Iron Overload (cont.)
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
In this Article
- What is hereditary hemochromatosis?
- How is hereditary hemachromatosis inherited?
- What are the symptoms and signs of hemochromatosis?
- How is hemochromatosis diagnosed?
- How is hemochromatosis treated?
- What are dietary recommendations in hemochromatosis?
- What are the recommendations for screening for liver cancer in hemochromatosis?
How is hemochromatosis treated?
The most effective treatment for hemochromatosis is to reduce iron in the body by phlebotomy (withdrawal of blood from the arm veins). One unit of blood, which contains 250 mg of iron, usually is withdrawn every one to two weeks. Serum ferritin and transferrin saturation are checked every two to three months. Once ferritin levels are below 50 ng/ml and transferrin saturations are below 50%, the frequency of phlebotomies are reduced to every two to three months. When hemochromatosis is diagnosed early and is treated effectively, damage to the liver, heart, testicles, pancreas and joints can be prevented completely, and patients maintain normal health. In patients with established cirrhosis, effective treatment can improve the function of the heart, skin color, and diabetes. However, cirrhosis is irreversible and the risk of developing liver cancer remains.
The benefits of therapeutic phlebotomy in hemochromatosis are as follows:
- It prevents the development of liver cirrhosis and liver cancer if the disease is discovered and treated early.
- It improves liver function partially in patients who have already developed advanced cirrhosis.
- It improves and/or completely resolves symptoms of weakness, liver pain, joint pain, and fatigue.
- It improves function of the heart in patients with mild and early heart disease.
What are dietary recommendations in hemochromatosis?
- A normal balanced diet is recommended without avoidance of iron containing foods provided patients are undergoing effective therapeutic phlebotomy.
- Alcohol should be avoided since alcohol consumption increases the risk of developing cirrhosis and liver cancer.
- Ingestion of high doses of vitamin C in patients with iron overload may lead to fatal abnormal heart rhythms. Therefore, it is reasonable to avoid vitamin C supplementation until patients are adequately treated.
- Raw seafood should be avoided since patients with hemochromatosis are at risk of acquiring bacterial infections that flourish in iron rich environment.
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