The usefulness of phlebotomy in the palliative care setting

To establish the reasons for phlebotomy and evaluate the usefulness of blood testing in the palliative setting.

The design was that of a questionnaire-based prospective study conducted in the 30-bed Specialist Palliative Care Unit at Milford Care Centre between March 23 and May 23, 2010. A questionnaire was completed by the performing clinician following each venipuncture, which included details of the admitted patient, the blood tests performed, the reason(s) for testing, and the usefulness of blood testing in diagnosing and influencing management.

Fifty blood tests were conducted on 37 inpatients. The mean age of patients was 66.7 years and 54.1% were male. The top three diagnoses were malignancy of bowel, ovary, and prostate, respectively. The top three reasons for venipuncture were to manage medications, establish the need for blood transfusion, and guide management of sepsis. Thirty percent of phlebotomy sessions changed management, 40.7% ruled in an important diagnosis, and 86% ruled out an important diagnosis. Forty-eight percent of phlebotomy sessions had at least one type of test "added on" that in hindsight was unnecessary.

Blood testing is a useful tool in the palliative setting to guide management and to ascertain diagnoses relevant to symptom control. For reasons of laboratory time and economic cost, unnecessary additional tests should be kept to a minimum.