From the Guidelines
Phlebotomy is a highly effective treatment for alleviating symptoms in patients with iron overload, as it reduces tissue iron stores to normal, improves survival, and enhances overall quality of life 1.
Benefits of Phlebotomy
The benefits of phlebotomy in patients with iron overload include:
- Improved sense of well-being and energy levels
- Improved cardiac function
- Improved control of diabetes
- Reduction in abdominal pain
- Reduction in skin pigmentation
- Normalization of elevated liver enzymes
- Reversal of hepatic fibrosis in approximately 30% of cases
- Elimination of the risk of iron overload-related hepatocellular carcinoma if iron removal is achieved before the development of cirrhosis
- Reduction in portal hypertension in patients with cirrhosis
Phlebotomy Procedure
Phlebotomy involves the removal of one unit of blood (approximately 200-250 mg of iron) once or twice a week, as tolerated by the patient 1. The procedure should be preceded by measurement of the hematocrit or hemoglobin to avoid reducing the hematocrit/hemoglobin to <80% of the starting value.
Maintenance Phlebotomy
After the initial intensive phase, maintenance phlebotomy is continued at less frequent intervals to maintain ferritin levels below 100 ng/mL 1. The frequency of maintenance phlebotomy varies among individuals, depending on the rate of iron accumulation.
Blood Donation
Regular blood donation (every 56 days in most countries) can serve as maintenance therapy for milder cases of iron overload 1.
Important Considerations
Patients should maintain adequate hydration before procedures and monitor for symptoms of anemia, such as dizziness or fatigue 1. Dietary modifications to reduce iron intake may complement but not replace phlebotomy therapy.
Conclusion Not Applicable
As per the guidelines, the focus is on providing a direct and evidence-based answer without a conclusion section. The most recent and highest-quality study 1 supports the use of phlebotomy as a safe and effective treatment for iron overload, with significant improvements in morbidity, mortality, and quality of life.
From the Research
Phlebotomy and Iron Overload
- Phlebotomy is a treatment used to remove excess iron from the body, and it has been shown to alleviate symptoms in patients with iron overload 2.
- Therapeutic phlebotomy typically involves the removal of 1 unit (450 to 500 mL) of blood weekly until the serum ferritin level is 10 to 20 microg/L, and then maintenance of the serum ferritin level at 50 microg/L or less thereafter by periodic removal of blood 2.
- Phlebotomy can help prevent complications of iron overload, including hepatic cirrhosis, primary liver cancer, diabetes mellitus, hypogonadotrophic hypogonadism, joint disease, and cardiomyopathy 2.
Blood Donation and Iron Overload
- Blood donation is a form of phlebotomy that can also help remove excess iron from the body.
- While there is no direct evidence that blood donation specifically alleviates symptoms in patients with iron overload, phlebotomy has been shown to be effective in reducing iron levels and improving symptoms in patients with iron overload 3, 2.
- It is likely that blood donation would have a similar effect, although the frequency and volume of blood donation may not be sufficient to significantly reduce iron levels in patients with severe iron overload.
Benefits of Phlebotomy
- Phlebotomy has been shown to improve quality of life and increase longevity in patients with iron overload 3, 2.
- Phlebotomy can also help reduce the risk of complications associated with iron overload, such as liver disease, diabetes, and heart disease 2, 4.
- In addition to removing excess iron, phlebotomy can also help reduce the risk of other health problems associated with iron overload, such as joint disease and hypogonadism 2, 4.