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 total blood volume, as supported by the most recent and highest quality study available 1. The duration should typically be 30-60 minutes per session, with the frequency determined by the child's clinical condition and hemoglobin levels.
- Key considerations for phlebotomy in sickle cell disease include:
- Indications: primarily for secondary iron overload from chronic transfusions or when preparing for exchange transfusion in acute complications
- Monitoring: vital signs should be closely monitored by experienced personnel
- Hydration: the child should be well-hydrated before the procedure to prevent vaso-occlusive crisis
- Replacement: blood removal should be replaced with normal saline (0.9% NaCl) at a 1:1 ratio to maintain intravascular volume and prevent hypotension, as indicated in the management of these patients 2. Phlebotomy helps reduce blood viscosity and iron burden, but must be balanced against the risk of worsening anemia in these patients who already have chronic hemolysis, highlighting the need for careful patient selection and monitoring, as discussed in the context of therapeutic phlebotomy 3 and the management of iron overload 4.