Symptoms of iron overload in your body are the same as too little but the consequences can be very serious
We need iron for many body processes, especially to make haemoglobin, the oxygen-carrying protein inside red blood cells.
Iron is found in meat, pulses, nuts, dried fruit, wholegrains, fortified breakfast cereals and dark-green leafy veg. The vitamin C in fruit helps us to absorb it. We need around 15mg a day, as we lose some during periods (men need around 9mg), and we store small amounts in our livers.
But iron overload is dangerous, and can be caused by unnecessary iron supplements, multiple blood transfusions, some rare diseases, and one of the most common genetic disorders – haemochromatosis.
Genetic haemochromatosis (GH) affects around one in 200 of us. Up to one in 10 northern Europeans carry the faulty HFE gene that causes it, but we can only develop the disease if both our parents pass on faulty genes.
Even then, we have only a one in 10 chance of developing GH, as other factors and our genes affect HFE activity.
Haemochromatosis increases how much iron we absorb from food, so that deposits build up in the liver and other organs, including the pancreas, heart, joints, skin and ovaries or testicles. This affects the way they work, and can lead to serious complications.
It can take years for iron to accumulate in these organs, so symptoms often don’t appear until early middle age. And as they’re non-specific, and frequently overlap with other conditions, such as thyroid disease or even depression, getting diagnosed may take time. However, iron overload may be detected earlier by blood tests for other conditions.
Fatigue is a major symptom, as it is for iron deficiency. Joint pain (often in the first and second digits) is common, and your periods may stop. Men can develop problems with erections.
Iron deposits in your skin may make you look suntanned, and in your pancreas can trigger diabetes, with thirst, weight loss or frequent urination.
Liver deposits can lead to enlargement, fibrosis and cirrhosis (or, rarely, cancer). Heart deposits can lead to cardiac failure, chest pain, breathlessness and ankle swelling, and brain deposits to memory and mood problems. However, symptoms can also remain mild and not progress.
You’ll be advised to avoid high-iron foods, too much alcohol and, of course, iron supplements. But you’ll also need to have the excess iron removed from your body by venesection (phlebotomy) – which is like donating blood.
Initially you’ll have around 500ml removed every week or two, which diverts your excess iron into making replacement blood cells. It can take a year or more to get back to normal levels.
You’ll then have regular blood tests every two to four months, to monitor your iron levels, but if this doesn’t suit (because of your veins or other medical problems) you may be given medication such as Deferasirox, which binds excess iron so it can be excreted in the stools. You may also need treatment for liver damage, arthritis or heart failure.
For information and support, call The Haemochromatosis Society on 020 8449 1363, or visit haemochromatosis.org.uk
5 tests that you may need
1. Blood tests to confirm the diagnosis and assess any damage or complications (blood count, iron levels, liver function, blood-sugar level).
2. Tests to exclude other causes of symptoms.
3. MR scan of the liver or heart to assess how much iron has been deposited. You may need an echocardiogram (ultrasound) and ECG (heart tracing) too.
4. Liver biopsy (less used nowadays), where a small sample is taken, using local anaesthetic, for laboratory examination.
5. Genetic testing to confirm the diagnosis and decide whether relatives should be offered checks before they develop any symptoms.