Phlebotomy Frequency

[Avidtrainer]

My doctor has ordered me to go for a phlebotomy on a weekly basis until my hemoglobin is at 15.5. He is requesting this based on a high normal hematocrit level on my last lab work which is a result of testosterone replacement therapy. Saturday is my next scheduled phlebotomy which would be my fifth phlebotomy in as many weeks. I have had four phlebotomy sessions in the past 30 days and the hemoglobin level has not changed much. I am trying to find out if I am supposed to keep going indefinitely until the level changes or if it is possible for me to give too much blood. After my last phlebotomy I felt tired for two days and wonder if it was associated with giving too much blood in the past 30 days. Last year when I did this the hemoglobin level went down quickly and was able to stop after three sessions because the level got below what my doctor ordered. I will list the four readings below:


05/09/2015 16.9 g/dl
05/16/2015 17.6 g/dl
05/23/2015 16.4 g/dl
05/31/2015 16.8 g/dl

 

[Vince Carter]

I know the Red Cross advises no less than 56(?) days between donations, if that's at all helping your question. It's a good question, I may need a TP soon so interested in any opinions.

 

[croaker24]

Are they checking your ferritin/iron levels?

 

[Nelson Vergel]

That is too frequent. Like Croaker24 asked you, your ferritin/iron may be low and make you tired.

What is your hematocrit blood level? That is the main variable to use to help decide about phlebotomy frequency.

 

[Avidtrainer]

Thanks for your replies. All I can tell you is that on my last lab work my hematocrit level was high normal so the doctor recommended a therapeutic phlebotomy. His order stated I was to go weekly until the hemaglobin level was 15.5. They are using the finger prick method to check the hemaglobin before they draw the blood and it has barely moved after four phlebotomy sessions. Last year it came down to where the doctor wanted it with three sessions. I'm not sure what to do or why the level is not moving. My doctor won't get back with me.

 

[CoastWatcher]

Do you have a copy of your last lab work? Can you post the hematocrit?

 

[Avidtrainer]

The hematocrit was 48.8 g/dL.

 

[CoastWatcher]

Nelson makes the point, on a sticky post, that it is the hematocrit that determines the need for a phlebotomy. Your hematocrit is in good shape, below 50.



https://www.excelmale.com/forum/showthread.php?420-Testosterone-Side-Effect-Management-Table

 

[Avidtrainer]

I believe the reason the doctor recommended the phlebotomy is because it is creeping up and would be over 50 soon. Last year when it was around 51, after I had three sessions it went down to low to mid 40's I believe. Now it is in the upper 40's.

 

[CoastWatcher]

The hematocrit was 48.8 g/dL.

The following is quoted in an excellent article on therapeutic phlebotomy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934278/


"Polycythaemia can be suspected in any person with an increase in haematocrit (more than 52% or 48% in men and women, respectively), an increase in haemoglobin level (more than 18.5 g/dL or 16.5 g/dL in men and women, respectively) or an increase in red blood cell count."

 

[Avidtrainer]

This is very disturbing to me. I went back to the blood bank Saturday to see if my hemoglobin level had changed and it had plummeted to 14.3. Why it suddenly plummeted after four weeks of giving blood with no change in the level is beyond me. Here is what I find very disturbing. I kept my doctor aware of what was going on concerning going each week for the phlebotomy and the hemoglobin level not changing. He told me to keep going and giving blood. Common sense told me I had given too much blood so I started doing some research and discovered an adult male has about 10 pints of blood. I gave four pints in 30 days meaning I gave 40% of my total blood volume in 30 days! I read where giving that much blood can be dangerous. Why wouldn't my doctor have stopped me after the second phlebotomy? The American Red Cross guidelines permit only giving blood once every 56 days and says it takes four to six weeks to replace red blood cells. Why didn't the blood bank have precautions in place that prevented me from giving that much blood in such a short time? I'm very upset over this and have felt very fatigued since the last draw the weekend before last. Does anyone have any suggestions how I should handle this negligence? I'm not the expert here and was putting my faith in the doctor and blood bank who are supposed to know what they are doing.

 

[ERO]

Most guys on TRT can donate every 56 days (as the Red Cross allows) and be fine if that helps at all. I know there are exceptions, but for most that is often enough to keep everything in the healthy range.

I would think hard about a new doctor as well.

 

[Butchmo]

The article cited ( "Current applications of therapeutic phlebotomy") does indeed describe when polycythemia can be suspected (Hct over 52 in men), but actually it goes on to say "Similarly, patients with hypogonadism on testosterone therapy and athletes on anabolic steroids who develop secondary polycythaemia are NOT candidates for phlebotomy." (emphasis added). I would note they DON"T explain why not! This mainstream medical view seems to be the problem for many. In fact I'm encountering resistance from my doctor to giving me a script for a therapeutic phlebotomy even though my Hct increased from 52.1 in January to 54.3 in March (just 8 weeks!) I was previously on Testim and had no problem, but in the last year switched to weekly T cypionate injections (0.5ml per week, 100mg of T). Other stuff I've read online (I'm not allowed to post links since this is my first post) from studies says risk of thrombotic events is "inconclusive" etc etc - or recommends stopping TRT as the solution to increased Hct. I would really like to have something from a medical source that agrees that TRT should be continued when Hct rises above normal and therapeutic phlebotomy used to decrease it, but I can't find anything. Any suggestions?

 

[ERO]

Why can't you just go to the Red Cross and donate? That is what probably 95% of us here on the forum do - Donate blood every 56 days at the Red Cross.

 

[Butchmo]

not everyone can donate

Why can't you just go to the Red Cross and donate? That is what probably 95% of us here on the forum do - Donate blood every 56 days at the Red Cross.

I'm HIV+ so donation isn't an option. My local blood bank will do therapeutic phlebotomy for free, but requires a prescription.

 

[ERO]

Ah, I see your dilemma. I have never tried to get a a prescription for one, and it amazes me that it is this difficult. It would seem like a no-brainer. Your hematrocrit is high, you cannot donate at the Red Cross, so here is your prescription to get it done. Wow...Hopefully some one here has some information to help you, or perhaps Dr. Crisler or Dr. Saya will chime in from Defy Medical with some helpful advice.

 

[Dr Justin Saya MD]

I prescribe therapeutic phlebotomies for my patients ALL the time. With few exceptions (usually site specific) there aren't any problems whatsoever.

 

[Dr Justin Saya MD]

Butchmo - Advice: find a new doctor...ANY new doctor...that understands this aspect of TRT! If they are dropping the ball here, chances are they are dropping the ball in other areas as well. You owe it to yourself to seek better care.

 

[midlifealpha]

I had to use the Defy prescription and go to OneBlood here in Florida. When I went to the Red Cross they didn't take anyone. Now on the other hand there was a blood truck at the office the other day but I didn't go into work I stayed at home. I think in Florida the key is to find when the truck is out in need if you want the free one. Otherwise the prescription from Defy worked great and cost $31 at OneBlood.

 

[gallan]

Where I am in Florida we have OneBlood plus three different hospital systems in a 30 mile radius and none of them are in a central information system together so essentially you could donate at all 4 of them and do monthly or even more frequent phlebotomies with no one the wiser. I did this successfully for awhile when my hematocrit was running high all the time. I also crashed my ferritin but supplementation has fixed that.