Case report
Year : 2026 Month : April Volume : 15 Issue : 2 Page : PC01 - PC03 Full Version

Therapeutic Venesection in Patient of Pulmonary Thromboembolism on Heparin: A Case Report
Aishwarya Ajith, R Krishnamoorthy, A Ashwin, M Sampat Kumar, R Niranj Rathan
1. Postgraduate, Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. 2. Head, Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. 3. Associate Professor, Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. 4. Assistant Professor, Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. 5. Associate Professor, Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
 
Correspondence Address :
R Niranj Rathan,
Sri Ramachandra Medical College and Research Institute, Porur,
Chennai-600116, Tamil Nadu, India.
E-mail: dr.aishwaryaajith@gmail.com
 
ABSTRACT
: Therapeutic venesection is a cornerstone in the management of polycythaemia to reduce hyperviscosity and thrombotic risk. However, its application in patients receiving anticoagulation, particularly heparin, is complex due to the potential for bleeding complications. The current case report describes a 40-year-old male who presented with progressive breathlessness, fatigue, and pedal oedema. Laboratory investigations revealed polycythaemia with elevated haemoglobin and haematocrit levels. The patient was diagnosed with acute pulmonary thromboembolism and severe pulmonary artery hypertension. He was initiated on unfractionated heparin therapy. Due to persistent symptoms and hyperviscosity, therapeutic venesection was performed after temporarily withholding heparin. A total volume of 450 mL of blood was removed. The procedure was well tolerated, with stable vital signs, and the patient showed symptomatic improvement following venesection. The present case highlights the therapeutic benefit and safety of venesection in a patient with polycythaemia and pulmonary thromboembolism receiving anticoagulation. Meticulous risk assessment, temporary cessation of anticoagulation at the time of venesection, and strict procedural monitoring were critical in preventing complications. A multidisciplinary approach ensured optimal patient outcomes. The novelty of the current case lies in the successful integration of therapeutic venesection in a high-risk anticoagulated patient, guided by an individualized risk-benefit assessment and coordinated multidisciplinary management to optimise safety and outcomes in complex thrombotic scenarios.
Keywords : Anticoagulation safety, Bleeding complications, Hyperviscosity, Polycythaemia, Pulmonary artery hypertension
DOI and Others : DOI: 10.7860/NJLM/2026/81235.2965 Date of Submission: Jun 19, 2025 Date of Peer Review: Jul 21, 2025 Date of Acceptance: Oct 21, 2025 Date of Publishing: Apr 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Sep 27, 2025 • Manual Googling: Oct 26, 2025 • iThenticate Software: Oct 20, 2025 (5%) ETYMOLOGY: Author Origin EMENDATIONS: 6
 
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