Management of Hemosiderosis Complicated by Coexistent Anemia with Recombinant Human Erythropoietin and Phlebotomy

Abstract

Patients with hemosiderosis who also suffer from coexistent anemia may be unable to tolerate frequent phlebotomies needed for depletion of body iron stores. Chelation therapy, an alternative approach, maybe unsuitable for some patients due to allergic reactions, poor response or intolerance of long-duration subcutaneous administration. The use of recombinant human erythropoietin in such patients could increase the hematocrit and improve exercise tolerance allowing for more frequent phlebotomies. We report the successful use of this combined approach in two such patients.

Rust and corrosion in hematopoietic stem cell transplantation: the problem of iron and oxidative stress

“…Both therapies were effective (more rapid iron depletion with deferoxamine) and were tolerated well without evidence of graft failure, including 21 patients who maintained full donor chimerism pre-and post-iron Some groups have combined erythropoietin with phlebotomy to enhance iron depletion safely. [99][100][101] Erythropoietin alone may reduce storage iron in part through stimulation of erythropoiesis and consequent utilization of iron stores. [102][103][104] Nine of 10 autograft patients in the study by Butt and Clark 6 underwent phlebotomy when they had ferritin levels over 2000 mg/l.…”

Hereditary hemochromatosis: progress and perspectives

“…Variations of DMT1 have been hypothesized to influence iron absorption, but this has not been demonstrated in vivo (89). At the same time, mice lacking HFE in combination with mutations in TFRC have a further increase in liver iron as compared to HFE knock‐out mice (87). Studies of modifiers in humans are not yet available, but wide variations in the phenotype expression of C282Y homozygotes suggest that modifiers are acting in this disease.…”

“…In anemic patients, chelating treatment should be proposed as well. Erythropoietin at variable doses has been used on an experimental basis, in order to fulfill venesection programs in anemic subjects with primary or secondary iron overload (86, 87) and in a single case of juvenile hemochromatosis with interacting β‐thalassemia (61). Iron chelators have little place in the treatment of the disease, except in the above‐mentioned conditions or in the rare patients that do not tolerate phlebotomy.…”

Iron depletion by phlebotomy with recombinant erythropoietin prior to allogeneic transplantation to prevent liver toxicity

“…4 EPO has also been successfully used to allow an increase in the frequency of phlebotomies in iron loaded anemic patients. 5 We found that EPO administration in this patient with advanced leukemia was safe, well-tolerated and permitted weekly phlebotomies on an outpatient basis. A reduction in iron stores and plasma iron, and improved liver function were achieved promptly, contributing to a favorable outcome after allogeneic HSCT, although other factors such as low-dose heparin infusions and conditioning with high-dose melphalan, a regimen associated with a low toxic profile and full donor engraftment, 6 might have contributed to preventing liver toxicity.…”