The effect of phlebotomy therapy in porphyria cutanea tarda. Its relation to the phlebotomy-induced reduction of iron stores.

. Porphyrin excretion and clinical signs have been studied in 21 patients with porphyria cutanea tarda treated by phlebotomy and in a control series of 12 patients. Phlebotomy was performed until signs of depleted iron stores appeared. Clinical and biochemical remission occurred in every phlebotomy-treated patient. In 18 patients who were bled frequently (usually 0.5 1 per week) and who were not given iron supplements in conjunction with phlebotomy, the urinary porphyrin excretion decreased in all to a level of 1 mg per day or less within 1/2 year. Remission ensued in patients with iron overload as well as in patients with quantitatively normal iron stores and in patients abstaining from alcohol as well as in patients with a persistent abuse of alcohol. A decrease in porphyrin excretion comparable to that of phlebotomy-treated patients occurred in only two out of the 12 control patients. There was a significant relationship between the period required until iron stores were depleted and until the urinary porphyrin excretion fell to 1 mg per day. In one patient given iron supplement for 6 1/2 months in conjunction with phlebotomy, more blood had to be removed to obtain a remission than in any other patient, and this patient had the longest treatment (16 months). Thus the results have shown that phlebotomy therapy is effective in porphyria cutanea tarda. It seems probable that the effect is mediated through the phlebotomy-induced reduction of iron stores.