Hazards of phlebotomy in polycythemic patients with cardiovascular disease

Three patients with polycythemia and previous evidence of cardiovascular disease underwent routine phlebotomies. Systolic hypotension followed by ineffective volume replacement with electrolyte solutions developed in all patients after phlebotomy. In two patients acute myocardial infarction and in a third cardiovascular collapse and death were temporally related to the procedure. This experience suggests that phlebotomy in patients with cardiovascular disease should be performed by the slow removal of small volumes of blood under continuous blood pressure monitoring. Effective restoration of the plasma volume with plasma or colloid is essential unless volume overload is present. (JAMA236:2080-2081, 1976)