nemoci-sympt/METABOLISMUS/hemochromatoza
Phlebotomy
- Gold standard in the management of hemochromatosis or iron overload
- Treatment often commenced when serum ferritin levels exceed the normal range
- Induction of a mildly iron-deficient state
- Quantification of serum ferritin concentrations, magnetic resonance imaging (MRI) to assess the liver and cardiac iron levels, and, in some cases, liver biopsy
- Avoid iron deficiency with lower serum ferritin levels
- May paradoxically, lead to further
- Hepcidin (type II acute-phase protein that mediates the hypoferremia associated with infection and inflammation) depression
- Increased iron absorption during therapeutic phlebotomy
- Delicate titration requiring in-depth knowledge of the patient’s serum ferritin levels
- Cannot be handled by a lay-person or outside the hospital setting.
- Contraindicated in
- Severe anemia, cardiac failure, or poor tolerance
- Phlebotomy tends to improve transaminase levels, skin pigmentation, and hepatic fibrosis but seem to have no beneficial effects on life expectancy in hemochromatosis-related hypogonadism, cirrhosis, destructive arthritis, and insulin-dependent diabetes [41]. Since dietary absorption of divalent metals, including iron, require the same transporter (DMT1), homeostasis of the other metals will be continuously abnormal in patients who undergo phlebotomy
