According to an article entitled Clinical Applications of Therapeutic Phlebotomy at www.ncbi.nlm.nih.gov, phlebotomy is the removal of blood from the body. Meanwhile, therapeutic phlebotomy is the preferred treatment for blood disorder in which the removal of red blood cells or serum iron is the most efficient method for managing the symptoms and complications. On that article, it is also explain that now therapeutic phlebotomy is indicated for the treatment of polycythemia vera, hemochromatosis, sickle cell disease, porphyria cutanea tarda, and nonalcoholic fatty lives disease with hyperferritinemia.
On that article, it is also explained that several thousand years ago, phlebotomy was used for preventive and curative treatments and now in modern medicine, phlebotomy is done in physician’s office, at a blood bank, or under the supervision of a doctor in a hospital and it is only done with a prescription that specifies the clinical indication and the required number of bloodlettings.
So, ho much blood is removed in a therapeutic phlebotomy procedures? As explained on the article entitled Clinical Applications of Therapeutic Phlebotomy at www.ncbi.nlm.nih.gov, a half of unit (250 mL) of blood is able to be removed during each session for patient with a small body mass, anemia, or cardiac or pulmonary disorders and each unit of blood (500 mL) usually represents the removal of 200 to 250 mg of iron depending on the Hb levels.
In that article, it is also explained that a prescription from a doctor is required for therapeutic phlebotomy because it is a medical intervention and this prescription should indicate the frequency of the procedures of phlebotomy and the target blood volume. It is also explained that the factors of patients such as weight, sex, age, overall health status, comorbidities, and the likelihood of compliance should be considered when prescribing a phlebotomy regimen.
At the Verywell Health site, it is explained that phlebotomy is a simple procedure and you can do that in a physician’s office, hospital or at a blood donation center. It is the same as donating blood. In the process, a needle will be put in a large blood vessel, usually in the elbow crease, to remove blood. A bag or syringes may be used to collect blood. Furthermore, on that site, it is also explained that in adults, a pint of blood (450 to 500 mL) is removed at a time. The frequency of phlebotomy varies based on your medical condition and the values of the laboratory.
On the Verywell Health site, it is explained that for PV, phlebotomy is done once or twice a week until the hematocrit is near normal. Then, phlebotomy is done every few months where it is done to keep the hematocrit near normal. Furthermore, it is explained that in hereditary hemochromatosis, phlebotomies may be weekly until the ferritin is normal. Phlebotomy is done every two to four months to prevent iron levels from building up again. In PCT, it is also explained that phlebotomy is done every two weeks for three to four months and discontinued.
Side Effects of Phlebotomy
According to the Verywell Health site, the main side effects of phlebotomy are related to the change in the volume of blood. The thing that you may feel is probably dizziness or low blood pressure afterward but others tolerate it without issues. So, after blood donation the technician asks you to sit up slowly before you stand. After that, you need to drink a lot of water. If you feel that the symptoms persist or cannot be tolerated after the blood is removed, saline fluid is able to be given via the IV to replace the volume removed.
Instructions After Your Therapeutic Phlebotomy Procedure
According to an article at Memorial Sloan Kettering Cancer Center site entitled Instructions After Your Therapeutic Phlebotomy Procedure, here are the instructions after your procedure.
- You have to leave the pressure bandage on your needle site for 3 to 6 hours after your procedure.
- You have to avoid activities that may strain the arm which is used during your procedure such as heavy lifting and exercise for at least 1 day after your procedure.
It is also explained in that article that you may feel dizzy or lightheaded after your therapeutic phlebotomy procedure. Here are the things that you are able to do to help keep it from happening.
- You are able to drink more liquids than usual for 1 to 2 days after your procedure. You have to try to drink at least 8 to 10 glasses each day.
- You have to avoid alcohol and drinks which contain caffeine such as tea, cola and coffee for the rest of the day after your procedure.
- You have to avoid strenuous exercise such as jogging for 1 day after your procedure.
- Make sure that you do not smoke for at least 1 hour after your procedure.
- You have to make sure that you do not take a hot bath for the rest of the day after your procedure.
Let’s say that you feel light headed or dizzy. If so, you have to sit down and place your head between your knees. Also, you are able to lie down flat and raise your feet and legs slightly. You are able to rest them on a couple of pillows.
How to Care for Your Needle Site
After the phlebotomy process, at your needle site, you may have discomfort, swelling, bleeding or bruising. To help with these side effects you can follow the guidelines below according to the Memorial Sloan Kettering Cancer Center site.
- Managing discomfort
You can manage your discomfort by holding ice or a cool pack over the site for 10 to 15 minutes and then take it off for 10 to 15 minutes and then repeat it as needed.
- Managing bleeding
You can raise your arm above your head and apply pressure with your other hand for 5 minutes or longer. You can also cover the site with bandage or put the pressure bandage back on the site if needed.
- Managing swelling
You can raise your arm above your head and apply pressure for 3 to 5 minutes. You can also hold ice or a cold pack over the site for 10 to 15 minutes and then take it off for 10 to 15 minutes and repeat it as needed.
- Managing bruising
To help the bruising fade, you can hold ice or a cold pack over the site for 10 to 15 minutes and then take it off for 10 to 15 minutes and repeat it as needed.