question from a user
When we're talking H&H, where does you cutoff fall for discontinuation of therapy? There is a lot of debate around secondary vs primary causes of erythrocytosis, with a lot of literature supporting the former to be of lesser concern. Something like PV, where you have additional clotting risks with things like elevated platelet counts vs something strictly related to RBC and nothing else in the case of something like testosterone replacement therapy or living at altitude. On the topic of therapeutic phlebotomy, how does one mitigate the risk of crashing their ferritin when using this as a front line means of controlling H&H? Just seems like the suppression of hepcidin during treatment and how it relates to iron stores/iron regulation could make that a little tricky.
AlphaMD's Answer
There shouldn't be a cut off if you are requiring therapeutic phlebotomy and doing so. If you're not doing it and you're getting into the mid and high fifties with your hematocrit we should just have more conversation about the importance of doing it. If someone has a blood dyscrasia endocrine or other specialists may need to be in the loop on therapy as we should be doing this as a collective together.
Usually during donation labs are drawn to look at those levels and if that is something of concern certain amounts of different components can be given back. There are also different forms of donation where they can take only certain parts or all of it. It is not common, but some guys require more than others and some not at all. We would sit down and discuss the risk/benefits and any concerns if needing this frequently.
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