Endpoint for a phlebotomy regimen – both of the following:
(1) serum ferritin < 50 ng/mL
(2) transferrin iron saturation < 50%
Protocol:
(1) When the hematocrit drops to <=75% of the initial hematocrit, measure serum ferritin. The MCV should be low since any anemia should be related to iron deficiency.
(2) When the serum ferritin is < 100 ng/mL, increase interval between phlebotomies.
(3) Once the endpoints are reached switch to a maintenance schedule.
Maintenance phlebotomy schedule (goal to keep serum ferritin < 50 ng/mL):
(1) male: 3 or 4 times per year (quarterly)
(2) female: 2 times a year (semiannual)
Limitations:
• Serum ferritin may be affected as an acute phase reactant so monitoring should involve levels when the patient is not undergoing a systemic reaction.
