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Vanessa R Thurlow - One of the best experts on this subject based on the ideXlab platform.
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Is suboptimal Phlebotomy technique impacting on potassium results for primary care?
Annals of clinical biochemistry, 2020Co-Authors: Ian R Bailey, Vanessa R ThurlowAbstract:Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate Phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local Phlebotomy clinics optimized their technique. The effect of improving Phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in Phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive. Primary care population serum potassium was inversely related to ambient temperature. Following the change in Phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%. Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during Phlebotomy to pseudohyperkalaemia has been underestimated.
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is suboptimal Phlebotomy technique impacting on potassium results for primary care
Annals of Clinical Biochemistry, 2008Co-Authors: Ian R Bailey, Vanessa R ThurlowAbstract:Background: Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate Phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local Phlebotomy clinics optimized their technique. Methods: The effect of improving Phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in Phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive. Results: Primary care population serum potassium was inversely related to ambient temperature. Following the change in Phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%. Conclusions: Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during Phlebotomy to pseudohyperkalaemia has been underestimated.
Erin K Daugherity - One of the best experts on this subject based on the ideXlab platform.
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comparing Phlebotomy by tail tip amputation facial vein puncture and tail vein incision in c57bl 6 mice by using physiologic and behavioral metrics of pain and distress
Journal of The American Association for Laboratory Animal Science, 2017Co-Authors: Elizabeth S Moore, Thomas A Cleland, Wendy O Williams, Teresa L Southard, Bret Pasch, Rachael N Labitt, Christine M. Peterson, Bhupinder Singh, Erin K DaugherityAbstract:Tail tip amputation with minimal restraint is not widely used for mouse Phlebotomy. In part, this infrequency may reflect policies influenced by tail tip amputation procedures for genotyping, which involve greater handling and tissue removal. To assess tail tip amputation with minimal restraint as a Phlebotomy technique, we compared it with 2 more common methods: scruffing with facial vein puncture and lateral tail vein incision with minimal restraint. Blood glucose levels, audible and ultrasonic vocalizations, postPhlebotomy activity and grooming behavior, open field and elevated plus maze behaviors, nest-building scores, and histologic changes at the Phlebotomy site were evaluated. Mice in the facial vein Phlebotomy group produced more audible vocalizations, exhibited lower postPhlebotomy activity in the open field, and had more severe histologic changes than did mice in the tail incision and tail tip amputation groups. Facial vein Phlebotomy did not affect grooming behavior relative to sham groups, whereas tail vein incision—but not tail tip amputation—increased tail grooming compared with that in control mice. Blood glucose levels, nest-building scores, and elevated plus maze behavior did not differ between groups, and no mice in any group produced ultrasonic vocalizations. Tail tip amputation mice did not perform differently than sham mice in any metric analyzed, indicating that this technique is a potentially superior method of blood collection in mice in terms of animal wellbeing.
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Comparing Phlebotomy by Tail Tip Amputation, Facial Vein Puncture, and Tail Vein Incision in C57BL/6 Mice by Using Physiologic and Behavioral Metrics of Pain and Distress
Journal of The American Association for Laboratory Animal Science, 2017Co-Authors: Elizabeth S Moore, Thomas A Cleland, Wendy O Williams, Teresa L Southard, Bret Pasch, Rachael N Labitt, Christine M. Peterson, Bhupinder Singh, Erin K DaugherityAbstract:Tail tip amputation with minimal restraint is not widely used for mouse Phlebotomy. In part, this infrequency may reflect policies influenced by tail tip amputation procedures for genotyping, which involve greater handling and tissue removal. To assess tail tip amputation with minimal restraint as a Phlebotomy technique, we compared it with 2 more common methods: scruffing with facial vein puncture and lateral tail vein incision with minimal restraint. Blood glucose levels, audible and ultrasonic vocalizations, postPhlebotomy activity and grooming behavior, open field and elevated plus maze behaviors, nest-building scores, and histologic changes at the Phlebotomy site were evaluated. Mice in the facial vein Phlebotomy group produced more audible vocalizations, exhibited lower postPhlebotomy activity in the open field, and had more severe histologic changes than did mice in the tail incision and tail tip amputation groups. Facial vein Phlebotomy did not affect grooming behavior relative to sham groups, whereas tail vein incision—but not tail tip amputation—increased tail grooming compared with that in control mice. Blood glucose levels, nest-building scores, and elevated plus maze behavior did not differ between groups, and no mice in any group produced ultrasonic vocalizations. Tail tip amputation mice did not perform differently than sham mice in any metric analyzed, indicating that this technique is a potentially superior method of blood collection in mice in terms of animal wellbeing.
Scott F Huntington - One of the best experts on this subject based on the ideXlab platform.
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the impact of Phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera
Blood Advances, 2018Co-Authors: Nikolai A Podoltsev, Amer M Zeidan, Rong Wang, Xiaoyi Wang, Amy J Davidoff, Scott F Huntington, Smith Giri, Steven D GoreAbstract:: 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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the impact of Phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera
Blood, 2017Co-Authors: Nikolai A Podoltsev, Amer M Zeidan, Rong Wang, Amy J Davidoff, Scott F Huntington, Smith GiriAbstract:Introduction: Polycythemia vera (PV) is a classical myeloproliferative neoplasm characterized by the overproduction of mature red blood cells leading to an increased risk of thrombosis. Maintenance of hematocrit below 45% using Phlebotomy improves rate of cardiovascular death and major thrombosis and is recommended for all PV patients. For high risk patients (> 60 years and/or with thrombosis history) cytoreductive therapy is recommended, with hydroxyurea (HU) being most commonly used among older PV patients. Little is known about the patterns of care and the impact of Phlebotomy and HU on the outcomes of PV patients in the real-world setting. Methods: We conducted a retrospective cohort study of older adults (aged 66-99 years) diagnosed with PV (International Classification of Diseases for Oncology, 3rd edition, code 9950) in 2007-2011 and included in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Patients were required to have: 1) continuous enrollment in Medicare Parts A and B from one year before PV diagnosis through death or end of study (12/31/2012), whichever came first; and 2) continuous Part D coverage from diagnosis to end of follow-up to capture HU use. HU users were restricted to those who had more than two HU prescription claims. Predictors of receiving Phlebotomy or HU were evaluated using multivariate logistic regression models. Thrombotic events were defined as the first occurrence of venous thrombosis, or arterial thrombosis, or sudden death after diagnosis. Multivariate Cox models were used to assess the impact of Phlebotomy and HU on two outcomes measured from the time of diagnosis, including overall survival and time to the above mentioned thrombotic events, adjusting for patient age at diagnosis, sex, race, Part D low income subsidy (LIS, a proxy marker for reduced out-of-pocket cost sharing, and lower socioeconomic status), influenza vaccination 12 months prior to diagnosis (an indicator for health care access), disability status (a claims-based proxy for poor performance status), modified Elixhauser comorbidity score (the original comorbidity score excluding cardiovascular conditions), and pre-existing cardiovascular conditions. Phlebotomy and HU were treated as time-dependent variables. Results: A total of 482 PV patients with a mean age of 77.7 years were identified. The majority of patients were female (55.6%) and white (90.0%). During the study period, 376 (78.0%) received Phlebotomy and/or HU. Among them, 136 (36.2%) patients underwent therapeutic Phlebotomy only, 95 (25.2%) received HU only, and 145 (38.6%) received both Phlebotomy and HU. On multivariable regression, patients with increasing age (p=.01) and non-white (p=.01) were less likely to get Phlebotomy; whereas patients who were male (p Conclusions: In this population-based study reflecting general clinical practice, Phlebotomy use was associated with improved overall survival among older adults with PV while HU-treated patients had decreased risk of thrombosis. Both treatment modalities were underused in this high-risk PV population. Disclosures Podoltsev: Incyte: Consultancy; CTI biopharma/Baxalta: Consultancy; Ariad: Consultancy; Alexion: Consultancy. Zeidan: Takeda: Speakers Bureau; Otsuka: Consultancy; AbbVie, Otsuka, Pfizer, Gilead, Celgene, Ariad, Incyte: Consultancy, Honoraria. Huntington: Celgene: Consultancy, Other: Travel; Janssen: Consultancy; Pharmacyclics: Honoraria. Ma: Incyte Corp.: Consultancy.
Klas Stig Peter Abelson - One of the best experts on this subject based on the ideXlab platform.
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physiological and pathological impact of blood sampling by retro bulbar sinus puncture and facial vein Phlebotomy in laboratory mice
PLOS ONE, 2014Co-Authors: Anne Charlotte Teilmann, Björn Rozell, Birgitte Holst, Andreas N Madsen, Klas Stig Peter AbelsonAbstract:Retro-bulbar sinus puncture and facial vein Phlebotomy are two widely used methods for blood sampling in laboratory mice. However, the animal welfare implications associated with these techniques are currently debated, and the possible physiological and pathological implications of blood sampling using these methods have been sparsely investigated. Therefore, this study was conducted to assess and compare the impacts of blood sampling by retro-bulbar sinus puncture and facial vein Phlebotomy. Blood was obtained from either the retro-bulbar sinus or the facial vein from male C57BL/6J mice at two time points, and the samples were analyzed for plasma corticosterone. Body weights were measured at the day of blood sampling and the day after blood sampling, and the food consumption was recorded automatically during the 24 hours post-procedure. At the end of study, cheeks and orbital regions were collected for histopathological analysis to assess the degree of tissue trauma. Mice subjected to facial vein Phlebotomy had significantly elevated plasma corticosterone levels at both time points in contrast to mice subjected to retro-bulbar sinus puncture, which did not. Both groups of sampled mice lost weight following blood sampling, but the body weight loss was higher in mice subjected to facial vein Phlebotomy. The food consumption was not significantly different between the two groups. At gross necropsy, subcutaneous hematomas were found in both groups and the histopathological analyses revealed extensive tissue trauma after both facial vein Phlebotomy and retro-bulbar sinus puncture. This study demonstrates that both blood sampling methods have a considerable impact on the animals' physiological condition, which should be considered whenever blood samples are obtained.
Nikolai A Podoltsev - One of the best experts on this subject based on the ideXlab platform.
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the impact of Phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera
Blood Advances, 2018Co-Authors: Nikolai A Podoltsev, Amer M Zeidan, Rong Wang, Xiaoyi Wang, Amy J Davidoff, Scott F Huntington, Smith Giri, Steven D GoreAbstract:: 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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the impact of Phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera
Blood, 2017Co-Authors: Nikolai A Podoltsev, Amer M Zeidan, Rong Wang, Amy J Davidoff, Scott F Huntington, Smith GiriAbstract:Introduction: Polycythemia vera (PV) is a classical myeloproliferative neoplasm characterized by the overproduction of mature red blood cells leading to an increased risk of thrombosis. Maintenance of hematocrit below 45% using Phlebotomy improves rate of cardiovascular death and major thrombosis and is recommended for all PV patients. For high risk patients (> 60 years and/or with thrombosis history) cytoreductive therapy is recommended, with hydroxyurea (HU) being most commonly used among older PV patients. Little is known about the patterns of care and the impact of Phlebotomy and HU on the outcomes of PV patients in the real-world setting. Methods: We conducted a retrospective cohort study of older adults (aged 66-99 years) diagnosed with PV (International Classification of Diseases for Oncology, 3rd edition, code 9950) in 2007-2011 and included in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Patients were required to have: 1) continuous enrollment in Medicare Parts A and B from one year before PV diagnosis through death or end of study (12/31/2012), whichever came first; and 2) continuous Part D coverage from diagnosis to end of follow-up to capture HU use. HU users were restricted to those who had more than two HU prescription claims. Predictors of receiving Phlebotomy or HU were evaluated using multivariate logistic regression models. Thrombotic events were defined as the first occurrence of venous thrombosis, or arterial thrombosis, or sudden death after diagnosis. Multivariate Cox models were used to assess the impact of Phlebotomy and HU on two outcomes measured from the time of diagnosis, including overall survival and time to the above mentioned thrombotic events, adjusting for patient age at diagnosis, sex, race, Part D low income subsidy (LIS, a proxy marker for reduced out-of-pocket cost sharing, and lower socioeconomic status), influenza vaccination 12 months prior to diagnosis (an indicator for health care access), disability status (a claims-based proxy for poor performance status), modified Elixhauser comorbidity score (the original comorbidity score excluding cardiovascular conditions), and pre-existing cardiovascular conditions. Phlebotomy and HU were treated as time-dependent variables. Results: A total of 482 PV patients with a mean age of 77.7 years were identified. The majority of patients were female (55.6%) and white (90.0%). During the study period, 376 (78.0%) received Phlebotomy and/or HU. Among them, 136 (36.2%) patients underwent therapeutic Phlebotomy only, 95 (25.2%) received HU only, and 145 (38.6%) received both Phlebotomy and HU. On multivariable regression, patients with increasing age (p=.01) and non-white (p=.01) were less likely to get Phlebotomy; whereas patients who were male (p Conclusions: In this population-based study reflecting general clinical practice, Phlebotomy use was associated with improved overall survival among older adults with PV while HU-treated patients had decreased risk of thrombosis. Both treatment modalities were underused in this high-risk PV population. Disclosures Podoltsev: Incyte: Consultancy; CTI biopharma/Baxalta: Consultancy; Ariad: Consultancy; Alexion: Consultancy. Zeidan: Takeda: Speakers Bureau; Otsuka: Consultancy; AbbVie, Otsuka, Pfizer, Gilead, Celgene, Ariad, Incyte: Consultancy, Honoraria. Huntington: Celgene: Consultancy, Other: Travel; Janssen: Consultancy; Pharmacyclics: Honoraria. Ma: Incyte Corp.: Consultancy.
