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 Blood 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
Iron overload is a potentially serious problem that is often overlooked because the symptoms are nonspecific and often develop gradually. A number of diagnostic tests are available, but their interpretation can be challenging. Once iron overload is diagnosed, the options for treatment are relatively straightforward in the majority of individuals. However, untreated individuals can develop life-threatening organ toxicity. Thus, it is important to identify iron overload before organ damage occurs.
An approach to evaluating individuals with suspected iron deficiency is presented here.
Separate topic reviews discuss the regulation of iron balance, the diagnosis of and treatment of hereditary hemochromatosis (HH), and the management of iron overload.
●Iron balance – (See "Regulation of iron balance".)
●HH population screening – (See "Screening for hereditary hemochromatosis".)
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- NORMAL IRON STORES
- CAUSES OF IRON OVERLOAD
- Overview of causes
- Transfusional iron overload
- Hereditary hemochromatosis
- Ineffective erythropoiesis
- Liver disease
- Rare causes
- CONSEQUENCES OF EXCESS IRON STORES
- Organ damage from reactive oxygen species
- Typical clinical findings
- SEQUENCE AND INTERPRETATION OF TESTING
- Overview of approach
- CBC, LFTs, and iron studies
- Noninvasive imaging (MRI)
- Other tests for selected individuals
- - Liver biopsy
- - Response to phlebotomy
- - Endomyocardial biopsy
- DIFFERENTIAL DIAGNOSIS
- Other causes of high ferritin
- Other cause of organ dysfunction
- POST-DIAGNOSTIC TESTING
- Determining the extent and severity
- Determining the cause(s)
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS