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Haemochromatosis Maintenance Phlebotomy — RACP Adult Medicine MCQ

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EasyGeneral Internal MedicineHaemochromatosis Maintenance PhlebotomyRACP Adult Medicine

A 60-year-old man with known hereditary haemochromatosis has been undergoing regular phlebotomy. His ferritin is now 45 µg/L. How frequently should maintenance phlebotomy continue?

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Correct answer: DAnnually

Once iron depletion is achieved (ferritin <50 µg/L), maintenance phlebotomy is performed every 2–4 months to keep ferritin in the 50–100 µg/L range (some guidelines use <50 µg/L as target). The frequency varies between individuals based on dietary iron intake and the rate of iron reaccumulation. The maintenance phase is lifelong. Haemoglobin should be checked before each venesection to avoid phlebotomy-induced anaemia (Hb should remain >120 g/L in men). Dietary advice to avoid iron supplements, vitamin C supplements (enhances iron absorption), and excessive alcohol is important.

Reference: eTG – 2025 – Gastrointestinal; EASL – 2010 – Haemochromatosis Guidelines