Would you recommend phlebotomy for a patient with previously treated ALL and HBV reactivation both now in remission but with elevated liver enzymes and ferritin, and liver biopsy with widespread peri-canalicular moderate iron deposition and perisinusoidal fibrosis with focal periportal fibrosis?

The case presented is not unusual. Patients do not always recall the number of transfusions received. I favor secondary hemochromatosis. If her HGB is above 11-12 g/dL, she could tolerate phlebotomies. I would be gentle with the schedule of phlebotomies, maybe a couple in 1-2 months, and follow her ...