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February 21, 1977

Hazards of Phlebotomy

JAMA. 1977;237(8):768. doi:10.1001/jama.1977.03270350028013

To the Editor.—  In a recent article (236:2080-2081,1976), Kiraly and associates reported the hazards of phlebotomy in three polycythemic patients with cardiovascular disease. The implication was that in these acutely ill patients, the phlebotomies played either the primary or a significant contributing role in the outcome. Although we agree with the authors that the phlebotomies (450 to 500 ml) were excessive and should not generally exceed 200 to 300 ml in such cases, evidence that the excessive venesection altered the outcome was not strong.The first patient, admitted with fever and mental obtundation (never explained), had only a moderate reduction in systolic blood pressure (130 to 100 mm Hg) after the phlebotomy and might well have died from sepsis the following day. The other two patients apparently were admitted with anginal symptoms that developed into full-blown myocardial infarctions approximately one-half and 12 hours after phlebotomy, respectively. The blood pressure reductions