Hemochromatosis (HHC) is a common genetic disorder where the body absorbs too much iron from the diet, leading to a harmful buildup of excess iron in organs like the liver, heart, and pancreas. If left untreated, this iron overload can cause significant organ damage and various health complications. The primary and most effective treatment for managing this condition is therapeutic phlebotomy, which involves the controlled removal of blood to physically reduce the total iron stores in the body. This procedure is identical to a standard blood donation.
The Initial Iron Reduction Phase
The initial phase of treatment, often called the depletion phase, requires the most frequent phlebotomy schedule to reduce high iron levels. The goal is to deplete accumulated iron reserves and stimulate the body to pull iron out of the organs and tissues. During a single session, approximately 450 to 500 milliliters of blood (one unit) is removed, which takes out about 200 to 250 milligrams of iron.
For most patients with significant iron overload, phlebotomy frequency is typically once a week. Individuals with extremely high iron stores may tolerate treatments twice a week to accelerate depletion. This high-frequency schedule continues until iron levels fall within a safe, low-normal range, which may take several months to over a year depending on the initial iron burden. Treatment must only be performed if the patient’s hemoglobin level remains adequate, typically above 12 to 13 g/dL, to prevent anemia.
The total number of phlebotomies required can be substantial, sometimes needing 50 to 100 or more procedures to normalize iron stores. The aggressive nature of this initial phase is necessary to mitigate the risk of serious complications, such as liver cirrhosis or heart disease. Once the body’s iron is sufficiently depleted, the treatment frequency is dramatically reduced, signaling the transition to the long-term maintenance phase.
The Long-Term Maintenance Schedule
Once the iron reduction phase is complete, patients move into a permanent maintenance schedule designed to prevent iron re-accumulation. This phase is necessary because the underlying condition causing excessive iron absorption remains. Maintenance phlebotomy frequency is much lighter and highly individualized, reflecting the slower rate at which iron re-accumulates.
For many adults, this typically means a phlebotomy every two to four months, translating to about three to six procedures per year. The interval between treatments is determined by monitoring blood tests, ensuring iron levels remain within the target range without causing iron deficiency. Men often require phlebotomy slightly more frequently than women, who naturally lose iron through menstruation until menopause.
Lifestyle factors can influence maintenance frequency. For example, alcohol consumption, which can harm the liver, might necessitate a slightly shorter interval between treatments. Avoiding iron supplements and uncooked seafood also helps support the maintenance schedule. The goal is to maintain a stable, low level of iron, protecting the organs from further damage.
How Monitoring Tests Determine Frequency
The exact frequency of phlebotomy is determined by two specific blood tests: serum ferritin and transferrin saturation. These tests provide data on the body’s current iron status, allowing for a tailored treatment schedule.
Serum ferritin (SF) is the measure of the body’s iron stores. During the initial reduction phase, phlebotomy continues until the SF level falls below 50 nanograms per milliliter (ng/mL). In the maintenance phase, the goal is to keep the SF level stable, typically within a range of 50 to 100 ng/mL, to prevent iron re-accumulation and iron deficiency.
Transferrin saturation (TSAT) measures the percentage of the protein transferrin bound to iron, reflecting the amount of iron circulating in the blood. An elevated TSAT, defined as greater than 45%, is an indicator of inappropriate iron absorption and is monitored throughout treatment. During the induction phase, ferritin levels are checked frequently, such as every 4 to 12 phlebotomies, or every one to three months.