{"id":48767,"date":"2022-02-11T09:30:55","date_gmt":"2022-02-11T14:30:55","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=48767"},"modified":"2022-02-08T12:31:17","modified_gmt":"2022-02-08T17:31:17","slug":"bloodletting","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/bloodletting\/","title":{"rendered":"Is bloodletting still used today?"},"content":{"rendered":"

Maybe you\u2019ve wandered the floors of an art gallery in the past, cringing at some of the medicinal practices depicted in paintings from the Medieval era: patients covered in leeches, drinking or eating questionable-looking substances, and being subjected to intentional head wounds or casual amputations. If so, you\u2019ve likely also come across art showing the historical practice of bloodletting, when doctors would use a fleam or a lancet to open up a patient\u2019s vein (usually the arm) and allow an unspecified amount of blood to drain into an empty vessel.<\/span><\/p>\n

If this sounds awfully dangerous and unscientific, that\u2019s because it was\u2014and after hitting a peak of popularity in the 18th century, <\/span>doctors began strongly discouraging the use of bloodletting to cure patients<\/span><\/a>, noting that even in the best case scenario there weren\u2019t any real bloodletting benefits (and could cause serious harm in the worst).<\/span><\/p>\n

But that doesn\u2019t mean those early doctors in the Middle Ages were completely off base; sometimes, removing blood from the body <\/span>can <\/span><\/i>be helpful, at least when done in a safe, controlled, and standardized way. It\u2019s called therapeutic phlebotomy, and it has about as much in common with historical bloodletting as lobotomies do with advanced neurosurgery. Here\u2019s how this practice has evolved over the years, how it\u2019s done, and who it benefits.<\/span><\/p>\n

What is bloodletting?<\/span><\/h2>\n

The first thing you need to know about the history of bloodletting is that its origins go way, <\/span>way <\/span><\/i>back. Some ancient Egyptian texts reference the practice. In Western medicine, it dates back to 5th century Greece, when Hippocrates (of the Hippocratic oath) theorized that our bodies were made up of four humors: blood, phlegm, black bile, and yellow bile. If one or more of these humors were out of balance with the rest, Hippocrates claimed, it could cause a host of common ailments and illnesses.<\/span><\/p>\n

From there, early doctors adopted the practice of bloodletting, or removing blood from the body, as a treatment for an imbalance of humors. The well-known ancient Greek physician, Galen of Pergamum, became a major proponent of the practice. Bloodletting was often used for treating symptoms like fevers, headaches, hypertension, gout, nosebleeds, yellow fever, and smallpox, among others. George Washington, famously, underwent <\/span>five bloodlettings in less than one day in an attempt to cure him<\/span><\/a> from the illness that ultimately killed him.<\/span><\/p>\n

So\u2026was bloodletting effective? Certainly, the physicians performing it thought it to be an effective way of purging excess humors. But, the real-world evidence in the early 19th century showed a different picture. A small study performed in 1836 by French physician Pierre Louis examined the effectiveness of bloodletting in patients with pneumonia; the <\/span>rate of improvement before and after bloodletting<\/span><\/a> in these patients wasn\u2019t significant, and Louis recommended bloodletting only be used for certain conditions\u2014not as a widespread treatment.<\/span><\/p>\n

Modern doctors believe that, in countless cases, bloodletting was not only unhelpful but <\/span>contributed to the death of the same patients<\/span><\/a>.<\/span><\/p>\n

When did bloodletting stop?<\/span><\/h2>\n

Eventually, the four humors theory was <\/span>debunked entirely in the mid- to late-1800s<\/span><\/a>. Doctors and scientists in Europe, like John Snow (who figured out that cholera was spreading through contaminated water in London) and microbiology pioneer Louis Pasteur, began promoting the <\/span>germ theory<\/span><\/a> of medicine. That is, the idea that microorganisms cause disease, not an imbalance of humors.\u00a0<\/span><\/p>\n

As the humors fell out of favor, so did bloodletting; in the early 1900s, doctors began moving away from the practice, <\/span>opting for blood transfusion over bloodletting in the 1920s<\/span><\/a>, and by the late 20th century, it was mostly eliminated as a legitimate medical treatment.<\/span><\/p>\n

Bloodletting versus therapeutic phlebotomy<\/span><\/h2>\n

Credible doctors may not be running around recommending bloodletting or leech therapy anymore, but that doesn\u2019t mean there is no current medical practice borrowing some of its methodologies (although the modern implementation is <\/span>much <\/span><\/i>more sophisticated!).<\/span><\/p>\n

Known as <\/span>therapeutic phlebotomy<\/span><\/a>, the procedure is essentially a blood draw, similar to a <\/span>blood donation<\/span><\/a>. Performed in a medical setting\u2014such as a doctor\u2019s office, hospital, or blood donation center\u2014under careful observation, patients have a specific amount of blood drawn from their body at predetermined intervals ranging from once a week to once every few months, as needed. In some cases, blood drawn during therapeutic phlebotomy can be donated if the patient meets all other blood donation criteria.<\/span><\/p>\n

\u201cTherapeutic phlebotomy is done through a large IV placed by a nurse,\u201d says medical oncologist <\/span>Sandy Kotiah, MD<\/span><\/a>, director of The Neuroendocrine Tumor Center at Mercy Medical Center in Baltimore. \u201cWe usually draw 500 milliliters of blood at a time, less if a person can\u2019t tolerate a full phlebotomy or is anemic.\u201d<\/span><\/p>\n

Why is therapeutic phlebotomy done? There are primarily only two medical conditions that rely on it as a treatment: polycythemia vera and hemochromatosis. It may also be used to treat the rare skin condition <\/span>porphyria cutanea tarda<\/span><\/a> and <\/span>increases of iron related to sickle cell anemia transfusions<\/span><\/a>.<\/span><\/p>\n

Polycythemia vera<\/span><\/h3>\n

Polycythemia vera is a rare blood condition that causes your body to make more red blood cells than you need. This is problematic, Dr. Kotiah says, because blood that\u2019s too thick with excess red blood cells impedes proper blood flow. It could turn into a blood clot that causes a stroke, heart attack, or embolism.<\/span><\/p>\n

Johns Hopkins Medicine reports that polycythemia vera happens as a result of a <\/span>genetic change in the body as you age<\/span><\/a>. Common symptoms of this condition include shortness of breath, fatigue, and dizziness. It occurs because your blood has become too thick to pick up oxygen, says University of Missouri Health Care hematologist and oncologist <\/span>Cherian Verghese<\/span><\/a>, MD.<\/span><\/p>\n

Hemochromatosis<\/span><\/h3>\n

People with hemochromatosis store too much iron in their bodies, often ending up with <\/span>toxic amounts of iron in vital organs like the heart, liver, and pancreas<\/span><\/a>. If left untreated, these excessively high levels of iron can lead to cirrhosis of the liver, impotence, diabetes, liver failure, and heart problems, among other conditions over time.<\/span><\/p>\n

Hemochromatosis is usually hereditary, passed down through parental genes, but <\/span>can also be caused by repeated blood transfusions<\/span><\/a>. Phlebotomy is a standard therapy for hemochromatosis.\u00a0 Part of your treatment plan can also be <\/span>managed through diet<\/span><\/a> and avoidance of iron-containing vitamins or supplements. In some cases, therapeutic phlebotomy may temporarily be discontinued, such as <\/span>during pregnancy<\/span><\/a> when iron levels often normalize.<\/span><\/p>\n

RELATED: <\/b>What do your hematocrit test results mean?<\/b><\/a><\/p>\n

3 therapeutic phlebotomy benefits<\/span><\/h2>\n

If you\u2019re still associating therapeutic phlebotomy with Medieval bloodletting, it\u2019s time to move on. Today\u2019s therapeutic phlebotomy is not only strictly regulated and standardized, it\u2019s a safe and highly effective treatment for people who have too many red blood cells or too much iron in their blood.\u00a0<\/span><\/p>\n

Here are the benefits of therapeutic phlebotomy to treat polycythemia vera and hemochromatosis.<\/span><\/p>\n

1. It\u2019s safe<\/span><\/h3>\n

According to Dr. Verghese, the only risks involved with therapeutic phlebotomy are localized; in other words, you could experience pain, bleeding, or mild inflammation from the IV placement, but there are no systemic complications.<\/span><\/p>\n

Dr. Kotiah agrees that therapeutic phlebotomy is largely safe\u2014and that the biggest hurdle is often people\u2019s fears of having blood drawn. \u201cIt\u2019s really well tolerated, although some people will have a <\/span>vasovagal response<\/span><\/a> causing lightheadedness or fainting, and if you draw too much blood, they could feel tired,\u201d Dr. Kotiah says. \u201cBut there are no long-term consequences\u2014it\u2019s really more annoying [to show up for regular phlebotomy] than anything else.\u201d<\/span><\/p>\n

2. It works well<\/span><\/h3>\n

Therapeutic phlebotomy is an effective treatment for these two blood conditions, though it can be slow-going at first; while hemoglobin levels will start dropping quickly, says Dr. Verghese, it can take a long time to get to your ultimate goal depending on how severe your condition is.\u00a0<\/span><\/p>\n

It may be worth it, though: A <\/span>2016 review<\/span><\/a> in the <\/span>Journal of Blood Medicine<\/span><\/i> suggests that phlebotomy can decrease the rates of cardiac death and blood clots in patients with polycythemia vera, as well as reduce iron levels in tissue and improve survival rates for patients with hemochromatosis.<\/span><\/p>\n

3. It can be used alongside other treatments<\/span><\/h3>\n

Some patients will need to take medication that also removes excess iron and red blood cells from the blood. It\u2019s safe to do this in conjunction with therapeutic phlebotomy as long as your blood count is being regularly and carefully monitored.\u00a0<\/span><\/p>\n

If your labs normalize with just using therapeutic phlebotomy that\u2019s an ideal scenario: \u201cMedication treatments are less effective and more expensive, plus you get side effects,\u201d Dr. Verghese explains. \u201cTherapeutic phlebotomy is effective, cheap, and has little side effects.\u201d<\/span><\/p>\n

Common medications used to treat polycythemia include Hydrea (<\/span>hydroxyurea<\/span><\/a>). Medications are typically not prescribed for hemochromatosis <\/span>unless a person can\u2019t tolerate phlebotomy, or the condition has been caused by blood transfusions<\/span><\/a> instead of genetics.<\/span><\/p>\n

Therapeutic phlebotomy side effects<\/span><\/h2>\n

Again, therapeutic phlebotomy is relatively safe for most people\u2014the biggest concern is localized pain and bleeding, or adverse reactions to blood draws such as fainting or dizziness. Rather than focus on side effects, per se, there are some potential pitfalls or drawbacks to this type of treatment.<\/span><\/p>\n

1. It requires a delicate balance<\/span><\/h3>\n

In order to perform therapeutic phlebotomy safely, in a way that doesn\u2019t overly <\/span>deplete your iron or blood cell count<\/span><\/a>, you\u2019ll have to get frequent blood work so your healthcare provider can determine the right amount of blood loss. <\/span>The optimal schedule for bloodletting has not been established, and the frequency can be tailored to the patient’s clinical status and hemoglobin level.<\/span><\/p>\n

\u201cWith polycythemia vera, you want iron levels to be low only to a certain point,\u201d says Dr. Verghese, \u201cso if you have high red blood counts but your iron is too low, then therapeutic phlebotomy isn\u2019t useful and you have to switch to medication.\u201d\u00a0<\/span><\/p>\n

Both doctors also talked about the effort involved with getting a hemochromatosis patient\u2019s blood levels right; because <\/span>iron is stored by a blood protein called ferritin<\/span><\/a>, lowering ferritin levels (not just iron levels) is actually key to treating patients with hemochromatosis.<\/span><\/p>\n

\u201cWe like to get ferritin levels lower than what most people can tolerate,\u201d Dr. Verghese says. \u201cSo where most people are at 500 [micrograms per liter] of ferritin, people with hemochromatosis may need to be as low as 50.\u201d<\/span><\/p>\n

2. It\u2019s a commitment<\/span><\/h3>\n

There are no cures for polycythemia vera or hemochromatosis, but therapeutic phlebotomy can help people manage both of these conditions successfully, improving their overall health outcomes. Due to the chronic nature of these issues, you\u2019ll need to commit to regular intervals of therapeutic phlebotomy for years to come.<\/span><\/p>\n

\u201cAt first, we do therapeutic phlebotomy more frequently because we\u2019re trying to get to our goal as quickly as possible,\u201d says Dr. Kotiah. \u201cOnce we get to the right level, less phlebotomy is needed to keep your iron levels at goal\u2014but it could take a year of going once per week before you can go down to once a month, or once every few months.\u201d<\/span><\/p>\n

For patients being treated with therapeutic phlebotomy it\u2019s important to attend all their scheduled appointments and keep up with their blood work. Usually blood work is obtained every three months and at the time of each phlebotomy: \u201cStaying on some sort of routine with phlebotomy will help you avoid more need for it,\u201d Dr. Kotiah adds.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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