Removing excess iron

The most commonly used treatment for haemochromatosis is to have blood removed regularly.  Doctors call this venesection (pronounced veen-a-section). You might also hear the term blood letting.

You have around a pint (500ml) of blood taken each time. This takes out around 250mg of iron.

The treatment is very like giving blood. The nurse or blood technician will put a rubber strap around your upper arm. This is called a tourniquet (torn-ik-ay). It helps your veins to stand out and makes it easier for the technician to put a needle into the vein.

The technician connects the needle to a storage bag, to collect your blood. Once it’s full, the nurse will take the needle out and put a small pressure dressing over the needle site. Usually this is just a cottonwool ball held in place with some surgical tape.

Preparing for venesection

Some people can feel faint when they give blood. It can help to make sure you’ve eaten a meal an hour or two beforehand. You’ll be losing a pint of fluid as well as blood cells. So drink plenty of fluids before and after you have the blood taken. Some people like to take a bit of light exercise before they go to the blood donation centre so that they’re nicely warmed up. This can help the technician to find a vein to put the needle into.  Don’t overdo the exercise though. Squeezing a stress ball can help the blood to flow during the procedure.

You may feel tired for a couple of days afterwards so it’s worth bearing this in mind when choosing a time for your treatment.

How does venesection treat haemochromatosis?

Your body uses iron to make red blood cells. These only last about 12 weeks, so they are constantly being replaced. When you have blood removed, your bone marrow steps up the production of red blood cells to make up for what’s been lost. As the bone marrow needs iron to do this, your body moves iron from the stores in the liver. So each time you have venesection, your liver iron stores will be reduced.

How often you have blood taken

The timing of your treatment depends on your test results. At first, you may have blood taken every one or two weeks. How long this is for varies a great deal between patients. If you have very heavy iron overload, you may need weekly treatment for a year or more.

When your blood results are within a normal range you have treatment less often. Again, how often varies. It may be as often as every 2 months, up to every 6 months.

Your doctor will do blood tests to check your ferritin and transferrin saturation (TSat) every few months. This is to make sure you are having venesection often enough to keep your iron levels within a normal range.

What happens to my blood?

This depends on the stage of your treatment.

When you first need treatment, doctors call this induction venesection. This continues until your iron levels are back to normal. You have the treatment as an out-patient in hospital. The blood that’s taken will be discarded.

Once your iron levels are normal, your treatment is called maintenance venesection. As long as you meet all the conditions for donating blood, your doctor is likely to suggest that you have your maintenance treatment as a blood donor. Then your blood can be used to help others in the same way as all donated blood. It’s perfectly healthy – haemochromatosis can’t be passed on to anyone else because it’s a genetic condition. In some centres you can donate blood when having induction treatment too.

If you are donating your blood, you’ll go to a Blood Transfusion Service (BTS) donation centre to have your treatment.  The BTS will register you as a haemochromatosis blood donor as you’ll be giving blood more often than is usual.

> Find out more about being a blood donor with haemochromatosis

Back to top

Alternatives to venesection

Generally, patients cope well with venesection, though it can be uncomfortable and inconvenient. If you have any other effects that you think are caused by it, do talk this over with your haemochromatosis team. In rare cases, where venesection isn’t suitable, there are two other options – erythrocytaphoresis and chelation therapy.

Erythrocytaphoresis

Erythrocytaphoresis (say eh-rith-roe-site-a-for-ee-sis) is a more recently developed treatment. It is a way of just removing your red blood cells, medically called erythrocytes, instead of whole blood.

To have the treatment, you have a needle put into a vein in each arm. The blood flows out of one needle into the machine. The machine removes the red cells and then the rest of the blood flows back into your arm through the other needle.

The effect of erythrocytaphoresis is much the same as having venesection. But it may remove more iron each time and so you may need treatment less often.

This is very rarely used in the UK and needs specialist equipment.

Chelation therapy

Sometimes it isn’t possible to take blood regularly with venesection. This may be because you have other medical conditions or don’t cope well with the treatment.  Your doctor may suggest a treatment called chelation (key-lay-shun).

Chelation uses medicines, called chelators, to remove the iron instead of taking blood. They bind with the iron, which then leaves the body in your pee (urine) or poo (bowel movements). It has side effects, including sickness, abdominal pain. diarrhoea, headache, aching joints and tiredness.

Chelation isn’t used very often to treat haemochromatosis. It doesn’t work as well as removing blood. But doctors use it to treat a variety of other blood conditions, so they know it is safe.

Back to top