The History and Importance of Phlebotomy - Research Paper Example

The History and Importance of Phlebotomy Introduction Blood is an emblem of life. It has been feared, respected, mythologized, and utilized in medicine from the earliest terms in human history. The human blood has saved numerous lives. Certain medical practices relating to blood have been in existence for a very long time and have continued to play crucial roles in the survival of human kind. One such practice is phlebotomy. With the development of science, blood has become a crucial component of human anatomy since it can be separated, examined, and utilized. It is believed that it is the most common medical practice that has been carried out by surgeons from antiquity to date. The medical professional who perform this exercise are commonly known as phlebotomists. To that effect, phlebotomists are medical practitioners tasked with drawing blood from a patient for medical testing, donations, research, transfusions, and diagnosis. In today’s world, phlebotomy comprises of a 5 billion-dollar business that involves organizations as well as hospitals across the globe. In most nations, just like any other medical professional, the phlebotomy personnel are required to be registered or licensed. In order to comprehend and explore the phlebotomy topic, drawing on a variety of sources the paper will discuss the history and importance of phlebotomy. Discussion History Hippocrite (460-277 B.C) is considered as father of modern science because he was responsible for the early medical history. He argued that the removal of ‘excess’ restored human balance for the sick persons. He further claimed that health could be restored via starving, plugging, or bloodletting (Parapia, 2008). Certainly, Assi and Baz (2014) note that phlebotomy is the practice of opening up a vein through puncture or incision in order to draw blood for therapeutic treatment, research, diagnosis, transfusions, and donations. According to Desai et al. (2008), phleb is a Greek meaning ‘related to blood.’ On the other hand, -otomy means ‘to make an opening.’ The professionals who perform phlebotomy by invading the body via incisions are known as phlebotomists. The art of bloodletting was flourishing before Hypocrites in the 5th century B.C. Phlebotomy was first documented in Egypt around 1000 B.C. The procedure of removing blood from the body dates back as far-off as 1400B.C. There was an Egyptian tomb that had paintings of leeches being applied to a sick person’s skins. In the early 1800 B.C., the leeches were in high demand since they were being used in a procedure known as bloodletting. The bloodletting procedures were so popular to the extent that the leeches were unable to keep up with the medicinal demands. In the 1830s, France imported an estimated 40 million leeches annually for medicinal purposes. In the following decade, England imported over 5 million leeches every year from the French. Through the early decades of the 18th century, thousands of leeches were utilized across Europe by physicians (Parapia, 2008). According to Conrad (2005), bloodletting was thought to remove impurities together with evil spirits from the body or simply make the return to its initial balanced state. By around 1800, anyone who claimed to have undergone medical training could carry out this procedure. At that time, bloodletting was being used to treat almost every disease. Typically, the barbers performed this process. The standard loss of blood was about 10 millilitres of blood. However, it was common for exceeding blood quantities to be withdrawn during these procedures. In fact, the untimely demise of President of George Washington was attributed to an excessive bloodletting in an attempt to treat an infection in the throat. The procedures of bloodletting also utilized a process known as venesection. ‘Veni’ is a prefix that means vein. In the procedure, the vein was pierced using a sharp object in order to drain blood. During that time, the lancet was instrument that was used to cut the vein (Marchioli, et al., 2013). The method was used since it was believed to remove any unwanted diseases from the body. Besides that, it was the only way in which a person suffering from fever could be relieved. However, it is crucial to note that the use aseptic practices were not known during that time. Similarly, during that time another procedure that was used was cupping. The method involved production of a vacuum effect by pulling blood to the capillaries below a glass cup that was heated. The heated glass cup was placed on the back of the patient to permit blood to flow more efficiently. Thereafter, a spring-loaded containing various blades made cuttings on the skin to initiate bleeding. The procedure often resulted in the production of scars (Parapia, 2008). As a profession, bloodletting is believed to have originated from the Barber Surgeons in the 12th century, in Italy. The Barber Surgeon carried a white and red staff, as well as a cane that as crowned with a ball as a demonstration of his bloodletting skills and his role the medical care sector during that time. The red stripe symbolized the patient’s blood, white stripe stripes stood for the bandages during the procedures, while the ball on top was for the cup that was used to collect blood flow. The Barber Surgeon could administer enemas, remove teeth, let blood, carry out surgeries, and even cut hair (Conrad, 1995). Bloodletting was used to treat various diseases, and it became a standard treatment for nearly each illness. It was practices prophylacticaly and therapeutically. One British literature suggested bloodletting for cancer, asthma, insanity, stroke, herpes, diabetes, coma, jaundice, acne, cholera, convulsions, scurvy, tuberculosis, smallpox, tetanus, gangrene, and smallpox. Additionally, bloodletting was also used to treat various forms of haemorrhaging, including excessive menstruation and nose bleeding. Furthermore, at the onset of childbirth or prior to surgery blood was drawn in order to prevent inflammation. Similarly, ahead of amputation, it was routine to draw blood a certain amount of blood that was equal to the quantity believed to circulate in the limb that is to be amputated (Parapia, 2008). In the 17th century, the invention of the microscope and developments in cellular physiology paved way for the examination of blood as a diagnostic tool. By the late 18th century, the benefits of bloodletting started to be seriously questioned. New statistical methods for analyzing treatment effectiveness were developed due to the advancement of evidence-based medicine. Most physicians had lost faith in the general effectiveness of bloodletting. However, in the late 1980s and 1990s, there was development of technology and laboratory function, and the phlebotomy profession emerged. Previously, medical technicians and medical technologists, as well were the only ones tasked with collecting blood samples. Although as the technology together with medical care industry experienced rapid advancements in last few decades, collection of specimens was handed over to other groups of trained professionals such as phlebotomists. Currently, there are more than 2 million phlebotomists across the world, with over 90,000 being found in the United States (Assi & Baz, 2014). Roles and responsibilities of phlebotomists The roles and responsibilities of phlebotomists are many. First, the major role of a phlebotomist is to acquire blood samples for diagnostic testing either by dermal puncture or venipuncture, which is puncturing of the vein. The phlebotomists, during this exercise various devices are usually used. This role requires courtesy, professionalism, and understanding from the phlebotomist when contacting the patient. The second role of a phlebotomist is to remove blood from donors during transfusions, or from patients who are suffering from a condition that is commonly known as polycythemia. According to Assi and Baz (2014), it is the overproduction of red blood cells whereby the blood should be removed in order to reduce the viscosity of the blood. The third role of phlebotomists is to collect and correctly package urine samples, accept incoming blood and body fluids, and directing specimens to the appropriate department for testing and analysis. Next, the phlebotomists are also supposed to make sure that the blood sample is taken correctly and properly, and that the suitable tools are used. The other role of the phlebotomists is proper labeling, handling, and transporting specimens by following department policies. Sixth is sorting specimens samples received and processing the specimens for delivery to laboratory departments. Finally, carrying out computer operations and/or updating the log sheets where needed. Other functions include, performing point-of-care testing, quality control checks, and observing all safety regulations. Importance of phlebotomy Phlebotomy is crucial since it offers a great medical service to those people who are in need of treatment in medical facilities. In a view shared by McGrew (2005), with no phlebotomy the process of diagnosis for infections and diseases would be practically impossible. Therefore, the major benefit of phlebotomy is making a diagnosis on the existence of diseases or any other infections in the body. Phlebotomy has also played a major role in blood transfusions. This has ensured the survival of numerous human beings, especially before and after surgical operations. Currently, phlebotomy may be carried out in the offices of the physicians, at a blood bank or in hospital under the supervision of a doctor after acquiring a medical prescription indicating the number of phlebotomy sessions needed. The bloodletting has steadily reduced as a treatment of a few select conditions. Phlebotomy is not only applied in the treatment of various disorders, but also used as a preventive measure. Phlebotomy is helpful in the treatment of polycythemia vera (PV). This is a condition whereby a patient’s blood needs to be removed in order to maintain the blood’s viscosity. The increased viscosity is due to the overproduction red blood cells, and white blood cells, as well as platelets in the bone marrow. Also known as erythrocytosis, it can be divided into absolute polycythemia (increase in red blood cells) and relative polycythemia (reduction in plasma volume). Polycythemia can be found in any individual with an increase in the haematocrit, with more that 51% in males and 47% in females (Assi & Baz, 2014). Absolute polycythemia can be further divided into primary and secondary polycythemia. Under primary polycythemia, there is polycythemia vera. PV is a myeloproliferative disorder that is attributed to the increased red blood cells, and in sometimes the white blood cells and platelet counts also increase, as well. PV occurs in any patient with an increased haemoglobin level of more than 18g/dL in males and 16g/dL in females (Fallah et al., 2011). The other signs and symptoms of the disorder include weight loss, peptic ulcer disease, pruritus after a warm bath, and gouty arthritis. Besides, an acute burning sensation on the four limbs is often followed by either a bluish or reddish coloration. The patients with polycythemia vera have tendency to develop cardiovascular accidents and venous thromboembolism. The major goal of the treatment via phlebotomy therapy is to lessen the thrombotic events. Phlebotomy reduces the haemorcatic levels to below 45.5%. This results in a reduction in the whole blood thus enhancing the flow of blood. The phlebotomy therapy in the treatment of polycythemia includes reduction of red blood cells mass together with minimizing the likelihood of deleterious clots. Currently, phlebotomy is regarded as the mainstay treatment of polycythemia. Studies have evidenced that the side effects of phlebotomy therapy are similar to those of blood donations. Tripathy, Panda, and Rath (2010) share the evidence that as for the patients who develop secondary polycythemia, not all of them are candidates for phlebotomy. For example, smoking, adrenal adenoma, and Cushing’s syndrome can cause secondary polycythemia, but these are no indications of phlebotomy. However, for patients who undergo renal transplants can develop polycythemia and phlebotomy may be utilized in such situations if they are not responding to the angiotensin II receptor blockers. Besides that, phlebotomy has also been found to minimize considerably diastolic and systolic blood pressures in the renal transplant patients (Assi & Baz, 2014). As for patients with cyanotic congenital disease, the American College of Cardiology in conjunction with the American Heart Association, in 2008, suggested doing therapeutic phlebotomy for these patients having haemoglobin levels more than 20g/dL, whilst taking care of the evade depleting iron. It has been evidenced that excessive phlebotomy may lead to iron deficiency, and in turn compromise the delivery of oxygen increasing the blood viscosity. As a result, there is a recurrence of the symptoms. Next, phlebotomy can also be used to treat porphyria cutanea tarda (PCT). This is a combination of disorders of heme metabolism that is linked to iron metabolism (Houschyar, et al., 2012). Dwyer et al. (2010) adds that PCT is rare metabolic disorder that is caused by insufficient amounts of uroporphyrinogen decarboxylase that results in the accumulation of extremely carboxylated porphyrins and uroporphyrinogen in the urine, liver, and plasma. Medically, porphyria cutanea tarda is associated with severe blistering on the skin, skin erosions, increased skins fragility with bullae, and with the sun-exposed areas of the body showing either hyper-pigmentation or hypo-pigmentation. PCT diagnosis requires both biochemical as well as clinical features. Even though there are numerous treatments for PCT, patients of PCT have long regarded phlebotomy as their treatment of choice. During the therapeutic phlebotomy, an estimated 450mL of whole blood is drawn during every phlebotomy session. The sessions are repeated after every two weeks until the levels of haemoglobin are below 11g/dL. Equally important, during the treatment of porphyria cutanea tarda until the levels of serum ferritin is below 20ng/mL. This value is nearer to the lower normal limit. Majority of the patients need 6 months to attain remission. On the contrary, clinical improvements have been noted in the first three months of after the commencement of phlebotomy (Assi & Baz, 2014). Recent studies have demonstrated that the use of phlebotomy in the treatment of porphyria cutanea tarda is superior to hydroxychlorine in reducing the production of porphyrin. Pursuing this further, the effectiveness of phlebotomy has been found that in the first two or three months and an upper limit of 9 months is the disappearance of skin blistering on the patients. This is usually followed by improvement in skin fragility, hyper-pigmentation for those who initially had hypo-pigmentation and hypo-pigmentation for those who had hyper-pigmentation. In some patients, pseudoscleroderma also improves. Therefore, phlebotomy is utilized to reduce the levels of iron along with preventing its accumulation in several organs including liver and kidney among others. Therapeutic phlebotomy is also a vital treatment part of different diseases, particularly those linked to iron overload (Assi & Baz, 2014) including hereditary hemochromatosis. Hemochromatosis, as cited by Falize et al. (2006) is a genetic disorder of iron metabolism resulting in the abnormal accumulation of iron in the pancrease, joints, heart, skins, and liver. Haemochromatosis is the major indicator of phlebotomy. There are two types of haemochromatosis: hereditary haemochromatosis and non-hereditary haemochromatosis. Only hereditary haemochromatosis can be treated via phlebotomy (Assi & Baz, 2014). Hereditary haemochromatosis is a severe genetic disorder and often requires multiple blood transfusions. The U.S Food and Drug Administration posits that therapeutic phlebotomy for patients is supposed to be done free of charge on condition that the units are to be entered into the allergenic blood supply. Hereditary haemochromatosis leads to excessive deposition of iron in several organs and tissues. Therefore, most patients are either asymptomatic or present with signs not specific to the disease. For patients with hereditary haemochromatosis, phlebotomy is the major therapy for them. The condition is usually treated with intermittent phlebotomy in order to maintain the levels of ferritin at suitable levels so as to reduce further deposition of iron. The liver functions as well as the hepatic fibrosis usually improve after phlebotomy (Houschyar, et al., 2012). In addition, these patients require a long-term maintenance schedule. However, for those patients who cannot tolerate phlebotomy as a result of anemia, deferasirox in manifested (Assi & Baz, 2014). Phlebotomy is a safe and cost-effective treatment, and has made a comeback in microsurgery together with re-implanting surgery after two decades. Assi and Baz (2014) claim that the use of leeches have resurfaced but with a new purpose. It is now being used to remove blood that has collected at tissues that have been newly transplanted. This reduces swelling following microsurgery, a certain type of a leech, Hirudo medicinalis secrets various biologically active substances, such as fibrinase, hyluronidase, an anticoagulant, proteinase inhibitors, and hirudin. These biologically active substances play a very crucial role in the microsurgery process. The substances prevent tissue decay and venous congestion. Equally important, they can be utilized in the postoperative care of skin grafts in addition to the reimplanting of toes, ears, fingers, and many other body parts. However, studies are being conducted at the University of Wisconsin in relation to the secondary infections of the ‘mechanical leech.’ Phlebotomy, as noted by Dwyer et al. (2010) could also be helpful in the prevention of the Alzheimer’s disease. The study reported that in the Alzheimer’s disease, phlebotomy could reduce the body iron that may be playing a crucial part in the progression along with pathogenesis of the Alzheimer’s disease. This hypothesis is supported by the evidence from the study that patients with the metabolic syndrome who experienced phlebotomy exhibited greater differences in the systolic blood glucose, pressure, iron, ferritin, and cholesterol. This minimizes the risks factors for the Alzheimer’s disease. Moreover, a study by Leo et al. also came to a conclusion that the reduction of iron via phlebotomy reduces the risk of cancer occurrence. Lastly, phlebotomy also prevents s sickle cell (Bouchaïr, et al., 2007). People suffering from sickle cell disease can be beneficiaries of either phlebotomy alone or when it is used together with hydroxyurea. Phlebotomy lessens the blood viscosity by means of reducing the level of haemoglobin level and is the reason for a reduction of the mean corpuscular haemoglobin concentration. As a result, it reduces the HbS molecule polymerisation in the sickle cell disease. Conclusion In summary, phlebotomy is the extraction of blood from a patient for testing, donations, research, and transfusion purposes. The professionals who perform the procedures are known as phlebotomists. Their roles include: obtaining blood samples for diagnostic testing, removing blood from donors for blood transfusions, collecting and accurately packaging urine specimens, accepting incoming specimens, directing the samples to the correct departments for testing and analysis, properly labeling, handling, and transporting specimens, performing point-of-care testing, and observing all safety regulations. Phlebotomy is believed to have its origin in Egypt around 1400 B.C. Various methods were used to draw blood in the subsequent years. In the 1800s leaches were used. Venesection was also done which was piercing of the vein with a sharp object to drain blood, and cupping where a vacuum was produced effecting a pull of blood to the capillaries under a heated glass cup. As a profession, phlebotomy emerged as a result of technological advancements and expansion of laboratory functions in the late 1980s and 1900s. The benefits of phlebotomy include: prevention of sickle cells, treatment of polycythemia vera, porphyria cutanea tarda, hereditary hemochromatosis, and use of leeches in microsurgery and implants, blood transfusions, blood donations, diagnosis of infections and diseases, prevention of sickle cell disease, and prevention of the Alzheimer’s disease. In future it is anticipated that the advances in medical knowledge and medical research will ensure that diagnoses become more refined while the treatments also become less evasive. References Assi, T. B., & Baz, E. (2014). “Current applications of therapeutic phlebotomy,” Blood Transfusion , 12 (1), 75-83. Bouchaïr N, Manigne P, Kanfer A, et al. (2000). “Prevention of sickle cell crises with multiple phlebotomies,” Arch Pediatric, 7(1):249-255. Conrad, L. (1995). The Western Medical Tradition: 800 B.C.-1800 A.D. Cambridge: Cambridge University Press. Desai, K., Jamil, H., Balasubramaniam, M., et al. (2008). “Phlebotomy improves therapeutic response to interferon in patients with chronic hepatitis C: A meta-analysis of six prospective randomized controlled trials,” Dig Dis Sci. 53:815-822. Dwyer, E., Zacharski, R., Balestra, J., et al. (2010). “Getting the iron out: Phlebotomy for Alzheimer’s disease?” Med Hypotheses. 72(3): 504-509. Fallah, M., Kharazmi, E., Sundquist, J., & Hemminki, K. (2011). “Higher risk of primary cancers after polycythaemia vera and vice versa,” Br J Haematol. 153(2):283-285. Falize, .L, Guillygomarc’h, A., Perrin, M., et al. (2006). “Reversibility of hepatic fibrosis in treated genetic hemochromatosis: A study of 36 cases,” Hepatology, 44(1):472-477. Houschyar, K. S, Lüdtke, R., Dobos, G., J., et al. (2012). “Effects of phlebotomy-induced reduction of body iron stores on metabolic syndrome: Results from a randomized clinical trial,” BMC Med. 10(1): 54. Marchioli R, Finazzi G, Specchia G, et al. (2013). “Cardiovascular events and intensity of treatment in polycythemia vera,” New England Journal of Medicine, 368:22–33 McGrew, R. (2005). Encyclopedia of Medical History, New York: Routledge. Parapia, A. (2008). “History of bloodletting by phlebotomy,” Br J Haematol, 143(1):490-495. Tripathy, S., Panda, S., Rath B. (2010). “Phlebotomy for rapid weaning and extubation in COPD patient with secondary polycythemia and respiratory failure,” Lung India.27:24-29. Read More