Hemochromatosis Management Guidelines

Induction Phase Protocol

The European Association for the Study of the Liver recommends aiming for serum ferritin of 50 μg/L during the induction phase to balance effective iron removal while preventing iatrogenic iron deficiency 1, 2
Remove 400-500 mL of blood weekly or every 2 weeks, depending on body weight and patient tolerance, with each unit removing approximately 200-250 mg of iron 1, 3
Check hemoglobin before every phlebotomy session and measure serum ferritin monthly or after every 4th phlebotomy, adjusting the frequency as needed 1, 3

Maintain serum ferritin between 50-100 μg/L with some flexibility, as recommended by the American Association for the Study of Liver Diseases and European Association for the Study of the Liver 1, 2, 3
Perform phlebotomy every 1-4 months depending on individual iron reaccumulation rates, with on average, serum ferritin rising approximately 100 μg/L per year without treatment 1, 3

Consider more relaxed ferritin targets during maintenance for elderly patients, with targets of <200 μg/L for women and <300 μg/L for men 2, 4
Patients with cardiomyopathy or arrhythmias face increased risk of sudden death with rapid iron mobilization, and may require slower phlebotomy schedules or iron chelation therapy 3, 4

Do not target ferritin below 50 μg/L during induction to prevent symptomatic iron deficiency, as recommended by the European Association for the Study of the Liver 1
Always monitor hemoglobin before each session and ferritin at appropriate intervals to avoid treatment complications 1, 3
Avoid vitamin C supplements entirely, especially during active iron depletion, as vitamin C accelerates iron mobilization, according to the European Association for the Study of the Liver 3, 4