Blood Iron Increased

When your body absorbs and stores too much iron from food, it can damage vital organs over time. This condition, known as iron overload or hemochromatosis, affects how your body handles an essential mineral that’s normally needed for healthy blood and energy.

Table of contents

• What is blood iron increased?
• Other names for this condition
• What causes increased iron levels?
• Signs and symptoms
• Organs affected by excess iron
• Possible complications
• How is it diagnosed?
• Treatment options
• Diet and lifestyle changes

What is blood iron increased?

Blood iron increased, also known as iron overload, is a condition in which your body absorbs and retains too much iron^[1]. Iron is an essential mineral that your body needs for many functions, including carrying oxygen in your blood through a protein called hemoglobin^[8]. However, when iron levels become too high, it becomes toxic to your body.

Your organs store the excess iron, which damages them over time. The condition especially damages your heart, liver, and pancreas^[1]. Your body doesn’t have a built-in way to get rid of excess iron, so it stores it in your tissues^[1]. About 25 percent of the iron in the body is stored as ferritin, a protein found in cells that circulates in the blood^[8].

Other names for this condition

Iron overload, Hemochromatosis, Secondary hemochromatosis, Hemosiderosis

What causes increased iron levels?

Most people with increased iron levels inherit the condition from their parents. This is called hereditary hemochromatosis or primary hemochromatosis^[1]. The cause is an altered gene that they pass on to you. It takes two copies of the altered gene—one from each parent—for you to develop the condition. If your parents each have only one copy, they likely won’t have the condition or know about the gene^[1].

Changes in the HFE gene usually cause hereditary hemochromatosis. The two most common variants are C282Y and H63D^[1]. A less common form of the condition, called juvenile hemochromatosis, comes from changes in the HJV or HAMP genes. These changes cause iron to build up much more quickly, so symptoms appear sooner, typically between the ages of 15 and 30^[1].

You can also develop iron overload secondary to another medical condition or treatment, called secondary hemochromatosis^[1]. This typically occurs in people who have disorders that impair red blood cell production, such as inherited disorders of hemoglobin structure or function, including sickle cell disease, thalassemia, or sideroblastic anemias^[6]. Iron can also accumulate in the body when people take in too much iron from iron therapy given in excessive amounts or for too long, or from repeated blood transfusions^[6].

If you have anemia, you can develop iron overload from frequent blood transfusions. If you have advanced liver disease, your liver may not be able to process iron properly, causing it to build up^[1]. Heavy alcohol use is also a risk factor for secondary iron overload^[1].

Hereditary hemochromatosis is more common in white people with ancestors from Northern Europe. It’s less common in people of African American, Hispanic, Asian, or Native American descent^[1]. It is particularly common in countries where lots of people have a Celtic background, such as Ireland, Scotland, and Wales^[3].

Signs and symptoms

Some people with iron overload never have symptoms. Many people don’t have any symptoms other than high levels of iron in their blood^[2]. Early symptoms often overlap with those of other common conditions, making the condition difficult to diagnose^[2]. Symptoms usually start between the ages of 30 and 60^[3].

Common symptoms of iron overload include^[1]:

• Fatigue (feeling tired a lot)
• Weakness
• Joint pain, particularly in the knuckles of your index and middle fingers
• Upper abdominal pain
• Weight loss
• Low libido or erectile dysfunction
• Skin darkening (a gray or bronze tint)
• Heart flutters (arrhythmias)

Other symptoms may include irregular periods or stopped or missed periods in women, brain fog, mood swings, depression, and anxiety^[3].

These symptoms happen when iron builds up to levels that start to affect your organs. Although hereditary hemochromatosis usually starts at birth, it takes a long time for iron to build up. Most people don’t develop symptoms until their 40s or 50s^[1]. The most common type of hemochromatosis is present at birth, but most people don’t experience symptoms until later in life—usually after age 40 in men and after age 60 in women^[2]. Women are more likely to develop symptoms after menopause, when they no longer lose iron with menstruation and pregnancy^[2].

If you have a milder form of iron overload, you might not ever notice it. Or symptoms might appear much later in life and resemble normal signs of aging^[1].

Organs affected by excess iron

• Liver
• Heart
• Pancreas
• Joints
• Pituitary gland
• Adrenals
• Thyroid
• Gallbladder
• Spleen
• Reproductive system

Your body needs iron, but too much becomes toxic. Your body doesn’t have a built-in way to get rid of excess iron, so it stashes it away in your tissues^[1]. Excess iron may accumulate in organs that normally store iron, such as the liver, spleen, and bone marrow, and in other organs that don’t normally store iron, such as the pancreas, heart, joints, and skin^[6].

As iron builds up, you may start to see it in your skin and feel it in your joints. It may also start to cause problems with your organs and glands^[1]. Iron overload affects your heart, liver, and pancreas the most^[1]. The most commonly affected joints are those of the hands, particularly the knuckles, wrists, elbows, hips, knees, and ankle joints^[7].

Possible complications

Iron overload can become life-threatening without treatment^[1]. The primary mechanism of organ damage is oxidative stress, as elevated intracellular iron levels increase free radical formation^[7]. Too much iron can lead to life-threatening conditions, such as liver disease, heart problems, and diabetes^[2].

If the condition is diagnosed and treated early on, hemochromatosis does not affect life expectancy and is unlikely to result in serious problems. But if it’s not found until it’s more advanced, the high iron levels can damage parts of the body^[3].

This can lead to potentially serious complications, such as^[3]:

• Liver problems—including scarring of the liver (cirrhosis) or liver cancer
• Diabetes—where the level of sugar in the blood becomes too high
• Arthritis—pain and swelling in the joints
• Heart failure—where the heart is unable to pump blood around the body properly

Other complications include chronic liver failure, increased risk of liver cancer, infertility, and an underactive thyroid gland (hypothyroidism)^[6]. Diabetes in people with iron overload occurs as a result of selective iron deposition in islet beta cells in the pancreas leading to functional failure and cell death^[7].

How is it diagnosed?

Hemochromatosis can be difficult to diagnose. Early symptoms such as stiff joints and fatigue may be due to conditions other than hemochromatosis^[5]. The condition may be identified because of irregular blood test results after testing is done for other reasons. It also may be revealed when screening family members of people diagnosed with the disease^[5].

The two key tests to detect iron overload are^[5]:

Serum transferrin saturation: This test measures the amount of iron bound to the protein transferrin that carries iron in the blood. Transferrin saturation values greater than 45% are considered too high.

Serum ferritin: This test measures the amount of iron stored in the liver. If the results of a serum transferrin saturation test are higher than usual, a healthcare professional may check serum ferritin levels.

These blood tests for iron are best performed after fasting. Elevations in one or all of these tests can be found in other disorders. You may need to have the tests repeated for the most accurate results^[5].

A healthcare professional may suggest other tests to confirm the diagnosis and to look for other problems^[5]:

• Liver function tests: These tests can help identify liver damage
• MRI: An MRI is a fast and noninvasive way to measure the degree of iron overload in the liver
• Testing for gene changes: Testing DNA for changes in the HFE gene is recommended if there are high levels of iron in the blood
• Liver biopsy: Removing a sample of liver tissue for testing if liver damage is suspected

If you’re considering genetic testing for hemochromatosis, discuss the reasons for and against with your healthcare professional or a genetic counselor^[5].

Treatment options

There’s currently no cure for iron overload, but there are treatments that can reduce the amount of iron in your body and reduce the risk of damage^[3]. Iron overload can become life-threatening without treatment, but fortunately, it is treatable^[1]. Treatment can help reduce your iron levels to prevent complications^[1].

There are two main treatments^[3]:

Venesection (phlebotomy): This is a procedure to remove some of your blood. The procedure is similar to giving blood. You lie back in a chair and a needle is used to drain a small amount of blood, usually about 500ml, from a vein in your arm^[11]. The removed blood includes red blood cells that contain iron, and your body will use up more iron to replace them, helping to reduce the amount of iron in your body^[11].

There are two main stages to treatment with venesection^[11]:

• Induction: Blood is removed on a frequent basis (usually weekly) until your iron levels are normal. This can sometimes take up to a year or more
• Maintenance: Blood is removed less often (usually 2 to 4 times a year) to keep your iron levels under control. This is usually needed for the rest of your life

Chelation therapy: This is used in a small number of cases where regular phlebotomies are not possible because it’s difficult to remove blood regularly—for example, if you have very thin or fragile veins^[11]. This involves taking medicine that removes iron from your blood and releases it into your urine or poo^[11].

Commonly used medicines are deferasirox, deferiprone, and deferoxamine^[6]. Iron chelation may be given by mouth using deferasirox or deferiprone, or by an infusion of deferoxamine, which can be given under the skin (subcutaneous) or into a vein (intravenous). Sometimes deferasirox and deferiprone can be given together^[6].

Iron chelation medications given by mouth are very effective in lowering the iron level in the body. Side effects of oral iron chelation include abdominal pain, diarrhea, and rash. The treatment sometimes causes liver and kidney damage, so blood tests are done periodically to monitor the function of these organs^[6].

Diet and lifestyle changes

You do not need to make any big changes to your diet, such as avoiding all foods containing iron, if you have iron overload. This is unlikely to be of much extra help if you’re having one of the treatments above, and could mean you do not get all the nutrition you need^[11].

You’ll usually be advised to^[11]:

• Have a generally healthy, balanced diet
• Avoid breakfast cereals that have been “fortified” with extra iron
• Avoid taking iron and vitamin C supplements—these may be harmful for people with high iron levels
• Be careful not to eat raw oysters and clams—these may contain a type of bacteria that can cause serious infections in people with high iron levels
• Avoid drinking excessive amounts of alcohol—this can increase the level of iron in your body and put extra strain on your liver

You do not need to make any big changes to your diet to control your iron levels if you’re having treatment, but you’ll usually be advised to avoid these specific items^[3].