Therapeutic phlebotomy ...

[fireman-163]

I have been on trt for almost 2 years. I had great results with the trt dose but had plateaued .. I decided to do a 12 week "cycle" of 300mg test cyp a week . I know a lot of guys have told me don't take less than 500mg a week but I wanted to start low as possible and see how it goes and have read that 300mg is more than enough to make gains ...Well I'm 4 weeks In and have low level polycythmia , hemoglobin is 18.1 and hematocrit of 50 a problem I have had before on just 100 mg a week trt dose but my doctor ordered therapeutic phlebotomy every 3 months and that kept it in check (high normal) well last week he wasn't satisfied with maintaining a high normal level and rewrote my scipt for once a week therapeutic phlebotomy till I come from an 18 to a 12 hemoglobin level! And left it so I can go in as often as I need to up to once a week to maintain after that... Which sounds good but my question is should I just stop my higher dose or "cycle" while I'm doing this once a week draw for several weeks? Any one been through this? Will it keep climbing at 300mg a week with weekly one unit blood letings? I'm guessing just losing that much blood weekly is going to make me weaker in general after 2 or 3 weeks. Should I just stop ?? I'm 4 weeks in I was just staring to see gains..

 

[Burrr]

12 seems really really low. I'm no doc, but weekly blood letting sounds like it could lead to other problems. I'd read up on it and educate yourself, unless you have unwaivering faith in that doc of yours

 

[fireman-163]

Yeah he just wants me to do it once a week till I'm down to 12 then matain with once every 2 months or so as needed. He does not know I've bumped my dose up..wouldn't be cool with it. I hadn't yet when I took his last blood test which came out high normal after 4 weeks of 300mg it only went up a little less than a point a .5 rise maybe..when they drew the first unit today. I'm going to do it for at least 3 weeks and see how it goes id be happy and stop with a 15.. I just hope it goes down with out me having to stop.

 

[Burrr]

Personally, I routinely see hemoglobin over 17 and crits above 55% and my Docs have no concerns over it. While I do live at high altitude, and those are common numbers up here, I've seen lots of guys post on cycle bloods with similar levels.
Acceptable limits on bloods are 17.7 and 51%, at least for a quest blood test.

I was under the understanding that you can do harm by giving blood to often, even when you have high RBC numbers. Loss of iron comes to mind.

 

[fireman-163]

Yeah i thought about that and just the fact that that much blood loss is sure to effect my energy and strength levels.. They are testing iron and feraratin every time before they draw Usually I have no problems when I was doing it once every 3 months but today I actually feel like shit after the draw I got dizzy and nauseous .. I do live in Florida though and it's hot as hell out side today.. Probably added to it "dehydration" maybe.

 

[Dr JIM]

Since when is an arbitrary crit of 50% an indication for therapeutic phlebotomy?

Sounds like misguided protocol medicine to me !

That's analogous to obtaining a "blood culture", or a CBC, or Anitbiotics, or ALL the above on any patient who has a "fever" of greater than 102 F

I mean signs, symptoms or risk factors don't they matter anymore?

 

[Michael Scally MD]

Therapeutic Phlebotomy for Testosterone-Induced Polycythemia: A Blood Center's Perspective

Objectives - To evaluate therapeutic phlebotomy (TP) requests for testosterone replacement therapy (TRT) and to highlight the impact to a blood center (BC) or service that provides TP for individuals on TRT.

Methods - Review of TP requests for individuals on TRT at our BC over a 3-year period from 2014 through 2016, as well as the total number of TP collections.

Results - Total TPs during 2014, 2015, and 2016 were 475, 500, and 569, respectively. Annual TP collections for patients on TRT were 193, 212, and 239, respectively. TRT patients with TP orders increased 71.4% during this period. After discontinuation of TP services for TRT at our BC, 32% continued to donate as volunteer blood donors at our BC.

Conclusions - Our BC observed increased TP requests for patients on TRT from 2014 through 2016. Our findings suggest that individuals on TRT may be presenting to BCs as volunteer blood donors to avoid charges for TP.

Van Buren NL, Hove AJ, French TA, Gorlin JB. Therapeutic Phlebotomy for Testosterone-Induced Polycythemia: A Blood Center's Perspective. American Journal of Clinical Pathology 2020. Therapeutic Phlebotomy for Testosterone-Induced Polycythemia: A Blood Center's Perspective

 

[Michael Scally MD]

How do I…perform therapeutic phlebotomy?

Background: Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting.

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. Providers can prescribe a course of TP for a number of indications, including hereditary hemochromatosis, polycythemia vera, iron overload, and testosterone replacement therapy.

Results: A course of prescribed TP specifies that patients can be phlebotomized more frequently than volunteer blood donors and reassures patients that TP is being performed per the orders of their provider. Prescribed TP also facilitates two-way communication between the referring provider and the transfusion medicine (TM) physician overseeing the TP.

The College of American Pathologists TM checklist describes several requirements regarding the documentation and performance of TP, and electronic medical record systems can be used to demonstrate compliance with these requirements.

Conclusions: TM physicians should discuss the advantages of prescribing TP with providers who mutually care for patients requiring this intervention.

Peedin AR, Karp JK. How do I…perform therapeutic phlebotomy? Transfusion. 2021 Feb 13. doi: 10.1111/trf.16308. Epub ahead of print. PMID: 33580971. https://onlinelibrary.wiley.com/doi/10.1111/trf.16308

 

[malfeasance]

12 seems really really low. I'm no doc, but weekly blood letting sounds like it could lead to other problems. I'd read up on it and educate yourself, unless you have unwaivering faith in that doc of yours

I took mine down to 13 using weekly bloodletting without any issues that I noticed. It went back up to 15 within a couple months of nothing but TRT.