How is phlebotomy used to treat hemochromatosis?

Updated: Apr 03, 2017
  • Author: Andrea Duchini, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

Once diagnosed, hemochromatosis is treated by phlebotomy to rid the body of excess iron and to maintain normal iron stores. Phlebotomy remains the sole recommended treatment for hereditary hemochromatosis and should be undertaken in a case-specific manner.

The AASLD guidelines state hereditary hemochromotosis patients who have evidence of iron overload are “strongly encouraged” to receive phlebotomy regularly until iron stores are depleted. The regular phlebotomies should continue for life, and the frequency of maintenance therapy should be based on serum ferritin levels. [7]

In the induction phase, weekly phlebotomy is made, with blood removal of 7 mL/kg per phlebotomy (not to exceed 550 mL per phlebotomy). [83] The efficacy of treatment is controlled by ferritin level evaluation in plasma once monthly until the values remain above the upper limits of normal (300 mcg/L in men; 200 mcg/L in women). The hemoglobin level must be checked before each procedure; the reference value is 12-13g/dL (120-130g/L). [83] Subsequently, evaluation of ferritin concentration should be performed bimonthly until its level is reduced below 50 mcg/L.

In the maintenance phase, the phlebotomy should be performed every 2-4 months. The interval between procedures is determined by the level of ferritin, which should be lower than 50 mcg/mL. [83, 84]


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