I second and third Sheryl’s advice about rotating the veins that are used! When I was doing weekly phlebotomies, I made them rotate between the veins on the inside of my elbow veins and those on the back of my hands or forearms, so no vein got used more often than once every four weeks. Once you’re on maintenance and can go two months or longer between phlebotomies, it doesn’t matter quite as much, because a punctured vein should be fully healed in eight weeks . . . but I still think it’s a good idea to rotate as much as possible.
I bleed easily, so they could use a thinner needle (22 gauge) on me, along with putting me in charge of keeping a blood pressure cuff pumped up to whatever they told me, usually around 50 mm of mercury, to help keep the blood flowing through the smaller needle. Thinner needles are easier for the phlebotomist and make a smaller hole in the vein, so less scarring. I know smaller needles won’t work for everyone, but if you bleed easily, it might work for you. If your blood doesn’t flow that easily and you can take aspirin without problems, Sheryl’s suggestion about taking aspirin to help with blood flow through the needle definitely worth a try. You could also ask about taking fish oil: like aspirin, fish oil also stops blood platelets from clumping together so easily, and aspirin and fish oil can be taken together.
Other hints about phlebotomy:
The warmer you are, the more your veins will fill up, and the easier they will be for the phlebotomist to get and the less poking around will be needed - so dress as warmly as you can manage. If I wasn’t nice and warm pre-phlebotomy, I would walk briskly up and down some nearby stairs until I was warm. I also wore a down vest so that I kept toasty even when I had to take my coat off. (And then I used my coat as lap blanket.) If they are willing to do it, having a nice warm compress wrapped around the arm to be used for five minutes or so ahead of time also makes the veins fill up better and it feels lovely. When they swab the skin over the intended puncture site, if they swab upwards – from the hand end up towards the heart – that pushes blood up the vein and may also help a bit in making the vein easier to get.
The lower your arm is, the more your veins will fill up, so make sure the phlebotomist positions your arm low enough so that the target vein is well below heart level. If the target vein is held close to heart level, the vein won't be anywhere near as full. Some of my phlebotomists had a lower stool they would sit on, because it was easier than sitting in a chair for them to align the needle along the vein of an arm that was held below heart level. The really expert phlebotomists could get the right angle whether they were positioned to sight along the needle or not; they just knew by touch the right angle to use.
I found that making sure that I drank a LOT of water the day before and the day of a phlebotomy was helpful, just to make sure I wasn’t dehydrated so my veins couldn’t use that as an excuse for not filling up properly. Taking along a bottle of rehydration solution and drinking it during the phlebotomy also helped – I used a home-made mix of one cup of fruit juice, one cup of water, and 1/8 tsp of salt. That’s about the same electrolyte mix as commercial sports drinks but I think tastes much better! I didn’t chill the drink – I just drank it at room temperature because I didn’t want it to cool me down.
Sheryl’s also bang on about keeping gentle but firm pressure over the phlebotomy site afterwards. I would ask that after the phlebotomist did the last check of the site that she (or he) put on a new cotton puff or folded up gauaze over the puncture and tape it in place with several pieces of tape to provide steady ongoing pressure. Like Sheryl, I’d leave that on for 24 hours and sometimes longer.
And about what your ferritin is doing – Sheryl’s right that there are two reasons for ferritin to be up: the first reason is too much iron, and the second reason is inflammation of some sort. Inflammation can put ferritin up – sometimes way up – even when iron levels are normal or even low. At the beginning, did your doctor do other iron tests (besides ferritin) to show that your iron really was too high, and do a test for inflammation such as the C-reactive protein to make sure that you didn’t have any inflammation that could be putting your ferritin up?
On the subject of inflammation, did they ever find out what caused your jaundice after your surgery? (I’m assuming you tested negative for common liver infections such as hepatitis A, B and C?) If your ferritin was coming down nicely and then bounced back up only after your liver biopsy, then maybe it was just the ferritin going up because of an inflammatory response to the biopsy itself – in that case, your ferritin should start coming down again with your next test. When you said the liver biopsy showed “just mild” – was it mild iron levels in the liver, or mild inflammation of the liver, or mild something else?
I hope some of this will be helpful in talking with your doctor -
