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Therapeutic Phlebotomy - H and H limits


lpregeno

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We perform therapeutic phlebotomy by appointment only. Occasionally a patient will come in and have his/her H and H drawn to see if he/she needs to have it performed and then schedule the phlebotomy for another day. Does anyone have any information on what the length of time this H and H is considered "good" for performing the procedure? Two days later? A week? Are there any rules about this? What is your facility doing if this occurs?

Thank you all for your help! 

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We do therapuetic phlebotomies here at our hospital from time to time.  For patients with polycythemia, we check the H&H just before the procedure.  (For hematochromatosis, we also check ferritin.)  The patient is then processed or deferred based on those results. 

I would say in both cases, if a phlebotomy is indicated by the lab tests, that is still going to be valid for some time, maybe even weeks.  i don't think blood counts are not likely to drop by themselves in polycythemia, and likewise iron levels are not going to drop.

You need to have you administrator establish a clear policy in any case..

Scott

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Spell it out in your procedure, whatever your medical director considers appropriate, then follow the procedure. Shouldn't cause any problems as long as you do that. We did our H&Hs immediately prior to the procedure, but we didn't see patients without an order for the phlebotomy. We did occasionally have a patient with a Hgb from their provider that was quite a bit higher than our result - we checked with the provider prior to phlebotomy and he/she wanted to specifiy a lower cut off for phlebotomy we checked with our med director and kept that info on file for future procedures for that patient.

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