From the Guidelines
To address high iron levels, I strongly recommend regular phlebotomy as the primary treatment, with the goal of reducing serum ferritin levels to 50-100 lg/L, as this approach has been shown to improve survival, reduce morbidity, and enhance quality of life in patients with hemochromatosis 1. The treatment of high iron levels, particularly in the context of hemochromatosis, is crucial to prevent long-term complications such as cirrhosis, heart failure, diabetes, and joint pain.
- Phlebotomy, the removal of blood, is the mainstay of treatment, with each unit of blood containing approximately 200-250 mg of iron, depending on the hemoglobin concentration 1.
- The frequency of phlebotomy can vary, but it is typically performed once or twice a week, with the aim of reducing iron stores to normal levels, which can take up to 2-3 years in patients with total body iron stores >30 g 1.
- It is essential to monitor serum ferritin levels regularly, as this reflects the depletion of iron stores, and to adjust the phlebotomy schedule accordingly to avoid iron deficiency 1.
- Dietary adjustments are not necessary, but avoiding vitamin C supplements and iron supplements is recommended, as vitamin C can accelerate iron mobilization and increase the risk of oxidative stress 1.
- For patients who cannot undergo phlebotomy, iron chelation therapy may be considered, although this is not the preferred first-line treatment for hemochromatosis 1.
- Regular monitoring of serum ferritin, transferrin saturation, and hemoglobin levels is crucial to track progress and adjust treatment as needed 1.
- High iron levels require prompt treatment to prevent serious complications, and phlebotomy has been shown to be a safe and effective treatment, with benefits including improved survival, reduced morbidity, and enhanced quality of life 1.
From the Research
High Iron Levels
- High iron levels can lead to serious clinical implications, including organ damage and tissue iron deposition 2, 3
- Iron overload disorders can be caused by genetic and environmental factors, with hereditary haemochromatosis and transfusional siderosis being two of the most common disorders 2
- Treatment options for iron overload include phlebotomy, chelation therapy, and erythrocytapheresis 2, 4, 3
Treatment Options
- Phlebotomy is the initial treatment of choice for hereditary haemochromatosis, while chelation therapy is a mainstay in the treatment of transfusional siderosis 2
- Deferiprone and deferasirox are two oral iron chelators that have shown promise in treating iron overload disorders 2, 5
- Erythrocytapheresis has been shown to reduce iron accumulation and prevent long-term complications of sickle cell disease without the need for chelation therapy 4
Iron Chelation Therapy
- Deferiprone has been shown to be non-inferior to deferoxamine in reducing liver iron concentration in patients with sickle cell disease or other anemias receiving chronic transfusion therapy 6
- Iron chelation therapy can prevent complications and target organ damage in patients with iron overload disorders 3, 5
- The efficacy and safety profiles of deferiprone have been found to be acceptable and consistent with those seen in patients with transfusion-dependent thalassemia 6