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Venesection treatment in haemochromatosis – current best practice from the BSG/BASL Special Interest Group
Singh, Prabhsimran Mortimore, Gerri Hicks, Kim McDonald, Natasha Cash, Johnny Lowry, Lisa Griffiths, William
Singh, Prabhsimran
Mortimore, Gerri
Hicks, Kim
McDonald, Natasha
Cash, Johnny
Lowry, Lisa
Griffiths, William
Affiliation
York and Scarborough Teaching Hospitals NHS Foundation Trust; Hull York Medical School; University of Derby; Royal Cornwall Hospitals NHS Trust; NHS Lanarkshire; Belfast Health and Social Care Trust; Somerset NHS Foundation Trust; Cambridge University Hospitals NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Warwick Medical School
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Publication date
2025-06-20
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Abstract
Haemochromatosis is the most common single gene disorder affecting the population of the UK, resulting in iron overload and organ damage. Venesection (therapeutic phlebotomy) has been the primary treatment offered to patients for more than half a century. Despite the prevalence of the condition in the UK, there has been little progress in new treatments being offered over this time. Moreover, there is a lack of robust research to guide the optimal frequency, timing and treatment targets for venesection treatment in haemochromatosis.
Retrospective cohort studies established a clear mortality benefit when treatment is commenced before the development of liver cirrhosis—assumed to be due to limiting the progression of liver disease and development of hepatocellular carcinoma. However, the benefit of venesection on symptoms of haemochromatosis lacks quality evidence.
In this best practice description, we review the currently available literature on the benefits and limitations of venesection treatment. We describe current practice as reflected by the experiences of a multidisciplinary team of professional members of the British Society of Gastroenterology/British Association for the Study of the Liver haemochromatosis Special Interest Group. We describe a framework and recommendations for treatment in addition to describing the management of treatment side effects and complications. Through this work and the establishment of consistency in treatment, patients will benefit from better evidence-based care and the profession will be better able to identify the potential value of future treatments.
Citation
Singh P, Mortimore G, Hicks K, McDonald N, Cash J, Lowry L, Griffiths W, Shearman S. Venesection treatment in haemochromatosis – current best practice from the BSG/BASL Special Interest Group. Frontline Gastroenterology. 2025 Jun 20. Epub ahead of print. doi: 10.1136/flgastro-2025-103172.
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© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial reuse. See rights and permissions. Published by BMJ Group.