COMMENTARY

Hemochromatosis: More Common Than You Think?

Rowen K. Zetterman, MD

Disclosures

October 22, 2012

In This Article

Treatment of Hemochromatosis

Patients with homozygous or compound heterozygous hemochromatosis associated with clinical evidence of iron overload should be treated, even if they are asymptomatic or have normal liver tests.[14] Weekly phlebotomy until the ferritin level is reduced to 50-100 µg/L should be followed by periodic phlebotomy at a frequency sufficient to maintain the ferritin level in that range. An occasional patient may be intolerant of weekly phlebotomy, necessitating a reduction of frequency to every other week.[19] Adequate phlebotomy can reduce hepatic fibrosis.[31]

Does treatment reduce the risk for hepatocellular carcinoma? Patients who are adequately treated for iron overload before the development of significant fibrosis or hepatic cirrhosis have essentially no increased risk for hepatocellular carcinoma.[32] Although some questions remain about carcinoma risk in the absence of cirrhosis,[33] patients with adequately treated hemochromatosis who lack cirrhosis have normal overall survival.[22,34]

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