Therapeutic phlebotomy should be performed when the expected benefit exceeds the potential risks of the procedure.


Conditions which may be treated by therapeutic phlebotomy:

(1) polycythemia vera with primary erythrocytosis

(2) erythrocytosis secondary to hypoxic lung disease

(3) erythrocytosis secondary to cyanotic heart disease

(4) erythrocytosis secondary to ectopic erythropoietin secretion (paraneoplastic)

(5) hemochromatosis

(6) hemoglobinopathy with impaired oxygen delivery


The benefit of phlebotomy for erythrocytosis is generally accepted when the hematocrit > 70% (hemoglobin > 24.7 g/dL) but may be controversial at lower levels.



(1) reduce risk of thrombosis and/or stroke

(2) reduce hyperviscosity

(3) reduce iron overload (in hemochromatosis)

(4) improved oxygen delivery


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