Treatment of heamochromatosis by phlebotomy

Phlebotomy might possibly be effective for improving survival in patients with haemochromatosis, but there is insufficient evidence from high-quality trials.

A systematic review (assessing screening of haemochromatosis) including 2 studies with a total of 409 subjects was abstracted in DARE. The diagnostic studies in the review are not reported here. A retrospective cohort study reported greater estimated Kaplan-Meier survival for patients who were adequately phlebotomised compared with those who were not (93% versus 48% at 5 years, and 78% versus 32% at 10 years), but the clinical comparability of the patient groups could not be determined. A before-and-after study reported improved liver histology in 42 out of 185 patients after phlebotomy (deterioration was reported in 2 patients); biopsy sampling error was a potential concern in this study.

Comment: The authors conclude that given the lack of evidence on the effectiveness of therapeutic phlebotomy, the effectiveness of screening in primary care could not be directly assessed.

Ədəbiyyat

1. Schmitt B, Golub RM, Green R. Screening primary care patients for hereditary hemochromatosis with transferrin saturation and serum ferritin level: systematic review for the American College of Physicians. Ann Intern Med 2005 Oct 4;143(7):522-36.