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 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.
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.