Haemochromatosis revisited

Table 1 Review about therapeutic recommendations

Who to start treatment	Patient with homozygous genotype HFE p.Cys282Tyr (C282Y/C282Y) and with biochemical indication of iron overload, namely, fasting transferrin saturation increase (≥ 45%) together with serum ferritin increase (> 300 μg/L for men and postmenopausal women, and > 200 μg/L in premenopausal women).
Initial phase or intensive (of induction)	Phlebotomies of 400-500 mL (according to body weight) weekly or every 2 wk (depending on the amount of initial iron excess). Objective: to reach a serum ferritin value of 50 μg/L, in the absence of anaemia.
Maintaining phase	One phlebotomy every 1-4 mo, depending on iron parameters.Objective: to maintain ferritin levels around 50 μg/L (without anaemia; haemoglobin levels should not be < 11 g/dL). Plasma ferritin should be verified prior to each phlebotomy, and transferrin saturation approximately twice a year.
When to stop	Patients presenting iron overload should never stop checking their iron parameters, and their treatment must be planned according to their iron parameters, general health condition, and age.