v Hemochromatosis

Hemochromatosis, the most common form of iron overload disease, is an inherited disorder that causes the body to absorb and store too much iron. The extra iron builds up in organs and damages them. Without treatment, the disease can cause these organs to fail.

Iron is an essential nutrient found in many foods. The greatest amount is found in red meat and iron-fortified bread and cereal. In the body, iron becomes part of hemoglobin, a molecule in the blood that transports oxygen from the lungs to all body tissues.

Healthy people usually absorb about 10 percent of the iron contained in the food they eat to meet the body needs. People with hemochromatosis absorb more than the body needs. The body has no natural way to rid itself of excess iron, so extra iron is stored in body tissues, especially the liver, heart, and pancreas.

Causes

Genetic or hereditary hemochromatosis is mainly associated with a defect in a gene called HFE, which helps regulate the amount of iron absorbed from food. There are two known important mutations in HFE, named C282Y and H63D. C282Y is the most important. When C282Y is inherited from both parents, iron is overabsorbed from the diet and hemochromatosis can result. H63D usually causes little increase in iron absorption, but a person with H63D from one parent and C282Y from the other may rarely develop hemochromatosis.

The genetic defect of hemochromatosis is present at birth, but symptoms rarely appear before adulthood. A person who inherits the defective gene from both parents may develop hemochromatosis. A person who inherits the defective gene from only one parent is a carrier for the disease but usually does not develop it. However, carriers might have a slight increase in iron absorption.

Scientists hope that further study of HFE will reveal how the body normally metabolizes iron. They also want to learn how iron injures cells and whether it contributes to organ damage in other diseases, such as alcoholic liver disease, hepatitis C, porphyria cutanea tarda, heart disease, reproductive disorders, cancer, autoimmune hepatitis, diabetes, and joint disease.

Juvenile hemochromatosis and neonatal hemochromatosis are two forms of the disease that are not caused by an HFE defect. Their cause is unknown. The juvenile form leads to severe iron overload and liver and heart disease in adolescents and young adults between the ages of 15 and 30, and the neonatal form causes the same problems in newborn infants.

Risk Factors

Hereditary hemochromatosis is one of the most common genetic disorders in the United States. It most often affects Caucasians of Northern European descent, although other ethnic groups are also affected. About 5 people in 1,000 (0.5 percent) of the U.S. Caucasian population carry two copies of the hemochromatosis gene and are susceptible to developing the disease. One person in 8 to 12 is a carrier of the abnormal gene. Hemochromatosis is less common in African Americans, Asian Americans, Hispanic Americans, and American Indians. Although both men and women can inherit the gene defect, men are about five times more likely to be diagnosed with the effects of hereditary hemochromatosis than women. Men also tend to develop problems from the excess iron at a younger age.

Symptoms

Joint pain is the most common complaint of people with hemochromatosis. Other common symptoms include fatigue, lack of energy, abdominal pain, loss of sex drive, and heart problems. Symptoms tend to occur in men between the ages of 30 and 50 and in women over age 50. However, many people have no symptoms when they are diagnosed.

If the disease is not detected early and treated, iron may accumulate in body tissues and may eventually lead to serious problems such as

• arthritis

• liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure

• damage to the pancreas, possibly causing diabetes

• heart abnormalities, such as irregular heart rhythms or congestive heart failure

• impotence

• early menopause

• abnormal pigmentation of the skin, making it look gray or bronze

• thyroid deficiency

• damage to the adrenal gland

Diagnosis

A thorough medical history, physical examination, and routine blood tests help rule out other conditions that could be causing the symptoms. This information often provides helpful clues, such as a family history of arthritis or unexplained liver disease.

Blood tests can determine whether the amount of iron stored in the body is too high. The transferrin saturation test determines how much iron is bound to the protein that carries iron in the blood. The serum ferritin test shows the level of iron in the liver. If either of these tests shows higher than normal levels of iron in the body, doctors can order a special blood test to detect the HFE mutation, which will help confirm the diagnosis. (If the mutation is not present, hereditary hemochromatosis is not the reason for the iron buildup, and the doctor will look for other causes.) A liver biopsy, in which a tiny piece of liver tissue is removed and examined under a microscope, may be needed. It will show how much iron has accumulated in the liver and whether the liver is damaged.

Hemochromatosis is often undiagnosed and untreated. It is considered rare and doctors may not think to test for it. The initial symptoms can be diverse and vague and can mimic the symptoms of many other diseases. Also, doctors may focus on the conditions caused by hemochromatosis—arthritis, liver disease, heart disease, or diabetes—rather than on the underlying iron overload. However, if the iron overload caused by hemochromatosis is diagnosed and treated before organ damage has occurred, a person can live a normal, healthy life.

Hemochromatosis is usually treated by a specialist in liver disorders (hepatologist), digestive disorders (gastroenterologist), or blood disorders (hematologist). Because of the other problems associated with hemochromatosis, several other specialists may be on the treatment team, such as an endocrinologist, cardiologist, or rheumatologist. Internists or family practitioners can also treat the disease.

v Diagnosis–How Do You Find Out

To diagnose hemochromatosis is an easy affair. Basically there are three tests that confirm an iron overload. First there is Transferrin Saturation (TS) or as it is called in some labs Percentage of Saturation:

Test # 1: After a 12-hour fast, measure Total Iron Binding Capacity (TIBC) and the Serum Iron (SI). To achieve the percentage of Saturation you divide the TIBC into SI.

Serum Iron	SI = Yields Transferrin Saturation (TS) = or in some labs Percentage of Saturation
Total Iron Binding Capacity  Safe range = 12-44%	TIBC

Any values above this range must be considered diagnostic for hemochromatosis and should cause immediate protocol treatment. Any values far below this range may be a sign of bleeding ulcers, chronic infection or cancer. Physicians should look for the cause of anemia.

Test # 2: Using the blood from the first draw, next check the amount of storage iron– Serum Ferritin (SF)
Safe range = 5-150

A hemochromatosis patient needs to be at the lowest end of this range. We say below 10. This needs to be the treatment goal.

Test # 3: This next test is given less frequently. It is initialized as UIBC. It stands for Unbound Iron Binding Capacity.
Safe range is above = 146

If a patient checks below this test value, then he or she needs to be treated for their hemochromatosis or their other iron overload condition.

If these tests measure out of safe ranges then aggressive treatment is indicated. Diagnosis without treatment is useless. The patient must be motivated to off-load the iron as fast as possible. The physician should not watch these values over time or ignore them thinking they will improve on their own. Once iron is absorbed in excess it will not correct itself. Iron is not excreted. Its only exit from the body is by frequent bleeding or chelation.

Some iron overloaded patients will present with a normal saturation and still have an overload of iron.

If there is family history or symptoms or elevated ferritin over time, the patient may be involved with this problem. In this case we recommend a course of trial treatment. If the patients can tolerate the protocol, then the treatment was justified. There are safety factors built into the proper treatment that will disqualify the patient if they are not truly iron overloaded. The physician sets the hematocrit level on the prescription for the blood bank, for instance.

If protocol treatment is tolerated after 4-6 weeks without the patient’s hematocrit or hemoglobin crashing, (below 30% or 10 respectively ), then that in itself is further confirmation of the hemochromatosis or the iron overload.

Treatment and Maintenance

The logic of the protocol treatment is to induce a mild anemia and maintain it until the storage iron is greatly reduced.  Serum ferritin is the measure of storage iron and this number needs to come down below 10.  This is accomplished by bloodletting–therapeutic phlebotomies.  By phlebotomy we mean removal of a full unit of blood from the patient, approximately 500 mls.  This should be done  in a medical setting.  The schedule of this treatment should be twice a week or at least once a week.  The patient must be motivated to off-load the iron as fast as possible.  The best outcomes are achieved by aggressive treatment.  Timid treatment does not work–these phlebotomies must be at least weekly.  The attending physician writes a prescription that tells the blood bank to remove a full unit of blood according to schedule as long as the patient has a qualifying hematocrit of 30% or more.  Some locations might prefer hemoglobin which should be set for 10 or above.

It is important to establish an anemia and not let up on it until de-ironing has been completed.  The might take from 6 months to three years depending on the iron burden.  Age is never a reason to disqualify someone from treatment.  Frailty, small of stature and extremely old/young may require the adjustment in amount of blood removed, but never adjust the frequency.  This process can arrest or reverse most symptoms and return the patient to a normal lifespan.  Some patients might experience a complete reversal of all symptoms.  To exclude anyone from treatment for any reason is a death sentence.

Chelation

For those people who cannot be bled because of extreme anemia, there is chelation.  The only chelator for iron approved in the US is Desferal (desferoxomine).  This approach lacks the complete efficacy of bloodletting and should be employed only where absolutely necessary.  Declared an orphan product by the manufacturer Norvartis , it is expensive.  A course of chelator per month $6000-$8000.  For some it is infused over night with a portable pump at home during sleep over a 12-hour period.  In some cases, the infusion pump is installed in the body of the patient.

There may be side effects for some patients.  This will off-load some iron and prolong the patient’s life.  Mild anemias such as the lesser thalassemia and some of the sideroblastic anemias may qualify for phlebotomy.  A physician considering chelation for a patient should consult an expert to see if their patient won’t qualify for bleeding after all.  For those patients who have tried this approach and found for some reason they could not tolerate this regimen are forced to look for an alternative.

Maintenance

After the patient has had their ferritin reduced below 10 they are declared de-ironed.  Now it is time to change the phlebotomy schedule.  Usually 2-6 times a year is sufficient to keep them from reaccumulating the overload.  In this process the threshold of the hematocrit/hemoglobin can be raised somewhat.  For the first year deciding how often is a matter of trial and error by the physician and patient.  Serum ferritin should be checked yearly to this end.  Maintenance will have to be a life time affair from this point on.  To permit re-accumulation is to invite a premature death.

Venous Access

Some patients will have limited access to the veins for various reasons.  There are some things that may help with this.  If the veins are small, deep set or without tensile strength, a smaller needle might be used.  A butterfly needle–18 gauge–helps tremendously.  It may take 10-15 minutes longer in the bleeding process but helps with venous health overall.  In some medical settings a glass bottle is used and set on the floor.  This approach can cause too much vacuum on the veins and may collapse them before a full unit is taken.  Blood banks and labs that use the latest equipment are the best treatment settings.  In some extreme cases a catheter or shunt can be installed in the shoulder for access.  This method has added maintenance problems so it should be used only if absolutely necessary.  In the list of priorities treatment needs to be at the top.  Any process that helps with patient compliance should be pursued.

Treatment–Patient Information

Currently, therapeutic phlebotomy or blood extraction is the most efficient means of tissue iron reduction.  However, preventive measures may be incorporated into diet and behavior that can reduce the amount of iron absorbed.

Phlebotomy

A phlebotomy is a procedure used to remove blood from a person. It is the opposite of a transfusion, which is a way to give blood to a person. Those with hemochromatosis (HH), also called iron overload disorder, and others with iron loading anemias, store excess iron in their bodies and must have phlebotomies to remove the iron.

Excess iron in a person’s body can cause damage to the liver, pancreas, pituitary, joints and heart. As a result of this damage, one can develop cirrhosis of the liver, diabetes, impotence, arthritis, and heart failure. Therefore, removing the excess iron as soon as possible is critical.
People can lose small amounts of iron by simply taking half an aspirin a day. But for those with serious iron overload, the phlebotomy is necessary because it removes about 250 milligrams of iron with each treatment. When iron stores are high, swift action to remove the excess is critical.

When Tests Indicate You Have Iron Overload

A doctor’s prescription or an order is needed to obtain the phlebotomies. Usually an order is written for weekly or twice-weekly phlebotomies so long as “pretreatment spun hematocrit is greater than 34%”. Hematocrit measures the volume or amount of hemoglobin contained in a person’s blood.

Hemoglobin is made up of heme which is the iron containing red part of the blood cell and globin which is a protein in the same red blood cell. Hemoglobin carries oxygen to the body’s tissues and carbon dioxide away from those same tissues.

Where Phlebotomy Treatments Are Done

Phlebotomies might be done at a blood donation center, as an outpatient in a hospital or even in a doctor’s office. Your doctor will probably advise places that provide the treatment. Consider convenience of location, cost to do the phlebotomy, and how responsive the center is to your situation.

Once you have determined the facility that will provide treatment, a trip to the lab is required. Before the phlebotomy may be done, hemoglobin and hematocrit will be checked. Usually centers have labs on site; the results will be forwarded to the attending nurse. These preliminary numbers help assure you do not become seriously anemic (not enough iron); the desire is to become only slightly anemic as a result of treatment. A person is entitled to the results of any lab tests.

Keep Good Records.....

You may request a copy of lab work from the office manager in charge of records in the doctor’s office. Obtaining lab results is highly recommended so that a journal may be compiled. Journals will become a valuable tool if you have to move to another town or seek treatment from another doctor. Knowing about your disorder and understanding the diagnostic process helps to speed recovery and avoid future health setbacks.

The Procedure

After the preliminary tests for hemoglobin and hematocrit are finished, a nurse prepares you for the phlebotomy. Usually you will stretch out on a comfortable recliner chair. The nurse takes your blood pressure, temperature and heart rate (pulse). These numbers will be recorded on your medical chart for future reference. The nurse then waits for the lab to call with hemoglobin and hematocrit readings. After being notified levels are within a safe range, your arm will be prepared for blood extraction.

A special band is tied around the upper part of the arm. This helps the vein to stand up. You may have to squeeze a soft rubber ball or make a fist several times to help the vein remain accessible. The nurse then swabs an iodine-based antiseptic on the vein and all around the area near the vein. This is to disinfect the area where the needle is to be inserted and to make certain no bacteria gets into your system during treatment.

A special needle is then inserted into the vein. You might feel a little pinch, but it lasts only a second. A piece of tape is placed over the needle to keep it stable; you just sit back and relax.

Some like to bring a headset with earphones or a good book to read during treatment. While relaxing, the blood flows from the needle, into a tube, and then into the blood bag. The blood bag sits on a special scale that measures the weight of the blood.

Myth #1. Taking two vials of blood from the arm is the same as a phlebotomy.

Incorrect: A true phlebotomy treatment involves removal of about 450cc of blood or a full bag.
When the bag is sufficiently filled, about one pint, the phlebotomy is complete. The speed with which the blood bag fills depends on the thickness/thinness of your blood. Drinking adequate amounts of water, at least 6-8 glasses a day for two weeks before the phlebotomy will help. If you are still in school, you may want to get permission to carry bottled water and drink at least 6 ounces each hour.

Myth #2. Iron can be removed by several methods.

Incorrect: Health food store products which claim to remove heavy metals will not remove iron. Only two methods remove iron from the body: phlebotomy and desferrioxamine which is a chelator used for those with conditions of ironloading anemia.

While the blood is flowing out of your arm, you might think about all the iron that is leaving your system. About 250 mgs of iron are removed with each extraction. Think about how well you will be and the dreadful diseases you may avoid by having this procedure. You may be finished in as few as ten minutes or as many as thirty; again, it depends on your vein and thickness of your blood.

After the treatment. After the phlebotomy, the nurse will remove the needle from your arm. You may need to keep the area bandaged or you may need to apply mild pressure if bleeding continues. You should rest for about 20 minutes following therapy. This is a precaution to insure you do not get weak or dizzy. You may be given a snack while you are resting and it is suggested you eat something after your therapy.

Your blood will be discarded regardless of where you have the phlebotomy. HH blood is currently handled in the same way as contaminated blood. Efforts are being made to change this. Don’t get frustrated or take it personally; your blood may be labeled contaminated, but you are not.

Between phlebotomies. You might consider learning to drink at least eight glasses of water a day, taking extra B12 with folic acid and vitamin E. These supplements help to build red blood cells, which assure adequate hemoglobin and hematocrit levels. Your doctor should recommend the amount you take of these vitamins because the dosage will depend on your weight and age.

It is important to remember that just because a supplement is beneficial, taking more than the recommended dose does not provide a greater benefit; indeed, it may cause damage. Also, gulping great amounts of water prior to therapy is not wise; you may actually cause yourself to become water intoxicated, a serious condition. Use wisdom; implement diet changes slowly and with knowledge of the potential dangers associated with these changes.

Diet tips. You also may consider eating more fiber, refrain from cooking in an iron skillet, and avoiding Vitamin C at mealtime. Fiber impedes iron absorption while vitamin C enhances iron absorption. Drinking tea with meals is helpful as the tannin in tea also impedes iron absorption. Decaffeinated tea might be the better choice; some physicians believe that too much caffeine can be unhealthy. Eat foods like fruit and juice high in vitamin C between meals. You should be aware that tobacco is rich in iron and that inhalation of this smoke directly or indirectly adds to your iron stores.

Exercise is a good idea. Regular, intense exercise or taking aspirin daily will cause some blood loss and thus iron loss. However, you should consult your doctor before incorporating any of these practices into your daily routine. Aspirin can be dangerous for youths with fever and it can interact with some drugs. Your pharmacist may be able to provide you with drug interaction advise; if not, contact your doctor.

Each person responds to treatment in a unique way. You may need many phlebotomies or only a few. Much depends on age, the extent of saturation, one’s physical condition including symptoms, and the speed with which an individual unloads iron. Your physician will help to determine this with a rough estimate of mobilizable iron.

Note: The following calculation method provides a rough estimate only; it is not an exact science. Ferritin levels can be unreliable or skewed when low or very high, which can lead to distortion of estimated number of extractions. Also, individuals with liver damage such as cirrhosis will unload faster than those without liver damage.

Other factors that may skew ferritin include presence of inflammation or infection. Used as a guideline to establish some benchmark of ferritin levels however, this rough calculation helps your physician determine a strategy for when ferritin can be measured so de-ironing progress can be evaluated and undue anemia can be avoided.

Initial ferritin x 10= approximation of mobilizable iron in milligrams (mgs) in your body. Since each phlebotomy removes about 250 milligrams of iron, you can estimate how close you are getting to an acceptable level.

Example: Ferritin of 195 x 10=an estimated 1950 milligrams of stored iron that can be removed with phlebotomy. The goal is to reach a safe ferritin range of 25-75ng/mL. Using the estimated mobilizable iron of 1950 minus 450 (to avoid total depletion of ferritin) you can calculate about how many treatments you might require. Example: 1950-450= 1500 mgs of iron needed to be removed. Each treatment removes about 250mgs of iron, therefore:1500 divided by 250=6 treatments needed to reach a safe ferritin range. Your ferritin may actually drop below the 25-75ng/mL range; a ferritin below 20ng/mL is considered anemia. In the course of treatment, your physician may recommend that your target ferritin be lower than the 25ng/mL whereby you might experience symptoms of anemia. Iron Disorders Institute considers this practice outdated and suggests de-ironing not include forced-sustained anemia to achieve de-ironed status.

Additional research and study must be done to determine benefits of de-ironing practices. Since Iron Disorders Institute is mindful of discomfort and problems related to anemia, IDI suggests a more conservative step down process of treatment using phases.

Prior to treatment, a patient will have demonstrated a fasting ferritin greater than 200ng/mL (females) or 300ng/mL (males) with an accompanying transferrin iron saturation percentage value greater than 45%.

Phase one: When ferritin is above 1000ng/mL phlebotomy treatments will be aggressive usually as frequent as twice weekly while tolerable and until ferritin drops below 1000ng/mL. Using the estimated number of extractions (ferritin X10, etc.) your physician will have an approximate timetable for when ferritin might be nearing phase two or when ferritin is below 750-800ng/mL.

Phase two: When patient has had an estimated number of treatments sufficient to drop ferritin below 1000ng/mL (preferably 750-800ng/mL) ferritin should be measured to confirm patient’s unloading pattern. Frequency of treatment may slow down from twice weekly to once a week or even to every other week depending upon judgment of attending physician. During phase two pretreatment hemoglobin of 12.0g/dL -13.0-g/dL (females) and 12.5g/dL to 13.5g/dL (males) is best as red blood cell production is better challenged when hemoglobin levels are within this range.

During phase two: Patient might consider incorporating routine exercise (twenty minute walk three times week minimum), adequate water intake (6-8 8oz glasses per day) and vitamin supplementation. Vitamin supplementation might include: B complex (without C) plus extra B6, folic acid and B12. Supplement amounts would depend upon patient’s age, weight, gender, and condition such as lactation, pregnancy, or presence of other medical conditions and established by attending physician. Except for B12, levels are provided in Food and Nutrition Board, Institute of Medicine-National Academy of Sciences, Dietary Reference Intakes: Tolerable Upper Intake Levels (UL) for Certain Nutrients and Food Components.

Phase two treatment continues until patient reaches ferritin of 300ng/mL (male), 200ng/mL female. Ferritin might be measured at this time to evaluate unloading pattern. Treatment frequency might be reduced once again from monthly or every six-eight weeks, maintaining pretreatment hemoglobin above 13.3g/dL but continued until ferritin is brought down to safe range 25-75ng/mL.

Phase three: Patient may donate blood routinely as defined by attending physician for optimum quality of health or may have periodic therapeutic phlebotomy by doctor’s order. Frequency of donation or therapeutic phlebotomy will depend upon patient’s personal health profile as observed by patient and attending physician: age, weight, response to treatment, symptoms, rate of iron unloading and general physical condition.

At anytime during treatment you experience symptoms of heart irregularities or severe abdominal pain or symptoms of anemia, alert your physician immediately.
Symptoms of anemia can often be misunderstood by a patient as reoccurring iron overload. Symptoms of anemia can include: fatigue, heart arrhythmia, headache, sensitivity to cold, shortness of breath, dizziness and restless legs syndrome. Again, if while treatment is in progress, you experience any of these symptoms, bring it to the attention of your physician.

The recovery phase of treatment. Recovery is a period of time when you have been adequately de-ironed and symptoms have diminished. Unfortunately, it is possible that not all symptoms will disappear. If excess iron has had enough time to damage critical organs, you may never restore these damaged organs to full function. Issues of this nature need to be discussed with the doctor to determine if additional treatment is appropriate.

During the recovery phase, you must be attentive to any sign of repeat symptoms. So long as you remain symptom-free, the doctor will retest your iron levels in three months. The initial three-month exam following recovery will provide your baseline. A baseline is the first set of numbers after a series of phlebotomies whereby a person’s pattern of unloading can be established. These numbers are very important to your doctor and to your health. From the baseline data the maintenance or treatment program for an individual will be established. Additional retests to discern baseline may have to be done; these will usually occur in three-month intervals.

A person’s length of recovery period, treatment and maintenance program is determined by how often that person must have a phlebotomy to keep iron levels in a normal range. Maintenance patients are those who have reached normal iron ranges and who can remain within those normal ranges by donating blood periodically.

Most blood donation centers allow one donation every eight weeks. If you are a candidate for maintenance, then a periodic blood donation will suffice. If you are found to need treatment, needing more than one extraction in eight weeks, the attending physician will provide you with the necessary order for additional phlebotomies. Your gastroenterologist or hematologist may refer you back to your family physician for the maintenance phase of your therapy. Afterwards, you may resume a normal, happy healthy life with only a small adjustment to your schedule: a life-saving, blood donation every now and then.


Source: Iron Disorders Institute Inc.
P.O. Box 2031
Greenville, South Carolina 29602
www.irondisorders.org

Screening for Hemochromatosis

Screening for hemochromatosis (testing people who have no symptoms) is not a routine part of medical care or checkups. However, researchers and public health officials do have some suggestions:
 

•	Brothers and sisters of people who have hemochromatosis should have their blood tested to see if they have the disease or are carriers.
•	Parents, children, and other close relatives of people who have the disease should consider testing.
•	Doctors should consider testing people who have joint disease, severe and continuing fatigue, heart disease, elevated liver enzymes, impotence, and diabetes, because these conditions may result from hemochromatosis.

Since the genetic defect is common and early detection and treatment are so effective, some researchers and education and advocacy groups have suggested that widespread screening for hemochromatosis would be cost-effective and should be conducted. However, a simple, inexpensive, and accurate test for routine screening does not yet exist, and the available options have limitations. For example, the genetic test provides a definitive diagnosis, but it is expensive. The blood test for transferrin saturation is widely available and relatively inexpensive, but it may have to be done twice with careful handling to confirm a diagnosis and to show that it is the consequence of iron overload.


Prepared by Iron Overload Disease Association, Inc.
433 Westwind Drive, North Palm Beach, FL, 33408-5123
(561) 840-8512
www.ironoverload.org

v Hemochromatosis and Anemia Diet
 

 
Prepared by Iron Overload Disease Association, Inc.
433 Westwind Drive, North Palm Beach, FL, 33408-5123
(561) 840-8512
www.ironoverload.org

v Objections to Genetic Testing

Sometime in the future the science will be firmed in this area and a one-time test of your genes will make sense.  Presently Iron Overload Diseases Assn. recommends a simple blood test called transferrin saturation (TS) or in some labs may be called percentage of saturation.  Any score above 44% will need immediate protocol intervention.  UIBC is an alternate test for screening.  Safe levels are above 146.  Testing for too much iron is not a onetime check but a lifetime survey.  Everybody in the bloodline will need this test at each and every physical no matter the age and no matter the gender.  All that is needed for good health where excess iron is concerned is vigilance and treatment where necessary.


Source: Iron Overload Diseases Association, Inc.

Hope Through Research

Current research in hemochromatosis is concentrated in four areas: