Diagnosis

Hereditary hemochromatosis can be difficult to diagnose. Early symptoms such as stiff joints and fatigue may be due to conditions other than hemochromatosis.

Many people with the disease don't have any signs or symptoms other than elevated levels of iron in their blood. Hemochromatosis may be identified because of abnormal blood tests done for other reasons or from screening of family members of people diagnosed with the disease.

Blood tests

The two key tests to detect iron overload are:

  • Serum transferrin saturation. This test measures the amount of iron bound to a protein (transferrin) that carries iron in your blood. Transferrin saturation values greater than 45 percent are considered too high.
  • Serum ferritin. This test measures the amount of iron stored in your liver. If the results of your serum transferrin saturation test are higher than normal, your doctor will check your serum ferritin.

Because a number of other conditions can also cause elevated ferritin, both blood tests are typically abnormal among people with this disorder and are best performed after you have been fasting. Elevations in one or all of these blood tests for iron can be found in other disorders. You may need to have the tests repeated for the most accurate results.

People with abnormal iron tests should undergo genetic testing to confirm the diagnosis. Most people will have two gene mutations.

Additional testing

Your doctor may suggest other tests to confirm the diagnosis and to look for other problems:

  • Liver function tests. These tests can help identify liver damage.
  • MRI. An MRI is a fast and noninvasive way to measure the degree of iron overload in your liver.
  • Testing for gene mutations. Testing your DNA for mutations in the HFE gene is recommended if you have high levels of iron in your blood. If you're considering genetic testing for hemochromatosis, discuss the pros and cons with your doctor or a genetic counselor.
  • Removing a sample of liver tissue for testing (liver biopsy). If liver damage is suspected, your doctor may have a sample of tissue from your liver removed, using a thin needle. The sample is sent to a laboratory to be checked for the presence of iron as well as for evidence of liver damage, especially scarring or cirrhosis. Risks of biopsy include bruising, bleeding and infection.

Screening healthy people for hemochromatosis

Genetic testing is recommended for all first-degree relatives — parents, siblings and children — of anyone diagnosed with hemochromatosis. If a mutation is found in only one parent, then children do not need to be tested.

Treatment

Blood removal

Doctors can treat hereditary hemochromatosis safely and effectively by removing blood from your body (phlebotomy) on a regular basis, just as if you were donating blood. Some blood collection centers in the United States have obtained permission from the Food and Drug Administration to collect this blood and use it for transfusion.

The goal of phlebotomy is to reduce your iron levels to normal. The amount of blood removed and how often it's removed depend on your age, your overall health and the severity of iron overload. It may take a year or longer to reduce the iron in your body to normal levels.

  • Initial treatment schedule. Initially, you may have a pint (about 470 milliliters) of blood taken once or twice a week — usually in a hospital or your doctor's office. 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.
  • Maintenance treatment schedule. Once your iron levels have returned to normal, blood can be removed less often, typically every two to four months. Some people may maintain normal iron levels without having any blood taken, and some may need to have blood removed monthly. The schedule depends on how rapidly iron accumulates in your body.

Treating hereditary hemochromatosis can help alleviate symptoms of tiredness, abdominal pain and skin darkening. It can help prevent serious complications such as liver disease, heart disease and diabetes. If you already have one of these conditions, phlebotomy may slow the progression of the disease, and in some cases even reverse it.

Phlebotomy will not reverse cirrhosis or improve joint pain.

If you have cirrhosis, your doctor may recommend periodic screening for liver cancer. This usually involves an abdominal ultrasound and a blood test.

Chelation for those who can't undergo blood removal

If you can't undergo phlebotomy, because you have anemia, for example, or heart complications, your doctor may recommend a medication to remove excess iron. The medication can be injected into your body, or it can be taken as a pill. The medication binds excess iron, allowing your body to expel iron through your urine or stool in a process that's called chelation.

Lifestyle and home remedies

In addition to therapeutic blood removal, you may further reduce your risk of complications from hemochromatosis if you:

  • Avoid iron supplements and multivitamins containing iron. These can increase your iron levels even more.
  • Avoid vitamin C supplements. Vitamin C increases absorption of iron. There's usually no need to restrict vitamin C in your diet, however.
  • Avoid alcohol. Alcohol greatly increases the risk of liver damage in people with hereditary hemochromatosis. If you have hereditary hemochromatosis and you already have liver disease, avoid alcohol completely.
  • Avoid eating raw fish and shellfish. People with hereditary hemochromatosis are susceptible to infections, particularly those caused by certain bacteria in raw fish and shellfish.

Additional dietary changes generally aren't required for people receiving blood removal treatment.

Preparing for your appointment

Make an appointment with your primary care doctor if you have any signs or symptoms that worry you. You may be referred to a specialist in digestive diseases (gastroenterologist), or to another specialist, depending on your symptoms. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes. Learn if you have any liver disease in your family by asking your family members, if possible.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Take a family member or friend along to help you remember what's been discussed.
  • Write down questions to ask your doctor.

Questions to ask your doctor

Some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • Is my condition temporary or will I always have it?
  • What treatments are available? And, what do you suggest for me?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any restrictions that I need to follow?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer questions your doctor may ask:

  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or do they come and go?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Does anyone in your family have hemochromatosis?
  • How many alcoholic beverages do you drink in a week?
  • Are you taking iron supplements or vitamin C?
  • Do you have a history of viral hepatitis, such as hepatitis C?
  • Have you required blood transfusions before?
Aug. 08, 2017
References
  1. Ferri FF. Hemochromatosis. In: Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed Sept. 5, 2015.
  2. Crownover BK, et al. Hereditary hemochromatosis. American Family Physician. 2013;87:183.
  3. Salgia RJ, et al. Diagnosis and management of hereditary hemochromatosis. Clinics in Liver Disease. 2015;19:187.
  4. Hemochromatosis. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.niddk.nih.gov/health-information/health-topics/liver-disease/hemochromatosis/Pages/facts.aspx. Accessed Sept. 5, 2015.
  5. What is hemochromatosis? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hemo/#. Accessed Sept. 5, 2015.
  6. Guidance for industry — Variances for blood collection from individuals with hereditary hemochromatosis. U.S. Food and Drug Administration. http://www.fda.gov/biologicsbloodvaccines/guidancecomplianceregulatoryinformation/guidances/blood/ucm076719.htm. Accessed Sept. 5, 2015.
  7. Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Sept. 24, 2015.