Each unit of blood from a nonanemic patient contains approximately 250 mg of iron. A patient with anemia can still be phlebotomized but the procedure will be less efficient.
The guidelines apply to a person:
(1) homozygous for hemochromatosis genes
(2) heterozygous for hemochromatosis genes
(3) with a hemochromatosis phenotype (iron overload and appropriate clinical features) irregardless of genotype for hemochromatosis genes
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Gender
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Age and Factors
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Serum Ferritin Threshold for Starting Phlebotomy
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male
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< 18 years
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>= 200 µg/L
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>= 18 years
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>= 300 µg/L
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female
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< 18 years, nonpregnant
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>= 200 µg/L
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< 18 years, pregnant
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>= 500 µg/L
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>= 18 to menopause, nonpregnant
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>= 200 µg/L
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>= 18 to menopause, pregnant
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>= 500 µg/L
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post-menopausal
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>= 300 µg/L
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where:
• Post-menopausal includes post-hysterectomy or states without menstruation.
• The original table was a little unclear for handling a female < 18 years and pregnant.
• A pregnant woman will lose 1 gram of iron if the pregnancy is taken to term.
• The notes to the table says that therapeutic phlebotomy is usually deferred in a pregnant woman unless there is significant cardiac or hepatic dysfunction. But then the patient would be become nonpregnant and a lower threshold would seem to apply. It would appear that the organ dysfunction becomes the key determinant.
• The patient with iron overload associated with chronic transfusion therapy for anemia is usually managed differently (with iron chelators) since they would probably not tolerate the loss of blood.
