Therapeutic Phlebotomy

Blood analysis is one of the best diagnostic tools available. It allows the Physician to determine a patients’ illness or disease, as well as the severity of that disease. Doctors use blood tests to routinely screen their patient’s cholesterol, glucose (sugar) and thyroid levels. Blood analysis is used by the emergency department to help determine if a patient is having a heart attack. You may even have your blood drawn by a Phlebotomist while applying for a job. But did you know that phlebotomy can fight disease?

Therapeutic Phlebotomy is not what you may traditionally think about blood collection. While ‘traditional’ phlebotomy, the drawing of your blood, places the importance on the blood results themselves, therapeutic phlebotomy is the act of drawing blood to treat disease. This treatment is used for diseases such as PCT.

Prophyria Cutanea Tarda, or PCT is a disease caused by a deficiency of an enzyme, uroporphyrinogen, or UROD in the liver. There is not an exact cause known for why some people have this deficiency in their liver while others don’t. It is believed PCT is inherent; around 20% of sufferers have the deficiency of UROD that can contribute to later development of PCT. This disease causes blisters on areas of the skin that are touched by the sun, such as the face, hands and arms. The patients’ skin can become fragile, and even a slight bump can cause a layer of this skin to peel away. The formed blisters can peel and re-blister. PCT also causes the skin of sufferers to get darker and thicker, scarred skin. Some patients even have an increase in their facial hair growth. Affecting more men than women, PCT can cause liver damage and even liver cancer. There are many factors that play a role in PCT such as alcohol and hepatitis C; however, the most important factor is iron levels in the liver. By removing iron from the sufferer’s body, PCT always leads to a remission. The treatment for this disease is therapeutic phlebotomy.

Iron is found in many of the foods we eat. Too much iron can be devastating for the body. Too much iron is, in essence, poison and is toxic to your organs. In Hemochromatosis, too much iron buildup, your organs such as your liver, can begin to malfunction. Your liver can become enlarged. Scarring (cirrhosis) can then occur, preventing your liver from working properly. Liver cancer can develop. Along with affecting the liver, toxic build up of iron can occur in your pancreas and heart. Hepatitis B and C can also cause iron to build up in the body.

If the toxic levels of iron in the body are not treated, organs can begin to fail. The heart may begin to beat abnormally, known as arrhythmias. If the dangerously high levels of iron are not treated, it can result in death. The treatment for PCT, and high iron levels, is therapeutic phlebotomy.

Polycythemia Vera (PV) is a disease that causes your body to produce too many red blood cells (hemacrit). This causes the blood to become “thick” and can increase the chance of clots. Blood clots can cause strokes. Sufferers from this disease become short of breath, tired and dizzy. They may get many painful headaches, flushed skin, and feel burning in their hands and feet. PV starts in the body’s bone marrow, where blood cells are made. While there isn’t one specific ‘cure-all’ for this disease, one treatment used is therapeutic phlebotomy. This allows the amount of red blood cells to be kept at a therapeutic level and lowers the risk of blood clots.

Pulmonary edema is the buildup of fluid around the lungs. It can be caused from heart disease, smoking or kidney failure. Sufferers of pulmonary edema also benefit from therapeutic phlebotomy which lowers their total blood volume.

So what is therapeutic phlebotomy? Unlike drawing blood to test it for disease, this type of phlebotomy is the drawing of blood to treat a disease. Patients are given scheduled phlebotomy sessions where blood is removed to reduce levels. For those diagnosed with PV,  too many red blood cells, by removing blood this treatment keeps their blood levels within normal range. In PCT, therapeutic phlebotomy not only reduces iron (ferritin) levels in the liver, it also reduces iron that is stored throughout the patients’ body as well.

Therapeutic phlebotomy is ordered by the physician. Many factors are taken into account to determine how many phlebotomy sessions the patient should have, how often they should occur, and how much blood should be removed. The average amount of blood drawn is usually one unit (500 mL) per session. This amount is more than is taken during blood donation. Before and during therapeutic phlebotomy treatment, the patient’s blood levels are carefully watched. For sufferers of PCT, the average treatment calls for one pint (unit) of blood to be removed every one or two weeks. This removes 250 mg of iron. For patients who have PCT, after several therapeutic phlebotomy sessions iron levels in their body have usually been lowered and the iron has been removed from their liver. An average of five to six total pints of blood is removed. However, these phlebotomy sessions are required until the iron levels remain consistently normal. This may take up to several years for some patients. For those who have PV, which causes too many red blood cells, the goal is to keep the patients’ hematocrit levels below 45%.

The human body has about 9-12 pints of blood. With removing so much blood, you may think therapeutic phlebotomy could cause anemia (not enough healthy blood cells.) but it doesn’t.  Only one pint of blood is usually removed, comparable to blood donation. After each phlebotomy session, the patient is asked to rest and is given fluids. The patient does not develop anemia because new red blood cells are produced by the body’s bone marrow. Within twenty-four hours of the phlebotomy session, the patient has replaced the fluid that was removed. Red blood cells are replaced in four to eight weeks.

Therapeutic phlebotomy has many advantages. Compared to other forms of treatment, it is relatively inexpensive. Each session takes a short period of time, around forty-five minutes. Risks are low, and include bruising at the needle puncture site, localized infection and dizziness. For patients suffering from disease, therapeutic phlebotomy can be a life-saving treatment that prevents dangerous buildup of levels that can ravage their bodies.


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