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 is 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 uL. 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.

The CountOnMe program launched an initiative using Neoteryx^® Mitra Microsample Collection Kits from Trajan Scientific and Medical to allow families to collect blood samples at home to assess tacrolimus and creatinine levels. Patients and families received the collection kit from their care providers at the hospital. They used the Mitra^® microsampling devices in the kit to perform finger-stick blood sampling at home, and then returned the blood samples by mail for analysis in the lab.

The at-home Microsample Collection Kits provided 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 the exposure to contagions in facilities, especially during pandemics, such as the COVID-19 outbreak.

How to Use the At-Home Mitra Microsample 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. If you don't get blood flow, you can massage the finger towards tip.
4. Touch the tip of the Mitra samplers in the device to the drop of blood and watch them absorb the blood like a sponge.
5. Ensure the sampling tip of the device is positioned over your fingertip, pointing downward to avoid under or over-sampling.
6. Write the time and date of the sample taken.
7. After all blood samples are collected, close the Mitra device and place it back inside the silver foil specimen bag that it came in.

Return the sample to the lab by placing the sealed specimen bag into the included envelope and drop 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 instructions in the kit to collect the sample. You can also follow the sampling videos you find on our website here.
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 often find it less traumatic.
3. Low cost – With finger-stick blood collection, parents don’t have to pull their kids out of school and travel to the clinic or take time off work as often.
4. Successful test sample collection – Finger-stick blood collection using the Mitra device has a higher success rate because users can easily make multiple attempts to collect the required amount of blood.
   
   
   
   
   Image Credits: iStock images, Trajan