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At least 721 records · Page 40Linked to original sources
PubMed1993

Phlebotomy--a minimalist approach.

For each patient, laboratories usually collect more blood than is needed for specific determinations. We reviewed the amount of blood collected for laboratory measurements for an entire hospital stay of 113 patients admitted during a 1-week period to a medical ward or to a medical intensive-care unit in our tertiary-care facility. The amount of blood obtained was also compared with the minimal amount needed for analysis for 18 of the most frequently ordered laboratory tests in our facility. For routine collections, a mean of 45 times the required volume of specimen (range, 2 to 102 times) was obtained. For optimal utilization of laboratory services, both the positive and the negative consequences of testing must be thoughtfully considered. Two potential adverse effects of withdrawal of blood for laboratory determinations are iatrogenic anemia and infection. Moreover, the cost of care is increased with additional analyses. Practical strategies for decreasing the amount of blood collected include an increased awareness of ordering practices, a thorough knowledge of the volume of blood needed for each laboratory test, experienced phlebotomy personnel, storage of blood specimens for potential subsequent use, and communication of accurate minimal volumes needed for specific measurements.

Anemia↗
PubMed1987

Influence of phlebotomy treatment on abnormal hypothalamic-pituitary function in genetic hemochromatosis.

To test the hypothesis that deficiencies in hypothalamic-pituitary function in genetic hemochromatosis result from cellular injury by iron deposits, we conducted provocative tests in 11 men with genetic hemochromatosis before and after iron depletion by serial phlebotomy and in 10 control subjects. We gave combination intravenous injections of insulin (0.15 U/kg), luteinizing hormone releasing hormone (LHRH, 100 micrograms), and thyrotropin releasing hormone (400 micrograms) and then measured plasma glucose, growth hormone, corticosteroids, follicle-stimulating hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone at 30-minute intervals for 90 minutes. Phlebotomy caused a substantial decrease in median values for serum ferritin, deferoxamine-chelatable iron, and hepatic iron concentration. Before phlebotomy, stimulation by hypoglycemia and thyrotropin releasing hormone caused significantly less secretion of growth hormone (P = 0.004) and prolactin (P = 0.03) in patients than in control subjects. No significant improvement was noted, however, in growth hormone or prolactin secretion after phlebotomy. Of the 11 patients, 7 had secondary hypogonadism, and phlebotomy did not improve the serum testosterone, follicle-stimulating hormone, luteinizing hormone, or responses to LHRH in any case. Chlorpromazine injections failed to elevate serum prolactin in all patients, and administration of levodopa caused a partial reduction in serum prolactin; thus, the hypothalamus may be an important locus of endocrine malfunction in these patients. We conclude that abnormal hypothalamic-pituitary function in genetic hemochromatosis is not substantially improved by iron-depletion therapy.

Adult↗
PubMed1989

Hemochromatosis.

This article discusses the pathophysiology and clinical manifestations of idiopathic and secondary hemochromatosis. Pedigree studies documenting the hereditary evidence for hemochromatosis are discussed. Current theories for the molecular mechanisms that result in iron overload are presented. Diagnostic strategies for assessing hemochromatosis and therapeutic modalities are reviewed.

Bloodletting↗
PubMed1980

Disorders of iron metabolism.

Although iron in minute amounts is necessary for the metabolism of most cells, it produces damage if present in excess. Clinical tools for the evaluation of iron stores include serum iron concentration, transferrin saturation, deferoxamine test, Prussian blue stains of liver and marrow, and serum ferritin concentration. Serum ferritin concentration is an excellent screening test for iron deficiency or excessive iron stores. If excessive iron stores is diagnosed, the iron should be removed with phlebotomies or chelation therapy.

Absorption↗
PubMed1980

Polycythemia vera and agnogenic myeloid metaplasia.

Age complications bring these patients to primary physicians more frequently than would be expected from incidence or prevalence statistics alone. Therapy is symptomatic. Termination in acute leukemia occurs in both conditions and the risk may be increased by radiation or myelosuppressive drugs. Careful management can prolong survival in polycythemia vera and improve the quality of life in both conditions.

Alkylating Agents↗
PubMed1989

Neonatal pain associated with caregiving procedures.

This article presents evidence that newborns react to aversive caregiving procedures--heelsticks, circumcision, and surgery--with distinct physiological, behavioral, and metabolic responses. These responses are similar to those associated with pain in adults. Suggestions are made on methods of ameliorating the infant's responses to aversive caregiving procedures.

Analgesics↗