Bloodletting

Bloodletting was a common medical procedure of antiquity that involved draining sometimes large quantities of blood from ill patients. It was believed to be helpful for a plethora of diseases, including everyday ailments like fever and headaches. There were detailed medical protocols for how much blood to take, how often, and from which anatomical locations. In infants,  the entry-point of choice for bloodletting was from the anterior fontenelle, or the “soft spot” on the top of the baby’s still-forming skull.

Modern medicine has demonstrated that bloodletting has little therapeutic benefit for most of the diseases that it was standardly used for. Additionally, bloodletting introduced all sorts of horrific complications like infections, hypovolemic shock, and even brain damage when the needle went too far into the infant’s head.

That being said, I was surprised to discover that there is at least one disease for which bloodletting is effective, and still used today! The disease has to do with iron in the blood. Most people think about blood-iron in the context of iron-deficient anaemia, or not having enough iron to make adequate red blood cells. But, it is also possible to have too much iron in the blood.

Iron overloading in North America is most often due to a genetic disease called hereditary hemachromatosis. It involves a mutation for a protein that normally regulates iron absorption in the gut. As a consequence, the gut absorbs too much iron and the blood becomes “overloaded”. Iron overload can have serious consequences causing damage to the liver, pancreas, pituitary gland, and skin.

Since the body has limited capacity for excreting iron, the best treatment for hereditary hemachromatosis is regular bloodletting to remove the excess iron. Of course, nowadays we use the fancy term “plebotomy”, but the principle is still the same! Neat, eh?