LQPB2501 - CMLE - Therapeutic Phlebotomy to Treat Testosterone Therapy-Induced Erythrocytosis-Therapeutic Phlebotomy to Treat Testosterone Therapy-Induced Erythrocytosis

Therapeutic Phlebotomy to Treat Testosterone Therapy-Induced Erythrocytosis

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This document from Yale School of Medicine and Yale New-Haven Hospital details therapeutic phlebotomy, focusing on its use to manage testosterone therapy-induced erythrocytosis (TIE). Therapeutic phlebotomy is the controlled removal of blood to reduce elevated hematocrit or iron levels, distinct from voluntary blood donation or autologous donation.<br /><br />A case study describes a 50-year-old male treated with testosterone replacement therapy (TRT) for low testosterone, who developed erythrocytosis with hematocrit rising to 54.3%, increasing clot risk. TRT was paused, and therapeutic phlebotomy performed, removing 500 mL of blood at a hospital apheresis clinic without adverse effects. Patients should be instructed to hydrate and avoid strenuous activity after the procedure.<br /><br />Therapeutic phlebotomy requires a healthcare provider's written order specifying volume, frequency, and target hematocrit. It is performed by physicians, nurses, or phlebotomists in clinical settings. Pre-procedure assessment includes verifying consent, hematocrit/hemoglobin (procedure postponed if hemoglobin < 11 g/dL), and vital signs. Equipment includes sterile blood collection sets, collection bags, and monitoring supplies. Blood is usually drawn over 10 minutes with patient monitoring for adverse events such as syncope or hematoma.<br /><br />In some cases, blood collected therapeutically can be used for allogeneic transfusion if patients meet donor eligibility criteria, have a provider prescription, and the collection follows regulatory standards. This is increasingly relevant as more men on TRT undergo frequent phlebotomies; some blood centers have FDA variances allowing use of red blood cells from these donors, though plasma and platelets must be discarded.<br /><br />The document also reviews the historical context of phlebotomy and highlights clinical guidelines recommending withholding TRT during erythrocytosis and using therapeutic phlebotomy to reduce hematocrit. It concludes that understanding therapeutic phlebotomy and its implications for blood donation is essential due to the growing patient population on TRT.<br /><br />Key points:<br />- Therapeutic phlebotomy treats conditions like TIE, hereditary hemochromatosis, and polycythemia vera.<br />- Requires medical prescription, patient assessment, and monitoring.<br />- Blood from such procedures may be used for transfusion if eligibility and regulatory criteria are met.<br />- TRT-induced erythrocytosis is a common and clinically significant indication.<br />- Only red blood cells from these donors are transfused; plasma and platelets are discarded.<br />- Patient education on hydration and post-procedure care is crucial.

Keywords

therapeutic phlebotomy

testosterone therapy-induced erythrocytosis

erythrocytosis management

testosterone replacement therapy

hematocrit reduction

blood donation eligibility

TRT complications

phlebotomy procedure guidelines

hereditary hemochromatosis treatment

polycythemia vera management