I am looking for other hospital policies regarding total volume of therapuetic phlebotomy on any given day. Can anyone help me out?

We have a retired MD who now needs therapuetic phlebotomies and is extremely upset with us because we have a policy of not removing more than one 450ml whole blood unit/week. Other area hospitalsI have checked with will remove up to 500mls every three days. We only offer this service on Tues., Wed. and Thursdays which limits us as well.

We want to know what the industry standard is to help us evaluate our policy. Please help.

It is not unheard of to do multiple phlebotomies (2)/week. I have done 2u at a time . . . but this was with MD approval and due to limited venous access for the 16g needle. Most places draw with 500mL bags now (I still use 450).

I work at a blood center, and we will often begin the "de-ironing" phase for hemachromatosis patients with 500 mL phlebotomies up to 3x/week.

We also would do 2-3 450 mL units a week for new hemochromatosis patients, though our Medical Director didn't like the idea much. The orders had to come from a hematologist, not a family practice doc.

We do 500 mL weekly.

There was a study published in the literature a few years ago about using automation to collect a dRBC (~500 ml of packed RBCs); and that this was MORE therapeutic than just a whole blood. The theory was somewhere along the lines (If I recall correctly...) that the fluid replacement in the procedure reduced the rebound effect of the RBC drain.

Might be worth looking in to ... if you have automation as an option!

As a blood center, we provide therapeutic phlebotomy for free for all patients (so that we can label and release units from donors with hemachromatosis into the general inventory). We have evaluated using apheresis, but it's just not as cost-effective to implement as routine practice. We can do it if the patient's condition warrants, but would prefer to collect whole blood.

Thanks. We've decided that our policy will be only one (up to 500 ml unit)/week. The last patient we drew two units from did not feel well afterwards. Nancy C

As a blood center, we provide therapeutic phlebotomy for free for all patients (so that we can label and release units from donors with hemachromatosis into the general inventory). We have evaluated using apheresis, but it's just not as cost-effective to implement as routine practice. We can do it if the patient's condition warrants, but would prefer to collect whole blood.

Is it safe and AABB allowed to use the blood?

Absolutely -- the FDA and AABB have approved this process. The key points are:

(1) It is only allowed for donors with a diagnosis of HH, and they must meet all other volunteer criteria.

(2) Therapeutic phlebotomy is provided free of charge to all individuals, regardless of diagnosis. This eliminates the financial incentive for someone to provide false information and present themself as a qualified as a volunteer donor when they do not.

For more information, visit http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/RegulationoftheBloodSupply/ExceptionsandAlternativeProcedures/default.htm, which details the "Exceptions and Alternative Procedures" approved by the FDA, #18.d and #18.f (note that although this has been approved for other centers, each facility must submit their own application for approval).

A variance can also be obtained from the AABB.

Thank you.

Liz

CAP requires the requesting physician to include the amount to remove, the frequency, and what lab values to monitor when performing a Therapeutic Phlebotomy. Do ya'll find they are doing this on every order?