Therapeutic Phlebotomy: Insurance Lab Coverage

Therapeutic phlebotomy is a medical procedure that treats certain blood disorders by removing blood from the body. It is considered a safe and effective treatment for conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda. While therapeutic phlebotomy is often covered by insurance, the specific coverage may vary depending on the insurance provider and the patient's location. Some patients may have to pay out-of-pocket fees for mobile phlebotomy services, but the laboratory testing fees are typically covered by insurance. It is important to check with the insurance provider to understand the specific coverage for therapeutic phlebotomy services.

Polycythemia Vera

PV occurs when there is a mutation in a gene that causes a problem with blood cell production. This mutation happens during a person's lifetime and is rarely inherited from parents. It can occur at any age but is more common in adults between 50 and 75, with men being more likely to get it than women.

The treatment for PV focuses on reducing the risk of complications and easing symptoms. The most common treatment is therapeutic phlebotomy, a procedure in which a specialist called a therapeutic phlebotomist removes blood from the body. This treatment is done frequently at the beginning, sometimes even weekly, and then less often once enough blood has been removed to reduce the body's iron stores. Other treatments include certain medicines, such as chemotherapy drugs and selective serotonin reuptake inhibitors (SSRIs) to relieve itching, which is a common symptom of PV.

While there is no cure for PV, proper treatment can help reduce or delay problems. It is important for individuals with PV to work closely with their healthcare providers to create a treatment plan and maintain physical activity to increase their heart rate and improve blood flow.

Hereditary Hemochromatosis

The condition has several early symptoms, including extreme tiredness, joint pain, abdominal pain, weight loss, and loss of sex drive. As the condition progresses, it can lead to arthritis, liver disease, liver cancer, diabetes, heart abnormalities, and skin discolouration.

While therapeutic phlebotomy is a safe and effective treatment for hereditary hemochromatosis, it is not a cure. Patients with this condition require regular treatment to maintain normal iron levels and prevent organ damage.

Acquired Hemochromatosis

Causes of Acquired Hemochromatosis

• Receiving multiple blood transfusions
• Thalassemia, sickle cell anemia, bone marrow failure, or other causes of severe anemia (usually after a blood transfusion)
• Alcoholic liver disease
• Taking too many iron supplements

Treatment for Acquired Hemochromatosis

The treatment for acquired hemochromatosis is largely the same as for hereditary hemochromatosis. It involves:

• Therapeutic phlebotomy: This procedure involves the removal of blood to reduce excessively high levels of iron.
• Chelation therapy: This involves the use of drugs that bind to iron and remove it from tissues.

Porphyria Cutanea Tarda

PCT is the most common type of porphyria and is one of the five conditions for which therapeutic phlebotomy is commonly used. It is a rare blood disorder that causes the skin to blister when exposed to sunlight. PCT occurs when porphyrin, a chemical in the body that is transformed into haemoglobin, builds up in the blood.

The treatment of PCT focuses on managing and stopping the symptoms. Lifestyle changes, such as limiting alcohol consumption and not smoking, may also help. Common treatment options include phlebotomy, which is the removal of blood to reduce iron, and antimalarial tablets such as chloroquine and hydroxychloroquine.

Post-Transplant Erythrocytosis

PTE is characterised by an elevated red blood cell mass, enhanced reticulocytosis, and heightened iron utilisation. It is thought to be caused by a combination of factors, including the continued secretion of erythropoietin from the diseased and chronically ischemic native kidneys, as well as the action of other growth factors on erythroid progenitors, such as angiotensin II, androgens, and insulin-like growth factor 1 (IGF-1).

PTE is associated with a range of symptoms, including malaise, headache, plethora, lethargy, and dizziness. Thromboembolic events occur in 10-30% of cases, and 1-2% of patients eventually die of associated complications.

The most effective treatment for PTE is inactivation of the renin-angiotensin system (RAS) by an angiotensin-converting enzyme (ACE) inhibitor, or an angiotensin II type 1 AT1 receptor blocker.

Frequently asked questions