Figure 3.

Second suction step is done immediately after skin scarifications.

Notes: (A and B) Bloody excretion starts to come out through the skin scratches (superficial skin scarifications; the Arabic term is shartat mihjam) in a rapid rate in the beginning and then slows down until stopping due to formation of blood clots. Bloody excretion persists until clotting occurs. (C) Bloody excretion is not profuse or causes hemorrhage if superficial skin scarifications (the Arabic term is shartat mihjam) are superficial and not deep. Causative pathological substances, eg, ferritin, iron, cholesterol, ROS and others, are directly excreted in the bloody excretion causing partial clearance of patient’s blood and interstitial spaces. (D) Blood clots are cleaned with sterile cotton, and sucking cups are evacuated. Suction is repeated for two to three times until no material comes out. Skin upliftings and scarifications are sterilized with povidone iodine. They disappear within many hours to few days. There is no need for antibiotics. (E) The same first suction step is applied to the upper part of the chest. (F) The same superficial skin scarification step is applied to the upper part of the chest. (G) Bloody excretion occurring through Al-hijamah is minimal (average 50 cc that does not aggravate the anemic status of thalassemia).

Abbreviation: ROS, reactive oxygen species.