Hemochromatosis

(Hereditary Hemochromatosis [HH]; Primary Hemachromatosis; Familial Hemochromatosis)

Definition

Hemochromatosis is a condition in which the body builds up too much iron. Two types of hemochromatosis are:

Primary or Hereditary Hemochromatosis (HH)

This type is caused by inherited genes and includes juvenile hemochromatosis. These genes cause the stomach and intestines to absorb too much iron. It is the most common genetic disorder in the United States.

Secondary Hemochromatosis

This type results from treatments or diseases that cause iron to build up in the body. This may include:This type results from treatments or diseases that cause iron to build up in the body. This may include: If found, early HH is easily treated. Untreated HH can lead to severe organ damage. Excess iron builds up in the cells of the liver, heart, pancreas, joints, and pituitary gland. This leads to diseases such as cirrhosis of the liver, liver cancer, diabetes, heart disease, and joint disease.
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Causes

HH is caused by a genetic defect. It is passed down through autosomal recessive inheritance. This means a child who inherits 2 genes, 1 from each parent, is very likely to develop HH. However, not all people who have 2 copies of the gene develop signs and symptoms of HH.

Risk Factors

Hemochromatosis usually present in men between 30-50 years old and in women over 50 years old (postmenopausal). Factors that increase your chance for developing HH include:
  • Family members with hemochromatosis
  • Western or Northern European ancestry
  • Alcoholism, which can lead to liver disease and secondary hemochromatosis

Symptoms

Many people have no symptoms when they are diagnosed. However, when they occur, symptoms may include:
  • Joint pain
  • Fatigue, lack of energy
  • Abdominal pain
  • Loss of sex drive
Complications may include:
  • Heart problems
  • Damage to the adrenal gland and resulting adrenal insufficiency
If the disease is not treated early, iron may build up in body tissues. This may eventually lead to serious problems such as:
  • Arthritis
  • Liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure
  • Damage to the pancreas, possibly causing diabetes
  • Heart abnormalities, such as irregular heart rhythms or congestive heart failure
  • Impotence
  • Early menopause
  • Abnormal pigmentation of the skin, making it look gray or bronze, or the eyes
  • Thyroid deficiency
  • Damage to the adrenal gland

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.Your bodily fluids may be tested. This can be done with blood tests, including genetic testing. Tests may be done to examine your liver. This can be done with a liver biopsy.Images may be taken of your bodily structures. This can be done with:

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Treatment

Treatment is simple, inexpensive, and safe.

Blood Removal

The first step is to rid the body of excess iron. The process is called phlebotomy. This means removing blood. The schedule will depend on how severe the iron overload is. A pint of blood will be taken once or twice a week for several months to a year. It may last longer.When iron levels return to normal, maintenance therapy is given. A pint of blood is given every 2 to 4 months for life. Some people may need it more often. Female patients may need to increase their schedule after menopause.The first step is to rid the body of excess iron. The process is called phlebotomy. This means removing blood. The schedule will depend on how severe the iron overload is. A pint of blood will be taken once or twice a week for several months to a year. It may last longer.When iron levels return to normal, maintenance therapy is given. A pint of blood is given every 2 to 4 months for life. Some people may need it more often. Female patients may need to increase their schedule after menopause.

Lifestyle Changes

Lifestyle changes include steps to reduce the amount of iron you consume and/or absorb, and to help protect your liver:
  • Do not eat red meat or raw shellfish.
  • Do not take vitamin C supplements.
  • Do not take iron supplements.
  • Avoid alcohol.

Treating Associated Medical Conditions

You may need to be treated for other conditions that have developed. Hemochromatosis can cause these to develop:
  • Diabetes
  • Liver cirrhosis
  • Heart failure
  • Enlargement of the spleen

Prevention

Screening for hemochromatosis is not a routine part of medical care. Researchers and public health officials do have some suggestions:
  • Brothers and sisters of people who have hemochromatosis should have their blood tested. This will help identify those who have the disease or are carriers.
  • Parents, children, and other close relatives of people who have the disease should consider testing.
A genetic counselor can help you review your family history, determine your specific risks, and review the appropriate testing.

RESOURCES

American Hemochromatosis Society
http://www.americanhs.org

American Society of Hematology
http://www.hematology.org

CANADIAN RESOURCES

Canadian Liver Foundation
http://www.liver.ca

Health Canada
http://www.hc-sc.gc.ca

References

Hemochromatosis. American Liver Foundation website. Available at: http://www.liverfoundation.org/abouttheliver/info/hemochromatosis/. Updated January 14, 2015. Accessed February 16, 2015.

Hemochromatosis. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddISeases/pubs/hemochromatosis/index.aspx. Updated March 19, 2014. Accessed February 16, 2015.

Hemochromatosis (iron storage disease). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncbddd/hemochromatosis/index.html. Updated September 23, 2013. Accessed February 16, 2015.

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