Cardiac transplantation in a patient with hereditary hemochromatosis: Roleof adjunctive phlebotomy and erythropoietin

We describe the case of a 36-year-old woman with hereditary hemochromatosis (HH) resulting in end-stage cardiomyopathy and treated successfully with o rthotopic cardiac transplantation. Before and after transplantation, the pa tient underwent aggressive treatment with frequent phlebotomy. We used eryt hropoietin concomitantly to maintain adequate hematocrit to support continu ed phlebotomy. We believe that aggressive use of phlebotomy provided the pa tient hemodynamic benefit and hastened the return of endocrine function pos t-transplantation. We also believe that the patient's history of high-dose vitamin C usage may have accelerated iron deposition in the heart and other vital organs.