Iron Overload Investigation, Treatment and Management
What is iron overload and why is it a problem?
Although iron is a key component required for production of red blood cells, too much iron is not good for us. Excessive body iron is a common problem in Haematology and it is a problem because iron can build up in tissues where it can be toxic, such as the heart muscle, the pancreas, the pituitary gland, skin, joints, liver and other tissues.
What causes iron overload?
High iron can be due to a genetic disorder known as Haemochromatosis. Occasionally it can be due to iron build up secondary to red cell destruction (due to immune problems or abnormally fragile red blood cells) where your body cannot eliminate the iron from destroyed blood cells fast enough. Sometimes, “transfusional iron overload” can occur in patients who have had multiple blood transfusions.
What are the symptoms of iron overload?
Excessive iron in the body can cause problems due to the iron being deposited into organs and interfering with organ function. Tiredness, cardiac failure, shortness of breath, diabetes, impotence, arthritis, liver abnormalities and skin pigmentation are some of the well-known symptoms of iron overload.
How is iron overload detected?
High iron is usually indicated by a high ferritin on an ‘iron studies’ blood test.
Normal ferritin is usually 20-300mcg/L
Excessively high ferritin is defined as greater than 1000mcg/L
Sometimes a high ferritin is not due to iron overload itself, but due to other disorders such as liver problems, alcohol intake or inflammation. High iron levels are usually investigated with further blood tests to check organ function, and to look for the Haemochromatosis gene mutation, as this is common in Australia. Occasionally other tests to evaluate specific body organs such as the heart or the liver may be required. Heart scans may include an echocardiogram, or a cardiac MRI scan. Liver biopsy is occasionally done to evaluate how much iron is in the liver, although non-invasive testing of liver iron is being developed, so be sure to discuss this with your doctor.
Is Haemochromatosis common?
In Australians this is a common condition because it is a common genetic abnormality in people of Northern European descent. Between 1 in 10 and 1 in 20 Australians have at least one copy of this gene, but iron overload only usually develops if you have two copies of the gene affected. This is a relatively common situation, with 1 in 400 Australians carrying two copies of the abnormal gene, and many of these people develop very high ferritin levels, which will require treatment. For more information about Haemochromatosis click here.
How is iron overload managed or treated?
Iron overload due to haemochromatosis is often managed using venesection – a procedure where blood is taken (like a blood donation) to remove iron from the body. To learn more about whether you are eligible for venesection to reduce your body's iron, click here.
How often do I need to have venesections?
Haemochromatosis patients may need venesections frequently (up to once a week) initially, to bring their ferritin levels down to a safer level. They can then reduce their venesections to once every month, three months or six months, in consulation with their doctor.
Where are venesections done?
These procedures, which are much like a blood donation, are performed in the chair at a blood collecting centre such as The Red Cross, or in a Day Oncology Centre. Discuss with your Haematologist which of these options are suitable for you.
Can my blood be used by the Red Cross?
If you qualify as a blood donor in every other respect, the Red Cross may be able to use your blood. Discuss this with your doctor.
Should I avoid meat?
Cutting down on dietary iron (red meat and offal) may help a little, but in true Haemochromatosis this is unlikely to be enough to get your iron levels down, and venesection is likely to be needed as well.
Can I drink alcohol?
Alcohol is another common cause of a high ferritin even in patients who do not have haemochromatosis or other iron overload states. Alcohol should be kept to a minimum in people with iron overload, as the alcohol will have a heightened toxic effect on your liver.
What about medications to reduce iron?
Some iron overload disorders are treated or prevented by the use of iron-binding medications.