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Phlebotomy Gaining Acceptance as HCV Treatment

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Most people associate the removal of blood from their veins with donating to the Red Cross or getting tested for some ailment. However, the removal of blood from someone’s body can serve many purposes. Learn how the safe ancient practice of bloodletting, or phlebotomy, has proven therapeutic value, and why it is gaining momentum as a treatment of chronic Hepatitis C.

Helping to alleviate a variety of illnesses for over 3,000 years, bloodletting has been practiced in most ancient medicinal cultures. Known in the modern healthcare setting as phlebotomy, the removal of blood from someone’s body can have many applications. In addition to being a diagnostic technique and a method of transferring blood to those who need it, phlebotomy is also used therapeutically. While phlebotomy treatment has targeted different kinds of liver diseases over the years, recent research demonstrates its application in the fight against chronic Hepatitis C.

Why Phlebotomy May Help

Phlebotomy may benefit those with Hepatitis C because it lessens the amount of iron in the bloodstream. Toxic in excessive amounts, too much iron in the body contributes to liver damage. As this mineral’s primary storage site, the liver is most susceptible to iron’s toxicity. Our bodies have a limited ability to eliminate excessive amounts of iron.

Because of the liver damage associated with chronic Hepatitis C, people with the virus often have difficulty excreting even normal amounts of iron from their body. Further, those with chronic Hepatitis C are especially vulnerable because the virus inflicts most of its damage by creating free radicals in the liver. As soon as iron molecules collide with those free radicals, liver cell death is the likely result.

Increasing evidence indicates that iron toxicity plays an important role in the pathogenesis of chronic Hepatitis C. As published in the June 2004 edition of Journal of Gastroenterology, Japanese researchers demonstrated this relationship by examining whether iron removal by repeated phlebotomy improves serum alanine aminotransferase (ALT) levels in patients with chronic Hepatitis C. An enzyme produced in liver cells, ALT leaks into the bloodstream when liver cells are damaged. The results showed that people with chronic Hepatitis C receiving biweekly phlebotomy had improvements in their ALT levels compared with those not receiving phlebotomies.

Recent Evidence

Two studies published in 2007 present compelling evidence to include phlebotomy in modern Hepatitis C treatment protocols:

  1. Better Than Diet – Knowing that iron likely plays an important role in the development of Hepatitis C, Japanese researchers examined which technique was best for lowering iron levels – phlebotomy or dietary restriction. As published in the May 2007 edition of Internal Medicine, these researchers conducted a randomized, controlled trial comparing phlebotomy with dietary iron reduction in people with chronic Hepatitis C. They concluded that phlebotomy is superior to dietary iron reduction in reducing liver damage from chronic Hepatitis C.
  2. Best With Interferon – As published in the September 2007 edition of Digestive Diseases and Sciences, Michigan scientists analyzed six randomized controlled trials comparing phlebotomy and interferon treatment, to interferon alone, in patients with chronic Hepatitis C. All studies used sustained viral response (SVR) as its endpoint, the continued clearance of the Hepatitis C virus from the blood six months after therapy. Researchers found that SVR was attained in 27 percent of patients in the phlebotomy plus interferon group, compared to 12 percent of patients achieving SVR in the interferon group. Although the six trials had different parameters, the authors concluded that phlebotomy improved a person with chronic Hepatitis C’s chances of attaining SVR when combined with interferon treatment.

Previous Non-Responders

Considering the results of studies using phlebotomy to help Hepatitis C, one can surmise that iron may play a role in the persistence of Hepatitis C infection – particularly in interferon non-responders. By removing some of the blood laden with excessive levels of iron, the currently prescribed medications seem to have a better chance at destroying the Hepatitis C virus the second time around. Theoretically, high dose interferon therapy combined with phlebotomy may be a way for previous non-responders to achieve treatment success. However, only continued research will confirm or deny this proposal.


Iron reduction therapy holds great promise as an effective treatment for those infected with Hepatitis C. Although phlebotomy alone does not reduce Hepatitis C viral load, it increases the effectiveness of interferon therapy when used either before or during administration of this standard medication.

Whether being considered in combination with interferon therapy or alone as an alternative treatment for individuals who cannot tolerate interferon, removing blood regularly decreases iron levels in the body by reducing the number of iron-rich red blood cells. Universally recognized as an iron reduction therapy leading to improvements in liver enzyme levels, the simplicity and safety of phlebotomy is gaining momentum as a recommended technique for Hepatitis C therapy.


Desai TK, et al., Phlebotomy Improves Therapeutic Response to Interferon in Patients with Chronic Hepatitis C: A Meta-Analysis of Six Prospective Randomized Controlled Trials, Digestive Diseases and Sciences, September 2007.

Girelli CM, et al., Effect of blood letting on serum aminotransferase levels of patients with chronic hepatitis C and iron overload, Recenti Progressi in Medicina, May 1998., Phlebotomy, Nancy Bateman, Yahoo Inc., 2007.

Sumida Y, et al., Effects of dietary iron reduction versus phlebotomy in patients with chronic hepatitis C: results from a randomized, controlled trial on 40 Japanese patients, Internal Medicine, May 2007., Iron and Hepatitis C, James E. Nelson, PhD and Kris V. Kowdley, MD, Current Hepatitis Reports, November 2004., A Brief History of Bloodletting, Gilbert R. Seigworth, MD, The Educational Broadcast Association, 2007.

Yano M, et al., A significant reduction in serum alanine aminotransferase levels after 3-month iron reduction therapy for chronic hepatitis C: a multicenter, prospective, randomized, controlled trial in Japan, Journal of Gastroenterology, June 2004.

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