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Haemochromatosis is Treated By Phlebotomy

Treatment of haemochromatosis is done by a simple procedure called a phlebotomy (removal of blood).  Phlebotomy is also called venesection or bloodletting. This is done to remove excess iron from the body and treat any or prevent organ damage. About 500mls or a pint of blood is removed every week or two depending on individual circumstances such as haemoglobin and serrum ferritin levels in order to create a mild anaemia.   This leaches iron from organs, such as liver etc and joints and areas of the body in which iron has been stored in excessive quantities and that iron is then used to create more red blood cells to replace those which are lost by phlebotomy.

Phlebotomy Questions and Answers:

What is a Phlebotomy? 

A phlebotomy is the same procedure as when you donate blood.  About 500 mls or a pint of blood is removed from a vein in your arm.  The whole procedure takes about an hour and is simple, safe and effective.

How often do I need to have Phlebotomies done?

For about a year or more you will probably need to have this procedure done once or even twice per week, sometimes less.  This depends on how much iron has been built up in your body and what is recommended by your doctor.  It also depends on what other health problems you may have.  Some doctors take a more aggressive approach than others.  Remember, the object is to induce a mild anaemia so as to leach the iron from various parts of the body where the iron has accumulated.

Do I need to have Phlebotomies for the rest of my life?

Yes, but when the iron levels have been reduced to safe levels, you will not need as many phlebotomies, ie. usually at this stage about 4 times per year or as recommended by your doctor - your blood needs to be monitored at that stage at least yearly, perhaps more frequently if your doctor recommends it.  Remember that you will also be helping to save the lives of many people!  You actually have a condition that is unique in that way so try not to think of it as a curse, but as a special gift you have been given to help others!!  Blood Banks are often in desperate need of blood donors.

What are the side effects of a Phlebotomy?

Some people are perfectly fine afterwards, while others are very tired for an hour or two, or even over the next 24 hours.  Sometimes you can feel a bit faint afterwards and if this happens while you are in the clinic or donor centre, it will usually happen when you stand up and they will lay you down with your feet up to allow the blood to flow back to your head.  Also they should give you water to drink to keep you hydrated.  Drink lots of water, juice or milk before and after the procedure to help with your blood volume.  If you have problems with blood pressure, ie. high or low, it is a good idea to rest for the rest of the day until your blood volume starts to build back up, as you can feel quite faint at times for a few hours after (not always, but sometimes it happens) and having a family member, friend, work mate, neighbour or someone you can rely on to drive you home is advisable unless you have been a regular blood donor and feel confident that you will be ok to drive.

As more phlebotomies are done not only does your ferritin level (iron) drop, but also your red blood cells (haemoglobin).  This cannot be avoided and actually helps to leach the iron out of the various parts of your body that iron has accumulated in.   The iron will leach out to help make more red blood cells!  Depending on how fast your red blood cells drop and at what level they are at, you will probably feel quite tired until phlebotomies are slowed down (when your iron levels are safe), as a mild anaemia is induced.  Obviously the closer the phlebotomies are together, the more likely this will happen, but take your doctors advice and he SHOULD monitor you closely.  The higher your ferritin level, the more likely you will need phlebotomies closer together.  Once again, take your doctor's advice and make sure he monitors your blood (ie iron tests and haemoglobin levels) closely.

Where can I get a Phlebotomy?

Therapeutic phlebotomies can be done at your local blood bank such as The Red Cross, Mobile Blood Banks, Hospitals, Clinics, Community Blood Centres, Work-base Drives.  Often your doctor will need to write a referral because your donation is for therapeutic purposes and outside the usual time frame for general donations so check with your doctor first.  You may need to make an appointment.

What happens during a Phlebotomy?

The donor sits or lies back in a reclining chair.  The skin covering the inner part of the elbow is cleaned.  An new, sterile needle connected to plastic tubing and a blood bag is inserted into the vein of the arm.  The donor is asked to squeeze their hand repeatedly to help blood flow from the vein into the blood bag.  About 500 mls or one pint is collected and sent to the laboratory for testing.  The donor is taken to an observation area for rest and light refreshments for about 15 minutes before being allowed to leave.

After Treatment

  • Drink water, Fruit Juice or Milk to replenish blood volume over 24 hours.
  • Avoid vigorous activity for 24 hours... rest if needed
  • Continue phlebotomies as needed.

Diet

It is important to be careful about your iron levels, particularly during treatment so that the ferritin level is reduced as quickly as possible.  Do not take iron pills, multivitamins or Vitamin C tablets.  Vitamin C helps increase iron absorption and therefore should be avoided completely by anyone who has haemochromatosis.  Juice is acceptable,  and fruit and vegetables.  Other things to avoid are raw seafood which can contain a deadly bacteria called "Vibrio vulnificus" which is fatal to anyone who has excessive iron levels - that means no raw oysters!!  Also avoid handling raw seafood, particularly shellfish while your iron levels are elevated or if you have liver damage. Cooked seafood is fine.  Drinking alcohol is like playing "russian roulette" and should be completely avoided in order to prevent liver disease on the already compromised liver.  If you have any raised liver enzymes or liver disease, consuming alcohol is downright crazy!

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