Treatment of Iron Overload in the “Ex‐Thalassemic”: Report from the Phlebotomy Programa

Abstract

Abstract: After successful marrow transplantation (BMT) iron overload remains an important cause of morbidity in Thalassemia. After BMT, patients have normal erythropoiesis capable of producing a hyperplastic response to phlebotomy so that this procedure can be contemplated as a method of mobilizing iron from overloaded tissues. Forty‐one patients (mean age 16±2.9 years) with prolonged follow‐up (range 2‐7 years) after BMT were submitted to a moderate intensity phlebotomy program (6 ml/kg blood withdrawal at 14‐day intervals) to reduce iron overload. Values are expressed as mean ± SD or as median with a range (25^th‐75^th percentile). Serum ferritin decreased from 2,587 (2,129‐4,817) to 280 (132‐920) μg/l (p < 0.0001), total transferrin increased from 2.34±0.37 to 2.9±0.66 g/l (p= 0.0001), transferrin saturation decreased from 90%±14% to 39%±34% (p < 0.0001). Liver iron concentration evaluated on liver biopsy specimens decreased from 20.8 (15.5‐28.1) to 3 (0.9‐14.6) mg/g dry weight (p < 0.0001). Alanine amino‐transaminase from 5.2±3.4 to 1.6±1.2 (p < 0.0001) times the upper level of normality. The histological grading for chronic hepatitis (Histology Activity Index) decreased from 4.2±2.4 to 2.3±1.8 (p < 0.0001). Phlebotomy is a safe, efficient, and widely applicable method to decrease iron overload in “ex‐thalassemic.”