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      Clinical applications of therapeutic phlebotomy

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          Abstract

          Phlebotomy is the removal of blood from the body, and therapeutic phlebotomy is the preferred treatment for blood disorders in which the removal of red blood cells or serum iron is the most efficient method for managing the symptoms and complications. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and nonalcoholic fatty liver disease with hyperferritinemia. This review discusses therapeutic phlebotomy and the related disorders and also offers guidelines for establishing a therapeutic phlebotomy program.

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          Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers.

          Annette Prüss-Ustün, Elisabetta Rapiti, Yvan JF Hutin (2005)
          The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively. Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated. 2005 Wiley-Liss, Inc.
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            Iron in fatty liver and in the metabolic syndrome: a promising therapeutic target.

            Silvia Fargion, Luca Valenti, Anna Ludovica Fracanzani … (2011)
            The dysmetabolic iron overload syndrome (DIOS) is now a frequent finding in the general population, as is detected in about one third of patients with nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome. The pathogenesis is related to altered regulation of iron transport associated with steatosis, insulin resistance, and subclinical inflammation, often in the presence of predisposing genetic factors. Evidence is accumulating that excessive body iron plays a causal role in insulin resistance through still undefined mechanisms that probably involve a reduced ability to burn carbohydrates and altered function of adipose tissue. Furthermore, DIOS may facilitate the evolution to type 2 diabetes by altering beta-cell function, the progression of cardiovascular disease by contributing to the recruitment and activation of macrophages within arterial lesions, and the natural history of liver disease by inducing oxidative stress in hepatocytes, activation of hepatic stellate cells, and malignant transformation by promotion of cell growth and DNA damage. Based on these premises, the association among DIOS, metabolic syndrome, and NAFLD is being investigated as a new risk factor to predict the development of overt cardiovascular and hepatic diseases, and possibly hepatocellular carcinoma, but most importantly, represents also a treatable condition. Indeed, iron depletion, most frequently achieved by phlebotomy, has been shown to decrease metabolic alterations and liver enzymes in controlled studies in NAFLD. Additional studies are warranted to evaluate the potential of iron reductive therapy on hard clinical outcomes in patients with DIOS. Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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              How I treat hemochromatosis.

              Geoffrey J. Barton, Ian Adams (2010)
              Hemochromatosis is a common genetic disorder in which iron may progressively accumulate in the liver, heart, and other organs. The primary goal of therapy is iron depletion to normalize body iron stores and to prevent or decrease organ dysfunction. The primary therapy to normalize iron stores is phlebotomy. In this opinion article, we discuss the indications for and monitoring of phlebotomy therapy to achieve iron depletion, maintenance therapy, dietary and pharmacologic maneuvers that could reduce iron absorption, and the role of voluntary blood donation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Blood Med
                Journal ID (iso-abbrev): J Blood Med
                Journal ID (publisher-id): Journal of Blood Medicine
                Title: Journal of Blood Medicine
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-2736
                Publication date Collection: 2016
                Publication date (Electronic): 18 July 2016
                Volume: 7
                Pages: 139-144
                Affiliations
                [1 ]Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon
                [2 ]Department of Physical Medicine and Rehabilitation, Soonchunhyang University, Cheonan Hospital, Cheonan, South Korea
                Author notes
                Correspondence: Ki Young Oh, Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Bongmyeong-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do 330-721, South Korea, Tel +82 41 570 3884, Fax +82 41 570 2776, Email okokykkh@ 123456schmc.ac.kr
                Article
                Publisher ID: jbm-7-139
                DOI: 10.2147/JBM.S108479
                PMC ID: 4957680
                PubMed ID: 27486346
                SO-VID: d7406c83-e460-420c-95a9-3bacb085d3db
                Copyright © © 2016 Kim and Oh. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                ScienceOpen disciplines: Hematology
                Keywords: therapeutic phlebotomy,hemochromatosis,polycythemia vera,porphyria cutanea tarda,sickle cell disease,nonalcoholic fatty liver disease
                Data availability:
                ScienceOpen disciplines: Hematology
                Keywords: therapeutic phlebotomy, hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, nonalcoholic fatty liver disease

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