Strategy for diagnosis and management in iron overload.
When suspecting an iron overload condition, the transferrin saturation levels should be determined. Levels higher than 45% and serum ferritin in men and postmenopausal women exceeding 200 microg/l confirm the iron overload. Afterwards, the HFE protein genotype should be determined. If it is C282Y or C282Y/H63D, the diagnosis of hereditary hemochromatosis can be accepted as the cause of the iron overload. In the absence of said genotypes, the overload is secondary or not related to the HFE protein. In hereditary hemochromatosis, the degree of iron overload and organic lesions must be established. Liver biopsies are very useful for obtaining said information and for the first case, the determination of serum ferritin is very useful. When less than 1000 microg/l, normal transaminases and no hepatomegalies, a treatment can be started without the need for a liver biopsy. In absence of anemia, the treatment is based on phlebotomies, 400-500 ml a week until obtaining depletion of excess iron. In presence of anemia, the treatment is based on chelating agents, preferably subcutaneous administered 8 hours a day.
Solís-Herruzo
J A
JA
Servicio de Medicina de Aparato Digestivo. Hospital Universitario 12 de Octubre. Madrid. Spain. jsolis.hdoc@salud.madrid.org
D004920:Erythropoiesis / Q000502:physiology; D006801:Humans; D019190:Iron Overload / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*