Therapeutic Bleeds

[Mirage]

What defines a therapeutic phlebotomy? Is it the method of collection, the volume collected, the purpose of collection etc? If we collect 300 ml of whole blood in a syringe and dispose of it, is this considered a therapeutic phlebotomy? Does this require a FDA registration or license?

[David Saikin]

I guess that a tp is the removal a determined volume of whole blood. It requires a physician's order. You do not need FDA registration to perform this procedure. I have used syringes, vauum tubes, and donor bags to accomplish these procedures. Some docs only want 250 cc removed, some want "a unit".

[Mary]

We require a physician's order with a cut off (i.e. do if HCT>50%). This can be a single order or a standing order for one year. We also ask for a diagnosis, which is usually polycythemia or hemachromatosis. The cuts offs for these 2 diseases can be very different. We require an H/H within the last 24 hours. GI bleeding is not uncommon in patients with polycythemia and you wouldn't want to remove a unit if their Hct is low. We monitor the patient with BP and Pulse readings before, during and after. After the procedure, we offer the patients orange juice and ask that they rest at least 5 minutes. The Indiana State Board of Health requires that we maintain a record of the disposal of the unit.

Some Blood Centers are now offering to draw patients with hemochromatosis.

Hope this helps.