aabb guidelines for therapeutic phlebotomy
36. AABB is now the Association for the Advancement of Blood & Biotherapies. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. } High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. Using comprehensive outcomes was also the common problems of most RCTs of traditional Chinese medicine published in Chinese. Am J Hematol. 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. These investigators stated that therapeutic phlebotomy was feasible and effective, and would prevent complications of iron overload. American Gastroenterological Association medical position statement on the management of hepatitis C. Gastroenterology. 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. Iron depletion was obtained within 28 weeks and was associated with endogenous production of EPO. Dmx8877 February 24, 2023, 2:07am 1. These researchers stated that further rigorously designed trials are needed to confirm these findings. } On the basis of diet intervention, the observation group was treated with electro-acupuncture at local points combined with blood-letting puncture and cupping, and the control group with oral administration of Probenecid. 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. The above policy is based on the following references: Last Review 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. Most patients are candidates for standard phlebotomy. Therapeutic Phlebotomy cont'd LSCM.25 3 Martin Health System Stuart, Florida Laboratory Services Therapeutic Whole Blood Phlebotomy Consent Therapeutic phlebotomy requires the removal of blood by venipuncture for medical reason(s). Rochester, MN: Mayo Clinic; January 2000; Ch. No blood-letting was further required during a 6-month period after introduction of rhEPO. Tefferi A. Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. 2005;10(2):145-149. } 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. Besa EC, Woermann U.Polycythemia vera. 2019;25(2):139-146. AABB is a leader in producing clinical practice guidelines for utilization of blood components. Treatment with busulfan or interferon- is usually effective in hydroxyurea failures. Gumus, Abbasoglu O, Tanyel C, et al. A total of 11 databases will be searched for studies conducted through June 2017. Optimal control is to keep the hematocrit below 45 %in men and 42 % in women. GUIDELINES FOR THERAPEUTIC PHLEBOTOMY PERFORMED BY THE CLINICAL SERVICE Policy: Therapeutic phlebotomies are performed on outpatients and inpatients on a Monday-Friday, 0800-1630 basis either in the DeGowin Blood Center Patient Services area or on the inpatient unit. PROs have been recommended to be reported for RCTs. Matrix Group International, Inc. 2011;29(6):761-770. In the combination group, pricking blood was used at the most painful points of the red turgid and painful joint once every 3 days, a total 3 times; moxibustion was applied at the same joint for 15 to 20 mins, once-daily. Valenti and colleagues (2012) stated that non-alcoholic fatty liver disease (NAFLD), defined by excessive liver fat deposition related to the metabolic syndrome, is a leading cause of progressive liver disease, for which accurate non-invasive staging systems and effective treatments are still lacking. . 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. Am J Gastroenterol. The included articles were examined for bias risk by using the Cochrane risk of bias assessment tool. In addition, the association develops informational documents and guidance regarding a wide range of clinical and technical topics facing transfusion medicine providers. Garza I, Schwedt TJ. Fifth, decreased UA elimination, caused by molybdenum and sulfur binding to copper in the kidneys. OL OL LI { 1988;109(5):406-413. The haematological management of patients with cyanotic congenital heart disease. These investigators searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches and hand-searches of relevant journals and conference proceedings. Survival is near-normal in ET and reasonably long in PV. 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. 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. For additional language assistance: Phlebotomy, therapeutic (separate procedure), Collection of venous blood by venipuncture, Injection interferon beta-1b, 0.25 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered), Injection, interferon alfacon-1, recombinant, 1 mcg, Interferon alfa-2A, recombinant, 3 million units, Interferon alfa-2B, recombinant, 1 million units, Interferon alfa-N3, (human leukocyte derived), 250,000 IU, Injection, interferon beta-1a, 1 mcg for intramuscular use, Injection, pegylated interferon alfa-2a, 180 mcg per ml, Injection, pegylated interferon alfa-2b, 10 mcg per 0.5 ml, Home injectable therapy; interferon, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drug and nursing visits coded separately), per diem, Abnormal level of blood mineral [non-alcoholic fatty liver disease with hyperferritinemia][not covered for hyperferritinemia in alcohol liver disease], Chronic myeloid leukemia, BCR/ABL-positive and negative, Essential (hemorrhagic) throbocythemia [unless with Polycythemia vera], Myelofibrosis [unless with Polycythemia vera], Multiple sclerosis (MS) [progressive multiple sclerosis], Alcoholic liver disease [hyperferritinemia in alcohol liver disease]. Zhao et al (2009) examined a more effective therapy for acute GA (AGA). Mean Hb concentration was 10.7 g/dL before phlebotomies and 8.8 to 9.2 g/dL during the4 years of treatment. Franchini M, Gandini G, Veneri D, et al. Pharma / TRT. Copyright Aetna Inc. All rights reserved. background-color:#eee; The Endocrine Society guidelines suggest stopping therapy if the hematocrit increases to 54 %. 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. What condition might be treated with therapeutic phlebotomy. Waltham, MA: UpToDate; reviewed May 2015. Risk factors for shortened survival in both PV and ET include advanced age, leukocytosis, and history of thrombosis. Almost all patients with PV harbor a JAK2 mutation. Then, a Meta-analysis was made by software Review Manager 5.1. The changes of UA, high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and the joint syndrome and symptom score before and after treatment were observed. Treatment of resistant hypertension. Hematology Am Soc Hematol Educ Program. For this reason, complementary and alternative medicine (CAM) therapies are used to improve the symptoms of the common cold. These researchers presented a pediatric case of a successful liver transplantation from a donor with beta-thalassemia intermedia. Pediatr Blood Cancer. For this purpose we prefer the use of hydroxyurea rather than an alkylating agent, radioactive 32P, or interferon alpha. background-position: right 65%; Kowdley KV, Brown KE, Ahn J, Sundaram V. ACG Clinical guideline: Hereditary hemochromatosis. Exp Biol Med (Maywood). Patient 2 had spherocytosis and no HFE coding region mutations. JC did not tell us that we qualified as a donor center because we draw therapeutic phlebotomies, but we were told that lab staff should not do the vital signs because it is outside of our scope of practice. Juvenile hemochromatosis associated with B-thalassemia treated by phlebotomy and recombinant human erythropoietin. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Hepatocellular injury due to acute graft rejection might have contributed to elevated ferritin levels by causing release of stored iron from the hemosiderotic liver graft. A total of 6prospective RCTs were identified: all used sustained viral response (SVR) as an endpoint. State of Florida- Medical Technologist License in at least one specialty: Immunohematology. 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. &AU$LJe$*l>oJ!|`Nm&qMt These researchers identified 39 patients on TRT who presented for blood donation over a 2-year period. 1984;169(4):184-187. 2010;33(2):81-88. The trial closed early due to a significant difference in risk of stroke between participants who stopped transfusion and those who continued as measured by re-occurrence of abnormal velocities on Doppler examination or the occurrence of overt stroke in the group that stopped transfusion. /ColorSpace 6 0 R /BitsPerComponent 8 /Length 197438 /Filter /FlateDecode } If not otherwise contraindicated because of a history of major bleeding or intolerance, we suggest that aspirin be given to all patients (Grade 2C). The mechanism of this effect is probably multi-factorial: The authorsobserved these two biological modifications intheir patients and suggested that they mediate the clinical effects. UpToDate [online serial]. Therapeutic phlebotomy is used to remove excess iron and maintain low normal body iron stores in patients with hemochromatosis. 2008;53(3):815-822. # color: white; Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Avoid activities that may strain the arm used during your procedure (such as exercise and heavy lifting) for at least 1 day after your procedure. padding: 15px; 2008;20(2):191-201, vi. 2012;18(29):3782-3786. First, the sample size of included studies was small. Lengfelder (2013) presented an overview on relevant topics of pathogenesis and diagnosis of PV. A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified. 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