Case Presentation: A 12 year old obese male presented to the Pediatric clinic for evaluation of dyspnea on exertion. Mother reported snoring and restless sleep since 7 years of age. [shmabstracts.com]

Doctor's Order Required Michigan law requires that a valid order signed by an authorized person be presented before any laboratory test or procedure can be conducted. [midmichigan.org]

Phlebotomy, known also as bloodletting or venesection, is a major therapeutic procedure that has been performed by physicians in various civilisations since antiquity up to the present 1, 2. [phlebotomytechnicianschools.net]

Studies with JAK inhibitors are presently ongoing. [aetna.com]

• Anemia

  It also emphasizes that anemia per se is not a contraindication to embarking on a therapeutic phlebotomy program. [nejm.org]

  You may develop anemia. Anemia is a low number of red blood cells or a low amount of hemoglobin in your red blood cells. Hemoglobin is a protein that helps carry oxygen throughout your body. Red blood cells use iron to create hemoglobin. [drugs.com]

  Disclosures: Off Label Use: Use of hydroxyurea in children with sickle cell anemia. © 2011 by The American Society of Hematology [bloodjournal.org]

  At anytime during treatment you experience symptoms of heart irregularities or severe abdominal pain or symptoms of anemia, alert your physician immediately. Symptoms of anemia can often be mistaken by a patient as symptoms of iron overload. [irondisorders.org]

• Hypotension

  Notify his primary care provider if he has hypotension or signs and symptoms of dehydration; she may cancel the procedure or order intravenous replacement fluids. [journals.lww.com]

  Interestingly, phlebotomy was only associated with self-limited adverse events (prevalence: 3.5%), such as hypotension, dizziness, syncope, headache, and weakness. [ncbi.nlm.nih.gov]

  Elderly patients with some cardiovascular compromise or cerebral vascular complications should have the volume replaced with saline solution after each procedure to avoid postural hypotension. [emedicine.medscape.com]

  Intolerance of phlebotomy Decreasing the phlebotomy interval to every 2 weeks is necessary in some patients, especially women. 9 In patients who report hypotension or dizziness, the volume of oral salt drinks can be increased; rarely, an intravenous saline [bloodjournal.org]

Tough to answer without a full workup of some kind, and maybe you have done that, I am not familiar with your posting history. Stress in marriage, work, anything, can cause a lot of problems. [allthingsmale.com]

• Thrombocytosis

  PV may also be suspected among the following patients: More than 18 g/dL elevated haemoglobin level in men and more than 16 g/dL in women More than 52% haematocrit in men and more than 47% in women Splenomegaly with or without leucocytosis and thrombocytosis [ephlebotomytraining.com]

  Thrombocythemia and Thrombocytosis. National Heart Lung and Blood Institute [On-line information]. Available online at http://www.nhlbi.nih.gov/health/dci/Diseases/thrm/thrm_what.html. Accessed March 2009. Mayo Clinic Staff (2009 February 3). [labtestsonline.it]

  Tefferi (2012) stated that PV and ET are myelo-proliferative neoplasms (MPN) primarily characterized by erythrocytosis and thrombocytosis, respectively. [aetna.com]

  Patients with thrombotic tendencies or those who develop thrombocytosis after phlebotomy should be treated with marrow suppression; consider anagrelide in younger patients (aged 50-70 y). [emedicine.medscape.com]

In providing TP, BloodworksNW must also undertake a diagnostic review for each patient to determine whether the treatment meets nationally accepted criteria treatment for Hereditary Hemochromatosis. [bloodworksnw.org]

Reviewing these diagnoses will help nurses understand why phlebotomy is an important part of treatment. [ncbi.nlm.nih.gov]

Initiation of therapeutic phlebotomy is based on serum ferritin and does not require liver biopsy Treatment has centered on cytoreduction by therapeutic phlebotomy and/or treatment with cytoreductive pharmaceuticals such as hydroxyurea or [alpha]-interferon [medical-dictionary.thefreedictionary.com]

[…] performed by our Registered Nurse • Q&A discussion during treatment with experienced clinician • No wait time • One-on-one care during treatment • Appointment Reminders when routine treatments are needed • Average time for treatment: 1 hour Further reading [defymedical.com]

What Is the Prognosis for People With Inherited Liver Diseases? With proper treatment, hemochromatosis and alpha-1 antitrypsin deficiency disease are usually not fatal. However, complications associated with the diseases can be. [webmd.com]

Prognosis and treatment of polycythemia vera. Last reviewed June 2013. UpToDate Inc., Waltham, MA. Wang WC, Dwan K. Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease. [aetna.com]

JAK2V617F mutational status and allele burden have little influence on clinical phenotype and prognosis in patients with post-polycythemia vera and post-essential thrombocythemia myelofibrosis. Haematologica. 2009 Jan. 94(1):144-6. [Medline]. [emedicine.medscape.com]

Normal iron metabolism and the pathophysiology of iron overload disorders. Clinic Biochem Rev. 2006; 27 :5–16. [ PMC free article ] [ PubMed ] 47. McLaren CE, McLachlan GJ, Halliday JW, et al. [ncbi.nlm.nih.gov]

Hereditary hemochromatosis: Pathophysiology, diagnosis, and management. Crit Care Nurs Clin North Am. 2008;20(2):191-201, vi. Finazzi G, Barbui T. Evidence and expertise in the management of polycythemia vera and essential thrombocythemia. [aetna.com]

The first 2 trials addressed the use of chronic transfusion to prevent primary stroke; the third utilized the drug hydroxycarbamide (hydroxyurea) and phlebotomy to prevent both recurrent (secondary) stroke and iron over-load in patients who had already [aetna.com]

Tell him to move slowly afterward when changing positions or standing, to prevent light-headedness, faintness, and a rapid drop in blood pressure. Tell him to drink plenty of liquids over the next 24 hours to replace lost fluid. [journals.lww.com]

People with alpha-1 antitrypsin deficiency are able to produce this protein; however, the disease prevents it from entering the bloodstream and it instead accumulates in the liver. [webmd.com]