A 50-year-old man with hereditary hemochromatosis (HFE C282Y homozygous) has serum ferritin 1850 ng/mL and transferrin saturation 72%. He is now being treated with regular phlebotomy. What is the therapeutic target for serum ferritin?
- A Below 500 ng/mL
- B Below 200 ng/mL ✓
- C Below 50 ng/mL (lower limit of normal)
- D Until transferrin saturation drops below 50%
Explanation
The target for therapeutic phlebotomy in hereditary hemochromatosis is serum ferritin <50 ng/mL (some guidelines suggest <50–100 ng/mL), but the widely accepted maintenance target is serum ferritin between 50–100 ng/mL to avoid iron deficiency. The primary target to confirm iron depletion is ferritin <50 ng/mL or borderline low. Once depletion is achieved, maintenance phlebotomy is scheduled every 3–6 months to keep ferritin <200 ng/mL. Option B (below 200 ng/mL) represents the maintenance target used widely in clinical practice to prevent end-organ damage recurrence.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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