What Is Therapeutic Phlebotomy?

Therapeutic phlebotomy is having your blood drawn by a phlebotomist for the purpose of the treatment of a disease. Most common cases involve iron overload disease such as hemochromatosis. Clinical policies for therapeutic phlebotomy may differ from carrier to carrier. Below is a list of the medically necessary indications:

  • Hemochromatosis (Hereditary included)
  • Sickle Cell Crisis
  • Porphyria cutanea tarda
  • Polycythemia vera
  • Polycythemia secondary to arterio-venous (A-V) fistulae
  • Polycythemia secondary to cor pulmonale
  • Polycythemia secondary to cyanotic congenital heart disease

How Much Blood is Drawn?

Therapeutic Phlebotomy

Therapeutic phlebotomy is a controlled removal of blood in large volumes. Usually about a pint of blood is drawn from a therapeutic phlebotomy patient. This is done to remove volume and excess iron, blood volume and red cell mass from body. Please make sure the procedure is done by a certified phlebotomist or someone who has gone through a phlebotomy certification process.

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What is a Typical Procedure for Therapeutic Phlebotomy?

  • Position the blood pressure cuff on the arm of the patient making sure to avoid dragging the tubing on the venipuncture site
  • Inflate the cuff and palpate the vein then deflate cuff
  • Place a towel under the patient’s arm and over the blood pressure cuff covering the cuff, the patient’s upper arm and the patient’s shoulder.
  • Prepare the venipuncture site on patient’s arm with alcohol swab or betadine scrub.
  • Get transfer pack and connect needle
  • Place hemostat on the needle line
  • Inflate the blood pressure cuff, perform the venipuncture and secure needle with medical tape
  • Remove hemostat and allow the blood to flow in to the transfer pack
  • The blood collection rate should be what the patient can tolerate, in a lot of cases it is about 10 to 15 minutes
  • Observe patient for adverse reactions and give fluids during and or immediately after procedure
  • Once desired volume has been drawn, place hemostat on transfer pack tube and close clamp on the needle line. Deflate blood pressure cuff and remove needle
  • Apply constant pressure on venipuncture site on patient with gauze until bleeding has commenced.
  • Remove needle from transfer pack and place needle in bio-hazard container and place the bag in to the bio-hazard trash container

Patients can have therapeutic phlebotomy procedures done using 8-9 60 CC syringes which are roughly equal to a 500 ml unit of blood.

Is Blood Donation an Option for a Patient with Hemochromatosis?

Patients with hereditary hemochromatosis are able to donate blood. Not often can one do something good for society as a whole and for them physically. Other diseases that require therapeutic phlebotomy do not allow for the patients to donate blood.

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