Therapeutic Phlebotomy

What is therapeutic phlebotomy?

Therapeutic phlebotomy (or therapeutic bleeding) is a procedure that reduces the number of red blood cells or excessive iron in your child’s body by removing whole blood. While red blood cells are responsible for carrying oxygen to all parts of your child’s body, too many of them can cause thickened blood (increased viscosity) with slow blood flow, resulting in reduced oxygen delivery to body tissues and increased blood clots. Too much iron in the blood causes a toxic overload which can lead to organ damage, joint pain and long-term health concerns.

If your child has hemochromatosis or polycythemia, his doctor may recommend therapeutic phlebotomy as part of his long-term care. Therapeutic phlebotomy is not a cure for your child’s condition. However, it can help your child avoid complications from his disorder and improve his quality of life.

Therapeutic phlebotomy involves drawing a doctor-determined amount of whole blood (which includes red blood cells, white blood cells, platelets and plasma) from a child. This blood is discarded, and replacement fluids (usually saline solution) are infused.

Who needs therapeutic phlebotomy?

Therapeutic phlebotomy can be performed on infants, children and adults. It is primarily used to treat:

  • Hemochromatosis, an iron overload disorder that causes the body to absorb too much iron from food. As the iron builds up in your child’s organs and tissues — such as liver, heart, pancreas — it causes pain, fatigue and joint issues. In later stages, the excess iron can lead to arthritis, diabetes, liver disease, heart problems and other chronic conditions.
  • Polycythemia vera, a bone marrow disease that increases the production of red blood cells and, in some cases, white blood cells and platelets. These excess cells can thicken your child’s blood and increase her risk of blood clots and bleeding.
  • Secondary polycythemia, a disorder similar to polycythemia vera, except it is caused by another primary disease, such as congenital heart disease or hypoxia, and is secondary to too much red blood cell transfusions.

What to expect

If your child is referred to the Apheresis Program for therapeutic phlebotomy, he will have an initial evaluation by a physician-nurse team in the Apheresis Unit. The apheresis team will already know about your child and his condition from your child’s referring physician.

On the day of your child’s procedure, our team will greet you and your child when you arrive. You will be directed to a patient area that includes:

  • A reclining chair or bed for your child
  • Chairs for you to sit with your child
  • A television to distract and entertain your child

Your child’s procedure will be overseen by board-certified physicians, experienced nurses and Child Life staff. At least one team member will be with you and your child at all times to provide comfort, answer questions, and ensure the procedure goes smoothly.

Before the procedure, a doctor will determine how much blood should be removed based on your child’s hematocrit levels. Hematocrit levels measure the ratio of red blood cells compared to whole blood. While ideal hematocrit levels vary and depend on your child’s age and gender, higher levels are generally cause for concern and one reason therapeutic phlebotomy may have been recommended in the first place.

How is therapeutic phlebotomy performed?

For therapeutic phlebotomy, your child’s blood will be withdrawn using a needle. The process is similar to donating blood.

Your child’s doctor will determine the amount of blood to be withdrawn from your child. The blood will be removed in increments and then discarded. An equal or greater amount of replacement fluid (saline solution) is then infused into your child through the same vein. Drawing blood in increments will be continues until the final amount of blood needed to be withdrawn is completed.

Therapeutic phlebotomy may take one to two hours to complete, depending on your child’s size and how much blood is removed.

Therapeutic phlebotomy may be repeated at regular intervals under the direction of your child’s physician and the apheresis team. For conditions such as hemochromatosis or polycythemia, this procedure may be performed repeatedly for years to help your child live a more normal life.


Therapeutic phlebotomy is a safe procedure, but side effects can occur. Your child may experience:

  • Symptoms similar to regular blood donation, such as nausea, vomiting, dizziness or fainting
  • Bruising, numbness, pain or infection at the site of the needle stick or catheter insertion

If your child experiences any of these symptoms, please tell your child’s medical team.