Specimen Requirements

Requirements for ordering Therapeutic Phlebotomy:

1. Either a CBC or Hematocrit & Hemoglobin order are required to be done prior to every therapeutic phlebotomy blood draw.
2. If the patient's diagnosis is "Hemochromatosis," then a ferritin order is required to be done every 6 months prior to the therapeutic phlebotomy draw.
3. The amount of blood to be removed must be noted (ex: 500mL, 250mL, etc.).
4. Cut off values for the Hemoglobin, Hematcrit, and/or the ferritin must be noted.
5. Frequency and duration of phlebotomy bust be noted.

Basic Requirements needed for order:

1. Patient name and date of birth
2. Provider's signature
3. ICD10 Diagnosis code

Specimen Type: Whole blood

Container/Tube: Blood unit collection bag

Specimen Volume: Physician determined

Specimen Minimum Volume: Physician determined

Collection Instructions:  Collect blood according therapeutic phlebotomy procedure and physician instructions.  Closely observe patient during procedure and follow up with Post Therapeutic Phlebotomy Instructions for Patient  form below.

Specimen Rejection:

If patient is not tolerating blood draw or vital signs are not within range, the procedure may be stopped at any time.