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Informed Consent Statement All selected patients gave their written informed consent to participate in the study and received assurance of confidentiality and of the privacy of their participation

Normal erythrocyte catabolism 90% extravascular hemolysis Spleen, liver, bone marrow, lymph nodes Globin + Heme Iron to transferrin, globin to amino acids (pool) Heme + Heme oxygenase: Biliverdin + CO2 Biliverdin is reduced to unconjugated bilirubin that binds to albumin and is transported to the liver In the liver it dissociates from albumin and is conjugated with glucuronic acid (conjugated bilirubin) Conjugated bilirubin: direct, water soluble Unconjugated bilirubin: indirect, insoluble in water, reacts with the addition of alcohol

The Medium-Term Timeline: Weeks 2 to 4 During a loading phase, you may receive weekly injections

Annals of the New York Academy of Sciences 2005;1054 407-416 137