2008.09.22 – Too much iron brings increased health risks

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Medical Edge: Too much iron brings increased health risks
9/22/2008 5:45:02 AM
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DEAR MAYO CLINIC: I was diagnosed with hemochromatosis two years ago. Blood has been drawn off about every three to four months. Is this disease linked to polycythemia vera? What kind of specialist should I see?

Hemochromatosis is a disorder that causes your body to absorb too much iron from the food you eat. The excess iron is stored in your organs, especially the liver, heart and pancreas. Sometimes the stored iron damages these organs, leading to other serious medical conditions, such as cirrhosis, liver cancer, heart disease and diabetes.

In most individuals who have the condition, hemochromatosis is a genetic illness. It’s one of the most common genetic defects in people of Northern European ancestry. Often, diagnosis comes as a result of an individual being tested for the disease because they either have abnormal blood iron tests, or have a first-degree relative — a parent, sibling, or — who has hemochromatosis. Most don’t show symptoms at the time of diagnosis.

Of those who do have symptoms, the most common is fatigue. Some people with hemochromatosis may have arthritis affecting their fingers, wrists, ankles and knees. Others may have diabetes accompanied by a discoloration of the skin that results from excess iron. Hemochromastosis may cause impotence in men and, rarely, infertility in women.

Unlike hemochromatosis, polycythemia vera is a blood disorder in which your bone marrow makes too many red blood cells. Although they aren’t linked, the standard treatment for the two diseases — phlebotomy — is the same.

Phlebotomy involves drawing a certain amount of blood and the iron contained therein from one of your veins. The goal in using phlebotomy for hemochromatosis is to reduce iron levels to normal. The amount of blood drawn depends on your age, your overall health and the severity of iron overload.

Initially, you may have a pint of blood taken once a week — usually at a blood bank or hospital. This process shouldn’t be uncomfortable. While you recline in a chair, a needle is inserted into a vein in your arm. The blood flows from the needle into a tube that’s attached to a blood bag. Depending on your veins and the consistency of your blood, the time needed to remove a pint of blood can range from 10 to 30 minutes. Once your iron levels have returned to normal, you may only need to have blood drawn three or four times a year.

During treatment, your doctor tracks your blood’s iron and hemoglobin levels to monitor your body’s iron stores and to check for anemia. If you become anemic, you won’t have enough red blood cells to carry adequate oxygen to your tissues. Therefore, your physician may perform phlebotomies less frequently to allow your bone marrow to recover and produce more red cells.

For most people, phlebotomy is the only treatment needed for hemochromatosis. But, there are some lifestyle changes you can make that will help, too. For example, I advise my patients to stop drinking, as alcohol and iron can combine to cause more liver damage. I also advise my patients not to consume iron supplements, multivitamin preparations containing iron, or excessive amounts of vitamin C.

People with hemochromatosis are susceptible to infection with the bacterium vibrio vulnificus, which can be found in uncooked seafood. Therefore uncooked seafood should be avoided. I usually don’t restrict red meat consumption because, as long as a person is undergoing regular phlebotomy, the amount of iron that’s contained in what an average person would eat in the form of red meat can be handled easily.

Because there’s currently no cure for hemochromatosis, treatment of the disorder is life-long. To develop an ongoing treatment plan that’s right for your situation, I recommend you consult a physician familiar with hemochromatosis. Traditionally, patients with this disease have been referred to liver doctors (hepatologists). But, increasingly, hematologists and even some general internists are managing hemochromatosis. — Raj Satyanarayana, M.D., Transplant Center, Mayo Clinic, Jacksonville, Fla.

E-mail a question to medicaledge@mayo.edu or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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