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We studied a 60-year-old male with idiopathic (primary) hemochromatosis and type III hyperlipoproteinemia. Periodical phlebotomy therapy could favourably influence the disease of iron metabolism as well as the familial lipoprotein disorder in addition to fenofibrate treatment. Idiopathic hemochromatosis as aggravating cause of type III hyperlipoproteinemia has not been reported yet.
A case of hepatocellular carcinoma in idiopathic hemochromatosis is discussed to illustrate the possible advantages of MR imaging. Since hepatic iron overload provides a natural source of paramagnetic contrast enhancement MRI should performed in preference to other investigative procedures to detect small and curative resectable hepatocellular carcinomas in patients with hemochromatosis.
22 cases of hemochromatosis were analysed. 19 cases were collected from Chinese medical journals and 3 from our hospital. We showed the similarities and differences between Chinese and western patients. The diagnosis, mode of heredity, possible pathogenesis and management of idiopathic hemochromatosis were also briefly discussed.
The data of HLA-haplotyping were used as an allele marker controlling hereditary hemochromatosis in 23 patients with beta-thalassemia. The results obtained have permitted a conclusion that hemosiderosis in patients with beta-thalassemia may be caused by association of beta-thalassemia gene with hereditary hemochromatosis. Early diagnosis of hyperferremia is of great prognostic importance as the adequate treatment timely conducted can prevent the development of irreversible changes in the patients.
Characterizing the distribution of parameters of iron metabolism by hemochromatosis genotype remains an important goal vis-à-vis potential screening strategies to identify individuals at genetic risk, since a specific marker to detect the abnormal gene has not been identified as yet. In the present investigation, we analyze serum iron values in ascertained families using a method which incorporates both segregation of the clinical affection status and the HLA linkage information to identify the underlying genotypes. The analysis is performed using an extension of the model presented by Bonney et al., comprising regressive models for segregation analysis and the multipoint linkage strategy implemented in LINKAGE. The gene was found to be completely recessive with respect to both clinical manifestations and serum iron abnormalities, with significant differences in expression by sex. Clinical manifestations were present for all male homozygotes in this data set, suggesting that the recessive hemochromatosis genotype is fully penetrant at all ages in males. This was not the case for younger females. Significant genotype-specific age and sex effects were found for serum iron values. It is interesting that deletion of the HLA marker information did not affect our ability to resolve the genetic model when we analyzed a bivariate phenotype. This serves as a reminder that a search for relevant biological markers can be equally important in discerning the genetic etiology of a disease trait, as a search for linked genetic markers.
The nature of non-transferrin-bound iron in the plasma or serum of iron-overloaded hemochromatosis patients was studied by high performance liquid chromatography (HPLC) and high resolution nuclear magnetic resonance (NMR). 500-MHz proton Hahn spin-echo NMR spectra of plasma or serum, combined with the use of the iron chelator desferrioxamine, suggests complexation of iron ions with citrate and a possible involvement of acetate. Addition of FeCl3 to hemochromatosis samples broadened the NMR signals from citrate. HPLC analysis rigorously confirmed the presence of an iron-citrate complex in ultrafiltrates of plasma or serum studies with added FeCl3 or desferrioxamine supported this conclusion. It is proposed that non-transferrin-bound iron in the plasma of iron-overloaded patients exists largely as complexes with citrate and possibly also as ternary iron-citrate-acetate complexes. The presence of such complexes would account for the ability of non-transferrin-bound iron to be measurable by the bleomycin assay and for its rapid clearance from the circulation by the liver.
Hemochromatosis, or primary iron overload, is a variably expressed genetic metabolic disorder greatly modified by sex, age, diet, and alcohol consumption. Although a diagnosis has been made at the bedside by careful documentation of the slow resolution of subcutaneous iron pigment, clinical diagnosis is frequently overlooked, and even autopsy may fail to reveal hemochromatosis as the cause for cirrhosis. Genetic linkage studies have confirmed the extremely high prevalence of this disorder. Untreated patients may succumb to sepsis caused by organisms such as Vibrio vulnificus, Yersinia species, and others whose virulence is altered by iron availability.
Parameters of nonspecific defence--complement protein function, circulating immune complex level, neutrophil phagocytic activity, completeness of the phagocytic reaction, C3c level, were evaluated in 162 carriers of hemochromatosis gene (114 homozygotes and 48 heterozygotes with respect to hereditary hemochromatosis) aged from 7 to 64 years. The analysis of the results obtained has permitted a conclusion that the suppression of the complement system function, according to the classic or alternative type, is associated with the disease pathogenesis--hyperferremia, and is caused by the damage of the immunocompetent organs and cells synthesizing individual proteins of the complement, as well as by infectious complications leading to hypocomplementemia with respect to separate components.
Hereditary hemochromatosis (HHC) is a common inherited disorder of iron metabolism characterized by excessive iron absorption and the toxic accumulation of iron in parenchymal cells. Homozygous inheritance of an abnormality on chromosome 6 causes this disorder by increasing the intestinal absorption of iron, which is slowly deposited in parenchymal cells of the liver, heart, pancreas, and other endocrine organs. Symptoms develop only after the marked accumulation of iron stores develop, which causes functional insufficiency of these organs. The symptoms are often variable, nonspecific, and attributed to other diseases. Early diagnosis requires a high index of suspicion and an awareness of the clinical features of HHC. Serum iron, total iron-binding capacity (TIBC), and ferritin levels are useful screening studies, but liver biopsy with quantitative chemical determination of iron concentration is essential to evaluate histopathological changes and to help distinguish hereditary hemochromatosis from secondary iron overload. Treatment with weekly phlebotomy frequently results in some clinical improvement in patients with established disease, and if initiated early, organ damage can be prevented and a normal life-span can be expected. The hereditary nature of the disease mandates familial screening of index cases.
A genetic analysis of the segregation of hereditary hemochromatosis, indexed by the measurement of latent capacity of transferrin (LCAP), was undertaken in an ascertained sample of 147 pedigrees from Brittany, France. There were no mean differences by sex in the distribution of LCAP in the control sample, although in the family data there was a higher representation of males with low values than of females with low values, consistent with the higher proportion of affected males. The results of bivariate segregation analysis revealed no systematic evidence for heterozygous expression either in the biochemical domain of LCAP abnormalities or in increased liability to overt symptomatic disease. Joint consideration of the quantitative variable with hemochromatosis affection status allowed clear resolution of a recessive single-gene inheritance pattern in these families.
This study concerns the association between the hemochromatosis susceptibility gene and a 10 kb Pvu II HLA-class I specific restriction fragment. Forty Pvu II fragments are detected after hybridization with A3 or B7 probes, and 20 among them are polymorphic. The 10 kb polymorphic Pvu II fragment correlates absolutely with the A3 serological allele and patients with hemochromatosis, heterozygous or homozygous for A3, have the 10 kb Pvu II band.
The authors have investigated the hypothesis that neonatal hemochromatosis (NH), a generally fatal disease of infancy, is due to abnormalities in cellular response to ambient levels of iron. The clinical and necropsy findings in two infants with NH, the results of evaluations for iron-storage disease in their first-degree relatives, and the results of the authors' studies of ferritin and transferrin-receptor (TfR) synthesis in NH and normal fibroblasts are presented. No differences between cultured skin fibroblasts from a normal infant and similar cells from the two infants with NH were seen with respect to TfR and ferritin synthesis rates or their modulation by iron. NH and adult idiopathic hemochromatosis (AH) share a pattern of siderosis in which epithelial and mesenchymal elements contain large quantities of stainable iron, while reticuloendothelial elements contain almost none. Although no familial correlation between NH and AH has been established, and none appeared to exist in these two families, the authors' results parallel those of previous studies of various cell types from persons with AH. The abnormalities in cellular iron handling, undefined at present, that are associated with the phenotype common to NH and AH do not appear primarily to involve the regulation by iron of rates of TfR and ferritin synthesis.
Thirteen men and one woman (mean age 48.8 yr +/- 6.9, range 36-63) with idiopathic hemochromatosis were treated by erythrocytapheresis. Iron depletion followed 9.60 months treatment (median 24), with 21-203 erythrocytaphereses (mean 93 +/- 61) and total iron removal of 4.2-40.6 g (mean 19 +/- 11.9). Trasferrin saturation decreased from 90 +/- 8.7% to 17 +/- 10.6% and serum ferritin from 3164 micrograms/L +/- 1488 to 60.5 micrograms/L +/- 77.5, and liver iron content normalized in all cases. Initial serum ferritin in the patients who were iron-depleted at 18 months (50%, cumulative percentage) was significantly lower than in those still iron loaded at that time (2280 micrograms/L +/- 940 vs 4049 micrograms/L +/- 1444, p less than 0.02). Clinical improvement was noted in all cases with about a 30% decrease in insulin requirement in most diabetics. Thus erythrocytapheresis appears to be effective and safe in obtaining iron depletion in idiopathic hemochromatosis.
Idiopathic hemochromatosis is a hereditary disease characterized by a progressive iron overload secondary to high intestinal iron absorption. After a latent period of many years, manifestations of liver cirrhosis, diabetes mellitus, cardiac failure, hypogonadism, skin hyperpigmentation and arthropathy can occur. Liver cirrhosis is the most common feature and it is complicated by hepatocellular carcinoma in 30% of cases. Tests of high sensibility are available for early diagnosis. Repeated phlebotomy can prevent clinical features in asymptomatic patients and can improve prognosis in symptomatic subjects. Current concepts in idiopathic hemochromatosis are reported in this review.
A study was carried out to determine the usefulness of erythrocyte ferritin analysis in identifying homozygotes and heterozygotes in families affected with hereditary hemochromatosis, an autosomal recessive disorder. To select the subjects the genotypes of 60 people from 26 affected families were determined by HLA-A and HLA-B haplotyping. In addition, data for 12 homozygotes for whom erythrocyte ferritin values were available from the literature were included. Likelihood analysis was used to evaluate the diagnostic value of erythrocyte ferritin analysis alone and in combination with serum ferritin testing. An erythrocyte ferritin value of 150 ag/cell or higher combined with a serum ferritin level above the 90th percentile indicated homozygosity, whereas a value of less than 150 ag/cell and a serum ferritin level at or below the 90th percentile indicated that homozygosity could be ruled out with a high degree of confidence. The probability of heterozygosity rose to 92% when the erythrocyte ferritin value was between 29 and 149 ag/cell and to 98% when this result was combined with a serum ferritin level at or below the 90th percentile. Erythrocyte ferritin analysis in combination with serum ferritin testing is useful for identifying homozygotes and a proportion of heterozygotes in families affected with hemochromatosis.
Idiopathic hemochromatosis is an hereditary iron overload. The study of HLA types demonstrated clearly the linkage with HLA system. The preferential correlation established with A3 (72%) but other alleles were linked: B7, B14. HLA alleles were only the markers of hemochromatosis allele (H) and were not implicated in other iron overload. Family studied, defined two linked haplotypes: A3, Cw7, B7, Bw6, BfS, DR2, GLO1 et A3, Cw8, B14, Cw6, BfF, DRw6, GLO2. Demonstration of the recessive mode of inheritance was established by family studies. The affected siblings had the same HLA haplotype that the proband and homozygous or heterozygous expressed state was assessed in siblings. The HLA family types allowed to detect in 147 families 88 potential diseased patients among of them 73% had early blood-drawing.
Idiopathic hemochromatosis is an inherited and primary disease. Its definition requires: a) a family history of abnormalities of iron storage; b) an association with HLA; c) inadequate iron absorption in relation to iron stores in liver and other territories; d) the absence of any other known causes of iron overload. The recent evidence of its high family related frequency and the existence of an effective treatment, demand the understanding of this entity and the strongest medical effort towards the diagnosis in the pre-cirrhotic stages. We present here the results from the study of 17 patients diagnosed of idiopathic hemochromatosis over a seven year period in the University Clinic of Navarra. Our aim is to review this subject and to compare our findings with those described in the current literature.
Clinicomorphological analysis of 8 necropsies of primary hemochromatosis permitted recognizing 2 main versions of the disease course: with a primary damage to the liver and pancreas and with a primary injury to the heart, with the latter version being encountered in patients of a younger age and running a more malignant course. The thanatogenesis of patients with hemochromatosis may be linked with acute renal failure.