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PloS One 2023Zinc deficiency continues to be a major concern for global public health. The zinc status of a target population is typically estimated by measuring circulating zinc...
Zinc deficiency continues to be a major concern for global public health. The zinc status of a target population is typically estimated by measuring circulating zinc levels, but the sampling procedures are not standardized and thus may result in analytical discrepancies. To examine this, we designed a study that controlled most of the technical parameters in order to focus on five pre-analytical variables reported to influence the measurement of zinc in blood samples, including (1) blood draw site (capillary or venous), (2) blood sample matrix (plasma or serum), (3) blood collection tube manufacturer (Becton, Dickinson and Company or Sarstedt AG & Co), (4) blood processing time (0, 4, or 24 hours), and (5) blood holding temperatures (4°C, 20°C, or 37°C). A diverse cohort of 60 healthy adults were recruited to provide sequential capillary and venous blood samples, which were carefully processed under a single chain of custody and measured for zinc content using inductively coupled plasma optical emission spectrometry. When comparing blood draw sites, the mean zinc content of capillary samples was 0.054 mg/L (8%; p<0.0001) higher than venous blood from the same donors. When comparing blood sample matrices, the mean zinc content of serum samples was 0.029 mg/L (5%; p<0.0001) higher than plasma samples from the same donors. When comparing blood collection tube manufacturer, the mean zinc content from venous blood samples did not differ between venders, but the mean zinc content from BD capillary plasma was 0.036 mg/L (6%; p<0.0001) higher than Sarstedt capillary plasma from the same donors. When comparing processing times, the mean zinc content of plasma and serum samples was 5-12% higher (p<0.0001) in samples processed 4-24 hour after collection. When comparing holding temperatures, the mean zinc content of plasma and serum samples was 0.5-7% higher (p = 0.0007 or p = 0.0061, respectively) in samples temporarily held at 20°C or 37°C after collection. Thus even with the same donors and blood draws, significant differences in zinc content were observed with different draw sites, tube types, and processing procedures, demonstrating that key pre-analytic variables can have an impact on zinc measurement, and subsequent classification of zinc status. Minimizing these pre-analytical variables is important for generating best practice guidelines for assessment of zinc status.
Topics: Adult; Humans; Plasma; Zinc; Phlebotomy; Body Temperature; Malnutrition
PubMed: 37713369
DOI: 10.1371/journal.pone.0286073 -
Journal of Clinical Oncology : Official... Nov 2015Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with a substantial symptom burden, thrombohemorrhagic complications, and impaired... (Review)
Review
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with a substantial symptom burden, thrombohemorrhagic complications, and impaired survival. A decade after the seminal discovery of an activating mutation in the tyrosine kinase JAK2 in nearly all patients with PV, new treatment options are finally beginning to emerge, necessitating a critical reappraisal of the underlying pathogenesis and therapeutic modalities available for PV. Herein, we comprehensively review clinical aspects of PV including diagnostic considerations, natural history, and risk factors for thrombosis. We summarize recent studies delineating the genetic basis of PV, including their implications for evolution to myelofibrosis and secondary acute myeloid leukemia. We assess the quality of evidence to support the use of currently available therapies, including aspirin, phlebotomy, hydroxyurea, and interferon. We analyze recent studies evaluating the safety and efficacy of JAK inhibitors, such as ruxolitinib, and evaluate their role in the context of other available therapies for PV. This review provides a framework for practicing hematologists and oncologists to make rational treatment decisions for patients with PV.
Topics: Aspirin; Clinical Trials, Phase II as Topic; Disease Progression; Female; Humans; Hydroxyurea; Incidence; Interferon-beta; Janus Kinase 2; Male; Phlebotomy; Point Mutation; Polycythemia Vera; Polyethylene Glycols; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome
PubMed: 26324368
DOI: 10.1200/JCO.2015.61.6474 -
Systematic Reviews May 2018Needle-related procedures are the most important source of pain in children in hospital setting. Unmanaged pain could result in short- and long-term physiological,... (Review)
Review
BACKGROUND
Needle-related procedures are the most important source of pain in children in hospital setting. Unmanaged pain could result in short- and long-term physiological, psychological, and emotional consequences. Although the efficacy of numerous interventions has been evaluated, procedural pain management is often suboptimal in children undergoing needle-related procedures. The main objective of this systematic review is to examine the evidence for the efficacy of the Buzzy® device for needle-related procedural pain in children.
METHODS
An electronic search will be conducted in the following databases: CENTRAL, PubMed, MEDLINE, EMBASE, PsycInfo, and CINAHL. There will be no restriction regarding the language, date of publication, and publication status. Eligible studies will be randomized controlled trials using the Buzzy® device for pain management in children undergoing needle-related procedures. Selection of studies, data extraction and management, assessment of risk of bias and quality of evidence will be performed by two independent reviewers. A third researcher will be consulted in case of discrepancies. Depending on the availability and quality of the data as well as clinical and statistical heterogeneity, a meta-analysis will be performed. Otherwise, findings will be qualitatively reported.
DISCUSSION
This will be the first systematic review to examine the efficacy of the Buzzy® device on pain management of children during needle-related procedures. Results of this review will guide clinical practice and recommendations for further research to improve procedural pediatric pain management.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017076531.
Topics: Child; Cold Temperature; Humans; Pain; Pain Management; Pain, Procedural; Pediatrics; Phlebotomy; Treatment Outcome; Vibration; Systematic Reviews as Topic
PubMed: 29788987
DOI: 10.1186/s13643-018-0738-1 -
CMAJ : Canadian Medical Association... Aug 2015
Review
Topics: Adult; Arthralgia; Blood Chemical Analysis; Diabetes Mellitus, Type 2; Fatigue; Ferritins; Follow-Up Studies; Hemochromatosis; Humans; Male; Metformin; Phlebotomy; Risk Assessment; Treatment Outcome
PubMed: 25288314
DOI: 10.1503/cmaj.140259 -
Advanced Biomedical Research 2017Nonalcoholic fatty liver disease (NAFLD), defined as excessive liver fat deposition and one of end-stage liver disease causes. Increased ferritin levels are associated...
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD), defined as excessive liver fat deposition and one of end-stage liver disease causes. Increased ferritin levels are associated with insulin resistance and a higher hepatic iron and fat content. Hyperferritinemia has been associated with severity of liver damage in NAFLD. The study aimed to evaluate the effects of phlebotomy on liver enzymes and histology in such patients.
MATERIALS AND METHODS
Thirty-two eligible patients who had NAFLD and after 6 months of lifestyle modification still had NAFLD, and whose ferritin serum was above 250 mg/dl, were enrolled in this clinical trial study. After written informed consent was obtained, each patient's blood serum was taken for aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK-P), complete blood count (CBC), total iron-binding capacity (TIBC), iron, and ferritin. Then the patients underwent liver biopsy. After that patients underwent phlebotomy, giving 350 cc blood monthly. Before every phlebotomy, hemoglobin and ferritin were checked. If they were in the goal range, phlebotomy was discontinued and the patient underwent liver biopsy. A serum sample was taken for testing at the beginning of the study. The results before and after phlebotomy were compared. The maximum duration of the study was 6 months.
RESULTS
Thirty-two patients (26 males and 6 females) were enrolled, and the mean average age was 33.7 ± 6.74 years. Phlebotomy improved liver enzymes and histology of liver significantly ( < 0.001) and induced reduction of ferritin.
CONCLUSION
Phlebotomy is effective for the improvement of liver enzymes and histology in patients with NAFLD and hyperferritinemia.
PubMed: 28299304
DOI: 10.4103/2277-9175.200787 -
JPMA. the Journal of the Pakistan... Apr 2023To determine the effect of flippits versus virtual reality on pain, fear and satisfaction among children during phlebotomy. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the effect of flippits versus virtual reality on pain, fear and satisfaction among children during phlebotomy.
METHOD
The quasi-experientialstudy was conducted at the Paediatric Medical Department of Kafrelsheikh University Hospital, Egypt, from November 2021 to April 2022, and comprised children of either gender aged 6-12 years. The subjects were randomised into flippits group A, virtual reality group B and control group C in which only traditional care was provided. Data was collected using a structured interview, Wong-Baker Faces Pain Rating Scale, Children's Fear Scale, and Blood Specimen Collection Satisfaction Evaluation Scale. Data was analysed using SPSS 20.
RESULTS
Of the 120 children, 40(33.3%) were in each of the three groups. There were 21(52.5%) boys and 19(47.5%) girlsin group A with mean age 8.2±1.6 years, 22(55%) boys and 18(45%) girlsin group B with mean age 7.8±1.7 years, and 27(67.5%) boys and 13(32.5%) girls in group C with mean age 7.9±1.9 years (p>0.05). Mean pain and fear scores were significantly lower and mean satisfaction score was higher in groups A and B than group C (p<0.05). There was no significant difference in the mean pain scores of group A and group B (p>0.05).
CONCLUSIONS
Flippits and virtual reality interventions had a positive effect on pain, fear and satisfaction levelsin children during phlebotomy.
Topics: Male; Female; Humans; Child; Phlebotomy; Pain; Fear; Virtual Reality; Personal Satisfaction; Anxiety
PubMed: 37482861
DOI: 10.47391/JPMA.EGY-S4-43 -
Journal of Medical Case Reports Jan 2019The porphyrias are a rare group of metabolic disorders that can either be inherited or acquired. Along the heme biosynthetic pathway, porphyrias can manifest with...
BACKGROUND
The porphyrias are a rare group of metabolic disorders that can either be inherited or acquired. Along the heme biosynthetic pathway, porphyrias can manifest with neurovisceral and/or cutaneous symptoms, depending on the defective enzyme. Porphyria cutanea tarda, the most common type of porphyria worldwide, is caused by a deficiency of uroporphyrinogen decarboxylase, a crucial enzyme in heme biosynthesis, which results in an accumulation of photosensitive byproducts, such as uroporphyrinogen, which leads to the fragility and blistering of sun-exposed skin. Porphyria cutanea tarda is a condition that affects the liver and skin by reduction and inhibition of uroporphyrinogen decarboxylase enzyme in erythrocytes. Areas of skin that are exposed to the sun can generate blisters, hyperpigmentation, and, sometimes, lesions that heal leaving a scar or keratosis. Liver damage might present in a wide range of ways from liver function test abnormalities to hepatocellular carcinoma. The toxic effect of iron plays a role in liver damage pathogenesis.
CASE PRESENTATION
A 59-year-old Turkish man presented with hyperpigmented skin lesions, fatigue, and elevated ferritin level and liver function tests. He was diagnosed as having porphyria cutanea tarda after a clinical investigation and treated with phlebotomy.
CONCLUSION
Porphyria cutanea tarda is a rare condition of the liver but it must be remembered in a differential diagnosis of liver disease with typical skin involvement to decrease morbidity and health costs with early treatment.
Topics: Fatigue; Humans; Hyperpigmentation; Male; Middle Aged; Phlebotomy; Porphyria Cutanea Tarda; Treatment Outcome; Uroporphyrinogen Decarboxylase
PubMed: 30661508
DOI: 10.1186/s13256-018-1956-9 -
Pediatric Emergency Care Oct 2023Needle-related procedures are among the most important sources of pain in children in different health care settings. Our study was aimed to evaluate the effectiveness... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Needle-related procedures are among the most important sources of pain in children in different health care settings. Our study was aimed to evaluate the effectiveness of Buzzy (MMJ Labs, Atlanta, Ga.), a palm-sized bee/ladybug-shaped device combining vibration and cold, as a nonpharmacological strategy to manage needle-related pain in children.
METHODS
In this single-center, randomized (1:1) controlled open-label study, we enrolled patients aged from 1 month to 18 years who had to undergo a planned outpatient blood sampling in Pisa University Hospital's Department of Pediatrics and randomly allocated them to either the BUZZY group (intervention group) or NO BUZZY group (control group). Pain was estimated using proper pain scales according to age.
RESULTS
Between May 2021 and January 2022, 234 children aged 8.8 ± 5.1 years (50.8% girls) were enrolled and 117 were treated with the Buzzy device. In the study population, pain inversely correlated with age (r = -0.52, P < 0.001); the intervention group showed significantly lower pain (2.5 ± 2.4 vs 4.7 ± 2.8, P < 0.001) and no difference was found between boys and girls. Significant reduction in pain scores was confirmed when stratifying children by age (29 days to <3 years, P = 0.002; ≥3 to ≤8 years, P < 0.001; >8 years, P < 0.001).
CONCLUSIONS
The Buzzy device effectively reduces pain caused by percutaneous antecubital venipuncture in children in different age groups and represents a cheap and easy-to-use strategy to manage routine needle-related procedures.
Topics: Male; Female; Humans; Child; Animals; Infant, Newborn; Phlebotomy; Pain Management; Vibration; Pain; Needles
PubMed: 37478814
DOI: 10.1097/PEC.0000000000003011 -
Journal of Perinatology : Official... Dec 2019Characterize frequency and volume of blood draws and transfusions in extremely low birth weight infants in the first 10 weeks of life.
OBJECTIVE
Characterize frequency and volume of blood draws and transfusions in extremely low birth weight infants in the first 10 weeks of life.
STUDY DESIGN
We included infants with a birth weight <1000 g born 23 0/7-29 6/7 weeks gestational age (GA) and with a length of stay ≥10 weeks, admitted between 2014 and 2016 to a single neonatal intensive care unit.
RESULTS
Of 54 infants, median (25th, 75th percentile) GA and birth weight were 25 weeks (24, 26) and 665 g (587, 822), respectively. Median number of blood draws per infant decreased from 57 (49, 65) in week 1 to 12 (8, 22) in week 10. Median volume of blood extracted was 83 mL (70, 97), and median number of blood transfusions was 8 (5, 10).
CONCLUSIONS
This cohort experienced a high number and volume of blood draws. Draw frequency and transfusions decreased over the first 10 weeks of life.
Topics: Anemia; Erythrocyte Transfusion; Female; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Male; Phlebotomy
PubMed: 31582812
DOI: 10.1038/s41372-019-0515-6 -
Trials Jan 2023Blood loss and red blood cell (RBC) transfusion in liver surgery are areas of concern for surgeons, anesthesiologists, and patients alike. While various methods are...
INTRODUCTION
Blood loss and red blood cell (RBC) transfusion in liver surgery are areas of concern for surgeons, anesthesiologists, and patients alike. While various methods are employed to reduce surgical blood loss, the evidence base surrounding each intervention is limited. Hypovolemic phlebotomy, the removal of whole blood from the patient without volume replacement during liver transection, has been strongly associated with decreased bleeding and RBC transfusion in observational studies. This trial aims to investigate whether hypovolemic phlebotomy is superior to usual care in reducing RBC transfusions in liver resection.
METHODS
This study is a double-blind multicenter randomized controlled trial. Adult patients undergoing major hepatic resections for any indication will be randomly allocated in a 1:1 ratio to either hypovolemic phlebotomy and usual care or usual care alone. Exclusion criteria will be minor resections, preoperative hemoglobin <100g/L, renal insufficiency, and other contraindication to hypovolemic phlebotomy. The primary outcome will be the proportion of patients receiving at least one allogeneic RBC transfusion unit within 30 days of the onset of surgery. Secondary outcomes will include transfusion of other allogeneic blood products, blood loss, morbidity, mortality, and intraoperative physiologic parameters. The surgical team will be blinded to the intervention. Randomization will occur on the morning of surgery. The sample size will comprise 440 patients. Enrolment will occur at four Canadian academic liver surgery centers over a 4-year period. Ethics approval will be obtained at participating sites before enrolment.
DISCUSSION
The results of this randomized control trial will provide high-quality evidence regarding the use of hypovolemic phlebotomy in major liver resection and its effects on RBC transfusion. If proven to be effective, this intervention could become standard of care in liver operations internationally and become incorporated within perioperative patient blood management programs.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03651154 . Registered on August 29 2018.
Topics: Adult; Humans; Hypovolemia; Phlebotomy; Canada; Blood Transfusion; Liver; Randomized Controlled Trials as Topic; Multicenter Studies as Topic; Clinical Trials, Phase III as Topic
PubMed: 36653812
DOI: 10.1186/s13063-022-07008-y