list-style-type: upper-alpha; Barton JC, McDonnell SM, Adams PC, et al. 2002;28(2):283-287. Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis. Length of treatment varied between 6 and 12 months. Mean corpuscular volume, mean corpuscular Hb concentration and serum ferritin were also reduced. Rocchi E, Gibertini P, Cassanelli M, et al. Serum ferritin and non-transferrin-bound iron also decreased significantly. Language services can be provided by calling the number on your member ID card. Iron overload disorders: Natural history, pathogenesis, diagnosis, and therapy. Iron overload in mild sideroblastic anaemias. Adult congenital heart disease. A study about how to achieve the most effective blood-letting therapy may also need to be conducted in the future. cursor: pointer; A total of 40 patients with AGA were randomly divided into a pricking blood combined with moxibustion group (a combination group) and a WM group, 20 cases in each group. UnitedHealthcare thanks care providers for their efforts in making the transition to ICD-10 a . Lengfelder (2013) presented an overview on relevant topics of pathogenesis and diagnosis of PV. Wheeler CJ, Kowdley KV. Near-iron deficiency-induced remission of gouty arthritis. 2011;86(4):357-361. Some physicians may write a letter of medical necessity, which the patient can take to their insurance company to justify the procedure. Barton e al (2006) treated 4 white adults (1 man, 3 women) who had iron overload associated with daily ingestion of iron supplements for 7, 15, 35, and 61 years, respectively. When PV is suspected, the presence of a JAK2 mutation confirms the diagnosis and its absence, combined with normal or increased serum erythropoietin level, excludes the diagnosis. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. You can go to blood centers where they will accept blood from a PV patient for what is referred to as "therapeutic phlebotomy." You will need to check with the respective blood center in your area. therapeutic agents (OncoTarget/ OncoTreat) Investigational October 1, 2017 December 21, 2022 0021U : Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5' - UTR-BMI1, CEP 164, 3'-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score (Apifiny ) maintenance of the serum ferritin level at 50 ug/L or less thereafter by periodic removal of blood. If the hematocrit cannot be kept below the upper limit of normal, even when the serum testosterone concentration is at the low end of the normal range during testosterone treatment, the patient should be evaluated for hypoxia and sleep apnea. Association between porphyria cutanea tarda and beta-thalassemia major. These researchers presented a pediatric case of a successful liver transplantation from a donor with beta-thalassemia intermedia. The JAK2V617F mutation, a point mutation in the tyrosine kinase gene JAK2 (Janus Kinase 2), has emerged as a central feature in the pathogenesis of MPN. The authors stated that phlebotomy appeared to enhance the efficacy of non-pegylated IFN monotherapy for CHC, but more research was required to confirm this. Original research: Use of hydroxyurea and phlebotomy in pediatric patients with hemoglobin SC disease. Treatment of resistant hypertension. Hereditary hemochromatosis: A review of the genetics, mechanism, diagnosis, and treatment of iron overload. border: none; } The degree of risk must be balanced against the burden of chronic transfusions. Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: Incidence, risk factors, and effect of treatments. Omaha, NE: eMedicine.com; updated September 12, 2002. Semin Hematol. These researchers stated that further rigorously designed trials are needed to confirm these findings. 2002;2(3):330-336. There was a positive correlation of log(10) serum ferritin and the quantity of iron removed by phlebotomy (p = 0.0371). Charnow (2018) noted that previous research suggested a plausible link between iron and gout, and ferritin stores excess iron, and urate acts as an iron chelator. Those who failed to show clinical improvement after at least 6 months at MTD were offered phlebotomy in addition to hydroxyurea; 5 out of 11 patients with HbSC who achieved MTD failed to demonstrate clinical improvement on hydroxyurea. The 2023 edition of ICD-10-CM E83.119 became effective on October 1, 2022. color: blue 2008;22(8):1494-1502. Guidelines from the American Gastroenterological Association (Dienstagand McHutchison, 2006) on management of hepatitis C concluded that clinical trials have failed to demonstrate the efficacy of phlebotomy in patients with chronic HCV infection, and that phlebotomy cannot currently be recommended as a treatment for HCV infection. Gilbert HS. 1983;19(3):205-266. ol.numberedList LI { 2008;93(3):372-380. Desai TK, Jamil LH, Balasubramaniam M, et al. Accessed November 12, 2002. Blood donation and testosterone replacement therapy. Four classifications of blood disorders are discussed here for which symptoms and complications can be managed by the use of therapeutic phlebotomy. Grossman ME, Poh-Fitzpatrick MB. The guideline developers recommend treatment by phlebotomy of patients with non-HFE iron overload who have an elevated hepatic iron concentration. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Second, UA over-production from ATP degradation. Labcorp patient service centers with this designation can perform collections for the H pylori breath test. OL OL OL LI { Association of subcutaneous testosterone pellet therapy with developing secondary polycythemia. A time for consensus? Treatment of hypertension in older adults, particularly isolated systolic hypertension. In 2 and 5 patients, deferasirox dose was increased to 15 and 20 mg/kg/day, respectively. Moreover, these researchers stated that any patient who developed HCT of greater than 50 % was advised to obtain phlebotomy. Yao and colleagues (2019) stated that many trials have reported that blood-letting therapy is effective for treating chronic urticaria. American Gastroenterological Association medical position statement on the management of hepatitis C. Gastroenterology. The Medline database and Cochrane registry of controlled trials were searched using the key words "phlebotomy" and "treatment of hepatitis C." Reference lists of review articles discussing the interaction between iron and CHC, and prospective RCTs comparing phlebotomy plus IFN therapy to IFN alone were searched to identify additional RCTs that compared phlebotomy plus IFN to IFN alone. Rochester, MN: Mayo Clinic; January 2000; Ch. The authors concluded that on the basis of diet intervention, electro-acupuncture plus blood-letting puncture and cupping was a better therapy for AGA. Therapeutic Phlebotomy Learn More Filter See order and shipping status Track order history Check out faster top: 0px; The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4 % to 40 %. The authors concluded that parents of 13/14 children receiving phlebotomy wished to switch to deferasirox, with 1/14 being satisfied with phlebotomy. You will need to stay seated for several minutes and then stand up slowly. 2017;64(1):188-196. The patient was successfully iron-depleted by combining phlebotomy with recombinant human erythropoietin. Dermatol Clin. The Endocrine Society guidelines suggest stopping therapy if the hematocrit increases to 54 %. } Total TPs during 2014, 2015, and 2016 were 475, 500, and 569, respectively. This list only includes tests, items and services that are covered no matter where you live. The authors concluded that during a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission (CR) to a marked reduction of incidence and severity of gouty attacks. 1 Polycythemia vera: Diagnosis and treatment 2002. Then, a Meta-analysis was made by software Review Manager 5.1. 2015;35(9):885-888. background-position: right 65%; Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequentred blood cellstransfusions. A total of 60 cases were randomly divided into an observation group and a control group, 30 cases in each group. In ancient times this process was known . Following splenectomy, the patient developed a sustained increase in hematocrit, an increase in the frequency of painful episodes, as well as new-onset dizziness and malaise. Therapeutic phlebotomy was one of them. Medicare Part B (Medical Insurance) covers blood you get as a hospital outpatient. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Moreover, a significant improvement in Chinese medicine syndrome by BLT (RR = 1.32; 95 % CI: 1.14 to 1.53, p = 0.0002; heterogeneity: p = 0.53, I2 = 0 %) and BPAD (RR = 1.47; 95 % CI: 1.06 to 2.04, p = 0.02; heterogeneity: p = 0.13, I2 = 56 %) was identified. Under CPT/HCPCS Modifiers added modifier 59. The comprehensive outcomes, which combine the clinical symptoms, signs, and laboratory examinations as one outcome, were not internationally recognized and could not reflect the characteristics of interventions. 2000;7(3):249-255. Am J Gastroenterol. You may need to wait in another room for a period of time. These researchers identified 39 patients on TRT who presented for blood donation over a 2-year period. 2016;241(7):737-744. Last Review09/21/2022. Of the 27 repeat donors, 12 (44 %) had persistently elevated Hb levels (greater than or equal to 180 g/L) at subsequent donations. Waltham, MA: UpToDate; reviewed May 2020. An improvement of the clinical and biochemical picture of porphyria cutanea tarda in both patients was obtained with chloroquine therapy given that their chronic anemia did not permit phlebotomy. The authors concluded that their BC observed increased TP requests for patients on TRT from 2014 through 2016. Magnetic resonance imaging (MRI)-assessed liver iron concentration (LIC) decreased with deferasirox (mean 12.5 10.1 to 8.5 9.3 mg Fe/g dry weight [dw]; p = 0.0005 versus baseline) and phlebotomy (10.2 6.8 to 8.3 9.2 mg Fe/g dw; p = 0.05). Other disease features include leukocytosis, splenomegaly, thrombo-hemorrhagic complications, vasomotor disturbances, pruritus, and a small risk of disease progression into acute myeloid leukemia or myelofibrosis. Sfeir HE, Klachko DM. 1999;84(3):248-253. The Helicobacter pylori (or H. Pylori) breath test is a simple and safe test used to detect an active H. pylori infection. Sampietro M, Fiorelli G, Fargion S. Iron overload in porphyria cutanea tarda. ul.ur li{ evoked migraine, pricking blood used as a complementary therapy, case report, specialists' experience summary, reviews, surveys, news articles, animal studies were excluded. The follow-up trial (STOP 2) indicated that individuals may revert to former risk status if transfusion is discontinued. Hepatology. Am J Med. The second trial (STOP II) investigated risk of stroke when transfusion was stopped after at least 30 months in this population. Hyperferritinemia and iron stores have been associated with the severity of liver damage in NAFLD, and iron depletion reduced insulin resistance and liver enzymes. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. The median time to development of polycythemia whereby 50 % of patients developed polycythemia was 50 months. 2012;87(3):285-293. The authors concluded that the combined ID-rhEPO therapy could authorize a prolonged administration of rhEPO in PMS patients, able to modify cortical excitability of the glutamatergic and gabaergic circuits. Dtsch Med Wochenschr. Rheumatology (Oxford). In the absence of indicators suggestive of significant liver disease (ALT, AST elevation), C282Y homozygotes who have an elevated ferritin (but less than 1,000 g/L) should proceed to phlebotomy without a liver biopsy. list-style-type : square !important; 2011;29(6):761-770. Patient 2 had spherocytosis and no HFE coding region mutations. The risk of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years. Fatima et al (2018) noted that iron could contribute to gouty inflammation by forming complexes with monosodium urate (MSU) crystals, stimulating oxidative stress through the generation of reactive oxygen species, and contributing to granulocyte and complement activation. Iron depletion was obtained within 28 weeks and was associated with endogenous production of EPO. } These investigators reported the case of a young Italian female with juvenile hemochromatosis who was unable to tolerate frequent phlebotomy because of co-existent ss-thalassemia trait. Xiong X-J, Wang P-Q, Li S-J. The treatment was well-tolerated except for muscle cramps and 1 popliteal vein thrombosis in a patient confined to chair. It is hard to tell exactly because we generally perform the therapeutic phlebotomy if the hemoglobin level is greater than 20 g/dL. There is no. To request a . Hyperferritinemia attributable to iron overload is resolved by therapeutic phlebotomy. list-style-type: upper-roman; A patient, 6-year old girl, with a diagnosis of cryptogenic liver cirrhosis underwent deceased donor liver transplantation from a thalassemic donor. Neurophysiol Clin. Main treatment aims are the reduction of thromboembolic events and the minimization of the risk of myelofibrosis and of acute leukemia. Zhongguo Zhen Jiu. Patient 1 had hemochromatosis, HFE C282Y homozygosity, and beta-thalassemia minor. Iron reduction before and during interferon therapy of chronic hepatitis C: Results of a multicenter, randomized, controlled trial. All statistical analyses were carried out with Review Manager 5.3. 2009;55(2):36-39. margin-top: 38px; Therapeutic Phlebotomy is the removal of whole blood from a patient, usually to lower the blood count, as in patients with Polycythemia or Red Cell Hyperplasia, or to remove excess iron, as in Hemochromatosis or Porphyria patients. Juvenile hemochromatosis associated with B-thalassemia treated by phlebotomy and recombinant human erythropoietin. } Pediatr Transplant. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; There are currently no systematic reviews of blood-letting therapy for chronic urticaria. Seventy-six percent received therapeutic phlebotomy services in a hospital or physician's office and 30 percent in a blood center. Third, the combination of different area selection and duration types of blood-letting therapy may have caused significant clinical heterogeneity. Estimated absorption of iron from supplements in patients 1 to 4 was 20.9 %, 1.9 %, 1.1 %, and 0.08 %. Summarell CC, Sheehan VA. When applied before iron overload becomes severe, this treatment also prevents complications of iron overload, including hepatic cirrhosis, primary liver cancer, diabetes mellitus, hypogonadotrophic hypogonadism, joint disease, and cardiomyopathy. Permission will be required if your reuse is not covered by the terms of the License. These patientshad an Hb level equal to or above 9.5 g/dL. margin-bottom: 38px; However, phlebotomy still has an important role in the treatment of three conditions: polycythemia vera (PV), hereditary hemochromatosis (iron overload disorder), and porphyria cutenea tarda (PCT). In an ER setting, an "encounter" is considered admission until discharge. In a Cochrane review, Wang and Dwan (2013) evaluated risks and benefits of chronic blood transfusion regimens in people with sickle cell disease to prevent first stroke or recurrences. Medicare only covers three. These researchers carried out a review of TP requests for individuals on TRT at their BC over a 3-year period from 2014 through 2016, as well as the total number of TP collections. J Tradit Chin Med. The effective rate was 96.7 % in the observation group, which was better than 86.7 % in the control group (p < 0.01). 04 . Preventive treatment of migraine in adults. Zhang et al (2010) examined the therapeutic effect of blood-letting cupping plus herbal medicine for the treatment of AGA. During the trial, 11 children in the standard care group suffered a stroke compared to 1 in the transfusion group, odds ratio [OR] of 0.08 (95 % CI: 0.01 to 0.66). Furthermore, an UpToDate review on Approach to the patient with suspected iron overload (Schrier and Bacon, 2017) states that In liver disease (e.g., viral hepatitis, alcoholic hepatitis, non-alcoholic steatohepatitis), injury to hepatocytes may cause an increase in serum ferritin despite normal total body iron stores The major treatments for iron overload include phlebotomy for those without significant anemia Removal of iron with a course of therapeutic phlebotomy (at least 5 to 6 phlebotomies) with normalization of the ferritin level. Wang WC, Dwan K. Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease. The combination of hydroxyurea and phlebotomy is not as effective as "standard" transfusion and chelation in preventing secondary stroke and iron over-load. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. The original articles were searched in accordance with a pre-defined standards (simple pricking blood treatment, or the pricking blood therapy was the principal approach), while those about other diseases (such as cerebrovascular disease, cervical spondylosis, etc.) OL OL OL OL LI { These researchers carried out a comprehensive electronic and manual bibliographic searches in Cochrane Central Register of Controlled Trials, Excerpt Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and Wanfang Database to identify RCTs in which hypertensive patients were treated with BLT or BLT plus anti-hypertensive drugs (BPAD) against placebo, no treatment or anti-hypertensive drugs. A total of 13sickle cell patients not ameliorated by conventional treatment entered a weekly venesection protocol (phlebotomy). After treatment, the UA, the ESR and the joint syndrome and symptom scores in the combination group decreased more apparently than those in the WM group (all p < 0.05). Omaha, NE: eMedicine.com; updated December 12, 2001. Hepatology. Patients (aged 12.4 years) received deferasirox (n = 12, 10 mg/kg/day starting dose) or phlebotomy (n = 14, 6 ml/kg/2 weeks) for 1 year. bottom: 20px; Zhao et al (2009) examined a more effective therapy for acute GA (AGA). Besa EC, Woermann U.Polycythemia vera. - (must be completed for Medicare patients where the reason for phlebotomy is not covered by insurance . } 2005;10(2):145-149. Cochrane Database Syst Rev. .headerBar { Waltham, MA: UpToDate; reviewed May 2021; May 2022. Thus, this disorder requires an aggressive therapeutic approach to achieve iron depletion. Gumus, Abbasoglu O, Tanyel C, et al. JG Murphy, ed. Target levels of phlebotomy should be a ferritin level of 50 to 100 g/L. The authors concluded deferasirox treatment or phlebotomy reduced iron burden in pediatric patients with beta-thalassemia major post-HSCT, with a manageable safety profile. General Liability insurance cover medical expenses and attorney fees which result from bodily injuries and property damage that your company or organization could be. 1993;87(6):1954-1959. This can lead to fainting. Blood-letting therapy for the common cold: A protocol for a systematic review of controlled trials. This patient no longer requires narcotic analgesics for pain, has resolution of constitutional symptoms, and has not required further hospitalizations for vaso-occlusive pain crises. If not otherwise contraindicated because of a history of major bleeding or intolerance, we suggest that aspirin be given to all patients (Grade 2C). Circulation. A marked rise in percent dense cells preceded clinical complications in 3 patients. Available at: https://www.renalandurologynews.com/home/news/nephrology/hyperuricemia/gout-risk-possibly-linked-to-iron-intake/. Copyright Aetna Inc. All rights reserved. Kowdley KV, Brown KE, Ahn J, Sundaram V. ACG Clinical guideline: Hereditary hemochromatosis. Last updated on 4/2/2021. Early attempts to lower iron burden including chelation therapy and/or phlebotomy should be considered to avoid organ toxicity and transplant failure. Zhao Q-W, Liu J, Qu X-D, et al. 2000;85(8):865-867. The authors stated that adequately powered RCTs with detailed pre-treatment iron studies should be considered to evaluate phlebotomy as an adjunct to pegylated IFN, with or without ribavirin. Garza I, Schwedt TJ. These investigators reported a case series of 14 pediatric patients with HbSC treated to maximum tolerated dose (MTD) with hydroxyurea. padding-bottom: 4px; The phlebotomy plus IFN group and the IFN group did not differ with respect to the percentage of patients with cirrhosis or genotype 1. Chin J Integr Med. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and NAFLD with hyperferritinemia. The meta-analysis revealed that BLT was highly effective in relieving pain (MD = -1.13, 95 % CI: -1.60 to -0.66, p < 0.00001), with marked alterations in the total effective (RR = 1.09, 95 % CI: 1.05 to 1.14, p < 0.0001) and curative rates (RR = 1.37, 95 % CI: 1.17 to 1.59, p < 0.0001). 7. } /*margin-bottom: 43px;*/ Lengfelder E. Diagnosis and therapy of polycythemia vera in the era of JAK2. 2003;42(12):1550-1555. Get the phlebotomist professional liability insurance coverage through CM&F today! #backTop:hover { First, the sample size of included studies was small. Renal & Urology News, September 3, 2018. Kim KH, Oh KY. Clinical applications of therapeutic phlebotomy. After the right amount of blood is drawn, the nurse will remove the needle and place a pressure bandage (bandage that wraps around your arm) over the needle site (the place on your arm where the . Therapeutic phlebotomy for testosterone-induced polycythemia. In 2 patients, direct sequencing was performed to detect coding region mutations of TFR2, HAMP, FPN1, HJV, and ALAS2. Waltham, MA: UpToDate; reviewed June 2013. Diagnosis, management, and differentiation from other hepatic porphyrias. padding-right: 18px; Facchini FS. Basile J, Bloch MJ. Follow-up with monthly phlebotomies after discharge yielded a favorable outcome with normal transplant functions. Zhen Ci Yan Jiu. eMedicine Internal Medicine Topic 1864. Chin-Yee et al (2017) noted that polycythemia is the most common adverse effect of testosterone replacement therapy (TRT) and may predispose patients to adverse vascular events. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. After transplantation of a hemosiderotic liver, it is important to monitor the recipient in terms of iron overload and toxicity. The authors concluded that although some positive findings were identified, no definite conclusions regarding the safety and efficacy of BLT as complementary and alternative approach for the treatment of hypertension could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. 2009;29(9):711-713. Target levels of phlebotomy should be a ferritin level of 50 to 100 g/L. Hematology Am Soc Hematol Educ Program. Pediatr Blood Cancer. border-radius: 4px; High-risk patients should receive cytoreductive therapy with hydroxyurea or interferon alpha. width: 100%; First, uric acid (UA) over-production from increased purines in the diet. .fixedHeaderWrap { Waltham, MA: UpToDate; reviewed May 2020. UpToDate [online serial]. The American Association for the Study of Liver Diseases' clinical practice guideline on "Diagnosis and management of hemochromatosis" (Bacon et al, 2011) provided the following recommendations: Barbui and colleagues (2011) presented a review of critical concepts and produced recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first- and second-line therapy, and therapy for special issues. Zhu et al (2015) compared the differences in clinical effectiveness between pricking blood combined with moxibustion and Western medication (WM) for the treatment of AGA. Aetna considers therapeutic phlebotomy experimental and investigational for treatment of the following conditionsbecause its effectiveness for these indications has not been established (not an all-inclusive list). padding: 15px; 1986;114(5):621-629. During treatment for hereditary hemochromatosis, dietary adjustments are unnecessary. Tefferi A. Prognosis and treatment of polycythemia vera. Using comprehensive outcomes was also the common problems of most RCTs of traditional Chinese medicine published in Chinese. Therapeutic phlebotomy was performed every 41 weeks, and the initial procedure was performed at 5 mL/kg, although the subsequent phlebotomy volumes were increased to 10 mL/kg with a maximum of 500 mL in cases with Hb levels of 8 g/dL. J Infus Nurs. Porphyria cutanea tarda. Waltham, MA: UpToDate; reviewed May 2020. Efficacy and safety of phlebotomy to reduce transfusional iron overload in adult, long-term survivors of acute leukemia. 2008;20(2):191-201, vi. However, the poor symmetry of funnel plot suggested a risk of bias. Extreme hyper-ferritinemia was detected shortly after transplantation. Medicare covers medically necessary blood tests ordered by a physician based on Medicare guidelines. Scheduled phlebotomy goodies people who have too much iron in their bluts, such as from hemochromatosis, or anyone is creating too many red blood cells, such as with polycythemia.Removing blood regularly decreases iron plane included which body by reducing the number of iron-rich red blood cells. Gout involves 7 aspects. } text-decoration: line-through; Bouchair et al (2000) reported the findings of sickle cell disease patients who suffered from frequent painful crises and were submitted to phlebotomies in order to reduce hospitalization days due to pain. A trial of phlebotomy to reduce viscosity in patients with higher hematocrit values should be considered as an intervention for symptomatic patients with sickle cell disease. In a pilot study, Creange et al (2013) evaluated the concept that iron depletion (ID) induced by blood-letting and followed by recombinant human erythropoietin (rhEPO) administration could be a therapeutic strategy in progressive multiple sclerosis (PMS) and that it could be assessed by neurophysiological measurements. .strikeThrough { Unfortunately, it can be difficult to qualify for reimbursement, or to get therapeutic phlebotomy covered by insurance. Hemodynamic effects of staged hematocrit reduction in patients with stable cor pulmonale and severely elevated hematocrit levels. These researchers stated that large-scale, multi-center RCTs with proper outcome measurements and long-term follow-up are needed to provide convincing proof. outline: none; Annual TP collections for patients on TRT were 193, 212, and 239, respectively. Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary toarterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale. LIC reductions were greater with deferasirox than with phlebotomy for patients with baseline serum ferritin 1,000 ng/ml or higher (-8.1 1.5 versus -3.5 5.7 mg Fe/g dw; p = 0.048). } 1988;109(5):406-413. According to guidelines from the Hemochromatosis Management Working Group (Barton et al, 1998), therapeutic phlebotomy should be initiated in men with serum ferritin levels of 300 ug/L or more and in women with serum ferritin levels of 200 ug/L or more, regardless of the presence or absence of symptoms.
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