What is Iron Overload?
Hemochromatosis is a genetic or an acquired condition which is caused by excessive iron retention in the body. Currently, this is defined as iron overload with a hereditary cause. Normally, iron can be lost during perspiration or is excreted from the cells located in the intestines. In healthy people, about 1 milligram of iron is gone each day through these means. In menstruating women, larger amounts of iron can be lost. However, 1 milligram of iron is also recovered by the body each day from daily dietary sources.
In affected individuals, there is impairment in the regulatory mechanism and too much amount of iron is absorbed leading to iron overload. Since the system does not have proper regulatory mechanism to eliminate the excess, the disproportion between the gains and losses will result in the retention and build-up of iron in many of the body organs. Frequently affected body organs include the liver, pancreas, joints, skin, heart, testicles and the pituitary and thyroid glands.
Excess Iron in Blood Symptoms
Patients with early hemochromatosis are usually asymptomatic. The condition can be only determined when a patient undergoes routine blood testing and the iron level in the blood is found to be elevated. Clinical manifestations in male population become noticeable usually at 40 to 50 years of age. In females, the disease may be manifested 10 to 20 years later than in males due to the excessive loss of iron through menstrual blood flow in the premenopausal period.
Initially, non-specific symptoms are experienced by affected individuals such as body weakness, lassitude, loss of weight, skin discoloration, abdominal discomfort and loss of sexual interest.
The accumulation of iron in the body can affect multiple organs leading to a wide range of symptoms. Commonly, this iron deposition leads to the development of skin darkening, where skin possesses a bronze appearance. Joint pain and arthritis are also common problems experienced by about 25% to 50% of the patients. The deposition of iron involving the pituitary gland and testicle causes testicle shrinkage and sexual dysfunction. Hypothyroidism may be the resulting condition when hemochromatosis affects the thyroid gland. If iron is deposited in the pancreas, insulin production will be significantly affected leading to diabetes mellitus. The condition also results to heart failure and abnormal heart rhythm s heart muscles are also affected. In the liver, iron causes scarring leading to liver diseases of varying degrees and also increases the risk of developing liver cancer.
Excess Iron in Blood Causes
The cause can be differentiated between primary and secondary cases. The former is hereditary or genetically determined while the latter which is the less frequent cause is acquired during life. Minor disturbances such as mutations in the DNA structure can potentially cause this problem.
Secondary hemochromatosis can be due to ineffective erythropoiesis, serious and chronic hemolysis, multiple blood transfusions, excessive parenteral iron supplement, iron poisoning, extreme dietary iron and alcohol-related cirrhosis.
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Excess Iron in Blood Treatment
The therapy is aimed at reducing iron level in the blood. The key factor that will determine the physician’s decision is the number of hemoglobin. When the amount of hemoglobin in the system is enough to tolerate blood removal, the physician will give an order for phlebotomy but if the level is low, the reduction of iron will involve the use of iron-chelation. For some instances, the doctor can order a combination of these two approaches.
In otherwise-healthy individuals, the standard treatment for reducing iron levels involves consistently programmed therapeutic phlebotomies. The duration and frequency is determined by a person’s age, sex, clinical diagnosis and gravity of symptoms. During the first course of treatment, the procedure is performed frequently and involves the removal of one unit of whole blood which contains 250 milligrams of iron, possibly, once every week until the iron levels go within the norm. After the stabilization and normalization of the levels of iron and other specific markers, the bloodletting procedure may already be scheduled every other month or depending on the individual rate of iron loading. Every 2 to 3 months, serum ferritin and transferring saturation are monitored. When the ferritin level goes below 50 ng/ml and the transferring saturation is at 50% or lower, the frequency of therapy is decreased.
In case when the individual is not able to endure routine blood draws, a chelating agent is offered for use. In the bloodstream, this agent, which is the drug Deferoxamine, attaches with iron and improves urine and fecal elimination. If the iron overload is chronic, the mainstream management is an injection of the chelating drugs subcutaneously over a period of 8 to 12 hours per day.
If the problem is diagnosed and is treated early, most of the manifestations can be prevented or reversed but when the problem s already chronic and is already in its advanced stages, clinical symptoms are usually not reversible.
For other problems such as diabetes mellitus, heart problems and liver insufficiency, conventional treatments can be used. Erectile dysfunction can be corrected with the administration of testosterone. If liver failure becomes severe, liver transplantation must be considered as an option.
