Phlebotomy in the Treatment of Iron Overload in Patients with Nonalcoholic and Alcoholic Fatty Liver Diseases
M. Penkova, S. Dragneva, C. Marinova, R. Ivanova, M. Gulubova, J. Ananiev, L. Mateva

Abstract
In patients with chronic liver disease, especially nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD) and chronic hepatitis C, iron overload is an important factor for the severity and course of disease. The clinical benefit of phlebotomy as iron reduction therapy in patients with NAFLD and ALD and iron is not clear yet. The aim of our study was to evaluate the effect of phlebotomy in the treatment of patients with NAFLD and ALD and iron overload. Material and methods: A total of 60 patients (45 –male, 15-female; age 44.56±7.19 y.) with serum markers, pointed iron overload (increased levels of serum iron, ferritin and tranferrin saturation > 30%) were included: 30 patients with NAFLD – steatosis (NAS, n= 8) иsteatohepatitis (NASH, n= 22) and 30 patients with ALD – steatosis (AS, n= 10) и alcoholic steatohepatitis (ASH, n= 20) with intakeof alcohol more than 40 g /daily. In patients with NAFLD serum insulin level and HOMA-IR were also assessed. Phlebotomies were carried out periodically according to the standard protocol for a follow-up period of 12 months. Results: In response to phlebotomy, there was a significant decrease (р = 0.001-0.0001) in serum levels of iron, ferritin and transferrin saturation in the whole group of patients, and also in the groups of patients with NAFLD and ALD. An improvement of liver enzymes – AST, ALT and GGT (р = 0.001-0.0001) was also found in the three groups of patients. In patients with NAFLD, a decrease of serum insulin on fasting (basal -18.46 ± 4.32 mIU/L vs11.27 ± 3.54 mIU/L, post phlebotomies, р = 0.005) and HOMA-IR(4.56 ± 2.54 vs 2.68 ± 1.73) were also present. In conclusion, our results show that phlebotomy is a safe and efficient therapy for the patients with nonalcoholic and alcoholic fatty liver disease and iron overload. Regular control of serum iron decrease is essential for the determination of phlebotomies’ frequency.

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