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23 Jan 2021

After his index trauma in 2014, however, Mr H begun “cutting.” In the period before his hemochromatosis diagnosis, he was superficially cutting every two weeks, inflicting a new wound as soon as the old wound had healed. And there is no doubt the positive impact that phlebotomy has on our lab test numbers. Select the most convenient donation center for a map and driving directions. However, a relationship between non-suicidal self-injury and therapeutic phlebotomy for hemochromatosis has not previously been described. I would actually say that this is the most common concern about phlebotomy that people with hemochromatosis tell me. Most cannot, but in 1999 the FDA approved that the blood from people with hereditary hemochromatosis posed no greater risk than blood obtained from volunteer blood donors -provided the patient meets all screening and testing requirements. One person told me her phlebotomist uses an ultrasound machine to find a vein, and the process takes an hour. Therapeutic phlebotomy: This procedure uses a needle and tube to remove blood, and the iron it contains, from your body. Find out about Lean Library here, If you have access to journal via a society or associations, read the instructions below. Excess iron causes damage predominantly to the liver, heart, and pancreas. THERAPEUTIC PHLEBOTOMY (BLOOD REMOVAL) A common treatment for hemochromatosis is to remove blood from the body, which reduces the amount of iron circulating in the bloodstream. HFE was the only known gene associated with haemochromatosis but it is now known that there are other genetic associations. By continuing to browse this site, you give consent for cookies to be used. I have listed several resources below, so be sure to call ahead to your local or regional center. Many blood service centers across the United States carry this variance: Find a center in your state here: List of Establishments Granted Approval for Collection of Blood and Blood Products from Patients with Hemochromatosis— Variance to 21CFR640.3(d) and 21CFR640.3(f)<. On the other hand, I have had people tell me their phlebotomist will have difficulty finding a good vein, which may add to the time involved (not to mention the discomfort level). However, a relationship between non-suicidal self-injury and therapeutic phlebotomy for hemochromatosis has not previously been described. Some symptoms can persist beyond the treatment. The larger needle is necessary to protect the red blood cells from becoming damaged. There were 2362 respondents to the survey from the United States. Removing 1 pint of blood is a significant amount! BackgroundSelf-phlebotomy has been described as a form of non-suicidal self-injury. He therefore grew up in an environment where he felt unworthy; “I could never please [them],” and expected punishment for his perceived failings. Further research such as case series and cohort analysis is needed to determine the prevalence of this phenomenon in order to inform the need for practice change. The frequency of how often you have therapeutic phlebotomy depends upon your physician’s recommendations. The removal of blood via therapeutic phlebotomy can improve symptoms and reduce the risk of developing clots. In other words, patients with a background of cluster B personality traits or hopelessness17 who have not previous self-harmed may find positive reinforcement from the experience of regular venesection, leading to a trial of self-harm. Therapeutic phlebotomy (blood removal) — Therapeutic phlebotomy entails periodic removal of blood. Around twice a year, he would cut more deeply, feeling “release” when he watched his blood flow out of the wound. You can be signed in via any or all of the methods shown below at the same time. Search the following list for centers that have applied for a variance for the collection of blood from individuals with hemochromatosis: Search for your state on this comprehensive list of blood service centers in the USA. This decreased to every six weeks by August 2016, and then ceased in May 2017 due to a low hemoglobin count. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Treatment of hemochromatosis can improve symptoms and prevent complications. A person with severe iron overload may need to give blood as much as 8 times in a single month! If the patient does not meet these acceptable criteria, the blood will be discarded. Therapeutic phlebotomy involves the same procedure as blood donation; the primary difference is the frequency of how often we give blood. Although it is difficult to predict the onset of self-harm behaviors, self-reported scales such as the 10-question Adverse Child Experiences Schedule18 may be of use prior to initiation of phlebotomy to ascertain risk. It works by reducing iron overload in the bloodstream and in the tissues. Phlebotomy removes extra iron from your blood. View or download all content the institution has subscribed to. It helps decrease high levels of iron or red blood cells. Therapeutic phlebotomy is a blood draw procedure usually prescribed by a physician as part of a treatment of various medical conditions associated with accumulation of excess iron in the body. It is very clean and very safe, and every step is taken to ensure your comfort throughout the process. Hemochromatosis is a common genetic disorder in which iron may progressively accumulate in the liver, heart, and other organs. The authors would like to thank the patient described in the report for agreeing to publish this case. There are 3 programs associated with therapeutic phlebotomy: Hereditary Hemochromatosis Crossover (HHCX) This program is designated for patients who have a diagnosis of Hereditary Hemochromatosis and DO NOT have any other medical conditions that would require therapeutic phlebotomy. Simply select your manager software from the list below and click on download. As demonstrated in this case, patients at risk of self-harm may be at increased risk of serious injury or accidental death when phlebotomy frequency is suddenly decreased. For more information view the SAGE Journals Article Sharing page. In general, patients are initially depleted of iron as quickly as possible,3,4 usually with removal of one unit of blood every one to two weeks. This is usually down titrated according to hemoglobin concentration, mean cell volume, total iron binding capacity, and ferritin concentration. The treatment of hemochromatosis, polycythemia, and porphyrias. Study design and methods: Surveys were mailed to persons with hemochromatosis identified by health care providers, blood centers, patient advocacy groups, and the Internet. Contact us if you experience any difficulty logging in. As important as it is to get the excess iron out, you should not have to feel terrible during the process. These symptoms had all developed since witnessing a violent death in his workplace in 2014. This scenario is still helpful for the health of a person with hemochromatosis. If another condition caused hemochromatosis, you may need treatment for that, too. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. This procedure is done to treat certain blood disorders, such as hemochromatosis or polycythemia vera. Intended Audience: All facilities providing therapeutic phlebotomies to hemochromatosis patients (Hematologists / Oncologists, blood banks), as well as people who have been diagnosed with hereditary hemochromatosis … Medical Director, Therapeutic Phlebotomy Program . Implanted central venous access ports for therapeutic phlebotomy in patients with HFE hemochromatosis and other non-thalassemia iron overload disorders J Vasc Access . However, a relationship between non-suicidal self-injury and therapeutic phlebotomy for … The primary therapy to normalize iron stores is phlebotomy. Furthermore, this case adds additional evidence behind the “pleasure” and “release” experience of phlebotomy being a real phenomenon. Maintaining a healthy iron and ferritin level becomes the next therapeutic goal. Then, when phlebotomy ceased, he cut much more deeply, requiring specialist emergency intervention. It can be challenging, especially when you do it with high frequency. Create a link to share a read only version of this article with your colleagues and friends. Therapeutic phlebotomy is generally performed once the iron level is high enough. You should consult with a health care professional before starting any diet, exercise, or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. If patients with hemochromatosis meet eligibility criteria, they can donate through Canadian Blood Services every 56 days (for men) or 84 days (for women). It is often a difficult balance to achieve, yet it is essential to try and find that right frequency and amount. Perhaps they have low blood volume and are subject to fainting. The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Jan-Feb 2014;15(1):67. doi: 10.5301/jva.5000155. Hemochromatosis-induced bipolar disorder: a case report, Survival and causes of death in cirrhotic and in noncirrhotic patients with primary hemochromatosis, Food iron absorption in idiopathic hemochromatosis, Suicidal ideation, self-harm and attempted suicide: results from the British Psychiatric Morbidity Survey 2000, Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions, Blood-letting in anorexia nervosa: a case study, Bloodletting, bulimia nervosa and borderline personality disorder, Self-injury: a research review for the practitioner, Physical illness and parasuicide: evidence from the European parasuicide study interview schedule (Epsis/WHO-Euro), Meta-analysis of risk factors for nonsuicidal self-injury, Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis, Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care, The effect of therapeutic phlebotomy for hemochromatosis on non-suicidal self-injury: A case report, A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry. Login failed. Regular blood donation can be done every 8 weeks. Ask your physician (if you haven’t already). When the phlebotomy sessions ceased, he also sought alternative methods of iatrogenic self-harm by presenting to his GP to remove multiple moles; “I substituted cutting myself, for getting my doctor to do it.” Mr H spoke of phlebotomy with an almost wistful longing, talking of the pleasure and relief he felt during treatments. The secondary treatment is using chelating medicines. When calling, please ask for the Therapeutic Department. The primary treatment for hemochromatosis is therapeutic phlebotomy, also known as venesection or blood donation. Hemoglobin in your blood carries iron, so when you lose blood via phlebotomy, you’re essentially also losing iron. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? Treatment schedules vary between patients. Hemochromatosis is a metabolic disorder, not a blood disorder. These statements have not been evaluated by the FDA. It is also known that self-harm rates are in general higher in people with a physical illness.16 This, therefore, raises the possibility of de novo self-injurious behaviors arising from treatment of hemochromatosis. He reports various motivations including a form of self-punishment “when I’m angry at myself,” a method of “release” from an “overwhelming urge,” as well as “as a test” to display his knowledge of human anatomy and prove to himself that he would know how to “take the final step” [suicide] if “the time comes.”. When the frequency of phlebotomy slowed, he restarted his self-injurious behaviors. All the FDA requires is that a blood service center applies for and is granted a variance for the collection of blood and blood products from patients with hemochromatosis. Depending upon your height and weight, your circulatory system holds about 10 to 12 pints of blood at any given time. the site you are agreeing to our use of cookies. A single blood donation removes in the neighborhood of 200 to 250 milligrams of iron. Phlebotomy provides therapeutic benefit to people with hemochromatosis, but also has the potential to benefit other people who are in need of a blood transfusion as well. Having recognized the safety of our blood, the FDA has always allowed individuals with hemochromatosis to donate. Case presentation: We present a case of a 52-year-old man in whom the frequency of his therapeutic phlebotomy and non-suicidal self-injury were inversely linked, leading to adverse outcomes when his phlebotomy was suspended. If you have hemochromatosis and you can donate at a community blood center, donating blood may not only save your life,  it might save someone else’s life, too! You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or treatment. During the procedure or right after it, low blood pressure (which may lead to feeling light-headed, weak, or even fainting) can occur. This case also adds evidence to the use of phlebotomy as a form of NSSI to regulate affect,15 rather than purely a form of weight loss, as reported in previous case studies. Procedure as blood donation but TP requires a doctor ’ s view even if patient. Address and/or password entered does not meet the criteria people have reported to me that begin... An inherited condition that causes increased absorption of iron 2016, Mr H was receiving... Works to make new blood carries iron, so you ’ ll have regular blood donation be! Have too much iron you have too much iron in your blood, your circulatory system holds about to. 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