Table of ContentsView AllTable of ContentsConditions TreatedHow It Is DoneManaging Side Effects
Table of ContentsView All
View All
Table of Contents
Conditions Treated
How It Is Done
Managing Side Effects
Therapeutic phlebotomyis a medical procedure in which blood is removed from the body to treat certain blood disorders likepolycythemia veraorhemochromatosis. It may be performed at a hospital or clinic.
The procedure reduces an excessively high number ofred blood cellsor excessively high levels of iron in the blood. Once these levels are normalized, the treatment may be given less frequently and sometimes stopped.
Although therapeutic phlebotomy is sometimes referred to as “blood-letting,” it is done for highly specific reasons rather than the generalized use of the centuries-old practice thought to cure illnesses up until the late 19th century.
This article describes what conditions therapeutic phlebotomy treats, how it works, and what to expect during treatment.
Benefits of Therapeutic Phlebotomy
There are five conditions for which therapeutic phlebotomy is commonly used:
Polycythemia Vera (PV)
Polycythemia vera (PV)is a rare blood cancer that causes your bone marrow to produce too many red blood cells. This can cause your blood to thicken and clot excessively. The clotting, in turn, can lead to a heart attack and stroke.
In adults with PV, 250 to 500 cubic centimeters (roughly 1 to 2 cups) of blood are removed daily or every other day until your HCT is between 0.4 and 0.45 (40% and 45%). Once normalized, your HCT will be retested every four to eight weeks.
Hereditary Hemochromatosis
Hereditary hemochromatosis is a genetic disorder that causes the excess absorption of iron in your intestine from the foods you eat. This can lead to iron overload, causing damage to your brain, heart, liver, and pancreas as iron starts to accumulate.
Hereditary hemochromatosis is most common in people of Northern European ancestry, most especially those of Celtic descent.
Therapeutic phlebotomy is a major part of the treatment, used to remove the excess iron before it can do any harm. Aferritin blood testmeasures blood iron levels in micrograms per liter of blood (μg/L ).
Therapeutic hemochromatosis is usually done once weekly or every two weeks until ferritin levels are 50 μg/L or less. Thereafter, ferritin levels are regularly monitored. The treatment can be repeated if necessary.
Acquired Hemochromatosis
Causes of secondary hemochromatosis include:
The treatment for acquired hemochromatosis is largely the same as for hereditary hemochromatosis.Chelation therapy(using drugs that bind to iron and remove it from tissues) may also be used.
Porphyria Cutanea Tarda (PCT)
Porphyria cutanea tarda(PTC)is a rare blood disorder that causes your skin to blister when exposed to sunlight. PCT occurs when porphyrin—a chemical in your body that is transformed intohemoglobin—builds up in your blood.
For PCT, therapeutic phlebotomy involves the removal of around 500 cubic centimeters (cc) of blood per day or every other day for a total of five to eight treatments. The aim is to reduce porphyrin to undetectable levels in blood and urine tests.
Kidney Transplant
PTE affects 10% to 15% of kidney recipients and usually develops eight to 24 months after the transplant. While HCT levels will normalize in 25% of people within two years, the other 75% may have persistently high counts which can increase the risk oforgan rejection.
In cases like this, therapeutic phlebotomy is used to help prevent organ rejection. The procedure and goals are largely the same as for polycythemia vera, with the aim of reducing HCT to normal levels.
How Therapeutic Phlebotomy Is Done
Therapeutic phlebotomy can be performed at a blood donor center, physician’s office, or a specializedapheresisunit at a hospital or dedicated facility.
Depending on how much blood is taken, the procedure can take an hour or less. Therapeutic phlebotomy is typically performed over several sessions. In between, blood tests are performed to see if levels have normalized.
Therapeutic phlebotomy may be performed daily or every other day for acute treatment. Maintenance treatments may be performed weekly, monthly, quarterly, or as needed depending on your blood results. Some cases, like acquired hemochromatosis, may not require follow-up treatments.
The procedure itself is more or less the same irrespective of the disease involved:
Tips to Manage Therapeutic Phlebotomy
It is not uncommon after therapeutic phlebotomy to feel lightheaded or dizzy due to the loss of blood. Nausea, vomiting, and bruising are not uncommon.
To better manage the side effects of therapeutic phlebotomy, the phlebotomist will advise you to:
Call your healthcare provider immediately if you experience a high fever or the bleeding won’t stop.
Summary
Therapeutic phlebotomy involves the removal of blood for blood to treat or manage conditions like polycythemia vera (PV), hereditary hemochromatosis, acquired hemochromatosis, porphyria cutanea tarda (PCT), and post-transplant erythrocytosis (PTE).
Blood is removed over several sessions when red blood cells or iron levels are dangerously high. The treatment will stop once levels are normalized, although maintenance treatments may be needed to keep the values within the expected range.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Thomas DP.The demise of bloodletting.J R Coll Physicians Edinb,2014;44(1):72-7. doi:10.4997/JRCPE.2014.117MedlinePlus.Polycythemia vera.Triguero A, Pedraza A, Perez-Encinas M, et al.Low-risk polycythemia vera treated with phlebotomies: clinical characteristics, hematologic control and complications in 453 patients from the Spanish Registry of Polycythemia Vera.Ann Hematol.2022;101(10):2231–2239. doi:10.1007/s00277-022-04963-zKane SF, Roberts C, Paulus R.Hereditary hemochromatosis: rapid evidence review.Am Fam Physician.2021;104(3):263-270.Kontoghiorghes GJ.Iron load toxicity in medicine: from molecular and cellular aspects to clinical implications.Int J Mol Sci. 2023;24(16):12928. doi:10.3390/ijms241612928National Organization for Rare Disorders.Porphyria cutanea tarda.Duan Y, Ni C, Huang L.Porphyria cutanea tarda treated with short-term high-dose hydroxychloroquine: a case report.AME Case Rep.2022 Apr 25:6:19. doi:10.21037/acr-21-77Alzoubi B, Kharei A, Machhi R, Aziz F, Swanson KJ, Parajuli S.Post-transplant erythrocytosis after kidney transplantation: a review.World J Transplant. 2021 Jun 18;11(6):220-230. doi:10.5500/wjt.v11.i6.220
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Thomas DP.The demise of bloodletting.J R Coll Physicians Edinb,2014;44(1):72-7. doi:10.4997/JRCPE.2014.117MedlinePlus.Polycythemia vera.Triguero A, Pedraza A, Perez-Encinas M, et al.Low-risk polycythemia vera treated with phlebotomies: clinical characteristics, hematologic control and complications in 453 patients from the Spanish Registry of Polycythemia Vera.Ann Hematol.2022;101(10):2231–2239. doi:10.1007/s00277-022-04963-zKane SF, Roberts C, Paulus R.Hereditary hemochromatosis: rapid evidence review.Am Fam Physician.2021;104(3):263-270.Kontoghiorghes GJ.Iron load toxicity in medicine: from molecular and cellular aspects to clinical implications.Int J Mol Sci. 2023;24(16):12928. doi:10.3390/ijms241612928National Organization for Rare Disorders.Porphyria cutanea tarda.Duan Y, Ni C, Huang L.Porphyria cutanea tarda treated with short-term high-dose hydroxychloroquine: a case report.AME Case Rep.2022 Apr 25:6:19. doi:10.21037/acr-21-77Alzoubi B, Kharei A, Machhi R, Aziz F, Swanson KJ, Parajuli S.Post-transplant erythrocytosis after kidney transplantation: a review.World J Transplant. 2021 Jun 18;11(6):220-230. doi:10.5500/wjt.v11.i6.220
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Thomas DP.The demise of bloodletting.J R Coll Physicians Edinb,2014;44(1):72-7. doi:10.4997/JRCPE.2014.117MedlinePlus.Polycythemia vera.Triguero A, Pedraza A, Perez-Encinas M, et al.Low-risk polycythemia vera treated with phlebotomies: clinical characteristics, hematologic control and complications in 453 patients from the Spanish Registry of Polycythemia Vera.Ann Hematol.2022;101(10):2231–2239. doi:10.1007/s00277-022-04963-zKane SF, Roberts C, Paulus R.Hereditary hemochromatosis: rapid evidence review.Am Fam Physician.2021;104(3):263-270.Kontoghiorghes GJ.Iron load toxicity in medicine: from molecular and cellular aspects to clinical implications.Int J Mol Sci. 2023;24(16):12928. doi:10.3390/ijms241612928National Organization for Rare Disorders.Porphyria cutanea tarda.Duan Y, Ni C, Huang L.Porphyria cutanea tarda treated with short-term high-dose hydroxychloroquine: a case report.AME Case Rep.2022 Apr 25:6:19. doi:10.21037/acr-21-77Alzoubi B, Kharei A, Machhi R, Aziz F, Swanson KJ, Parajuli S.Post-transplant erythrocytosis after kidney transplantation: a review.World J Transplant. 2021 Jun 18;11(6):220-230. doi:10.5500/wjt.v11.i6.220
Thomas DP.The demise of bloodletting.J R Coll Physicians Edinb,2014;44(1):72-7. doi:10.4997/JRCPE.2014.117
MedlinePlus.Polycythemia vera.
Triguero A, Pedraza A, Perez-Encinas M, et al.Low-risk polycythemia vera treated with phlebotomies: clinical characteristics, hematologic control and complications in 453 patients from the Spanish Registry of Polycythemia Vera.Ann Hematol.2022;101(10):2231–2239. doi:10.1007/s00277-022-04963-z
Kane SF, Roberts C, Paulus R.Hereditary hemochromatosis: rapid evidence review.Am Fam Physician.2021;104(3):263-270.
Kontoghiorghes GJ.Iron load toxicity in medicine: from molecular and cellular aspects to clinical implications.Int J Mol Sci. 2023;24(16):12928. doi:10.3390/ijms241612928
National Organization for Rare Disorders.Porphyria cutanea tarda.
Duan Y, Ni C, Huang L.Porphyria cutanea tarda treated with short-term high-dose hydroxychloroquine: a case report.AME Case Rep.2022 Apr 25:6:19. doi:10.21037/acr-21-77
Alzoubi B, Kharei A, Machhi R, Aziz F, Swanson KJ, Parajuli S.Post-transplant erythrocytosis after kidney transplantation: a review.World J Transplant. 2021 Jun 18;11(6):220-230. doi:10.5500/wjt.v11.i6.220
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