Therapeutic Phlebotomy

Therapeutic phlebotomies are performed by apheresis personnel. They are normally scheduled in advance to take place weekdays in PMH room 861. However, some inpatients may need phlebotomy. Our personnel may perform phlebotomy of whole blood units if requested. A physician's order is required to performing the service. For inpatients, the order can be written in the hospital chart. If phlebotomy is requested at odd hours when no apheresis personnel are available on the premises, consider the following:

1. Can the clinical team member do the phlebotomy themselves? We can provide the phlebotomy bag; they can pick it up in Transfusion Services (the lab). There is not really any magic trick to doing it themselves -- the arm scrub need not be performed in the same compulsive manner if we are not going to be transfusing the blood.
2. Can the phlebotomy wait until regular hours when an apheresis employee is present on campus?

If the answers to the above are no, consult faculty or the apheresis supervisor for help if you think the need for an emergency phlebotomy exists.

Indications for therapeutic phlebotomy are few. Most involve polycythemia, with hematocrits greater than 55%. Emergencies may arise with risk or occurrence of cerebrovascular accident from high viscosity. In these patients, removal of two or three units can be performed over the course of a few hours, although saline replacement may be necessary for volume maintanance. Another indication (usually not an emergency) may be hemosiderosis.

Units drawn for therapeutic phlebotomy are discarded. These units will not be transfused to other patients. The donor/patient will not have infectious disease testing performed.

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