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Journal of Feline Medicine and Surgery Dec 2018A retrospective multicentre case series of feline primary erythrocytosis (PE) was evaluated. The aim was to gain better understanding of disease presentation and...
CASE SERIES SUMMARY
A retrospective multicentre case series of feline primary erythrocytosis (PE) was evaluated. The aim was to gain better understanding of disease presentation and progression to guide management and prognostication. Case records were assessed for evidence of increased packed cell volume (PCV; >48%), sufficient investigation to rule out relative and secondary erythrocytosis, and follow-up data for at least 12 months or until death. Eighteen cats were included in the case series. No significant trends in signalment were noted. Seizures and mentation changes were the most common presenting signs (both n = 10). Median PCV was 70% (median total protein concentration of 76 g/l) with no other consistent haematological changes. Sixteen cats survived to discharge. Phlebotomy was performed initially in 15/16 surviving animals and performed after discharge in 10/16. Hydroxyurea was the most common adjunctive therapy, used in 10/16 cats. Of the 16 patients surviving to discharge, 14 patients were still alive at the conclusion of the study (survival time >17 months post-discharge), with the two non-survivors having lived for 5 years or more after diagnosis. PCV, when stabilised, did not correlate with resolution of clinical signs.
RELEVANCE AND NOVEL INFORMATION
In contrast to perceptions, feline PE was generally well managed via a combination of phlebotomy and medical therapy, with evidence of prolonged survival times. The use of hydroxyurea enabled cessation or repeat phlebotomies.
Topics: Animals; Cat Diseases; Cats; Female; Hematocrit; Male; Phlebotomy; Polycythemia; Retrospective Studies; Seizures; Treatment Outcome
PubMed: 29364032
DOI: 10.1177/1098612X17750333 -
Transfusion Mar 2015Therapeutic phlebotomy is increasingly used in patients with transfusional siderosis to mitigate organ injury associated with iron overload (IO). Laboratory response... (Comparative Study)
Comparative Study
BACKGROUND
Therapeutic phlebotomy is increasingly used in patients with transfusional siderosis to mitigate organ injury associated with iron overload (IO). Laboratory response variables and therapy duration are not well characterized in such patients.
STUDY DESIGN AND METHODS
We retrospectively evaluated 99 consecutive patients undergoing therapeutic phlebotomy for either transfusional IO (TIO, n = 88; 76% had undergone hematopoietic transplantation) or nontransfusional indications (hyperferritinemia or erythrocytosis; n = 11). Complete blood cell count, serum ferritin (SF), transferrin saturation, and transaminases were measured serially. Phlebotomy goal was an SF level of less than 300 μg/L.
RESULTS
Mean SF levels before phlebotomy among TIO and nontransfusional subjects were 3093 and 396 μg/L, respectively. Transfusion burden in the TIO group was 94 ± 108 (mean ± SD) RBC units; approximately half completed therapy with 24 ± 23 phlebotomies (range, 1-103). One-third were lost to follow-up. Overall, 15% had mild adverse effects, including headache, nausea, and dizziness, mainly during first phlebotomy. Prior transfusion burden correlated poorly with initial ferritin and total number of phlebotomies to target in the TIO group. However, number of phlebotomies to target was strongly correlated with initial SF (R(2) = 0.8; p < 0.0001) in both TIO and nontransfusional groups. ALT decreased significantly with serial phlebotomy in all groups (mean initial and final values, 61 and 39 U/L; p = 0.03).
CONCLUSIONS
Initial SF but not transfusion burden predicted number of phlebotomies to target in patients with TIO. Despite good treatment tolerance, significant losses to follow-up were noted. Providing patients with an estimated phlebotomy number and follow-up duration, and thus a finite endpoint, may improve compliance. Hepatic function improved with iron offloading.
Topics: Adolescent; Adult; Alanine Transaminase; Aspartate Aminotransferases; Dizziness; Endpoint Determination; Erythrocyte Indices; Ferritins; Hematologic Diseases; Hematopoietic Stem Cell Transplantation; Hemoglobins; Humans; Iron Overload; Middle Aged; Nausea; Neoplasms; Phlebotomy; Retrospective Studies; Transferrin; Transfusion Reaction; Young Adult
PubMed: 25209879
DOI: 10.1111/trf.12854 -
Journal of the American Association For... May 2019We compared 6 frequently used mouse blood-sampling methods (lateral tail incision; tail-tip amputation; sublingual, submandibular, and saphenous vein puncture; and...
We compared 6 frequently used mouse blood-sampling methods (lateral tail incision; tail-tip amputation; sublingual, submandibular, and saphenous vein puncture; and retrobulbar sinus puncture during isoflurane anesthesia) with regard to induction of local and systemic inflammation, stomach contents, weight changes, and corticosterone levels at 6 h to 12 d after sampling. Local inflammation was assessed through histopathology and assessment of the expression of inflammation and tissue damage-related genes (, , , , , and ) in sampled tissue. Systemic inflammation was assessed through quantification of plasma haptoglobin levels, measurement of blood expression, and evaluation of histopathologic changes in lung, kidney, liver, and spleen. Apart from slight, transient increases in plasma haptoglobin levels after lateral tail incision, retrobulbar sinus puncture, and saphenous vein puncture, no other signs of systemic inflammation were found. Mice subjected to retrobulbar sinus puncture, sublingual puncture, or isoflurane anesthesia only showed the highest plasma corticosterone concentrations. Retrobulbar sinus puncture had the largest effect on body weight loss. Retrobulbar sinus puncture, sublingual puncture, and submandibular puncture only showed minor and in, most cases, fastresolving inflammation. By contrast, blood sampling by lateral tail incision, tail-tip amputation, or saphenous vein puncture caused tissue damage and inflammation locally at the sampling site, which resolved more slowly compared with head-region sampling techniques, according to results from pathologic and gene expression assessments. Expression of , , and increased 10- to 1000-fold and did not return to baseline until day 6 after sampling or later and did not resolve after tail-tip amputation within the 12-d observation period. Increased expression of genes involved in inflammation and tissue repair correlated with histopathologic changes and may thus represent a quantitative supplement to histopathology. In conclusion, none of the tested methods for obtaining blood samples from mice is superior, according to simultaneous immunologic, histopathologic, and animal welfare-related parameters.
Topics: Anesthesia; Anesthetics, Inhalation; Animal Welfare; Animals; Blood Specimen Collection; Corticosterone; Inflammation; Isoflurane; Laboratory Animal Science; Male; Mice; Phlebotomy
PubMed: 30947767
DOI: 10.30802/AALAS-JAALAS-18-000064 -
Disease-a-month : DM Oct 1999
Review
Topics: Blood Transfusion; Critical Illness; Erythropoietin; Hemoglobins; Humans; Phlebotomy; Risk Factors
PubMed: 10568177
DOI: 10.1016/s0011-5029(99)90012-3 -
Brain and Behavior Mar 2021Anemia is common in prematurely born infants due to blood loss resulting from frequent phlebotomies and may contribute to their neurobehavioral deficits. Preclinical...
INTRODUCTION
Anemia is common in prematurely born infants due to blood loss resulting from frequent phlebotomies and may contribute to their neurobehavioral deficits. Preclinical models of phlebotomy-induced anemia (PIA) have revealed metabolic and genomic changes in multiple brain structures of young mice, yet the impact of neonatal PIA on early-life and adult behavior has not been assessed.
METHODS
The present study employed a range of behavioral measures in phlebotomized anemic neonatal mice to investigate short- and long-term neurodevelopmental effects. PIA from postnatal (P) days 3 to 14 caused sex-specific changes in social behavior, novelty preference, and anxiety at P17 that persisted into adulthood.
RESULTS
Our preclinical model suggests that PIA may contribute to acute and long-term behavioral and affective deficits and warrants further substantiation of the observed behavioral phenomena in larger samples.
CONCLUSIONS
We conclude that this model is a useful tool for beginning to better understand the lasting effect that early-life PIA might have on the developing brain. The differential impact of PIA on male and female subjects warrants further exploration for the development of appropriately targeted interventions.
Topics: Anemia; Animals; Behavior, Animal; Cognition; Female; Male; Mice; Phlebotomy; Sex Characteristics
PubMed: 33605555
DOI: 10.1002/brb3.1780 -
HPB : the Official Journal of the... Mar 2020Hypovolemic phlebotomy (HP) is a novel intervention that involves intraoperative removal of whole blood (7-10 mL/kg) without volume replacement. The subsequent central... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypovolemic phlebotomy (HP) is a novel intervention that involves intraoperative removal of whole blood (7-10 mL/kg) without volume replacement. The subsequent central venous pressure (CVP) reduction is hypothesized to decrease blood loss and the need for blood transfusion. The objective was to conduct a systematic assessment of the safety and efficacy of HP on blood loss and transfusion in the liver surgery literature.
METHODS
MEDLINE, EMBASE, and Cochrane Library databases were searched. Outcomes of interest included blood loss, allogenic red blood cell transfusion, postoperative adverse events, and CVP change. A qualitative synthesis and meta-analysis were performed as appropriate.
RESULTS
Four cohort studies, one case series, and three randomized controlled trials involving 2255 patients were included. Meta-analysis of studies involving liver resections for any indication (n = 6) found no difference in transfusion (OR 0.38, p = 0.12) or incidence of adverse events with HP compared to non-use. Pooling of studies involving liver resections for an underlying pathology (n = 4) revealed HP was associated with significant reduction in transfusion (OR 0.25, p = 0.03) but no differences in blood loss (-173 mL, p = 0.17).
CONCLUSION
This review suggests HP is safe and associated with decreased transfusion in patients undergoing liver surgery. It supports further investigation.
Topics: Blood Loss, Surgical; Blood Transfusion; Hepatectomy; Humans; Hypovolemia; Phlebotomy; Treatment Outcome
PubMed: 31734240
DOI: 10.1016/j.hpb.2019.10.001 -
Journal of the American Veterinary... Jul 2012To establish reference ranges for critical care blood values measured in wild and aquarium-housed elasmobranchs by use of a point-of-care (POC) blood analyzer and to... (Comparative Study)
Comparative Study
Evaluation of critical care blood analytes assessed with a point-of-care portable blood analyzer in wild and aquarium-housed elasmobranchs and the influence of phlebotomy site on results.
OBJECTIVE
To establish reference ranges for critical care blood values measured in wild and aquarium-housed elasmobranchs by use of a point-of-care (POC) blood analyzer and to compare values on the basis of species category (pelagic, benthic, or intermediate) and phlebotomy site.
DESIGN
Cross-sectional study.
ANIMALS
66 wild and 89 aquarium-housed elasmobranchs (sharks and rays).
PROCEDURES
Aquarium-housed elasmobranchs were anesthetized for sample collection; wild elasmobranchs were caught via hook and line fishing, manually restrained for sample collection, and released. Blood was collected from 2 sites/fish (dorsal sinus region and tail vasculature) and analyzed with the POC analyzer. Reference values of critical care blood analytes were calculated for species most represented in each population. Values were compared on the basis of species categorization (pelagic, intermediate, or benthic) and collection site.
RESULTS
Oxygen saturation and circulating concentrations of lactate and glucose were significantly different among aquarium-housed pelagic, intermediate, and benthic species. Lactate concentration was significantly different among these categories in wild elasmobranchs. Significant differences were detected between samples from the 2 collection sites for all blood analytes. In both study populations, pH and lactate values were infrequently < 7.2 or > 5 mmol/L, respectively.
CONCLUSIONS AND CLINICAL RELEVANCE
Brevity of handling or chemical restraint may have reduced secondary stress responses in fish because extreme variations in blood analyte values were infrequent. Sample collection site, species categorization, acclimation to handling, and restraint technique should be considered when assessing values obtained with the POC analyzer used in this study for blood analytes and immediate metabolic status in elasmobranchs.
Topics: Animals; Animals, Domestic; Animals, Wild; Blood Chemical Analysis; Blood Gas Analysis; Blood Glucose; Critical Care; Cross-Sectional Studies; Elasmobranchii; Female; Hydrogen-Ion Concentration; Lactates; Male; Oxygen; Phlebotomy; Point-of-Care Systems; Reference Values; Sharks; Species Specificity; Specimen Handling
PubMed: 22720996
DOI: 10.2460/javma.241.1.117 -
Medicine Nov 2022Deep venipuncture catheterization is widely used in clinical anesthesia. However, it is worth thinking about how to improve the rate of successful catheter insertion,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Deep venipuncture catheterization is widely used in clinical anesthesia. However, it is worth thinking about how to improve the rate of successful catheter insertion, and relieve patients' discomfort. This paper aimed to compare the clinical advantages between trocar and steel needle.
METHODS
Total 503 adult patients were recruited and randomly assigned. The control group was punctured with steel needle, and the experimental group was punctured with trocar needle. Clinical and followed-up information was recorded. Pearson's chi-squared and spearman test were performed to analyze the correlation between intervention and relative parameters. Univariate logistic regression was performed to verify the odds ratio of trocar needle compared with steel needle.
RESULTS
Pearson's chi-square test and Spearman's correlation test showed a significant correlation between puncture success, puncture comfort, successful catheter insertion, puncture time, thrombosis, catheter fever, bleeding, infection and interventions (P < .05). Univariate logistic regression showed that there existed better puncture comfort (odds ratio [OR] = 6.548, 95% confidence interval [CI]: 4.320-9.925, P < .001), higher successful catheter insertion (OR = 6.060, 95% CI: 3.278-11.204, P < .001), shorter puncture time (OR = 0.147, 95% CI: 0.093-0.233, P < .001), lesser thrombosis (OR = 0.194, 95% CI: 0.121-0.312, P < .001), lesser catheter fever (OR = 0.263, 95% CI: 0.158-0.438, P < .001), lesser bleeding (OR = 0.082, 95% CI: 0.045-0.150, P < .001) and lesser infection (OR = 0.340, 95% CI: 0.202-0.571, P < .001) in trocar group compared with steel needle group.
CONCLUSION
Trocar application in deep venipuncture catheterization can improve successful catheter insertion, relieve pain and discomfort of patients, reduce incidence of complications, and provide better security for patients.
Topics: Humans; Adult; Phlebotomy; Catheterization, Central Venous; Steel; Hemorrhage; Thrombosis; Surgical Instruments
PubMed: 36401416
DOI: 10.1097/MD.0000000000031216 -
BMC Health Services Research Aug 2019The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in...
BACKGROUND
The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model.
METHOD
A qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method.
RESULTS
Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient's accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians.
CONCLUSION
The study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient's safety, and health care.
Topics: Anti-Retroviral Agents; Community Health Services; Feasibility Studies; Focus Groups; HIV Infections; Humans; Phlebotomy; Qualitative Research; Zambia
PubMed: 31412849
DOI: 10.1186/s12913-019-4386-5 -
Clinical Biochemistry Jun 2022Capillary blood samples are generally assumed as unsuitable for coagulation testing since it is recognized that contamination with tissue factor and dilution with tissue...
OBJECTIVES
Capillary blood samples are generally assumed as unsuitable for coagulation testing since it is recognized that contamination with tissue factor and dilution with tissue fluid affects the coagulation assay. However, limited data is available about coagulations assays in which capillary blood sampling is compared to the standard venous blood withdrawal method. The aim of this study was to perform a method comparison between capillary and venous blood sampling for routine coagulation assays.
METHODS
Both venous and capillary (finger stick) blood samples were collected from 188 healthy volunteers and patients. In citrate plasma, International Normalized Ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer were measured according to routine protocols using the ACL-TOP 750 LAS (Werfen) coagulation analyzer. Regression analysis was performed and the mean relative difference between capillary and venous sampling was reflected to the total allowable error (TEa).
RESULTS
Strong correlations and acceptable variations, using the TEa as decision limit, were found for INR, PT, TT, fibrinogen, and D-dimer between capillary and venous sampling. However, capillary sampling resulted in significant shorter APTT values when using the standard APTT-SP Liquid reagent with a mean bias of -10.4% [95% CI -12.4 to -8.4].
CONCLUSION
Based on these results, capillary blood sampling proved to be an alternative blood withdrawal method for routine coagulation assays, with the exception of APTT, if a venipuncture is unavailable or undesired.
Topics: Blood Coagulation; Blood Coagulation Tests; Fibrinogen; Humans; Partial Thromboplastin Time; Phlebotomy
PubMed: 35123976
DOI: 10.1016/j.clinbiochem.2022.01.010