From the Guidelines
The initial treatment for patients diagnosed with hemochromatosis is therapeutic phlebotomy, which involves regular blood removal to reduce iron overload, with a target ferritin level of 50-100 μg/L, as recommended by the most recent guidelines 1. The goal of therapeutic phlebotomy is to remove excess iron from the body, and it is typically performed weekly or biweekly, with one unit of blood (approximately 500 mL) removed at a time.
- The initial intensive phase of phlebotomy usually continues until serum ferritin levels reach 50-100 μg/L and transferrin saturation falls below 50% 1.
- After reaching target levels, patients transition to maintenance therapy with less frequent phlebotomies, usually every 2-4 months, to keep ferritin levels in the low-normal range 1.
- Therapeutic phlebotomy is effective because it forces the body to use stored iron to make new red blood cells, thereby gradually depleting excess iron.
- Patients should stay well-hydrated before and after procedures and monitor for symptoms like lightheadedness or fatigue.
- Those who cannot tolerate phlebotomy due to anemia or other conditions may be prescribed iron chelation therapy with medications like deferasirox or deferoxamine as an alternative treatment 1. It's worth noting that the most recent guidelines from the European Association for the Study of the Liver (EASL) recommend a target ferritin level of 50-100 μg/L for both the induction and maintenance phases of phlebotomy 1.
- Additionally, the guidelines suggest that patients with hemochromatosis should be monitored for reaccumulation of iron and undergo maintenance phlebotomy to keep ferritin levels within the target range 1.
- The use of iron chelation therapy, such as deferasirox or deferoxamine, may be considered in patients who cannot tolerate phlebotomy or have severe iron overload 1.
- However, the evidence for the use of iron chelation therapy in hemochromatosis is limited, and it should only be used under the guidance of a specialist 1.
From the FDA Drug Label
Deferoxamine mesylate is not indicated for the treatment of primary hemochromatosis, since phlebotomy is the method of choice for removing excess iron in this disorder. The initial treatment for patients diagnosed with hemochromatosis is phlebotomy, which is the method of choice for removing excess iron in this disorder 2.
From the Research
Initial Treatment for Hemochromatosis
The initial treatment for patients diagnosed with hemochromatosis typically involves the removal of excess iron from the body.
- Phlebotomy, or the removal of blood, is a common method used to reduce iron levels in patients with hemochromatosis 3, 4, 5.
- Erythrocytapheresis, a procedure that removes red blood cells from the body, is also used as an alternative to phlebotomy 4.
- The choice of treatment depends on the individual patient's condition and the severity of their iron overload.
Phlebotomy Therapy
Phlebotomy therapy is often used to treat hemochromatosis, and it involves the regular removal of blood to reduce iron levels in the body.
- Studies have shown that phlebotomy is effective in reducing iron levels and improving symptoms in patients with hemochromatosis 3, 5.
- However, phlebotomy can also lead to iron deficiency if not monitored properly, and patients may require iron supplements to prevent this 6.
Erythrocytapheresis Therapy
Erythrocytapheresis is a newer treatment option for hemochromatosis that involves the removal of red blood cells from the body.
- Studies have shown that erythrocytapheresis is effective in reducing iron levels and may be a more efficient treatment option than phlebotomy 4.
- Erythrocytapheresis may also be less likely to lead to iron deficiency than phlebotomy, as it removes less iron per procedure 4.
Monitoring Treatment
Monitoring of iron levels and other parameters is crucial during treatment for hemochromatosis.