Are Phlebotomies Dangerous?
Most patients tolerate phlebotomies rather well. They are no different from a blood donation, except that the blood should not be reused. Special care must be taken in patients with cardiovascular instability, for instance by administering saline solution before or during the phlebotomy. Phlebotomy causes an increase in platelet counts and white cell counts in many patients as a result of iron deficiency, and this may require further adjustment to treatment. Studies by the Polycythemia Vera Study Group (PVSG) showed that patients treated with phlebotomy alone had a very low incidence of acute leukemia compared to treatment by alkyating agents and radioactive posphorus (no longer in common use because of their leukemogenicity – see Q 18). However, the phlebotomy group had a higher incidence of thrombosis and hemorrhage in the first two years of treatment. This is one of the reasons attention was focused on the agents discussed in Q 18, 19.
