Editing Iron overload (section)

=== Phlebotomy ===

[[Phlebotomy]], [[bloodletting]] or [[venesection]] is the mainstay of treatment in iron overload, consisting of regularly scheduled blood draws to remove red blood cells (and iron) from the body.<ref name="NEJM Olynyk" /> Upon initial diagnosis of iron overload, the phlebotomies may be performed weekly or twice weekly, until iron levels are normalized. Once the serum ferritin and transferrin saturation are within the normal range, maintenance phlebotomies may be needed in some (depending upon the rate of reabsorption of iron), scheduled at varying frequencies to keep iron stores within normal range.<ref name="AASLD guidelines" /> A phlebotomy session typically draws between 450 and 500 mL of blood.<ref>{{cite journal|last1=Barton|first1=James C.|title=Management of Hemochromatosis|journal=Annals of Internal Medicine|date=1 December 1998|volume=129|issue=11_Part_2|pages=932–39|doi=10.7326/0003-4819-129-11_Part_2-199812011-00003|pmid=9867745|s2cid=53087679}}</ref> Routine phlebotomy may reverse liver fibrosis and alleviate some symptoms of hemochromatosis, but chronic arthritis is usually not responsive to treatment.<ref name="NEJM Olynyk" /> In those with hemochromatosis; the blood drawn during phlebotomy is safe to be [[blood donation|donated]].<ref>{{cite web|author=NIH blood bank|title=Hemochromatosis Donor Program|url=https://clinicalcenter.nih.gov/blooddonor/donationtypes/hemochromatosis.html}}</ref><ref name="AASLD guidelines" />

Phlebotomy is associated with improved survival if it is initiated before the onset of cirrhosis or diabetes.<ref name="AASLD guidelines" />