Hemochromatosis

Treatment Overview

Treatment for hemochromatosis can:

• Safely and rapidly remove excess iron from the blood.
• Limit the progression and possible complications of the disorder.
• Prevent organ damage.

Doctors treat hemochromatosis by removing the extra iron in the body. Phlebotomy is most often the first choice, because it's safer and quicker than injecting medicine (chelation therapy).⁶

• Phlebotomy is a procedure that removes blood from the body in a process similar to donating blood. Phlebotomy is the preferred method of treating most forms of hemochromatosis. Most people with hemochromatosis need regular phlebotomy throughout their lives. Doctors will monitor the serum ferritin levels to make sure treatment is lowering iron stores.
• Chelating agents are medicines that help your body get rid of excess iron. The chelating agents deferoxamine and deferasirox bind to iron in your blood. When your kidneys filter the blood, the iron attached to the chelating agent leaves your body through the urine. Doctors can use deferoxamine or deferasirox treatment if you cannot have phlebotomy.

Treatment for hemochromatosis can reverse most symptoms and prevent complications. If treatment begins before liver damage (cirrhosis) develops, a person with hemochromatosis may have a normal life span.¹

Initial treatment

Many doctors advise regular phlebotomy for people who are diagnosed with hemochromatosis, even if they do not yet show symptoms.⁵ Depending upon the amount of iron in your blood, it may take 30 or more phlebotomies to bring your iron levels down to the desired level. Treatment usually begins with phlebotomy once or twice a week until iron levels are in a target range. Most people are free of early-stage symptoms soon after phlebotomy begins. Weekly treatment continues until:¹

• Ferritin iron levels are less than 50 nanograms (ng) per milliliter.
• Transferrin saturation levels are less than 50%.
• Hemoglobin concentration levels off. The ideal levels are not the same for men and women.

After levels are stable, you'll have fewer phlebotomy treatments—first monthly and then about every 3 months. The goal is keeping serum ferritin levels normal (about 50 ng per milliliter).² The mild iron deficiency that regular phlebotomy causes will protect the body from excess iron buildup in the future.

Phlebotomy is not possible for all people. In these cases, doctors use medicines known as chelating agents (deferoxamine or deferasirox) to remove excess iron. Deferoxamine is slowly injected under the skin (subcutaneously) daily. You can use a portable pump to inject the medicine. This is something you can do at home. Deferasirox is taken by mouth.

Chelating agents cause the excess iron to pass out of your body through the urine. It's a slower process than phlebotomy, taking twice as long. It also means you'll need more treatments to lower iron stores back to normal.

Hemochromatosis caused by blood transfusions or vitamin overdoses often does not need further chelating treatment after you've reached normal iron levels. The cause of the condition must be found and stopped before treatment begins.

Ongoing treatment

Most people with hemochromatosis need regular phlebotomy throughout their lives. Ferritin iron levels and serum transferrin saturation levels are monitored throughout treatment. You may need phlebotomies every 2 to 3 months.¹ Some people, especially older adults, may not need maintenance phlebotomy as often, because they may have a medical condition that causes iron levels to lower (anemia).

If you cannot have phlebotomy, you may inject a chelating agent (deferoxamine) to remove excess iron. This is something you can learn to do at home. There is also a pill taken by mouth (deferasirox).

Throughout treatment, your doctor will monitor your condition. You may have a number of procedures to watch for complications, such as liver damage, heart disease or cancer. Monitoring of hemochromatosis may include:

• Liver biopsy.
• Bone marrow aspirate, which removes a small amount of bone marrow fluid to examine certain types of blood cells.
• CT scan or MRI.

Treatment if the condition gets worse

Phlebotomy may help with advanced (late-stage) hemochromatosis. Phlebotomy treatment can improve some symptoms and in some cases may prevent further damage. But phlebotomy usually does not reverse advanced complications of late-stage hemochromatosis, such as liver damage, heart failure, or diabetes. People with organ damage or other complications from advanced hemochromatosis may require treatment that is specific to the problem.

What to think about

Chelating agents are medicines that treat hemochromatosis when you cannot have phlebotomy. Conditions that might require this treatment include:⁷

• Anemia caused by other blood disorders.
• Severe hemochromatosis that is resistant to phlebotomy treatment.
• An intolerance for phlebotomy.
• A limited life expectancy.
• A transfusion-dependent illness, such as hemophilia.

Frequent phlebotomy, especially in the beginning of treatment, may cause symptoms of mild anemia (weakness and fatigue). Getting rest and drinking plenty of fluids often help to relieve these symptoms. Avoiding physical activity for 24 hours after phlebotomy can help too. Do not take iron for these symptoms. That only adds to the iron overload problem.

Go to previous section	Go to top of page	Go to next section
Author:	Debby Golonka, MPH	Last Updated: April 30, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Brian Leber, MDCM, FRCPC - Hematology
© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.