What volume of blood is withdrawn during phlebotomy for polycythemia (excessive red blood cell count)?

From the Guidelines

Phlebotomy for polycythemia typically involves withdrawing 300 to 450 ml of blood weekly or twice weekly until the hematocrit target is reached, with the goal of maintaining the hematocrit below 45%. The amount of blood withdrawn per session may vary depending on the patient's individual needs and response to treatment, as well as their overall health status and hematocrit levels 1.

Key Considerations

• The induction phase of phlebotomy involves more frequent sessions, with the goal of rapidly reducing hematocrit levels to the target range.
• The maintenance phase involves less frequent sessions, with the goal of maintaining the hematocrit within the target range.
• The procedure helps reduce blood viscosity by removing excess red blood cells, which decreases the risk of thrombotic events like stroke or heart attack.
• Patients should be well-hydrated before the procedure and may need iron studies monitored, as repeated phlebotomies can lead to iron deficiency 1.

Important Details

• Cytoreduction is strongly recommended in high-risk cases, such as patients with an age older than 60 years, or those with a previous thrombotic event 1.
• Poor tolerance to phlebotomy is an additional indication to cytoreductive therapy 1.
• Iron supplementation is indicated in cases of documented severe tissue iron deficiency associated with detrimental symptoms 1.

From the Research

Phlebotomy for Polycythemia

• The goal of phlebotomy in polycythemia vera is to maintain a hematocrit of less than 45% 2, 3.
• Phlebotomy is a critical component of therapy for polycythemia vera, and it is typically performed to remove one unit of blood 4.
• The frequency and volume of phlebotomy may vary depending on the individual patient's needs and response to therapy 5.
• Phlebotomy is often used in combination with other therapies, such as aspirin and cytoreductive therapy, to manage polycythemia vera 2, 3, 6.

Volume of Blood Withdrawn

• The volume of blood withdrawn during phlebotomy for polycythemia vera is typically one unit of blood, which is approximately 450-500 mL 4.
• The exact volume of blood withdrawn may vary depending on the individual patient's needs and the specific protocol being used 5.

Importance of Phlebotomy

• Phlebotomy is an essential component of therapy for polycythemia vera, as it helps to reduce the risk of thrombosis and other complications 2, 3, 6.
• Regular phlebotomy can help to improve symptoms and quality of life for patients with polycythemia vera 2, 6.