Therapeutic Phlebotomy

What is therapeutic phlebotomy? 

Therapeutic phlebotomy is a procedure to take some blood from your child to treat a disease or condition.

Your child might need therapeutic phlebotomy to treat iron overload. Iron overload is having too much iron in the blood. Iron overload is more likely with certain diseases and treatments. These include: 

• Having repeated blood transfusions  
• Stem cell transplant 
• Beta thalassemia 
• Hemochromatosis, a condition where the body absorbs too much iron from food
• Other diseases or treatments 

Ask your health care provider if you are not sure why your child needs therapeutic phlebotomy. 

Getting ready for therapeutic phlebotomy

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

• It has been at least 2 weeks since any surgeries or general anesthesia. 
• 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 are well-hydrated. 

What to expect during therapeutic phlebotomy

Therapeutic phlebotomy usually takes 20 to 40 minutes. Your child will sit in a comfortable chair during the procedure. 

Therapeutic phlebotomy requires a needle stick or central line. It 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 vital signs before, during, and after the procedure. Vital signs include blood pressure, heart rate, breathing, temperature, and oxygen level. 

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. The procedure will not start again until the doctor says it can. 

The doctor will tell the team how much blood to take. Therapeutic phlebotomy may remove up to 500 mL of blood. This is about the same amount as 1 pint (2 cups). 

Next, your child gets a saline solution to replace the amount of blood that was taken. A saline solution is a mixture of salt and water. This solution will be given through your child’s IV or central line. This process takes about 30 minutes.

After your child gets the saline, a nurse takes out the IV (if they have one). If your child has a central line, the central line will not be taken out. Your child should eat a snack and have something to drink before leaving the procedure area.

After therapeutic phlebotomy 

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

Your child can go back to normal activities 1 hour after the procedure. But they should 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. 

Your child may need therapeutic phlebotomy multiple times until they have a normal amount of iron in their blood. The care team will recommend tests that are needed to check your child’s iron levels. 

Care at home

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. Vitamin C 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 you give your child any supplements. 

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

When to call your care team

You should call your care team if your child experiences any of the following:

• Dizziness or lightheadedness
• Fainting
• Bleeding
• Infections
• Fever
• Severe pain

Always follow specific instructions from your child’s care team.

Questions to ask your care team

• How does therapeutic phlebotomy work?
• Why does my child need therapeutic phlebotomy?
• How long will the procedure take?
• Are there any side effects?
• What activities should my child avoid before or after the procedure?
• How often will my child need therapeutic phlebotomy?

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