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Phlebotomy has been the mainstay of treatment for iron overload. Initiation of therapeutic phlebotomy has been demonstrated to have significant survival benefit in patients with and without cirrhosis. Every four phlebotomy treatments removes approximately 1 g of iron. Although an optimal regimen has not been specified, early and rapid depletion of iron stores is the goal of therapy. Weekly phlebotomy is generally instituted in the early phase of treatment, with frequent monitoring of the hemoglobin as well as ferritin levels. In most cases, the therapeutic goal is a serum ferritin level less than 50 mcg/L. After initial depletion of iron stores, maintenance phlebotomy can be performed two to four times a year with ongoing periodic monitoring of serum ferritin levels. Maintaining appropriate follow-up is the key to avoiding the damaging long-term effects of iron deposition, avoiding cirrhosis, and improving overall survival.

With the general success and relatively low cost of phlebotomy, chelation therapy for hereditary hemochromatosis is only rarely employed. Subcutaneous desferrioxamine (1-2 g daily infused over 8 hours) is typically used when phlebotomy is contraindicated or in the case of specific cardiac disease that can be improved with aggressive iron depletion.

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  • Category: Digestion