Standard Phlebotomy Volume for Adults: 450 mL
The standard volume for therapeutic phlebotomy in adults is 450-500 mL of blood per session, which should be performed weekly or biweekly until target parameters are reached. 1
Evidence-Based Guidelines for Phlebotomy
Volume Recommendations
- 450-500 mL is the standard volume for adult therapeutic phlebotomy 1
- This volume:
- Corresponds to approximately 200-250 mg of iron removal per session 1
- Is consistent across multiple clinical practice guidelines
- Is the standard volume used in blood donation centers
Monitoring During Phlebotomy
- Check hemoglobin/hematocrit prior to each phlebotomy session 1
- Ensure hematocrit/hemoglobin falls by no more than 20% of the prior level 1
- Monitor serum ferritin every 10-12 phlebotomies in iron overload conditions 1
Frequency of Phlebotomy
- Weekly or biweekly sessions are recommended during the induction phase 1
- Maintenance phase frequency should be adjusted based on laboratory parameters 1
Clinical Applications and Considerations
Hemochromatosis Management
- Continue frequent phlebotomy until serum ferritin reaches 50-100 μg/L 1
- Maintenance phlebotomy should keep ferritin between 50-100 μg/L 1
- Avoid vitamin C supplements during treatment 1
Polycythemia Vera Management
- Target hematocrit below 45% 1
- Phlebotomy of 300-450 mL weekly or twice weekly until target hematocrit is reached 1
- Maintain same volume per session in maintenance phase, adjusting intervals based on hematocrit levels 1
Potential Complications and Precautions
Common Side Effects
- Vasovagal reactions (relatively common) 2
- Hematoma formation at venipuncture site
- Fatigue and lightheadedness
Serious Complications (Rare)
- Nerve injury during venipuncture 2
- Excessive iron depletion leading to symptomatic iron deficiency 3
- Anemia if phlebotomy is too aggressive 4
Risk Mitigation
- Ensure adequate hydration before and after procedure 1
- Avoid vigorous physical activity for 24 hours after phlebotomy 1
- Carefully monitor for signs of iron deficiency, especially during maintenance phase 3
- Provide appropriate venipuncture technique to minimize nerve injury risk 2
Special Considerations
- Patients with advanced fibrosis or cirrhosis can still undergo phlebotomy, but may require closer monitoring 1
- For patients with poor tolerance to phlebotomy, consider cytoreductive therapy as an alternative 1
- Avoid iron supplementation except in cases of documented severe tissue iron deficiency with detrimental symptoms 1
- Blood collected during therapeutic phlebotomy may be suitable for donation if the patient meets other donor criteria 1
By adhering to these evidence-based guidelines for phlebotomy volume and frequency, clinicians can effectively manage conditions requiring iron removal while minimizing potential complications.