# Therapeutic Phlebotomy



## Redloh (Apr 25, 2022)

Background: I'm on TRT, and my hematocrit runs high (51-52%). I'd like to get it back down to mid-upper 40s. When I lived in the same state as my doctor, I would get therapeutic phlebotomy in their office, but that's no longer the case. Now, the best they can do is give me a handwritten script for me to get it at another lab of my choosing. However, LabCorp and Quest require an official lab requisition (barcoded, etc. like from privatemdlabs). I've also tried calling other clinics in my area, but none are able to provide the service unless they are the ones treating me. Most are even very skeptical about the request in the first place for my "normal" hematocrit, even though its clearly at the high upper end. Lastly, I can't go to Red Cross because as a child I contracted hep c (now cured) from my mother.

Has anyone encountered this situation, and does anyone know of any way to order a lab req for therapeutic phlebotomy? Thanks!


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## Adrenolin (Apr 25, 2022)

Redloh said:


> Background: I'm on TRT, and my hematocrit runs high (51-52%). I'd like to get it back down to mid-upper 40s. When I lived in the same state as my doctor, I would get therapeutic phlebotomy in their office, but that's no longer the case. Now, the best they can do is give me a handwritten script for me to get it at another lab of my choosing. However, LabCorp and Quest require an official lab requisition (barcoded, etc. like from privatemdlabs). I've also tried calling other clinics in my area, but none are able to provide the service unless they are the ones treating me. Most are even very skeptical about the request in the first place for my "normal" hematocrit, even though its clearly at the high upper end. Lastly, I can't go to Red Cross because as a child I contracted hep c (now cured) from my mother.
> 
> Has anyone encountered this situation, and does anyone know of any way to order a lab req for therapeutic phlebotomy? Thanks!


Do it yourself.  I have... wasn't fun, but it definitely helped.


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## Adrenolin (Apr 25, 2022)

Blood Draw Kit K-Shield Advantage Blood Bag BK-64A Each/1
					

Blood Draw Kit K-Shield Advantage Blood Bag BK-64A Each/1




					heymedsupply.com
				





I didn't use anything like that.. but that is probably what you're looking for if you're gonna do it at home. 

I just used an 18ga pin on a 5cc barrel, put it in a vein and pulled back until the plunger came out of the barrel.  The blood flowed strong and filled a 2 cup measuring cup in a couple minutes. Crude, but effective.


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## Redloh (Apr 25, 2022)

Adrenolin said:


> Do it yourself.  I have... wasn't fun, but it definitely helped.


I did this last year actually and made the mistake of tossing it in the trash double-bagged in the summer. Smelled like a corpse outside that week!

Besides some psychosomatic hesitance (IV makes me light-headed for some reason; no issues w/ my IM shots), the other problem with doing it myself was flow stopped after half the IV bag was filled. Used 21g IV needle. Maybe a bad angle, vein collapsed, coagulated, etc? May try again if all else fails


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## Redloh (Apr 25, 2022)

Adrenolin said:


> I didn't use anything like that.. but that is probably what you're looking for if you're gonna do it at home.
> 
> I just used an 18ga pin on a 5cc barrel, put it in a vein and pulled back until the plunger came out of the barrel.  The blood flowed strong and filled a 2 cup measuring cup in a couple minutes. Crude, but effective.


Dear lord 18ga... I might have to do the lemon trick to keep from blacking out lol


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## Adrenolin (Apr 25, 2022)

Redloh said:


> Dear lord 18ga... I might have to do the lemon trick to keep from blacking out lol


I don't know that trick, but I'm right there with you.. I hate giving blood. I was scared/nervous of that when I did it as well. 

If you look up home phlebotomy kits, they almost all come with 16ga. I didn't even know about them until someone mentioned them on another forum last week. The 18 was bad enough,  I definitely don't want to go bigger than that, but I suspect it's to help keep the flow. @BRICKS can you shed any light here?


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## Redloh (Apr 25, 2022)

Adrenolin said:


> I don't know that trick, but I'm right there with you.. I hate giving blood. I was scared/nervous of that when I did it as well.
> 
> If you look up home phlebotomy kits, they almost all come with 16ga. I didn't even know about them until someone mentioned them on another forum last week. The 18 was bad enough,  I definitely don't want to go bigger than that, but I suspect it's to help keep the flow. @BRICKS can you shed any light here?





Can't post links yet, but you get the idea. I have a buddy who does tattoos, and he legit keeps lemons on hand for clients that get woozy

16ga is basically a capri sun straw. My pin was too small I guess, which explains the loss of flow


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## snake (Apr 25, 2022)

Most Dr. will bitch about your crits at 52 but won't do anything about it. Some won't even script ya for some blood letting until you hit 60%


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## Butch_C (Apr 25, 2022)

If it is an issue your doctor should write a script.


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## Redloh (Apr 25, 2022)

Butch_C said:


> If it is an issue your doctor should write a script.


He did, but it's an actual handwritten script. He said he can't order up a blood draw from outside labs for this, which is why they do it in house normally. Other offices in my area won't touch the script unless they are the treating physician. Same goes for places like LabCorp and Quest, which require a lab req.


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## Butch_C (Apr 25, 2022)

Redloh said:


> He did, but it's an actual handwritten script. He said he can't order up a blood draw from outside labs for this, which is why they do it in house normally. Other offices in my area won't touch the script unless they are the treating physician. Same goes for places like LabCorp and Quest, which require a lab req.


Here 1blood will still do a therapeutic blood draw even if you were hep-c as long as you have a script. They may charge as they will dispose of it vr selling it to hospitals.


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## FlyingPapaya (Apr 25, 2022)

Donate whole blood???????


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## beefnewton (Apr 25, 2022)

I've had to do this a lot in the past, but it's easy to go anemic if you do it too often.  Red Cross is a real pain to donate.  I was on "permanent deferral" at one time due to being honest about TRT.  Didn't matter that it was doctor-prescribed at the time... blacklisted.  I appealed that, and it had to go all the way to the national director.  After that got resolved,  then they wouldn't take my blood because my blood pressure was always too high (white coat).  After that I just started doing it myself and used 16G needles with an aquarium dosing pump for poor man's peristaltic action.  I hate doing it.. absolutely hate it.  Another blood bank popped up around here, and they've been way easier to work with.  They also take double red cells because mine are so juicy.

Here's a video of it.  Probably over-complicated or a better way, but it works.









						Phlebotomy.mov
					

Shared with Dropbox




					www.dropbox.com


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## Redloh (Apr 25, 2022)

Butch_C said:


> Here 1blood will still do a therapeutic blood draw even if you were hep-c as long as you have a script. They may charge as they will dispose of it vr selling it to hospitals.


I used to live in FL and there were way more places there like 1blood. Good luck in small town Georgia though


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## Redloh (Apr 25, 2022)

beefnewton said:


> I've had to do this a lot in the past, but it's easy to go anemic if you do it too often.  Red Cross is a real pain to donate.  I was on "permanent deferral" at one time due to being honest about TRT.  Didn't matter that it was doctor-prescribed at the time... blacklisted.  I appealed that, and it had to go all the way to the national director.  After that got resolved,  then they wouldn't take my blood because my blood pressure was always too high (white coat).  After that I just started doing it myself and used 16G needles with an aquarium dosing pump for poor man's peristaltic action.  I hate doing it.. absolutely hate it.  Another blood bank popped up around here, and they've been way easier to work with.  They also take double red cells because mine are so juicy.
> 
> Here's a video of it.  Probably over-complicated or a better way, but it works.
> 
> ...


That's actually a pretty creative setup! Don't know anything about aquariums so this was totally not on my radar. I may go that route if 16 or 18ga doesn't do the trick.

I still wish privatemdlabs or the like had an option for donating a pint


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## beefnewton (Apr 25, 2022)

Doctors around here have been terrible when it comes to TRT.  I went through seven local doctors trying to do it proper and legal, but in the end, the last one I had actually did more harm than good.  He's dead, now... probably from following his own advice.  Anyway, after all of that, I just went UGL and started watching my own labs, which included hematocrit.  At one point, I was getting nervous about it and went to a walk-in clinic, explained the situation, and the doctor said something like "we can test it, but even if it's high, we can't do anything about it."  So after that I just learned to do it myself.


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## Redloh (Apr 25, 2022)

Curious about using the dosing pump. What speed setting do you use? I'm imagining a bad scenario of totally fucking up the vein due to speed/suction being too high. Or is that not a concern with those small pumps?


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## BRICKS (Apr 25, 2022)

Adrenolin said:


> I don't know that trick, but I'm right there with you.. I hate giving blood. I was scared/nervous of that when I did it as well.
> 
> If you look up home phlebotomy kits, they almost all come with 16ga. I didn't even know about them until someone mentioned them on another forum last week. The 18 was bad enough,  I definitely don't want to go bigger than that, but I suspect it's to help keep the flow. @BRICKS can you shed any light here?


As far as needles go, the bigger the better, 16 or 14 gauge.  Personally never had to offload blood.  Just had labs done last week for trt doc.  2 weeks post blast Hgb smack dab in the middle of normal.


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## beefnewton (Apr 25, 2022)

Redloh said:


> Curious about using the dosing pump. What speed setting do you use? I'm imagining a bad scenario of totally fucking up the vein due to speed/suction being too high. Or is that not a concern with those small pumps?



It doesn't go that high.  I've often wondered that, too, but I've never had issues.  I have the biggest problem with air getting into the tubing due to the juryrigged coupler I use between the needle and the first run of tubing.  Once air starts getting in, it takes so much longer to finish a draw.  I stopped having that once I started using plumbing tape to seal around the coupler.  Yea, it's a really wonky setup.  I should probably get things that are actually for this purpose, like an actual phlebotomy kit.  But every time I get done, I clean up, and just move on because I don't want to dick around with it any further.  I've done it this way multiple times a year for at least five years.  My biggest concern is always getting the tubes mixed up and end up injecting air, but even then it takes a lot of air and would be very noticeable and easily stopped.  As soon as I pierce the vein, blood starts flowing and would be easily seen going in reverse.


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## Dex (Apr 25, 2022)

18g IV (16g if you can handle the extra girth) and 500 bag of sterile NS. Drain half of the bag. Prime the IV tubing with the NS. Insert the IV into arm and then attach to bag of NS. Hang bag lower than arm. The blood should come out using this method. It will stop by 250ml if you drained half of the bag of NS. 

I can't donate anymore since I'm on blood thinners.


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## Yano (Apr 25, 2022)

My best advice on this if you are going to try it is set up some kind of safety , spring clamp , spring loaded clips , something like that so if you black out and let go, it pinches the line closed tight and you don't bleed out, you don't really want a clip you have to snap or squeeze and hold to close ... no i'm not fucking with you weirder shit has happened trust me  ,,, 

Second tip , use a graduated cylinder , a bottle , a blood bag ,, something that you can get a fairly accurate measurement from. DO NOT just think you can tell whats enough or too much and just drain into the sink.  This is how you get fucked up and pass out. 

As mentioned by other folks an 18g works well for drawing, you can go as small as a 21 thats what they use at the Dr's office to fill the little tubes it will just take longer.


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## tealc (May 4, 2022)

Redloh said:


> Background: I'm on TRT, and my hematocrit runs high (51-52%). I'd like to get it back down to mid-upper 40s. When I lived in the same state as my doctor, I would get therapeutic phlebotomy in their office, but that's no longer the case. Now, the best they can do is give me a handwritten script for me to get it at another lab of my choosing. However, LabCorp and Quest require an official lab requisition (barcoded, etc. like from privatemdlabs). I've also tried calling other clinics in my area, but none are able to provide the service unless they are the ones treating me. Most are even very skeptical about the request in the first place for my "normal" hematocrit, even though its clearly at the high upper end. Lastly, I can't go to Red Cross because as a child I contracted hep c (now cured) from my mother.
> 
> Has anyone encountered this situation, and does anyone know of any way to order a lab req for therapeutic phlebotomy? Thanks!


My dr sends me to the local infusion center at the hospital and I get phlebotomised for $125 each trip. It’s a good racket. I too have issues with Red Cross.


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