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Resources for Hematology Fellows

Less Is More: Fingerstick Technology May Overtake Venipuncture for Blood Sampling

In the average hospital or clinic setting, standard blood tests usually consist of at least two tubes of blood, yet only small quantities are actually used: despite evolving analytic technology, the amount of blood wasted is estimated at 25 million liters annually. Consultation for “anemia” in the hospital can often reveal an iatrogenic cause: A recent study demonstrated a risk of hospital-acquired anemia at 20 percent. This has led to opinion papers on appropriate blood utilization and developing technology to gain the same amount of information from a smaller quantity, as little as 5 mL compared to the standard 40 mL drawn at each venipuncture. The foreseen benefits of this are far-reaching, from patients who are already cytopenic from chemotherapy (or post-transplant) to patients who avoid vital diagnostic testing because of needle phobia. A recent article in The New Yorker about a Silicon Valley startup described dozens of blood tests available by a single finger-stick, at a fraction of the cost larger corporate laboratories normally charge.

This presents a challenge and an opportunity for clinicians: accessible, affordable testing at convenient locations obviates venipuncture and seems to be user-friendly. The challenge lies in appropriate patient counseling: Is autonomous testing an inevitable outcome? If so, who has the medical responsibility of following up, and would this require “confirmatory” testing, thus negating cost savings? Iatrogenic blood loss remains a clear issue in clinical care, and stemming the tide of blood waste is an important issue for the hematology workforce.