As most of you would have done, you would have dissected the word and noted the “phobia” part of the term. Yes, it is a fear of something. But before I say what it is, allow me to tell you how I came upon this word.

On a busy day at the infusion center, I was assigned several new patients. One of them was a lady in her mid thirties requiring an infusion of a biologic agent for rheumatoid arthritis (RA). Except for her RA, this lady was fairly healthy and didnt appear to be anxious at all even after we went over some key points about her new infusion treatment plan and went through a nursing assessment. She had no questions and settled into her infusion chair. I went to get my supplies and returned to start her peripheral IV. No problems starting her IV and while I was busy connecting the  IV tubing and starting the infusion pump, this lady bent over and head first, fell out of the chair. Thump!! She passed out!

With the help of a co-worker, we assisted her back in the chair. The patient was conscious, pale, cold and clammy. Her pulse was rapid, breathing was not labored, BP was low at 90/60. (initial BP was 130/80. Patient was anxious but denied any chest pain,headaches  or any other pain. She did not require any oxygen and we started a rapid infusion of 0.9% Normal Saline as ordered by her doctor.

Trypanophobia – is the fear of injections or needle sticks. It is also known as belenophobia, blenophobia and needle-phobia. These are referred to as “Specific Phobia, Blood Injection Injury Type”, recognized in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR). Trypanophobia can result in significant vasovagal responses or avoidance of important of medical procedures. Persons with this phobia feel anxiety almost immediately upon confronting the phobic stimulus. The intensity of the reaction varies and can differ with each exposure to the phobic stimulus.

Now back to my patient…she fully recovered after a liter of NS and completed her infusion treatment. As she felt better, she began to tell me of her past experience with traumatic blood draws as a child. She also said she suffered through multiple allergy testings and have always had vasovagal response to any needlesticks!! Wow, how did I miss that during my assessment??

Good question…how did I miss this important information during my assessment? Does any one routinely ask patients if they have “trypanophobia”? Do patients with these phobia volunteer this information? This patient did not have any overt signs of anxiety even after I showed her the medication guide which clearly showed she was about to get an IV stick. These phobias are common but not well recognized. Perhaps, in many infusion centers, the question should be asked.

What’s next for the patient? She will be back in another month for her next infusion. Our plan of treatment now includes giving her  “Valium” and more topical anesthetic to her IV site prior to venipuncture.