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Training & Education - Treatment & Management

Patient Compliance

Patient compliance is crucial to successful treatment.
Most patients tolerate phlebotomy treatment well. For the majority of patients, compliance with phlebotomy treatment is related to the:

  • Patient's understanding of the importance of lifetime treatment.
  • Skill of the phlebotomist.
  • Patient's confidence in the clinician.

Patient complaints related to phlebotomy treatment include:

  • Fatigue as the most commonly reported problem.
  • Discomfort or other problems from needle puncture.
  • Tediousness of treatment.
  • Concern that overbleeding may lead to anemia.
  • Blood disposal as opposed to transfusion.

(EASL 2000)

Encourage patients to:

  • Drink fluids before and after treatment.
  • Avoid vigorous physical activity for 24 hours after treatment.
  • Continue phlebotomy treatments.

Download a print-friendly "Phlebotomy Information for Patients with Hemochromatosis."


Phlebotomy is the most simple, inexpensive, and effective treatment for hemochromatosis. There is no evidence that hemochromatosis can be treated by diet alone. However, many patients are concerned about their diet as an adjunct to phlebotomy.

Although studies are inconclusive about the dietary factors associated with high iron stores (Fleming DJ 2002; Garry PJ 2000), the following general diet modifications are suggested for hemochromatosis patients: (Barton JC, 2000; CDC Expert Panel on Hemochromatosis, 2000 and 2002).

  • Avoid iron supplements.
  • Read the label of multivitamins to make sure they do not contain iron.
  • Limit vitamin C supplementation to 500 mg/day. Vitamin C speeds up intestinal iron absorption. Eating natural foods that contain vitamin C is fine.
  • Avoid eating raw shellfish. Hemochromatosis patients are susceptible to infections with Vibrio vulnificus and Salmonella enteriditis; raw shellfish can contain these bacteria.
  • Avoid more than moderate alcohol consumption, one drink per day for females, no more than two per day for males. Patients with liver damage should avoid alcohol.

A dietitian who understands hemochromatosis can help formulate an effective diet plan if the patient has complex dietary requirements.

Compared to the importance of phlebotomy in managing iron overload, dietary factors probably play a minor role.

Download a print-friendly "Diet information for patients with hemochromatosis."

Blood Safety

Patients should be informed that blood collected during phlebotomy treatment is usually safe for transfusion and is an untapped resource for augmenting the U.S. blood shortage.

Myth: Blood from a patient with hemochromatosis or iron overload is iron rich.
Fact: One unit of blood contains about 200 mg iron, the same as blood from any other person. Excess iron is stored in an individual's organs, not in the blood supply.

Myth: Blood from a patient with hemochromatosis or iron overload is unsafe.
Fact: In 1999, the Food and Drug Administration (FDA) announced that blood from patients with hemochromatosis and iron overload (who pass the standard donation screening interview) is safe to use, but a blood donation facility must meet the following criteria: the blood collection center may not charge for therapeutic phlebotomy, and the blood center must apply to FDA for exemption from existing regulations. As part of that exemption, the blood center must collect and submit specified data to FDA. FDA will consider exemption applications case by case. Patient questions about blood donation can be referred to the Iron Disorders Institute.