Hi Jan, replacing the equal amount of normal saline is done to maintain the blood volume, and also important especially in older people who have cardiovascular conditions. Otherwise when a person stands up without the saline, it could cause a serious drop in blood pressure.

I'm sure it's because a healthy person's blood reproduces itself in a healthy manner. Where a PV person's blood (that is not normal), it's far too "thick" which is why it's being removed. The correct protocol for a PV patient having Phlebotomy is replacing the same amount of blood removed with either Saline solution or Lactated Ringers (equal parts, typically 500 ml's of blood removed, then 500 ml's of solution inserted). This helps thin their blood (which helps keep blood clots from forming in the heart, brain/strokes, or lungs). A PV patient's bone marrow is severely compromised, so doing the fluid replacement after a Phlebotomy session also helps relating to the patient's bone marrow's health.

I have had an MPN for 24 years and not heard nor read of what you are saying about replacement fluids, but will see what my Dr. says.

Blood banks can actually be a good alternative for uninsured or underinsured patients when phlebotomies are needed, even tho they don’t want your blood they can do the draw and throw the blood away.

That’s interesting about the apple juice, Rosanna, but makes sense. They never offer me juice until the end of the phlebotomy.

I'm so sorry for everything you've gone through, and continue to be going through. I "knew" something was really wrong with me before my Hem & Hemo levels started going above the "normal reference ranges" in 2016. I wasn't referred to an Onco/Hema until towards the end of 2017, beginning of 2018 (challenge in getting an appointment at the Cancer Institute). I just read your post again, and realized how you spell Hematologist differently than here in the USA. Many of my long-time friends live in the UK, and they spell things differently over there too. Yes, please talk to your Hemo Doc about immediately after the # of ml's of blood are removed, that using the same IV line, to replace the same quantity of ml's that were removed with at least Saline solution, or even better in the USA is called "Lactated Ringers." It really helps relating to your bone marrow's health. And both the Cancer Institute, and now the hospital's "Infusion Lab" that I have my Phlebotomy sessions done always have me start drinking little cold containers of apple juice at the same time they've begun removing the blood. My blood is really thick, so someone has to sit and monitor how the blood is flowing through the IV line into the collection container, because mine clots so easily that they often have to "flush the IV line" with saline, to get my blood to start flowing (out) again. I am 5'5" in height, and weigh 118 pounds. That's pretty much the standard here for anyone having blood removed (even if it's a 200 pound male). Keep me updated, and the hospital's Infusion Lab staff is amazing. But they're very strict in that the patient has to start drinking the little sealed 4 ounce cups of cold apple juice the moment they start withdrawing the blood. And you have to drink 3 of the containers. They said that's to insure that the patients glucose levels stay stabilized throughout the Phlebotomy sessions. Nice to meet you!