From the Guidelines
Patients with hemochromatosis should have regular monitoring of serum ferritin, transferrin saturation, hemoglobin, and liver function tests to prevent complications from iron overload and ensure timely adjustments in treatment. The primary indicators of iron overload status are serum ferritin and transferrin saturation, with ferritin reflecting total body iron stores and transferrin saturation indicating the percentage of iron-binding sites occupied on transferrin 1.
Key Monitoring Parameters
- Serum ferritin: should be monitored every month during the induction phase and every 6 months during the maintenance phase to ensure that the target value is achieved and maintained 1
- Transferrin saturation: may remain increased even when serum ferritin levels are within the target range, and its monitoring is still a topic of debate due to the lack of evidence-based target levels 1
- Hemoglobin: should be monitored at the time of each bloodletting session to ensure that therapeutic phlebotomy doesn't cause anemia, and if hemoglobin concentrations are <12 g/dl, the frequency of phlebotomy should be decreased 1
- Liver function tests: are essential to monitor for hepatic damage, as the liver is a primary site of iron deposition 1
Additional Considerations
- Blood glucose monitoring is important because hemochromatosis increases the risk of diabetes 1
- For patients with established organ damage, additional tests may include cardiac function tests, thyroid function tests, and sex hormone levels 1
- Plasma folate and plasma cobalamin should be periodically checked, especially in patients who require numerous venesections, and vitamin supplements should be administered if necessary 1
From the Research
Monitoring Labs for Hemochromatosis
To monitor patients with hemochromatosis, several laboratory tests are essential. These include:
- Ferritin levels: to assess iron stores 2
- Transferrin saturation (TS): to evaluate iron status 3, 4
- Soluble transferrin receptor (sTfR) determination: to predict iron deficiency, especially when ferritin is not reliable 3
- Hemoglobin (Hb) levels: to guide the pace of phlebotomy therapy and detect anemia 4, 5
- Mean corpuscular volume (MCV): to assess erythropoietic iron availability and guide phlebotomy therapy 4
Laboratory Tests for Phlebotomy Therapy
During phlebotomy therapy, the following laboratory tests are crucial:
- Regular monitoring of ferritin levels to avoid iron depletion 5
- Transferrin saturation to assess iron status 3, 4
- Hemoglobin and MCV to guide the pace of phlebotomy and detect iron deficiency 4, 5
- Soluble transferrin receptor to predict iron deficiency when ferritin is not reliable 3
Frequency of Laboratory Tests
The frequency of laboratory tests may vary depending on the patient's response to phlebotomy therapy. However, regular monitoring of ferritin, transferrin saturation, hemoglobin, and MCV is necessary to adjust the therapy and prevent iron deficiency or overload 3, 4, 5, 6