An alternative to liver biopsy, CT, or MRI as a means of documenting iron overload may be provided by quantitative phlebotomy performed during treatment. The removal of 4 to 5 grams of iron through documented successive phlebotomies (16 to 20 phlebotomies) without the development of anemia is indicative of iron overload. One unit, or 450 mL, of blood is assumed to contain approximately 200 to 250 mg of iron.
Quantitative phlebotomy is useful in patients for whom liver biopsy is contraindicated or patients who refuse the procedure. Quantitative phlebotomy also is typically less costly.