Bleeding-edge technology in cardiology - or the mixed blessings of phlebotomy throughout the ages

Cardiovascular benefits of phlebotomy: relationship to changes in hemorheological variables

Renewed interest in the age-old concept of “bloodletting”, a therapeutic approach practiced until as recently as the 19th century, has been stimulated by the knowledge that blood loss, such as following regular donation, is associated with significant reductions in key hemorheological variables, including whole blood viscosity (WBV), plasma viscosity, hematocrit and fibrinogen. An elevated WBV appears to be both a strong predictor of cardiovascular disease and an important factor in the development of atherosclerosis. Elevated WBV through wall shear stress is the most direct physiological parameter that influences the rupture and erosion of vulnerable plaques. In addition to WBV reduction, phlebotomy may reduce an individual’s cardiovascular risk through reductions in excessive iron, oxidative stress and inflammation. Reflecting these findings, blood donation in males has shown significant drops in the incidence of cardiovascular events, as well as in procedures such as percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. Collectively, the available data on the benefits of therapeutic phlebotomy point to the importance of monitoring WBV as part of a cardiovascular risk factor, along with other risk-modifying measures, whenever an increased cardiovascular risk is detected. The development of a scanning capillary tube viscometer allows the measurement of WBV in a clinical setting, which can prove to be valuable in providing an early warning sign of an increased risk of cardiovascular disease.

Bleeding-edge technology in cardiology - or the mixed blessings of phlebotomy throughout the ages

Bloodletting in medicine is as old as mankind. Its survival in modern times and against all odds closely resembles an evolutionary pathway that involves step by step progress, with payoffs and experience gained at each step to refine and improve its use. In order to continue to function in a changing environment and time, diverse applicability is a prerequisite. It is argued that bloodletting is embedded in our common subconscious memory and therefore we should not be surprised that its practice will pop up from time to time to remind us of the very roots of human medical thinking. (Neth Heart J 2010;18:218-22.).