Therapeutic Phlebotomy

Therapeutic phlebotomy removes blood to treat conditions that involve having too many red blood cells or too much iron in your body. Too many red blood cells can make your blood too thick. This can lead to harmful clots, heart attacks and strokes. Too much iron (a key ingredient in red blood cells) can damage organs like your heart, liver and pancreas.

Healthcare providers mostly use phlebotomy to treat:

• Polycythemia vera: With this blood disorder, your body makes too many red blood cells. Providers remove blood so that your percentage of red blood cells (hematocrit) is below 45%. You may need other treatments to reduce your risk of blood clots.
• Hereditary hemochromatosis: With this genetic condition, your body stores too much iron and deposits it into important organs like your heart and liver. Providers do genetic tests to confirm the diagnosis and then measure your iron levels using a ferritin test.

Another name for therapeutic phlebotomy is venesection. It’s the modern form of an ancient practice called bloodletting. Centuries ago, doctors would open a vein or use leeches to draw out blood from a sick patient. Doing this, they thought, helped balance the body’s “humors”: blood, phlegm and bile. Bloodletting was mistaken as a cure-all for all kinds of illnesses.

Today, we know better. Now, blood removal is only used in select conditions to manage symptoms or prevent life-threatening complications. It’s a controlled process that’s as painless as giving blood.

What happens during a therapeutic phlebotomy?

The procedure is the same as donating blood. You may get it done at a blood bank, hospital, infusion center or your doctor’s office. You may be seated or lying down during the procedure. It goes like this:

1. A healthcare provider will clean the area where they’ll draw blood (usually your forearm).
2. They’ll use a needle to insert an attached thin tube, which is connected to a collection bag.
3. They may ask you to make a fist, relaxing and squeezing periodically, to help blood flow.
4. The blood will flow through the tube and into the bag.
5. Your provider will remove the tube, place pressure on the injection site to stop the bleeding and bandage the area.

Providers usually remove one unit of blood per session. This is the same as a pint (450 to 500 milliliters). They may remove more or less blood. Much depends on your health and how often you’ll come back for more sessions.

The procedure may take as little as 15 minutes or up to an hour.

How long will I need this treatment?

It depends on your condition. You may need lots of sessions at first to get your red blood cells or iron to safe levels. Visits may be as frequent as daily or as spread out as monthly. Afterward, many people need maintenance phlebotomies to keep their values in a target range. You may only need treatment every few months or so.

Your provider will use tests to monitor your red blood cells and iron levels closely. Your treatment schedule depends on your test results.

How long will it take for me to feel better?

It’s normal to feel dizzy, weak or a little lightheaded after having your blood drawn. This is why it’s important to rest afterward. A healthcare provider will give you a snack and something to drink to help your body recover. You should start to feel better within the first 15 minutes or so.

They’ll check your blood pressure and make sure you feel OK before they clear you to leave.

You should start to feel better as your body makes more plasma (the liquid part of blood). It only takes a few days for your plasma to replenish, especially if you drink a lot of fluids. It takes about a month or two for your red blood cells to recover. Your body will use its iron stores to make more red blood cells.

Is there anything I can do to make this treatment easier on me?

Let your healthcare provider know if you’re afraid of needles. They can talk you through the procedure or provide distractions that help the time go by.

Keep in mind, though, that the only pain is usually a quick sting when the needle goes in. It may help to look away if the thought of this makes you nervous.

Go easy on yourself the rest of the day as your body recovers. Avoid vigorous activity, like heavy exercise, for the next few days, and rest when your body needs it. Also, drink plenty of water to help replenish your plasma. Avoid alcohol, which leads to dehydration.

When should I call my healthcare provider?

After your treatment session, call your provider if you have:

• Signs of infection, like warmth, swelling or redness at the IV site
• Signs of very low blood pressure, like feeling as if you could pass out

Pay attention to what your provider tells you before you leave. They’ll explain which symptoms are normal and which signal a problem you should let them know about.

What is the difference between phlebotomy and therapeutic phlebotomy?

A phlebotomy is a blood draw. It can be done for all types of reasons. Usually, it happens so healthcare providers can do blood tests to check for signs of disease. A therapeutic phlebotomy is a much larger blood removal used as a treatment.

Is donating blood the same as therapeutic phlebotomy?

The process is basically the same, but the purposes are different. When you donate blood, you’re making it available for others who need it. The main benefit for you is the feeling that you’re doing good for others. With therapeutic phlebotomy, you get the direct benefit of blood removal as a treatment.