Therapeutic phlebotomy

This chapter focuses on therapeutic phlebotomy which involves the therapeutic removal of whole blood, in order to decrease abnormally elevated iron stores or red blood cell (RBC) mass. In patients with erythrocytosis, phlebotomy decreases the blood viscosity and improves cardiac hemodynamics, which improves oxygen delivery and decrease the risk of thrombosis. The removal of circulating erythrocytes leads to decreased total body iron and mitigate the adverse effects of iron toxicity, such as liver, cardiac and endocrine gland dysfunction. Therapeutic phlebotomy is indicated for treatment of hereditary hemochromatosism, which is the most common cause of iron overload. The typical regimen of therapeutic phlebotomy is once per week until iron stores are depleted and the every 3-4 months to maintain normal ferritin levels. Some of the adverse effects of therapeutic phlebotomy include vasovagal reactions and infection, bruising or hematoma formation at the site of venipuncture and some patients may have symptoms of hypovolemia.

Duke Scholars

Author Beth H. Shaz Pathology