A 55-year-old man with haemochromatosis (HFE C282Y homozygous, ferritin 2400 ng/mL, transferrin saturation 78%) has been treated with weekly phlebotomy for 18 months. Which ferritin target indicates adequate iron depletion therapy?
- A Ferritin 50–100 ng/mL ✓
- B Ferritin < 300 ng/mL
- C Ferritin < 20 ng/mL indicates overdepletion
- D Ferritin < 500 ng/mL is the acceptable treatment endpoint
Correct answer: A. Ferritin 50–100 ng/mL
Explanation
In HFE haemochromatosis, the goal of phlebotomy therapy is to deplete excess iron stores, targeting serum ferritin to 50–100 ng/mL (some guidelines accept <50 ng/mL) with transferrin saturation <50%. Ferritin <20 ng/mL indicates iron deficiency and over-depletion, which should be avoided. Once the target is reached, maintenance phlebotomy (typically every 3–4 months) prevents re-accumulation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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