An alternative to liver biopsy as a means of documenting iron overload may be provided by quantitative phlebotomy performed during treatment (See next section.) The removal of 4 to 5 grams of iron through documented successive phlebotomies (16 to 20 phleblotomies) without development of anemia is indicative of iron overload. (One unit, or 450 mL, of blood is assumed to contain approximately 200 to 250 mg of iron.)

Quantitative phlebotomy is useful in patients for whom liver biopsy is contraindicated, refused, or not needed for other reasons.