A patient with hemochromatosis may undergo a series of phlebotomies in order to reduce the body iron stores. Once the iron has been depleted sufficiently the patient may switch to a maintenance schedule..


Endpoint for a phlebotomy regimen – both of the following:

(1) serum ferritin < 50 ng/mL

(2) transferrin iron saturation < 50%



(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)



• Serum ferritin may be affected as an acute phase reactant so monitoring should involve levels when the patient is not undergoing a systemic reaction.


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