Diagnosis of hemochromatosis probands in a community hospital.
OBJECTIVE
To evaluate factors that lead to the diagnosis of hemochromatosis probands in a community hospital, including education of physicians about hemochromatosis and iron overload, specialty of physicians, diagnostic indicators of hemochromatosis, and clinical manifestations of hemochromatosis probands.


METHODS
We conducted a hemochromatosis education program for health care personnel associated with a community hospital and the public during 1990 to 1994. Data on physicians who diagnosed probands, diagnostic indicators of hemochromatosis, and manifestations of hemochromatosis and associated illnesses were tabulated. Iron grades of all hospital liver biopsy specimens obtained from Caucasian subjects during 1990 to 1994 were also analyzed.


RESULTS
We identified 162 hemochromatosis probands; 66.7% were diagnosed by physicians who participated in our education program. Primary care and internal medicine subspecialty physicians diagnosed 66.7% and 29.6% of probands, respectively, based on elevated serum iron parameters and hepatic enzyme concentrations (51.9% and 36.4% of probands, respectively). Iron overload occurred in 90.7%, and was associated with clinical manifestations in most. Of 844 hospital liver biopsy specimens from Caucasians, 8.5% had increased iron grades; 4.6% represented hemochromatosis.


CONCLUSIONS
Physicians with current education readily diagnose hemochromatosis probands during routine health care delivery, but most probands identified in this manner have iron overload. Our results suggest that community physicians and hospitals could contribute substantially to hemochromatosis screening programs, permitting detection of more homozygotes before the development of iron overload.
Barton
J C
JC
Southern Iron Disorders Center, Brookwood Medical Center, Birmingham, Alabama, USA.
Barton
N H
NH
Alford
T J
TJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing; D005260:Female; D006432:Hemochromatosis / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D006720:Homozygote; D006764:Hospitals, Community; D006801:Humans; D007388:Internal Medicine; D019190:Iron Overload / Q000235:genetics; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care