A 55-year-old female patient with
hemosiderosis induced by administration of excessive doses of parenteral
iron was successfully treated with regular phlebotomy combined with recombinant human
erythropoietin (rHuEPO). Ferrokinetic data before
therapy showed 28.0 mumol/l of serum
iron, 4.1 mumol/l of unsaturated
iron-binding capacity, 4,060 ng/ml of serum
ferritin, 148 min of plasma
iron disappearance time, 45% of red cell
iron utilization and 0.4 mg/kg/day of plasma
iron turnover rate. She had 300-ml phlebotomies, first every other week then weekly, and
subcutaneous injections of rHuEPO twice a week. Two years later, the total volume of phlebotomized blood reached 31 liters and her ferrokinetic data showed: serum
iron 8.6 mumol/l,
iron-binding capacity 39.6 mumol/l, serum
ferritin 277 ng/ml, plasma
iron disappearance time 52 min, red cell
iron utilization 100% and plasma
iron turnover rate 0.5 mg/kg/day. During the phlebotomy
therapy, her
hemoglobin levels were maintained above 12 g/dl. No adverse effect due to rHuEPO occurred. These findings provide evidence for the efficacy of rHuEPO in multiple phlebotomy
therapy for
hemosiderosis and may open new avenues for its clinical application.