Approach to the patient with suspected iron overload
- Stanley L Schrier, MD
Stanley L Schrier, MD
- Editor-in-Chief — Hematology
- Section Editor — Myeloproliferative Disorders; Red Cell Disorders
- Professor of Medicine
- Stanford University School of Medicine
- Bruce R Bacon, MD
Bruce R Bacon, MD
- Professor of Internal Medicine
- Saint Louis University School of Medicine
- Section Editors
- William C Mentzer, MD
William C Mentzer, MD
- Section Editor — Red Cell Disorders
- Professor of Pediatrics
- University of California, San Francisco
- Donald H Mahoney, Jr, MD
Donald H Mahoney, Jr, MD
- Section Editor — Pediatric Hematology
- Professor of Pediatrics
- Baylor College of Medicine
The normal iron content of the body is 3 to 4 grams. It exists in the following forms:
●Hemoglobin in circulating red cells – Approximately 2.5 grams
●Iron-containing proteins other than hemoglobin (eg, myoglobin, cytochromes, catalase) – 400 mg
●Iron bound to transferrin in plasma – 3 to 7 mg
The remainder is storage iron in the form of ferritin or hemosiderin. Adult men have approximately 1 g of storage iron (mostly in liver, spleen, and bone marrow). Adult women have less storage iron, depending upon the extent of menses, pregnancies, deliveries, lactation, and iron intake, and some may have no stores .
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- www.genetests.org (Accessed on March 11, 2014).
- IRON TOXICITY
- CAUSES OF IRON OVERLOAD
- Increased absorption from a normal diet
- - Hereditary hemochromatosis
- Massive increase in oral iron intake
- Multiple infusions of iron-containing agents
- Neonatal or perinatal iron overload
- Liver disease
- TESTS AVAILABLE FOR DOCUMENTING IRON OVERLOAD
- Routine iron studies
- - Increased transferrin saturation
- - Increased ferritin
- High levels of ferritin in the absence of iron overload
- Extremely high levels of ferritin
- MRI and SQUID techniques
- Liver biopsy
- Response to phlebotomy
- Endomyocardial biopsy
- WHEN TO SUSPECT IRON OVERLOAD
- EVALUATION OF SUSPECTED CASES
- MAKING THE DIAGNOSIS OF IRON OVERLOAD
- DETERMINING THE SEVERITY AND UNDERLYING CAUSE OF IRON OVERLOAD
- Determining the extent and severity
- Determining the cause(s)
- - Alcoholic liver disease
- Genetic testing for hereditary hemochromatosis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS