Three printable decision cards for clinicians working with medicinal leech therapy. Each card is versioned, dated, and reviewer-stamped. Print directly to a single page from your browser.
Cards are educational references. They do not substitute for institutional protocol, infectious disease consult, hematology consult, or active clinical supervision. Verify against your local institution's policies before clinical use.
Suspected or confirmed Aeromonas infection complicating medicinal leech therapy. Adult inpatients and outpatients. Pediatric: consult pediatric ID.
Reviewed by: Andrei Dokukin, MD — ASH Editorial Board
1
Suspect Aeromonas infection
Within 4 weeks of leech therapy: erythema, pain, swelling, purulent drainage, fever, or any soft-tissue infection sign at or near a bite site. Aeromonas is the dominant pathogen because Aeromonas veronii / hydrophila colonise the leech gut.
Onset ranges from within 24 hours of leech application to 10 days or more, with delayed cases reported up to 26 days after the start of therapy
Site adjacent to leech application most common; distant fasciitis possible
Concomitant flap failure is a red flag
2
Workup
Blood cultures ×2, wound culture, CBC, CRP/procalcitonin if available. Imaging (US/CT) if fasciitis or abscess suspected.
Notify microbiology: "history of medicinal leech therapy — query Aeromonas"
Aeromonas grows on standard blood agar but may be missed if not flagged
3
Initiate empiric antibiotic
Cover Aeromonas spp. while awaiting culture. First-line: ciprofloxacin 750 mg PO BID or 400 mg IV BID. Alternatives: TMP-SMX, third-generation cephalosporin + fluoroquinolone, or doxycycline.
AVOID empiric ampicillin / amoxicillin (Aeromonas typically resistant)
AVOID first-generation cephalosporins
Adjust based on culture + susceptibility at 48-72 hours
4
Source control
Drain abscess if present. Debride necrotic tissue. For flap salvage, consult plastic surgery for re-exploration if salvage still viable.
5
Escalate
If sepsis, necrotizing fasciitis, or rapid progression: ICU, broad-spectrum coverage (piperacillin-tazobactam + ciprofloxacin), urgent surgical consult, infectious disease consult.
Necrotizing soft-tissue infection mortality is high; do not delay surgical exploration
Reduce immunosuppression where safely possible
6
Document + report
Document leech batch, supplier, hospital protocol followed, antibiotic prophylaxis history. Report to institutional infection-control and to MAUDE if device-related adverse event.
Cumulative blood loss assessment during leech therapy. Iron supplementation timing. Restrictive transfusion threshold per AABB 2023 guidelines.
Reviewed by: Andrei Dokukin, MD — ASH Editorial Board
1
Assess baseline + ongoing bleeding
Each detached leech produces 6-24 hours of low-grade bleeding (10-50 mL per site). With multiple leeches over multiple sessions, cumulative blood loss is clinically significant.
Baseline Hgb/Hct + iron studies + reticulocyte count BEFORE initiation
Daily Hgb monitoring during active therapy
Measure total session blood loss; do not underestimate (a saturated 30 × 30 cm abdominal pad ≈ 100 mL)
2
Iron supplementation
Initiate oral iron at therapy start: ferrous sulfate 325 mg PO TID or equivalent. IV iron (iron sucrose, ferric carboxymaltose) if oral not tolerated.
3
Transfusion threshold
Restrictive transfusion strategy: transfuse if Hgb < 7 g/dL, OR Hgb < 8 g/dL with symptoms (orthostasis, dyspnea, tachycardia, ischemia). In actively bleeding microsurgery flap patient, lower threshold (7.5-8 g/dL) is reasonable.
AABB 2023 guidelines support 7 g/dL restrictive threshold for most hospitalised adults
Anticipate need for type & screen BEFORE Hgb drop is critical
4
Stop therapy + hemostasis if bleeding excessive
If a bite site bleeds >24h after detachment, OR pulsatile: apply pressure 10 minutes. If still bleeding, topical hemostatic (gelfoam, surgicel, thrombin), suture if mechanical control needed.
Excessive bleeding from a single bite is RARE; if seen, check coagulation panel
If hemorrhagic shock, transfusion failure, or coagulopathy: massive transfusion protocol, hematology consult, ICU. Document leech sessions in the bleeding history.
Printing tips
Use Chrome / Edge print preview for best results (Cmd/Ctrl + P).
Set "Background graphics" ON to preserve severity color coding.
Each algorithm card fits on a single landscape page.
Page header / footer can be turned off for clean print.
This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.