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Diabetic. Noticed Hgb and ferritin is low. Had gastric bypass. What to do?

Jun 2013
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My husbands mother died of liver cancer from hemochromocytosis, her oncologist insisted my husband be tested for the disease. However his Hgb and ferritin is low (ruled out GI bleeding) so his PCP will not order the test and wants him to take iron. He has done nothing else to determine why his iron is low, could it be in the organs?
He is 65 has type II diabetes and a gastric bypass 10years ago.
Posted Tue, 11 Jun 2013 in Liver and Gall Bladder
Answered by Dr. Sushil Kumar Sompur 10 hours later
Hi there ~

Hereditary hemochromatosis causes your body to absorb too much iron from the food you eat. The excess iron is stored in your organs, especially your liver, heart and pancreas. The excess iron can poison these organs, leading to life-threatening conditions such as cancer, heart arrhythmias and cirrhosis. It is unusual for someone with a family history of hemochromatosis to have anemia or low iron. You husband should be checked for other conditions that can cause anemia. However, here is some educational material about hemochromatosis. Also having type II DM and gastric bypass does not have anything to do with hemochromatosis.

Many people inherit the faulty genes that cause hemochromatosis — it is the most common genetic disease in Caucasians. But only a minority of those with the genes develop serious problems. Hemochromatosis is more likely to be serious in men.

Signs and symptoms of hereditary hemochromatosis usually appear in midlife. Iron can be dropped to safe levels by regularly removing blood from your body.

Factors that increase your risk of hereditary hemochromatosis include:

Having 2 copies of a mutated HFE gene. This is the greatest risk factor for hereditary hemochromatosis.
Family history. If you have a first-degree relative — a parent or sibling — with hemochromatosis, you're more likely to develop the disease. If you have a family history of alcoholism, heart attacks, diabetes, liver disease, arthritis or impotence, your risk of hemochromatosis is greater.
Ethnicity. People of Northern European descent are more prone to hereditary hemochromatosis than are people of other ethnic backgrounds. Hemochromatosis is less common in African-Americans, Hispanics and Asian-Americans.
Being a man. Men are more likely to develop signs and symptoms of hemochromatosis at an earlier age. Because women lose iron through menstruation and pregnancy, they tend to store less of the mineral than men do. After menopause or a hysterectomy, the risk for women increases.

Make an appointment with your family doctor if you have any signs or symptoms that worry you. You may be referred to a specialist in digestive diseases (gastroenterologist), or to another specialist, depending on your symptoms. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes. Learn if you have any liver disease in your family by asking your family members, if possible.
Make a list of all medications, vitamins or supplements that you're taking.
Take a family member or friend along to help you remember things.
Write down questions to ask your doctor.
Questions to ask your doctor
Some basic questions to ask your doctor include:

What is likely causing my symptoms or condition?
Are there other possible causes for my symptoms or condition?
What kinds of tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach that you're suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist? What will that cost, and will my insurance cover it?
Are there any brochures or other printed material that I can take with me? What websites do you recommend?
Don't hesitate to ask other questions during your appointment.

What to expect from your doctor
Be ready to answer questions your doctor may ask:

When did you begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Does anyone in your family have hemochromatosis?
How many alcoholic beverages do you drink in a week?
Are you taking iron supplements or vitamin C?
Do you have a history of viral hepatitis, such as hepatitis C?

Blood removal
Doctors can treat hereditary hemochromatosis safely and effectively by removing blood from your body (phlebotomy) on a regular basis, just as if you were donating blood. (In fact, this blood is safe to be used by other people.) The goal is to reduce your iron levels to normal. The amount of blood drawn depends on your age, your overall health and the severity of iron overload. It may take several years to reduce the iron in your body to normal levels.

Initial treatment schedule. Initially, you may have a pint (470 milliliters) of blood taken once or twice a week — usually in a hospital or your doctor's office. This process shouldn't be too uncomfortable. While you recline in a chair, a needle is inserted into a vein in your arm. The blood flows from the needle into a tube that's attached to a blood bag. Depending on the condition of your veins and the consistency of your blood, the time needed to remove a pint of blood can range from 10 to 30 minutes.
Maintenance treatment schedule. Once your iron levels have returned to normal, blood draws can be less frequent, typically every three to four months. Some people may maintain normal iron levels without any blood draws, and some may need to have blood drawn monthly. The schedule depends on how rapidly iron accumulates in your body.
Treating hereditary hemochromatosis can help alleviate symptoms of tiredness, abdominal pain and skin darkening. It can help prevent serious complications such as liver disease, heart disease and diabetes. If you already have one of these conditions, phlebotomy may slow the progression of the disease, and in some cases even reverse it.

If you have hemochromatosis but no complications of cirrhosis or diabetes, you have the same life expectancy as a healthy person of your same age.

Phlebotomy will not reverse cirrhosis or improve joint pain.

If you have cirrhosis, your doctor may recommend periodic screening for liver cancer. This usually involves an abdominal ultrasound and a blood test.

Chelation for those who can't undergo blood removal
If you can't undergo phlebotomy, because you have anemia, for example, or heart complications, your doctor may recommend a medication to remove excess iron. The medication can be injected into your body, or it can be taken as a pill. The medication causes your body to expel iron through your urine or stool in a process that's sometimes called chelation.

I hope this helps.

Take care and have a lovely day!
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