at-home blood collection helps doctor monitor young patients in UK

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For the second episode of the Microsamplify Podcast from Neoteryx, our Technical Director James Rudge, PhD, spoke with pediatric nephrologist Jon Jin Kim, MD, from Nottingham Children’s Hospital, part of the NHS in the United Kingdom. Dr. Kim told us about the EMEESY Children's Kidney Network and the ground-breaking home sampling blood collection kit that he and his team developed and customized using the Neoteryx^® Mitra microsampling device from Trajan Scientific and Medical.

Dr. Kim explained how the CountOnMe^® program provides young kidney transplant patients with an option for them or their parents to collect their blood at home using a simple finger-stick method. For children and families who live far away from the hospital, this is a safe and convenient way to track creatinine and tacrolimus levels. This option was valued even more during the coronavirus pandemic lockdowns, when people had to be extra careful in limiting their exposure to viral pathogens.

Neoteryx: Hi Dr. Kim, and thank you for your time today, especially under the current circumstances. Could you let us know a little bit about yourself and what you do on a day-to-day basis to help pediatric transplant patients?

Dr. Kim: Hi James, thanks for the invite to do this interview concerning CountOnMe. At the time of recording this interview, there is an outbreak of coronavirus, which is really causing a lot of stress. I am a pediatric nephrologist working at Nottingham Children's Hospital. We cover quite a big geographical area in the UK. We stretch all the way up to Yorkshire, down to the Midlands and across to the east coast. It's an area almost the size of Scotland. Some of our patients have to travel quite far to come see us in Nottingham, because we are located almost at the corner of this geographical area. We see about 10% of the pediatric population. I look after children from CKD to dialysis to transplantation. 

Neoteryx: You have created a home sampling kit called CountOnMe^®. Could you tell us a little about the kit, and what prompted you to develop it?

Dr. Kim: We wanted to find an easier way for children and their families to get their blood tests done. Some of our families were having to travel up to three hours to come and visit us. And I thought, if we could have a kit that allows patients to do their blood draws at home, this would be fantastic! Once we started off with this idea, we wanted to come up with a good name for the kit. We named it CountOnMe, which represents the kids doing their own blood collection at home and is also about us trusting the patients and wanting them to be more involved in their care. 

This idea has now become the CountOnMe kit, and we hope to take it a bit further. Essentially, the kit has all you need to do a blood collection. It contains all the equipment you need. We built it to be very user-friendly, and so it won't look scary for children. We have a designer who came up with very simple drawings on how to do the blood collection. 

Neoteryx: How do patients and parents of your transplant recipients use the kit?

Dr. Kim: We have a small number of patients who have been using the CountOnMe kits at home for the past year. We've been asking them to collect blood with the kits once a month. Over the past year, we've learned a lot about the best way to do it. We made some small mistakes at the start. We learned that not only can you under-fill the sample tip on the Mitra device, but you can also over-fill the sample tip. This means that you can put too much blood on the absorbent tips. In the last few months, we have fine-tuned how we teach patients to collect their blood, and now we are getting quite reliable results.

Neoteryx: So, you've found a better way to instruct the patients and their parents on how to collect their blood? I presume that involves instructing how to use the finger-stick and the tip of the device to allow that sample to fill the tip for a few seconds and then gently pull the tip away. And then they have to close up the samples in the cartridge and prepare the bag for sending. Is that the procedure that you recommend?

Dr. Kim: That's exactly right, James. We made some videos for patients to watch how to do it. Sometimes it's easier to understand how to do it by looking at the videos. If I can, I'd like to give two important tips on how to do this.

The first tip: to make it easier to get the blood, it is best to "milk" the finger upwards by squeezing from the bottom of the finger to the top--up and down--so you get a nice drop of blood.

The second tip: do exactly as Neoteryx advises, which is to use the Mitra tip pointing downwards and just barely touch the tip of the device onto the drop of blood. And just let the tip absorb or soak up the blood on its own. That way you ensure that the whole of the tip gets filled up, and it does so in a very controlled way. 

Neoteryx: That's an excellent description. And people will be able to follow the link to your website to see the video and learn more. How long does it take to get a result after mailing or posting a collected sample?

Dr. Kim: It depends on your local laboratory. In theory, you will get a result in two working days, because it takes one day for you to post it and for the lab to receive it. (In the UK, we use First Class mail, which takes one day.) When the lab gets it, it takes another day for them to process or test the sample. In practice, it depends on how often your lab is doing the testing. It might not do testing every day. Having said that, there is no reason you shouldn't be able to get your result in 24 hours because. If we have more patients submitting blood samples, then it makes more sense for the lab to run the tests every day. It really just depends on the logistics and the lab.

Neoteryx: So the CountOnMe sample is a dried blood sample. How do the results from the CountOnMe samples on the Mitra tips compare to a standard blood test?

Dr. Kim: That's a very good question, James! If I can, I'd like to answer that in two parts. 
The first part is determining the precision of the test. When lab experts are setting up their tests, they use standard reagents. They know the exact value of what they are testing. The precision is about 2%, which is about as good as any lab test can be, whether you are conducting it with patient-collected samples or the with samples collected in the hospital. Once the lab has set up the assay, it is very precise. 

The second part is determining what happens when patients collect blood samples themselves and send their samples to the lab. I think with this method you introduce a little bit of variability. That's why we are very focused on making sure that patients are comfortable and taking their time to learn how to do the blood collection at home. We found that if you take the time to teach patients how to do the blood collection correctly at home, then you can get very consistent results--results that are comparable to the results you get with blood samples collected in hospital.

It would be nice to do more validation studies, but I think from a practical point of view, we are ready to roll out our program to more patients. We have learned over the past year how to manage the variability, and the labs have learned how to work with these remote samples, so from my point of view, the tests are reliable and we are ready expand the blood collection at home.

Neoteryx: You've been running this program for over a year, which is super. Do you already have patients using the kit and, if so, what has been their feedback? 

Dr. Kim: We've provided at-home blood collection kits to only a small number of patients over the past year. Those we have managed to train really like it. They find it a very flexible way of doing the blood draws and testing. It saves them a day off school and a day off work, and it saves them from having to travel. It's easier because they do it on the sofa in the comfort of home. I also find that it makes them more engaged in their treatment as well, so I think it is quite beneficial. As I said, there has been a learning curve over the past year, but in the last few months we've learned how to do this at-home sampling properly, and I think that is the main thing. I can't emphasize enough how important it is to make sure that people are comfortable doing the blood collection in the correct way. 
  
Neoteryx: You mentioned earlier about the COVID-19 pandemic situation. With the virus pandemic in mind, what's your advice to parents and your patients who are taking immunosuppressives at the moment? 

Dr. Kim: I am sure there is a lot of anxiety right now regarding the risks posed by the COVID-19 pandemic. My message is to talk to your medical care teams, to listen to the government's advice. For example, the UK government has advised that patients with organ transplants need to self-isolate for the next 12 weeks. I think we really have to follow their guidelines as strictly as possible to reduce risk. For some patients, it is still very important to come to hospital for follow-up appointments, but you must talk to your medical team about safety precautions. There are some things we can only do in hospital, like a full-panel of blood tests and a general check-up. For patients who are very stable, I think the care team could mention that there is a way now to do blood collection at home to save you from going out, which could be risky. Talk to your medical team and find out what is the best option for you.

Neoteryx: This is obviously a very worrying time for many people, so thank you for that message. Getting back to the kits, are they available now and how do people find more information about the kits?

Dr. Kim: I've got to admit that we didn't make these kits with the idea to provide them during a viral pandemic, so actually, we've been doing this on a small scale for our own patients in Nottingham. If healthcare professionals want help doing at-home blood collection for testing their own patients, I would tell them what I have told my colleagues here in the UK. We can help you set it up at any level. We can mail out some sample kits for patients to try at-home sampling. We can even help you make a list of what you should include in your kits to help your patients. At the lab level, we'd be happy to put you in touch with our lab contact in Manchester, who would likely be more than happy to work with your local labs to help support getting them set up for testing there. We're here to try and democratize the system. We're here to support care teams as much as possible, and help make it safer for patients.

Neoteryx: Thank you for taking the time to talk to us about the CountOnMe program and home sampling kits, Dr. Kim. We wish you all the greatest success with this ground-breaking service for at-home sample collection!