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Modern Bloodletting: A Patient Perspective

While the procedure had broader applications in the past, it is now reserved as a therapy for a narrower list of conditions, including polycythemia vera (a myeloproliferative disorder that causes an increase in red cell production), hemochromatosis (iron overload), and sickle cell disease. Therapeutic phlebotomies are often performed at infusion clinics, and patients are instructed to eat a snack or meal and drink plenty of fluids prior to the procedure. As with a blood donation, the blood in a therapeutic phlebotomy is removed via a needle and attached collection bag. While the amount of blood removed in traditional bloodletting wasn’t as regulated (and, oftentimes, too much blood was taken)

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 Old Therapy, New Questions: Rethinking Phlebotomy in a Pharmacologic Landscape

Therapeutic phlebotomy remains a key intervention in the management of erythrocytosis and iron overload disorders, particularly polycythemia vera (PV) and hereditary hemochromatosis. Despite its historical origins as an ancient practice, venesection continues to be recommended in international guidelines for the reduction of hematocrit and iron burden, thereby mitigating thrombotic and organ-related complications. However, the evolving landscape of targeted pharmacologic therapies is reshaping the therapeutic paradigm.

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The periodic removal of a small amount of blood is known to be beneficial in a handful of specific ailments, especially those involving iron overload. Recent studies also suggest but do not prove that regular blood donation may have other benefits, like cutting the risk of strokes, heart attacks or cancer.

Bloodletting: A Brief Historical Perspective and Modern Medical Applications

Today we recognize that the “four humours” theory was completely incorrect, and the practice of bloodletting has been largely removed from modern medical practice. However, there are certain conditions in which therapeutic phlebotomy is considered effective. For example, hereditary hemochromatosis is a genetic disorder that results in increased intestinal iron absorption and iron deposition throughout tissues and vital organs. Therapeutic phlebotomy is often conducted on these patients in order to remove excess iron from the bloodstream.

Challenges of Therapeutic Phlebotomy: Side Effects, Anxiety, and Logistical Inconvenience

In addition to physical side effects, patients undergoing therapeutic phlebotomy may also experience emotional challenges such as anxiety and discomfort during the procedure. For many individuals, the sight of blood or the sensation of having blood drawn can be anxiety-inducing, leading to feelings of fear or unease.

Clinical applications of therapeutic phlebotomy

Phlebotomy is the removal of blood from the body, and therapeutic phlebotomy is the preferred treatment for blood disorders in which the removal of red blood cells or serum iron is the most efficient method for managing the symptoms and complications. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and nonalcoholic fatty liver disease with hyperferritinemia.

Current applications of therapeutic phlebotomy

Phlebotomy, known also as bloodletting or venesection, is a major therapeutic procedure that has been performed by physicians in various civilisations since antiquity up to the present1,2. In the past it was practised using cupping, lancets or by the application of leeches2. This procedure often weakened the patient and resulted in his or her death. A famous example is that of President George Washington who died in 1799 following the removal of approximately 1.7 litres of blood during a bloodletting procedure for acute epiglottitis3. Originally, several thousand years ago, phlebotomy was used for the treatment of various disorders, but in addition to its therapeutic benefits, phlebotomy also had a preventive role.

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People with polycythemia vera often need regular blood draws to keep the disease in check.

Is bloodletting still used today?

Bloodletting, once a common practice believed to balance the body’s humors, has evolved into a modern, safe, and regulated procedure known as therapeutic phlebotomy, primarily used to treat conditions like polycythemia vera and hemochromatosis.

Polycythemia Vera and Phlebotomy

“Virtually everyone with polycythemia vera will get phlebotomies as part of their treatment plan,” he said. “When people get diagnosed, we're talking about hematocrits that are often in the 55 percent to 60 percent range, sometimes a little bit higher, and our goal is to keep that below 45 percent at least.”

Therapeutic phlebotomy

Therapeutic phlebotomy is relatively safe and efficient at depleting iron stores in the body; thus, this procedure is effective for treating patients with hemochromatosis, polycythemia vera, and related conditions.

Therapeutic Phlebotomy for Hemochromatosis

Therapeutic phlebotomy is the cornerstone, front line, most important element of hemochromatosis treatment.

Who Needs a Therapeutic Phlebotomy?

Many oncology practices treat patients with benign and malignant hematologic diagnoses. As a result, oncology nurses often are required to care for these patients. One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15-30 minutes. The procedure is ordered as a treatment for hereditary hemochromatosis, polycythemia vera, and secondary polycythemia