What is Therapeutic Phlebotomy

Therapeutic phlebotomy is the planned removal of blood from a person’s body for the purpose of treating a medical condition. The procedure is similar to donating blood. Usually, about a pint (470 mL, or 0.47 L) of blood is removed. The average adult has 9–12 pints (4.3–5.7 L) of blood in the body.

Therapeutic phlebotomy may be used to treat the following medical conditions:

• Hemochromatosis. This is a condition in which the blood contains too much iron.
• Polycythemia vera. This is a condition in which the blood contains too many red blood cells.
• Porphyria cutanea tarda. This is a disease in which an important part of hemoglobin is not made properly. It results in the buildup of abnormal amounts of porphyrins in the body.
• Sickle cell disease. This is a condition in which the red blood cells form an abnormal crescent shape rather than a round shape.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Nausea or light-headedness.
• Low blood pressure (hypotension).
• Soreness, bleeding, swelling, or bruising at the needle insertion site.
• Infection.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners (anticoagulants).
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• Wear clothing with sleeves that can be raised above the elbow.
• Plan to have someone take you home from the hospital or clinic.
• You may have a blood sample taken.
• Your blood pressure, pulse rate, and breathing rate will be measured.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be cleaned with an antiseptic.
• You may be given a medicine to numb the area (local anesthetic).
• A tourniquet will be placed on your arm.
• A needle will be inserted into one of your veins.
• Tubing and a collection bag will be attached to that needle.
• Blood will flow through the needle and tubing into the collection bag.
• The collection bag will be placed lower than your arm to allow gravity to help the flow of blood into the bag.
• You may be asked to open and close your hand slowly and continually during the entire collection.
• After the specified amount of blood has been removed from your body, the collection bag and tubing will be clamped.
• The needle will be removed from your vein.
• Pressure will be held on the site of the needle insertion to stop the bleeding.
• A bandage (dressing) will be placed over the needle insertion site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, pulse rate, and breathing rate will be measured after the procedure.
• You will be encouraged to drink fluids.
• Your recovery will be assessed and monitored.
• You can return to your normal activities as told by your health care provider.

Summary

• Therapeutic phlebotomy is the planned removal of blood from a person’s body for the purpose of treating a medical condition.
• Therapeutic phlebotomy may be used to treat hemochromatosis, polycythemia vera, porphyria cutanea tarda, or sickle cell disease.
• In the procedure, a needle is inserted and about a pint (470 mL, or 0.47 L) of blood is removed. The average adult has 9–12 pints (4.3–5.7 L) of blood in the body.
• This is generally a safe procedure, but it can sometimes cause problems such as nausea, light-headedness, or low blood pressure (hypotension).

Therapeutic Phlebotomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Light-headedness or dizziness. You may feel faint.
• Nausea.
• Tiredness (fatigue).

Follow these instructions at home:

Eating and drinking

• Be sure to eat well-balanced meals for the next 24 hours.
• Drink enough fluid to keep your urine pale yellow.
• Avoid drinking alcohol on the day that you had the procedure.

Activity

• Return to your normal activities as told by your health care provider. Most people can go back to their normal activities right away.
• Avoid activities that take a lot of effort for about 5 hours after the procedure. Athletes should avoid strenuous exercise for at least 12 hours.
• Avoid heavy lifting or pulling for about 5 hours after the procedure. Do not lift anything that is heavier than 10 lb (4.5 kg).
• Change positions slowly for the remainder of the day. This will help to prevent light-headedness or fainting.
• If you feel light-headed, lie down until the feeling goes away.

Needle insertion site care

• Keep your bandage (dressing) dry. You can remove the bandage after about 5 hours or as told by your health care provider.
• If you have bleeding from the needle insertion site, raise (elevate) your arm and press firmly on the site until the bleeding stops.
• If you have bruising at the site, apply ice to the area:
  • Remove the dressing.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day for the first 24 hours.
• If the swelling does not go away after 24 hours, apply a warm, moist cloth (warm compress) to the area for 20 minutes, 2–3 times a day.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for at least 30 minutes after the procedure.
• Keep all follow-up visits as told by your health care provider. This is important. You may need to continue having regular therapeutic phlebotomy treatments as directed.

Contact a health care provider if you:

• Have redness, swelling, or pain at the needle insertion site.
• Have fluid or blood coming from the needle insertion site.
• Have pus or a bad smell coming from the needle insertion site.
• Notice that the needle insertion site feels warm to the touch.
• Feel light-headed, dizzy, or nauseous, and the feeling does not go away.
• Have new bruising at the needle insertion site.
• Feel weaker than normal.
• Have a fever or chills.

Get help right away if:

• You faint.
• You have chest pain.
• You have trouble breathing.
• You have severe nausea or vomiting.

Summary

• After the procedure, it is common to have some light-headedness, dizziness, nausea, or tiredness (fatigue).
• Be sure to eat well-balanced meals for the next 24 hours. Drink enough fluid to keep your urine pale yellow.
• Return to your normal activities as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. You may need to continue having regular therapeutic phlebotomy treatments as directed.