Results of therapeutic phlebotomy in patients with hemochromatosis

Complications of iron overload	Expected treatment outcome
None	Prevention of complications of iron overload; normal life expectancy
Weakness, fatigue, lethargy	Improvement in majority of patients
Elevated serum concentrations of hepatic enzymes	Resolution or marked improvement
Hepatomegaly	Resolution often occurs
Hepatic cirrhosis	No change
Increased risk for primary liver cancer	No change*
Right upper quadrant pain	Resolution or marked improvement^¶
Arthropathy	Improvement in arthralgias sometimes occurs; change in joint deformity is rare; progression is sometimes seen
Hypogonadotrophic hypogonadism	Resolution is rare
Diabetes mellitus	Occasional improvement, often temporary
Hypothyroidism, hypogonadism	Resolution is rare
Cardiomyopathy	Resolution sometimes occurs
Hyperpigmentation	Resolution usually occurs
Hyperferritinemia	Resolution
Excess absorption and storage of nonferrous metals^Δ
Infection with Vibrio vulnificus or other bacteria	Little or no change

* Increased risk occurs only in persons with cirrhosis.
¶ Right upper quadrant pain in persons with hemochromatosis is often related to hepatic iron overload. In these cases, therapeutic phlebotomy usually results in marked improvement or resolution. However, right upper quadrant pain may also be caused by primary liver cancer, portal vein thrombosis, gallbladder disease, lesions in the hepatic flexure, or nephrolithiasis. Iron depletion alone will not alleviate right upper quadrant pain due to these causes.
Δ Cobalt, manganese, zinc, and lead.

Adapted from: Barton JC, McDonnell SM, Adams PC, et al. Management of hemochromatosis. Hemochromatosis Management Working Group. Ann Intern Med 1998; 129:932.

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Results of therapeutic phlebotomy in patients with hemochromatosis