Impacto da sangria terapêutica no perfil do ferro e em parâmetros hematológicos e bioquímicos em pacientes com hiperferritinemia

Abstract

Therapeutic phlebotomy is an essential, safe, and low-cost treatment for diseases associated with iron overload, aiming to normalize iron kinetics in the body. In Brazil, iron profile monitoring during follow-up between phlebotomies is not routine, which could contribute to more targeted and individualized strategies. The objective was to evaluate the iron profile after therapeutic phlebotomies in patients with hyperferritinemia. A primary, observational, longitudinal prospective cohort study was conducted at the Regional Blood Center of Uberaba/MG, between October 2024 and June 2025. Patients with indication for therapeutic phlebotomy due to hyperferritinemia, over 18 years old, were included. 10 ml of peripheral blood were collected at two time points: before the first phlebotomy and 15 days after the procedure. Complete blood count, vitamin B12, folic acid, iron profile, and liver function were evaluated. In the red blood cell series, women showed an increase in mean corpuscular volume and mean corpuscular hemoglobin (p=0.0401 and p=0.0394). Men showed significant reduction in red blood cells (p<0.0001), hemoglobin (p=0.0008), hematocrit (p<0.0001), and RDW (p<0.0001). Combined analysis showed a decrease in total leukocytes (p=0.0033), without substantial platelet variation. In the iron profile, serum iron decreased in men (p=0.0165). Total iron binding capacity increased in women (p=0.0277) and latent iron binding capacity increased in both sexes (p=0.0070 and p=0.0061). Transferrin saturation index and ferritin reduced significantly in men (p=0.0027 and p<0.0001) and women (p=0.0210 and p=0.0312). Alkaline phosphatase reduction was observed (p=0.0451), without significant variations in other biochemical parameters. However, 18.42% of patients presented anemia before the first phlebotomy, increasing to 23.68% after the procedure, with the majority having a diagnosis of hyperferritinemia. Therapeutic phlebotomy demonstrated significant impact on the evaluated laboratory parameters. Changes in iron profile markers, such as ferritin reduction and transferrin saturation index, confirm the procedure's efficacy. Results show selective hematological response, with reduction in red blood cell series parameters in men. The increase in anemia reinforces the need for systematic laboratory monitoring between sessions to avoid iatrogenic complications. The lack of routine monitoring of these parameters in Brazilian institutions reinforces the need for serial evaluation, allowing more assertive and individualized clinical management.