Reducing bruising after venepuncture.

Bruising after venepuncture is undesirable. To verify an apparent increase in bruising after introducing a new venepuncture system in a small district general hospital and to improve the venepuncture service two prospective audits of the incidence and severity of bruising after venepuncture were performed in two groups of 100 consecutive inpatients undergoing venepuncture by phlebotomists. In the first audit bruising was detected in 45 patients, of whom 34(76%) had bruises > 100 mm2 in area. After modification of the technique, whereby the phlebotomists ensured that haemostasis had been attained before leaving the patient, bruising was significantly reduced, occurring in 25 patients only 9 of whom (36%) had bruises > 100mm2 in area (both p < 0.01) in the second audit. Monitoring of standards and simple modification of technique resulted in significant reduction in incidence and severity of bruising, improving the quality of the venepuncture service.

Liver disease in haemophiliacs: an overstated problem?

Successful percutaneous liver biopsy was carried out on 12 multi-transfused haemophiliacs from the Manchester area with persistently abnormal liver function tests. Only one patient showed evidence of chronic active hepatitis with progression to active micronodular cirrhosis although a further four patients showed some evidence of mild chronic active hepatitis. This represents a much lower incidence of severe histological liver damage than many previous reports and implies that liver biopsy in asymptomatic haemophiliacs may not be indicated as a routine procedure, particularly in the absence of proven therapy. Dynamic liver function tests may prove to be a useful indicator of deteriorating liver function in the otherwise asymptomatic haemophiliac.