Initial treatment goals include inducing iron-deficient hematopoiesis without developing debilitating symptoms of anemia. A hemoglobin concentration of 10.0 to 12.0 g/dL is often used as a target range. The initial treatment phase continues until excess stored iron is removed and ferritin levels decrease to approximately 50 ng/mL. It may take up to three years for this to be accomplished.17 Ferritin and hemoglobin levels are periodically monitored during this treatment phase.
The number of phlebotomies needed to reduce iron levels and induce anemia is related to the degree of initial iron overload and varies for each patient.
Erythrocytapheresis is a newer therapeutic alternative by which only erythrocytes are removed. Platelets and plasma are returned to the patient. An advantage to this approach over whole-blood phlebotomy is that more significant amounts of iron may be removed per phlebotomy session.18
Patients may be referred to a hematologist or gastroenterologist during the initial treatment phase. Many patients receive therapeutic phlebotomy services in a hospital or doctor's office but may also undergo phlebotomy at a blood center.
