Comparison of hemolysis in blood samples collected using an automatic incision device and a manual lance

Objective: To evaluate the magnitude of hemolysis in blood specimens collected from the heels of newborns using an automated blood collection device that uses a spring-loaded lance with blood collected using a manual lance. Design: A randomized controlled trial involving 134 newborns assigned to have blood collected using either an automated blood collection device or a manual lance. A single experienced individual performed all blood collections. Serum hemoglobin concentrations were measured in all samples to gauge the extent of hemolysis. Setting: A neonatology unit in a 740-bed tertiary care teaching hospital. Patients: Healthy newborns with gestational ages ranging from 33 weeks to 41 weeks. Blood samples were collected from study participants at between 7 and 126 hours postpartum. Group I consisted of 66 individuals who had blood collected using the manual lance. Group 2 contained 68 individuals with blood collected using a spring-loaded automatic lance. Main Outcome Measure: Plasma hemoglobin content as an indicator of the extent of hemolysis. Results: There were no significant differences between newborns in groups I and 2 with respect to gestational age, birth weight, or time interval between birth and time of blood collection. We found a highly significant difference with respect to plasma hemoglobin concentrations in specimens collected with an automated lance (hemoglobin, 2.35 g/L) vs that collected using the hand-held lance (hemoglobin, 4.85 g/L). Conclusion: Use of an automated spring-loaded lance allows for the collection of blood specimens with smaller levels of plasma hemoglobin.