What is the target laboratory result for therapeutic phlebotomy (blood donation) in hereditary hemochromatosis?

From the Guidelines

The target laboratory result for therapeutic phlebotomy in hereditary hemochromatosis is to maintain serum ferritin levels between 50-100 μg/L, as recommended by the most recent and highest quality study 1. This target range is based on the European Association for the Study of the Liver (EASL) clinical practice guidelines on haemochromatosis, which suggest that serum ferritin levels should be maintained between 50-100 μg/L during the maintenance phase of phlebotomy treatment 1. The guidelines also recommend monitoring hemoglobin levels before each phlebotomy, with a minimum level of 12 g/dL recommended before proceeding with blood removal to prevent anemia-related complications 1. Key points to consider in the management of hereditary hemochromatosis include:

• The induction phase of phlebotomy treatment, where the goal is to reduce serum ferritin levels to 50 μg/L 1
• The maintenance phase, where the goal is to maintain serum ferritin levels between 50-100 μg/L 1
• Monitoring of hemoglobin levels before each phlebotomy to prevent anemia-related complications 1
• The use of erythrocytapheresis as a therapeutic option in selected cases, particularly in patients with severe iron overload or those who are unable to undergo phlebotomy 1. It is essential to prioritize the most recent and highest quality study, which in this case is the EASL clinical practice guidelines on haemochromatosis 1, to ensure that patients with hereditary hemochromatosis receive evidence-based care that optimizes their morbidity, mortality, and quality of life outcomes.

From the Research

Target Laboratory Result for Therapeutic Phlebotomy

The target laboratory result for therapeutic phlebotomy in hereditary hemochromatosis is:

• Serum ferritin concentration below 50 μg/L 2
• Serum ferritin concentration below 100 ng/mL 3, 4
• Transferrin saturation below 30 percent 5
• Transferrin saturation below 40% 2

Treatment Endpoints

The treatment endpoints for therapeutic phlebotomy in hereditary hemochromatosis are:

• Reduction of patient's hematocrit between 32-35% at the end of each session 2
• Achievement of a ferritin value below 100 ng/ml 4
• Maintenance of the mean corpuscular volume (MCV) at 3 percent below baseline 5

Phlebotomy Schedule

The phlebotomy schedule for therapeutic phlebotomy in hereditary hemochromatosis is:

• Weekly or biweekly phlebotomies 5
• Bimonthly erythrocytapheresis until normalisation of the serum ferritin 2
• Monthly erythrocytapheresis until complete desaturation 2