Iron Overload (cont.)
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One unit of blood, which contains 250 mg of iron, usually is withdrawn every one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, the 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 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.
What are the recommendations for screening for liver cancer in hemochromatosis?
Liver
cancers (hepatoma or hepatocellular cancer) mainly
occur in patients with cirrhosis. Therefore, patients with hemochromatosis and
cirrhosis should have abdominal ultrasound examinations and blood tests for alpha-fetal protein
(a protein produced by liver cancer) every six months.
Last Editorial Review: 2/28/2007
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