madman
Super Moderator
Abstract
Background: Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting.
Methods: Patients who require TP are not infrequently told by their healthcare providers to “just go donate blood,” but TP should always be offered in the context of a prescribed course of therapy. Providers can prescribe a course of TP for a number of indications, including hereditary hemochromatosis, polycythemia vera, iron overload, and testosterone replacement therapy.
Results: A course of prescribed TP specifies that patients can be phlebotomized more frequently than volunteer blood donors and reassures patients that TP is being performed per the orders of their provider. Prescribed TP also facilitates two-way communication between the referring provider and the transfusion medicine (TM) physician overseeing the TP. The College of American Pathologists TM checklist describes several requirements regarding the documentation and performance of TP, and electronic medical record systems can be used to demonstrate compliance with these requirements.
Conclusions: TM physicians should discuss the advantages of prescribing TP with providers who mutually care for patients requiring this intervention.
1 | INTRODUCTION
Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting. Ancient Egyptian papyri indicate that therapeutic ‘bleeding’ by scarification was an accepted procedure during that era. In the millennium that followed, phlebotomy was utilized around the globe for a variety of indications, including everything from headaches to evil spirits.1 In the most recent century, modern medical knowledge has served to refine the indications for TP to now include hereditary hemochromatosis (HH), polycythemia vera (PV), iron overload, and testosterone replacement therapy, among others.
In this article, we describe our institutional approach to performing TP at our hospital-based blood donor center, including how we demonstrate compliance with the College of American Pathologists (CAP) checklist requirements regarding the documentation and performance of TP.2 We hope that the discussion that follows will highlight some of the ethical considerations that transfusion medicine (TM) physicians should consider when evaluating their own institutional policies and procedures regarding TP.
1.1 | Initiating TP for patients
1.2 | Role of TM physicians in TP
1.3 | Handling ‘emergent’ inpatient TP requests
1.4 | Erythrocytapheresis
1.5 | Telling patients to “just go donate blood”
2 | CONCLUSIONS
We acknowledge the significant heterogeneity across healthcare settings in providing TP to patients. This publication serves to highlight our institutional practices and how we navigate providing and documenting TP. More importantly, this publication encourages dialog about how TP is handled across facilities. The heterogeneity of TP is ripe for further exploration and could be a subject of future research.
Regardless of how TP is delivered to patients, TM providers play an important role in TP for patients with a number of diagnoses. Harnessing the electronic medical record may facilitate compliance with CAP checklist items. Institutions that perform TP should also consider how they can communicate the benefits of prescribed TP as a documented prescription for TP is optimal for the referring provider, the supervising TM physician, and— most importantly—the patient.
Background: Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting.
Methods: Patients who require TP are not infrequently told by their healthcare providers to “just go donate blood,” but TP should always be offered in the context of a prescribed course of therapy. Providers can prescribe a course of TP for a number of indications, including hereditary hemochromatosis, polycythemia vera, iron overload, and testosterone replacement therapy.
Results: A course of prescribed TP specifies that patients can be phlebotomized more frequently than volunteer blood donors and reassures patients that TP is being performed per the orders of their provider. Prescribed TP also facilitates two-way communication between the referring provider and the transfusion medicine (TM) physician overseeing the TP. The College of American Pathologists TM checklist describes several requirements regarding the documentation and performance of TP, and electronic medical record systems can be used to demonstrate compliance with these requirements.
Conclusions: TM physicians should discuss the advantages of prescribing TP with providers who mutually care for patients requiring this intervention.
1 | INTRODUCTION
Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting. Ancient Egyptian papyri indicate that therapeutic ‘bleeding’ by scarification was an accepted procedure during that era. In the millennium that followed, phlebotomy was utilized around the globe for a variety of indications, including everything from headaches to evil spirits.1 In the most recent century, modern medical knowledge has served to refine the indications for TP to now include hereditary hemochromatosis (HH), polycythemia vera (PV), iron overload, and testosterone replacement therapy, among others.
In this article, we describe our institutional approach to performing TP at our hospital-based blood donor center, including how we demonstrate compliance with the College of American Pathologists (CAP) checklist requirements regarding the documentation and performance of TP.2 We hope that the discussion that follows will highlight some of the ethical considerations that transfusion medicine (TM) physicians should consider when evaluating their own institutional policies and procedures regarding TP.
1.1 | Initiating TP for patients
1.2 | Role of TM physicians in TP
1.3 | Handling ‘emergent’ inpatient TP requests
1.4 | Erythrocytapheresis
1.5 | Telling patients to “just go donate blood”
2 | CONCLUSIONS
We acknowledge the significant heterogeneity across healthcare settings in providing TP to patients. This publication serves to highlight our institutional practices and how we navigate providing and documenting TP. More importantly, this publication encourages dialog about how TP is handled across facilities. The heterogeneity of TP is ripe for further exploration and could be a subject of future research.
Regardless of how TP is delivered to patients, TM providers play an important role in TP for patients with a number of diagnoses. Harnessing the electronic medical record may facilitate compliance with CAP checklist items. Institutions that perform TP should also consider how they can communicate the benefits of prescribed TP as a documented prescription for TP is optimal for the referring provider, the supervising TM physician, and— most importantly—the patient.
