NHS ‘Count on Me’ program helps pediatric transplant patients self-manage blood draws at home

Close monitoring of patients is essential after a kidney transplant to ensure the body is not rejecting its new organ. Kidney transplant patients typically receive therapeutic drugs post-transplant to help their bodies accept the new organ and remain healthy. These therapeutic drugs require monitoring to make sure the patient is receiving the correct dosage for the greatest benefit without negative side effects or complications.

After getting a kidney transplant, even very young patients must get frequent blood draws for therapeutic drug monitoring (TDM) to check the blood concentration level of the therapeutic drug, tacrolimus. 

Why Blood Draws Are Critical and What They Tell Us

The immune system is inclined to attack foreign organisms introduced to the body, and the body interprets a new organ as foreign. Tacrolimus is a therapeutic drug administered orally to prevent rejection by inhibiting, or suppressing, the production of T-lymphocytes immune cells.

The dosage level of this immunosuppressant requires close monitoring to ensure it’s within a narrow therapeutic range. Extremely high concentrations lead to toxicity. Low levels can cause organ rejection. Examining blood samples from patients receiving this drug help the healthcare providers adjust the dose to ensure efficacy and avoid toxicity.

Patient monitoring is also essential to keep an eye on creatinine levels in the blood, which indicate if the kidney is being accepted and functioning well. Research shows an effective renal transplant should have creatinine levels of 100-120 umol/L. Higher levels (for example, 25% more than the average level), are a sign of acute transplant rejection.

Regular monitoring of blood samples is critical to determine appropriate levels of each chemical. This is particularly important in young patients, whose bodies can be more sensitive.

How Blood Collection is Performed

Blood microsampling methods that provide a simple and precise way to collect blood are in high demand, particularly for younger patients who must get frequent blood draws. Techniques that replace venipuncture are becoming more popular, such as a finger-stick blood collection method that can still provide the proper volume of blood needed to determine pharmacokinetic parameters and correct quantities of drug concentrations.

A finger-stick blood draw involves collecting blood from a fingertip on a swab or filter paper. It is then dried and stored. New programs using these simpler and more convenient methods of blood collection have been launched to enable parents of young transplant patients to easily collect blood samples at home. One such program is the CountOnMe® program at Nottingham University Hospital, part of the NHS in the United Kingdom.

CountOnMe uses Mitra Blood Collection Kits from Neoteryx to allow families to collect blood samples at home to assess tacrolimus and creatinine levels. Patients and families receive the collection kit from their care providers at the hospital. They use the microsampling tips in the kit to perform capillary blood sampling at home, and then return the blood samples by mail for analysis in the lab.

The at-home Mitra Blood Collection Kits provide a convenient and low-stress way of collecting blood samples from young patients in a comfortable, familiar environment. Remote blood collection options are a very real advantage for children and other vulnerable patients who should avoid contagions, especially during the COVID-19 outbreak.

How to Use the At-Home Mitra Blood Collection Kits

Ensure your hands are clean and dry.

1. Twist off the tab of the lancet, included in the kit.
2. Prick the end of any finger using the lancet.
3. Squeeze the finger to ensure enough blood flows.
4. Take each of the Mitra tips and allow them to absorb the drop of blood.
5. Ensure the tip is pointing downward to avoid under or over-sampling.
6. Write the time and date of the sample taken.
7. Remove the sticker on the closed clamshell case & use it to seal the bag.

Return the sample by placing the sealed bag into the included envelope and dropping the envelope in the nearest mailbox.

4 Benefits of Finger-Stick Blood Collection

1. Easy to administer – You (or a parent/caregiver) just need to follow the included instructions to collect the sample.
2. Less invasive – It’s an excellent method for pediatric blood sampling. It’s less invasive than venous blood draws from the arm, so kids also find it less traumatic.
3. Low cost – With finger-stick blood collection, parents don’t have to travel to the clinic or take time off work as often.
4. Successful test sample collection – Finger-stick blood collection using the Mitra microsamplers has a higher success rate because users can easily make multiple attempts to collect the required amount of blood.