Journal of Clinical Cases

Clinical Profiling With Therapeutic Phlebotomy As An Adjunct Therapy In Symptomatic Patients At A Tertiary Care Hospital

Dr. Neha Singh, Dr. Saurabh Lahre, Dr. Bankim Das

GROUP A Boold Transfusion Officer, AIIMS Patna. EMail: [email protected]

Corresponding Author: Neha Singh

ABSTRACT

Background:Therapeutic phlebotomy is a medical procedure that involves removing blood, particularly red blood cells or serum iron, as a treatment for specific blood disorders. Historically known as bloodletting, this ancient practice had two primary methods: generalized techniques, such as venesection (vein cutting) and arteriotomy (artery cutting), and systemic techniques, including cupping and the use of leeches. The procedure was believed to stimulate the bone marrow to produce new red blood cells while simultaneously reducing serum iron levels. In modern medicine, therapeutic phlebotomy is used to manage conditions by decreasing red blood cell mass, lowering hematocrit (the proportion of red blood cells in the blood), reducing blood viscosity, or inducing iron deficiency. This approach helps alleviate symptoms and complications associated with various diseases.

Objectives :Therapeutic phlebotomy allows for a controlled and gradual decrease in red cell mass leading to improved blood flow and symptomatic relief in polycythaemia. The present study was aimed to determine the impact of serial fixed volume therapeutic phlebotomy protocol on the symptoms in patients of polycythemia.

Material and Method :This prospective longitudinal study was conducted over 37 months. The desired haematocrit for polycythemia vera and secondary polycythemia was 45% and 52% respectively. A fixed volume of 250 ml phlebotomy was performe. Presenting symptoms was evaluated before and after each procedure quesnarried based assement like mild ,moderate severe relif in symptoms Volume to reduced= initial Hct-Desired Hct/79 X blood volume/kg X body weight/kg.

Results :From 2019 to 2024, a total of 151 therapeutic phlebotomy (TP) procedures were performed on 44 patients. Since the introduction of TP in 2019, the mean interval between procedures has been approximately 22 days. Polycythemia vera was the predominant indication for TP, followed by congenital heart disease. Platelet counts varied among patients, with some exhibiting levels exceeding 400,000/µL, while the average platelet count was 340,000/µL.Uncommon presentations for TP included polycythemia with optic neuritis, acute appendicitis, obesity with nasal obstruction, chronic obstructive pulmonary disease (COPD), sarcoidosis, and coronary artery disease with hypertension. Pre-procedure and post procedure symptoms of patient compared with paired T test and chi squared test ( The two-tailed P value equals 0.6657) with mild and moderate symptoms group.

Conclusion :Our protocol yielded rapid and marked improvement in patients of primary and secondary polycythemia with minimal adverse events and significant amelioration of clinical parameters.

Key Words:Therapeutic phlebotomy, hemochromatosis, polycythemia Vera, porphyria cutanea tarda, sickle cell disease.