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Therapeutic Phlebotomy

What is therapeutic phlebotomy? 

Therapeutic phlebotomy is a procedure that treats conditions such as iron overload. The procedure involves taking some blood from your child. It usually takes 20 to 40 minutes. 

Reasons for therapeutic phlebotomy 

Your child might need therapeutic phlebotomy to treat iron overload. Iron overload is having too much iron in the blood. Blood has iron in it. But having too much can cause health problems. 

Iron overload is more likely with certain diseases and treatments. For example, your child could get iron overload from: 

  • A stem cell transplant 
  • Many transfusions  
  • Beta thalassemia 
  • Other diseases or treatments 

Other things also cause iron overload. Ask the doctor or nurse if you are not sure why your child needs therapeutic phlebotomy. 

If your child needs therapeutic phlebotomy, they have it when: 

  • It has been at least 2 weeks since any surgeries or sedation  
  • They do not have a fever.
  • They feel healthy. 
    • Your child might have a chronic disease such as sickle cell disease. But your child should not be feeling sick with another problem, such as a cold or infection. 
  • They have enough fluid in their body. 

What to expect 

Therapeutic phlebotomy is done through an IV (by vein). It can also be done through a central line if your child has one. 

A member of your child’s care team will check their blood pressure, heart rate, breathing, temperature, and oxygen level before, during, and after the procedure. 

The care team will also check to see if your child is anxious, irritable, dizzy, pale, or thirsty.  

If your child has any of these problems, the care team will stop the procedure and tell the doctor. The procedure will not start again until the doctor says it can. 

Therapeutic phlebotomy takes about 500 ml of blood or less. This is about 1 pint (2 cups) or less. 

After the blood is taken, your child gets the same amount of saline solution through the IV or central line. This replaces the blood. Giving the saline takes about 30 minutes. 

After your child gets the saline, a nurse takes out the IV. Your child should eat a snack and have something to drink before leaving the procedure area.

Man getting blood drawn

Therapeutic phlebotomy requires a needle stick or central line.

After the procedure 

Check to see if your child feels dizzy or faint after treatment. They might have low blood pressure, low blood sugar, or feel dizzy from not having enough fluid in their body. Tell a member of the care team if this happens. 

Your child may go home if they feel well enough and their blood pressure, breathing, oxygen, and other signs are normal.  

Your child can go back to normal activities 1 hour after the procedure. But they should also avoid any vigorous exercise, such as running or jumping, for 24 hours before and after the procedure. 

Normal eating and drinking are fine unless your child’s doctor tells you something else. 

Follow-up treatments 

Your child may need therapeutic phlebotomy until tests show a normal amount of iron in your child’s liver. The test is magnetic resonance imaging or MRI. This is a painless scan. 

Other important information 

If your child has too much iron in the blood, do not give iron supplements or vitamins that have iron in them. Your child should also avoid taking extra vitamin C, because it makes the body take more iron from foods. Foods and drinks that have vitamin C, such as orange juice and strawberries, are safe for your child. But talk to the care team before giving them any supplements 

Drinking alcohol is dangerous if the blood has too much iron. It can harm the liver. If your child is older, you let them know that alcohol is dangerous for their condition and should be avoided. 

Key Points

  • Therapeutic phlebotomy is a procedure that can be used to treat conditions such as iron overload.  
  • The procedure involves taking some blood from your child’s body. 
  • Blood will be taken either by IV or through a central line if your child has one. 
  • Your child’s care team will explain why your child might need therapeutic phlebotomy and the steps you should take after the procedure. 
  • Your child can usually go back to normal activities an hour after the procedure. But they should avoid vigorous activity for 24 hours.


Reviewed: August 2022