My therapeutic self-phlebotomy Experiences and how to replenish iron almost instantly. Warning: last resort

[TRTplus291]

I wanted to post this for the benefit of those of us without access to blood donation or therapeutic phlebotomies for whatever reasons

TLDR for the TLDR: don't do this, it's absolute last resort. I'm crazy and stubborn and hate the US healthcare system so I did it myself 4 times so far, successfully each time.


----------------------------TLDR------------------------------

Supplies:

-Kawasumi dry blood bag
-Quick-release reusable tourniquet
-Medical tape
-Gram scale large enough for bag
-Phone stopwatch function
-2x2" gauze pads
-Self-cohesive stretchy bandage (coban)
-Alcohol swabs
-Paper towels just in case

WAY BEFORE BLOOD DRAW

-Research. Read everything about technique, safety, how much you can safely draw, etc. Watch videos of how the pros do it. Read the rest of this post past the TLDR for other important info and how I replenish iron quickly.

-Practice. Apply, tighten, loosen, and release the tourniquet several times till comfortable with all steps. Close and open the pinch clamp on the blood bag tubing too. Practice wrapping the coban around your arm

-check ferritin levels



BEFORE BLOOD DRAW:


-have good food, hydration, and sleep <--INSANELY IMPORTANT!!! Don't dare to do this if you did not eat/drink/sleep well prior.

-Ideally have a second person available in case you pass out. They should know how to clamp the tubing, release the tourniquet, remove the needle, and apply pressure. I didn't do this step so that makes me stupider and/or braver

-pick area that's easy to clean, no carpeting or rugs

-Wash hands and gather supplies

-have short, written procedure in front of you!

-Cut coban wrap to length, about 2 feet. Roll one end tightly like a cigarette.

-Cut a few short strips of medical tape. Place within easy reach

-tourniquet loosely on upper arm, ready to go

-Gauze pad open and ready

-Swab desired vein, spiralling out. usually big one in elbow crook

-Bag on zeroed-out scale, stopwatch started



DURING DRAW:

-Tighten tourniquet till veins stand up

-pinch needle wings together and Insert needle at shallow angle, about halfway into vein with bevel opening up away from skin.

-while holding tubing with drawn arm hand to keep needle steady, tape needle to arm by placing tape across back end of clear safety shield behind needle wings

-squeeze hand every 5-10 seconds to help flow

-Watch scale number, should go up about 2 g every second. Stop around 500-550 g


AFTER DRAW:


-CLOSE PINCH CLAMP! or big mess
-stop timer
-RELEASE TOURNIQUET! or big mess+big bruise

-Grab gauze with free hand and hold lightly over site
-Grab tubing with drawn arm hand, pull needle out via tubing, while immediately applying firm pressure
-Wrap coban around arm, with "cigarette" over site to make pressure point.

Leave wrap on for at least a few hours to reduce chance of bruising!!!

Enjoy food and water and rest after
Cut needle off bag, throw into sharps. Drain blood into toilet. Yes it's legal and gross.


My results after drawing 3 pints via two draws

Systolic Blood pressure dropped 15-20 points a few days after, even with blood volume restored. No more shortness of breath.

Only minor bruising, mainly because I forgot to release the tourniquet the first time, and took the coban wrap off too soon the second time (opposite arm)

Results after 4 blood draws total: BP dropped another 5 points on average measured one week after last draw. No bruising whatsoever the 3rd and 4th time. It is VERY important to keep the pressure bandage on for at least a few hours afterwards. This reduces the risk of bruising and also helps the wound to heal faster/better for less scarring. The needle cuts a slit through the skin and vein and you want to keep it closed; if a blood clot keeps it open slightly, that area fills with scar tissue. PRESSURE!!!!!

Timeline: First 2 draws 24 hr apart, averaged 689 ml each in early June.
3rd draw late August 707ml in 7:23. Zero bruising, mark healed in 4 days: barely a pink mark then
4th Early October 745 ml in 6:48. Zero bruising, mark healed in 4 days: barely a pink mark then

The whole point of this is to reduce blood viscosity to reduce blood pressure and it worked well.


----REPLENISHING IRON----

Supplies:

-2% plain lidocaine w/preservative
-100ml Vial Uniferon 200 iron dextran (this is technically vet grade but made in exact same facility as human-grade iron dextran. Pharmacosmos is the manufacturer
-Short draw needle, 23-25g
-Long, thin needle for deep IM injection 1.25-1.5", 23-27G
27g 1.25" with 3ml syringe, 25g (preferred!) or 23g 1.5" with 5ml+ syringes
-3 to 5 ml syringe depending on dose


Draw equal amounts lidocaine, then iron into syringe. Inject deep IM into dorsoglute or ventroglute with z-track technique to avoid subq skin/tissue staining. This is also why a long thin needle is required!!!! There will be a mild to moderate ache the next couple days but should not be debilitating by any means. 500 ml of blood at 50% HCT will have about 250 mg of iron. Iron is directly proportional to HCT and total draw volume so figure out your iron dose to replenish after each draw.


--------------------------END OF TLDR-(I have a way longer version of this I am willing to post if anyone is willing to read it. Let me know---------------------------

PS Terumo makes a dry blood bag kit also
advantage vs Kawasumi: The Terumo needle is definitely sharper with a longer bevel and makes a cleaner slit (verified with very shallow inserts on my own belly, I sacrifice myself for science here!) Test bags were not used for blood draws FYI

Disadvantages of Terumo (I haven't used these for blood draws yet but plan to next go around):
-Longer 1.5" needle vs 1" Kawasumi needle so more flow resistance/ slower flow
-no extra "backeye" slot at the tip of the needle so flow will be harder to maintain if the tip sucks up to the vein wall
-crappier slide clamp on the tubing vs slick pinch clamp on the Kawasumi. Can prepare a loose knot in the line and pull tight to clamp as a workaround
-50% more cost when bought new. I bought a bunch of expired ones in original packaging for cheap so that's why I got them

 

[KillTheKing]

So you live in the US and there's not a Red Cross anywhere to be found?

 

[nullandvoid]

I've done this many times myself but with an aquarium dosing pump for poor man's peristaltic action, but I was able to stop once a blood bank that isn't Red Cross showed up in the area. Red Cross begs for your blood but then goes out of its way to refuse your donation... blood pressure being my primary issue. It's just fine at home.. 120's/70's, but it gets amped up at doctor's office or anywhere it gets checked (white coat).

For me, self-phlebotomy was an obnoxious process, and I absolutely hated having to do it. The process above sounds way more elegant and proper than the the way I did it. I just kind of worked out a way where I was able to get a needle with tubing inserted with a piece of tape waiting to hold it in place with one hand. Then I'd reach over and start the dosing pump and just sit there for 10-20 minutes uncomfortably.

I just always increased my iron supplements after doing it, but I like the idea of an actual infusion. Donating/dumping does devastate my iron/ferritin, and for years I've had blood chemistry just on the fringe of going shitty. Earlier on I even went full anemic, and that takes a very long time to get yourself out of that hole. I've discovered over time my hematocrit can be a lot higher before needing to worry so have reduced frequency. Blood chemistry and iron/ferritin continue improving.

 

[dick_starbuck]

Why would you ever consider doing this?

 

[rastaman69]

Holy shit. I don't think I'd ever try this myself, and I'm a big fan of doing things myself.

 

[TRTplus291]

Why would you ever consider doing this?

Your question is very understandable.

1) Red Cross and local blood centers don't want blood with non-prescribed anabolics in it. I don't want to question their reasoning and I didn't feel right lying about my use either. Nor did I want to waste their time and resources by having them draw my blood then calling back with "the flu" so they throw it out.

2) Getting a prescription for a therapeutic draw (where it's tossed) is an absolute pain in the city I live in. No good, affordable docs. Basically, it's pick one. I bought many years worth of supplies for the cost of one dr visit in town

3) I can routinely draw more blood (about 700 ml) than they are allowed to draw(450-550 ml), so fewer pokes for the same HCT drop

4) I know my veins and the good spots to poke for consistent flow and no bruising after

5) due to previous bad experiences with US healthcare/insurance I became almost totally DIY as far as my personal health care and am overall better off for it

6) The big fear surrounding DIY phlebotomy (passing out and bleeding out) is somewhat overblown. Using the blood bags it's essentially impossible to overdraw to a dangerous level as the bags are pressure rated to 0.5 bar (7 psi or 380 mmhg) for 10 minutes without leaks, whereas max blood pressure for most of us never exceeds 150 mmhg, so almost a 3:1 safety factor. If the needle falls out early the bleeding will slow down and stop much sooner.

Passing out is still possible but far less likely with good food, hydration, and sleeping beforehand. I didn't feel dizzy or lightheaded at any point during any draw, even my first one.

 

[TRTplus291]

I've done this many times myself but with an aquarium dosing pump for poor man's peristaltic action, but I was able to stop once a blood bank that isn't Red Cross showed up in the area. Red Cross begs for your blood but then goes out of its way to refuse your donation... blood pressure being my primary issue. It's just fine at home.. 120's/70's, but it gets amped up at doctor's office or anywhere it gets checked (white coat).

For me, self-phlebotomy was an obnoxious process, and I absolutely hated having to do it. The process above sounds way more elegant and proper than the the way I did it. I just kind of worked out a way where I was able to get a needle with tubing inserted with a piece of tape waiting to hold it in place with one hand. Then I'd reach over and start the dosing pump and just sit there for 10-20 minutes uncomfortably.

I just always increased my iron supplements after doing it, but I like the idea of an actual infusion. Donating/dumping does devastate my iron/ferritin, and for years I've had blood chemistry just on the fringe of going shitty. Earlier on I even went full anemic, and that takes a very long time to get yourself out of that hole. I've discovered over time my hematocrit can be a lot higher before needing to worry so have reduced frequency. Blood chemistry and iron/ferritin continue improving.

The bags with the tubing and big 16g needles work so consistently. Even my thick blood flowed pretty fast with the Kawasumi kit.

What size needles did you use with the aquarium pump?

I would be very wary of IV iron due to possible infiltration and tissue damage/staining as a result. I found IM to work well with up to 500 mg iron dextran and equal lidocaine, totaling 5 ml. Smaller doses around 300 mg don't even cause muscle soreness for me anymore. If you consider diy IV iron, better be a good vein marksman.

 

[dick_starbuck]

Your question is very understandable.

1) Red Cross and local blood centers don't want blood with non-prescribed anabolics in it. I don't want to question their reasoning and I didn't feel right lying about my use either. Nor did I want to waste their time and resources by having them draw my blood then calling back with "the flu" so they throw it out.

2) Getting a prescription for a therapeutic draw (where it's tossed) is an absolute pain in the city I live in. No good, affordable docs. Basically, it's pick one. I bought many years worth of supplies for the cost of one dr visit in town

3) I can routinely draw more blood (about 700 ml) than they are allowed to draw(450-550 ml), so fewer pokes for the same HCT drop

4) I know my veins and the good spots to poke for consistent flow and no bruising after

5) due to previous bad experiences with US healthcare/insurance I became almost totally DIY as far as my personal health care and am overall better off for it

6) The big fear surrounding DIY phlebotomy (passing out and bleeding out) is somewhat overblown. Using the blood bags it's essentially impossible to overdraw to a dangerous level as the bags are pressure rated to 0.5 bar (7 psi or 380 mmhg) for 10 minutes without leaks, whereas max blood pressure for most of us never exceeds 150 mmhg, so almost a 3:1 safety factor. If the needle falls out early the bleeding will slow down and stop much sooner.

Passing out is still possible but far less likely with good food, hydration, and sleeping beforehand. I didn't feel dizzy or lightheaded at any point during any draw, even my first one.

Thank you for the detailed reply.

Why are you doing phlebotomy in the first place? I thought we, as a community, were past this?

 

[TRTplus291]

Holy shit. I don't think I'd ever try this myself, and I'm a big fan of doing things myself.

I don't blame you. I just finally got too pissed with doctors and blood centers around where I live, with so many rules.
I'm pissed at US healthcare in general as I have fallen between the cracks many times.

So you live in the US and there's not a Red Cross anywhere to be found?

There's a number of them around, but I don't feel right lying to them or other blood centers about my anabolic use, and getting a therapeutic prescription is an absolute pain in my city

 

[TRTplus291]

Thank you for the detailed reply.

Why are you doing phlebotomy in the first place? I thought we, as a community, were past this?

I only did it initially to take the edge off acute high HCT signs/ symptoms I was noticing when I had to stop exercising for some months due to injuries. The soonest affordable doctor appointment was months out and I didn't want to wait that long.

Now that I'm working out and doing cardio again, I won't be doing this much, again more of a last resort if my BP and HCT climb too high, causing symptoms. The iron shots take care of possible ferritin crashes.

Also there's a certain satisfaction in successfully accomplishing something that is taboo to non-medical people. A "pro" once dug around a bunch in one of my veins for a blood test using a much smaller needle. I hit the exact same vein with a 16g for my second phlebotomy, using my non-dominant hand in one go, no adjustments or digging.

I agree that diet/exercise/supplements are preferable to giant needles for controlling HCT long term (I honestly hate daily pills but that's just me)

 

[KillTheKing]

I don't blame you. I just finally got too pissed with doctors and blood centers around where I live, with so many rules.
I'm pissed at US healthcare in general as I have fallen between the cracks many times.

There's a number of them around, but I don't feel right lying to them or other blood centers about my anabolic use, and getting a therapeutic prescription is an absolute pain in my city

You shouldn't feel to bad about lying to them. Whoever gets your blood would be enhanced!

 

[TRTplus291]

You shouldn't feel to bad about lying to them. Whoever gets your blood would be enhanced!

Lol! Deca-enhanced babies. You know they wont be crying due to poor gains!

I get what you're saying and I don't hold it against anyone enhanced who does fudge things to donate, I just didn't feel right doing that myself. Besides, grannies on Tren are dangerous.

 

[nullandvoid]

The bags with the tubing and big 16g needles work so consistently. Even my thick blood flowed pretty fast with the Kawasumi kit.

What size needles did you use with the aquarium pump?

I would be very wary of IV iron due to possible infiltration and tissue damage/staining as a result. I found IM to work well with up to 500 mg iron dextran and equal lidocaine, totaling 5 ml. Smaller doses around 300 mg don't even cause muscle soreness for me anymore. If you consider diy IV iron, better be a good vein marksman.

I use 16g needles, as well. I was actually using the term infusion incorrectly; I was referring to your IM method. I just never considered trying to replenish iron other than oral. Just always seemed a bit more medical than I could handle.

 

[TRTplus291]

I use 16g needles, as well. I was actually using the term infusion incorrectly; I was referring to your IM method. I just never considered trying to replenish iron other than oral. Just always seemed a bit more medical than I could handle.

I found out that the 16g standalone luer lock needles are designed differently than blood bag needles. The blood bag needles are the same outer diameter but have thinner walls for bigger inner diameter=much better flow. Also the kawasumi bag needles have the extra "backeye" slot at the tip so they don't block off nearly as easily.

I could draw blood at over 2 ml/sec for the majority of each draw till the bag filled and the backpressure slowed flow. That's the equivalent of a 480 ml donation in 4 minutes flat which is quite fast.

And remember shorter needles flow better than longer ones all else being equal. Kawasumi bags have 1" needles vs standard 1.5" blood bank needles. That's 1/3 less flow resistance right there!

It took a lot of research before I felt confident enough to inject iron dextran myself, but the brand I mentioned works surprisingly well and pain free when injected as I instructed. For me, it beats twice daily iron pills that caused sulfur burps and were only absorbed around 10% anyways.

 

[rastaman69]

You shouldn't feel to bad about lying to them. Whoever gets your blood would be enhanced!

First time I donated while after starting TRT I was smiling to myself thinking "careful, this batch is coming in a bit hot".

My TRT doc instructs me to either donate blood or get therapeutic phlebotomy when my HCT gets a little high. I generally donate when I'm eligible anyway. I've donated on blast too, whatever.

 

[dick_starbuck]

So are you guys unaware of methods of lowering HCT that don't involve.... this?

 

[nullandvoid]

Yea we're just totally ignorant and haven't tried other methods.

Cue the talk of naringin or nattokinase (spoiler alert: they don't do shit).

 

[dick_starbuck]

Yea we're just totally ignorant and haven't tried other methods.

So you'd rather practice home phlebotomy instead of doing nothing at all, which is perfectly acceptable. Or trying methylene blue or IP6?

Secondary erythrocytosis from androgens is not serious unless you have a genetic clotting condition. I thought this information was well known in our community now?

Adding 5mg methylene blue EOD has dropped my HCT back into normal from high 50s/low 60s. If you're really concerned about it, I'd much rather do that then home phlebotomy.

 

[TRTplus291]

So are you guys unaware of methods of lowering HCT that don't involve.... this?

As I stated in my original post, it's more of a last resort than anything. I personally only do it if I get actual high HCT signs/ symptoms, mainly high BP and shortness of breath at rest in my case. My platelet count is normal so I don't worry about clotting. I make sure my ferritin stays at acceptable levels to boot. Exercise and hydration works best for me to keep HCT from climbing way too high normally. I generally only need to do this once every few months at most. If I can get to the point where I'm exercising near-daily I hope to put off bloodletting indefinitely, though that isn't guaranteed.

This method also reduces PFAS in the body too, though I'm not losing sleep over those regardless. I read that it can lower cholesterol slightly though again don't count on it.

 

[rastaman69]

So you'd rather practice home phlebotomy instead of doing nothing at all, which is perfectly acceptable. Or trying methylene blue or IP6?

Secondary erythrocytosis from androgens is not serious unless you have a genetic clotting condition. I thought this information was well known in our community now?

Adding 5mg methylene blue EOD has dropped my HCT back into normal from high 50s/low 60s. If you're really concerned about it, I'd much rather do that then home phlebotomy.

I've never heard of anybody in forums taking methylene blue. I've tried it, it's such a bizarre substance. My TRT doc actually brought it up. He's an older guy like myself and he said he feels like he can go "just a little bit harder" in the gym with methylene blue. I've never heard of the HCT reduction from it. Do you notice any other benefits?

I stayed the night at my girlfriends house one night after taking it. I used her bathroom in the middle of the night but didn't flush (trying to be quiet). She saw the water the next day and asked about it . It was blue/green.