Therapeutic venesection for haemochromatosis, PV or PCT are rebatable on the Medicare Benefits Schedule (MBS; item number 13757).
Venesection normalises ferritin levels
The aim is to reduce ferritin levels to 50 – 100 micrograms/L by having patients undergo venesection every one to two weeks, removing 500 mL of blood each time, until this treatment target is reached. This amount of blood would typically contain 200 – 250 mg of iron.
A venesection is a simple and effective way of reducing the number of red blood cells in your blood. This may be needed to reduce iron levels or the thickness of the blood to safe levels.
Venesection is usually commenced once serum ferritin increases above 200 μg/L in premenopausal women and 300 μg/L in postmenopausal women and men.
On average, each venesection removes 450–500 mL of blood, which is equivalent to 200–250 mg of iron. The aim is to reduce serum ferritin levels to 50–100 μg/L.
Serum ferritin levels are generally considered high when they are above 1000 ng/mL. There are a number of conditions other than iron overload that can affect your serum ferritin. These can make diagnosing iron overload difficult.
Venesection means the removal of blood, just like giving a blood donation. Every unit of blood (500ml) removed contains about 250mg of iron.
The two key tests to detect iron overload are: Serum transferrin saturation. This test measures the amount of iron bound to the protein transferrin that carries iron in your blood. Transferrin saturation values greater than 45% are considered too high.
You'll need to have a venesection regularly until your serum ferritin (SF) is between 20-30 μg/l and your transferrin saturation (TSAT) is below 50%. Depending upon your iron levels at initial diagnosis, it may take several months to several years of venesection to reduce your iron levels to normal.
You should feel better within a few minutes. To minimize the risk of feeling faint, always eat normally and keep well hydrated prior to the procedure. Tiredness - You may feel tired following a venesection for a day or two. Avoid excessive exercise until the next day.
There is a risk of fainting so that on their first occasion of venesection or subsequently (according to their individual response) they should avoid driving and not operate machinery that day. Maintain the dressing for 2 to 3 hours after the procedure.
You may feel a little lethargic for a couple of days. You can resume all your normal activities after the procedure. Keep hydrated and drink two litres of fluid daily for 48 to 72 hours following your procedure.
Blood tests
liver test. a transferrin saturation level test (Tsat) to check how much iron in the blood is bound to the protein transferrin. This shows if you have a high iron level in the blood.
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 link.
Hemochromatosis has been separated into four distinct disorders – hereditary (classic) hemochromatosis, also known as HFE-related hemochromatosis; hemochromatosis type 2 (juvenile hemochromatosis); hemochromatosis type 3, also known as TFR2-related hemochromatosis; and hemochromatosis type 4, also known as ferroportin ...
Hereditary hemochromatosis is a genetic disorder that can cause severe liver disease and other health problems. Early diagnosis and treatment is critical to prevent complications from the disorder. If you have a family health history of hemochromatosis, talk to your doctor about testing for hereditary hemochromatosis.
Phlebotomy may resolve joint pain and heart disease. Studies suggest that phlebotomy improves joint symptoms in approximately 20 percent of people with hereditary hemochromatosis. Phlebotomy is most likely to reverse heart disease when it is in an early stage.
Disease Overview
Iron accumulation in classic hereditary hemochromatosis occurs slowly over many years. Eventually, iron accumulation causes tissue damage and impaired functioning of affected organs. In many affected individuals, symptoms may not become apparent until some point between 40-60 years of age.
Avoid vitamin C supplements - Vitamin C increases iron absorption. However, whole fruits and vegetables that contain vitamin C generally do not contain enough vitamin C to increase iron absorption if eaten in moderation.
This build-up of iron, known as iron overload, can cause unpleasant symptoms. If it is not treated, this can damage parts of the body such as the liver, joints, pancreas and heart.
Leukemia cells show increased iron uptake and decreased iron efflux, leading to elevated cellular iron levels. The systematic iron pool in patients with leukemia is also increased, which is aggravated by multiple red-blood-cell transfusions.