Patient compliance with phlebotomy therapy for iron overload associated with hemochromatosis

Am J Gastroenterol. 2003 Sep;98(9):2072-7. doi: 10.1111/j.1572-0241.2003.07292.x.


Objective: The aim of this study was to evaluate patient compliance with phlebotomy therapy of hemochromatosis-associated iron overload.

Methods: We reviewed medical records of white adults with hemochromatosis and iron overload diagnosed during medical care. We defined three elements of compliance: 1) achieving iron depletion (serum ferritin </= 20 ng/ml); 2) timeliness of phlebotomies on a weekly or biweekly schedule to achieve iron depletion; and 3) participation in therapy to maintain serum ferritin </= 50 ng/ml. We evaluated associations of timeliness of phlebotomy and participation in maintenance therapy with these variables: age at diagnosis, sex, pretreatment serum ferritin concentration, HFE genotype, units of blood removed to achieve iron depletion, and presence or absence of cirrhosis at diagnosis.

Results: A total of 118 patients were evaluable for iron depletion and 142 for maintenance therapy; 96.6% achieved iron depletion, and 33.1% and 43.2% followed weekly and biweekly schedules, respectively. Timeliness was not significantly associated with the variables we evaluated. In the first year of maintenance therapy, 84.0% of patients complied; the percentage of C282Y homozygotes complying was significantly greater than that of other patients. Average compliance with maintenance therapy decreased 6.8% annually; the mean follow-up after achieving iron depletion was 4.1 +/- 2.8 yr (range 0.6-9.7 yr).

Conclusions: Most patients with hemochromatosis diagnosed in medical care achieve iron depletion with phlebotomy; one-third tolerate and adhere to weekly phlebotomy. There is a constant rate of decline in the percentage of patients who comply with maintenance therapy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Attitude to Health
  • Cohort Studies
  • Evaluation Studies as Topic
  • Female
  • Follow-Up Studies
  • Hemochromatosis / complications
  • Hemochromatosis / diagnosis
  • Hemochromatosis / therapy*
  • Humans
  • Iron Overload / complications
  • Iron Overload / diagnosis
  • Iron Overload / therapy*
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Phlebotomy / methods*
  • Probability
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Treatment Outcome