Steps:
(1) Reduce the serum ferritin to the range of 10-20 µg/L. This will remove the overload in iron stores. The patient will show hematologic evidence of mild iron deficiency.
(2) The hemoglobin and hematocrit are then allowed to return to the normal range, with the serum ferritin kept <= 50 µg/L by periodic phlebotomies.
The frequency for measuring serum ferritin depends on the severity of the overload at presentation and the number of phlebotomies performed. Thus, a person with severe overload will not need ferritin measurements very often early in the therapeutic course. Once the serum ferritin has been reduced to 100 µg/L or less then serum ferritin should be measured after every 1-2 phlebotomies.
Frequency of maintenance phlebotomies:
(1) for adult men: 3-4 units per year
(2) for adult women: 1-2 units per year
(3) for older patients, no phlebotomies may be required.
Surrogate measures of mild iron deficiency for patients without chronic anemia:
(1) hemoglobin < 11 g/dL or hematocrit < 33 percent
(2) for more than 3 weeks
