How does everyone feel about requiring that a recent hct be on file before a therapeutic phlebotomy performed in a hospital setting? We have some concerns of setting a limit because a patient with hemochromatosis may have a low value but a TP may still be indicated.

We require a hematocrit within the past 7 days. If the patient has not had one done then we do one. Our doctors usually specify orders like for example, "draw if hct >32."

We do a finger stick Hemocue before therapeupic phlebotomy. These are done in our donpr center along with Aotologous, Allogeneic and apheresis donors. We require a physician order with a cut off value be in the chart. I think we get a renewal order periodically so that the primary care physician knows where the patient counts are at. Our medical director follows up everu procedure with a "progress note", letter to the primary care doctor.

We require the physicans to sign a consent form annually and state the patient's diagnosis, the "cut off" for the hematocrit, and the frequency of the bleeding. We place these orders in the electronic patient chart and in a patient comment in our Cerner computer. The patient also has to sign a consent form with each phlebotomy. This is an "invasive procedure" and we feel the consents are needed.

If the physician does not specify a cut off, our policy states we will do a phlebotomy if the Hct is >50% or we call the doctor.

We do an "in-line" draw for the H&H on our "known" therapeutics.

How does everyone feel about requiring that a recent hct be on file before a therapeutic phlebotomy performed in a hospital setting? We have some concerns of setting a limit because a patient with hemochromatosis may have a low value but a TP may still be indicated.

We perform a spun hematocrit on patients without a current H/H. On sickle cell patients we do not do this because they are transfused after the phlebotomy.