Background and Objectives: Two of the authors, one heterosexual and one homosexual, both voluntarily donated blood to a well-known health institution in the Philippines. As they were filling out the paperwork, one of the authors' attention was called by one of the questions in the form: “Nakipagtalik ka na ba sa iyong kauri?,” which can be literally translated as “Have you had sex with your own kind?”. This erroneously phrased question was the sole question interrogated and problematized in the study. Methodology: Reviews of Standpoint Theory and the methodology associated with it and, in effect, used in the study, formed part of the critique, divided into individual narrations and interpretations by each author. A third co-author, a hematologist, lent her insight on the logistics and issues of phlebotomy. Institutional ethnography was brought to bear on the narratives Results and Conclusion This three-author collaboration is presented as a claim that an interdisciplinary approach may open new vistas to a phenomenon that has long existed but been ignored. Reviews of Standpoint Theory and curriculum planning for health professionals are recommended.
Phlebotomy ; Communication ; Homosexuality ; Blood Donation

BACKGROUND: Accurate patient identification is fundamental in transfusion medicine. Our hypothesis is that an open question about patients' ABO blood group would be helpful for accurate identification of the patient and for accurate laboratory testing. METHODS: We added some blanks, including the patient's ABO blood group on the tube label, which should be filled in by the phlebotomist on the spot. From Aug 1, 2012 to May 31, 2013, we analyzed the effect of the additional step for identification of a misidentification 'incident' in 31,454 tests of 14,864 patients. We surveyed on 21 phlebotomists with regard to whether the changed label reinforces patient identification. In addition, the discrepancy rate between the ABO blood group perceived by the patient and the test result was analyzed. RESULTS: Patient-misidentification error rate during this study was 0.022%, and 81.0% of the phlebotomists answered that the changed label reinforces patient identification. The total discrepancy rate was 1.93%. Patients without previous results showed a higher discrepancy rate (3.08%) than patients with previous results (0.35%). Males (2.48%) showed a higher discrepancy rate than females (1.38%). Patients older than 50 years showed a higher discrepancy rate (2.87%) than patients younger than 50 years (0.82%). According to ABO blood group, group O showed the lowest discrepancy rate (0.87%). CONCLUSION: Checking ABO blood group known by the patient helped phlebotomists to correctly identify the intended patient. Active corrective action by the transfusion laboratory when discrepancies exist could increase test reliability and pave the way for safe transfusion, which will ultimately improve the quality of transfusion medicine.
Female ; Humans ; Male ; Phlebotomy* ; Transfusion Medicine

BACKGROUND: The returning time of inpatient specimen analysis is usually slow because phlebotomists deliver all the collected specimens at the end of their work cycle. In addition, manual specimen reception further delays the reporting time and imposes a heavy workload on the technical staff, thus compromising effectiveness. Therefore, we have created an automated specimen reception system to tackle testing delays and enhance the efficiency and quality of specimen collection and handling. METHODS: In May 2015, the pre-analytical processing of inpatient samples was renovated. We automated the specimen reception in parallel with barcode printing and introduced pneumatic tubes to deliver samples for routine chemistry tests. We compared the reporting time of the automated system with that of the manual system and analyzed the distribution pattern of the specimens according to handling time. RESULTS: The median reporting time was advanced by 41 minutes, from 09:33 AM to 08:52 AM for the manual and automated reception, respectively. Moreover, with the reduction in hands-on time, the blood specimens reached the laboratory immediately after phlebotomy, thereby improving the processing efficiency by spreading out the interval during which the specimens arrived in the laboratory. Additionally, the new system allowed the identification of the phlebotomist who collected the specimens and tracking the specimens from collection to test result. CONCLUSIONS: With the introduction of our automatic reception system, the reporting time was considerably reduced. Therefore, the satisfaction of the clinician and the technical staff was improved.
Chemistry* ; Humans ; Inpatients* ; Phlebotomy ; Specimen Handling

BACKGROUND: In vitro levels of complement C3 and C4 proteins are sensitive to storage conditions. To avoid in vitro complement activation when testing is delayed, serum should be frozen at -20degrees C within 2 hr of venipuncture. However, this is impractical in routine laboratory work. Therefore, we investigated alterations in C3 and C4 levels in refrigerated specimens over time and derived formulae to estimate initial levels of complement concentrations in delayed testing. METHODS: Ten fresh specimens were measured for C3 and C4 concentrations and were refrigerated at 4degrees C. We measured C3 and C4 levels in refrigerated samples daily for 4 days using an automated nephelometer (Beckman Coulter Inc., USA). RESULTS: C3 and C4 levels were significantly increased over time in refrigerated specimens (P<0.001, P<0.001, respectively). The increments in C3 and C4 levels were described by the equations: C3 (mg/dL)=3.55x+87.18 (r=0.9909), and C4 (mg/dL)=0.72x+22.3 (r=0.9395), where x=the number of days samples were refrigerated before testing. Increases in C3 and C4 concentrations were described on a percentage basis by the equations: DeltaC3 (%)=4.14x+1.07 (r=0.9903), and DeltaC4 (%)=3.57x+2.48 (r=0.9405). CONCLUSIONS: As the measured C3 and C4 concentrations increased by 3.55 mg/dL (4.1%) and 0.72 mg/dL (3.6%) per day in refrigerated specimens, the levels of C3 and C4 should be adjusted in delayed testing. We proposed that the formulae presented be used to back-calculate initial levels of C3 and C4 concentrations.
Complement Activation ; Complement C3* ; Complement C4 ; Complement System Proteins ; Phlebotomy

OBJECTIVE: To define the anatomy of the lateral antebrachial cutaneous nerve (LABCN) and the cephalic vein (CV) in the anterior forearm region of living humans using ultrasonography for preventing LABCN injury during cephalic venipuncture. METHODS: Thirty forearms of 15 healthy volunteers were evaluated using ultrasonography to identify the point where the LABCN begins to contact with the CV, and the point where the LABCN separates from the CV. The LABCN pathway in the forearm in relation to a nerve conduction study was also evaluated. RESULTS: The LABCNs came in contact with the CV at a mean of 0.6±1.6 cm distal to the elbow crease, and separated from the CV at a mean of 7.0±3.4 cm distal to the elbow crease. The mean distance between the conventionally used recording points (point R) for the LABCN conduction study and the actual sonographic measured LABCN was 2.4±2.4 mm. LABCN usually presented laterally at the point R (83.3%). CONCLUSION: The LABCN had close proximity to the CV in the proximal first quarter of the forearm. Cephalic venipuncture in this area should be avoided, and performed with caution if needed.
Elbow ; Forearm ; Healthy Volunteers ; Humans ; Neural Conduction ; Phlebotomy ; Ultrasonography ; Veins*

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.
Bacteremia* ; Child* ; Culture Media ; Extremities ; Fever ; Humans ; Phlebotomy

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.
Bacteremia* ; Child* ; Culture Media ; Extremities ; Fever ; Humans ; Phlebotomy

BACKGROUND: The National Committee for Clinical Laboratory Standards (NCCLS) recommends that the analytical variability must not exceed 25% of the biological variability in automated blood cell analysis. This study was conducted to determine whether routine automated blood cell analysis by Coulter STKS (Coulter Corp., Miami, FL, U.S.A) comforms with the NCCLS's recommendations. METHODS: Routine CBC analysis with STKS was performed on 22 healthy volunteers. The tests included calculating WBC, RBC, hemoglobin, MCV, platelet, MPV, and percentages of the granulocytes, lymphocytes, and monocytes. Blood samples were collected twice in one week interval to study the total variability. For the analytical variability, blood samples from 12 subjects were tested twice immediately after venipuncture for within-run variability, and samples from 10 subjects were tested immediately and 6 hours after venipuncture for within-day variability. The analytical variability was calculated as the sum of within-run and within-day variabilities. The biological variability was calculated by subtracting the analytical variability from total variability. The ratios of analytical and biological variabilities were calculated by dividing the analytical variability by the biological variability. RESULTS: Ratios of analytical and biological variabilities were as follows: 0.22 for WBC, 0.20 for RBC, 0.21 for hemoglobin, 0.39 for platelet, 1.98 for MPV, 0.07 for %granulocyte, 0.11 for %lymphocyte, and 1.81 for %monocyte. The ratio for MCV was not obtained because the analytical variability exceeded total variability. CONCLUSIONS: The analytical variability did not exceed 25% of the biological variability in all test categories except platelet, MPV and the percentage of monocyte. Thus, it is recommended that the analytic variability of all test categories be reduced so as to be in conformity with the NCCLS' recommendations.
Blood Cells* ; Blood Platelets ; Granulocytes ; Healthy Volunteers ; Lymphocytes ; Monocytes ; Phlebotomy

J-guide wires have been widely used for central venous catheterization with the popularity of the Seldinger technique. However, many adverse sequelae of central venous catheterization have been reported. We report two cases of J-guide wire breakage during central venous catheterization. Venipuncture by a steel needle was easily achieved in each case. However, insertion of a J-guide wire was difficult to perform, and pulling out the guide wire from the steel needle was more difficult, which caused breakage of the core and the uncoiling of the spring coil of the guide wire. The tip of the guide wire was not cut off, and there were no complications. With the removal of the guide wire, weak resistance was felt that which was not supposed to be sufficient to cut off the guide wire. It was assumed that an inherent fault in the manufacturing process of the guide wire could lead to this type of breakage.
Catheterization, Central Venous* ; Central Venous Catheters* ; Needles ; Phlebotomy ; Steel

Porphyria cutanea tarda(PCT) is a photocutaneous disorder due to excessive porphyrins in the skin. We experienced 4 male patients who showed typical clinical manifestations. Histologic findings revealed subepidermal bullae with festooned derrnal papi11ae, and typical porphyrin excretion pattern of PCT was detected. One case had on 500mg daily of chloroquine with r.linical and biochemical improvement 4 months later without any adverse effects. Other 2 cases had on 125mg of chloroquine twice a week and the other one had perforrned phlebotomy.
Chloroquine ; Humans ; Male ; Phlebotomy ; Porphyria Cutanea Tarda* ; Porphyrias* ; Porphyrins ; Skin