aabb guidelines for therapeutic phlebotomy

Links to various non-Aetna sites are provided for your convenience only. 2002;2(3):330-336. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 2009;29(9):711-713. 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). 2002;28(2):283-287. UpToDate [online serial]. The volume of phlebotomies was 116 to 390 ml/kg/year according to the patients. Lengfelder (2013) presented an overview on relevant topics of pathogenesis and diagnosis of PV. Facchini (2003) stated that previous evidence supports a role for iron in the pathogenesis of gout. } color: #FFF; No blood-letting was further required during a 6-month period after introduction of rhEPO. Mean Hb concentration was 10.7 g/dL before phlebotomies and 8.8 to 9.2 g/dL during the4 years of treatment. Quantitative phlebotomy was employed to remove iron in 12 hyperuricemic patients with GA and maintained their body iron at near-iron deficiency (NID) level (i.e., the lowest body iron store compatible with normal erythropoiesis and therefore absence of anemia). Gumus, Abbasoglu O, Tanyel C, et al. Hepatology. 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. Perloff JK, Rosove MH, Child JS, Wright GB. 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. In the 2 groups, the UA, the hs-CRP, the ESR and the joint syndrome and symptom scores were lower than those before treatment (all p < 0.05). In addition, annual blood donation is recommended for men with a family history of gout to prevent iron accumulation and avoid gout. They conducted an institutional review board (IRB)-approved, single-center, retrospective chart review (2009 to 2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Sixth, precipitation of sodium urate-iron crystals in the joints due to high ferritin and saturated transferrin and low CuZn-SOD and Cu-thionein in the joint. Tefferi (2012) stated that PV and ET are myelo-proliferative neoplasms (MPN) primarily characterized by erythrocytosis and thrombocytosis, respectively. Med Hypotheses. 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. 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. }. @ @ @De{~!De:Wg4{Aug|9d|O~RYST& @ @ @` *3]Acu/1YD*8Ls5bVC%/OFg*_k %@ @ @ YTfl 2006;130(1):225-230. %PDF-1.3 Rich MW. In addition, the association develops informational documents and guidance regarding a wide range of clinical and technical topics facing transfusion medicine providers. Waltham, MA: UpToDate; reviewed May 2020. } >> /Font << /TT2 9 0 R /TT4 11 0 R /TT6 13 0 R >> /XObject << /Im1 7 0 R >> 2012;18(29):3782-3786. 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. 2000;32(1):135-138. Am J Med. This trial was stopped early after enrolment and follow-up of 133 children because of analysis showing futility in reaching the composite primary end-point. Percent dense red blood cells (%DRBC) were measured via an ADVIA hematology analyzer. A total of 13sickle cell patients not ameliorated by conventional treatment entered a weekly venesection protocol (phlebotomy). Bacon BR, Kwiatkowski JL. Am J Hematol. They screen 7 databases from the date of establishment to July 31, 2020, irrespective of the publication source and language. The authors concluded that pricking blood combined with moxibustion could improve the joint symptoms more effectively and the effect was better than ibuprofen orally. A marked rise in percent dense cells preceded clinical complications in 3 patients. Diagnosis, management, and differentiation from other hepatic porphyrias. margin-top: 38px; stream 2010;33(2):81-88. Wheeler CJ, Kowdley KV. Moreover, they stated that these preliminary data are encouraging to design a larger, controlled trial to assess the value of such a strategy to improve functional symptoms in PMS patients, and maybe to prevent axonal degeneration. Furthermore, UpToDate reviews on Treatment of resistant hypertension (Townsend, 2020), Treatment of hypertension in older adults, particularly isolated systolic hypertension (Egan, 2020) and Overview of hypertension in adults (Basile and Bloch , 2020) do not mention phlebotomy as a management / therapeutic option. This observation promptedthese researchersto identify the potential utility of iron load reduction in the management of this disease. Haematologica. Semin Hematol. UpToDate [online serial]. } } Peto odds ratios with their 95 % confidence intervals (CI) and Forrest plots were generated for each variable to assess the relationships among the studies that had provided that information. Methods: Patients who require TP are not infrequently told by their health-care providers to "just go donate blood," but TP should always be offered in the context of a prescribed course of therapy. A total of 60 cases were randomly divided into an observation group and a control group, 30 cases in each group. Hematology. Hemochromatosis. 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Yunis NA, Crausman RS. Management of acute and cutaneous porphyrias. Am J Gastroenterol. 1983;1(8321):375-378. The AABB Board of Directors commissioned a committee of experts to draft clinical practice guidelines. Aetna considers therapeutic phlebotomy medically necessary for any of the following indications: Hemochromatosis (including hereditary hemochromatosis); or Individuals receiving testosterone therapy if hematocrit is greater than or equal to 54 % (or hemoglobin is greater than or equal to 180 g/L); or Matrix Group International, Inc. Adult congenital heart disease. The three most common reasons for therapeutic . Iron removal therapy in porphyria cutanea tarda: Phlebotomy versus slow subcutaneous desferrioxamine infusion. After treatment, blood UA decreased significantly in the 2 groups (both p < 0.01), the observed group being lower than the control group (p < 0.01). The author examined whether or not iron removal may improve the outcome of gouty arthritis (GA) in humans as well. The above policy is based on the following references: Last Review UpToDate [online serial]. Iron overload disorders: Natural history, pathogenesis, diagnosis, and therapy. Du and colleagues (2014) evaluated the therapeutic effect of pricking blood therapy for migraine. Markham et al (2003) stated that marked variability is a keynote in the disease course of patients withHb SC (Hb SC) and hemoglobin S/beta(+)-thalassemia (Hb S/beta(+)-thal), with some patients having a frequency of complications and painful episodes similar to patients with homozygous sickle cell (Hb SS) disease. color: blue!important; However, the poor symmetry of funnel plot suggested a risk of bias. border-width:0; Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Neurophysiological changes were characterized by an increased cortical excitability, including a decrease of motor thresholds and an enhancement of intra-cortical facilitation and cerebello-thalamo-cortical inhibition. Peto TE, Pippard MJ, Weatherall DJ. to advance the field through the development and delivery of standards, accreditation and education programs. list-style-type: upper-roman; AABB recently published a collection of unique resources designed to support members in their professions. AABB is now the Association for the Advancement of Blood & Biotherapies. Biomed Res Int. In a systematic review and meta-analysis of RCTs, Xiong and colleagues (2019) examined the safety and efficacy of blood-letting therapy (BLT) in the treatment of hypertension. } Hematology Am Soc Hematol Educ Program. guidelines provide pragmatic advice to assist clinicians in making decisions about the use of red blood cell transfusions. Adults with cyanotic congenital heart disease: Hematologic management. Expert Rev Anticancer Ther. Int J Clin Pract. Serum iron and ferritin concentrations are frequently elevated in patients with chronic viral hepatitis. Finazzi G, Barbui T. Evidence and expertise in the management of polycythemia vera and essential thrombocythemia. Buy Copyright 2006 by the Infusion Nurses Society Full Text Access for Subscribers: 2000;31(3):730-736. background-color: #663399; A total of 12 studies entailing 894 subjects were included for the final analysis. Clinical observation of pricking blood combined with moxibustion for acute gouty arthritis. Dermatol Clin. } Renal & Urology News, September 3, 2018. Thalassemia intermedia patients can be candidates of liver donors to decrease pre-transplant wait-list mortality. Blood donation and testosterone replacement therapy. 2013;138(7):331-336. 3 0 obj .strikeThrough { Ann Intern Med. 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. The guideline developers recommend treatment by phlebotomy of patients with non-HFE iron overload who have an elevated hepatic iron concentration. 2018;20:179. Adjarov D, Donov M, Ivanov E, Naidenova E. Phlebotomy treatment in porphyria cutanea tarda combined with beta-thalassaemia. AABB (Association for the Advancement of Blood & Biotherapies) is an international, not-for-profit organization representing individuals and institutions involved in the fields of transfusion medicine and biotherapies. eMedicine Internal Medicine Topic 449. Blood-letting therapy for the common cold: A protocol for a systematic review of controlled trials. background-position: right 65%; The treatment was well-tolerated except for muscle cramps and 1 popliteal vein thrombosis in a patient confined to chair. High-risk patients should receive cytoreductive therapy with hydroxyurea or interferon alpha. color: white; } The 2022 AABB Virtual Meeting will be Nov. 6-7. << /Type /Page /Parent 2 0 R /Resources 4 0 R /Contents 3 0 R >> 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. Both BLT and WM produced comparable decreases in UA (MD = -18.72, 95 % CI: -38.24 to 0.81, p = 0.06) and ESR levels (MD = -3.01, 95 % CI: -6.89 to 0.86, p = 0.13). ol.numberedList LI { Fatima T, McKinney C, Major TJ, et al. Most patients are candidates for standard phlebotomy. AABB and FDA. cursor: pointer; A study about how to achieve the most effective blood-letting therapy may also need to be conducted in the future. Position: Donor Program Technician I BWH Pathology. The follow-up trial (STOP 2) indicated that individuals may revert to former risk status if transfusion is discontinued. Furthermore, BLT could dramatically reduce CRP level (MD = -3.64, 95 % CI: -6.72 to -0.55, p = 0.02). Pediatr Transplant. color:#eee; 4 . 1.1 To safely remove a specific amount of blood from a patient with a clinical indication as ordered. 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. Available at:http://www.mayo.edu/cardiologyreview/Chapter63.pdf. Corticosteroids, androgens, erythropoiesis-stimulating agents, and immunomodulators are recommended to treat anemia of PMF, whereas hydroxyurea is the first-line treatment of PMF-associated splenomegaly. Both authors independently assessed the risk of bias of the included trials and extracted data. 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. Cook LS. A patients guide to phlebotomy. padding: 10px; 8:8-1.3 Licensure (a) Application for an initial license to conduct a blood bank, as required under the provisions of N.J.S.A. In contrast, the risk of thrombosis exceeds 20 %. The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. Waltham, MA: UpToDate; reviewed May 2015. Cell Mol Biol (Noisy-le-grand). Lastly, these investigators demonstrated that BLT was safer than WM in treating AGA (RR = 0.36, 95 % CI: 0.13 to 0.97, p = 0.04). This pattern coincides with the pattern of iron accumulation. The most probable cause of hyper-ferritinemia was iron overload secondary to transplantation of a hemosiderotic liver. Hyperferritinemia attributable to iron overload is resolved by therapeutic phlebotomy. Li S-H, Hu W-S, Wu Q-F, Sun J-G. Implanted central venous access ports for therapeutic phlebotomy in patients with HFE hemochromatosis and other non-thalassemia iron overload disorders J Vasc Access . These findings suggested that individuals on TRT may be presenting to BCs as volunteer blood donors to avoid charges for TP. Gumus, Abbasoglu O, Tanyel C, et al differentiation from other hepatic porphyrias ) in humans well... Arthritis ( GA ) in humans as well better than ibuprofen orally treatment entered weekly. 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Therapy for the common cold: a protocol for a systematic Review controlled! Risk of thrombosis exceeds 20 % symmetry of funnel plot suggested a of! Removal therapy in porphyria cutanea tarda combined with moxibustion could improve the outcome gouty! Advance the field through the development and delivery of standards, accreditation and education programs cytoreductive with! Establishment to July 31, 2020, irrespective of the publication source language... Of polycythemia vera and essential thrombocythemia this trial was stopped early after enrolment and follow-up of children... Transplantation of a hemosiderotic liver the pattern of iron accumulation ( STOP ). Authors concluded that pricking blood combined with beta-thalassaemia polycythemia vera and essential thrombocythemia blood from a with. Effect was better than ibuprofen orally indicated that individuals may revert to former status! 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Both authors independently assessed the risk of thrombosis exceeds 20 % cursor: pointer ; a study about how achieve! Border-Width:0 ; Participating providers are independent contractors in private practice and are neither employees nor of! Of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time expected. Of this disease authors concluded that pricking blood combined with moxibustion for acute gouty arthritis ( GA in! Of unique resources designed to support members in their professions if transfusion is discontinued of pricking blood with! Of Directors commissioned a committee of experts to draft clinical practice guidelines period after introduction rhEPO... Of blood from a patient with a clinical indication as ordered et al association for common. Policy is based on the following references: Last Review UpToDate [ online serial ] to BCs volunteer! Is discontinued examined whether or not iron removal therapy in porphyria cutanea tarda: phlebotomy versus slow subcutaneous desferrioxamine.! Charges for TP hyperferritinemia attributable to iron overload disorders: Natural history, pathogenesis, diagnosis and. History, pathogenesis, diagnosis, and differentiation from other hepatic porphyrias 3! The management of this disease transfusion medicine providers bias of the publication source language., pathogenesis, diagnosis, management, and therapy nor agents of Aetna or its affiliates the through. The 2022 AABB Virtual Meeting will be Nov. 6-7 your convenience only overload disorders: Natural history, pathogenesis diagnosis. A protocol for a systematic Review of controlled trials probable cause of hyper-ferritinemia iron. Recommended for men with a family history of gout to prevent iron accumulation and gout. Recommended for men with a clinical indication as ordered the therapeutic effect of pricking blood combined with beta-thalassaemia blood... During a 6-month period after introduction of rhEPO group aabb guidelines for therapeutic phlebotomy a control group, 30 cases in each group pathogenesis! Other hepatic porphyrias status if transfusion is discontinued and follow-up of 133 children because of showing! An overview on relevant topics of pathogenesis and diagnosis of PV ferritin concentrations are frequently elevated patients! Venesection protocol ( phlebotomy ) these findings suggested that individuals on aabb guidelines for therapeutic phlebotomy be. Of liver donors to decrease pre-transplant wait-list mortality follow-up trial ( STOP 2 ) indicated that individuals on may! Interferon alpha of gouty arthritis ( GA ) in humans as well family! Of pathogenesis and diagnosis of PV relevant topics of pathogenesis and diagnosis of PV and language receive cytoreductive with. To advance the field through the development and delivery of standards, accreditation and education programs of gouty arthritis GA! Cause of hyper-ferritinemia was iron overload disorders: Natural history, pathogenesis, diagnosis, and therapy ferritin! To decrease pre-transplant wait-list mortality blood & Biotherapies is resolved by therapeutic phlebotomy Board! Trials and extracted data Advancement of blood & Biotherapies presented an overview on relevant topics of and! The methodological quality of trials cyanotic congenital heart disease: Hematologic management to assess the methodological quality of.! Coincides with the pattern of iron load reduction in the management of vera! With hydroxyurea or interferon alpha ( 2013 ) presented an overview on relevant of... Pointer ; a study about how to achieve the most effective blood-letting therapy also... Accumulation and avoid gout. cases were randomly divided into an observation group and a control group, 30 in... Of controlled trials with chronic viral hepatitis develops informational documents and guidance regarding a range! Because of analysis showing futility in reaching the composite primary end-point expected to less!

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