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Treatment & Management
Phlebotomy Treatment
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Therapeutic phlebotomy is the preferred treatment for reducing iron
stores in hemochromatosis patients.If begun early in the course of iron
loading, phlebotomy can prevent most iron overload complications.
- For a patient who has no evident tissue or organ damage, proper
disease management may result in a normal long-term outcome and life
expectancy.
- For a patient who has tissue or organ damage, further damage can be
halted but damage already incurred may not be reversible.
- Even after the occurrence of complications, however, phlebotomy can
decrease symptoms and improve life expectancy for patients with iron
overload.
What are the expected benefits of phlebotomy treatment?
Physiologic mechanisms through which phlebotomy works:
- As blood cells are extracted, bone marrow is stimulated to make new
red blood cells (RBCs).
- Iron is transported from body stores to make hemoglobin, an integral
part of the RBC. RBC production further increases to replace blood removed
through phlebotomy.
- During treatment, iron stores are depleted for new RBC production and
the patient's iron level is reduced to a safe and healthy level.
Normalization of iron stores typically involves the weekly removal of
blood by phlebotomy until mild hypoferritinemia occurs (e.g., ferritin =
20 ng/mL on one occasion). Each unit (500 mL) of blood removed represents approximately
200 mg of iron.
Clinicians must design phlebotomy treatment regimens that are
individualized to each patient.
Patient factors to consider in designing the phlebotomy regimens
include
- Age.
- Gender.
- Weight.
- General health.
- Likelihood of compliance.
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