A 58-year-old man with hereditary haemochromatosis (HFE C282Y homozygous) presents with serum ferritin 1850 ng/mL and transferrin saturation 82%. He has no cirrhosis on biopsy. He is initiated on phlebotomy. What is the target ferritin for maintenance phlebotomy after depletion therapy?

• A Ferritin < 300 ng/mL
• B Ferritin < 200 ng/mL
• C Ferritin < 500 ng/mL
• D Ferritin 50–100 ng/mL ✓

Explanation

Current guidelines (EASL, AASLD) recommend therapeutic phlebotomy in hereditary haemochromatosis aiming to deplete iron stores with a target serum ferritin of 50–100 ng/mL during the maintenance phase. The depletion phase involves weekly phlebotomy until ferritin falls to this range, then maintenance phlebotomy every 2–4 months. This iron depletion prevents end-organ damage including cirrhosis, diabetes, and cardiomyopathy; established cirrhosis is not fully reversible.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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