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Training & Education - Treatment & Management

Phlebotomy Treatment

Therapeutic phlebotomy is the preferred treatment for reducing iron stores in hemochromatosis patients.

If begun early in the course of iron loading, phlebotomy can prevent most iron overload complications.

  • For a patient who has no evident tissue or organ damage, proper disease management may result in a normal long-term outcome and life expectancy.
  • For a patient who has tissue or organ damage, further damage can be halted but damage already incurred may not be reversible.
  • Even after the occurrence of complications, however, phlebotomy can decrease symptoms and improve life expectancy for patients with iron overload.

What are the expected benefits of phlebotomy treatment?

Physiologic mechanisms through which phlebotomy works:
  • As blood cells are extracted, bone marrow is stimulated to make new red blood cells (RBCs).
  • Iron is transported from body stores to make hemoglobin, an integral part of the RBC. RBC production further increases to replace blood removed through phlebotomy.
  • During treatment, iron stores are depleted for new RBC production and the patient's iron level is reduced to a safe and healthy level.

illustration of phlebotomy treatment

Normalization of iron stores typically involves the weekly removal of blood by phlebotomy until mild hypoferritinemia occurs (e.g., ferritin = 20 ng/mL on one occasion). Each unit (500 mL) of blood removed represents approximately 200 mg of iron.

Phlebotomy Regimen

Clinicians must design phlebotomy treatment regimens that are individualized to each patient.

Patient factors to consider in designing the phlebotomy regimens include:

  • Age.
  • Gender.
  • Weight.
  • General health.
  • Likelihood of compliance.