number of transfusions, LIC, ferritin, iron saturation and number of phlebotomy sessions. This study was approved by the Children's Hospital of Wisconsin Institutional Review Board prior to data collection. Results: Patient Demographics: We identified 25 pediatric and young adult childhood cancer survivors who underwent phlebotomy for transfusional iron overload. The mean age was 11.6 years (SD 6.1) and 10 (40%) were female. Oncologic diagnoses included ALL (36%), AML (8%), NHL (12%), Ewing sarcoma (16%), Osteosarcoma (4%), Neuroblastoma (12%) and CNS malignancies (12%). Transfusions/Phlebotomy/Diagnostic Tests: (Table 2) Patients received a median of 25.0 (IQR 17 - 34) pRBC transfusions. No patient had fewer than 10 transfusions. Median number of phlebotomy sessions was 6 (IQR 4-8) occurring over a median period of 0.36 years (IQR 0.28 - 0.59). Prior to phlebotomy, the median LIC was 7.5 mg/g (IQR 5.6-9.0) and median ferritin was 1110.0 ng/mL (IQR 700 - 2030). No patients demonstrated cardiac transfusional iron overload on T2* MRI (n=18). 23 (92%) patients have completed phlebotomy. One patient discontinued phlebotomy due to inability to safely obtain vascular access and no patients developed iron deficiency anemia. LIC was reduced by a median of 2.4 mg/g (IQR 1.1 - 3.6) and ferritin was reduced by median of 586 ng/mL (IQR 366-875). Correlation between number of transfusions received and phlebotomy sessions administered was poor (R2=0.017). Conclusions: Management guidelines are absent for transfusional iron overload in pediatric and young adult survivors of cancer. We demonstrate a phlebotomy algorithm that is an effective and well tolerated treatment for pediatric and young adult oncology patients with therapy related transfusional iron overload. Correlation between number of transfusions received and phlebotomy treatments required to remove deposited iron was poor necessitating serial assessments of iron status. Using this management algorithm, prospective studies can evaluate the effect of excess iron removal on iron overload complications in pediatric and young adult cancer survivors. Disclosures No relevant conflicts of interest to declare.
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Aygun, Banu, Nicole A. Mortier, Karen Kesler, Willliam H. Schultz, Ofelia A. Alvarez, Zora R. Rogers, Janet L. Kwiatkowski, et al. "Therapeutic Phlebotomy in Children with Sickle Cell Anemia, Stroke, and Iron Overload: The SWiTCH Experience." Blood 118, no. 21 (November 18, 2011): 1044. http://dx.doi.org/10.1182/blood.v118.21.1044.1044.
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Abstract Abstract 1044 Background: Stroke With Transfusions Changing to Hydroxyurea (SWiTCH Clinical Trials.gov NCT00122980), an NHLBI-sponsored Phase III multicenter trial, compared chronic blood transfusions/chelation to hydroxyurea/phlebotomy for the reduction of recurrent stroke and improvement in iron overload management in children with sickle cell anemia (SCA) and history of overt stroke. To date, however, phlebotomy to manage iron overload has not been commonly performed in children, especially those with SCA. Objective: To describe the experience with SWiTCH phlebotomy procedures, including success rate, associated adverse events, and effect on liver iron stores. Methods: Quantitative liver iron concentration (LIC) was measured by liver biopsy at study entry. Only subjects with LIC > 5 mg Fe/gram dry weight liver (DWL) were eligible for randomization. Those randomized to hydroxyurea/phlebotomy received decreasing volumes of monthly transfusion during hydroxyurea dose escalation, which lasted 4–9 months. Phlebotomy was performed every 4±1 weeks after discontinuation of transfusions. The prescribed phlebotomy volume was 10 mL/kg (maximum 500 mL) for Hb ≥ 8.0 gm/dL, and 5 mL/kg for Hb 7.0–7.9 gm/dL. Phlebotomy was held if Hb was <7.0 gm/dL. Phlebotomy was performed over 30 minutes with immediate normal saline replacement, typically using peripheral venous access. Exit LIC by liver biopsy was obtained in those completing 30 months of therapy. Ferritin was monitored monthly in all subjects using a centralized laboratory. Results: Sixty-seven children (mean age 13.0 ± 4.0 years; range 5.2–19.0 years) with history of previous stroke and transfusion therapy for an average of 7.4 ± 3.8 years (range 1.5–15.5 years) were randomized to the hydroxyurea/phlebotomy arm. Most of them had also received chelation therapy: 47 (71%) with deferoxamine for an average of 4.8 ± 3.2 years, and 57 (86%) with deferasirox for 1.5 ± 0.8 years prior to study entry. Their average entry LIC was 16.5 ± 9.4 mg/gram DWL. Sixty of 67 children (90%) successfully transitioned to hydroxyurea after 7.2 ± 2.4 months of transfusion overlap; one subject had a stroke during overlap and six failed to demonstrate adequate response/compliance to hydroxyurea to safely discontinue transfusions. These 60 subjects received an average of 8 ± 3 transfusions providing 63 ± 44 mL/kg PRBCs before completing transition and commencing phlebotomy, and 3 ± 3 transfusions providing 19 ± 20 mL/kg PRBCs after starting phlebotomy, for various clinical indications. During the course of the study, a total of 935 phlebotomies were performed (mean 16 per subject) removing an average total volume of 127 ± 74 mL/kg per subject. The mean pre-phlebotomy Hb level on hydroxyurea (9.1 gm/dL) was not significantly different than the mean pre-transfusion Hb during the transfusion overlap period (9.0 gm/dL). Mean ferritin for these 60 subjects on the hydroxyurea/phlebotomy arm decreased from 3523 ± 2150 ng/mL at study entry to 2227 ± 1646 ng/mL (p<0.0001) at exit; and decreased in 50 of 60 subjects. For the 23 patients on the hydroxyurea/phlebotomy arm who completed 30 months of study treatment, the average LIC was unchanged (18.5 mg Fe/gram DWL at entry compared to 18.1 mg Fe/gram at exit, p=0.817). However, average ferritin level for these subjects was significantly lower at exit (4216 ± 2799 ng/mL vs 2356 ± 2032 ng/mL, respectively, p=0.0003). Of 968 protocol-directed phlebotomy procedures, 935 (97%) were performed; 94% of which were at full prescribed volume. Of the 33 phlebotomy procedures that were not performed, 11 were held due to Hb < 7.0 gm/dL and 9 due to poor venous access. There were only 33 grade 2 adverse events (3.5% prevalence) reported in 12 subjects and no serious adverse events. The most common complication was hypotension (9 events; 5 subjects) followed by dizziness, syncope, headache and weakness. Six subjects had a recurrent stroke but there was no temporal relationship to the phlebotomy procedures. Conclusions: Therapeutic phlebotomies were well-tolerated and did not result in worsening anemia or stroke recurrence in this cohort of children with SCA and previous stroke switched to hydroxyurea. Although ferritin levels decreased significantly, we did not demonstrate an overall decrease in LIC in this heavily iron overloaded cohort, most likely due to continued iron loading with transfusions in the overlap period and subsequent short duration of phlebotomy. Disclosures: Off Label Use: Use of hydroxyurea in children with sickle cell anemia.
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Kumar, Madhan Srinivasan, Sumukh Arun Kumar, Rahul Mishra, Manoj Rai, Susan George, George M. Abraham, and Kala Seetharaman. "Self-Sustainability with Therapeutic Phlebotomy, a Solution to the National Blood Crisis?" Blood 142, Supplement 1 (November 28, 2023): 5051. http://dx.doi.org/10.1182/blood-2023-187612.
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CONCLUSION Hereditary hemochromatosis (HH) is a genetic condition associated with iron overload in the human body. The mainstay of treatment remains therapeutic phlebotomy. On August 1st, 2022, the American Red Cross approved using blood obtained from therapeutic phlebotomy for transfusion. While normal individuals can donate blood only as often as once in 56 days, individuals with HH can have phlebotomy as often as once weekly. Utilizing the blood collected from these patients could be a significant resource to mitigate the shortage of blood needed for transfusion. We aimed to quantify the number of units of blood removed by therapeutic phlebotomy from individuals with HH and assess its potential contribution to total units of blood required in a community hospital for two years (2021 and 2022). We retrospectively reviewed electronic medical records of adult individuals who underwent therapeutic phlebotomy at Saint Vincent Hospital between January 1, 2021, and December 31, 2022. Patients with hereditary hemochromatosis were identified based on a positive genetic test for HFE gene mutations. We collected data including gender, race, age at diagnosis, and the number of units of blood removed from patients during the study period. The total number of units transfused in the in-patient care services and operating room was obtained. A descriptive statistic was performed using R version 4.2.2 statistics software. A total of 112 patients received therapeutic phlebotomy over two years (2021 and 2022) of whom 65% (N=73) had a diagnosis of HH. A majority of the patients were males (60%, 44/73) and were non-Hispanic/Latino (85%, 62/73). The mean age at diagnosis of HH was 62 [standard deviation (SD): 17] years. The median number of units of blood removed by phlebotomy per patient with HH was 3 (2-5), the annual distribution is as displayed in Table 1. A total of 504 units of whole blood was removed through therapeutic phlebotomy from 73 patients during the study period. The total requirement for blood transfusion across all the departments in the hospital was 6065 units (2,733 units in 2021 and 3,332 units in 2022). The total number of units removed through therapeutic phlebotomy in HH patients represented 8.31% (504/6065 Units) and 82.49% (504/611 Units) of total units of blood requirement for the entire hospital and operating room respectively (Table 2). The units of blood removed through therapeutic phlebotomy of patients with HH, could potentially help sustain 8.31% of total blood requirement of the hospital. Primarily, over 82% of the demand from the operating room could be fulfilled if the entirety of the blood from therapeutic phlebotomy were to be transfused. Overcoming technical challenges in utilizing the blood from therapeutic phlebotomy for transfusion in routine clinical practice could help mitigate the national blood crisis and aid in self-sustainability of blood products at a community level. Our study highlights the need for broader efforts to create awareness and incentivizing re-utilization of blood obtained from therapeutic phlebotomy.
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Brass, Alister. "Pointless phlebotomy in Canberra." Medical Journal of Australia 142, no. 13 (June 1985): 670. http://dx.doi.org/10.5694/j.1326-5377.1985.tb113586.x.
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Davey, R. Bruce. "Pointless phlebotomy in Canberra." Medical Journal of Australia 143, no. 6 (September 1985): 268. http://dx.doi.org/10.5694/j.1326-5377.1985.tb122997.x.
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Izmailov, G. A., and S. G. Izmailov. "Device for subcutaneous phlebotomy." Kazan medical journal 77, no. 5 (October 15, 1996): 397–98. http://dx.doi.org/10.17816/kazmj104645.
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The phlebotomes for reliable shutdown from blood circulation of subcutaneously dilated branches of large and small subcutaneous veins of the femur, crus and foot are suggested to improve surgical treatment methods of varicose disease. The technology of subcutaneous dissection of venous collaterals using phlebotomes is described. The observations of 80 operated patients show resistant immediate and distant results with good cosmetic effect allowing to recommend the instruments for a wide use in surgical practice.
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Lloyd, Mark, and Patrick J. Morris. "Phlebotomy Techniques in Crocodilians." Bulletin of the Association of Reptilian and Amphibian Veterinarians 9, no. 3 (January 1999): 12–14. http://dx.doi.org/10.5818/1076-3139.9.3.12.
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Lloyd, Mark, and Patrick J. Morris. "Phlebotomy Techniques in Snakes." Bulletin of the Association of Reptilian and Amphibian Veterinarians 9, no. 4 (January 1999): 30–33. http://dx.doi.org/10.5818/1076-3139.9.4.30.
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&NA;. "Preventing Needlesticks During Phlebotomy." American Journal of Nursing 99, no. 5 (May 1999): 24AA. http://dx.doi.org/10.1097/00000446-199905000-00025.
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Henry, Vanda. "Considerations for phlebotomy training." British Journal of Healthcare Assistants 1, no. 8 (November 2007): 365–66. http://dx.doi.org/10.12968/bjha.2007.1.8.27624.
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DALE, JANE C., and SARALYN K. PRUETT. "Phlebotomy—a Minimalist Approach." Mayo Clinic Proceedings 68, no. 3 (March 1993): 249–55. http://dx.doi.org/10.1016/s0025-6196(12)60044-5.
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Franklin, G. F., A. M. Bal, and H. McKenzie. "Phlebotomy tourniquets and MRSA." Journal of Hospital Infection 65, no. 2 (February 2007): 173–75. http://dx.doi.org/10.1016/j.jhin.2006.10.010.
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Wenk, R. E., and M. K. Brewer. "Simple, Nontraumatic Therapeutic Phlebotomy." Transfusion 15, no. 4 (March 25, 2003): 380. http://dx.doi.org/10.1046/j.1537-2995.1975.15476034564.x.
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Cook, Jim. "Standardizing Phlebotomy Job Descriptions." Laboratory Medicine 48, no. 1 (January 29, 2017): e4-e13. http://dx.doi.org/10.1093/labmed/lmw051.
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Adzamli, I., M. Tettey, J. Sagoe, J. Amoako, K. Dzefi-Tettey, and S. Mohammed. "Phlebotomy by House Officers." Postgraduate Medical Journal of Ghana 6, no. 2 (July 12, 2022): 108–12. http://dx.doi.org/10.60014/pmjg.v6i2.125.
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Background: Phlebotomy is a highly complex technique, requiring knowledge and skill to perform. In advanced societies, all phlebotomists undergo a wellstructured training with certification.Objective: This study examines the practice of phlebotomy by house-officers (HO) in Korle-Bu Teaching Hospital, as part of expediency in health service delivery.Methodology: Self-administered questionnaires were obtained from 54 Ghanaian trained HOs (out of a total of 85 HOs) from four main departments of the Korle-Bu Teaching Hospital in December 2010. Data obtained were analysed statistically using SPSS(Version 12; SPSS Inc, Chicago, IL, USA) programme.Results: There were 54 HOs who had worked for a minimum of six months. Thirty-five (64.5%) of them felt that venesection was not their job description. Forty-nine (90.2%) received no formal training and 40 (74.1%) received informal training in phlebotomyduring Medical School. Thirty 32 (59.3%) used the dorsum of the hand as the main site for venesection and 25 (46.5%) did not know avoidable sites during venesection. Fifty-three (98.1%) did not check for allergies to antiseptics and adhesives before performingvenesection. Thirty-seven (68.5%) did not know the names of all the additives in the various sample bottles and 29 (53.7%) did not understand the colour coding of the sample bottles. In addition, 34 (63.0%) did not know the blood volume required for all the varioustests. Twenty-nine (53.7%) did not know that laboratory results of analytes were affected by patient's posture.Conclusion: Training in the Medical School does not adequately prepare the House Officer to carry out phlebotomy competently and efficiently.
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Miasnikova, Galina Y., Xiaomei Niu, Mehdi Nouraie, Adelina I. Sergueeva, Daniel J. Okhotin, Tatiana Ammosova, Sergei Nekhai, et al. "Effect of Phlebotomy Therapy On Hemoglobin Concentration and Tricuspid Regurgitation Velocity in Chuvash Polycythemia." Blood 114, no. 22 (November 20, 2009): 1897. http://dx.doi.org/10.1182/blood.v114.22.1897.1897.
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Abstract Abstract 1897 Poster Board I-920 Background: Chuvash polycythemia is caused by homozygosity for the VHL598C>T mutation, which leads to up-regulation of HIF-1a and HIF-2a in normoxia. As the result, circulating concentrations of erythropoietin are elevated. Chuvash polycythemia patients suffer from cardiovascular abnormalities that include pulmonary arterial hypertension, thrombosis and stroke. Phlebotomy is a common therapy for patients to decrease symptoms such as plethora and headache. However, the outcomes of phlebotomy have not been assessed for these patients. The objective of this analysis is to evaluate the effect of phlebotomy on hemoglobin concentration, serum concentrations of ferritin and erythropoietin, and echocardiographically-determined tricuspid regurgitation velocity, which reflects systolic pulmonary artery pressure. Methods: One hundred twenty patients homozygous for VHL598C>T and 38 controls of comparable age and gender from Chuvash Republic of the Russian Federation were studied. Clinical and demographic characteristics were determined and echocardiography was performed. Serum ferritin and erythropoietin concentrations were measured by ELISA. Results: The median (interquartile) age for Chuvash polycythemia cases was 36 (22–48) years. They included 68 females (56%). Chuvash polycythemia patients had higher serum erythropoietin concentration (medians of 46 versus 8 mIU/ml, P = 0.0001) and lower serum ferritin concentration (medians of 12 versus 48 ng/ml, P = 0.0001) compared to controls. Tricuspid regurgitation velocity was higher in cases than controls (medians of 2.5 vs. 2.3 m/sec, P = 0.007). Among the cases, 87 (71%) had a history of phlebotomy and 54 of these had phlebotomy within the last year. Phlebotomy was associated with higher erythropoietin concentration (P = 0.033) and lower ferritin concentration (P = 0.024) but no significant difference in hemoglobin concentration (P = 0.9) (Table 1). After adjusting for the effect of age, phlebotomy was associated with significantly higher odds of tricuspid regurgitation velocity ≥2.5 (m/sec) (odds ratio: 3.3; 95% CI: 1.1–9.9). Conclusion: Patients with Chuvash polycythemia tend to mobilize iron stores and increase erythropoietin production to maintain a constant, elevated hemoglobin concentration despite phlebotomy therapy. In this process, estimated pulmonary systolic blood pressure appears to increase. Therefore, phlebotomy therapy might be a risk factor for pulmonary hypertension in the context of Chuvash polycythemia. Disclosures: No relevant conflicts of interest to declare.