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.
Keywords: myelodysplastic syndromeazacitidineiron overloadphlebotomy