Blood donation for iron removal in individuals with HFE mutations: study of efficacy and safety and short review on hemochromatosis and blood donation

• DOI: 10.3389/fmed.2024.1362941
• Publication Date: 2024-03-19T11:52:27Z
• Authors: Laura Infanti; Gerda Leitner; Morten Moe; Vildana Pehlic; Marco Cattaneo; Pascal Benkert; Andreas Holbro; Jakob Passweg; Nina Worel; Andreas Buser
• Keywords: Phlebotomy; Hereditary hemochromatosis

Background Elevated serum ferritin with/without HFE variants in asymptomatic persons leads frequently to referral for blood donation. Hemochromatosis (p.C282Y/p.C282Y) only requires treatment. We evaluated safety and feasibility of iron removal healthy with elevated using donation procedures. Materials methods Thirty subjects >200 ng/mL (women) or >300 (men) p.C282Y/p.C282Y, p.C282Y/p.H63D p.H63D/p.H63D were randomized weekly phlebotomy (removal 450 mL whole blood) erythrapheresis 360 red cells) every 14 days. The target was <100 ng/mL. A full count measured at each visit. Hemoglobin (Hb) ≥140 g/L required inclusion. If Hb dropped <120 <130 (men), procedures postponed (7 days). Primary endpoint the number needed target; secondary objectives duration treatment compliance. effect tested Poisson regression; compared between study arms Kruskal–Wallis test. Results Twenty-five 30 participants men (83%); mean age 47 years (SD 10.5), BMI 26.6 kg/m 2 3.6); 17 had nine p.C282Y/p.H63D, four p.H63D/p.H63D. Median baseline 150 (IQR 144, 1,559), median 504 406,620). Twenty-seven completed study. Treatment arm ( p < 0.001) variant = 0.007) influenced primary significantly. To levels ng/mL, a 7.5 6.2, 9.8) phlebotomies 4.0 3.0, 5.8) erythraphereses during 66.5 days 49,103) 78.5 46139), respectively 0.448). Low principal reason protocol violation; anemia occurred 13 (48%). Immediate complications infrequent; fatigue reported after 25% 45% erythraphereses. Thirty-five because low 15 non-medical reasons. interval 7.0 7.7) 14.0 14, 20) erythraphereses, respectively. Conclusion Blood remove effectively HC, but frequent treatments cause decrease that can impair feasibility.