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How Effective Is Bloodletting Therapy?

Ever heard of withdrawal of blood from the body to prevent or cure illnesses? If not, then you will be surprised to know that an ancient system of medicine called bloodletting has made way into modern medical science. Bloodletting is giving the present day doctors some hope of curing disorders that could be difficult to manage using conventional techniques [1] .

Ancient medicine believed that blood and other bodily fluids had to necessarily remain in proper balance so that good health could be maintained [2] . In the late 19th century, bloodletting was the most common medical practice performed by surgeons. However, it is also important to know that modern day medical science does not permit the use of bloodletting therapy for general ailments, its usage is restricted to the treatment of only some medical conditions.

Read on to know more about bloodletting therapy, how it was used in the ancient days and how effective it is in the present day medical scenario.

What Is Bloodletting?

Bloodletting has been in use for over 100 years to cure illness and restore health. Blood is drawn out of the patient's body to heal him or her. It could either be done by a physician using instruments or with the use of live leeches [3] . In ancient times and according to a few British medical texts, bloodletting was initially recommended for almost all ailments. Some of them are listed below [4] .

  • Asthma
  • Cancer
  • Acne
  • Coma
  • Cholera
  • Diabetes
  • Convulsions
  • Epilepsy
  • Gangrene
  • Gout
  • Herpes
  • Indigestion
  • Insanity
  • Jaundice
  • Leprosy
  • Plague
  • Scurvy
  • Pneumonia
  • Ophthalmia
  • Smallpox
  • Stroke
  • Tetanus
  • Tuberculosis

History Of Bloodletting Therapy

In the ancient days, in the absence of specialized treatments specifically for conditions such as hypertension, bloodletting was able to temporarily reduce blood pressure. This was made possible by reducing blood volume through bloodletting therapy [5] . Historical use of bloodletting was never considered harmful to the patients.

Historians believed that ancient Egyptians strictly followed the practice of bloodletting (was proven through the presence of bloodletting instruments in the Egyptian burials) [6] .

The idea of bloodletting was modelled on the process of menstruation. It was believed that one can conduct bleeding for the patient to return to good health conditions. During the Roman Empire, a famous Greek physician advocated physician-initiated bloodletting.

During ancient times, the two key concepts that were used to support the outcomes of bloodletting were [7] as follows:

Blood was first created and then used up; it did not circulate and hence got stagnant in the extremities

Humoural balance formed the basis for illness or health (the four humours being phlegm, yellow bile, black bile and blood - blood being the dormant humour)

The blood (either arterial or venous) to be let out was dependent on the ailment. Greek physicians believed that the way of bloodletting to be followed was dependent on the link between different blood vessels with different organs. For instance, in case of liver problems, bloodletting was done from the vein in the right hand, whereas in case of problems with the spleen, it was done from the vein in the left hand. As the severity of the disease increases, the amount of blood let out would also increase [8] .

Modern Day Bloodletting

In modern medicine, bloodletting is usually addressed as therapeutic phlebotomy. Phlebotomy is defined as the process of making an incision in a vein with a needle. This procedure is called venipuncture [9] . The person performing the procedure is called phlebotomist.

Therapeutic phlebotomy is primarily used to treat conditions such as [10]

Polycythemia vera [11] : This is a stem cell bone marrow disorder. This condition leads to overproduction of red blood cells. There could be variable overproduction of platelets and white blood cells as well. The treatment of this condition includes phlebotomy so that red blood cell mass can be reduced along with a decrease in the chance of dangerous clots.

Haemochromatosis [12] : This is a genetic disorder. The disorder is associated with iron metabolism and leads to abnormal iron accumulation in the heart, joints, liver, pancreas, pituitary and skin. Periodic phlebotomy is used for its treatment so that ferritin levels can be maintained at a reasonable level in order to minimize further iron deposition.

Porphyria cutanea tarda [13] : This is a group of disorders of heme metabolism. This is also associated with an abnormality in iron metabolism. Phlebotomy is used to treat this disorder so that the iron levels can decrease and hence its accumulation in various organs can be prevented.

Leech Therapy

One of the old age bloodletting methodologies that has made a comeback into modern science is leech therapy. It is primarily used in the areas of microsurgery and reimplantation surgery [14] .

Process of leech therapy [15] : Live leeches are attached to the target area to draw blood. The leeches in turn release proteins and peptides that help in blood thinning and hence prevent clotting. Leeches are highly effective in increasing blood circulation. Use of leeches for this therapy helps in the reduction of venous congestion. It also prevents tissue necrosis. Leech therapy is therefore used in postoperative care of skin grafts and re-implanted fingers, ears, and toes.

Acupuncture And Modern Bloodletting

Acupuncture was originally considered a form of bloodletting. The needles used during acupuncture were the lances and the acupuncture points were locations over veins that had to be opened. The Chinese concept of life force (chi) [16] was believed to be present partially in the blood and hence bloodletting could be used to free up the flow of chi. This concept was quite similar to that of the ancient Greek physician who believed that bloodletting allowed the free flow of static blood in the tissues of the body.

Many texts link the functions of the body to celestial events. Acupuncture was able to bring about all the concepts of life force, astrology and blood together. The main idea was to focus on balance and flow [17] , and acupuncture does just that; it uses needling to restore balance and flow to the natural rhythmic motions.

However, as dangers of bloodletting evolved in medical science, the present day acupuncture has been made to purely concentrate on chi and not on blood. The focus now is on just drawing out imaginary toxins.

Nevertheless, bloodletting (along with the modern-day acupuncture) does exist in muted forms in various traditions both in the East and the West.

How Bloodletting Works

Staphylococcus aureus (staph) is a type of bacteria on the skin or nostrils of healthy people. This bacteria is responsible for skin infections such as pimples and boils. Serious infections of the blood, bones and lungs can also occur due to the presence of staph. These bacteria are believed to be turning more and more resistant to antibiotic therapy as days pass by [18] .

Staph thrives on iron compounds. It enables the growth of infection by obtaining iron. Staph is more drawn to a particular kind of iron, which is found in heme - the molecule in red blood cells that helps in carrying oxygen [19] .

When an infection initiates, heme iron is the preferred iron source. If there is no heme available, then the bacterium's chances of thriving may fail. Research has discovered a gene cluster within the bacteria that promotes heme transfer [20] . This is an advantage for the bacterium.

According to studies, when these genes mutate, it gets hard for the bacteria to launch an infection successfully. So, it can be inferred and understood from this theory reported by a medical research team that when there is less amount of available blood, it becomes harder for the bacterium to hunt for enough heme to thrive [21] . In short, less blood would mean that the bacterial pathogens would starve of iron and hence the bacterial growth would slow down.

Bloodletting May Provide Health Benefits For Obese People

A study conducted in Germany suggests that obese people could improve their health by donating blood. Obese people with metabolic syndrome (collection of symptoms associated with heart disease such as high blood pressure) were studied under the research. It was found that donating blood caused a reduction in blood pressure. Other health benefits observed were reduced risk of heart disease [22] .

The study goes on to say that doctors can begin considering blood donation as a possible treatment option for people with metabolic syndrome. However, more studies are yet to be conducted on this treatment possibility to reach conclusive answers.

Bloodletting Helps In Blood Pressure Drop [23]

Studies reveal that high levels of iron are linked to Type 2 diabetes and metabolic syndrome. It was also found through research that bloodletting could possibly reduce blood pressure in patients who suffer from treatment-resistant high blood pressure. Researchers say that bloodletting can show a significant decrease in heart rate and consequently a reduction in blood glucose levels as well.

Can Blood Donation Be Considered A Therapy?

When the volume of blood is reduced through bloodletting, there would also be a decrease in the blood pressure, according to medical experts [24] . Therefore, bloodletting can be considered a therapy to a great extent. However, it is still not clear if this approach can stabilize blood pressure as well in the same patients. The long-term effects of reducing the volume of blood need to be analyzed and studied rigorously to reach a conclusion.

As metabolic syndrome is not contagious, donating the blood by patients who possess this condition would not create any health risks for the receiver.

Withdrawal of blood is the most opted treatment for conditions such as hemochromatosis (a condition wherein there is too much iron build-up in the body) [25] .

Although it has been proved that withdrawal of blood can reduce blood pressure in obese people with metabolic syndrome, it is still unclear if this kind of therapy can reduce the risks associated with conditions like stroke and heart attack.

Side Effects Of Bloodletting

The following are some of the side effects of this therapy [26] :

  • Anaemia
  • Tiredness
  • Dizziness
  • Exhaustion
  • General weakness (asthenia)
  • Fatigue

On A Final Note...

Bloodletting was the most opted treatment method before antibiotics were developed. During the last few hours of America's first president, bloodletting was performed in order to save him (although the technique failed in reviving him) [27] . Highly regarded medical textbooks have advocated bloodletting as the best treatment for acute pneumonia.

Bloodletting has also been used in Ayurveda, Unani (as it is based on using bloodletting for correcting a supposed humoural imbalance) [28] and traditional Chinese systems of alternative medicine.

Many medical experts believe that 100 years from now, physicians might be astonished by the overuse of antibiotics and the human tendency to follow polypharmacy. Also, it is believed that bloodletting would again gain a lot of fame and find extensive usage in the future of medical science where treatments such as radiation and chemotherapy would be considered blunt and harmful.

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Story first published: Monday, March 11, 2019, 9:00 [IST]