Hemostasis Today
NewsFeed
Headlines Hematology Health Medicine VTE ASH Plasma Donation
May, 2026
May 2026
M T W T F S S
 123
45678910
11121314151617
18192021222324
25262728293031
Chokri Ben Lamine: 50 High Yield Pearls for Therapeutic Phlebotomy
image/AI generated
Mar 29, 2026, 11:51

Chokri Ben Lamine: 50 High Yield Pearls for Therapeutic Phlebotomy

Chokri Ben Lamine, Adult Hematology and SCT Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital and Research Center, shared a post on X:

“Therapeutic Phlebotomy – 50 High-Yield Pearls 

  • Amount
  • Frequency
  • Indications
  • Technique

Basics

  • Controlled removal of whole blood decreases iron, decreases viscosity
  • 1 unit (450–500 mL) removes 200–250 mg iron
  • Main goals: decreases ferritin OR decreases hematocrit
  • First-line in iron overload and PV
  • Cheap, effective, guideline-driven.

Indications (Core Hematology)

  • Hereditary hemochromatosis
  • Secondary erythrocytosis (selected cases)
  • Porphyria cutanea tarda
  • Transfusional iron overload (if Hb allows)

Other/Selective Uses

  • NAFLD with hyperferritinemia (controversial)
  • Chronic hepatitis C (historical)
  • Sickle cell iron overload (rare; chelation preferred)
  • Testosterone-induced erythrocytosis
  • Cyanotic heart disease (symptomatic hyperviscosity)

Contraindications / Caution

  • Severe anemia (Hb <11–12 g/dL)
  • Hemodynamic instability
  • Poor venous access
  • Advanced cardiac disease (relative)
  • Pregnancy (relative; case-by-case)

Amount (How Much?)

  • Standard: 450–500 mL per session
  • Small patients: 5–7 mL/kg
  • Frail/elderly: consider 250–350 mL
  • Pediatric: weight-based strictly Adjust by Hb, tolerance, comorbidities

Frequency (Key Differences!)

  • Hemochromatosis induction: weekly Until ferritin ~50 ng/mL
  • Maintenance: every 2–4 months
  • PV: every 2–3 days initially (if needed)
  • PV goal: Hct <45% (men) / <42% (women)
  • Secondary erythrocytosis: symptom-guided
  • Porphyria cutanea tarda: q1–2 weeks
  • Always reassess Hb before each session

Targets

  • Ferritin target: ~50 ng/mL (HH)
  • Avoid ferritin <20 (iron deficiency )
  • PV hematocrit target: <45% ( reduces thrombosis)
  • Monitor transferrin saturation
  • Symptom improvement is key endpoint

Monitoring

  • Hb before each session
  • Ferritin every 4–8 sessions
  • LFTs if liver disease
  • Cardiac MRI if severe iron overload
  • Watch for iron deficiency symptoms

Technique (Practical)

  • Large-bore needle (16–18G)
  • Standard blood donation bag
  • Patient seated/reclined
  • Remove over 10–15 min
  • Apply pressure post-procedure
  • Hydrate before and after Observe 15–30 min (vasovagal risk)

Complications

  • Hypotension, vasovagal syncope
  • Iron deficiency (over-treatment)
  • Fatigue Local hematoma

Key Clinical Pearls

  • HH: phlebotomy first, chelation second
  • PV: phlebotomy reduces thrombosis risk (ELN/NCCN)
  • Don’t delay treatment waiting genetics
  • Always individualize volume and frequency
  • Combine with cytoreduction in high-risk PV

MCQ Patient with PV, Hct 52%, best immediate step?

  1. Aspirin only
  2. Phlebotomy to target Hct <45%
  3. Transfusion
  4. Observation

Answer: B

OSCE Scenario: Middle-aged patient with ferritin 1200:

  • Check transferrin saturation
  • Start weekly phlebotomy
  • Monitor ferritin trend
  • Educate on lifelong maintenance”

Stay updated with Hemostasis Today.

Chokri Ben Lamine Health Hematology Hemostasis Hemostasis News Hemostasis Today Hereditary hemochromatosis Medicine Porphyria cutanea tarda Secondary erythrocytosis Therapeutic Phlebotomy Transfusion Medicine
NewsFeed