What is Therapeutic Phlebotomy?

Although many individuals are familiar with term phlebotomy, as it is a common and routine procedure for diagnostic testing, many individuals are unfamiliar with the term therapeutic phlebotomy.

In some ways, therapeutic phlebotomy is similar to a routine phlebotomy procedure in that it also involves the withdrawal of blood and the use of similar equipment such as needles and sterilization tools.

Therapeutic phlebotomy, however, is different in that the procedure involves slightly different steps and the process of collecting blood is for the purpose of treating diseases and not diagnosing diseases.

Blood Disorders and Therapeutic Phlebotomy

Individuals who may be in need of therapeutic phlebotomy are those who were previously diagnosed with various forms of blood related disorders. In such cases, therapeutic phlebotomy is medically necessary to remove volumes of blood with the intention of decreasing an individuals blood level. Additionally, it will relieve the body of excessive red cell mass and iron. This blood collection process usually involves the removable of a single pint of blood.

Individuals in need of therapeutic phlebotomy may have one or more of the following blood disorders:

• Hemochomatosis: Excessive iron in the blood.
• Sickle Cell Crisis: Rigid and abnormally shaped red blood cells. It restricts blood flow.
• Porphyria cutanea tarda: A photosensitive skin disease.
• Polycythemia vera: An excessive level of red blood cells. It causes blood to thicken.
• Polycythemia secondary to cyanotic congenital heart disease: Related to an increase in the number of red blood cells and the lack of blood flow.
• Number of red blood cells and a respiratory disorder.
• Polycythemia secondary to arterio-venous fistulae: An increase in the number of red blood cells and an abnormal passageway between an artery and a vein.

A Therapeutic Phlebotomy Procedure

1. A blood pressure cuff is used as a tourniquet in order to increase the blood flow into the the median cubital vein. This is possible once the blood pressure cuff is inflated.
2. The vein is palpated to ensure its visibility and location.
3. Once the vein of interest is located, the blood pressure cuff is deflated.
4. A towel is placed under the patient’s arm and is used to cover the forearm, blood pressure cuff and the patient’s shoulder.
5. The venipuncture site is sterilized with an antiseptic such as an alcohol swab or a betadine scrub.
6. A transfer pack is connected to the needle of choice.
7. A hemostat should be connected to the needle line to prevent the flow of blood.
8. Inflate the blood pressure cuff once again.
9. Begin collecting blood and secure the needle to the arm with medical tape.
10. Allow blood to flow into the transfer pack by removing the hemostat.
11. Blood should be withdrawn at a collection rate tolerable by the patient. This usually equates to 10 to 15 minutes of withdrawing blood. Be sure to observe the patient throughout this time due to possible adverse reactions. Although fluids may be optional during the blood collection process, it is mandatory that patients receive fluids immediately following the procedure.
12. Upon the desired volume of blood collected, the hemostat should be placed on the transfer pack and the clamp should be closed on the needle line.
13. Deflate the blood pressure cuff and remove the needle from the patient’s arm
14. Use a gauze to apply constant pressure on the venipuncture site in order to initiate bleeding.
15. Remove the needle from the transfer pack and dispose of biohazard materials appropriately. Needles should be placed in a biohazard container and transfer packs should be placed in a biohazard trash container.

The use of therapeutic phlebotomy may be medically necessary for individuals with various blood disorders. The use of this technique will help to maintain a controlled blood level and ultimately help to improve the functionality of blood within these individuals. By attending therapeutic phlebotomy sessions as prescribed, individuals with these disorders can maintain a viable lifestyle.

References: Guidelines for Therapeutic Phlebotomy (The University of Iowa Hospitals and Clinics)