Iron Overload: Too much metal can lead to other problems

May 9, 2000

By John Crowe
Scripps Howard News Service

#

You may have thought bleeding as a medical procedure went out with alchemy and patent medicines, but for those with iron overload, or hemochromatosis, it’s a valid treatment.

In fact, therapeutic phlebotomy, as the regular drawing of blood is called, is the main treatment for iron overload. Because iron is carried in red blood cells, drawing blood off helps lower the body’s iron level.

Some hemochromatosis patients may also need to watch their diet to limit iron intake.

Hemochromatosis may be more common than generally recognized.

Harvard physician Kenneth Bridges calls iron overload "the most unrecognized problem in American medicine," and Dr. Virgil Fairbanks, a physician at the Mayo Clinic in Rochester, Minn., goes so far as to call the prevalence of the condition "an epidemic."

Dr. Jed Freeman, a hematologist and medical director of the North State Blood Center in Redding, Calif., doesn’t go that far, but did characterize the hemochromatosis as "one of the most common hereditary disorders known to mankind."

It occurs when there is a mutated gene on one or both strands of a person’s DNA. Those without the genetic variation do not get hemochromatosis. The body takes the iron it needs and disposes of any excess.

But the hemochromatosis patient cannot adequately metabolize and dispose of iron, and the body absorbs too much. Over time, the excess iron may be deposited in the joints, in organs like the heart or liver, or in the thyroid.

Freeman said the hemochromatosis may be a factor in diseases ranging from arthritis to diabetes to liver damage. Excess iron can cause thyroid problems, increase the risk for stroke or heart attacks and may lead to testicular problems in men.

"The body can’t get rid of the iron and it starts to interfere with other organs and builds up in the joints," added Dr. William Reeder, an arthritis specialist in Redding.

Hemochromatosis crops up most frequently in people of Northern European descent where the full disorder (both genes) may occur in as many as three to five people per 1,000. A partial disorder (one altered gene) may occur in as many as one in 10 Americans of Northern European descent, Freeman said.

That works out to a lot of people, but many are never aware they have the condition.

"Many are asymptomatic until their 50s and 60s. It takes a while to build up," Freeman explained. He said in those cases where hemochromatosis is diagnosed early or if a person with hemochromatosis is a regular blood donor, symptoms may never appear.

Ralph Weiland, 75 said he had no symptoms whatsoever" despite an enormously high blood iron count noted several years ago.

Weiland learned about his condition when he went to a dermatologist to have a skin spot checked.

The skin doctor though his skin color was "off," suggesting a possible liver problem.

A blood test confirmed that he had a high blood-iron count, although his liver was fine.

He began having his blood drawn at the rate of one pint every two weeks, a process that went on for two years. It was then bumped up to once weekly and within a year, his blood iron level was down to normal levels.

He hasn’t changed his diet and made no changes in his lifestyle to deal with the condition. "It took me 68 years to find out I had the condition," he said, "I’ll never live long enough to go that high again."

Craig Ives was diagnosed at 29. A swollen lymph node in the groin area led to the blood check that confirmed the presence of high iron in his blood. The iron deposits were high enough that he would trigger metal detection devices at airports, he said.

For six months afterward, Ives had his blood drawn weekly to bring his iron level down. Now, he gives blood every two months.

Although his blood iron is at normal levels, Kristine Ives said he did sustain some minor liver damage from the disease, has some joint pain from the iron deposits and tires easily.

His diet has changed to keep the iron intake low. No more liver or spinach," she said. The family also limits its beef consumption.

without the genetic variation do not get hemochromatosis. The body takes the iron it needs and disposes of any excess.

But the hemochromatosis patient cannot adequately metabolize and dispose of iron, and the body absorbs too much. Over time, the excess iron may be deposited in the joints, in organs like the heart or liver, or in the thyroid.

Freeman said the hemochromatosis may be a factor in diseases ranging from arthritis to diabetes to liver damage. Excess iron can cause thyroid problems, increase the risk for stroke or heart attacks and may lead to testicular problems in men.

"The body can't get rid of the iron and it starts to interfere with other organs and builds up in the joints," added Dr. William Reeder, an arthritis specialist in Redding.

Hemochromatosis crops up most frequently in people of Northern European descent where the full disorder (both genes) may occur in as many as three to five people per 1,000. A partial disorder (one altered gene) may occur in as many as one in 10 Americans of Northern European descent, Freeman said.

That works out to a lot of peo ple, but many are never aware they have the condition.

"Many are asymptomatic until their 50s and 60s. It takes a while to build up," Freeman explained. He said in those cases where hemochromatosis is diagnosed early or if a person with hemochromatosis is a regular blood donor, symptoms may never appear.

Ralph Weiland, 75 said he had no symptoms whatsoever" despite an enormously high blood iron count noted several years ago.

Weiland learned about his condition when he went to a dermatologist to have a skin spot checked.

The skin doctor though his skin color was "off," suggesting a possible liver problem.

A blood test confirmed that he had a high bloodiron count, although his liver was fine.

He began having his blood drawn at the rate of one pint every two weeks, a process that went on for two years. It was then bumped up to once weekly and within a year, his blood iron level was down to normal levels.

He hasn't changed his diet and made no changes in his lifestyle to deal with the condition. "It took me 68 years to find out I had the condition," he said, "I"ll never live long enough to go that high again."