is therapeutic phlebotomy covered by insurance

The combination of hydroxyurea and phlebotomy is not as effective as "standard" transfusion and chelation in preventing secondary stroke and iron over-load. 2019;114(8):1202-1218. Percent dense red blood cells (%DRBC) were measured via an ADVIA hematology analyzer. Repeated phlebotomy resulted in a dramatic decrease in symptoms. Typically, therapeutic phlebotomy consists of (i) removal of unit (450 to 500 ml) of blood weekly until the serum ferritin level is 10 to 20 ug/L, and (ii) maintenance of the serum ferritin level at 50 ug/L or less thereafter by periodic removal of blood. However, the poor symmetry of funnel plot suggested a risk of bias. A total of 34 cases of AGA were treated by blood-letting cupping plus herbal medicine; 21 cases were cured, and 13 cases improved. The presently available treatment options in PV were discussed and recommendations for the clinical management were given. list-style-type: lower-roman; The volume of phlebotomies was 116 to 390 ml/kg/year according to the patients. Zhao et al (2009) examined a more effective therapy for acute GA (AGA). Chin-Yee B, Lazo-Langner A, Butler-Foster T, et al. Available at: http://www.cachnet.org/learning_phlebotomy.html. The authors concluded that pricking blood combined with moxibustion could improve the joint symptoms more effectively and the effect was better than ibuprofen orally. In 2 patients with severe cardiac siderosis, a clinically relevant improvement in myocardial T2* was observed, following phlebotomy and deferasirox therapy (n = 1 each). A study about how to achieve the most effective blood-letting therapy may also need to be conducted in the future. Am J Hematol. Lottenberg R, Hassell KL. Available at:http://www.mayo.edu/cardiologyreview/Chapter63.pdf. These are referred to as therapeutic phlebotomies. During the trial, 11 children in the standard care group suffered a stroke compared to 1 in the transfusion group, odds ratio [OR] of 0.08 (95 % CI: 0.01 to 0.66). Transfusion. TRT patients with TP orders increased 71.4 % during this period. Results of meta-analysis indicated that the therapeutic effect of the pricking blood therapy was significantly superior to that of non-bleeding therapies in relieving migraine [OR = 6.23, 95 % CI: 4.03 to 9.63, Z = 8.24, p < 0.00 001]. } Amelioration of painful crises in sickle cell disease by venesections. Furthermore, UpToDate reviews on Treatment of resistant hypertension (Townsend, 2020), Treatment of hypertension in older adults, particularly isolated systolic hypertension (Egan, 2020) and Overview of hypertension in adults (Basile and Bloch , 2020) do not mention phlebotomy as a management / therapeutic option. Phlebotomy (therapeutic bleeding) is a controlled removal of a large volume (usually a pint or more) of blood. UpToDate [online serial]. 2013;138(7):331-336. The authors concluded that on the basis of diet intervention, electro-acupuncture plus blood-letting puncture and cupping was a better therapy for AGA. Toronto, ON: CACHNET; 2002. Franchini M, Gandini G, Veneri D, et al. Therefore, iron can increase the activity of xanthine oxidase, the sole enzymatic source of urate in human beings. UpToDate [online serial]. On the other hand, menstruating women are seldom afflicted by gout, because the monthly blood loss causes them to accumulate iron to a much lesser degree. Some of these men with hemoglobin levels below that threshold simply present as regular whole blood donors and we don't see them. Treatment of acute gouty arthritis by blood-letting cupping plus herbal medicine. A total of 144 hospitalization days were recorded in the7 patients in the year preceding the treatment. An improvement of the clinical and biochemical picture of porphyria cutanea tarda in both patients was obtained with chloroquine therapy given that their chronic anemia did not permit phlebotomy. 2013;43(5-6):303-312. Tefferi (2012) stated that PV and ET are myelo-proliferative neoplasms (MPN) primarily characterized by erythrocytosis and thrombocytosis, respectively. These researchers carried out a review of TP requests for individuals on TRT at their BC over a 3-year period from 2014 through 2016, as well as the total number of TP collections. During maintenance of NID for 28 months, gouty attacks markedly diminished in every patient, from a cumulative amount of 48 and 53 attacks per year before (year -2, -1), to 32, 11 and 7 during induction (year 0) and maintenance (year +1, +2) of NID, respectively. Lee and colleagues (2017) stated that many people experience the common cold, but there is currently no special treatment. Pediatr Transplant. Neurophysiol Clin. The included articles were examined for bias risk by using the Cochrane risk of bias assessment tool. This pattern coincides with the pattern of iron accumulation. Accessed November 12, 2002. Hepatocellular injury due to acute graft rejection might have contributed to elevated ferritin levels by causing release of stored iron from the hemosiderotic liver graft. 2014;39(3):232-237. When PV is suspected, the presence of a JAK2 mutation confirms the diagnosis and its absence, combined with normal or increased serum erythropoietin level, excludes the diagnosis. } Zhu Y, Yu H, Pan Y, et al. Treatment of hypertension in older adults, particularly isolated systolic hypertension. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and NAFLD with hyperferritinemia. Therapeutic phlebotomy is used to remove excess iron and maintain low normal body iron stores in patients with hemochromatosis. It is one of the preferred treatments for blood disorders. However, all completed clinical trials of hydroxyurea have excluded patients with hemoglobin SC (HbSC) disease; HbSC differs significantly in pathophysiology from HbSS, as HbC does not sickle, but instead causes cellular dehydration which potentiates sickling of HbS. The guideline developers recommend treatment by phlebotomy of patients with non-HFE iron overload who have an elevated hepatic iron concentration. Waltham, MA: UpToDate; reviewed May 2020. Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequentred blood cellstransfusions. Lengfelder (2013) presented an overview on relevant topics of pathogenesis and diagnosis of PV. A decrease in gout flares following phlebotomy to attain NID levels in hyperuricemic patients is also suggestive of a role in gout. Seventy-six percent of respondents reported full or partial insurance coverage of therapeutic phlebotomy charges. Read more about how MDsave works. eMedicine Internal Medicine Topic 975. Peto TE, Pippard MJ, Weatherall DJ. Charnow (2018) noted that previous research suggested a plausible link between iron and gout, and ferritin stores excess iron, and urate acts as an iron chelator. The 10-year risk of leukemic/fibrotic transformation is less than 1 %/1 % in ET and less than 3 %/10 % in PV. 1986;114(5):621-629. .newText { list-style-type: decimal; Compared with anti-hypertensive drugs, blood pressure (BP) was significantly reduced by BLT (RR = 1.21, 95 % CI: 1.01 to 1.44, p = 0.03; heterogeneity: p = 0.06, I2 = 60 %) and BPAD (RR = 1.25, 95 % CI: 1.02 to 1.53, p = 0.03; heterogeneity: p = 0.01, I2 = 71 %). --> Waltham, MA: UpToDate; reviewed May 2020. The volumes and frequencies of phlebotomies were adjusted according to the patients ages, the Hb concentrations and the serum ferritin levels. In the WM group, 0.3 g ibuprofen was prescribed orally twice-daily for 10 days. Is therapeutic phlebotomy covered by insurance? Dtsch Med Wochenschr. - (must be completed for Medicare patients where the reason for phlebotomy is not covered by insurance . One possible explanation is that the higher hematocrit in these syndromes may contribute to an increase in blood viscosity, leading to vaso-occlusive pain episodes as well as an increased incidence of thrombo-embolic complications and retinopathy. Asian J Androl. 2018;20(2):195-199. Peto odds ratios with their 95 % confidence intervals (CI) and Forrest plots were generated for each variable to assess the relationships among the studies that had provided that information. 2020;154(1):33-37. } }. Fatigue, bruising, dehydration, and dizziness were among the most commonly reported adverse effects of phlebotomy (Table 1). This patient no longer requires narcotic analgesics for pain, has resolution of constitutional symptoms, and has not required further hospitalizations for vaso-occlusive pain crises. Iron overload and prolonged ingestion of iron supplements: Clinical features and mutation analysis of hemochromatosis-associated genes in four cases. 2017;96(51):e9315. therapeutic agents (OncoTarget/ OncoTreat) Investigational October 1, 2017 December 21, 2022 0021U : Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5' - UTR-BMI1, CEP 164, 3'-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score (Apifiny ) The authorsinitiated a therapeutic phlebotomy program in order to lower the hematocrit to pre-splenectomy values, as well as to induce iron deficiency. Seventy-six percent received therapeutic phlebotomy services in a hospital or physician's office and 30 percent in a blood center. Phlebotomy has one course this removes family from the body. These investigatorspresented a patient with Hb SC disease with an excellent baseline functional status who developed splenic infarction at a high altitude. Fatima et al (2018) noted that iron could contribute to gouty inflammation by forming complexes with monosodium urate (MSU) crystals, stimulating oxidative stress through the generation of reactive oxygen species, and contributing to granulocyte and complement activation. Management of acute and cutaneous porphyrias. outline: none; Almost all patients with PV harbor a JAK2 mutation. Badminton MN, Elder GH. Kowdley KV, Brown KE, Ahn J, Sundaram V. ACG Clinical guideline: Hereditary hemochromatosis. The authors stated that phlebotomy is a convenient method for porphyria cutanea tarda combined with beta-thalassemia. Hepatology. 6. The vast majority of Blue Cross Blue Shield insurance plans cover therapy. } 2002;56(4):272-278. The moxibustion was adopted for 10 days. Zhu et al (2015) compared the differences in clinical effectiveness between pricking blood combined with moxibustion and Western medication (WM) for the treatment of AGA. The investigator cited a study (Facchini, 2003) showing that use of phlebotomy to maintain NID levels in patients with hyperuricemia was associated with a marked decrease in the incidence and severity of gouty attacks. You may have lightheadedness, dizziness, sweating, paleness, or fatigue after a phlebotomy. Rheumatology (Oxford). } Therapeutic phlebotomy for testosterone-induced polycythemia. Get the phlebotomist professional liability insurance coverage through CM&F today! width: 100%; The author examined whether or not iron removal may improve the outcome of gouty arthritis (GA) in humans as well. A trial of phlebotomy to reduce viscosity in patients with higher hematocrit values should be considered as an intervention for symptomatic patients with sickle cell disease. Franchini M, Veneri D. Hereditary hemochromatosis. Dermatologica. When applied before iron overload becomes severe, this treatment also prevents complications of iron overload, including hepatic cirrhosis, primary liver cancer, diabetes mellitus, hypogonadotrophic hypogonadism, joint disease, and cardiomyopathy. Alcohol and iron greatly affect most of these aspects. Markham et al (2003) stated that marked variability is a keynote in the disease course of patients withHb SC (Hb SC) and hemoglobin S/beta(+)-thalassemia (Hb S/beta(+)-thal), with some patients having a frequency of complications and painful episodes similar to patients with homozygous sickle cell (Hb SS) disease. Patient 4 had no anemia and no coding region mutations in HFE, TFR2, HAMP, FPN1, HJV, or ALAS2. Adults with cyanotic congenital heart disease: Hematologic management. The phlebotomy plus IFN group and the IFN group did not differ with respect to the percentage of patients with cirrhosis or genotype 1. z-index: 99; Chin-Yee et al (2017) noted that polycythemia is the most common adverse effect of testosterone replacement therapy (TRT) and may predispose patients to adverse vascular events. The authors stated that they have presented a protocol for a systematic review of BL for the common cold; they hoped that this study will form the basis to conduct additional research and provide evidence for the use of BL for the common cold. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Int J Clin Pract. OL OL LI { J Blood Med. text-decoration: underline; Therapeutic phlebotomy was performed every 41 weeks, and the initial procedure was performed at 5 mL/kg, although the subsequent phlebotomy volumes were increased to 10 mL/kg with a maximum of 500 mL in cases with Hb levels of 8 g/dL. Moreover, they stated that these preliminary data are encouraging to design a larger, controlled trial to assess the value of such a strategy to improve functional symptoms in PMS patients, and maybe to prevent axonal degeneration. If the hematocrit cannot be kept below the upper limit of normal, even when the serum testosterone concentration is at the low end of the normal range during testosterone treatment, the patient should be evaluated for hypoxia and sleep apnea. The authors concluded deferasirox treatment or phlebotomy reduced iron burden in pediatric patients with beta-thalassemia major post-HSCT, with a manageable safety profile. The stroke rate (7 strokes on hydroxyurea and phlebotomy, none on transfusion and chelation, OR of 16.49 (95 % CI: 0.92 to 294.84)) was within the non-inferiority margin, but the liver iron content was not better in the alternative arm. } For patients at high risk for thrombosis (i.e., age of greater than 60, prior thrombosis), we recommend that treatment with phlebotomy be supplemented with the use of a myelosuppressive agent. Greenway A, Ware RE, Thornburg CD. Hematology Am Soc Hematol Educ Program. After the right amount of blood is drawn, the nurse will remove the needle and place a pressure bandage (bandage that wraps around your arm) over the needle site (the place on your arm where the . The mean number of pellets administered was 12 (range of 6 to 16). Peto odds ratio for SVR in phlebotomy plus IFN group was 2.7; 95 % CI: 1.6 to 4.5, p < 0.0001. The appropriate dose is 75 to 100 mg/day. The degree of risk must be balanced against the burden of chronic transfusions. Rotker KL, Alavian M, Nelson B, et al. Randomized and quasi-randomized controlled trials comparing blood transfusion as prophylaxis for stroke in people with sickle cell disease to alternative or no treatment were selected for analysis. 2008;53(3):815-822. Wheeler CJ, Kowdley KV. Porphyria cutanea tarda. Postgrad Med. Follow-up with monthly phlebotomies after discharge yielded a favorable outcome with normal transplant functions. @media print { } The mean follow-up was 566 days. Phlebotomy improves therapeutic response to interferon in patients with chronic hepatitis C: A meta-analysis of six prospective randomized controlled trials. Hemochromatosis (including hereditary hemochromatosis); Individuals receiving testosterone therapy if hematocrit is greater than or equal to 54 % (or hemoglobin is greater than or equal to 180 g/L); Non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration; Chronic hepatitis C (adjunctive therapy with interferon), Hyperferritinemia in alcohol liver disease, Myeloproliferative disorders without polycythemia vera, removal of 1 unit (450 to 500 ml) of blood weekly until the serum ferritin level is 10 to 20 ug/L, and. This study aims to evaluate the safety and effectiveness of BL for the common cold. ; Writing Committee of the General Haematology Task Force. The following code (s) above E83.119 contain annotation back-references that may be applicable to E83.119 : E00-E89. Statistical analysis was performed using Comprehensive Meta-Analysis version 2.0. . These findings raised concerns regarding the persistent risk of vascular events in these donors, especially when coupled with the misperception by patients and health care providers that donation has reduced or eliminated the risks of TRT-induced polycythemia. Barton JC, McDonnell SM, Adams PC, et al. .headerBar { The authors concluded that large scale clinical trials are needed to evaluate the safety and effectiveness of hydroxyurea and hydroxyurea with phlebotomy in patients with HbSC disease. .arrowPurpleSmall, a:hover.arrowPurpleSmall { View Lab Locations Employment drug testing Patient 2 had spherocytosis and no HFE coding region mutations. Medicare covers medically necessary blood tests ordered by a physician based on Medicare guidelines. Accessed November 12, 2002. 2011;54(1):328-343. Magnetic resonance imaging (MRI)-assessed liver iron concentration (LIC) decreased with deferasirox (mean 12.5 10.1 to 8.5 9.3 mg Fe/g dry weight [dw]; p = 0.0005 versus baseline) and phlebotomy (10.2 6.8 to 8.3 9.2 mg Fe/g dw; p = 0.05). Therapeutic Phlebotomy Therapeutic Phlebotomy Filter Sort By Product Name 1 Item Show 15 These products are for therapeutic purposes only for our patients. padding: 10px; In contrast, the risk of thrombosis exceeds 20 %. # color: white; Bouchair et al (2000) reported the findings of sickle cell disease patients who suffered from frequent painful crises and were submitted to phlebotomies in order to reduce hospitalization days due to pain. the concentration of Hb level is known to influence the blood viscosity and its decrease always improved rheology in sickle cell disease patients; the mean corpuscularHb concentration is a critical factor concerning the HbS molecule polymerization in sickle cell disease, and its slight reduction may have an important biological effect. } Accessed November 12, 2002. Hepatology. UpToDate [online serial]. } Therapeutic Phlebotomy Learn More Filter See order and shipping status Track order history Check out faster Biomed Res Int. list-style-type: upper-roman; #closethis { The authors concluded that the STOP trial demonstrated a significantly reduced risk of stroke in participants with abnormal transcranial Doppler ultrasonography velocities receiving regular blood transfusions. You may need to wait in another room for a period of time. In a systematic review and meta-analysis of RCTs, Xiong and colleagues (2019) examined the safety and efficacy of blood-letting therapy (BLT) in the treatment of hypertension. Gout risk possibly linked to iron intake. Under Article Title changed title from "Infusion, Injection and Hydration Services" to "Billing and Coding: Infusion, Injection and Hydration Services". 1 Egan BM. De Gobbi et al (2000) noted that juvenile hemochromatosis is a rare genetic disorder that causes iron overload. .strikeThrough { 2003;42(12):1550-1555. Inati A, Kahale M, Sbeiti N, et al. Fifth, decreased UA elimination, caused by molybdenum and sulfur binding to copper in the kidneys. Adult congenital heart disease. If your insurance company isn't covering mobile phlebotomy service, VeniExpress is currently offering a special discount for patients over the age of 60. High-risk patients should receive cytoreductive therapy with hydroxyurea or interferon alpha. font-size: 18px; Inati et al (2017) stated that iron overload is well documented in patients with beta-thalassemia major, and patients who have undergone hematopoietic stem cell transplantation (HSCT) remain at risk as a result of pre- and immediate post-HSCT transfusions. Philadelphia-negative classical myeloproliferative neoplasms: Critical concepts and management recommendations from European LeukemiaNet. For a few rare blood disorders, however, phlebotomy is performed as a medical intervention for disease management. This can lead to fainting. However, few studies have provided evidence for the safety and efficacy of BL for the common cold. 1988;109(5):406-413. Pediatr Blood Cancer. } Bacon BR, Kwiatkowski JL. The authors stated that although the data showed potential effectiveness of blood-letting therapy in chronic urticaria, the quality of the evidence was low, and there were many aspects that can be improved in future studies. Near-iron deficiency-induced remission of gouty arthritis. These investigators reported a case series of 14 pediatric patients with HbSC treated to maximum tolerated dose (MTD) with hydroxyurea. Furthermore, an UpToDate review on Approach to the patient with suspected iron overload (Bacon and Kwiatkowski, 2021) states that The major treatments for iron overload include phlebotomy for those without significant anemia, and chelation therapy for those with anemia. Where to go for Therapeutic Phlebotomy As a Polycythemia Vera patient, you can not give blood to the Red Cross. Multiple venipunctures (36410 or 36415) during the same encounter, to draw blood specimen (s), may only be billed as a single procedure with units of service = 1 (one) regardless of the number of attempts or veins entered. A phlebotomy performed for therapeutic purposes is an eligible procedure and should be reported under code 99195 (phlebotomy, therapeutic). top: 0px; color: red!important; UpToDate [online serial]. CM&F continues to invest in service and technology helping to support our clients wherever they are. 2006;81(10):760-767. Sixth, precipitation of sodium urate-iron crystals in the joints due to high ferritin and saturated transferrin and low CuZn-SOD and Cu-thionein in the joint. Last Review09/21/2022. Iron overload disorders: Natural history, pathogenesis, diagnosis, and therapy. Effective for dates of service on or after May 1, 2021, procedure code 99195 for therapeutic phlebotomy will become a benefit of the Children with Special Health Care Needs (CSHCN) Services Program. The American Association for the Study of Liver Diseases' clinical practice guideline on "Diagnosis and management of hemochromatosis" (Bacon et al, 2011) stated that the guideline developers recommended treatment by phlebotomy of patients with non-hereditary hemochromatosis (HFE) iron overload who have an elevated hepatic iron concentration. } Li et al (2022) noted that blood-letting therapy (BLT) is often used for the treatment of AGA; however, limited evidence-based reports exist on the safety and effectiveness of BLT. An evidence-based approach to the treatment of adults with sickle cell disease. A JAK2 mutation is found in approximately 60 % of patients with ET. 2002;2(3):330-336. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. The striking decrease of the number of hospitalization days for all the patients suggests a closed relationship between therapy and clinical improvement. Moreover, the authors stated that confirmation of this will require RCT with detailed pre-treatment iron studies and appropriately powered to demonstrate a statistically significant benefit. Tefferi A. Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. The median time to development of polycythemia whereby 50 % of patients developed polycythemia was 50 months. These findings suggested that individuals on TRT may be presenting to BCs as volunteer blood donors to avoid charges for TP. Summarell CC, Sheehan VA. eMedicine Internal Medicine Topic 449. 09/21/2022 Waltham, MA: UpToDate; reviewed June 2013. color:#eee; The doubtful applicability of this evidenceto pegylated IFN was also highlighted. Dig Dis Sci. border-width:0; In 4 patients with PMS, blood-letting was performed until ID was induced, and then rhEPO was administered (300 UI/kg/week). The mean Hb level at all clinic visits was 173 g/L (range of 134 to 205 g/L; n = 108); Hb concentrations of 180 g/L or more (calculated HCT of greater than or equal to 54%) were measured at 25 % of appointments. The 2023 edition of ICD-10-CM E83.119 became effective on October 1, 2022. Waltham, MA: UpToDate; reviewed May 2020. Ann Intern Med. This list only includes tests, items and services that are covered no matter where you live. Hepatology. Markham MJ, Lottenberg R, Zumberg M. Role of phlebotomy in the management of hemoglobin SC disease: Case report and review of the literature. These researchers noted that Kowdley et al recently demonstrated in a multi-center study in 628 adult patients with NAFLD from the NAFLD-clinical research network database with central re-evaluation of liver histology and iron staining that the increased serum ferritin level was an independent predictor of liver damage in patients with NAFLD, and was useful to identify NAFLD patients at risk of non-alcoholic steatohepatitis and advanced fibrosis. The authors concluded that these findings indicated that incorporation of serum ferritin level may improve the performance of non-invasive scoring of liver damage in patients with NAFLD, and that iron depletion (most frequently achieved by phlebotomy) still represents an attractive therapeutic target to prevent the progression of liver damage in these patients. Both patients were also suffering from hepatitis C virus infection, iron overload and anemia. Therapeutic phlebotomy: A review of diagnoses and treatment considerations. A total of 40 patients with AGA were randomly divided into a pricking blood combined with moxibustion group (a combination group) and a WM group, 20 cases in each group. Seventh, development of inflammation, triggered by tyrosine bonding to the sodium-urate-iron crystals and being transformed by tyrosine kinase. Following splenectomy, the patient developed a sustained increase in hematocrit, an increase in the frequency of painful episodes, as well as new-onset dizziness and malaise. Early attempts to lower iron burden including chelation therapy and/or phlebotomy should be considered to avoid organ toxicity and transplant failure. You may also be given a drink or light snack. These investigators also stated that maintenance of NID by depleting the levels via phlebotomy in patients with gout induces either complete or marked reduction in incidence and severity of gout flares in humans. Treatment of resistant hypertension. Four classifications of blood disorders are discussed here for which symptoms and complications can be managed by the use of therapeutic phlebotomy. Liver transplantation from a deceased donor with -thalassemia intermedia is not contraindicated: A case report. JG Murphy, ed. In a meta-analysis of randomized controlled trials (RCTs), Desai and colleagues (2008) compared phlebotomy and IFN to IFN alone for the treatment of chronic hepatitis C (CHC). The authors concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established. The authors concluded that the therapeutic effect of this therapy was satisfactory for AGA. They conducted an institutional review board (IRB)-approved, single-center, retrospective chart review (2009 to 2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Thalassemia intermedia patients can be candidates of liver donors to decrease pre-transplant wait-list mortality. Length of treatment varied between 6 and 12 months. Sustained viral response was attained in 50/182 (27 %) patients in the phlebotomy plus IFN group, compared to 22/185 (12 %) patients in the IFN group.

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