Treatment of Hemochromatosis

How do doctors treat hemochromatosis?

In most cases, doctors treat hemochromatosis with phlebotomy, or drawing about a pint of blood at a time, on a regular schedule. This is the most direct and safe way to lower body stores of iron.

Treatment of hemochromatosis can improve symptoms and prevent complications.

Phlebotomy

Phlebotomy removes extra iron from your blood. Phlebotomy is simple, inexpensive, and safe.

How much blood is drawn and how often depends on your iron levels. Doctors usually start by having a pint of blood drawn once or twice a week for several months. Doctors will order regular blood tests to check iron and ferritin levels.

Phlebotomy is usually done in blood banks just like routine blood donation. In some cases, blood drawn from people with hemochromatosis may be donated and used in people who need blood transfusions.

After phlebotomy has removed extra iron and blood levels of iron and ferritin return to normal, doctors will reduce phlebotomies to once every 1 to 3 months and eventually to 2 to 3 times a year. Doctors will continue to order regular blood tests to check iron and ferritin levels.

Other treatments

People who receive blood transfusions to treat certain types of anemia and develop secondary hemochromatosis cannot have phlebotomy to lower their iron levels. To treat secondary hemochromatosis in these people, doctors prescribe medicines, called chelating agents, that bind to iron and allow it to pass from the body in urine. Chelating agents may be pills taken by mouth or intravenous (IV) medicines, and they do not remove iron as effectively as phlebotomy.

Doctors treat neonatal hemochromatosis in newborns with exchange transfusions—removing blood and replacing it with donor blood—and IV immunoglobulin—a solution of antibodies from healthy people. These treatments do not always work to reverse severe liver damage, and a liver transplant may be needed. Often the newborn’s mother or father can serve as a living liver donor. Only a small part of the adult donor liver is needed for transplantation into a newborn.

How do doctors treat the complications of hemochromatosis?

Phlebotomy can prevent the complications of hemochromatosis. For people who already have complications such as cirrhosis, liver failure, or liver cancer when they are diagnosed with hemochromatosis, phlebotomy may not be able to restore health.

Doctors can treat many complications of cirrhosis with medicines, minor medical procedures, and surgery. People with liver failure or liver cancer usually need a liver transplant to restore health.

Can I prevent hemochromatosis?

You can’t prevent inheriting the gene mutations that cause primary hemochromatosis. However, early diagnosis is important since early treatment with phlebotomy can prevent complications of iron overload caused by these gene mutations.

If you have a close relative—a parent, brother or sister, or child—with hemochromatosis, you should be checked for hemochromatosis. Talk with your doctor about testing you and your family members.

Secondary hemochromatosis due to blood transfusion cannot be prevented easily. However, doctors can check iron levels and start treatment with chelating agents early, before iron overload causes damage to the liver, joints, and other organs.

If doctors know a pregnant woman is at risk for having an infant with neonatal hemochromatosis due to a family history of the condition, doctors can treat the pregnant woman with IV immunoglobulin to lower the chance that the newborn will have severe iron overload.