Iron overload has been observed in a number of congenital or acquired conditions from which HHC must be differentiated.
The disease must also be differentiated from blood pathology (thalassemia, sideroblastic anemia, hereditary atransferrinemia, microcytic anemia, tardive cutaneous porphyria), liver diseases (alcoholic liver damage, chronic viral hepatitis, non-alcoholic steatohepatitis). A diet rich in proteins is shown, without foods containing iron.
Bloodletting is the most accessible way to remove excess iron from the body. Usually 300-500 ml of blood is removed with a frequency of 1-2 times a week. The number of phlebotomies is calculated depending on the level of hemoglobin, blood hematocrit, ferritin, and the amount of excess iron. This takes into account that 500 ml of blood contains 200-250 mg of iron, mainly in the hemoglobin of erythrocytes.
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Bleeding continues until the patient develops mild anemia. A modification of this extracorporeal technique is cytapheresis (CA) (removal of the cellular part of the blood with the return of autoplasma in a closed circuit). In addition to the mechanical removal of blood cells, CA has a detoxifying effect and helps to reduce the severity of degenerative-inflammatory processes. Each patient undergoes 8-10 sessions of accutane with a further transition to maintenance therapy using CA or hemoexfusions in the amount of 2-3 sessions for 3 months.
Drug treatment is based on the use of deferoxamine (desferal, desferin), 10 ml of a 10% solution intramuscularly or intravenously by drip. accutane drug has a high specific activity towards Fe3+ ions. At the same time, 500 mg of Desferal are able to remove 42.5 mg of iron from the body. The duration of the course is 20-40 days. At the same time, cirrhosis, diabetes mellitus and heart failure are treated. Frequently observed anemic syndrome in patients with HCH in the presence of hutThe exact content of iron in the liver tissue limits the use of efferent therapy.
Our clinic has developed a scheme for the use of recombinant erythropoietin against the background of CA.
The drug promotes increased utilization of iron from the body's depot, due to which there is a decrease in the total reserves of the microelement, an increase in hemoglobin levels. Recombinant erythropoietin is administered at a dose of 25 μg/kg of body weight against the background of isotretinoin sessions performed 2 times a week for 10-15 weeks.
The forecast is determined by the degree and duration of overloads.