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Therapeutic phlebotomy


What is therapeutic phlebotomy?

Therapeutic phlebotomy is a procedure that takes some blood from a patient. It takes 20 to 40 minutes.

Why is therapeutic phlebotomy done?

Your child might need therapeutic phlebotomy for a condition called “iron overload.” Iron overload is having too much iron in the blood. Your blood normally has iron in it, but having too much can cause health problems.

Iron overload is more likely with certain diseases and treatments. For example, your child could get iron overload from having a stem cell (bone marrow) transplant, many transfusions, a disease called beta thalassemia, or other diseases or treatments.

Who needs therapeutic phlebotomy?

People with iron overload need therapeutic phlebotomy. Some conditions that can cause iron overload include:

  • Sickle cell disease – If your child needs blood transfusions (extra blood) for a long time, he might get iron overload.
  • Polycythemia – Having too many red blood cells. This can happen because of cancer, or on its own.
  • Transplant – If your child gets a transplant, such as a stem cell (bone marrow) transplant, he might get transfusions. Having many transfusions can cause iron overload.

Other things also cause iron overload. Ask the doctor or nurse if you are not sure why your child needs therapeutic phlebotomy.

When can my child have therapeutic phlebotomy?

Your child may have therapeutic phlebotomy when the following items are all true.

  • It has been at least 2 weeks since any surgeries or sedation – Sedation is anesthesia that makes your child relaxed and sleepy.
  • Your child’s hemoglobin level is too high. This shows there is too much iron in the blood.
  • Your child’s body temperature is normal – Your child does not have a fever.
  • Your child is feeling healthy – Your child might have a chronic disease such as sickle cell, but should not be feeling sick with another problem, such as a cold or infection.
  • Your child has enough fluid in his body – Your child should not have signs of being dehydrated.

What happens in the procedure?

Therapeutic phlebotomy is done through an IV (by vein) or central line if your child has one.

A nurse checks your child’s blood pressure, heart rate, breathing, temperature, and oxygen level before, during, and after the procedure. They also check to see if your child is anxious, irritable, dizzy, pale, or thirsty. If your child has any of these problems, the nurse will stop the procedure and tell the doctor. The procedure will not start again until the doctor says it can.

How much blood does the procedure take?

Therapeutic phlebotomy takes about 500 ml of blood or less. This is about 1 pint (2 cups) or less.

After the blood is taken, your child gets the same amount of saline solution (water with a little salt) through the IV or central line. This replaces the blood. Giving the saline takes about 30 minutes.

After your child gets the saline, a nurse takes out the IV. Your child should eat a snack and have something to drink before leaving the procedure area. St. Jude has snacks and drinks available for your child.

After the procedure

Check to see if your child feels dizzy or faint after treatment. He might have low blood pressure, low blood sugar, or feel dizzy from not having enough fluid in the body. Tell a nurse if this happens.

Your child may go home if he feels well enough and his blood pressure, breathing, oxygen, and other signs are normal. Normal activities are OK one (1) hour after the procedure. Your child should also avoid any vigorous exercise, such as running or jumping, for 24 hours before and after the procedure. Normal eating and drinking are fine unless your child’s doctor tells you something else.

How long will my child need therapeutic phlebotomy?

Until tests show a normal amount of iron in your child’s liver. The test is magnetic resonance imaging, or MRI. This is a painless scan that measures the amount of iron.

Other important information

  • If your child has too much iron in the blood, do not give iron supplements or vitamins that have iron in them. Your child should also avoid taking extra vitamin C, because it makes the body take more iron from foods. Foods and drinks that have vitamin C, such as orange juice and strawberries, are safe for your child. But ask the doctor or nurse before giving your child any vitamins or supplements.
  • Most St. Jude patients are too young to drink alcohol legally. But you should know that drinking alcohol is dangerous if the blood has too much iron. It can harm the liver. This information is included because some older children might be interested in drinking alcohol. You should tell your child that alcohol is dangerous for his condition and should be avoided.


If you have questions about therapeutic phlebotomy, ask your child’s doctor or nurse.


This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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