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Therapeutic phlebotomy [10] [12] Indications First-line treatment for hereditary hemochromatosis (including asymptomatic patients) Consider in patients with secondary iron overload (e.g., for patients with symptomatic porphyria cutanea tarda) Contraindications Inability to tolerate the procedure (e.g., due to anxiety) Low hemoglobin (e.g., due to iron-loading anemia) Conditions sensitive to fluid shifts (e.g., end-stage liver disease, congestive heart failure) Therapeutic regimen Iron chelation therapy [10] Indications First-line treatment for secondary iron overload due to iron-loading anemia Consider for hereditary hemochromatosis refractory to therapeutic phlebotomy and patients with contraindications to phlebotomy