Phlebotomy as a treatment of transfusion related iron overload in a patient on effective treatment of myelodysplastic syndrome with azacytydine

Abstract

We present the case of 75 year-old-man who was treated with azacitidine because of myelodysplastic syndrome RAEB-2 (refractory anemia with excess of blasts 2). The treatment was started with azacitidine, erytropoietin and regular blood transfusion (13 units in total). After 4 courses of treat­ment the blood picture has normalized and the program of regular venesections was implemented. The patient underwent 11 phlebotomy sessions which resulted in ferritin level decrease from 879 μg/mL to 471 μg/mL. After 27 cycles of azacitidine treatment the disease transformed to acute myeloblastic leukamia. The patient survived 3 years from the diagnosis of MDS. We believe that signifficant reduction of ferritin level prevented the development of iron overload symptoms and delayed transformation to acute leukemia.