If you are injured and cut yourself fibrin forms part of your body’s emergency response unit. It is a tough protein substance that forms long thread-like chains.
A cut in the skin must be closed quickly so that virsuses, bacteria and fungi cannot enter and cause infection. When a blood vessel is cut or broken platelets travel toward it and plug the gap. They are stuck together by a fibrous material called fibrin. This mesh of blood and fibrin forms a scab which keeps pathogens out and allows the wound to heal.
Fibrin is made from fibrinogen, a soluble protein that is produced by the liver and found in the blood plasma. When an injury results in bleeding the fibrinogen is converted into fibrin at the site of the wound by a clotting enzyme called thrombin.
However after the blood draw fibrin can be the phlebotomist’s and blood test technician’s foe. Once collected blood undergoes irreversible changes; and one of these is coagulation. If the blood clots in a tube it can lead to inaccurate results and instrumentation problems. Fibrin can form in all tubes during the blood testing procedure and the common causes are overfilling, premature centrifugation, improper mixing and incomplete clotting (delayed or prolonged coagulations that results in fibrin formation). All of these issues can be resolved by following standard procedures.
Blood – the poet’s and artist’s muse. This is part two of our look at some of the funny and thoughtful quotes tainted with blood.
“Music is not written in red, white and blue. It is written in the heart’s blood of the composer.” – Nellie Melba, superstar soprano
“The word ‘politics’ is derived from the word ‘poly’, meaning ‘many’, and the word ‘ticks’, meaning ‘blood sucking parasites’”. -Larry Hardiman, comedian
“All the soarings of my mind begin in my blood.” – Rainer Maria Rilke, Bohemian-Austrian poet
“Your belt is stopping the blood flow to your head!” – Singer Darius Danesh to Simon Cowell
“Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead.” – Gene Fowler, journalist, author and dramatist.
“When liberty comes with hands dabbled in blood it is hard to shake hands with her.” – Oscar Wilde, playwright, poet and author
“The true colour of life is the colour of the body, the colour of the covered red, the implicit and not explicit red of the living heart and the pulses. It is the modest colour of the unpublished blood.” - Alice Meynell, writer
Blood is the vital life force that flows through us, and it’s also the source of some funny and thought provoking quotes.
“Playwriting gets into your blood and you can’t stop it. At least not until the producers or the public tell you to.” – T. S. Eliot, poet and playwright
“Blood is that fragile scarlet tree we carry within us.” – Osbert Sitwell, writer
“Blood is thicker than water… but it makes lousy lemonade!” Alfred E Newman, fictional mascot that appeared on the cover of MAD magazine
“Blood will tell, but often it tells too much.” – Don Marquis, humorist
“You know you’re old if they have discontinued your blood type.” – Phyllis Diller, actress
“I have nothing to offer but blood, toil, tears and sweat.” – Winston Churchill, statesman, former Prime Minister
“Like getting into a bleeding competition with a blood bank.” - Richard Branson, entrepreneur
“Of all that is written, I love only what a person has written with his own blood.” – Friedrich Nietzsche, philosopher
“I was always shocked when I went to the doctor’s office and they did my X-ray and didn’t find that I had eight more ribs than I should have or that my blood was the colour green.” – Nicolas Cage, actor
From the very first day of training phlebotomists have to know the importance of correctly labelling blood samples. It cannot be emphasised enough that patient care depends on it.
The possible outcome of failing to follow your facility’s labelling protocol could be disastrous for a patient. It could lead to over-treatment, under-treatment or misdiagnosis.
The GP or consultant who has requested the patient’s blood test relies on it to diagnose a disease or to monitor the course of a condition or treatment.
This means that a phlebotomist must have an absolute commitment to the job. If phlebotomists are aware of the consequences of mislabelling they are more likely to follow the rules.
Follow your local guidelines to the letter. You may well experience times when you are rushed off your feet and be tempted to use a temporary identifier. Even if you think you’ll be able to get by with your own system, don’t do it. Complete identification as soon as the blood is drawn is essential. The potential risks to your patient are too great to contemplate otherwise.
If mistakes are made and a patient is harmed it could also damage the reputation of the hospital or facility and lead to disciplinary action.
Phlebotomists have a much more important job and greater responsibilities than can be seen on the surface. Employers must understand the pressures they face, value them and offer rewards accordingly.
There are so many rules, procedures and manuals covering the drawing of blood specimens that we thought we’d boil down the essentials into 7 golden rules. They’ll not only help you the phlebotomist but will also ensure that patients will become your new best friends – well almost!
1) Guard against injury – always use gloves, needle disposal units and proper procedures to minimize your risk of an accidental needle stick. The potential risks include contracting some form of hepatitis or even HIV.
2) Label specimens immediately – this does not mean using temporary markers to be replaced later when you find the time. Complete identification is a must. Find the time. Patients have died because of mislabelled specimens.
3) Befriend the medial vein – it’s the vein of choice for a number of reasons – it doesn’t hurt as much as other veins; it isn’t hidden amongst an undergrowth of nerves or arteries; it is generally closer to the surface of the skin; and it is more stationary.
4) Puncture the skin at a fifteen degree angle – most textbooks agree on a fifteen-to-thirty degree angle of insertion – anymore and you are liable to cause hematoma–blood leaking into surrounding tissues which can be painful for the patient.
5) Stretch the skin at the puncture site – this anchors the vein and minimizes the pain of the puncture.
6) Know when to quit – if your patient’s arm is looking like a sieve you’ve gone way too far. Blood draws are not easy and everyone can experience difficulty at some time, even the most experienced practitioner. After two failed attempts you should consider calling for someone else. Do not be afraid to ask for help.
7) Treat patients like family – for many people hospitals are nerve-wracking places at the best of times. A calm manner, gentle technique and kind words will ease their fears.
Newborn blood screening is a vital part of the national child public health programme and it is offered to every baby in the United Kingdom. The aim is to identify those infants who are at high risk of having some medical conditions before the symptoms develop.
Conditions that are tested for in the UK are Congenital Hypothyroidism (CHT), Phenylketonuria (PKU), Sickle cell disorders, Cystic Fibrosis (CF) and Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD).
Screening is not diagnosis; it identifies babes who will need to have further diagnostic tests to determine whether or not they have a condition. Early detection means that treatment can start sooner so as to minimise the severity of the condition. The heel prick can cause the baby some distress, and it is inevitably painful.
According to a Canadian study premature babies who undergo a heel prick test can benefit from skin to skin contact with their parents. Although such contact is not always encouraged in UK neonatal units the researchers from McGill University found that it could aid their recovery.
The scientists carried out the test on babies who were being cuddled. They measured their facial expressions, heart rate and blood oxygen levels to gauge the amount of pain suffered.
Pain scores after 90 seconds for the cuddled babies were markedly lower than for those who were not cuddled by their parents.
Blood groups were discovered in 1901 by the Austrian biologist and physician Karl Landsteiner (1868-1943).
In 1875 he pointed out that when people are given blood transfusions from other animals the foreign blood corpuscles are clumped and broken up in blood vessels. This clumping can cause toxic reactions, with fatal consequences.
Landsteiner later suggested that a similar reaction might occur when the blood of one person is transfused to another individual, and that this might be the reason why shock and jaundice followed earlier attempts at blood transfusion. He discovered that the clumping was an immunological reaction caused by the raising of antibodies against donor blood cells.
The physician classified blood into the now familiar blood groups, A, B, AB, and O and showed that new blood cells are destroyed when blood is transfused between individuals of group A or B. The problems occur when the donor blood comes from a person belonging to a different group. For this research he was awarded the Nobel Prize in Physiology or Medicine in 1930.
William Harvey was the man who discovered the circulation of blood. Born in Folkestone, Kent on 1 April 1578, he was educated at King’s College, Canterbury and then studied at Cambridge University. After a study trip to Italy he returned to England in 1602 to practice as a physician. His career was helped by the fact that he was married to Elizabeth Browne, the daughter of Elizabeth I’s physician.
Harvey became a fellow of the Royal College of Physicians in 1609 and in 1618 became the physician to King James I and his son Charles when he became king. Both royals took a close interest in his research and encouraged his intellectual pursuits.
Harvey was enthralled by the way blood flowed through the human body and the role that valves played in circulation. In 1628 he published his landmark theories in a book called ‘Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus’ (’An Anatomical Study of the Motion of the Heart and of the Blood in Animals’). He explained how the heart propelled blood through the body in a circular course.
His research met with some controversy as most people at the time believed that food was converted into blood by the liver, and then consumed as fuel by the body.
Despite the furore his ideas were accepted and he was widely recognized as a leader in his field. Harvey also made another landmark contribution to medicine. He was the first person to suggest that the reproduction of humans and other mammals was via fertilization of an egg by a sperm.
