From the Research
Phlebotomy in children with sickle cell disease should be performed cautiously, with a recommended volume of 5-10 ml/kg of blood removed per session, not exceeding 10-15% of the child's total blood volume, as supported by the most recent and highest quality study available 1. The duration of the procedure typically ranges from 15-30 minutes, depending on the child's size and condition.
- Blood removal should be replaced with normal saline (0.9% sodium chloride) at a 1:1 ratio to maintain intravascular volume and prevent hypotension.
- This replacement should be administered during or immediately after the phlebotomy.
- Phlebotomy is primarily indicated in cases of iron overload from chronic transfusions or to reduce blood viscosity before procedures.
- The frequency varies based on the child's clinical needs, ranging from monthly to quarterly sessions. Close monitoring of vital signs, hemoglobin levels, and hydration status is essential during the procedure, as highlighted in studies such as 2 and 3.
- Children should be well-hydrated before phlebotomy to minimize complications like vaso-occlusive crises. This approach helps balance the need to remove excess iron or reduce blood viscosity while maintaining cardiovascular stability in these vulnerable patients, with the goal of reducing morbidity, mortality, and improving quality of life, as emphasized in 4 and 5.