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[6] Treatment Phlebotomy: indicated in all patients with symptomatic PCT Procedure: ∼ 450 mL of blood is removed every 2 weeks Therapeutic targets Serum ferritin level ∼ 15 ng/mL (near the lower limit of normal) Plasma porphyrin level ∼ 1 mcg/dL Low-dose hydroxychloroquine or chloroquine Indications include: Patients unable to tolerate phlebotomy (e.g., concurrent anemia) Presence of HFE gene mutation No severe iron overload Duration: until plasma or urine porphyrins have normalized Ongoing management Treatment of hepatitis C (after initiation of treatment for PCT) [2] Hepatocellular carcinoma screening: α-fetoprotein and liver imaging [7] Acute intermittent porphyria (AIP) Epidemiology Etiology and pathophysiology [2] Autosomal dominant gene mutation, with variable penetrance Approx