Patients with hereditary hemochromatosis reach safe range of transferrin saturation sooner with erythrocytaphereses than with phlebotomies

Abstract

Introduction For the maintenance treatment of patients with hereditary hemochromatosis (HH), it is advised to keep the transferrin saturation (TSAT) <70% to prevent formation of non‐transferrin‐bound iron and labile plasma iron. The period of the initial iron depletion may last up to 1 year or longer and during this period, the patient is exposed to elevated TSAT levels. Therapeutic erythrocytapheresis (TE) is a modality which has proven to reduce treatment duration of patients with iron overload from HH. In this study, we investigated the time to reach TSAT <70% for both treatment modalities. Methods From a previous randomized controlled trial comparing erythrocytaphereses with phlebotomies (PBMs), we performed an analysis in a subgroup of patients who presented with TSAT >70%. Mann‐Whitney U tests were performed to compare the number of treatments and the number of weeks to reach the interim goal of a persistent level of <70% for TSAT between TE and PBM. Results The period to reach TSAT levels of <70% was statistically significant shorter for the TE group compared to the PBM treatment group (median treatment procedures [IQR] 2.0 (5) vs 16.0 (23), P‐value: <.001, and median treatment duration [IQR]: 5.5 (11) vs 19.0 (29) weeks, P‐value: .007). Conclusion Patients with HH reach a safe TSAT <70% significantly sooner and with less treatment procedures with TE compared to PBM.

A comparison between erythrocytapheresis and venesection for the treatment of JAK2‐mutated polycythaemia

“…Our findings are similar to those of a previous study by Choe et al 13 Similar benefits were also observed in two other studies examining the role of erythrocytapheresis in patients with hereditary haemachromatosis. 14,15 Compared to therapeutic venesection, erythrocytapheresis reduced the number of sessions and removed up to twice as much red blood cells and iron.…”

Hereditary Hemochromatosis – How Not to Overlook and Properly Manage “Iron People”- a Critical Overview

“…Therefore, it is cost-effective, particularly in the induction phase of HH therapy -fewer interventions are required in longer treatment intervals. Personalized EA may represent the preferred therapeutic option, if available, for suitable and selected HH patients presenting good antecubital venous access and fair cardiac function [91,94,95]. EA is suggested to be more suitable for subgroups of HH patients with cardiac disease as it is related to insignificant hemodynamic alterations compared with phlebotomy, and individuals with thrombocytopenia or hypoproteinaemia as other than RBCs blood components are returned to the circulation [80].…”

Hemochromatosis—How Not to Overlook and Properly Manage “Iron People”—A Review

“…Therefore, it is cost-effective, particularly in the induction HC treatment-fewer procedures are needed in longer treatment intervals. Personalized EA may represent the preferred therapeutic option, if available, for suitable and selected HC patients presenting good antecubital venous access and fair cardiac function [88,91,92]. EA is suggested to be more suitable for subgroups of HC patients with cardiac disease as it is related to insignificant hemodynamic alterations in comparison with phlebotomy, but also to individuals with low platelet count or low protein levels as only RBCs are removed during EA and other blood constituents return to the body [77].…”