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Therapeutic Phlebotomy

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Therapeutic Phlebotomy is a procedure performed in an outpatient setting (Clinic or Physicians Office) to remove red blood cells (RBCs) from the body. One or two peripheral intravenous lines (PIVs) are started to perform the procedure if you do not have any other type of vascular access device (CVL or portacath). Getting a PIV started or accessing a portacath tends to be the most uncomfortable part of the procedure. The PIV lines are used to remove blood from the body and to replace the blood removed with a blood product or intravenous fluids. Your physician will explain the procedure to you and decide how much blood is to be removed and if you require any replacement blood products or fluids during the procedure. The procedure will last from two to four hours.


This procedure is performed for many diseases and reasons. Your physician will explain why it is necessary for your treatment. In general therapeutic phlebotomy is performed to decrease the thickness of RBCs, to decrease iron overload in hyper-transfused states, or to allow for the transfusions of RBCs with normal hemoglobin.

Red blood cells pick up oxygen from the lungs and deliver the oxygen to the body cells. Certain types of diseases (congenital cyanotic heart disease, eisenmenger’s syndrome, and sickle cell anemia) prevent the RBCs from picking up enough oxygen from the lungs. This causes the body to produce an increased number of RBCs in order to increase oxygen delivery to the cells. This condition is called erythrocytosis (polycythemia). As the number of RBCs increase, the blood becomes thicker and symptoms of fatigue, headache, muscle aches, visual disturbances or bleeding problems may develop. Many of these symptoms can be controlled by periodically removing blood from the body with therapeutic phlebotomy.


Side effects during and after the procedure are uncommon. There may be minor discomfort associated with the insertion of the intravenous lines or accessing the portacath. Special topical numbing medications can be used to decrease the discomfort. Ask your physician about the use of these products. Your iron stores may become low if periodic phlebotomies are necessary. Your physician will monitor your body’s iron stores and may prescribe iron supplements if needed.

During the procedure: If you experience dizziness, a feeling of fainting, nausea, or you begin not to feel well during the procedure, tell your healthcare provider. If these symptoms are felt during the procedure, your healthcare provider will slow the blood removal procedure and may want to give you more fluids.

After the procedure: You may experience dizziness and a feeling of being tired. These feelings may last a few days.

  • If you experience dizziness when rising from a sitting or lying position try to rise slowly.
  • If you experience dizziness while walking or standing, sit down and place your head between your knees, or lay down flat.
  • You should begin to feel better 24 to 48 hours after the procedure, but this will vary from one person to another.
  • Call your physician if you are concerned about how you feel after the procedure.

Caring for your PIV sites after procedure: Your PIV sites will be covered with a dressing or band-aid. Leave the dressing on for 2-4 hours and watch for bleeding. If bleeding should occur hold pressure to the area for 5 – 10 minutes, then cover with a dressing or band-aid. If the bleeding does not stop after 10 minutes, call your physician.


There are no special preparations for therapeutic phlebotomy procedures. The following are things you should know:

  • If you are not fluid restricted by your physician, you should try to drink plenty of fluids before and for 1 – 2 days after the procedure.
  • Do not stop taking any medications unless your physician instructs you to do so.
  • Eat your normal meals before and after the procedure.
  • You should have someone accompany you during the procedure to drive you home.


This varies from person to person and depends on how quickly your body produces RBCs. Your physician will monitor your hemoglobin and hematocrit and will rely on you to report your symptoms of fatigue, headache, muscle aches, feeling of fainting, chest pain, joint pain, coughing up bloody secretions, visual disturbances or bleeding problems. Those who benefit from phlebotomy may require the procedure a few times a year or every 3 – 6 weeks. The time will vary from one person to another.

Disclaimer:This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 05/2018

(757) 668-7000