Therapeutic Phlebotomy

Therapeutic Phlebotomy: Controlled Blood Removal as Treatment

Therapeutic Phlebotomy
Therapeutic phlebotomy, often simply termed as "bloodletting," has been practiced for centuries, dating back to ancient civilizations like the Egyptians and Greeks. They believed that removing blood from the body could rid it of evil spirits or balance out the four humors: blood, phlegm, black bile, and yellow bile. While modern medicine has debunked these ancient theories, controlled blood removal remains a medically approved treatment for specific conditions. One such condition is polycythemia vera, but there are several others where therapeutic phlebotomy has proven beneficial.

 Therapeutic Phlebotomy Procedure

Undergoing therapeutic phlebotomy is similar to giving blood at a blood donation center. The patient is comfortably seated, and a large needle is inserted into a vein, typically in the arm. Blood is then drawn into a bag. The entire process can last anywhere from 30 minutes to an hour, depending on the volume of blood being removed.

It's essential to drink plenty of fluids before and after the procedure to help replace the lost volume and prevent feelings of dizziness or lightheadedness.

Patient Experiences

Patients undergoing therapeutic phlebotomy often report a range of experiences. Some feel revitalized, while others might feel tired immediately after the procedure. Temporary dizziness or lightheadedness is not uncommon. For those with conditions like hemochromatosis, they often report feeling 'lighter' and less fatigued as excess iron is removed from their system. Over time, with regular phlebotomies, symptoms related to their underlying condition, such as joint pain in hemochromatosis or itching in polycythemia vera, often diminish.

Risks and Side Effects of Therapeutic Phlebotomy

As with any medical procedure, there are potential risks involved. These can include:

  • Bruising at the needle site
  • Infection, although this is rare if proper aseptic techniques are used
  • Feeling faint or dizzy
  • Hematoma (a collection of blood outside of blood vessels)

It's also worth noting that over time, veins can become scarred or harder to access. In such cases, a phlebotomist or healthcare provider might choose a different site or vein for blood removal.

Polycythemia Vera (PV)

Polycythemia vera is a rare type of blood cancer where the bone marrow produces too many red blood cells. This overproduction thickens the blood, slowing its flow and increasing the risk of clots. These clots can lead to severe complications such as heart attacks or strokes. By regularly removing a specific volume of blood, therapeutic phlebotomy reduces the number of circulating red blood cells. This procedure brings the hematocrit closer to normal levels, reducing the associated risks. Patients might require frequent phlebotomies initially, with the frequency tapering off as the condition stabilizes.


Hemochromatosis is a genetic disorder causing the body to absorb too much iron from food. Over time, this excess iron accumulates in organs, particularly the liver, heart, and pancreas, leading to complications such as liver disease, heart problems, or diabetes. Through therapeutic phlebotomy, blood is removed regularly to decrease the body's iron levels. Blood may be removed weekly until iron levels normalize, and maintenance sessions might follow every 2-4 months.

Porphyria Cutanea Tarda (PCT)

PCT, the most common type of porphyria, arises from a deficiency of the enzyme uroporphyrinogen decarboxylase. Patients exhibit symptoms like blisters on sun-exposed skin, excessive hair growth, and liver abnormalities. Elevated liver iron stores often accompany PCT, and iron plays a role in its manifestation. Therapeutic phlebotomy serves to reduce these iron stores, subsequently decreasing porphyrin levels in the liver and mitigating symptoms.

Secondary Polycythemia

Beyond the primary polycythemia vera, there's secondary polycythemia, where red blood cell overproduction results from external factors, such as chronic hypoxia or tumors secreting erythropoietin. Therapeutic phlebotomy can address the excessive red blood cells, offering symptomatic relief and reducing potential complications.

Patient Monitoring and Individualized Care

For those undergoing therapeutic phlebotomy, regular monitoring is crucial. It ensures that optimal hematocrit or iron levels are maintained and complications are avoided. Factors like the patient's age, overall health, and the underlying condition dictate the frequency and volume of blood removal. Regular blood tests and clinical assessments guide adjustments in the phlebotomy regimen, ensuring each patient receives care tailored to their unique needs.