EASL Clinical Practice Guidelines

Recommendations for the management of HFE-HC:

  • Patients with HFE-HC and evidence of excess iron should be treated with phlebotomy (1C).
  • C282Y homozygotes without evidence for iron overload could be monitored annually and treatment instituted when the ferritin rises above normal (2C).
  • Phlebotomy should be carried out by removing 400–500 ml of blood (200–250 mg iron) weekly or every two weeks. Adequate hydration before and after treatment, and avoidance of vigorous physical activity for 24 h after phlebotomy is recommended (1C).
  • Phlebotomy can be carried out also in patients with advanced fibrosis or cirrhosis (2C).
  • Before the initiation of phlebotomy, patients with HFE-HC should be assessed for complications including diabetes mellitus, joint disease, endocrine deficiency (hypothyroidism), cardiac disease, porphyria cutanea tarda, and osteoporosis (1C).
  • Complications of HFE-HC (liver cirrhosis, diabetes, arthropathy, hypogonadism, PCT) should be managed regardless of whether or not HC is the underlying cause and whether there is symptomatic relief or improvement during phlebotomy (1C).
  • To minimize the risk of additional complications, patients with HFE-HC could be immunized against hepatitis A and B while iron overloaded (2C).