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 per session, not exceeding 10-15% of total blood volume, as supported by the most recent and highest quality study available 1. The duration should typically be 15-30 minutes per session, adjusted based on the child's tolerance and clinical status.
- Key considerations for phlebotomy in sickle cell disease include:
- Reducing blood viscosity and hyperviscosity symptoms by removing excess red blood cells and iron
- Managing iron overload from chronic transfusions
- Balancing the benefit against the risk of worsening anemia
- Replacement with normal saline (0.9% NaCl) is generally recommended at a 1:1 ratio to maintain intravascular volume and prevent hypotension, especially in younger children or those with cardiovascular compromise, as indicated by studies on transfusion therapy in children with sickle cell disease 2. The saline should be administered during or immediately after the phlebotomy.
- For children with severe anemia (hemoglobin <6 g/dL), phlebotomy should be avoided unless absolutely necessary, considering the potential for worsening anemia and the importance of maintaining adequate oxygen delivery to tissues. The procedure should be performed by experienced personnel with appropriate monitoring of vital signs throughout, emphasizing the need for careful patient selection and monitoring to minimize risks associated with phlebotomy in this population 3, 4.
- The goal of phlebotomy in sickle cell disease is to reduce iron overload and decrease the risk of complications such as stroke, while also improving quality of life by reducing symptoms of hyperviscosity and iron overload, as highlighted in studies on the long-term results of hydroxyurea/phlebotomy therapy 3.