Canterbury DHB

Context

Management

Venesection is the treatment of choice. All patients presenting clinically with signs of iron-related tissue damage should have frequent venesections - one to two per week initially. Subsequent venesections should be carried out weekly or at longer intervals. Each venesection will remove approximately 200-250 mg of iron. A person with symptomatic haemochromatosis may require a couple of years of venesection before the iron stores are depleted. Venesection should be continued until iron deficient haematopoiesis is detected by mild anaemia and fall of MCV. A reduced serum ferritin level can confirm this.

If the patient appears suitable, (e.g. normal LFTs , no evidence of end organ damage), they should be referred, through their GP, to NZBS. See NZBS criteria and referral form on Community HealthPathways.

See also HealthPathways - Haemachromatosis.

Patients can also be bled at the laboratory at Ashburton Hospital. See referral form on Community HealthPathways.

The management of the well person with laboratory evidence of iron overload due to HFE mutations is more difficult but often the patient insists on venesection for their peace of mind. If venesection is used, monitor ferritin level aiming at less than 200.

In This Section

Venesection in Haematology

Venesection in Haematology

In general, these patients should be reviewed annually by the Haematologist. See referral form – Therapeutic Venesection Form.

Monitor with ferritin levels and check any pre venesection abnormalities of liver function regularly. Aim for ferritin of less than 200. At that stage, 3-4 venesections per year will usually be all that is required. Some patients experience difficulty with venesections. Taking the blood slowly, taking less than 430 mL, or replacing the blood removed with 0.9S should all be considered.

Advise patients to drink fluids and eat well prior to each procedure.

The minimum haemoglobin concentration prior to each procedure will normally be 110 g/L.

Consult with haematologist if BP is > 180/100 or if the pulse rate is outside the range of 50-90 bpm, or if the patient has a concurrent viral infection.

See:

About this Canterbury DHB document (6332):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

August 2017

Next Review:

August 2019

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 6332