The first step in treatment for hemochromatosis is to rid the body of excess iron. This process is called phlebotomy, which means removing blood the same way it is drawn from donors at blood banks. Based on the severity of the iron overload, it may take years to deplete the iron stores of individuals with symptoms. But if an early diagnosis is made, 30 or fewer phlebotomies may be sufficient to reduce iron to safe levels. A pint of blood taken once or twice a week for several months to a year may be all that is necessary. Blood serum iron and transferrin saturation levels will be tested periodically to monitor iron levels. The goal is to bring blood transferrin saturation levels to 15 percent and keep them there.
Patients with cardiac disease may tolerate removal of only 0.5 units of blood weekly.
Phlebotomy should be continued for the life of the individual. Typically for maintenance, men will require phlebotomy three to four times a year and women one to two times per year. In all cases, hemoglobin needs to be monitored to avoid anemia.
Phlebotomy has been found to markedly reduce symptoms of weakness, lethargy, and abdominal pain and to decrease liver enlargement. Glucose intolerance and insulin requirements decrease in some patients. If therapy is initiated early, it will decrease the risk of cirrhosis and possibly liver cancer. Pre-cirrhotic patients whose iron levels are successfully reduced have a normal life expectancy.
Once hemochromatosis is established, treatment cannot cure the associated conditions, but it will help most of them improve. The main exception is arthritis, which does not improve even after excess iron is removed.
People with hemochromatosis should restrict their intake of vitamin C and alcohol, as these both facilitate iron absorption. They should also avoid raw shellfish, as they are more susceptible to Vibrio vulnificus infection.
Last reviewed on 6/4/09
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