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PubMed1974

Effects of cyclic starvation-feeding and of splenectomy on the development of hemosiderosis in rat livers.

The development of siderosis of liver and spleen was investigated in rats subjected alternately to periods of starvation and periods of feeding of diets rich in iron (0.71% or 1.23% Fe) or of control diets, during periods ranging up to 245 days. With 0.71% iron in the diet, cyclic starvation-feeding markedly enhanced the accumulation of iron in rat livers by comparison to feeding ad libitum even though rats fed ad libitum ingested far greater total amounts of iron than cyclically fed rats. With 1.23% iron in the diet, the concentration of iron in livers reached more or less the same plateau in cyclically starved-fed rats and in rats fed ad libitum (betwen 4 and 5 mg Fe/g wet weight); but the mean rate of accumulation of iron in the livers of cyclically starved and fed rats was more than twice that in rats fed ad libitum, whereas mean ingestion of iron per feeding day was only 16% higher in the former group. Surgical removal of the spleen enhanced the accumulation of iron in the liver in cyclically starved-fed rats and in rats fed ad libitum. Histologically, siderosis of the liver was moderate in rats fed the diet with 0.71% iron but was severe in rats fed the diet with 1.23% iron and most severe in those without spleens. Stainable iron was deposited in hepatocytes and in Kupffer cells. None of the rats developed cirrhosis of the liver. The data suggest that in rats a barrier to the absorption of iron from the gut, or to its later utilization, is surmounted if the concentration of iron in the food exceeds a certain limit value, somewhere between 0.71 and 1.23%. With iron in the food below this value, cyclic starvation-feeding markedly potentiates accumulation of iron in the liver in the course of several months, but siderosis is moderate. With iron in the food above the limit value, cyclic starvation-feeding and feeding ad libitum can equally lead to massive siderosis of the liver.

Animals↗
PubMed1982

Failure of serum ferritin levels to predict bone-marrow iron content after intravenous iron-dextran therapy.

The relation between serum ferritin levels and stainable-iron deposits in the liver, spleen, and bone marrow was investigated in 36 patients with chronic renal failure who died after being on haemodialysis for 1-103 months. Elemental iron (mean, 5450 mg) had been given intravenously as iron dextran to patients in a long-term subgroup, who had been on dialysis for more than 3 months. The results of semiquantitative histochemical assessment of tissue iron in slides obtained at necropsy (scale 0 to 4+) were confirmed by chemical analyses of tissue iron. Serum ferritin levels correlated well with the degree of hepatosplenic siderosis but did not always correlate with bone-marrow iron stores in these patients. Serum ferritin concentrations were raised in 10 marrow-iron-depleted subjects (mean, 1336 ng/dl). The paradoxical association of hepatosplenic siderosis with marrow iron depletion was observed in most of the patients on dialysis for less than 40 months. The histochemical data show that the bulk of intravenously injected iron dextran is taken up by the liver and spleen; that the hepatosplenic stores fail to be mobilised to the bone marrow; and that intravenous iron-dextran therapy, by-passing the intestinal mechanism for the regulation of iron absorption, carries a high risk of long-term hepatosplenic siderosis.

Aged↗
PubMed1987

Seasonal iron overload in Svalbard reindeer liver.

Changes in liver iron concentration in relation to seasonal body weight variations and food iron intake have been investigated in 77 Svalbard reindeer by chemical and histological methods. During the winter season the body weight decreased about 43% in females and 39% in males. Liver weight was reduced about 65% in both sexes. The liver iron concentration showed little or no difference between the sexes and was 29 +/- 13 mg iron/100 g wet weight in the autumn. The concentration increased in late winter to 291 +/- 52 mg iron/100 g in animals eating iron-rich forage plants, and to 165 +/- 92 mg iron/100 g in animals eating forage plants with a normal iron content. Starving animals with a very high iron concentration of the rumen content usually had massive siderosis in both parenchymal and nonparenchymal cells of the liver. In contrast, siderosis was restricted to nonparenchymal cells in starving animals with normal rumen iron concentration. Transferrin saturation was significantly higher in animals eating iron-rich forage plants than in those eating forage plants with a normal content. Therefore it is proposed that seasonal liver siderosis is a result of a) translocation of iron from catabolized blood and lean tissue that is recovered in nonparenchymal cells and b) high uptake of food iron with deposition in the parenchymal cells.

Animals↗
PubMedDate not supplied

Improvement of siderotic ERG.

For fear of endophthalmitis and siderosis, ferrous intraocular foreign bodies are usually removed as soon as they are discovered; markedly reduced, siderotic ERG changes are considered permanent. We report a patient who presented with a chronically retained intravitreal foreign body and significant clinical as well as electrophysiologic signs of siderosis. Only 3 months after surgery, the ERG showed almost complete recovery. If siderosis is not present, adequate and regular follow-up examinations may in certain cases substitute for immediate removal of chronically retained intraocular foreign bodies.

Adult↗
PubMed1989

[HLA studies and histochemical detection of liver iron in porphyria cutanea tarda].

With regard to disturbances of the iron metabolism, porphyria cutanea tarda (PCT) is most frequently accompanied by liver siderosis. In 74 out of 88 patients suffering from PCT (84%), we found histochemical evidence of liver siderosis. These patients showed a significantly higher incidence of HLA A3--which has been proved to be associated with hemochromatosis--than those without liver siderosis (39.2% vs. 7.1%). With part of the PCT patients, disorders of the iron metabolism related to the HLA system (A3) might contribute to the manifestation of the disease. We discuss PCT as the result of the combined action of several predisposing genetic markers and exogenic factors.

Biopsy↗
PubMed1993

Hepatic morphology and iron quantitation in perinatal hemochromatosis. Comparison with a large perinatal control population, including cases with chronic liver disease.

We compared hepatic morphology, hepatocellular siderosis, extrahepatic parenchymal siderosis, and (by chemical assay of liver and spleen) the amount of elemental iron and copper in 12 cases of perinatal hemochromatosis (PH) with 119 perinatal controls. Controls were subgrouped according to diagnoses based on clinical and autopsy findings; 37 had chronic liver disease, either hepatic fibrosis (17) or cirrhosis (20). Graded semiquantitatively, hepatocellular siderosis varied widely among controls, and some showed more than PH cases. By chemical assay, total hepatic iron in PH cases was not significantly greater than in any control group except the preterm. Therefore, our findings do not support an etiological role for iron in PH. Its distinctive hepatic morphology seems related to onset of liver disease during fetal life, when periportal hepatocytes normally contain hemosiderin (as in 71 of 82 controls without chronic liver disease). Environmental agents (such as hypoxia, virus, drug) that could damage a fetal liver would usually damage other fetal organs as well. They would be unlikely to recur in a subsequent pregnancy and thereby account for PH occurring in siblings. In initiating PH, therefore, putative environmental agents may need to interact with a factor or factors intrinsic to the developing fetal liver.

Chronic Disease↗
PubMed1990

Transferrin receptor expression in rat liver: immunohistochemical and biochemical analysis of the effect of age and iron storage.

Hepatic transferrin receptors were studied in normal male rats at 1 to 59 wk after weaning, using immunohistochemical and biochemical techniques. The number of transferrin receptors measured and the intensity of the staining in situ decreased rapidly during the first 10 wk of life and more slowly thereafter. Immunohistochemistry further demonstrated changes in the topographical and (sub)cellular localization of the transferrin receptor. In the young rat livers, staining was almost exclusively present on hepatocytes in acinar zone 2 + 3 in a honeycomb to sinusoidal pattern. With aging, a panacinar heterogeneous and mainly sinusoidal staining of hepatocytes was more frequent. Kupffer cell positivity was more obvious as compared with the young rat livers. The observed changes in transferrin receptor expression may partly be explained by age-dependent alterations in DNA synthesis and proliferative potential of the liver cells. A series of rats were iron loaded with carbonyl iron up to 39 wk and "unloaded" by administration of a normal diet during 20 wk. In these animals, serial histochemical studies showed predominantly parenchymal (7 to 14 wk), mixed parenchymal and reticuloendothelial (39 wk) and almost exclusive reticuloendothelial siderosis (59 wk). In the siderotic livers transferrin receptor numbers tended to be lower than in the controls with significant differences after 14 and 39 wk. Immunohistochemistry showed decreased parenchymal but increased reticuloendothelial transferrin receptor expression with iron load. After the period of unloading, parenchymal transferrin receptors were virtually absent despite the negligible siderosis of these cells. In contrast, siderotic reticuloendothelial cells were intensely positive. These findings support down-regulation of parenchymal transferrin receptor resulting from iron storage. However, the positivity of siderotic reticuloendothelial cells and the absence of re-emergence of parenchymal receptors in conditions of minimal parenchymal and prominent reticuloendothelial siderosis need further elucidation.

Aging↗
PubMed1983

Experimental hepatic iron overload in the baboon: results of a two-year study. Evolution of biological and morphologic hepatic parameters of iron overload.

Four baboons receiving intramuscular iron for 15 months were compared with two control baboons. From the overall two-year observation period the following data emerge: (1) The baboon is a suitable animal for obtaining a massive and chronic iron overload. Liver iron concentrations reached very high levels (ranging from 41.3 to 180.6 mumol/100 mg dry weight vs 1.7 +/- 0.5, mean +/- SEM, in controls), and a major liver iron overload (ie, with concentration values greater than or equal to 18) was present in all four animals for an average period of 16.5 months (range 14-19). (2) When compared with human hepatic iron-overload disorders, iron distribution was similar to that observed in secondary (transfusional) hepatic siderosis since iron deposits were found primarily in sinusoidal cells. However, a marked parenchymal siderosis was also obtained close to that observed in primary (genetic) siderosis. Iron toxicity was present biologically as indicated by an increase in serum transaminases. Histologically, a slight fibrosis was observed in the most heavily iron-overloaded baboon. On the whole, this study of subhuman primates brings new evidence that iron per se has only a minor hepatic damaging effect. It also suggests that the iron-overloaded baboon liver provides a promising tool for the study of liver cell disturbances in human iron overload.

Animals↗
PubMed1980

Morphological changes of the liver in uremic patients treated with chronic hemodialysis--laparoscopic observations and light- and electron-microscopic studies.

In order to clarify morphological changes of the liver in the uremic state, 16 uremic patients treated with chronic hemodialysis were studied. Biopsy was performed in 14 cases under laparoscopic observation and in two on the occasion of renal transplantation. One uremic patients not being treated with dialysis was also studied for comparison. All biopsy specimens were examined by light and electron microscopy. The liver usually appeared mildly or moderately swollen under laparoscopic observations, which was considered at least partially due to the enlargement of the hepatocytes. All patients had hepatocytes with an Orcein-negative "ground glass" appearance, in which marked proliferation of smooth endoplasmic reticulum (SER) was found by electron microscopy. Since the patient not being on dialysis also had such hepatocytes, this finding may be characteristic of uremia. With electron microscopy, in addition to proliferation of SER, alteration of mitochondria and rough endoplasmic reticulum (RER) and an increase in cytoplasmic lipid droplets were observed. Hypertrophy of the Golgi apparatus containing electron-dense particles (VLDL) was often found in patients associated with hypertriglyceridemia. Amorphous electron-dense inclusions in microbodies were occasionally observed. Siderosis was observed in nine patients including three having parenchymal siderosis. With electron microscopy, various siderosomes were seen in the cytoplasm of hepatocytes in patients with parencymal siderosis. Conclusively, these histological and ultrastructral features of hepatocytes are rather associated with several metabolic abnormalities in uremia.

Adolescent↗
PubMed1985

Statistical analysis of relationship between iron accumulation and hepatitis B surface antigen.

Statistical analysis was carried out to determine the relationships of iron deposition among hepatocytes, Kupffer cells, bile duct epithelial cells, portal tracts, and spleens using 68 autopsy cases obtained from Kenya, which included cases of Bantu siderosis. Of 68 cases, 33 (49%) showed siderosis. Cirrhosis was observed in 19 cases, of which 10 (53%) showed siderosis. However, there was no correlation between iron deposition and cirrhosis (Pearson chi 2 = 0.6734). The finding suggests that iron accumulation does not lead to cellular injury. On the other hand, there was a strong association between iron deposition in the livers and that in the spleens. There was also a strong correlation between the presence of hepatitis B surface antigen and iron deposition in the Kupffer cells and in the spleens. Therefore, it is suggested that the hepatitis B virus infection affects the iron metabolism of the reticuloendothelial system.

Female↗
PubMed2002

Testing for haemochromatosis in a liver clinic population: relationship between ethnic origin, HFE gene mutations, liver histology and serum iron markers.

OBJECTIVE: To identify the most appropriate testing strategy for genetic haemochromatosis in a liver clinic population by determining the ethnic distribution of the HFE mutations and the relationship between serum iron markers, hepatic siderosis and HFE genotype. DESIGN AND SETTING: Observational study of 427 patients being investigated for abnormal liver function tests between 1997 and 2000 attending a liver clinic at a teaching district general hospital in south London, UK. METHODS: All patients were tested for H63D and C282Y gene mutations, and the ethnic origin was determined. Data were available for most patients for non-fasting serum iron, ferritin and transferrin saturation on presentation and fibrosis and siderosis scores from liver biopsy. RESULTS: The C282Y mutation was not detected in any patients of Asian or Afro-Caribbean origin but was found almost exclusively in northern Europeans, especially those classified as Celtic, one in seven of whom were heterozygous for this mutation. Three per cent of all the patients tested were C282Y homozygotes. The H63D mutation was distributed more widely. An elevated serum transferrin saturation was both a more sensitive and a more specific test for genetic haemochromatosis than either serum ferritin or iron. Significantly raised mean siderosis scores were found on liver biopsy in C282Y homozygote and C282Y/H63D compound heterozygote groups but not in wild-type, simple heterozygote, or H63D homozygote groups. Forty-five per cent of the C282Y homozygotes detected already had cirrhosis. CONCLUSIONS: In a multiracial liver clinic population, previously undiagnosed C282Y homozygosity was found to be common (3% in our study) but restricted to those of northern European heritage, particularly those with Celtic ancestry. A serum transferrin saturation proved a better initial test to select patients for genotyping than serum iron or ferritin. Laboratory costs can be minimized with no loss of diagnostic sensitivity by selecting patients for genotyping based on northern European ethnic origin and raised serum transferrin saturation.

Ethnicity↗
PubMed1992

The effect of ethanol metabolism on ferritin uptake by freshly isolated rat hepatocytes: is acetaldehyde responsible for this alteration?

Alcohol abuse is associated with disturbances to iron metabolism in man, ranging from anemia to siderosis. Also seen in these patients are increased serum ferritin levels. Since the liver not only stores iron in cytosolic ferritin, but has also been shown to take up this molecule from the plasma by an active transport mechanism, it has been suggested that the iron in this circulating ferritin may contribute to the increased incidence of siderosis seen in alcoholics. As part of an ongoing study of these disturbances, using a rat model, we have examined the uptake of ferritin by freshly isolated hepatocyte suspension to test the hypothesis that increased hepatocyte uptake of ferritin iron contributes to the siderosis seen in some alcoholics. Incubation of hepatocytes in the presence of ethanol resulted in a progressive reduction in uptake with increasing alcohol concentration, from 1.23 +/- 0.05 ng of ferritin/10(6) cells/min to 0.65 +/- 0.02 ng/10(6) cells/min (mean +/- SD) at an ethanol concentration of 100 mM. 4-Methylpyrazole (0.1 mM) restored 70% of this activity, but higher concentrations also decreased ferritin uptake in the absence of ethanol. The addition of 5 microM cyanamide decreased ferritin uptake slightly in the presence of ethanol (0.82 +/- 0.04 ng of ferritin/10(6) hepatocytes/min vs. 0.86 +/- 0.03 ng/10(6) cells/min for ethanol alone), while having no effect in the absence of ethanol (1.01 +/- 0.04 vs. 1.12 +/- 0.05 ng/10(6) cells/min). Preincubation of the hepatocytes with acetaldehyde resulted in a dose-dependent reduction to a maximum reduction of approximately 25% at 300 microM acetaldehyde.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaldehyde↗
PubMed1989

The cerebral vasculature in dementia pugilistica.

The brains of 22 ex-boxers were examined histologically to determine the frequency of recent or old haemorrhage. Four boxers had died from an acute intracerebral bleed, usually soon after a boxing bout. Seven of the other 18 showed evidence of previous perivascular haemorrhage, as detected by Perls' ferrocyanide test for iron, and a similar number showed minor degrees of meningeal or subpial siderosis, consistent with previous meningeal bleeding; cerebellar siderosis was present in six cases. Seventeen of the 22 boxers showed evidence of recent or past haemorrhage. Control material showed an incidence of 11% for perivascular iron deposition and only 4% for minor degrees of meningeal siderosis.

Aged↗
PubMedDate not supplied

[Neonatal hemochromatosis. Report of 3 autopsy cases].

INTRODUCTION: Neonatal hemochromatosis is a disease that starts in utero, characterized by severe fibrosis or cirrhosis and siderosis of the liver and other organs without affecting the mononuclear fagocytic system. The most important clinical features are severe hepatic failure at birth and hypoglycemia. The diagnosis is made excluding other diseases more frequently seen in the neonatal period and with at least two of the clinicopathologic criteria delineated by Knisely. METHODS: A retrospective analysis of the autopsies of newborn done at the Department of Pathology of the Hospital de Pediatría, C.M.N. SXXI, IMSS, a tertiary care facility in the period 1989 from 1997. Those cases with primarily hepatic disease as the main diagnosis were chosen. The degree of siderosis was determined cualitatively. The amount of Fe and copper in the liver and spleen in samples fixed in formalin was obtained using X ray fluorescence in the Instituto Nacional de Investigaciones Nucleares, two control cases were also tested. RESULTS: Only four out of 210 autopsies of newborn babies were found to have hepatic disease as a main diagnosis but without an etiology determined. In three of such cases the diagnosis of neonatal hemochromatosis was made. All patients were male with ages six, 29 and 36 days, one with Down's syndrome. The ratio of iron deposits in liver/spleen in hemochromatosis' cases was higher to 1.5 in the liver in contrast to the two control cases. CONCLUSIONS: These cases showed the utility of the autopsy in establishing the adequate diagnosis in three cases of neonatal hemochromatosis. The importance of establishing an accurate diagnosis is to recognize it as an entity with a lethal course, that can be potentially managed with liver transplant as well as genetic counseling to the family. A remarkable finding in the study of these cases was the ratio of iron concentration in the liver and spleen that allowed to discard other causes of siderosis. To our knowledge this finding has never been recorded.

Copper↗
PubMed1990

[Iron metabolism and chloroquine phosphate therapy in porphyria cutanea tarda].

The knowledge about the influence of chloroquine phosphate (CQ) on the iron metabolism in porphyria cutanea tarda (PCT) is still insufficient. In a study on 138 PCT patients treated with CQ, we observed decreasing serum iron concentration, transferrin saturation, and hepatic siderosis, as well as an increasing level of transferrin. After a one-year therapy with CQ, the patients showed normal porphyrinuria. Since there were no statistical correlations between the degree of hepatic siderosis and porphyrinuria, and since we repeatedly found remission of the PCT in spite of the continued existence of hepatic siderosis, the removal of iron cannot be regarded as the only principle of action in CQ therapy. In comparison with chloroquine, phlebotomy obviously has--even with regard to the iron deposits--no decisive advantages.

Adult↗
PubMed1998

Oral iron chelating therapy. A single center interim report on deferiprone (L1) in thalassemia.

BACKGROUND AND OBJECTIVE: Deferiprone (L1) is a largely studied oral chelator in clinical setting, however, no definite conclusions concerning efficacy and toxicity still could be drawn. In an ongoing prospective trial with L1, we evaluated the efficacy and tolerance-toxicity in patients with thalassemia major previously treated by desferrioxamine (DFO); the specific aim of the study is to demonstrate that L1 could be an alternative to DFO in some patients with an acceptable toxicity. DESIGN AND METHODS: Sixty-nine patients over 13 years of age with poor compliance to DFO were considered for the study. The design included a liver biopsy before starting L1 in all patients in order to define liver siderosis either by histologic grading or by hepatic iron concentration (HIC); only patients with a minimum HIC of 4 mg/g dry weight entered the study. A repetition of the liver biopsy after one year of L1 was planned; further evaluations included serum ferritin, plasma iron, transferrin TIBC and iron urine excretion. L1 was given at 70 mg/kg/day in three divided doses. Toxicity was monitored either clinically or by controlling liver, kidney and marrow function by specific tests. Concerning clinical characteristics 52 patients showed hypogonadism (78%), 39 growth retardation (58%), 6 diabetes (9%), 4 cardiomyopathy (6%), 9 hypothyroidism (12%); 45 patients had chronic liver damage (65%). RESULTS: We focus this report on data collected in a group of 29 patients with a minimum follow-up of one year (14-33 months). The mean ferritin value was 3748 ng/mL (range: 200-10,000) and 2550 ng/mL (range: 80-14,500), before and while on L1 therapy, respectively (p = 0.001); the mean sideruria changed from 17.25 mg/dL (range: 5.4-50) to 20.98 mg/dL (range: 10-40), on DFO and L1, respectively (p = 0.078); the ratio between plasma iron (sideremia) and transferrin TIBC changed from 0.96 with DFO to 0.86 with L1 (0.014). A correlation with grade of liver siderosis and serum ferritin (p = 0.069) and iron urine excretion (p = 0.008) was recorded. The judgement of efficacy showed that L1 was effective (EF) in 9 patients, no assessable (UN) in 11 patients, not effective (NE) in 2 patients and with no advantages with respect to DFO in 7 patients. Liver biopsy was repeated in 20 patients showing a reduction of grade of liver siderosis and iron content in 7 patients. Clinical toxic effects of L1 were gastric intolerance (one patient), joint pain (three patients) and mild and temporary neutropenia (one patient). INTERPRETATION AND CONCLUSIONS: This preliminary experience shows that L1 is effective in several patients with thalassemia with poor compliance to DFO and to improve iron burden and iron excretion with generally minor side effects. L1 could be an alternative to DFO in some patients, however the recognition of neutropenia warrants a careful evaluation of patients and efforts finalized to early recognition of those to be addressed with this new and still experimental therapy.

Adolescent↗
PubMed1998

Hepatic iron overload in patients with chronic viral hepatitis: role of HFE gene mutations.

Mild to moderate hepatic iron overload is frequent in patients with chronic viral hepatitis (CH). We evaluated the role of hemochromatosis (HFE) gene mutations and other acquired factors in the development of iron overload in these patients. We studied 110 patients with chronic B or C viral hepatitis (31 women, 79 men), including 20 with cirrhosis, and 139 controls. Hepatic iron was evaluated by semiquantitative analysis in all the patients, and hepatic iron concentration (HIC) was determined in 97 of them (26 women, 71 men). C282Y and H63D mutations were sought in all the subjects by a polymerase chain reaction-restriction assay. The frequency of HFE genotypes and alleles did not differ in patients and controls. No relation was detected between hepatic iron stores and HFE gene mutations in women. In men, all C282Y heterozygotes had iron overload, and the H63D mutation was significantly more frequent in patients with more marked hepatic siderosis than in those with mild or no siderosis (P = .0039) and in controls (P = .0008). Heavy alcohol intake and hepatic cirrhosis were also associated with increased hepatic iron stores in the men. In the 71 men in whom HIC was measured, multiple regression analysis showed that this variable was related independently only to alcohol intake and HFE gene mutations. We suggest that in patients with CH, iron accumulates in the liver as the result of an interplay between genetic and acquired factors, and that increased liver iron stores may influence progression toward liver fibrosis.

Adult↗
PubMed1975

Transfusional iron overload: the relationship between tissue iron concentration and hepatic fibrosis in thalassaemia.

The interrelationships between liver iron concentration, the duration of iron-loading, and hepatic fibrosis, assessed morphometrically, have been studied in 32 specimens of liver obtained from 19 heavily transfused patients with thalassaemia major whose age ranged from 4 to 19 yr. Similar observations were made in a matched group of thalassaemic patients treated with long-term chelation therapy. The degree of liver damage ranged from very slight increase in fibrous tissue to severe fibrosis and cirrhosis. The severity of the fibrosis was closely correlated both with liver iron concentration and with age. While the relationship between fibrosis and age was linear, both the severity and the rate of fibrosis were exponentially related to liver iron concentration, damage accelerating as liver iron concentration exceeded 3 per cent, dry weight. By producing a modest but significant reduction in liver iron concentration chelation therapy resulted in a disproportionate but predictable retardation in the progression of the fibrosis. The factors affecting the distribution of iron between parenchymal and reticuloendothelial cells were also examined. In general stainable iron was uniformly distributed between parenchymal and reticuloendothelial cells from the early stages of iron-loading. Parenchymal siderosis was relatively heavier in splenectomised patients and in patients with liver iron concentrations above 3 per cent, dry weight than in non-splenectomised patients or patients with liver iron levels of less than 3 per cent, dry weight, but this did not affect the severity of the fibrosis. The relevance of these findings to the traditional concepts of the pathology of transfusional siderosis is discussed.

Adolescent↗