Impact of therapeutic phlebotomy on haematological parameters of patients and their clinical outcome

Abstract

Background: Phlebotomy, also known as bloodletting or venesection, is a major therapeutic procedure. Currently, there are three main indications for therapeutic phlebotomy i.e., haemochromatosis, polycythaemia vera (PV) and porphyria cutanea tarda (PCT) along with sickle cell disease, some cases of secondary polycythaemia like post renal transplant patient and cyanotic heart disease and hypoxic conditions like chronic lung disease. Aims and Objective: To evaluate the effect of therapeutic phlebotomy on haematological parameters and also its role in clinical outcome. Materials and Methods: The study was carried out at Department of Transfusion Medicine with collaboration of Department of Clinical Haematology, SCB MCH, Cuttack from January-2016 to September-2017. This is a prospective study comprising of 55 cases of erythrocytosis, on whom 393 procedures of therapeutic phlebotomy done after scrutinizing the eligibility criteria. There were 393 procedures of phlebotomy conducted over 55 cases. Results: After 393 procedures, with a mean of 6 procedures for each patient, there was reduction in Hb, Hct, WBC, RBC, TPC ,Ferritin from (18.7± 2.1)gm/dl, (57±6.6 )%, (10.5±5.9)10³/µl, (6.9±1.8)10⁶/µl, (458.5±312)10³/µl, (246.05±84.4)ng/dl to (14.9±1.91)gm/dl, (46.1±4.1)%, (7.35±4.4)10³/µl,( 5.1±1)10⁶/µl, (304.5±243)10³/µl, (195±98.3)ng/dl respectively. Conclusion: Therapeutic phlebotomy is a cost effective and safe treatment for patients having high haematocrit. In conclusion, the evidence that we have observed, indicates that phlebotomy is safe and provides good efficacy with relatively low costs, so it should be the first line of treatment in the above cases as cytoreductive therapy has serious adverse effects and further studies are needed to improve the treatment guidelines for phlebotomy.