title: Effects of Phlebotomy on Liver Enzymes and Histology of Patients with Nonalcoholic Fatty Liver Disease.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD), defined as excessive liver fat deposition and one of end-stage liver disease causes. Increased ferritin levels are associated with insulin resistance and a higher hepatic iron and fat content. Hyperferritinemia has been associated with severity of liver damage in NAFLD. The study aimed to evaluate the effects of phlebotomy on liver enzymes and histology in such patients.
  
  
  METHODS
  Thirty-two eligible patients who had NAFLD and after 6 months of lifestyle modification still had NAFLD, and whose ferritin serum was above 250 mg/dl, were enrolled in this clinical trial study. After written informed consent was obtained, each patient's blood serum was taken for aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK-P), complete blood count (CBC), total iron-binding capacity (TIBC), iron, and ferritin. Then the patients underwent liver biopsy. After that patients underwent phlebotomy, giving 350 cc blood monthly. Before every phlebotomy, hemoglobin and ferritin were checked. If they were in the goal range, phlebotomy was discontinued and the patient underwent liver biopsy. A serum sample was taken for testing at the beginning of the study. The results before and after phlebotomy were compared. The maximum duration of the study was 6 months.
  
  
  RESULTS
  Thirty-two patients (26 males and 6 females) were enrolled, and the mean average age was 33.7 ± 6.74 years. Phlebotomy improved liver enzymes and histology of liver significantly (P< 0.001) and induced reduction of ferritin.
  
  
  CONCLUSIONS
  Phlebotomy is effective for the improvement of liver enzymes and histology in patients with NAFLD and hyperferritinemia.
authors.affiliation: Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Khodadoostan
authors.affiliation: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Zamanidoost
authors.affiliation: Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shavakhi
authors.affiliation: Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hosein
authors.initials: H
authors.lastname: Sanei
authors.affiliation: Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Masood
authors.initials: M
authors.lastname: Shahbazi
authors.affiliation: Department of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ahmadian
keywords: Hyperferritinemia; nonalcoholic fatty liver disease; phlebotomy